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.     

单克隆抗体免疫细胞化学法在胸腹水肿瘤细胞学检查中意义

用本室制备的对胃癌、结肠癌和肺癌选择较强的单克隆抗体MG7、MG9、MC3及MC5对321例次胸腹水的脱落细胞进行免疫细胞化学检杳。结果表明,用本法检查胸腹水中相应肿瘤细胞,反应灵敏、阳性率高、特异性强、结果可靠。若结合常规病理细胞学检查,对于不典型癌细与异型间皮细胞的鉴别,提高了胸腹水相应癌细胞的阳性检出率,以及推测胸腹水癌细胞的器官来源有较大的价值.尤其适用于解决临床疑难病例的诊断。     

免疫组化和苏木素伊红染色在良恶性胸腹水诊断的应用价值

目的探讨免疫组化和常规HE染色在临床良、恶性胸腹水鉴别诊断中的应用价值。方法收集本院患者胸腹水标本50例,制成细胞学蜡块行HE染色和免疫组化染色观察。结果50例标本中恶性肿瘤细胞32例,反应性间皮细胞13例,结核5例。结论传统细胞学涂片对于良、恶性胸腹水鉴别诊断较困难,应用免疫组化作鉴别诊断可提高诊断阳性率。     

胸腹腔积液细胞染色体检查对恶性肿瘤的诊断意义

鉴别“良”、“恶”性胸腹水仍是目前临床上经常遇到的难题之一。脱落细胞检查是鉴别诊断的重要手段,但其阳性率通常为55～60%。常见脱落细胞少或间皮细胞形态变化较大,细胞形态不典型,对良、恶性胸腹水很难作出正确诊断。医学细胞遗传学的进展,对肿瘤细胞遗传学的特点有了新的认识。为了给临床提供新的诊断方法,本文对胸腹水细胞染色体检查良、恶性肿瘤的诊断意义,诊断标准进     

血性胸腹水涂片中红细胞的去除方法

胸腹水脱落细胞的检测，已成为病理诊断的常规，多数胸腹水中含有大量红细胞，影响结果和观察。如果既去除红细胞，又保持其它细胞的完整性，以利于HB或免疫细胞化学标记后的鉴别诊断，很有必要。我们在临床细胞学检验中，经过反复摸索，采用稀盐酸洗涤法，解决了上述问题，取得了满意的效果，现介绍如下。     

胸腹水细胞沉渣包埋技术及应用

胸腹水细胞学查检常规方法是胸腹水离心涂片后HE染色、镜检。该方法存在缺点：首先涂片中的细胞为散在单个或少数成团细胞，在光镜下有时很难鉴别增生间皮细胞、组织细胞、肿瘤细胞；其次不能像石蜡包埋细胞块，该方法克服了以上缺点，有利于提高胸腹水细胞学诊断的准确率。     

胸腹水细胞沉渣石蜡包埋技术与应用

胸腹水等体液细胞学涂片检查早已广泛应用于临床，方法简单，经济快速，对阴性及大部分阳性胸腹水标本都能够明确诊断，而少部分病例单靠细胞学涂片难以做出明确诊断，往往需借助免疫细胞化学及细胞化学等手段进行鉴别诊断。细胞学涂片难以制出合乎免疫细胞化学要求的多张涂片，且细胞较为分散，面积大，浪费昂贵的免疫组化试剂。为克服这一缺点，我们经过摸索将细胞沉渣进行石蜡包埋、切片，并应用于临床几年来取得了较好的效果。     

细胞蜡块结合免疫细胞化学在浆膜腔积液病理诊断中的应用

正近年来,随着恶性肿瘤发病率的升高,肿瘤的早期发现及诊断已成为肿瘤防治领域的重点问题~([1])。浆膜腔积液是多种疾病的常见临床表现,传统方法采用脱落细胞学检查鉴别良、恶性。但由于多种因素限制细胞学诊断阳性率较低,易漏诊~([2])。此外,细胞形态学诊断在鉴定肿瘤细胞来源和肿瘤细胞类型方面有一定局限性,而免疫细胞化学的检测对鉴别诊断非常有价值~([1])。采用浆膜腔积液离心后的细胞制作     

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。     

Mesothelioma of the tunica vaginalis testis with prominent adenomatoid features: a case report

Malignant mesotheliomas of the testis arise from the tunica vaginalis, formed from the evagination of the abdominal peritoneum into the scrotum. It is an extremely rare tumor representing 0.3% to 5% of all malignant mesotheliomas. We presented an interesting case of 68-year-old male with swelling and slightly painful in the right scrotum. Histologically, the lesion were composed of small tubular, microcystic, gland lined by flattened epithelioid cells and vague signet ring cells set in a myxofibrous stroma, which is resemblance to adenomatoid tumor. But the tumor cells showed significant atypical cytologic morphology and invaded into spermatic cord tissue, which indicated the diagnosis of malignant tumor. Immunohistochemistry study showed positive expression of CK, CK5/6, CK7, Calretinin, D2-40 and Vimentin which indicated the diagnosis of malignant mesothelioma. This case of mesothelioma should be classified as epithelial in type. To our knowledge, the mesothelioma of the tunica vaginalis testis with adenomatoid tumor-like microscopic features is very rare.     

CEA、CYFRA21-1、NSE、SF联检鉴别癌性与结核性胸水

目的 :通过对胸水多项肿瘤标志物联合检测来鉴别癌性与结核性胸水 ,以提高癌性胸水诊断的阳性率。方法 :用放射免疫分析和化学发光法测定 6 9例 (男 4 7,女 2 2 )结核性胸水、10 7例 (男 83,女 2 4 )癌性胸水CEA、CYFRA2 1- 1、NSE、SF水平 ,两组间进行比较。结果 :癌性胸水组四项肿瘤标志物均值及阳性率均显著高于结核性胸水组 (p均 <0 0 1)。四项指标联检对癌性胸水诊断的阳性率为 95 33%。结论 :胸水CEA、CYFRA2 1- 1、NSE、SF水平检测对鉴别癌性胸水与结核性胸水有重要价值 ,四项指标联合检测可显著提高癌性胸水的阳性诊断率。     

恶性间皮瘤的肿瘤相关成纤维细胞的特点

目的:通过观察恶性间皮瘤的肿瘤相关成纤维细胞(tumor-associated fibroblasts,TAF)的免疫表型特点,探讨其在诊断治疗中的意义.方法:收集恶性间皮瘤10例,食管癌、乳腺癌、结肠癌标本各10例,观察这些肿瘤TAF的CK,CK19,Calretinin,HBME-1,Vimentin,Sny,S-100等表达情况.结果:10例恶性间皮瘤、食管鳞状细胞癌、乳腺浸润性导管癌、结肠腺癌的TAF都阳性表达Vimentin,均灶状表达Syn,S-100.10例恶性间皮瘤的TAF阳性表达CK,CK19,Calretinin,弱阳性表达HBME-1;10例食管鳞状细胞癌、乳腺浸润性导管癌、结肠腺癌的TAFs均局灶弱阳性表达CK,Calretinin,不表达HMBE-1及CK19;恶性间皮瘤组的TAF表达Calretinin,CK19,CK,HBME-1的积分光密度值(integrated optical density,IOD)显高于其余3组(P＜0.05).结论:恶性间皮瘤的TrAF与一般常见的上皮性肿瘤的TAF免疫表型既有共性又有不同,深入了解其免疫表型及分子生物学特性对研究恶性间皮瘤的诊断及治疗有重大意义.     

Scoring system for differential diagnosis of malignant mesothelioma and reactive mesothelial cells on cytology specimens

Cytology is the only useful tool in the detection of malignant mesothelioma (MM) at an early stage. No other methods, such as immunocytochemistry or electron microscopy, are available to distinguish MM from reactive mesothelial cells (RMC). Some objective analysis of cytology specimens is necessary. On the basis of our case review and cytological features described in previous articles, we developed a scoring system for malignant mesothelioma (SSMM) of effusion cytology to distinguish MM cells from RMC. Mesothelioma cells in effusions from 22 patients (20 pleural and 2 peritoneal mesotheliomas) were compared with RMC from 20 patients without obvious tumor cells and 50 effusions containing metastatic carcinoma cells. The SSMM is based on characteristic features of mesothelial and malignant cells. The total achievable score is 10 points: one point each is given for variety of cell size, cyanophilic cytoplasm with villosity/windows/bleb, sheet‐like arrangement, mirror‐ball‐like cell clusters, nuclear atypia, and cannibalism, respectively. Further two points each are ascribed for acidophilic large nucleoli and multinucleated cells with more than eight nuclei. The total score for each of the 22 mesotheliomas was more than 5 points. On the other hand, all RMC and the 50 metastatic carcinoma cases scored less than 3 points, aside from two cases that were treated with OK432. No single characteristic feature was observed to be consistent within the 22 mesotheliomas analyzed. Ancillary use of immunocytochemistry, such as podoplanin (D2‐40) and calretinin, supported the diagnostic accuracy of the SSMM. SSMM is useful for the differential diagnosis of MM. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Early cytological diagnosis of diffuse malignant mesothelioma of the peritoneum: a case report

Mesotheliomas are the most frequent primary malignant tumors of serosal cavities with a poor prognosis. A definitive and early diagnosis on effusion samples is important, because recent advances in therapy for patients with mesothelioma may result in an improved outcome if they are applied to stage I disease.We report a case of malignant peritoneal mesothelioma diagnosed repeatedly by cytology in ascites fluids 1.5 yr before the diagnosis was confirmed by biopsy histology. The cytological diagnoses were supported by immunocytochemistry, DNA-cytometry, and AgNOR-analysis. Routine cytology supported by three adjuvant methods enabled us to correctly establish the diagnosis. Our case suggests that a cytological diagnosis of malignant mesothelioma supported by adjuvant methods should not be rejected even if based on negative histological results.     

Epithelioid angiosarcoma at chest wall which needs to be carefully distinguished from malignant mesothelioma: report of a rare case

Angiosarcoma is a malignant soft tissue tumor the cells of which variably recapitulate the morphologic and functional features of normal endothelium. Most lesions are located in the deep muscles of the lower extremities followed by the arm, trunk and head and neck. Herein we present a case of epithelioid angiosarcoma which is a variant of angiosarcoma at chest wall in a 73-year-old female. Morphologically, the tumor cells are arranged predominantly in luminal structures which can be seen in both angiosarcoma and malignant mesothelioma. Most of the tumor cells are large rounded “epithelioid” cells with abundant eosinophilic cytoplasm which can be also seen in both tumors. The epithelioid of cytomorphology and the localization at chest wall of this case may remind of a diagnosis of malignant mesothelioma which should be carefully distinguished from epithelioid angiosarcoma from imaging and morphology. CT scanning of the patient shows a mass at her chest wall, the majority of which is around the rib but not inside the lung which indicates a tumor originates more likely from soft tissues of chest wall but not pleura. Immunohistochemical staining shows that the tumor cells are positive for cytokeratin, CD31, Vimentin and WT1, and negative for CEA, TTF-1, Calretinin, Mesothelial Cell (MC), CD56, CK19, and Hepatocyte. Thus this case is diagnosed as epithelioid angiosarcoma but not malignant mesothelioma. From this case we suggest that carefully reading and understanding of the imaging are a very important clue for appropriate diagnosis. A misdiagnosis may occur on the basis of misunderstanding of tumor localization and a consequent inappropriate immunohistochemical staining programme.     

Well-differentiated papillary mesothelioma: A 17-year single institution experience with a series of 75 cases

We present our experience with 75 cases of well-differentiated papillary mesothelioma (WDPM) that were diagnosed at our institution between 2000 and 2017. The patients included 58 females and 17 males with age ranging from 18 to 69 years (mean, 42 years). Clinically, the vast majority of WDPMs were incidental findings during laparotomy or laparoscopic surgery for a variety of benign or malignant disease. The lesion manifested as either a small solitary nodule or multiple miliary nodules on the peritoneum or serosal surfaces of internal organs. Histologically, 67 cases were consistent with a classical WDPM, of which 6 cases contained microinvasive foci and 1 case had malignant transformation. Eight cases were hybrid tumors with variable combined component of adenomatoid tumor (n = 4), multicystic mesothelioma (n = 2), and both (n = 2). By immunohistochemistry, besides calretinin, D2-40, CK5/6 and WT1, 94% (29/31) of cases also showed immunostaining for PAX8. In comparison, PAX8 staining was only present in 12% (6/50) of epithelioid malignant mesothelioma selected as control cases. Follow-up information available in 46 cases revealed no signs of tumor progression or local recurrence except for the case that showed transformation to a fully malignant mesothelioma after a period of 15 years. Our comprehensive study further expanded the clinical and histopathological spectrum of WDPM. Compared with epithelioid malignant mesothelioma, PAX8 staining is highly sensitive and specific for WDPM (P < 0.001).