SATB2

SATB2
  • 文章类型: Journal Article
    哺乳动物牙列表现出明显的异齿,更简单的牙齿位于颌骨的前部区域,更复杂的牙齿位于后部。虽然先前已经描述了信号传导中的一些区域特异性差异,在这里,我们对牙本质形成早期阶段的基因表达进行了全面分析,以全面了解早期颌骨形成过程中涉及的信号通路。在牙本质发生的两个早期阶段(E11.5和E12.5)分别分析了下颌前部和后部区域的基因表达。基因表达谱分析揭示了小鼠下颌骨中不同的区域特异性表达模式,包括几种已知的BMP和FGF信号成员,我们还鉴定了几种新的分子,这些分子在前后轴的表达上表现出显著差异,它可能在门牙和磨牙规范中起作用。接下来,我们跟踪了一个前分子,SATB2不仅在门牙细菌开始的前间充质中表达,然而,我们在磨牙周围的间充质中发现了一个明显的SATB2阳性区域。Satb2缺陷的动物表现出门牙发育缺陷,证实了SATB2在前牙形成中的关键作用。另一方面,在磨牙区域观察到异位牙胚,表明Satb2缺乏在各个下颌区域的不同作用。总之,我们的数据提供了丰富的基本信息来源,它可用于确定驱动早期胚胎下颌模式的分子调节,并有助于更深入地了解针对切牙和磨牙发育的分子信号。
    Mammalian dentition exhibits distinct heterodonty, with more simple teeth located in the anterior area of the jaw and more complex teeth situated posteriorly. While some region-specific differences in signalling have been described previously, here we performed a comprehensive analysis of gene expression at the early stages of odontogenesis to obtain complete knowledge of the signalling pathways involved in early jaw patterning. Gene expression was analysed separately on anterior and posterior areas of the lower jaw at two early stages (E11.5 and E12.5) of odontogenesis. Gene expression profiling revealed distinct region-specific expression patterns in mouse mandibles, including several known BMP and FGF signalling members and we also identified several new molecules exhibiting significant differences in expression along the anterior-posterior axis, which potentially can play the role during incisor and molar specification. Next, we followed one of the anterior molecules, SATB2, which was expressed not only in the anterior mesenchyme where incisor germs are initiated, however, we uncovered a distinct SATB2-positive region in the mesenchyme closely surrounding molars. Satb2-deficient animals demonstrated defective incisor development confirming a crucial role of SATB2 in formation of anterior teeth. On the other hand, ectopic tooth germs were observed in the molar area indicating differential effect of Satb2-deficiency in individual jaw regions. In conclusion, our data provide a rich source of fundamental information, which can be used to determine molecular regulation driving early embryonic jaw patterning and serve for a deeper understanding of molecular signalling directed towards incisor and molar development.
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  • 文章类型: Journal Article
    背景:已知神经发育障碍相关基因,Satb2在确定上层神经元规范中起着重要作用。然而,尚不清楚该基因在发育过程中如何调节其他新皮质区域。也缺乏对其在新皮层发育中的空间调节途径的全面描述。
    结果:在这项工作中,我们利用空间转录组学和免疫染色,通过比较Satb2+/+和Satb2-/-小鼠在胚胎阶段,系统地研究了Satb2的区域特异性基因调控。包括心室区(VZ)或心室下区(SVZ),中间区(IZ)和皮质板(CP)。染色结果显示,这三个区域在Satb2-/-小鼠中变得中等或显著更薄。在细胞层面,细胞数量在VZ/SVZ中增加,而CP中的细胞数量减少。空间转录组学数据表明,许多重要的基因和相关途径在Satb2-/-小鼠中以区域特异性方式失调。在VZ/SVZ中,参与神经前体细胞增殖的关键基因,包括中间祖细胞标记Tbr2和乳酸产生相关基因Ldha,在Satb2-/-小鼠中上调。在IZ,调节神经元分化和迁移的关键基因,如Rnd2,在Satb2-/-小鼠中表现出异位表达。在CP中,谱系特异性基因,Tbr1和Bcl11b,表达异常。神经肽相关基因Npy在Satb2-/-小鼠中下调。最后,我们通过免疫荧光或qPCR验证了关键调节因子的异常表达。
    结论:总之,我们的工作提供了有关Satb2在新皮质发育中调控的区域特异性基因和途径的见解。
    BACKGROUND: It is known that the neurodevelopmental disorder associated gene, Satb2, plays important roles in determining the upper layer neuron specification. However, it is not well known how this gene regulates other neocortical regions during the development. It is also lack of comprehensive delineation of its spatially regulatory pathways in neocortical development.
    RESULTS: In this work, we utilized spatial transcriptomics and immuno-staining to systematically investigate the region-specific gene regulation of Satb2 by comparing the Satb2+/+ and Satb2-/- mice at embryonic stages, including the ventricle zone (VZ) or subventricle zone (SVZ), intermediate zone (IZ) and cortical plate (CP) respectively. The staining result reveals that these three regions become moderately or significantly thinner in the Satb2-/- mice. In the cellular level, the cell number increases in the VZ/SVZ, whereas the cell number decreases in the CP. The spatial transcriptomics data show that many important genes and relevant pathways are dysregulated in Satb2-/- mice in a region-specific manner. In the VZ/SVZ, the key genes involved in neural precursor cell proliferation, including the intermediate progenitor marker Tbr2 and the lactate production related gene Ldha, are up-regulated in Satb2-/- mice. In the IZ, the key genes in regulating neuronal differentiation and migration, such as Rnd2, exhibit ectopic expressions in the Satb2-/- mice. In the CP, the lineage-specific genes, Tbr1 and Bcl11b, are abnormally expressed. The neuropeptide related gene Npy is down-regulated in Satb2-/- mice. Finally, we validated the abnormal expressions of key regulators by using immunofluorescence or qPCR.
    CONCLUSIONS: In summary, our work provides insights on the region-specific genes and pathways which are regulated by Satb2 in neocortical development.
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  • 文章类型: Journal Article
    已经检查了许多免疫组织化学染色在建立转移性高分化神经内分泌肿瘤(NET)的起源部位中的实用性。在胃肠道(GI),区分转移性十二指肠NETs与空肠和其他GINETs对于临床检查很重要,预后,和治疗。最近的一项研究表明,激素原转化酶2(PCSK2或PC2)在小肠和阑尾NETs中广泛表达。因为这项研究不包括十二指肠NET,我们检测了PCSK2在十二指肠和其他GINETs中的表达。
    GINETs(n=69)和13个相应的胃淋巴结转移,十二指肠,胰腺,回肠,附录,和直肠评估PCSK2的表达,以及ISL1,NKX2.2,CDX2,SATB2和PAX8。使用H评分系统评估每种染色的表达,通过卡方检验评估不同部位的表达差异。
    PCSK2在十二指肠中的表达频率相似(50%),胰腺(59%),和回肠NETs(40%)。PCSK2在胃中很少表达(0%),阑尾(8%),和直肠(25%)NET。然而,将PCSK2纳入包括ISL1,NKX2.2,CDX2和SATB2的组,可以开发一种算法,该算法对回肠NETs的分类具有87%的灵敏度和93%的特异性;对胰十二指肠NETs的灵敏度和特异性分别为68%和98%.
    与之前的发现相比,PCSK2不显示对任何特定GI位点的特异性。将PCSK2的表达与ISL1,NKX2.2,CDX2和SATB2的表达相结合的算法方法可用于区分胰腺,十二指肠,回肠,阑尾,直肠NET。
    A number of immunohistochemical stains have been examined for utility in establishing the site of origin for metastatic well-differentiated neuroendocrine tumors (NETs). In the gastrointestinal (GI) tract, distinguishing metastatic duodenal NETs from jejunoileal and other GI NETs is important for clinical work-up, prognosis, and therapy. A recent study indicated that prohormone convertase 2 (PCSK2 or PC2) had broad expression in small intestine and appendiceal NETs. Because the study did not include duodenal NETs, we examined PCSK2 expression in duodenal and other GI NETs.
    GI NETs (n = 69) and 13 corresponding lymph node metastases from stomach, duodenum, pancreas, ileum, appendix, and rectum were evaluated for the expression of PCSK2, along with ISL1, NKX2.2, CDX2, SATB2, and PAX8. Expression of each stain was evaluated using the H-score system, and differences in expression by site were evaluated by the chi square test.
    PCSK2 was expressed at similar frequency in duodenal (50%), pancreatic (59%), and ileal NETs (40%). PCSK2 was infrequently expressed in stomach (0%), appendiceal (8%), and rectal (25%) NETs. However, incorporating PCSK2 into a panel including ISL1, NKX2.2, CDX2, and SATB2 allowed development of an algorithm which had 87% sensitivity and 93% specificity for classification of ileal NETs; and 68% sensitivity and 98% specificity for pancreaticoduodenal NETs.
    In contrast to previous findings, PCSK2 does not show specificity for any particular GI site. An algorithmic approach incorporating the expression of PCSK2 with that of ISL1, NKX2.2, CDX2, and SATB2 is useful in discriminating pancreatic, duodenal, ileal, appendiceal, and rectal NETs.
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  • 文章类型: Journal Article
    背景:肺是肿瘤转移的常见部位。虽然形态学和免疫表型可以帮助区分原发性和转移性肿瘤,由于形态学和免疫组织化学特征重叠,区分肺浸润性黏液腺癌(PIMA)和转移性结直肠腺癌(CRC)有时可能具有挑战性.家族特异性标志物,如CDX2,TTF-1和napsinA有助于肺非粘液腺癌(PNMA),然而,当应用于PIMA时,它们是非特异性和不敏感的。SATB2是将CRC与上消化道和胰胆管肿瘤区分开的较新标记;其在将CRC与PIMA区分开方面的效用尚未完全阐明。
    目的:评估谱系特异性和粘蛋白糖蛋白免疫染色在区分PIMA和CRC中的性能。
    方法:我们对包含34个PNMA,31PIMA,和32CRC与CK7,CK20,SATB2,CDX2,绒毛,TTF-1,napsinA,和凝胶形成粘蛋白MUC2,MUC5AC,MUC6
    结果:PIMA显示SATB2(6%)的显着(>50%的细胞)表达,CDX2(6%),villin(74%),TTF-1(13%),和napsinA(23%)。然而,在几乎所有的PIMA(30/31)和转移性CRC中均未见显著的CK7表达。
    结论:我们的结果表明,CK7仍然是区分原发性PIMA和转移性CRC的最有用的标志物之一。粘蛋白糖蛋白MUC5AC和MUC6的表达和MUC2表达的缺乏有利于PIMA的诊断,但是这些标记物的表达过于异质,无法用于临床。据我们所知,这是唯一比较肺转移瘤切除标本中PIMA和转移性CRC的免疫组织化学特征的研究。
    BACKGROUND: The lungs are a common site of tumor metastasis. While morphology and immunophenotype can help differentiate primary from metastatic tumors, distinguishing pulmonary invasive mucinous adenocarcinoma (PIMA) from metastatic colorectal adenocarcinoma (CRC) may occasionally be challenging due to overlapping morphological and immunohistochemical features. Lineage-specific markers such as CDX2, TTF-1, and napsin A are helpful with pulmonary non-mucinous adenocarcinoma (PNMA), however they are non-specific and insensitive when applied to PIMA. SATB2 is a newer marker that distinguishes CRC from upper gastrointestinal and pancreaticobiliary tumors; its utility in distinguishing CRC from PIMA has not been fully elucidated.
    OBJECTIVE: To evaluate the performance of lineage-specific and mucin glycoprotein immunostains in distinguishing PIMA and CRC.
    METHODS: We stained tissue microarrays comprising 34 PNMA, 31 PIMA, and 32 CRC with CK7, CK20, SATB2, CDX2, villin, TTF-1, napsin A, and gel-forming mucins MUC2, MUC5AC, and MUC6.
    RESULTS: PIMA showed significant (>50% of cells) expression of SATB2 (6%), CDX2 (6%), villin (74%), TTF-1 (13%), and napsin A (23%). However, significant CK7 expression was seen in nearly all PIMA (30/31) and none of the metastatic CRC.
    CONCLUSIONS: Our results suggest that CK7 remains one of the most useful markers for distinguishing primary PIMA from metastatic CRC. Expression of the mucin glycoproteins MUC5AC and MUC6 and lack of expression of MUC2 favored a diagnosis of PIMA, but expression of these markers was too heterogeneous to be of clinical utility. To our knowledge this is the only study comparing the immunohistochemical profile of PIMA and metastatic CRC in lung metastasectomy specimens.
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  • 文章类型: Journal Article
    卵巢粘液性肿瘤作为原发性或继发性的准确分层总是具有挑战性的,因为它们显示出重叠的组织形态学和免疫组织化学特征。对80例粘液性卵巢肿瘤进行了SATB2和PAX8的免疫组织化学染色,分为53例原发性[25例原发性卵巢粘液性癌(POMC)和28例粘液性交界性肿瘤(MBT)]和27例继发性(结肠起源的12例,7阑尾起源,和胃源8)。表达与不同的临床病理参数相关。在53例原发性卵巢粘液性肿瘤(POMNs)中,有38例(71.69%)检测到PAX8阳性免疫染色,在继发性卵巢粘液性肿瘤中无阳性(0/27)。在27例继发性卵巢粘液性肿瘤中,有16例(59.26%)检测到SATB2阳性表达。所研究的POMN均未显示SATB2的任何阳性免疫染色(0/53)。SATB2-/PAX8+和SATB2+/PAX8-的谱可用于区分POMNCs与胃肠道来源的继发性卵巢粘液性肿瘤,分别,具有100%的特异性。PAX8的表达与一些临床病理参数相关,为PAX8可能用作预后标志物提供了基础。
    Accurate stratification of an ovarian mucinous neoplasm as primary or secondary is always challenging as they show overlapping histomorphological and immunohistochemical features. Immunohistochemical staining for SATB2 and PAX8 was performed on 80 cases of mucinous ovarian neoplasms subdivided into 53 primary [25 primary ovarian mucinous carcinomas (POMCs) and 28 mucinous borderline tumors (MBTs)] and 27 secondary (12 of colonic origin, 7 of appendiceal origin, and 8 of gastric origin). Expression was correlated with different clinicopathologic parameters. PAX8-positive immunostaining was detected in 38 out of 53 cases (71.69%) of primary ovarian mucinous neoplasms (POMNs) with null positivity in the secondary ovarian mucinous tumors (0/27). SATB2-positive expression was detected in 16 out of 27 cases (59.26%) of the secondary ovarian mucinous tumors. None of the studied POMNs showed any positive immunostaining for SATB2 (0/53). A profile of SATB2-/PAX8+ and SATB2+/PAX8- can be used to differentiate POMNCs from secondary ovarian mucinous tumors of GI origin, respectively, with 100% specificity. PAX8 expression is associated with some clinicopathologic parameters providing the basis for the possible usage of PAX8 as prognostic marker.
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  • 文章类型: Journal Article
    背景:玻璃综合征,源自染色体2q33.1微缺失,表现为智力残疾,小头畸形,癫痫,和鲜明的特点,包括小颌畸形,向下倾斜的睑裂,腭裂,拥挤的牙齿。最近,SATB2位于删除区域内,被鉴定为玻璃综合征的致病基因。已经报道了SATB2编码区内的许多致病变体。
    目的:鉴于1号和2号染色体间从头相互易位的患者出现智力障碍和多种先天性异常,怀疑致病基因的破坏。这项研究试图确定患者的致病基因。
    方法:进行长读全基因组测序,并分析候选基因的表达水平。
    结果:断点检测成功。虽然染色体1上的断点破坏了RNF220,但它不被认为是遗传原因。相反,SATB2位于2号染色体上断裂点的约100kb端粒区。患者的临床特征与先前报道的玻璃综合征相似,尽管缺乏证实的SATB2表达减少。
    结论:由于临床特征相似,患者被诊断为玻璃综合征。这使我们假设SATB2下游区域的破坏可能导致Glass综合征。在断点连接中鉴定的微同源性表明涉及微同源性介导的断裂诱导的修复机制或模板转换的潜在分子机制。
    BACKGROUND: Glass syndrome, derived from chromosomal 2q33.1 microdeletions, manifests with intellectual disability, microcephaly, epilepsy, and distinctive features, including micrognathia, down-slanting palpebral fissures, cleft palate, and crowded teeth. Recently, SATB2 located within the deletion region, was identified as the causative gene responsible for Glass syndrome. Numerous disease-causing variants within the SATB2 coding region have been reported.
    OBJECTIVE: Given the presentation of intellectual disability and multiple congenital anomalies in a patient with a de novo reciprocal translocation between chromosomes 1 and 2, disruption of the causative gene(s) was suspected. This study sought to identify the causative gene in the patient.
    METHODS: Long-read whole-genome sequencing was performed, and the expression level of the candidate gene was analyzed.
    RESULTS: The detection of breakpoints was successful. While the breakpoint on chromosome 1 disrupted RNF220, it was not deemed to be a genetic cause. Conversely, SATB2 is located in the approximately 100-kb telomeric region of the breakpoint on chromosome 2. The patient\'s clinical features resembled those of previously reported cases of Glass syndrome, despite the lack of confirmed reduced SATB2 expression.
    CONCLUSIONS: The patient was diagnosed with Glass syndrome due to the similarity in clinical features. This led us to hypothesize that disruption in the downstream region of SATB2 could result in Glass syndrome. The microhomologies identified in the breakpoint junctions indicate a potential molecular mechanism involving microhomology-mediated break-induced repair mechanism or template switching.
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  • 文章类型: Case Reports
    毛细血管扩张骨肉瘤(TOS)是骨肉瘤的一种罕见变体,通常会影响年轻人和长骨。正在讨论的病例出现在一名57岁女性的下颌骨中,并在一周内迅速增长。微观上,肿瘤的特征是被间变性细胞包围的大血管腔。在各个病灶均观察到了薄型花边肿瘤骨样。还注意到丰富的多核破骨细胞巨细胞以及坏死区域。肿瘤细胞SATB2阳性,而细胞角蛋白AE1/3、CD34阴性。在超过50%的肿瘤细胞中观察到Ki-67阳性。因此诊断为高度毛细血管扩张骨肉瘤。
    Telangiectatic osteosarcoma (TOS) is a rare variant of osteosarcoma that typically affects young individuals and long bones. The case under discussion was seen in the mandible of a 57-year-old female and had rapidly grown in size within a week. Microscopically, the tumour was characterised by large vascular cavities surrounded by anaplastic cells. Thin lacy tumour osteoid was observed at various foci. Abundant multinucleated osteoclastic giant cells along with areas of necrosis were also noted. The tumour cells were positive for SATB2, while negative for Cytokeratin AE1/3, CD 34. Ki-67 positivity was observed in more than 50% of tumour cells. A diagnosis of high grade telangiectatic osteosarcoma was thus made.
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  • 文章类型: Journal Article
    特殊的富含AT的序列结合蛋白2(SATB2)是一种与核附着区结合的核基质蛋白,参与染色质重塑和转录调控。在干细胞中,它调节维持多能性和自我更新以及上皮-间质转化(EMT)所需的基因的表达。在这项研究中,我们研究了SATB2在前列腺癌中的致癌作用,并评估了SATB2在人正常前列腺上皮细胞(PrECs)中的过表达是否诱导了癌症干细胞(CSC)的特性.结果表明,SATB2在前列腺癌细胞系和CSC中高表达,但不是在Precs中。SATB2在PrEC中的过表达诱导细胞转化,这通过在软琼脂中形成菌落和在悬浮液中形成球状体来证明。SATB2在PrECs中的过表达也导致干细胞标记(CD44和CD133)的诱导,多能性维持转录因子(cMYC,OCT4、SOX2、KLF4和NANOG),CADHERIN开关,和EMT相关转录因子。染色质免疫沉淀实验证明SATB2可以直接与BCL-2、BSP、南诺,MYC,XIAP,KLF4和HOXA2,表明SATB2能够直接调节多能性/自我更新,细胞存活,和扩散。由于前列腺CSC在癌症发生中起着至关重要的作用,programming,和转移,我们还研究了SATB2敲低对干性的影响。SATB2敲低在前列腺CSCs抑制球体形成,细胞活力,菌落形成,细胞运动性,迁移,和入侵与他们混乱的对照组相比。在CSCs中SATB2敲低也上调E-CADHERIN的表达和抑制N-CADHERIN的表达,蜗牛,SLUG,ZEB1SATB2在前列腺腺癌中的表达明显高于正常组织。总的来说,我们的数据表明,SATB2作为一种致癌因子,能够通过诱导CSC特征诱导PrECs的恶性改变.
    Special AT-rich sequence binding protein-2 (SATB2) is a nuclear matrix protein that binds to nuclear attachment regions and is involved in chromatin remodeling and transcription regulation. In stem cells, it regulates the expression of genes required for maintaining pluripotency and self-renewal and epithelial-mesenchymal transition (EMT). In this study, we examined the oncogenic role of SATB2 in prostate cancer and assessed whether overexpression of SATB2 in human normal prostate epithelial cells (PrECs) induces properties of cancer stem cells (CSCs). The results demonstrate that SATB2 is highly expressed in prostate cancer cell lines and CSCs, but not in PrECs. Overexpression of SATB2 in PrECs induces cellular transformation which was evident by the formation of colonies in soft agar and spheroids in suspension. Overexpression of SATB2 in PrECs also resulted in induction of stem cell markers (CD44 and CD133), pluripotency-maintaining transcription factors (cMYC, OCT4, SOX2, KLF4, and NANOG), CADHERIN switch, and EMT-related transcription factors. Chromatin immunoprecipitation assay demonstrated that SATB2 can directly bind to promoters of BCL-2, BSP, NANOG, MYC, XIAP, KLF4, and HOXA2, suggesting SATB2 is capable of directly regulating pluripotency/self-renewal, cell survival, and proliferation. Since prostate CSCs play a crucial role in cancer initiation, progression, and metastasis, we also examined the effects of SATB2 knockdown on stemness. SATB2 knockdown in prostate CSCs inhibited spheroid formation, cell viability, colony formation, cell motility, migration, and invasion compared to their scrambled control groups. SATB2 knockdown in CSCs also upregulated the expression of E-CADHERIN and inhibited the expression of N-CADHERIN, SNAIL, SLUG, and ZEB1. The expression of SATB2 was significantly higher in prostate adenocarcinoma compared to normal tissues. Overall, our data suggest that SATB2 acts as an oncogenic factor where it is capable of inducing malignant changes in PrECs by inducing CSC characteristics.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    阑尾神经内分泌肿瘤(NETs)很常见,通常在阑尾切除术时被确定为偶然病变。管理指南基于肿瘤大小,入侵程度,和Ki67增殖指数。大多数小肠NET由产生5-羟色胺的EC细胞组成,但是还有多种其他神经内分泌细胞类型。在直肠里,有表达肽YY(PYY)的L细胞肿瘤,胰高血糖素样肽(GLPs),和胰腺多肽(PP);它们被认为比产生5-羟色胺的肿瘤具有更好的预后。我们根据细胞类型调查了阑尾是否有不同的神经内分泌肿瘤类型,以及这种区别是否具有临床意义。我们从UHN多伦多和UHCMC(克利夫兰)的病理档案中收集了135个阑尾NETs。我们分析了生物标志物的表达,包括CDX2,SATB2,PSAP,血清素,胰高血糖素(检测GLPs),PYY,和胰腺多肽(PP),并将结果与临床病理参数相关联。免疫组织化学鉴定出三种类型的阑尾NETs。有75(56%)被分类为EC细胞肿瘤,有37(27%)被分类为L细胞肿瘤;其余23(17%)表达血清素和L细胞生物标志物之一,并被分类为混合。EC细胞肿瘤明显更大,涉及固有肌层的侵袭更广泛,浆膜下,和阑尾膜与L细胞肿瘤相比。混合肿瘤在所有这些参数中处于中间。EC细胞和混合肿瘤均具有淋巴和/或血管浸润,而L细胞肿瘤则没有。与EC-cellNET不同,L细胞肿瘤与淋巴结转移无关。肿瘤类型与pT分期相关,该系列中唯一患有远处转移性疾病的患者患有EC细胞肿瘤。我们的研究证实阑尾NETs不是同质肿瘤群体。至少有三种类型的附录NET,包括EC-cell,L-细胞,和混合肿瘤。这些信息对患者的监测很重要,因为监测尿5HIAA水平仅适用于产生5-羟色胺的肿瘤患者,而GLPs和/或PP的测量更适合L细胞肿瘤患者。我们的数据还表明,肿瘤类型与EC细胞肿瘤表现出最具侵略性的行为有关。
    Appendiceal neuroendocrine tumors (NETs) are common and often are identified as incidental lesions at the time of appendectomy. The guidelines for management are based on tumor size, degree of invasion, and the Ki67 proliferation index. Most small bowel NETs are composed of serotonin-producing EC-cells, but there are multiple other neuroendocrine cell types. In the rectum, there are L-cell tumors that express peptide YY (PYY), glucagon-like peptides (GLPs), and pancreatic polypeptide (PP); they are thought to have a better prognosis than serotonin-producing tumors. We investigated whether the appendix has distinct neuroendocrine tumor types based on cell type and whether that distinction has clinical significance. We collected 135 appendiceal NETs from the pathology archives of UHN Toronto and UHCMC (Cleveland). We analyzed the expression of biomarkers including CDX2, SATB2, PSAP, serotonin, glucagon (that detects GLPs), PYY, and pancreatic polypeptide (PP) and correlated the results with clinicopathologic parameters. Immunohistochemistry identified three types of appendiceal NETs. There were 75 (56%) classified as EC-cell tumors and 37 (27%) classified as L-cell tumors; the remaining 23 (17%) expressed serotonin and one of the L-cell biomarkers and were classified as mixed. EC-cell tumors were significantly larger with more extensive invasion involving the muscularis propria, subserosa, and mesoappendix compared with L-cell tumors. Mixed tumors were intermediate in all of these parameters. Both EC-cell and mixed tumors had lymphatic and/or vascular invasion while L-cell tumors had none. Unlike EC-cell NETs, L-cell tumors were not associated with lymph node metastasis. Tumor type correlated with pT stage and the only patient with distant metastatic disease in this series had an EC-cell tumor. Our study confirms that appendiceal NETs are not a homogeneous tumor population. There are at least three types of appendiceal NET, including EC-cell, L-cell, and mixed tumors. This information is important for surveillance of patients, as monitoring urinary 5HIAA levels is only appropriate for patients with serotonin-producing tumors, whereas measurement of GLPs and/or PP is more appropriate for patients with L-cell tumors. Our data also show that tumor type is of significance with EC-cell tumors exhibiting the most aggressive behavior.
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