←しおりをご利用いただけます。

免疫染色玉手箱診断ᨺᑕ⥺἞⒪ᚋ࡟Ⓨ⏕ࡋࡓᏊᐑ⾑⟶⫗⭘㻌̿ච␿⤌⧊໬Ꮫࢆ୰ᚰ࡟̿㻌㻌බ┈㈈ᅋἲே㻌 ࡀࢇ◊✲఍㻌 ᭷᫂⑓㝔㻌 ⮫ᗋ⑓⌮ࢭࣥࢱ࣮㻌 ⑓⌮㒊 㻝㻕㻘㻌බ┈㈈ᅋἲே㻌 ࡀࢇ◊✲఍㻌 ᭷᫂⑓㝔㻌 ⮫ᗋ⑓⌮ࢭࣥࢱ࣮㻌 ⣽⬊デ᩿㒊 㻞㻕㻌▼஭⬶ᖹ 㻝㻕㻘㻌 ᑠᯇிᏊ 㻞㻕㻌㻌㻌䛿䛨䜑䛻ᨺᑕ⥺⒪ἲࡣᝏᛶ⑌ᝈࡢ἞⒪࡟ᑐࡋ࡚ᗈࡃ⏝࠸ࡽࢀ࡚࠸ࡿࡀࠊࡑࡢ἞⒪࡟ࡼࡗ࡚⫗⭘ࡢⓎ⏕ࡀㄏⓎࡉࢀࡿࡇ࡜ࡶ▱ࡽࢀ࡚࠸ࡿ 1)ࠋ1948 ᖺ࡟ Cahan1)ࡽ࡟ࡼࡗ࡚ⱥᩥ࡛ึࡵ࡚ᨺᑕ⥺ㄏⓎ⫗⭘࡟㛵ࡍࡿሗ࿌ࡀ࡞ࡉࢀ࡚௨᮶ࠊᵝࠎ࡞ሗ࿌ࡀࡉࢀ࡚࠸ࡿ 2)ࠋࡲࡓࠊᨺᑕ⥺ㄏⓎ⫗⭘ࡢṇ☜࡞Ⓨ⏕⋡ࡣ୙࡛᫂࠶ࡿࡀࠊᨺᑕ⥺⒪ἲࢆཷࡅࡓᝈ⪅ࡢ 1%ᮍ‶࡜ࡢሗ࿌ࡶ࠶ࡾࠊ඲⫗⭘ᝈ⪅ࡢ 0.5ࠥ5%ࢆ༨
ࡵࡿ 3)ࠋⓎ⏕㢖ᗘࡢ㧗࠸⤌⧊ᆺࡣ㦵⫗⭘ࡸᮍศ໬ከᙧ⫗⭘࡛࠶ࡿ 4)ࠋᨺᑕ⥺ㄏⓎ⫗⭘ࡢ᫂☜࡞ᐃ⩏ࡣ☜❧ࡉࢀ࡚࠸࡞࠸ࡀࠊ1948 ᖺ࡟ Cahan ࡽࡀᥦၐࡋࡓデ᩿ᇶ‽ࢆࡶ࡜࡟ Arlen5)ࡽࡀಟṇࢆຍ࠼ࡓࡶࡢࡀ⌧ᅾཷࡅධࢀࡽࢀ࡚࠸ࡿࠋࡑࡢデ᩿ᇶ‽ࡣࠊ1. ᨺᑕ⥺↷ᑕṔࡀ࠶ࡿࡇ࡜ࠊ2. ᨺᑕ⥺↷ᑕ⠊ᅖෆ࠿ࡽⓎ⏕ࡋࡓ⫗⭘࡛࠶ࡿࡇ࡜ࠊ3. ᨺᑕ⥺↷ᑕᚋᑡ࡞ࡃ࡜ࡶ 3 ᖺ௨ୖࡢ₯అᮇ㛫ࢆ᭷ࡋ࡚࠸
ࡿࡇ࡜ࠊ4. ⤌⧊Ꮫⓗ࡟⫗⭘࡜デ᩿ࡉࢀࠊཎⓎ⭘⒆࡜␗࡞ࡿ⤌⧊ᆺ࡛࠶ࡿࡇ࡜࡜ࡉࢀ࡚࠸ࡿࠋ
ࡇࡇ࡛ࡣࠊᨺᑕ⥺἞⒪ᚋ࡟Ⓨ⏕ࡋࡓᏊᐑ⾑⟶⫗⭘ࡢ⑕౛ࢆᥦ♧ࡍࡿ࡜࡜ࡶ࡟ࠊ⾑⟶⫗⭘ࡢデ᩿࡟⏝࠸ࡽࢀࡿ⾑⟶ෆ⓶࣐࣮࣮࢝࡟ࡘ࠸࡚ࡶࠊᩥ⊩ⓗ࡞᝟ሗࢆ஺࠼ሗ࿌ࡍࡿࠋ⮫ᗋᡤぢ70 ௦ዪᛶ୺ッ㸸୙ṇฟ⾑⌧⑓Ṕ㸸Ꮚᐑ㢕㒊ᡥᖹୖ⓶⒴࡟࡚ᨺᑕ⥺἞⒪ᚋ 14 ᖺ⤒㐣⑓⌮⤌⧊Ꮫⓗᡤぢ㢮෇ᙧࠥ⣳㗽ᙧ᰾ࢆ᭷ࡍࡿ⭘⒆⣽⬊ࡀ⾑⟶ᵝࡢ⣽⿣ࢆᙧᡂࡋ࡞ࡀࡽ୙つ๎࡟(Figure 1a, b)࠶ࡿ࠸ࡣங㢌≧(Figure 1c)ࠊ⣴≧࡟ቑṪࡋ࡚࠾ࡾࠊ୍㒊ࠊୖ⓶ᵝࡢ㓄ิࢆ࿊ࡍࡿ࡜ࡇࢁࡶㄆࡵࡽࢀࡓ
(Figure 1d)ࠋᏊᐑእ⭷ࠊ୧ഃ௜ᒓჾࠊ⭤⬔እ⭷࡬ࡢᾐ₶ࡀࡳࡽࢀࡓࡀࠊඖࠎࡢᡥᖹୖ⓶⒴ࡢṧᏑࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋච␿⤌⧊໬Ꮫ࡟࡚ CD31, ERG, vimentin, Ki-67 㝧ᛶࢆ♧ࡋࡓ(⾲ 1, Figure2a-d)ࠋᙧែീ࠾ࡼࡧච␿⤌⧊໬Ꮫࡢ⤖ᯝࡼࡾ⾑⟶⫗⭘࡜デ᩿ࡉࢀࡓࠋ

-1-免疫染色玉手箱
診断abcdFigure 1 HE ᡤぢ.
a, ⾑⟶ᵝࡢ⣽⿣ࢆᙧᡂࡍࡿ(20). b, ⣳㗽ᙧࢆ࿊ࡍࡿ⭘⒆⣽⬊(40). c, ங㢌≧ቑṪࢆㄆࡵࡿ(20).
d, ୖ⓶ᵝࡢ㓄ิࢆ࿊ࡍࡿ(40).

⾲ 1 ච␿⤌⧊໬Ꮫࡢ⤖ᯝཇ੓ӆ੓

CD31 (JC70A), ERG (EPR3864), vimentin (V9), Ki-67 (MIB-1)
CD10 (56C6), CD34 (NU-4A1), Factor VIII (F8/86), Cytokeratin (AE1/AE3),
Melanosome (HMB45)(-2-)ෆࡣ Clone ྡ免疫染色玉手箱
診断
abcdFigure 2 ච␿⤌⧊໬Ꮫ.
a, CD31 (20). b, ERG (20). c, Vimentin (20). d, Ki-67 (20).

⾑⟶ෆ⓶䝬䞊䜹䞊䛻䛴䛔䛶⾑⟶ෆ⓶࣐࣮࣮࢝࡜ࡋ࡚ 1) CD31, 2) CD34, 3) Factor VIII-related antigen (FVIII), 4) ERG(ETS related gene), 5) FLI-1 (friend leukemia integration 1)࡞࡝ࡀᣲࡆࡽࢀࠊ⾑⟶⫗⭘࡛㝧ᛶࢆ♧ࡍࠋ1) CD31 ࡣ PECAM-1 (Platelet endothelial cell adhesion molecule 1)࡜ࡋ࡚ࡶ▱ࡽࢀ࡚࠾ࡾࠊ⾑⟶ෆ⓶⣽⬊ࠊ⾑ᑠᯈࠊᕧ᰾⌫ࡸ୍㒊ࡢ㐀⾑⣽⬊࡟Ⓨ⌧ࡍࡿ⣽⬊⭷⢾ࢱࣥࣃࢡ࡛࠶ࡿ 6, 7)ࠋ
ࡲࡓࠊឤᗘࡸ≉␗ᗘࡢ㧗࠸⾑⟶ෆ⓶࣐࣮࣮࡛࢝࠶ࡿࡀ 8)ࠊᙧ㉁⣽⬊ࡸ⤌⧊⌫࡟ࡶⓎ⌧ࡀࡳࡽࢀࡿࡇ࡜ࡀ࠶ࡿ 6)ࠋ≉࡟ᚋ⪅࡟ࡘ࠸࡚ࡣࠊ⭘⒆ෆࡢ⤌⧊⌫ࡀ㝧ᛶࢆ࿊ࡍࡿࡇ࡜࡛ࠊㄗࡗࡓデ᩿ࢆᘬࡁ㉳ࡇࡍྍ⬟ᛶࡀ࠶ࡿࡢ࡛ὀពࡀᚲせ࡛࠶ࡿ 6, 8)ࠋ
2) CD34 ࡣ㐀⾑ᖿ⣽⬊ࠊ⾑⟶ෆ⓶⣽⬊ࠊ⥺⥔ⱆ⣽⬊ࡸ࢝ࣁ࣮ࣝ௓ᅾ⣽⬊࡟Ⓨ⌧ࡍࡿ⣽⬊⭷㈏㏻
ᆺࢩ࢔ࣝ໬⢾ࢱࣥࣃࢡ࡛࠶ࡿ 6,7,9)ࠋ
ࡋࡤࡋࡤࣜࣥࣃ⟶ෆ⓶⣽⬊࡟ࡶᙅ࠸Ⓨ⌧ࡀࡳࡽࢀ 6)ࠊCD31
࡜ẚ㍑ࡋ࡚ࡸࡸ≉␗ᗘࡢప࠸⾑⟶ෆ⓶࣐࣮࣮࡛࢝࠶ࡿ 9)ࠋࡑࡢ࡯࠿࡟ࠊ㝯㉳ᛶ⓶⭵⥺⥔⫗⭘ࡸᏙ❧ᛶ⥺⥔ᛶ⭘⒆࡞࡝ࡢ㌾㒊⤌⧊⭘⒆ࡢ࣐࣮࣮࢝࡜ࡋ࡚ࡶ౑ࢃࢀࡿ 6)ࠋ
3) FVIII ࡣ⾑⟶ෆ⓶⣽⬊ࡸᕧ᰾⌫ࡢ⣽⬊㉁࡟ࢱࣥࣃࢡⓎ⌧ࢆ࿊ࡍࡿ 7)ࠋࡲࡓࠊFVIII ࡣ CD31
ࡸ CD34 ࡜ẚ㍑ࡋ࡚ឤᗘࡀࡸࡸప࠸ࠋ

-3-

免疫染色玉手箱診断4) ERG ࢱࣥࣃࢡࡣ ETS ㌿෗ᅉᏊࣇ࢓࣑࣮ࣜࡢ୍ဨ࡛࠶ࡿ ERG 㑇ఏᏊ࡟ࡼࡗ࡚ࢥ࣮ࢻࡉࢀࠊ
⾑⟶ෆ⓶⣽⬊ࡢ᰾࡟Ⓨ⌧ࡍࡿ 6)ࠋERG ࡣ⾑⟶ᛶ⭘⒆ࡢデ᩿࡟࠾࠸࡚ឤᗘ࣭≉␗ᗘࡢ㧗࠸࣐࣮࣮࡛࢝࠶ࡿ 6,9)ࠋ࣮ࣘ࢖ࣥࢢ⫗⭘ࢆጞࡵ࡜ࡍࡿ୍㒊ࡢ⫗⭘ࡸ๓❧⭢⒴ࡢ⣙༙ᩘ࡟࠾࠸࡚ᰁⰍయ㌿ᗙ࡟ࡼࡾ⼥ྜ㑇ఏᏊࡀᙧᡂࡉࢀࠊච␿⤌⧊໬Ꮫ࡟࠾࠸࡚ ERG ࢱࣥࣃࢡࡀ㝧ᛶ࡜࡞ࡿ 6)ࠋ
ࡲࡓࠊ㢮ୖ⓶⫗⭘ࡢ୰࡟ࡣ ERG ࢱࣥࣃࢡⓎ⌧ࢆ࿊ࡍࡿࡶࡢࡶ࠶ࡿࡓࡵࠊ⾑⟶⫗⭘࡜㢮ୖ⓶⫗⭘ࡢ㚷ู࡟ ERG ࢆ⏝࠸ࡿሙྜ࡟ࡣὀពࢆせࡍࡿ 10)ࠋ5) FLI-1 ࢱࣥࣃࢡࡣ ETS ㌿෗ᅉᏊࣇ࢓࣑࣮ࣜࡢ୍ဨ࡛࠶ࡿ FLI-1 㑇ఏᏊ࡟ࡼࡗ࡚ࢥ࣮ࢻࡉࢀࠊ
⾑⟶ෆ⓶⣽⬊ࡸ୍㒊ࡢ㐀⾑⣽⬊ࡢ᰾࡟Ⓨ⌧ࡀࡳࡽࢀࡿ 11)ࠋࡲࡓࠊ⾑⟶ෆ⓶⣽⬊࡬ࡢศ໬ࢆࡳ
ࡿឤᗘࡢ㧗࠸࣐࣮࣮࡛࢝࠶ࡿ௚ࠊsmall round cell tumor ࢆ㚷ูࡍࡿ㝿ࡢ࣐࣮࣮࢝࡜ࡋ࡚ࡶ⏝࠸ࡽࢀࡿ 11)ࠋ⾑⟶⫗⭘࡛ࡣࡇࢀࡽ඲࡚ࡢ⾑⟶ෆ⓶࣐࣮࣮࢝ࡀⓎ⌧ࡍࡿ࡜ࡣ㝈ࡽࡎࠊ୍㒊ࡢࡳ࡟Ⓨ⌧ࢆ࿊ࡍࡿሙྜࡶ࠶ࡿࠋࡑࡢࡓࡵࠊ⾑⟶⫗⭘ࡢデ᩿࡟㝿ࡋ࡚ࠊ」ᩘࡢ࣐࣮࣮࢝ࢆే⏝ࡍࡿࡇ࡜ࡀ᥎ዡࡉࢀࡿࠋ
ࡲࡓࠊ⾑⟶⫗⭘ࡢ 10%ࠊ㢮ୖ⓶⾑⟶⫗⭘ࡢ⣙ 50%ࡢ⑕౛࡛ࠊCytokeratin ࡀ㝧ᛶ࡜࡞ࡿⅬ࡟ࡶὀពࡍࡿᚲせࡀ࠶ࡿ 12)ࠋ䜎䛸䜑௒ᅇࠊᨺᑕ⥺἞⒪ᚋ࡟Ⓨ⏕ࡋࡓᏊᐑ⾑⟶⫗⭘ࡢ⑕౛ሗ࿌࡜࡜ࡶ࡟ࠊ⾑⟶⫗⭘ࡢデ᩿࡟⏝࠸ࡽࢀࡿ⾑⟶ෆ⓶࣐࣮࣮࢝࡟ࡘ࠸࡚ࡢᩥ⊩ⓗሗ࿌ࢆᥦ♧ࡋࡓࠋච␿⤌⧊໬Ꮫࡣࠊ⤌⧊デ᩿ࢆ⾜࠺ୖ࡛኱ኚ᭷⏝࡞᪉ἲ࡛࠶ࡾỗ⏝ࡉࢀ࡚࠸ࡿࡀࠊᢠయࡢ≉ᛶࢆ⌮ゎࡏࡎ⏝࠸ࡿ࡜ࠊpitfall ࡟㝗ࡗ࡚ࡋࡲ࠺
ྍ⬟ᛶࡀ࠶ࡿࡢ࡛ὀពࡋࡓ࠸ࠋᮏ✏ࡀ⾑⟶⫗⭘ࡢデ᩿࡟ᙺ❧࡚ࡤᖾ࠸࡛࠶ࡿࠋཧ⪃ᩥ⊩
1. CAHAN WG, WOODARD HQ, et al. Sarcoma arising in irradiated bone; report of 11 cases.
Cancer. 1948; 1: 3-29.
2. Echchikhi Y, Loughlimi H, et al. Radiation-induced osteosarcoma of the skull base afterradiation therapy in a patient with nasopharyngeal carcinoma: a case report and review of theliterature. J Med Case Rep. 2016; 10: 334. Review.
3. Joo MW, Kang YK, et al. Post-radiation sarcoma: A study by the Eastern Asian Musculoskeletal
Oncology Group. PLoS One. 2018; 13: e0204927.
4. Sheppard DG, Libshitz HI. Post-radiation sarcomas: a review of the clinical and imaging
features in 63 cases. Clin Radiol. 2001; 56: 22-9.
5. Arlen M, Higinbotham NL, et al. Radiation-induced sarcoma of bone. Cancer. 1971; 28: 1087-99.
6. Miettinen M. Immunohistochemistry of soft tissue tumours - review with emphasis on 10markers. Histopathology. 2014; 64: 101-18.
7. Wang ZB, Yuan J, et al. Transcription factor ERG is a specific and sensitive diagnostic marker
for hepatic angiosarcoma. World J Gastroenterol. 2014; 20: 3672-9.
8. McKenney JK, Weiss SW, et al. CD31 expression in intratumoral macrophages: a potential
diagnostic pitfall. Am J Surg Pathol. 2001; 25: 1167-73.
9. Naeem N, Mushtaq S, et al. Effectiveness of Vascular Markers (Immunohistochemical Stains) inSoft Tissue Sarcomas. J Coll Physicians Surg Pak. 2018; 28: 352-356.
10. Miettinen M, Wang Z, et al. ERG expression in epithelioid sarcoma: a diagnostic pitfall. Am JSurg Pathol. 2013; 37: 1580-5.
11. Rossi S, Orvieto E, et al. Utility of the immunohistochemical detection of FLI-1 expression inround cell and vascular neoplasm using a monoclonal antibody. Mod Pathol. 2004; 17: 547-52.
12. Rao P, Lahat G, et al. Angiosarcoma: a tissue microarray study with diagnostic implications. Am
J Dermatopathol. 2013; 35: 432-7.

-4-