Abstract
SMARCB1 (INI-1) is a tumor-suppressor gene located on chromosome 22q11.2. Its gene product is ubiquitously expressed in nuclei of all normal tissues. SMARCB1 gene inactivation has been implicated in the pathogenesis of a diverse group of malignant neoplasms that tend to share "rhabdoid" cytomorphology. This group of SMARCB1-deficient tumors is now further expanded by a subset of carcinomas arising in the sinonasal tract. SMARCB1 immunostaining was performed on 142 sinonasal carcinomas. Tumors that showed loss of expression were further characterized for SMARCB1 deletions by fluorescence in situ hybridization. Nine of 142 (6%) primary sinonasal carcinomas showed loss of SMARCB1 expression by immunohistochemistry. Five patients were women, and patients ranged in age from 33 to 78 years (mean 59 y). The SMARCB1-deficient tumors were characterized by nests, sheets, and cords of cells without any histologic evidence of specific (eg, squamous or glandular) differentiation. The tumors comprised varying proportions of basaloid and rhabdoid cells. The SMARCB1-deficient carcinomas had been diagnosed as nonkeratinizing squamous cell carcinomas (n=3), sinonasal undifferentiated carcinomas (n=2), myoepithelial carcinoma (n=2), nonintestinal adenocarcinoma (n=1), and carcinoma, not otherwise specified (n=1). Fluorescence in situ hybridization analysis revealed SMARCB1 deletions in 6 of 8 (75%) carcinomas. The SMARCB1-deficient carcinomas did not harbor human papillomavirus or NUT-1 alterations. Six patients presented with T4 disease, 5 patients developed local recurrences and/or distant metastases, and 4 died of their disease. Inactivation of the SMARCB1 tumor-suppressor gene appears to be involved in the pathogenesis of a subset of sinonasal carcinomas, further expanding the family of SMARCB1-deficient neoplasms and further delineating a bewildering group of poorly/undifferentiated, aggressive carcinomas arising at this site. The ability to detect SMARCB1 loss by immunohistochemistry, particularly when dealing with poorly differentiated carcinomas with basaloid or rhabdoid features, should facilitate a more comprehensive understanding of these sinonasal carcinomas including clinical behavior and response to targeted therapies.
摘要
SMARCB1 (INI-1)为位于染色体22q11.2的抑癌基因。其基因产物广泛表达于所有正常组织的细胞核。SMARCB1 基因失活与一组细胞学形态上表现为横纹肌样的疾病发病有关。目前进一步将这组SMARCB1缺乏肿瘤的谱系扩展到了鼻腔鼻窦癌。
材料与方法:142例鼻腔鼻窦癌行SMARCB1 免疫组化染色。免疫组化不表达的病例进一步做荧光原位杂交检测SMARCB1 缺失。9/142 (6%) 原发性鼻腔鼻窦癌免疫组化检测到SMARCB1 表达缺失。5例女性,患者年龄范围为33-78 岁,(中位年龄59岁)。SMARCB1缺乏肿瘤形态学上表现为巢状、片状、条索状,没有特异性组织分化的证据(如鳞状或腺样分化)。肿瘤由不同比例的基底样和横纹肌样细胞构成。SMARCB1缺乏性癌被诊断为非角化鳞癌(n=3)、鼻腔鼻窦未分化癌(n=2)、肌上皮癌(n=2)、非肠型腺癌(n=1)和非特定类型的癌 (n=1)。FISH结果表明6/8 (75%) 的癌SMARCB1缺失。SMARCB1缺失癌无HPV感染或NUT-1改变。6例患者为T4期,5 例有局灶复发和/或远处转移,4例死亡。
结论:SMARCB1 肿瘤抑癌基因的失活与一组鼻腔鼻窦癌发病有关,进一步扩展了SMARCB1缺乏肿瘤的谱系,有助于描述一类使人迷惑的、发生于该部位的侵袭性、低/未分化癌。免疫组化检测SMARCB1 缺失,尤其诊断基底样或横纹肌样低分化癌时,有助于更好地理解这类鼻腔鼻窦癌的临床生物学行为和对靶向治疗的反应。
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