胸腔积液脱落细胞免疫组化染色对肿瘤来源鉴别诊断价值的探讨

目的:评估波形蛋白(VIM)、神经特异度钙结合蛋白(CR)、间皮细胞(MC),细胞角蛋白7(CK7)和甲状腺转录因子-1(TTF-1)免疫组化染色在转移性肺腺癌和恶性间皮瘤鉴别诊断中的价值.方法:收集经病理学确诊的恶性胸腔积液患者82例,选取其中的胸膜转移性肺腺癌和恶性胸膜间皮瘤患者纳入分析.评估TTF-1、CK7、Vimentin、MC和Calretinin 5项指标对胸膜转移性肺腺癌和恶性胸膜间皮瘤的诊断灵敏度和特异度.结果:VIM(x2 =4.99,P=0.014)、CR(x2 =23.74,P=0.01)和MC(x2 =13.08,P=0.001)的表达在恶性胸膜间皮瘤的表达高于胸膜转移性肺腺癌.而TTF-1(x2 =21.67,P＜0.01)和CK7(x2 =18.12,P＜0.01)在胸膜转移性肺腺癌表达高于恶性胸膜间皮瘤.对于恶性间皮瘤的诊断,VIM的灵敏度为72.7％(8/11),特异度为64.4％ (29/45);CR的灵敏度为90.9％ (10/11),特异度为84.4％(38/45);MC的灵敏度为72.7％ (8/11),特异度为82.2％ (37/45).对于胸膜转移性肺腺癌的诊断,CK7的灵敏度为95.6％ (43/45),特异度为54.5％ (6/11);TTF-1的灵敏度为82.2％(37/45),特异度为90.9％(10/11).结论:胸腔积液脱落细胞的TTF-1、CK7、Vimentin、MC和Calretinin免疫组化染色对恶性胸膜间皮瘤和胸膜转移性肺腺癌的鉴别具有较高价值.     

免疫组化对恶性胸膜上皮型间皮瘤与肺腺癌鉴别诊断价值的探讨

目的:探讨免疫组化对恶性胸膜上皮型间皮瘤与肺腺癌鉴别诊断的价值。方法:用免疫组化SP法检测27例胸膜上皮型恶性间皮瘤和30例肺腺癌组织中,Calretinin、WT1、D2-40、CK5/6、CEA、MOC-31和TTF-1的表达情况,并应用受试者工作曲线(ROC)对检查结果分析,选择更合适的一组抗体用于恶性间皮瘤与肺腺癌的鉴别诊断。结果:Calretinin、D2-40、WT-1、CK5/6、CEA、MOC-31和TTF-1在恶性间皮瘤组织中的阳性表达率分别为92.5%(25/27)、92.5%(25/27)、96.3%(26/27)、77.8%(21/27)、11.1%(3/27)、0(0/27)和37.0%(10/27);在腺癌组织中的阳性率分别为13.3%(4/30)、6.7%(2/30)、10.0%(3/30)、26.7%(8/30)、90.0%(27/30)、83.3%(25/30)和96.7%(29/30)。间皮瘤阳性标志Calretinin、D2-40、WT1和CK5/6的ROC曲线下面积(AUC)值分别为0.896、0.930、0.931和0.756,腺癌标志CEA、TTF-1和MOC-31的AUC值分别为0.894、0.917和0.798。结论:免疫组化是鉴别恶性间皮瘤与腺癌最好的方法,Calretinin、WT1、D2-40、CEA和TFF-1是较为理想的标志,可作为恶性间皮瘤和腺癌鉴别诊断中的首选抗体。     

D2-40联合Calretinin在恶性胸膜间皮瘤诊断及鉴别诊断中的价值

[目的]探讨D2-40在恶性胸膜间皮瘤诊断中的潜在价值.[方法]对余姚市人民医院及复旦大学附属中山医院病理科自1999—2009年诊断的31例恶性胸膜间皮瘤和30例肺腺癌进行回顾性分析并进行免疫组化检测,观察D2-40 、Calretinin 、CEA 、TTF-1在恶性间皮瘤和肺腺癌中的表达.[结果] D2-40、Calretinin在恶性胸膜间皮瘤中的灵敏度分别为80.6％、83.9％,特异性分别为93.3％、86.7％,两者联合诊断的灵敏度93.5％,其中上皮型间皮瘤为100.0％.CEA、TTF-1在肺腺癌中的灵敏度分别为90.0％、83.3％,特异性分别为87.1％和100.0％.[结论]D2-40联合Calretinin可以提高恶性胸膜间皮瘤鉴别诊断的准确率.D2-40、Calretinin 、CEA、TTF-1联合检测是鉴别恶性胸膜间皮瘤和肺腺癌的一组有价值的抗体.     

胸腔积液细胞学及免疫细胞化学在鉴别肺转移性腺癌和间皮细胞中的临床价值分析

目的:探讨胸腔积液细胞学及免疫细胞化学在鉴别肺转移性腺癌和间皮源性细胞的临床价值。方法:应用细胞学和细胞块免疫细胞化学方法,检测96例胸腔积液中转移性腺癌和间皮细胞,在细胞学形态上的鉴别及在CEA、CK、TTF-1、KI67、CR、Vimentin中的表达。每例均制备细胞学涂片和细胞块,并用细胞块切片作免疫细胞化学染色。结果:细胞形态学和免疫细胞化学相结合,96例胸腔积液中诊断腺癌42例,间皮细胞54例。结论:细胞学和CEA、CK、TTF-1、KI67、CR、Vimentin6种抗体联合检测,可鉴别诊断肺转移性腺癌细胞和间皮源性的细胞,提高了疑难病例诊断准确率。     

24例胸膜间皮瘤与肺腺癌免疫组化研究

２４例胸膜间皮瘤的组织学类型主要为上皮型，纤维型和混合型。２４例原发性肺腺癌作对照。免疫组化标记抗体包括抗细胞角蛋白（Ｋｅｒａｔｉｎ），癌胚抗原（ＣＥＡ），波形蛋白（Ｖｉｍｅｎｔｉｎ）和上皮细胞膜抗原（ＥＭＡ）。免疫组化标记结果表明Ｋｅｒａｔｉｎ、Ｖｉｍｅｎｔｉｎ和ＣＥＡ对鉴别胸膜间皮瘤与原发性肺腺癌有一定的实用价值。     

胸腔积液细胞学及免疫细胞化学在鉴别肺转移性腺癌和间皮细胞中的临床价值分析

目的：探讨胸腔积液细胞学及免疫细胞化学在鉴别肺转移性腺癌和间皮源性细胞的临床价值。方法：应用细胞学和细胞块免疫细胞化学方法,检测96例胸腔积液中转移性腺癌和间皮细胞,在细胞学形态上的鉴别及在CEA、CK、TTF-1、KI67、CR、Vimentin中的表达。每例均制备细胞学涂片和细胞块,并用细胞块切片作免疫细胞化学染色。结果：细胞形态学和免疫细胞化学相结合,96例胸腔积液中诊断腺癌42例,间皮细胞54例。结论：细胞学和CEA、CK、TTF-1、KI67、CR、Vimentin6种抗体联合检测,可鉴别诊断肺转移性腺癌细胞和间皮源性的细胞,提高了疑难病例诊断准确率。     

联合检测E-cadherin、GEA及Calretinin在浆膜腔积液细胞学鉴别诊断中的意义

背景与目的:浆膜腔积液中转移性腺癌细胞、恶性上皮型间皮瘤细胞和反应性间皮细胞的形态有不少相似之处,有时仅凭形态学特征不能做出准确诊断.近年来免疫细胞化学在这方面得到较多应用,但国内报道仅局限于用CK、EMA、CEA、Vim和HBME-1几种抗体,而且不能较好地进行细胞学的鉴别诊断.本研究旨在探讨联合检测E-cadherin、CEA及calretinin在浆膜腔积液鉴别诊断中的应用价值.方法:选用浆膜腔积液标本共93例,其中胸水66例、腹水24例、心包积液3例.经组织学检查或结合临床资料证实的转移性腺癌55例、恶性上皮型间皮瘤6例、间皮细胞反应性增生32例.每例均制备HE染色的涂片和细胞块,并用细胞块切片作免疫细胞化学染色.结果:E-cadherin、CEA对诊断转移性腺癌的敏感性分别为85.5%(47/55)、78.2%(43/55),特异性分别为100%(38/38)、97.4%(37/38).E-cadherin 和CEA联合应用诊断浆膜腔积液转移性腺癌的阳性率为96.4%(53/55).Calretinin 对诊断间皮瘤和间皮细胞增生的敏感性和特异性分别为81.6%(31/38)和87.2%(48/55).结论:E-cadherin、CEA和calretinin是鉴别浆膜腔积液转移性腺癌细胞和间皮源性细胞有价值的一组抗体.     

联合检测E-cadherin、CEA及Calretinin在浆膜腔积液细胞学鉴别诊断中的意义

背景与目的：浆膜腔积液中转移性腺癌细胞、恶性上皮型间皮瘤细胞和反应性间皮细胞的形态有不少相似之处，有时仅凭形态学特征不能做出准确诊断。近年来免疫细胞化学在这方面得到较多应用，但国内报道仅局限于用CK、EMA、CEA、Vim和HBME-1几种抗体，而且不能较好地进行细胞学的鉴别诊断。本研究旨在探讨联合检测E-cadherin、CEA及calretinin在浆膜腔积液鉴别诊断中的应用价值。方法：选用浆膜腔积液标本共93例，其中胸水66例、腹水24例、心包积液3例。经组织学检查或结合临床资料证实的转移性腺癌55例、恶性上皮型间皮瘤6例、间皮细胞反应性增生32例。每例均制备HE染色的涂片和细胞块，并用细胞块切片作免疫细胞化学染色。结果：E-cadherin、CEA对诊断转移性腺癌的敏感性分别为85．5％(47／55)、78．2％(43／55)，特异性分别为100％(38／38)、97．4％(37／38)。E-cadherin和CEA联合应用诊断浆膜腔积液转移性腺癌的阳性率为96．4％(53／55)。Calretinin对诊断间皮瘤和间皮细胞增生的敏感性和特异性分别为81.6％(31／38)和87．2％(48／55)。结论：E-cadherin、CEA和calretinin是鉴别浆膜腔积液转移性腺癌细胞和间皮源性细胞有价值的一组抗体。     

胸腹水细胞块的免疫细胞化学研究

[目的]行多项胸腹水细胞块的免疫细胞化学检测,探索一组鉴别良恶性及肿瘤起源的有价值的常规一抗试剂组.[方法]收集胸腹水标本制成细胞块,HE染色筛检出间皮细胞反应性增生及可疑恶性或查见恶性细胞的病例59例.免疫细胞化学方法采用SP法,一抗用HBME-1、钙网膜蛋白(CR)、E-cad、CD44、CK7、CK20,腹水加做CA19-9(女性加做CA125),胸水加做TTF-1.[结果]HBME-1在间皮瘤中表达57.1%(4/7)、转移腺癌中表达51.1%(23/45);钙网膜蛋白在间皮瘤中表达100%、腺癌中未表达;E-cad( )见于96.4%(53/55)恶性肿瘤;CD44( )见于反应性增生及恶性间皮瘤;TTF-1在肺癌中表达80.6%(25/31)、非肺源性未见表达;CK7( )在转移腺癌中表达86.7%(39/45),无特异性;CK20( )在肠癌中表达100%,CK7(-)/CK20( )具肠源性特异性;CA19-9在胃肠癌中表达100%,间皮瘤中亦表达2/7;CA125在卵巢癌表达75.0%(3/4),特异性100%.[结论]E-cad鉴别良恶性胸腹水;CR鉴别是否间皮起源、TTF-1鉴别肺源性、CK7/CK20鉴别肠源性转移癌具有特异性及敏感性特点,它们可作为常规一抗鉴别良恶性及肿瘤起源.CA125鉴别卵巢癌具有相同特点,可作为女性患者腹水常规一抗.     

Novel marker D2-40, combined with calretinin, CEA, and TTF-1: an optimal set of immunodiagnostic markers for pleural mesothelioma

BACKGROUND: Malignant pleural mesothelioma is a challenging disease with regard to diagnosis and treatment; early and accurate diagnosis would lead to appropriate therapeutic strategies, including extrapleural pneumonectomy. Immunohistochemistry has proven valuable for the diagnosis of the most common epithelioid mesothelioma, although it is often difficult to differentiate it from pulmonary or metastatic adenocarcinoma with absolute certainty if a single antibody is employed. The current study was designed to identify an immunodiagnostic panel for pleural mesothelioma. METHODS: Large surgical specimens from 66 cases with pleural mesothelioma and 66 with lung adenocarcinoma were immunohistochemically reevaluated under uniform conditions. The antibodies examined were directed against the novel mesothelial marker D2-40, as well as calretinin, CEA, and TTF-1. RESULTS: For mesothelioma the sensitivities of D2-40 and calretinin were 84.8% and 87.9%, respectively, and their specificities were both 95.5%. For adenocarcinoma, the sensitivities of CEA and TTF-1 were 95.5% and 92.4%, respectively, and their specificities were both 100%. Immunoreactivity to D2-40 and calretinin was observed in most areas of epithelioid differentiation in mesothelioma. Western blots also showed higher levels of D2-40 antigen in pleura invaded by epithelioid mesothelioma as compared with unaffected pleura. CONCLUSIONS: These data strongly suggest the significant usefulness of D2-40 and calretinin as positive markers, and of CEA and TTF-1 as negative markers, for pleural mesothelioma. The 4-antibody immunohistochemical panel showed high sensitivity and specificity with regard to differentiation of epithelioid mesothelioma from lung adenocarcinoma.     

免疫细胞化学染色检查协助鉴别浆膜腔积液中转移性腺癌原发部位

目的：探讨一组鉴别浆膜腔积液中转移性腺癌原发部位的抗体。方法：对31例浆膜腔积液转移性腺癌制备细胞蜡块切片作TTF-1、CA125、CK7、CK20免疫细胞化学染色,这些病例经组织学或结合临床资料证实：肺腺癌15例、卵巢腺癌10例、胃肠癌6例。结果：肺腺癌的阳性表达分别是TTF-1（73.3%）、CA125（26.7%）、CK7（73.3%）、CK20（0%）,卵巢腺癌的阳性表达分别是TTF-1（0%）、CA125（70.0%）、CK7（100.0%）、CK20（0%）,胃肠腺癌的阳性表达分别是TTF-1（0%）、CA125（16.7%）、CK7（0%）、CK20（100.0%）。TTF-1在肺腺癌的表达具有高度敏感性（73.3%）及特异性（100%）,CA125在卵巢腺癌的表达也有较高的敏感性（70.0%）,CK7（-）/CK20（＋）在胃肠腺癌的表达100%。结论：联合检测TTF-1、CA125、CK7、CK20能有效鉴别浆膜腔积液中来自肺、卵巢、胃肠道的腺癌。     

Manganese superoxide dismutase as a diagnostic marker for malignant pleural mesothelioma

Although several immunohistochemical markers are available, differential diagnosis between mesothelioma and metastatic adenocarcinoma of the pleura is difficult. We have found that the immunoreactivity of manganese superoxide dismutase (MnSOD), an important antioxidant enzyme, is high in mesothelioma compared to healthy pleural mesothelium. The aim of the present study was to investigate whether MnSOD can be used in the differential diagnosis of malignant mesothelioma and metastatic adenocarcinoma of the pleura. MnSOD expression was assessed by using immunohistochemistry in biopsies of malignant mesothelioma (n = 35) and metastatic adenocarcinoma of the pleura (n = 21). MnSOD immunoreactivity was assessed semiquantitatively with and without microwave pretreatment. Fifteen of the 35 malignant mesotheliomas showed moderate or strong MnSOD expression without and 23 with microwave pretreatment, the corresponding figures for metastatic adenocarcinoma of the pleura being 1 and 2 out of 21 (P = 0.002 and P < 0.001, respectively by Fisher's exact test). Only mesothelioma biopsies showed strong MnSOD reactivity, and it was never negative in mesothelioma, whereas one-third of the adenocarcinomas showed no MnSOD reactivity. In conclusion, MnSOD immunoreactivity can, combined with other markers, aid the differential diagnosis between malignant mesothelioma and metastatic adenocarcinoma of the pleura.     

Utility of anti-L523S antibody in the diagnosis of benign and malignant serous effusions

BACKGROUND: Immunohistochemistry is helpful in distinguishing metastatic carcinoma from atypical mesothelial cells; however, it is not useful in differentiating atypical mesothelial cells from malignant mesothelial cells. K homolog domain containing protein overexpressed in cancer (KOC), a member of the insulin-like growth factor mRNA-binding protein (IMP) family, also known as L523S and IMP3, is expressed during embryogenesis and in various malignancies. Using a mouse monoclonal antibody (L523S) against KOC, KOC expression was investigated in malignant tumors and reactive mesothelial cells in serous effusions. METHODS: Seventy-six cases with paraffin-embedded pleural, pericardial, and peritoneal serous effusion cell blocks including 60 malignant serous effusions (11 malignant pleural mesotheliomas and 49 metastatic carcinomas) and benign pleural effusions (14 cases with reactive mesothelial cells and 2 cases with atypical cells with uncertain significance) were selected for immunohistochemical analysis with L523S, calretinin, and CK5/6. RESULTS: Immunohistochemical studies showed that positive staining for KOC of variable degrees of intensity was observed in 47 of 60 cases in malignant serous effusions including 10 of 11 mesotheliomas and 36 of 49 metastatic carcinomas. The associated reactive mesothelial cells were negative for KOC but positive for calretinin and CK5/6. All 11 malignant mesotheliomas exhibited positivity for calretinin, and 9 of 11 cases had CK5/6 staining. In addition, 16 cases that were originally diagnosed either as pleural effusions with reactive mesothelial cells (14) or atypical cells with uncertain significance (2) were also tested for KOC expression. Interestingly, 3 of 16 cases exhibited various degrees of positivity for KOC, 2 of which were diagnosed as lung adenocarcinoma with a recurrence after tumor resection and 1 as malignant pleural mesothelioma. CONCLUSIONS: Anti-L523S antibody is a useful marker for the detection of malignant cells in serous effusions and it can have significant utility in differentiating reactive mesothelial cells from malignant mesothelioma and metastatic carcinoma in combination with calretinin and CK5/6 staining.     

CA 125 和CEA 在女性腹膜原发浆液性乳头状癌中表达的观察

 目的　探讨卵巢癌抗原 CA1 2 5和癌胚抗原 (CEA)在女性腹膜原发浆液性乳头状癌鉴别诊断中的意义。方法　应用免疫组织化学 S- P法 ,对 6例女性腹膜原发浆液性乳头状癌的腹膜病灶和卵巢病灶同时做 CA1 2 5检测 ,对腹膜病灶做 CEA检测。结果　 4例腹膜病灶和卵巢病灶均为CA1 2 5阴性表达 ,2例单一腹膜病灶或卵巢病灶呈弱阳性表达 ;4例腹膜病灶 CEA阳性表达 ,2例阴性表达。结论　CA1 2 5对区别女性腹膜原发浆液性乳头状癌与卵巢原发癌的腹膜转移有一定的鉴别诊断意义和临床应用价值 ,CEA对腹膜原发癌与上皮性恶性间皮瘤的鉴别无特异性。