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病理诊断免疫组化- 神经系统
一、星形细胞瘤
1.毛细胞星形细胞瘤(WHO I)
阳性:GFAP
2.室管膜下巨细胞星形细胞瘤(WHO I)
阳性:GFAP,S-100
3.弥漫性星形细胞瘤(WHO II)
阳性:Vimentin,GFAP,S-100,SOX2,Caveolin,Oligo-2(91%),一些PCK,P53(50%)
4.毛黏液样星形细胞瘤
阳性:GFAP,S-100,一些SYN
阴性:NF,CgA
5.多形性黄色星形细胞瘤(WHO II)
阳性:GFAP,S-100,CD34,一些SYN,一些NF, Class III β-tubulin,MAP2
6.间变型星形细胞瘤(WHO III)
阳性:GFAP,S-100,SOX2,caveolin,70%-90% P53
7.伴有神经毡样岛的胶质神经元肿瘤(WHO II/III)
阳性:胶质成分GFAP,神经毡样岛SYN,神经节细胞样细胞NeuN,Hu,P53
8.多形性胶质母细胞瘤(WHO IV)
阳性:GFAP,S-100,SOX2,caveolin,vimentin,>50%PCK,70%-90%P53
阴性:CAM5.2,CK7,CK20
9.巨细胞胶质母细胞瘤(WHO IV)
阳性:70%-90% P53
10.胶质肉瘤(WHO IV)
阳性:上皮分化区可呈CAM5.2,CK7,CK20
阴性:GFAP
二、少突胶质肿瘤
1.少突胶质瘤(WHO II)
阳性:Oligo-2,S-100,CD57,SOX2
阴性caveolin
2.间变型少突胶质瘤(WHO III)
三、室管膜肿瘤
1.室管膜下瘤(WHO II)
阳性:GFAP,NCAM,NSE
2.黏液乳头状室管膜瘤(WHO I)
阳性:GFAP,vimentin,S-100,AB/PAS
阴性:CK
3.室管膜瘤(WHO II)
间变型室管膜瘤(WHO III)
阳性:EMA,CK7,CAM5.2,CK34βE12,GFAP,vimentin,S-100,SOX2,nestin,EMA,CD99,TTF-1,NeuN
四、脉络丛肿瘤
脉络丛乳头状瘤(WHO I)
不典型脉络丛乳头状瘤(WHO II)
脉络丛乳头状癌(WHO III)
阳性:vimentin,S-100,GFAP,transthyretin,CD99,PCK,CK7,EMA,podoplanin,Kir7.1
阴性:SOX2,caveolin,NeuN,CEA,ER,Ber-Ep4,TTF-1,CK20
五、其他神经上皮肿瘤
1.星形母细胞瘤
阳性:GFAP,S-100,vimentin,EMA,LCK
阴性:CAM5.2,PCK
2.血管中心性胶质瘤(WHO I)
阳性:GFAP,S-100,vimentin,podoplanin,EMA
阴性:NSE,Syn,CgA,NeuN
3.第三脑室脊索样胶质瘤(WHO II)
阳性:GFAP,vimentin,S-100,EMA,EGFR,merlin
阴性:P53,P21,MDM2,CK
六、神经元肿瘤、胶质神经元混合性肿瘤
1.婴儿促纤维增生性星形细胞瘤
婴儿促纤维增生性节细胞胶质瘤(WHO I)
阳性:GFAP,S-100,Syn,NF
2.胚胎发育不良性神经上皮肿瘤
阳性:S-100,GFAP,Syn,NF
3.神经节细胞胶质瘤(WHO I或III)和神经节细胞瘤(WHO I)
阳性:S-100,GFAP,CD34,SOX2,Syn,NF,MAP2,NeuN
4.小脑发育不良性神经节细胞瘤(WHO I)
阳性:S-100,Syn,NF,p-AKT,p-S6,Leu-4,L7,PEP19,calbindin
阴性:PTEN
5.乳头状胶质神经元肿瘤(WHO I)
阳性:Syn,NSE,CD56,β-tubulin,NeuN,NF,GFAP,Oligo-2
6.第四脑室伴有菊形团形成的胶质神经元肿瘤(WHO I)
阳性:Syn,NSE,MAP2,GFAP,S-100
7.中枢神经细胞瘤(WHO II)和脑室外神经细胞瘤
阳性:Syn,NeuN
阴性:GFAP,NF,CgA
8.小脑脂肪神经细胞瘤(WHO II)和脑室外神经细胞瘤
阳性:NSE,MAP2,Syn,GFAP,NeuN
七、松果体区肿瘤
1.松果体细胞瘤(WHO I)
阳性:Retinal S-antigen,Syn,NSE,NF,β-tubulin(Class III),tau,PGP9.5,CgA
2.中等分化的松果体实质肿瘤(WHO II)
阳性:Syn,NSE,NF,Retinal S-antigen,CgA
3.松果体母细胞瘤(WHO III)
阳性:Syn,NSE,NF,β-tubulin(Class III),CgA,Retinal S-antigen
4.松果体区乳头状肿瘤(WHO II/III)
阳性:PCK,CAM5.2,CK18,vimentin,S-100,NSE,MAP2,NCAM,transthyretin,GFAP,EMA
阴性:NF
八、胚胎性肿瘤
1.髓母细胞瘤
阳性:神经细胞标志(Syn,NSE,NeuN,NF,β-tubulin),GFAP,PCK,EMA
阴性:CD99,SOX2
2.中枢神经系统的原始神经外胚叶瘤(WHO IV)
阳性:Syn,NSE,NeuN,NF,β-tubulin,vimentin,GFAP
3.髓上皮瘤(WHO IV)
阳性:nestin,vimentin,CK,EMA,NF,Syn,β-tubulin,GFAP
4.室管膜母细胞瘤(WHO IV)
阳性:S-100,vimentin
5.不典型畸胎样或横纹肌样瘤(WHO IV)
阳性:GFAP,S-100,Syn,NF,vimentin,SMA,EMA
九、神经鞘瘤、神经纤维瘤、神经束膜瘤、恶性外周神经鞘瘤
十、脑膜肿瘤
脑膜瘤(WHO I)
不典型脑膜瘤(WHO II)
间变型脑膜瘤(WHO II)
阳性:vimentin,claudin 1,PCK,CK7,CK19,CAM5.2,S-100,EMA
阴性:CD34,GFAP
脑膜黑色素细胞瘤、弥漫性黑色素细胞增生和恶性黑色素瘤
阳性:S-100,Melan-A
十一、淋巴造血组织肿瘤
十二、生殖细胞肿瘤
1.生殖细胞瘤
阳性:PLAP,CD117,OCT-4;若有合体滋养叶细胞样成分,可呈β-HCG,h-PL,CK
阴性:CD30,AFD
2.胚胎癌
阳性:CK,PLAP,CD30,OCT-4
阴性CD117,AFP,EMA
3.卵黄囊瘤或内胚窦瘤
阳性:AFP,CK
阴性:CD117,OCT-4,β-HCG,h-PL,CD30
4.绒毛膜癌
阳性:β-HCG,h-PL,CK
阴性:CD117,OCT-4,CD30,AFP
5.畸胎瘤和混合型生殖细胞肿瘤
十三、鞍区肿瘤
1.腺垂体梭形细胞嗜酸细胞瘤(WHO I)
阳性:vimentin,EMA,S-100,Galectin-3
阴性:CK,GFAP,Syn,CgA,SMA,desmin,CD34
2.神经垂体细胞瘤(WHO I)
阳性:S-100,GFAP
阴性:CK,Syn,CgA
3.神经垂体颗粒细胞瘤(WHO I)
阳性:S-100
4.颅咽管瘤(WHO I)
阳性:PCK,HCK,LCK,P63,CK7,β-catenin
十四、其他肿瘤
1.脊索瘤
阳性:PCK,EMA,S-100
2.内淋巴囊瘤
阳性:PCK,EMA
3.嗅神经母细胞瘤
阳性:Syn,NF,MAP2,S-100
阴性:CD99
4.小脑血管母细胞瘤
阳性:间质细胞呈S-100,NSE,CD56,vimentin,Inhibin-α,D2-40
阴性:EMA,CD10,CAM5.2,RCC
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