锁骨上淋巴结转移癌233例分析

目的：探讨锁骨上淋巴结（SCL）已知发部位转移癌的病理学特别。方法：对1980－1999年（近20年）233例和1961－1980年（前20年）246例已知原发部位SCL转移癌患者的性别、年龄、转移癌原发部位和组织学类型等进行比较分析。结果：近20年来，转移癌的患者趋于高龄、女性增多，转移性肺癌（尤其是左侧SCL）增多，双侧SCL转移癌的原发部位皆肺居首位，转移性腺癌、鳞癌和未分化癌也首先来自肺，左侧SCL转移性黏液腺癌（包括印戒细胞癌）主要来自胃肠道（6／10例，特别是胃），右侧者全部来自肺（8／8例）等。结论：在寻找SCL来源未明转移癌的原发部位时，任何一侧（尤其是右侧）SCL转移癌（无论是腺癌、鳞癌或未分化癌）都应首先考虑转移性肺癌的可能性。     

p16在原发性卵巢黏液性和子宫内膜样肿瘤和转移性腺癌中的表达

原发性卵巢上皮性肿瘤与转移性腺癌的鉴别有时比较困难，特别是肿瘤显示黏液样、子宫内膜样或混合性子宫内膜样／黏液性分化时。伴有这些类型分化的转移性腺癌可来自于多个部位，如胃肠道和子宫（子宫内膜和宫颈）。大多数宫颈内膜腺癌显示黏液性和（或）宫内膜样分化，它们转移至卵巢比较少见，而且常表现为转移性癌的一些特征，如双侧卵巢累及，结节行生长。     

细胞角蛋白7和20在卵巢转移癌中的表达

目的 观察卵巢转移癌的临床资料、病理形态和免疫组织化学改变,为鉴别卵巢转移癌与原发癌提供依据。方法 对27例卵巢转移癌（其中胃癌12例,结肠癌11例,其他4例）进行了临床和病理形态观察,同时采用免疫组织化学（SP法）对其分别进行细胞角蛋白[CK（AE1/AE3）]、细胞角蛋白7（CK7）、细胞角蛋白20（CK20）、癌胚抗原、波形蛋白、nm23抗原检测。结果 卵巢转移性胃癌12例中11例为双侧实性,卵巢转移性结肠癌11例中7例为单侧囊实性,组织学检查胃癌卵巢转移12例全部以印戒细胞癌或低分化腺癌散在分布为特征,而结肠癌卵巢转移则11例中8例与子宫内膜样癌相似,CK20阳性染色使卵巢转移性胃癌7例及结肠癌8例得到明确诊断,在转移性结肠癌中CK20有稳定的表达,卵巢转移性胃肠道癌中CK7多数阴性,癌胚抗原、波形蛋白、nm23的联合使用使转移性胃癌11例,结肠癌10例得到明确诊断,结论 CK7和CK20在鉴别来自胃肠道的卵巢转移癌中具有重要意义。当几种抗体联合使用时意义更大。     

MG_7和MC_3单克隆抗体在鉴别原发性与转移性卵巢癌中的意义

转移性卵巢癌约85％来源于胃肠道癌,如果原发癌灶表浅或隐匿,以及少见的卵巢原发性克氏瘤单靠普遍病理组织学诊断就非常困难,容易造成误诊。实验取53例石蜡切片,其中卵巢上皮性癌33例、转移性腺癌18例、诊断原发或继发卵巢癌困难者2例。以胃癌为免疫原     

CK7单克隆抗体在鉴别卵巢原发性与胃肠道源性转移癌中的意义

目的研究ＣＫ７单克隆抗体在鉴别卵巢原发性癌和来源于胃肠道的卵巢转移性癌中的意义。方法采用免疫组织化学ＡＢＣ方法对４６例卵巢原发性癌、３４例原发灶在胃的卵巢转移性癌和３０例原发灶在肠的卵巢转移性癌进行了ＣＫ７单克隆抗体表达的检测。结果４６例卵巢原发性癌ＣＫ７均呈阳性表达,而３０例来源于肠的卵巢转移性癌ＣＫ７均为阴性,３４例来源于胃的卵巢转移性癌５０％呈ＣＫ７阳性表达。两组卵巢转移性癌的ＣＫ７阳性率与原发癌相比均有显著性差异（Ｐ＜０００１）。结论ＣＫ７单克隆抗体作为一个原发性卵巢癌的特异性标记,对鉴别卵巢原发性癌和来源于胃肠道的卵巢转移癌有重要意义     

恶性上皮性肿瘤中CK20的表达及其临床意义

目的　研究单克隆抗体CK2 0在恶性上皮性肿瘤和卵巢转移性腺癌组织中的表达及其意义。方法　应用S P法对鼻咽非角化性癌、乳腺浸润性导管癌、肺的鳞癌和腺癌、卵巢黏液性囊腺癌、胃腺癌和结肠直肠腺癌各组总计 6 7例和 4 1例分别进行了CK2 0和CK19检测。结果　CK2 0阳性率 :肺腺癌 1/ 7(14 3% ) ,卵巢浆液性和黏液性腺癌 3/ 12 (33 3% ) ,胃腺癌 3/ 9(33 3% ) ,结肠直肠腺癌组 2 1/ 2 2 (95 5 % ) ,其他癌组织均呈阴性。结肠直肠腺癌组组与其他各组间比较差异有显著性 (P <0 0 1)。CK19在上述 4 1例癌组织中均呈强阳性表达。结论　CK2 0表达对鉴别结肠腺癌和直肠腺癌与肺腺癌和乳腺浸润性导管癌具有高度特异性和较高的敏感性 ;CK2 0高表达对鉴别卵巢原发性腺癌与卵巢的结肠腺癌或直肠腺癌转移具有一定的意义     

联合检测CK7、CK20和SATB2在卵巢原发性黏液腺癌和转移性结直肠腺癌中的表达及鉴别意义

目的探讨联合检测CK7、CK20和SATB2在卵巢原发性黏液腺癌和转移性结直肠腺癌中的表达及鉴别意义。方法收集安徽医科大学第一附属医院2011～2016年确诊的卵巢原发性黏液腺癌26例、卵巢转移性结直肠腺癌29例、结直肠原发性黏液腺癌50例。采用免疫组化EnVision两步法检测CK7、CK20和SATB2的表达。结果 CK7在卵巢原发性黏液腺癌中的阳性率显著高于卵巢转移性结直肠腺癌和结直肠原发性黏液腺癌,差异有统计学意义(P0.05);CK20和SATB2在卵巢转移性结直肠腺癌和结直肠原发性黏液腺癌中的阳性率显著高于卵巢原发性黏液腺癌,差异有统计学意义(P0.05);CK7~+/CK20~-、CK7~-/CK20~+和CK7~+/CK20~+在卵巢原发性黏液腺癌和转移性结直肠腺癌中的表达,差异有显著性(P0.05);CK7~-/CK20~-在两者中的表达差异无显著性(P0.05),卵巢原发性黏液腺癌以CK7~+/CK20~-常见,卵巢转移性结直肠腺癌以CK7~-/CK20~+常见;CK7、CK20和SATB2检测的灵敏度分别为82.8%、75.9%、65.5%,特异度分别为80.8%、61.5%、100%。结论 SATB2是鉴别卵巢原发性黏液腺癌和转移性结直肠腺癌高度特异性的免疫组化标志物,可以联合检测CK7、CK20和SATB2提高卵巢黏液性腺癌病理诊断的准确性。     

联合检测TTF1、CK5/6、p63和napsinA在肺鳞癌和腺癌鉴别诊断中的价值

目的 探讨TTF1、CK5/6、p63和napsinA联合检测在肺鳞状细胞癌和腺癌鉴别诊断中的价值.方法 应用免疫组化EnVision法分别检测30例肺鳞状细胞癌和30例肺腺癌中TTF1、CK5/6、p63和napsinA的表达.结果 CK5/6、p63、TTF1和napsinA在肺鳞状细胞癌中的阳性率分别为96.7%、100%、20%和0,同时在肺腺癌中的阳性率分别为10%、20%、86.7%和90%.单个标志物中,CK5/6阳性和napsinA阴性对肺鳞状细胞癌与腺癌的鉴别诊断具有较高的特异性和敏感性;联合标志物检测中,p63和CK5/6共同表达阳性与TTF1和napsinA共同表达阴性在肺鳞状细胞癌的诊断中具有较高的特异性.结论 TTF1、CK5/6、p63和napsinA联合检测可鉴别肺鳞状细胞癌和腺癌,p63和CK5/6共同阳性表达与TTF1和napsinA共同阴性表达更加支持肺鳞状细胞癌,而非肺腺癌,反之亦然.     

TTF-1、SP-A在肺腺癌诊断及鉴别诊断中的价值

目的 评价甲状腺转录因子-1(TTF-1)、肺泡表面活性蛋白A (SP-A)在肺腺癌中表达的敏感性和特异性,探讨他们在肺腺癌诊断及鉴别诊断中的价值.方法 选择经组织学和临床资料证实的肺原发性腺癌40例、转移性腺癌13例,采用免疫组化EnVision法检测TTF-1及SP-A的表达情况.结果 40例肺腺癌中有32例表达TTF-1、27例表达SP-A;13例转移性腺癌中只有1例肝细胞癌胞质表达TTF-1、无SP-A表达.TTF-1和SP-A在肺腺癌中表达的敏感性分别为80%和67.5%、特异性均为100%.结论TTF-1在肺腺癌中表达有较高的敏感性和特异性,在排除甲状腺癌可能后,可作为鉴别肺原发性和转移性腺癌的可靠标记;而SP-A敏感性较低且随分化程度降低表达下降,故TTF-1对肺腺癌鉴别诊断的价值优于SP-A.     

CD10在皮肤附属器肿瘤中的表达及在区分皮肤转移性肾细胞癌鉴别诊断中的潜在作用

外科病理诊断中肿瘤发生皮肤转移并不少见，其提示肿瘤复发或发生结外扩散。某些恶性肿瘤如肾细胞癌发生皮肤转移的临床症状可能会导致皮肤原发性恶性肿瘤的诊断。有3％～11％肾细胞癌可发生皮肤转移，而皮肤转移性肾细胞癌的形态学特点与皮肤原发的附属器肿瘤特别是具有透明细胞分化者难以鉴别。为了确定CD10在各种皮肤附属器病变中的表达以及其在区分转移性肾细胞癌中的价值，作者研究了57例原发性附属器肿瘤，其中小汗腺分化31例，大汗腺分化16例，皮脂腺分化10例、正常皮肤3例和4例皮肤转移性肾细胞癌。结果发现CD10表达于正常皮肤的皮脂腺，小汗腺和大汗腺上皮表达阴性，而汗腺周围的肌上皮细胞表达CD10。     

Malignant tumors of the small intestine: a histopathologic study of 41 cases among 1,312 consecutive specimens of small intestine

There are few comprehensive studies of small intestinal malignancies. The author retrospectively reviewed 1,312 archival pathologic specimens of the small intestine in the last 10 years in our pathologic laboratory in search for malignant tumors of the small intestine. There were 22 cases (1.7%) of primary adenocarcinoma, 3 cases (0.2%) of primary squamous cell carcinoma, 6 cases (0.5%) of metastatic carcinoma, 6 cases (0.5%) of malignant lymphoma, 3 cases (0.2%) of carcinoid tumor, and 1 case (0.08%) of gastrointestinal stromal tumor (GIST). Of the 25 cases of primary adenocarcinoma and squamous cell carcinoma, 24 cases were located in the duodenum and 1 case in the ileum. The 22 cases of adenocarcinoma were classified into 7 well differentiated, 7 moderately differentiated, and 8 poorly differentiated adenocarcinomas. All the three squamous cell carcinomas were moderately differentiated ones with keratinization and intercellular bridges. In the 25 cases of carcinoma, immunoreactive p53 protein was present in 23 cases, and the Ki-67 labeling ranged from 40% to 95% with a mean of 76%. In the 6 cases of metastatic adenocarcinoma, the origin was ovary in 1 case, pancreas in 2 cases, gall bladder in 1 case, lung in 1 case, and colon in 1 case. In the 6 cases of lymphoma, 4 cases were diffuse large B-cell lymphomas and 2 cases were peripheral T-cell lymphomas. In the 3 cases of carcinoid tumor, all were typical carcinoids and immunohistochemically positive for at least one of neuroendocrine markers (chromogranin, synaptophysin, neuron specific enolase, and CD56). In the 1 case of GIST, the cell type is spindle and GIST cells were immunohistochemically positive for KIT and CD34. The histological risk was intermediate. Forty-one cases of small intestinal malignancies were reviewed histopathologically.     

Immunohistochemical confirmation of pulmonary papillary adenocarcinoma metastatic to ovaries

Metastatic papillary adenocarcinomas of the ovary are rare compared to primary ovarian papillary serous carcinomas. We report a case of pulmonary papillary adenocarcinoma metastatic to the ovary and show how this tumor can be differentiated immunohistochemically from an ovarian primary. Paraffin blocks of the ovarian tumor were analyzed for carcinoembryonic antigen, CA 125, surfactant, E-cadherin, N-cadherin, and vimentin. These markers are useful in differentiating epithelial tumors of lung versus ovarian origin. The papillary tumor showed expression of carcinoembryonic antigen, surfactant, and E-cadherin, but was negative for CA 125, N-cadherin, and vimentin. These findings support a lung carcinoma metastatic to the ovary.     

WT1, monoclonal CEA, TTF1, and CA125 antibodies in the differential diagnosis of lung, breast, and ovarian adenocarcinomas in serous effusions

The distinction between metastatic adenocarcinomas of lung (LAC), breast (BAC), and ovary (OAC) in serous effusions can be very difficult since they all can present as tight cell clusters. This is particularly challenging when the malignant effusion is the patient's initial presentation or when the patient has a history of more than one primary. The aim of this study is to evaluate the usefulness of WT1, monoclonal CEA (mCEA), TTF1, and CA125 antibodies in the differential diagnosis of metastatic adenocarcinoma from the lung, breast and ovary in serous effusions. Forty-six samples of serous effusions with their corresponding cell blocks were retrieved from our hospital computer system, including 13 BACs, 13 LACs, and 20 OACs. The diagnoses were confirmed by the surgical resection. Formalin-fixed and paraffin-embedded cell block sections were immunostained for WT1, mCEA, TTF1, and CA125. Two observers blindly reviewed the immunostained slides without knowledge of the previous clinical or histologic diagnoses. The staining intensity was graded semiquantitatively as negative, 0; weak, 1+; moderate, 2+; and strong, 3+. The percentage of positively staining cells was estimated. The distribution patterns of reactivity for WT1 and TTF1 were recorded as nuclear, and mCEA and CA125 as membranous stain. Metastatic OACs showed positive immunoreactivity to WT1 in 19/20 (95%) cases, CA125 in 20/20 (100%), and all showed negative reaction for both mCEA (0/20, 0%) and TTF1 (0/20, 0%). BAC showed positive reaction in 6/13 (46%) cases to CA125 and mCEA. Staining pattern was diffuse for CA125 and focal for mCEA. Only 2/13 (15%) were positive for WT1, while all of 13 BAC cases (0/13, 0%) were negative for TTF1. LAC showed positive immunoreactivity for TTF1 in 9/13 (69%) with a characteristic nuclear staining pattern, but only 3/13 (23%) were focally stained for WT1. In addition, 8/13 (62%) of LAC cases were positive for both CA125 and mCEA. Our results demonstrate that the WT1 stain is specific for metastatic carcinoma of ovarian primary, showing a high sensitivity. In addition, CA125 stain is very sensitive for OACs, but could be positive in about a half of LAC and BAC cases. An immunostaining pattern of positive mCEA as well as negative WT1 rules out OACs, raising the possibility of LACs and BACs. A positive TTF1 staining supports the diagnosis of metastatic carcinoma originating from lung rather than breast, while a negative TTF1 favors the diagnosis of a breast primary. Immunohistochemical studies with WT1, TTF1, and mCEA antibodies are useful in the differential diagnosis of metastatic adenocarcinomas of lung, breast, and ovary.     

浆膜腔积液中转移癌原发部位的细胞学研究

目的探讨能检测浆膜腔转移性腺癌原发部位的有效方法。方法对89例浆膜腔转移性腺癌行常规HE染色,其中肺癌40例、乳腺癌6例、卵巢癌21例、胃肠及胰腺癌22例,从癌细胞群等18个形态学方面进行观察。其中75例采用免疫细胞化学SP法检测了CA125、CA199、SPB、甲状腺转录因子（TTF）-1的表达。结果通过形态学对比研究发现不同原发部位的转移癌的癌细胞总量、细胞群大小、细胞群与单个细胞的比例、细胞群形态及涂片背景等方面各有一些特点：肺癌、乳腺癌中小细胞群各占95％、100％;卵巢癌多以大群存在,占85．7％,并且在涂片中癌细胞数量较多,以群团为主;部分胃肠癌（45．5％）在涂片中数量较少,并以单个散在为主（40．9％）;肺癌及卵巢癌中都可见沙砾体。SPB、TTF-1可以用来支持在浆膜腔转移性肺腺癌的来源,CA125阳性支持卵巢癌来源。CA199在各组癌中都有表达,无明显统计学差异。但若用于腹水,对胃肠、胰腺来源的肿瘤还是有帮助的。结论浆膜腔转移性腺癌的形态学观察、辅以免疫细胞化学染色和基本临床资料三者结合对推测原发部位很有意义。     

Expression of cytokeratins 7 and 20 in carcinomas of the gastrointestinal tract

AIMS: The differential expression of cytokeratin (CK) 7 and 20 by carcinomas may help in determining the primary site of a metastatic tumour. The aim of this study was to extend the published data on CK7 and CK20 expression in epithelial neoplasms of the gastrointestinal tract by considering the degree of differentiation and including some unusual neoplasms. METHODS AND RESULTS: Cases referred to the Armed Forces Institute of Pathology were studied prospectively for immunohistochemical expression of CK7 and CK20. Lesions from 105 patients were analysed. Adenocarcinomas of the upper gastrointestinal tract were positive for both CK7 and CK20 in 78% of cases; only poorly differentiated lesions were CK7-. Well-differentiated and moderately differentiated adenocarcinomas of the large intestine, including appendix, were CK7-/CK20+ in the great majority of cases, as were goblet cell carcinoids, but half of the poorly differentiated adenocarcinomas exhibited aberrant expression, as did most of the mixed goblet cell carcinoid/adenocarcinomas. All five high-grade neuroendocrine carcinomas were negative for both CK7 and CK20. CONCLUSIONS: Not only the site but also the grade and histological type of a gastrointestinal carcinoma should be considered when assessing cytokeratin phenotype.