Tumor Markers in Pheochromocytomas
نویسندگان
چکیده
.........................................................................................................................................................10 INTRODUCTION................................................................................................................................................11 REVIEW OF THE LITERATURE...................................................................................................................12 1. SYMPATHOADRENAL SYSTEM..................................................................................................................12 1.1 The adrenal gland .........................................................................................................................12 1.2 The paraganglion system ..............................................................................................................13 2. PHEOCHROMOCYTOMAS ..........................................................................................................................15 2.1 Genetic basis and associated syndromes .....................................................................................16 2.1.1 von Hippel-Lindau disease..................................................................................................................16 2.1.2 Neurofibromatosis type 1 ....................................................................................................................16 2.1.3 Multiple endocrine neoplasia type II ..................................................................................................17 2.1.4 Hereditary paragangliomas .................................................................................................................17 2.1.5 Sporadic pheochromocytomas ............................................................................................................17 2.2 Clinical presentation.....................................................................................................................18 2.3 Diagnosis.......................................................................................................................................20 2.4 Treatment.......................................................................................................................................21 2.5 Histopathology ..............................................................................................................................22 2.6 Immunohistochemical diagnosis...................................................................................................24 2.7 Prognosis.......................................................................................................................................25 3. TUMORIGENESIS.......................................................................................................................................26 3.1 General remarks............................................................................................................................26 3.2 Growth stimulation........................................................................................................................27 3.2.1 Cell cycle..............................................................................................................................................27 3.2.2 Growth factors .....................................................................................................................................27 3.2.3 Proliferation activity ............................................................................................................................28 3.3 Growth inhibition ..........................................................................................................................29 3.3.1 Inhibins/activins...................................................................................................................................29 3.3.2 Cyclin-dependent kinases....................................................................................................................30 3.4 Limitless replicative potential.......................................................................................................30 3.5 Apoptosis .......................................................................................................................................31 3.5.1 p53 ........................................................................................................................................................31 3.6 Angiogenesis..................................................................................................................................32 3.6.1 Vascular endothelial growth factor (VEGF) ......................................................................................32 3.6.2 Microvessel density .............................................................................................................................33 3.7 Invasion and metastasis ................................................................................................................33 3.7.1 Matrix metalloproteinases ...................................................................................................................34 3.7.2 Tenascin ...............................................................................................................................................34 3.7.3 Cyclooxygenase-2 (COX-2)................................................................................................................35 AIMS OF THE STUDY.......................................................................................................................................37 MATERIALS AND METHODS........................................................................................................................38 1. CLINICAL MATERIAL (STUDY I-V)...........................................................................................................38 2. IMMUNOHISTOCHEMISTRY (STUDY I-V) .................................................................................................39 2.1 Microvessel density (Study III) .....................................................................................................40
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