The Clinicopathological Features Of Malignant Peripheral Nerve Sheath Tumors And The Expression Significance Of S-100,SOX-10 And Nestin Proteins

Background:Malignant peripheral nerve sheath tumors(MPNST)are a rare type of malignant tumor that originates from peripheral nerves and differentiates into nerve sheaths.The tumor is a heterogeneous tumor mainly composed of fibroblasts,schwann cells,CD34 positive dendritic cells,EMA positive tunica cells and primitive neuroepithelial cells and so on.The disease is more common in adults,and there is no gender difference in the incidence.Extremities and head and neck are the most common sites,and they are often near large nerve trunks.MPNST is highly invasive,with atypical clinical symptoms and lack of characteristic imaging feature.It is difficult to provide effective help for the diagnosis of malignant peripheral nerve sheath tumors.Therefore,the diagnosis of MPNST still depends mainly on the results of pathology.However,as a multi-source heterogeneous peripheral neurotumor,the histomorphology of MPNST is complex and changeable.It is very difficult to distinguish between benign and malignant tumors in MPNST,and immunohistochemical detection is still needed to assist diagnosis.Currently,S-100 is the most commonly used immunomarker for the diagnosis of MPNST.However,many studies have shown its limited specificity,with about 50%of the nucleus being stained.With the progress of some research,SOX-10 and Nestin have gradually entered the vision of pathologists as possible markers of malignant peripheral nerve sheath tumors.SOX-10 is a neural crest transcription factor and one of the important members of the SOX family.And it is a molecular marker of neural ectoderm stem and progenitor cells.In the differentiation,maturation and maintenance of Schwann cells and melanocytes,SOX-10 plays an indispensable and important role.The studies found that SOX-10 was positively expressed in most melanoma and half of MPNST,and its sensitivity and specificity were higher than S-100 protein.Nestin,as a type VI intermediate silk protein,is expressed in many tumors and tumor stem cells.Compared with other neural markers,Nestin has been proved to be a more sensitive marker of MPNST by some scholars However,due to the low incidence of MPNST,there are few related reports.Some scholars speculated that when used in combination with other markers,it may contribute to the diagnosis of MPNST.Objective:The study attempts to understand the general characteristics of the MPNST by analyzing the clinical data of patients(such as age,gender,and location).In this study,we tried to deepen the understanding of MPNST by observing the gross specimens and microscopic manifestations,and analyzing the morphological characteristics of different grades and histological types.In this study,we performed experiments to observe the expression of S-100,SOX-10,and Nestin in MPNST of different ages,genders,locations,grades and histological types.Finally,we tried to find the diagnostic value of S-100,SOX10,Nestin by comparing with other benign peripheral nerve tumors.Methods:1.Data Collection:Collect the tissue samples of 53 patients with malignant peripheral nerve sheath tumors diagnosed in the First Affiliated Hospital of Zhengzhou University from May 2013 to November,2019,and obtain the clinical and pathological data of patients by consulting clinical records and pathological examination information.In addition,we collected tissue samples from 30 benign peripheral nerve tumors as controls,including 10 cases of schwannomas,10 cases of neurofibromas,and 10 cases neurofibromatosis of type I.All of the benign caseshave been excluded from malignant peripheral nerve sheath tumors.2.Immunohistochemistry(IHC)method was used to stain all paraffin section specimens with S-100,SOX-10 and Nestin antibodies.And the expression of the above antibodies in pathological specimens was observed under the microscope.3.Statistical Methods:This study used SPSS 24.0 statistical software to analyze the data.The expressions of S-100,SOX-10 and Nestin in malignant peripheral peripheral nerve sheath tumors of different ages,genders,disease sites and different subtypes were analyzed respectively,by using chi-square test or Fisher exact probability method.The differences in the expression intensity of S-100,SOX-10,Nestin in different histological grades of MPNST were statistically processed by using the Spearman test.If P<0.05,the difference will be considered statistically significant.Results:1.In this study,the main onset age of malignant peripheral schwannoma was 30-60 years old,and there was no difference in incidence between men and women.The most common sites were limbs,trunk,head and neck,and the retroperitoneum and mediastinum also had a higher incidence.2.The differences of S-100,SOX-10 and Nestin expression in benign peripheral nerve tumors and malignant peripheral nerve sheath tumors are statistically significant(χ2=9.532,P<0.05;x2=15.913,P<0.05;χ2=4.222,P<0.05).The positive expression intensity of S-100 was negatively correlated with the histological grade of malignant peripheral nerve sheath tumor(rs=-0.296,P<0.05).3.Compared with S-100 and SOX-10 proteins,Nestin has higher sensitivity and specificity for malignant peripheral nerve sheath tumors(92.5%,26.7%).4.The expression of S-100,SOX-10 and Nestin in malignant peripheral nerve sheath tumors of different ages,genders,disease sites and different histological subtypes was not statistically significant P>0.05).Conclusion:1.S-100,SOX-10,Nestin protein can be used as a meaningful immunohistochemical index for the differential diagnosis of malignant peripheral nerve sheath tumors and benign peripheral nerve tumors,and the expression intensity of SOX-10 and Nestin protein in MPNST was better than that in the control group.The positive expression intensity of S-100 protein was positively correlated with the differentiation degree of malignant peripheral nerve sheath tumors;2.Compared with S-100 and SOX-10 expression,the expression of Nestin protein in MPNST has higher sensitivity and specificity;3.The expression of S-100,SOX-10 and Nestin had no significant correlation with the gender,age,location of occurrence and histological classification of patients with malignant peripheral nerve sheath tumors,and the tumor could not be further evaluated.