联合抗体在胸水细胞块肺腺癌细胞和增生性间皮细胞中的表达及意义

目的：探讨联合抗体的运用在鉴别胸水肺腺癌细胞和反应性增生间皮细胞中的意义。方法：胸水细胞块切片后行免疫组织化学sP法检N25例胸水转移性肺腺癌细胞和20例反应性增生间皮细胞中甲状腺转录因子．1、细胞角蛋白-7、间皮细胞及钙结合蛋白表达。结果：甲状腺转录因子-1、细胞角蛋白．7、间皮细胞和钙结合蛋白在胸水肺腺癌细胞和反应性增生间皮细胞中的表达比较差异有统计学意义fP〈0．05）。甲状腺转录因子．1和细胞角蛋白-7联合标记胸水肺腺癌细胞的敏感性为88％,特异性为100％;间皮细胞和钙结合蛋白联合标记胸水增生性间皮细胞的敏感性为60％,特异性为95％。结论：联合应用甲状腺转录因子．1、细胞角蛋白-7、间皮细胞和钙结合蛋白抗体检测胸水细胞块对鉴别肺腺癌细胞和反应性增生间皮细胞具有较高的应用价值。     

TCT免疫细胞化学在胸腹水转移性腺癌诊断中的应用

目的:探讨液基细胞制片(TCT)免疫细胞化学在胸腹水转移性腺癌诊断中的应用价值。方法:应用一组单克隆抗体(mAb),采用TCT免疫细胞化学染色法检测117例胸腹水细胞标本,其中腺癌102例、反应性间皮细胞增生15例,观察细胞抗原表达。结果:102例腺癌中MOC31、CEA、EMA、E-Cadherin、TTF-1和vim阳性表达率分别为100%、69%、100%、100%、30%和0.98%,des和calretinin全部呈阴性表达。在15例反应性增生间皮细胞中calretinin、vim、des、CEA和EMA的阳性表达率分别为100%、100%、60%、6%和6%,MOC31、E-Cadherin和TTF-1全部呈阴性表达。MOC31、CEA、EMA和E-Cadherin在腺癌细胞中表达特异性为100%、94%、94%和100%,敏感性100%、69%、100%和100%。des、calretinin和vim在反应性增生间皮细胞中表达特异性100%、100%和99.02%,敏感性为60%、100%和100%。结论:应用TCT免疫细胞化学方法,选择性的联合使用一组抗体(MOC31、E-Cadherin、EMA、CEA、calretinin、vim、des、TTF-1),有助于胸腹水转移性腺癌细胞与反应性间皮细胞的鉴别诊断。     

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.     

代谢组学的检查结果在非小细胞肺癌鉴别诊断中的应用

目的探讨代谢组学在非小细胞肺癌(NSCLC)定性诊断中的初步应用。方法收集201例NSCLC患者,按照病理类型,将患者分为鳞状细胞癌(SCC)组(n=71)和腺癌(AC)组(n=130)。免疫组织化学染色法检测肺癌组织KI-67抗原(ki67)、细胞角蛋白5/6(CK5/6)和CK7的表达;超高效液相色谱-四级杆飞行时间质谱(UPLC-Q/TOF-MS)检测患者血清中代谢组学。结果 SCC组呈典型的鳞状细胞癌结构,ki67增殖指数为21.9%,CK5/6表达阳性,而CK7表达阴性或呈弱阳性;AC组呈典型的腺腔样结构,ki67增殖指数为17.6%,CK7表达阳性,而CK5/6表达阴性或呈弱阳性。UPLC-Q/TOF-MS筛选出具有差异的代谢物共有28种,其中差异最为明显的小分子代谢物共有6种,分别为:L亮氨酸(L-leucine)、肉毒碱(carnitine)、 C16鞘氨醇(C16 sphinganine)、 13,16,19-二十二碳三烯酸(DA)、溶血磷脂酰乙醇胺(18∶2/0∶0)[LysoPE(18∶2/0∶0)]、磷脂酰胆碱[PC(20∶4/P-16∶0)]。这些代谢物均具有较好的诊断价值,其中L-Leucine特异性最高,LysoPE的敏感性最高。结论代谢组学检对肺SCC和AC有较好的鉴别诊断价值。     

基底型细胞角蛋白在乳腺导管内增生性病变诊断中的应用

目的比较不同类型基底型细胞角蛋白(CK5、CK34βE12和CK14)在乳腺导管内增生性病变中的辅助诊断价值,并结合肌上皮标记、超微电镜对普通型导管增生的细胞成分进行初步分析。方法参照2003年WHO乳腺疾病分类的诊断标准筛选出28例导管普通型增生(UDH)、10例不典型增生(ADH)和25例导管原位癌(DCIS)。所有病例均进行CK5/6、CK34βE12、CK14、CK8、浕SMA、calponin和p63的免疫组化染色。4例UDH和1例DCIS通过电镜观察其增生细胞的超微结构。结果CK5/6在UDH、ADH和DCIS增生细胞中的阳性表达率分别为92.9%、10.0%和0。CK34βE12和CK14的阳性表达率分别为96.4%和82.1%(UDH)、20.0%和30.0%(ADH)、24.0%和28.0%(DCIS)。所有UDH的增生细胞均不表达浕SMA、calponin和p63。电镜观察显示UDH和DCIS的增生细胞中未发现符合肌上皮超微特征的细胞存在。结论基底型CK有助于UDH和ADH/DCIS的鉴别诊断,其中CK5/6较CK34βE12和CK14特异性更高。免疫组化染色和电镜观察结果支持UDH的增生细胞含有多种成分,包括定向干细胞、腺中间细胞和腺终端细胞等,但未发现具有肌上皮特点的细胞参与其中。     

细胞角蛋白片段19等指标在非小细胞肺癌诊断中的应用

目的　研究胸水和血清细胞角蛋白片段 19(CK - 19)等指标在非小细胞性肺癌 (NSCLC)实验室诊断中的应用价值 .方法　采用ELISA法检测 4 5例NSCLC、5 0例良性肺疾病患者血清和胸水中CK - 19水平 ,30例健康体检者血清CK - 19水平 ,同步测定了乳酸脱氢酶 (LDH)、腺苷脱氨酶 (ADA)、C反应蛋白 (CRP)、癌胚抗原 (CEA)、免疫球蛋白E(IgE)水平 ,进行显著性检验及相关性分析 .结果　NSCLC组血清和胸水中CK - 19、CEA和LDH水平均明显高于良性肺疾病组 (p <0 .0 5 ) ,而血清ADA水平均低于良性肺疾病组和健康对照组 (p <0 .0 5 ) .良性肺疾病组血清和胸水CRP水平明显高于NSCLC组 (p <0 .0 5 ) .胸水中CK - 19水平与血清CK - 19水平高度相关 (NSCLC组r=0 .86 8;良性肺疾病组r=0 .5 4 6 2 ) .胸水和血清CK - 19对肺癌的诊断敏感性、特异性和准确性分别为 93.3%和 71.1%、91.7%和 87.5 %、92 %和 81.6 % .结论　胸水和血清CK - 19检测对NSCLC的诊断是一个较好的指标 ,联合检测相关指标有助于临床诊断     

LCT与ICC结合在胸腹水细胞学鉴别诊断中的应用

目的:探讨液基薄层细胞检测(LCT)技术与免疫细胞化学(ICC)技术在胸腹水细胞学鉴别诊断中的意义.方法:在87例胸腹水液基细胞涂片中应用免疫细胞化学技术检测癌胚抗原(CEA)、上皮细胞膜抗原(EMA)、间皮细胞(MC)抗体及波形蛋白(Vimentin)的表达并与HE染色比较.结果:腺癌中CEA、EMA、MC、Vimentin阳性表达率分别为88.2%、90.2%、5.9%和3.9%.增生性间皮细胞中CEA、EMA、MC、Vimentin阳性表达率分别为5.6%、2.8%、97.2%和88.9%.结论:免疫细胞化学技术可应用于胸腹水LCT涂片.选择一组特异的抗体(CEA、EMA、MC、Vimentin)并结合脱落细胞HE染色可以在转移性腺癌与增生性间皮细胞的鉴别诊断中起重要作用.     

胸腹腔积液离心石蜡包埋在病理诊断中的价值

目的探讨离心石蜡包埋和免疫组化在临床胸腹腔积液病理鉴别诊断中应用价值。方法胸腹腔积液标本100例,离心石蜡包埋后行HE染色和免疫组化染色观察,并与常规涂片比较诊断结果。结果判定100例标本中鳞状细胞癌1例,恶性上皮型间皮瘤5例,腺癌27例,间皮细胞增生67例。讨论胸腹腔积液离心石蜡包埋有助于提高其病理诊断阳性率,判断肿瘤原发部位,评估预后,指导治疗方案的选择。     

肺腺癌罕见部位转移3例并文献复习

目的探讨3例罕见部位肺腺癌转移病例的临床病理学特征、诊断、鉴别诊断及预后。方法收集3例肺腺癌转移至卵巢、十二指肠、前列腺的临床资料,对其进行HE及免疫组化染色,并复习相关文献。结果例1女性,47岁,单侧附件囊实性占位,形态学有管囊状结构,首先考虑原发性肿瘤。免疫表型:Napsin A、TTF-1、CK7、CK(AE1/AE2)、ALK(D5F3)、CA125、Mucin-1、CEA阳性;例2女性,70岁,内镜提示十二指肠多发新生物,形态学示小肠黏膜间出现分化差的癌细胞。免疫表型:CK(AE1/AE2)、CK8/18、Napsin A、TTF-1阳性;例3男性,73岁,前列腺穿刺标本,形态学显示前列腺组织间可见分化差的癌伴坏死。免疫表型:CK(AE1/AE3)、CK8/18、TTF-1阳性,Ki-67增殖指数较低,结合肺部占位,可考虑肺腺癌转移。结论 3例患者均以转移灶就诊,为肺腺癌罕见转移部位,尤其例1以单侧附件单囊性附壁结节形式出现的转移癌极其罕见,ALK基因为融合型,值得关注;肺腺癌转移至小肠及前列腺可能提示患者预后较差。     

The diagnostic utility of D2-40 for malignant mesothelioma versus pulmonary carcinoma with pleural involvement

Differentiating malignant mesothelioma (MM) from pulmonary carcinoma in pleural fluid cytology can be challenging. Recent studies have suggested that D2-40, a novel lymphatic marker, may be a useful marker for mesothelial differentiation in surgical specimens. However, there are no available data regarding its utility in effusion cytology specimens. We investigated the utility of D2-40 in pleural fluid cytology in differentiating MM from pulmonary carcinomas. Twenty cases of pleural effusion smears of surgically confirmed MM with their corresponding cell blocks were retrieved from the database of the hospital computer system. We also included 10 cases of metastatic pulmonary adenocarcinoma (PA) and 10 cases metastatic pulmonary squamous cell carcinoma (PSCC) involving the pleural fluid. Cell blocks were formalin-fixed, paraffin embedded, and immunostained for TTF1, p63, calretinin, CK5/6, WT-1, and D2-40. Cases were scored as negative (<5% positivity) or positive (>5% moderate/strong positivity). The positive rates for TTF1, p63, calretinin, CK5/6, WT-1, and D2-40 were as follows: MM (0/20), (0/20), (17/20), (18/20), (19/20), (17/20), for PA (8/10), (0/10), (3/10), (0/10), (0/10), (0/10), and for PSCC (1/10), (10/10), (6/10), (10/10), (0/15), (0/10). The staining pattern for D2-40 was characterized by thick membranous staining. Diffuse cytoplasmic staining by D2-40 was seen in 2 cases of pulmonary carcinoma, counted as negative. Our study showed that in differentiating MM from PA, CK5/6, WT-1, and D2-40 have high specificity and sensitivity for MM. Although calretinin is a sensitive IHC marker for MM, it is not specific since it stained 30% of PA. Conversely, to differentiate between MM and PSCC, p63 and WT-1 are the best available markers. We recommend a panel of CK5/6, p63, D2-40, and WT-1 to differentiate MM from pulmonary carcinomas in effusion cytology specimens.     

联合检测IFN-γ、VEGF-C、CRP及ADA对结核性与恶性胸腔积液鉴别诊断的价值

目的探讨干扰素-γ(IFN-γ)、血管内皮生长因子(VEGF-C)、C-反应蛋白(CRP)及腺苷脱氨酶(ADA)在结核性与恶性胸腔积液鉴别诊断中的应用价值。方法检测122例临床确诊的胸腔积液患者(恶性胸腔积液56例,结核性胸膜炎48例,其他类型18例)胸水和血清中的IFN-γ、VEGF-C、CRP及ADA含量。结果结核组的IFN-γ、CRP浓度及ADA活性明显高于恶性肿瘤组,差异有统计学意义(P0.01),根据受试者工作特征(ROC)曲线结果判断,以100ng/L为临界值,IFN-γ对结核性胸腔积液诊断的灵敏度、特异性分别为83.1%、92.3%;以45U/L为临界值,ADA对结核性胸腔积液诊断的灵敏度、特异性分别为85.6%、96.3%;以110mg/L为临界值,CRP对结核性胸腔积液诊断的灵敏度、特异性分别为79.1%、84.2%;三项指标联合检测,其灵敏度、特异性分别达到87.8%和86.0%。恶性胸腔积液中VEGF-C高于结核性及其他类型胸腔积液(P0.01);VEGF-C/ADA≥8对恶性胸腔积液诊断的灵敏度、特异性分别为86.3%、82.6%;VEGF-C/ADA≤3对结核性胸腔积液诊断的灵敏度、特性度分别为85.1%、87.1%。结论联合检测IFN-γ、VEGF-C、CRP及ADA可以提高结核性胸膜炎诊断的灵敏度及特异性,VEGF-C与ADA浓度比值对胸腔积液的鉴别诊断具有较好的临床价值。     

Expression of cytokeratin 5/6 in epithelial neoplasms: an immunohistochemical study of 509 cases.

Cytokeratin 5/6 (CK 5/6) immunoreactivity has been observed in the vast majority of cases of malignant mesothelioma but only rarely in pulmonary adenocarcinomas. Thus, CK 5/6 has been used to distinguish malignant mesothelioma from pulmonary adenocarcinoma. However, the utility of CK 5/6 in distinguishing pleural malignant mesothelioma from pleural metastases from nonpulmonary adenocarcinoma, as well as peritoneal malignant mesothelioma from peritoneal metastatic adenocarcinoma, has not yet been adequately addressed because the tissue expression of CK 5/6 in nonpulmonary neoplasms has not been well defined. We have studied the CK 5/6 expression in 509 cases of various epithelial tumors by immunohistochemistry. We found that the vast majority of cases of squamous cell carcinoma, basal cell carcinoma, thymoma, salivary gland tumor, and biphasic malignant mesothelioma were positive for CK 5/6. In addition, CK 5/6 immunoreactivity was detected in 15 of 24 cases (62%) of transitional cell carcinoma, in 5 of 10 cases (50%) of endometrial adenocarcinoma, in about one third of cases of pancreatic adenocarcinoma (38%) and breast adenocarcinoma (31%), and in one quarter of cases of ovarian adenocarcinomas (25%). Our study confirms the diagnostic utility of CK 5/6 immunohistochemistry in distinguishing biphasic mesothelioma from pulmonary adenocarcinoma but raises caution about its use for the differential diagnosis of pleural or peritoneal malignant mesothelioma versus pleural or peritoneal metastatic nonpulmonary adenocarcinoma, because many types of nonpulmonary adenocarcinomas may be positive for CK 5/6.     

Ten cases of feline mesothelioma: an immunohistochemical and ultrastructural study

In the cat only 10 cases of mesothelioma, mainly of the peritoneum, have been previously reported. This paper describes a further 10 cases, eight pleural and two peritoneal, in males and females aged 1-17 years. Histologically, five tumours were epithelial, three fibrosarcomatous and two biphasic. Immunohistochemical markers used in human pathology for the identification of mesotheliomas include vimentin, cytokeratin (CK) AE1/AE3, HBME-1, CK 5/6, calretinin, thrombomodulin, carcinoembryonic antigen (CEA), CD15, E-cadherin and desmin. All 10 feline mesotheliomas were positive for vimentin and CK AE1/AE3, six were positive for HBME-1, two for CK5/6, three for CEA and four for E-cadherin. All were negative for desmin and calretinin. Antibodies to thrombomodulin and CD15 failed to cross-react with feline tissues. Electron microscopy, performed in four cases, revealed microvillar structures, desmosomes and intracytoplasmic lumina, confirming its value as a diagnostic tool. The study showed that mesothelial marker antibodies commonly used in human patients can be used for the diagnosis of feline mesothelioma, preferably as a panel of antibodies rather than only one.     

Utility of CK7 and CK20 immunohistochemistry in the detection of synchronous breast and colon carcinoma in a pleural effusion: a case report and supporting survey of archival material

We present a case of synchronous breast and colon carcinoma in a pleural effusion, to our knowledge the first such reported case in the English-language literature. The patient was a 55-yr-old white female with known metastatic breast and colon carcinoma who developed a malignant pleural effusion which demonstrated two strikingly different populations of malignant cells by immunohistochemical study of cell block material. One cell population demonstrated a cytokeratin (CK)7+/CK20-/ER+ phenotype, while the other demonstrated a CK7-/CK20+/ER- phenotype, consistent with breast and colon origin, respectively. An immunohistochemical survey of archival breast and colon primary and metastatic carcinomas confirmed the established CK7+/CK20- phenotype of breast and CK7-/CK20+ phenotype of colon primary carcinomas, and the maintenance of this phenotype in metastases thereof. A survey of benign and malignant mesothelial lesions confirmed the absence of staining for estrogen receptor, but showed 6/10 cases weakly positive for CK20, which has not been described in other published series. This unusual case graphically illustrates the utility of cytokeratin subset immunohistochemistry in effusion cytology.     

ADA、ACE、LDH、CEA的联合检测在结核性和恶性胸腔积液中的鉴别诊断价值

目的测定血清和胸水中腺苷脱氨酶（ADA）、血管紧张素转化酶（ACE）、乳酸脱氢酶（LDH）与癌胚抗原（CEA）的水平,探讨其指标联合检测对结核性和恶性胸水的鉴别诊断意义。方法对临床已确诊的72例胸腔积液患者（结核性40例,恶性32例）的胸水和血清分别采用酶免疫法和化学发光法进行ADA、ACE、LDH和CEA含量测定。结果结核性胸水中ADA的含量为（60.2±20.10）U/L,ACE的含量为（35±9.6）U/L,LDH的含量为（338±41）U/L,CEA的含量为（12.8±5.82）μg/L;在恶性胸水中,ADA为（11.02±5.23）U/L,ACE为（16±11.0）U/L,LDH为（379±69.0）U/L,CEA为（39.9±19.7）μg/L。结核性胸水ADA和ACE含量较恶性胸水组明显增高（P〈0.01）,CEA在恶性胸水中含量较结核性胸水组明显增高（P〈0.01）。胸水中ADA和ACE的检测对结性性胸膜积液诊断的敏感性分别为84.3%、87.5%,特异性分别为87.5%、80.0%;而胸水中LDH和CEA的检测对恶性胸膜积液诊断的敏感分别为84.3%、75.0%,特异性分别为80.0%、93.0%。四项指标联合检测敏感性性为78.1%,特异性为97.5%,较单一指标的特异性高。结论胸水中ADA、ACE、LDH和CEA的联合检测对结核性和恶性胸水的鉴别诊断具有一定价值,有助于临床胸水性质的诊断。     

HPV感染和p53异常表达与宫颈鳞癌的关系

目的研究宫颈鳞癌与p53蛋白表达和HPV感染的关系,探讨宫颈鳞癌的形成机制。方法采用RT-PCR法分别检测p53基因在39例宫颈鳞癌组织和39例正常宫颈黏膜组织中的表达情况以及PCR方法检测HPV在这些组织中的感染情况。结果 HPV在宫颈鳞癌组中阳性率为48.72%(19/39),正常组织中为14.81%(4/27),p53基因表达在宫颈鳞癌组中阳性率为53.85%(21/39),正常组织中为18.52%(5/27),宫颈癌组的HPV感染和p53表达均高于正常组(P0.05)。结论 HPV感染与p53基因的异常表达与宫颈鳞癌发生密切相关,联合检测能提高准确性。