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.     

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。     

浆膜腔积液转移性肺腺癌细胞中TTF-1的表达

目的 探讨甲状腺转录因子-1(TTF-1)在浆膜腔积液肺腺癌细胞中的表达，为肺腺癌的诊断和鉴别诊断提供新的依据。方法 选用浆膜腔积液转移性腺癌共60例(胸水40例，腹水17例，心包积液3例)。经组织学或结合临床资料证实的肺腺癌36例，泌尿生殖道腺癌14例，胃肠道腺癌8例，乳腺癌2例。每例均制备HE染色的涂片和离心沉渣经琼脂和石蜡包埋而成的细胞块，并用细胞块切片作TTF-1免疫细胞化学染色。结果 36例肺腺癌中有26例表达TTF-1，24例肺外腺癌中只有2例表达TTF-1，其敏感性为72．2％，特异性为91．7％。结论 TTF-1在浆膜腔积液肺腺癌具有较高的敏感性和特异性，在排除甲状腺癌的可能性后，TTF-1阳性表达很大程度上提示腺癌原发于肺。     

用免疫细胞化学鉴别胸腹水脱落细胞在肿瘤诊断中的价值

探讨免疫细胞化学鉴别胸腹水中上皮来源恶性肿瘤细胞和间皮源性细胞的价值。应用免疫细胞化学方法,检测80例患者胸腹水恶性肿瘤细胞和间皮细胞的细胞学形态及ESA、CEA、CK、D2-40、CR、Mesothlial、KI67、Vimentin等8种蛋白的表达情况。结果表明：胸腹水脱落细胞学检测和这8种蛋白联合检测可鉴别上皮来源恶性肿瘤细胞和间皮细胞。两种方法联合检测胸腹水,提高了脱落细胞学疑难病例诊断的准确率。     

乳腺癌转移性胸腔积液14例临床病理学特征及分子分型分析

目的 探讨乳腺癌转移性胸腔积液的临床与预后改变、细胞学特点及分子分型.方法 回顾性分析14例乳腺癌转移性胸腔积液的临床病理学资料,并进行液基细胞学制片、常规细胞蜡块HE染色,从癌细胞的形态学、免疫细胞化学染色及免疫荧光染色等方面进行观察.结果 乳腺癌转移性胸腔积液以浸润性导管癌为主,也可以为浸润性小叶癌,分子分型以Lu...     

肺腺癌胸水涂片褪色后行免疫组化染色与细胞蜡块的比较

正肺腺癌是胸腔积液中最常见的转移性恶性肿瘤[1],在无法获取活检组织时,主要通过胸水脱落细胞学检查来明确诊断。但实际工作中往往因细胞蜕变或者分化差而难以与间皮细胞或鳞癌等鉴别,这时需结合免疫组化辅助诊断。文献报道[2-4]制作细胞蜡块可解决诊断问题,但是常遭遇标本细胞量少且难以重新取材,因此若能在原涂片上行免疫组化染色获得诊断结果对制定后续治疗方案显得异常重要。本文就已做过细胞蜡块的胸水TCT涂片褪色后行免疫组化染     

免疫组化标志物在鉴别浆膜腔积液恶性肿瘤细胞中的应用价值

目的探讨免疫组化标志物鉴别浆膜腔积液中恶性肿瘤来源及分类的临床价值。方法细胞学筛选恶性浆膜腔积液105例,分别采用常规细胞学涂片、薄层液基细胞技术制片、薄层液基细胞技术制片+常规细胞学涂片以及细胞蜡块切片结合免疫组化检测分析。结果对105例浆膜腔积液恶性肿瘤细胞来源及类型进行鉴别:胸水60例中腺癌58例,分别来源:肺42例、乳腺10例、卵巢4例及胃肠道2例;鳞癌1例;恶性间皮瘤1例。心包积液9例,均为腺癌,分别来源:肺6例,乳腺3例。腹水36例,其中腺癌35例,22例来源于卵巢,胃肠道12例,肺来源1例,弥漫大B细胞淋巴瘤1例。薄层液基细胞技术制片、薄层液基细胞技术制片+常规细胞学涂片以及细胞蜡块切片联合免疫组化检出率明显优于常规细胞学涂片(P0.05)。细胞蜡块切片联合免疫组化检测能准确鉴别浆膜腔积液中恶性肿瘤的来源及分类。结论常规细胞学涂片、薄层液基细胞技术制片、薄层液基细胞技术制片+常规细胞学涂片以及细胞蜡块切片结合免疫组化检测分析,在疑难恶性浆膜腔积液鉴别诊断及分类中具有重要的价值,值得临床推广应用。     

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.     

间皮相关抗体在胸膜恶性间皮瘤和胸膜转移癌鉴别诊断中的作用

目的　探讨calretinin、CK5 / 6、mesothelialcell(MC)、CEA和vimentin在胸膜恶性间皮瘤及胸膜转移性肺腺癌中的表达及其在鉴别诊断中的作用。方法　用免疫组化EnVision二步法检测 13例胸膜恶性间皮瘤和 13例胸膜转移性肺腺癌中的calretinin、CK5 / 6、MC、CEA、vimentin的表达情况。结果　calretinin、CK5 / 6、CEA在恶性间皮瘤与胸膜转移性肺腺癌中表达差异有显著性 (P <0 0 5 )。MC、vimentin在恶性间皮瘤和胸膜转移性肺腺癌中表达差异无显著性 (P >0 0 5 )。结论　间皮相关抗体calretinin、CK5 / 6及癌抗体CEA对鉴别胸膜恶性间皮瘤及胸膜转移性肺腺癌有诊断价值。     

Napsin A (TA02) is a useful alternative to thyroid transcription factor-1 (TTF-1) for the identification of pulmonary adenocarcinoma cells in pleural effusions

The purpose of this study was to test napsin A as a diagnostic marker of metastatic lung adenocarcinoma in pleural effusions, and to compare its performance with TTF-1. Napsin A and TTF-1 reactivities were determined immunohistochemically on formalin-fixed paraffin embedded cell blocks from 50 pleural effusion (5 mesotheliomas, 10 mesothelial proliferations, 12 pulmonary, and 23 nonpulmonary metastases). The results were evaluated separately, and correlated to the final diagnoses. Concordant results were obtained in 48/50 cases. TTF-1 and Napsin A were positive in 8/12 and 10/12 pulmonary adenocarcinomas, respectively. Both markers were negative in 42 cases, including two lung carcinomas. Napsin reactivity was found in more than 75% of the tumor cells in 9/10 positive cases, whereas TTF-1 reactivity was seen in more than 75% of the tumor cells in 2/8 positive cases only (P < 0.05). This makes napsin A an alternative to TTF-1 in cytological diagnosis of effusions in which tumor cells may be scanty.     

A fine decision tree consisted of CK5/6, IMP3 and TTF1 for cytological diagnosis among reactive mesothelial cells,metastatic adenocarcinoma of lung and non-lung origin in pleural effusion

The utility of combination with CK5/6, IMP3 and TTF1 to differentiate among reactive mesothelial cells (RMs), metastatic adenocarcinoma of lung (LAC) and non-lung (NLAC) origin was investigated by using immunocytochemistry (ICC) and conventional PCR (C-PCR) in pleural effusion. A total of 108 cell blocks (32 RMs, 51 LAC and 25 NLAC were evaluated by ICC for CK5/6, IMP3 and TTF1 protein expression. In addition, we further performed C-PCR for amplification of CK5/6, IMP3 and TTF1 DNA from 28 specimens (9 MAC and 7 RMs, 6 LAC and 6 NLAC) for molecular diagnosis. CK5/6 staining was observed in the majority of reactive specimens (78.1%) and was rare in adenocarcinoma cells (14.5%), whereas the opposite was true for IMP3 and TTF1. We found a high frequency of TTF1 positivity (76.5%) in LAC, but not in NLAC (4.0%); while there was no significant difference of IMP3 expression in LAC (88.2%) and NLAC (88.0%). The 487 bp DNA fragments of IMP3 was expected to be amplified in 6/9 of adenocarcinoma cases showed negative in ICC; and the 394 bp DNA fragments of CK5/6 was also expected to be amplified in 4/7 of RMs cases showed negative in ICC. Consistent with ICC results, there was significant difference of TTF1 expression in the LAC and NLAC compared with IMP3 expression. The combination with CK5/6, IMP3 and TTF1 immunostaining appears to be useful to improve the accuracy of cytological diagnoses between RMs, metastatic adenocarcinoma of lung and non-lung origin in pleural effusion. In addition, C-PCR may act as a useful supplemental approach for ICC, especially negative cases in ICC for differential cytological diagnosis.     

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。     

Value of immunocytochemistry in the study of malignant effusions

Recognition of malignant effusion relies heavily on cytologic examination despite the difficulty of distinguishing atypical mesothelial hyperplasia from metastatic carcinoma. The combination of CEA, EMA, vimentin, keratin, high-molecular-weight cytokeratin (HMWK), low-molecular-weight cytokeratin (LMWK), and Alcian blue was tested in 51 cytologic specimens of pleural, peritoneal, and pericardial effusions. These showed metastatic carcinoma in 38 cases (ovary, 14; lung, 8; breast, 7; GI, 4; endometrium, 4; bladder, 1) and mesothelial processes in 13 (hyperplasia, 9; mesothelioma, 4). Strong positivity for EMA (92%), CEA (90%), and Alcian blue (71%) was noted in metastatic carcinoma but not in the mesothelial processes. Keratin was positive in all cases of mesothelioma but occurred also in mesothelial hyperplasias (44%) and metastatic carcinomas (47%). In mesothelial cells, HMWK was consistently stronger than LMWK, whereas in adenocarcinoma the reverse was true. There was no difference in the degree or distribution of positivity of any of the markers among the various primary sites of the neoplasms. Our findings are consistent with the view that immunocytochemistry with a battery of antibodies is useful in the recognition of malignant effusions but cannot, as yet, determine the site of origin of metastatic neoplasms.     

Prospektiver Vergleich der diagnostischen Wertigkeit von Zytologie und Immunzytologie bei thorakoskopisch-bioptisch untersuchten Pleuraergüssen

Summary Two issues have been elaborated: (1) the value of immunocytochemistry in the diagnosis of pleural effusions, and (2) the reactivity of the investigated antibodies with different classes of cells in pleural effusions. Effusions of unknown origin from 38 patients were investigated using thoracoscopy, pleural biopsies, conventional cytology, and immunocytochemistry. The following antibodies were used: those monoclonal against various leukocyte antigens, macrophage antigens, epithelial membrane antigen (EMA), various cytoskeleton antigens, and melanoma antigens; those polyclonal against CEA and ferritin. All of the techniques used showed 18 patients (48%) as having a tumor-cell negative effusion. A pleural tumor with a malignant effusion showed in 13 patients (34%); in 12 of these immunocytochemistry also revealed tumor cells. Seven patients (18%) had a tumor of the pleura with a tumor-cell negative effusion; in 2 of these immunocytochemistry revealed a tumor-cell positive effusion. There was no difference with regard to the number of NK cells in patients with inflammation of the pleura and negative cytology and patients with tumor of the pleura and malignant effusion (3% vs 4.5%). Tumor cells were mainly stained by EMA, cytokeratin, and CEA. CEA was the only antibody to be tumor-cell specific, while EMA and cytokeratin were expressed by mesothelial cells also. The antibody against ferritin was a significant marker for mesothelial cells.

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Abkürzungen BSA Bovines Serumalbumin - CEA Carcinoembryonales Antigen - DAB Diaminobenzidin - EMA Epitheliales Membranantigen - HE Haematoxylin-Eosin - LA Lymphangiosis carcinomatosa - LCA Leucoyte common antigen (= Pan-Leukozytenantigen) - NCA Nicht spezifische kreuzreagierende Aktivität - NK-Zellen Natürliche Killerzellen - PK Pleurakarzinose - undiff Ca undifferenziertes Karzinom