CK15及CK19在表皮及皮肤附属器肿瘤中的表达及其诊断价值

目的:检测表皮干细胞标记物细胞角蛋白15（CK15）及细胞角蛋白19（CK19）在表皮肿瘤及皮肤附属器肿瘤中的表达强度。方法:选择155例东营市人民医院病理科确诊的皮肤肿瘤，进行免疫组织化学检测，观察并记录CK15和CK19的表达强度。结果:155例皮肤肿瘤组织中CK15和CK19的表达强度不同。CK15毛分化肿瘤均显示阳性表达，而且外毛根鞘瘤/癌与鳞状细胞癌的表达有统计学差异（P＜0.05），毛母细胞瘤与组织形态学相近的基底细胞癌、汗孔瘤的表达有统计学差异（P＜0.05）。CK19在鳞状细胞癌、外毛根鞘瘤、外毛根鞘癌中几乎不表达，鳞状细胞癌与基底细胞癌、汗腺来源肿瘤及毛发上皮来源肿瘤均存在统计学差异（P＜0.05）。结论:免疫组织化学检测CK15、CK19的表达强度可以用来诊断及鉴别诊断组织学形态相近的皮肤肿瘤。     

表浅膀胱癌Pgp与突变p53蛋白表达的相互关系及其共表达的意义

目的探讨表浅膀胱移行细咆癌中Pgp与突变p53蛋白表达的相互关系及其共表达情况在预测复发方面的价值.方法应用免疫组织化学SP法,检测46例随访3年以上、术前未经化疗的原发性表浅膀胱移行细胞癌中Pgp、突变p53蛋白表达情况.结果Pgp、突变p53蛋白的阳性表达率分别为45.7%、58.7%,PgP与突变p53蛋白的表达密切相关(P＜0.01);其中二者均阳性、其中之一阳性或均阴性表达率分别为34.8%、34.8%、30.4%,单因素Kaplan-Meier生存分析示Pgp与突变p53蛋白共表达情况与术后复发密切相关(P＜0.05).结论Pgp与突变p53蛋白共表达情况是判定原发性表浅膀胱移行细胞癌复发的重要指标.     

食管肉瘤样癌临床病理和免疫组化分析

目的 :观察食管肉瘤样癌 (sar comatoidcarcinoma ,SC)的临床病理特点和免疫组织化学表达 ,探讨其可能的组织起源。方法 :采用光镜观察和免疫组化标记 ,对 4例食管SC进行回顾性研究。结果 :SC多见于 5 0岁以上的男性。主要症状为进行性吞咽困难和胸骨后疼痛。肿瘤多呈息肉样或蕈样 ,表现为癌和梭形细胞肉瘤双相形态特征 ,癌和肉瘤组织相互之间可见移行过渡。免疫组化 ,4例SC中的癌成分对上皮性标记物CK和EMA均呈阳性表达 ,对间叶性标记物Vimentin表达阳性 1例 ;肉瘤成分Vimentin表达阳性 3例 ,弱阳性 1例 ,部分瘤细胞S 10 0蛋白表达阳性 2例 ,SMA阳性 1例 ;同时对CK或EMA表达阳性各 1例。结论 :食管SC是一种不同于食管其他型癌的少见的恶性肿瘤 ,肉瘤样癌细胞的双重形态表象可能是癌细胞多向转化的结果     

肾脏黏液样小管状和梭形细胞癌2例报道及文献复习

目的探讨黏液样小管状和梭形细胞癌（MTSC）的临床病理特征、组织发生、鉴别诊断及预后。方法通过HE、免疫组织化学染色及免疫组织化学观察2例MTSC,随访39及83月,并复习相关文献。结果2例MTSC均为女性,发病年龄分别为60及73岁,肿瘤界限清楚,组织学示紧密排列的、小而狭长的小管,其间为淡染黏液样间质。瘤细胞呈立方形至梭形,嗜酸性胞浆,核级别低,核分裂相很少见。2例CK34βE12、E-cadherin、CK7、CK19、vimentin均为阳性,1例部分表达NSE及Syn,Ki-67增殖指数<5%,随访期内患者病情稳定。结论MTSC是一种罕见的低级别肾上皮性肿瘤,免疫组织化学支持MTSC起源于远端小管的假设,与乳头状肾细胞癌相似,可有神经内分泌分化。单独全肾切除术预后较好,但需密切随访。     

鼻多形性低度恶性腺癌临床病理观察

目的:探讨鼻腔多形性低度恶性腺癌(PLGA)的临床病理特点和鉴别诊断。方法:回顾分析4例鼻部PLGA的临床病理和免疫表型特点,并复习文献。结果:4例PLGA患者均为中老年,男女各半。受累部位单侧鼻腔2例,双侧鼻腔2例。临床主要表现为鼻塞和鼻出血,或伴流涕和嗅觉减退。光镜下肿瘤呈现细胞形态单一,组织结构多样的特点。免疫组织化学染色显示肿瘤细胞CK(AE1/AE3)、S-100、SMA、Vim阳性,部分病例EMA和CEA阳性,而p63和GFAP阴性。结论:鼻腔多形性低度恶性腺癌非常罕见,具有和小涎腺多形性低度恶性腺癌相似的组织形态学特点,与腺样囊性癌的鉴别非常重要,免疫组化Vim检测有助于二者的鉴别。     

食管肉瘤样癌临床病理和免疫组化分析

目的：观察食管肉瘤样癌(sarcomatoid carcinoma，SC)的临床病理特点和免疫组织化学表达，探讨其可能的组织起源。方法：采用光镜观察和免疫组化标记，对4例食管SC进行回顾性研究。结果：SC多见于50岁以上的男性。主要症状为进行性吞咽困难和胸骨后疼痛。肿瘤多呈息肉样或蕈样，表现为癌和梭形细胞肉瘤双相形态特征，癌和肉瘤组织相互之间可见移行过渡。免疫组化，4例SC中的癌成分对上皮性标记物CK和EMA均呈阳性表达，对间叶性标记物Vimentin表达阳性1例；肉瘤成分Vimentin表达阳性3例，弱阳性1例，部分瘤细胞S1100蛋白表达阳性2例，SMA阳性1例；同时对CK或EMA表达阳性各1例。结论：食管SC是一种不同于食管其他型癌的少见的恶性肿瘤，肉瘤样癌细胞的双重形态表象可能是癌细胞多向转化的结果。     

膀胱移行细胞癌中VEGF、bFGF及其受体的表达和临床意义

目的 探讨VEGF、bFGF及其受体在膀胱移行细胞癌中的表达和临床意义。方法 应用免疫组织化学SABC法研究65例膀胱浅表性与浸润性移行细胞癌VEGF及其受体flk,flt,bFGF及其受体flg的表达。结果 浸润性癌组VEGF及其受体、bFGF及其受体的表达显著高于非浸润性癌组（P＜0．01）。浅表性癌组中5例复发病例5项指标均呈阳性或强阳性表达。结论 5项指标的共同表达与癌组织浸润能力密切相关。浅表性膀胱移行细胞癌中VEGF及其受体、bFGF及其受体的共同表达或高表达可作为判断肿瘤早期浸润及复发倾向的参考指标。     

热休克蛋白70在膀胱移行细胞癌中的表达

目的　研究HSP70在膀胱移行细胞癌中的表达。方法　采用免疫组织化学S -P染色法 ,检测 6 3例膀胱移行细胞癌组织中HSP70的表达。结果　HSP70在膀胱移行细胞癌中的阳性表达率为 4 7 6 2 % (30 /6 3)。HSP70的表达与膀胱移行细胞癌的分级和分期呈正相关 (P <0 0 5 )。结论　HSP70在膀胱移行细胞癌中的表达与癌组织的分级和分期有关。检测膀胱移行细胞癌中HSP70表达可为临床判断预后提供依据。     

卵巢印戒细胞间质瘤的临床病理分析

目的 :探讨卵巢印戒细胞间质瘤(signet-ring stromal tumor,SRST)的临床病理特点、鉴别诊断、治疗、生物学行为及预后。 方法 :采用HE、组织化学和免疫组织化学SP法检测SRST肿瘤细胞PAS-D、CK、CK7、CK20、Vi-mentin、Actin、inhibin、calretinin的表达。 结果 :4例SRST患者年龄20～56岁(平均40岁),所有肿瘤均为单侧发生。组织学表现为印戒样细胞与梭形细胞混合存在,无上皮分化(如腺管、细胞巢或条索)。组织化学染色PAS-D、免疫组织化学染色CK、CK7、CK20、inhibin、calretinin均为阴性,Vimentin和Actin阳性。患者随访11～52个月(平均27.8个月),均生存,无肿瘤复发或转移。 结论 :SRST是少见的卵巢良性肿瘤,预后好,组织学上与Krukenberg瘤等肿瘤易混淆,结合临床病理特征、组织化学和免疫组织化学有助于SRST的诊断。     

38例肺源性脑转移瘤临床病理分析

目的 肺源性脑转移瘤临床病理特征。方法 研究38例肺源性脑转移瘤的临床和病理特点，男性27例，女性11例，年龄在30-74岁之间。其中5例转移性癌作免疫组织化学染色和电镜观察。结果 20例为腺癌，12/20为乳头状腺癌；5例为腺鳞癌，7例为鳞形细胞癌，4例为燕麦细胞癌，2例为不典型类癌；5例乳头状腺癌作免疫组织化学染色示CK（5/5）和CEA（4/5）为阳性；电镜显示转移性乳头状腺癌具有肺泡II型上皮细胞分化潜能。结论 肿癌中腺癌更易发生脑转移，免疫组织化学在鉴别诊断中有一定的辅助作用，转移性乳头状腺癌具有异质性。     

罕见浆细胞样移行细胞癌的病理临床研究(英文)

目的总结并探讨膀胱浆细胞样移行细胞癌的病理特征、诊断和鉴别诊断及临床特点。方法采用常规HE、巴氏染色和免疫组化方法(S-P方法),光镜观察2例膀胱浆细胞样移行细胞癌,通过临床随访和文献复习对此罕见膀胱肿瘤进行讨论。结果其特点是除粘膜有原位癌外,肿瘤多侵犯固有膜和／或肌层。细胞形态和浆细胞相似。肿瘤细胞高表达AEI／AE3,CEA和CK18。临床预后较一般的移行细胞癌差。结论膀胱浆细胞样移行细胞癌罕见,具有其特有的组织病理学和生物学特点,诊断膀胱肿瘤时应考虑到该肿瘤的可能性。     

Spindle cell carcinoma of the nasal cavity

We report an extremely rare case of spindle cell carcinoma of the sinonasal cavity. A 75-year-old man was admitted to our hospital because of right nasal obstruction. Nasal endoscopy showed a polypoid tumor measuring 3?×?3?cm at the nasal septum in the right nasal cavity, and an excisional biopsy was performed. Computed tomography (CT) demonstrated the nasal tumor extended to the maxillary sinus. Histologically, the tumor consisted of malignant spindle cells with hyperchromatic nuclei. Mitotic figures and necrosis were recognized. In some areas, edematous changes were recognized. No apparent differentiation was noted. The tumor cells were free of keratinization and intercellular bridge formations; therefore, there were no squamous cell components. Immunohistochemically, the tumor cells were positive for pancytokeratin, cytokeratin (CK)5/6, CK18, CK19, high molecular weight CK, p63, and vimentin. The tumor cells were negative for epithelial membrane antigen, CK7, CK14, p53 protein, S100 protein, HMB45, chromogranin, synaptophysin, CD34, CD56, glial fibrillary acidic protein, neuron-specific enolase, neurofilaments, ??-smooth muscle actin, neuroblastoma, myoglobin, carcinoembryonic antigen (CEA), carbohydrate antigen (CA)19-9, CD3, CD20, CD30, CD45RO, and CD45. A pathological diagnosis of spindle cell carcinoma of sinonasal lesion was made. The patient underwent resection of right maxilla followed by chemotherapy and radiation and was alive without metastasis 5?years after initial presentation.     

尿路移行细胞癌微转移的检测

目的 探讨尿路移行细胞癌患者外周血CK20的表达及临床意义.方法 采用逆转录聚合酶链反应(RT-PCR)检测47例尿路移行细胞癌患者和14例健康志愿者以及18例非肿瘤患者外周血CK20的表达.以GAPDH作为内参照.结果 14例健康志愿者和18例非肿瘤患者外周血CK20的表达均为阴性;47例尿路移行细胞癌患者外周血CK20阳性表达率为21.3%(10/47):T1为0(0/29),T2为20%(2/10),T3为100%(4/4),T4为100%(4/4).随访12个月,6例(T2～T3)外周血CK20阳性的尿路移行细胞癌有3例(T3G2膀胱癌1例,TaG2和T3G2输尿管癌各1例)发生远处转移.结论 检测外周血CK20表达,可以提示癌细胞的血行播散,对判断预后以及指导治疗具有一定临床价值.     

Failure of anticytokeratin 18 antibody to improve flow cytometric detection of bladder cancer.

BACKGROUND. Bladder washing specimens containing inflammatory or squamous cells have been difficult to accurately analyze with single-parameter DNA flow cytometric (FCM) methods. METHODS. The anticytokeratin 18 antibody, CK5, was used in a multiparameter assay of 275 bladder washing and voided urine specimens to immunoselect only the bladder transitional cells for DNA analysis. RESULTS. Flow cytometric detection of transitional cell carcinoma was increased by immunoselection of CK5-positive cells in specimens from patients with disease. Unfortunately, a similar increase in hyperdiploid cells in pathologically benign specimens was observed, which resulted in a false-positive rate of 45%. In some instances, multiparameter FCM assays with CK5 could detect aneuploid cell populations not clearly evident by single-parameter analysis. CONCLUSIONS. However, the results from this study of the hyperdiploid cell fraction showed that the increased sensitivity resulting from the use of CK5 was not clinically useful because of the decrease in specificity.     

尿核基质蛋白22和细胞角蛋白18在膀胱移行细胞癌中的表达及其临床意义

目的 探讨尿核基质蛋白22(NMP22)和细胞角蛋白18(CK18)在膀胱移行细胞癌中的表达及其临床意义.方法 采用酶联免疫吸附法(ELISA)对293例膀胱移行细胞癌、400例非移行细胞肿瘤、105例泌尿系良性病患者进行尿NMP22和CK18蛋白水平的检测.结果 膀胱移行细胞癌患者术前NMP22和CK18表达中位值分别为17.3 U/ml和484.2 U/L,非移行细胞肿瘤患者分别为6.8 U/ml和156.0 U/L,良性疾病患者分别为2.3 U/ml和66.6 U/L,3组之间进行比较,差异有统计学意义(P<0.001).以NMP22 10 U/ml和CK18 120 U/L为界值,其对膀胱移行细胞癌诊断的敏感度分别为79.2%和78.2%,特异度分别为88.6%和82.9%,两者联合检测的敏感度为91.7%.对术后患者动态观察,治疗有效患者的NMP22和CK18表达水平较治疗前明显下降,而复发、转移的患者则上升,差异有统计学意义(P<0.01).NMP22和CK18对膀胱移行细胞癌的检测有显著的相关性(r=0.689 P<0.0001).NMP22和CK18表达水平在不同病理分级和不同分期的患者中比较,差异有统计学意义(均P<0.01).结论 尿NMP22和CK18检测可作为膀胱移行细胞癌术前诊断、病情监测重要指标,两者联合检测可进一步提高敏感度.     

Coexpression of cytokeratins 7 and 20 confirms urothelial carcinoma presenting as an intrarenal tumor

BACKGROUND: The differentiation of epithelial tumors arising in the kidney (urothelial vs. renal cell carcinoma) sometimes can be difficult by clinical and radiologic studies. Because urothelial and renal epithelium express unique cytokeratin (CK) 7 and 20 profiles, the authors studied the utility of these markers to confirm the diagnosis of urothelial carcinomas that present clinically as kidney masses. METHODS: Using commercially available monoclonal antibodies, paraffin section immunohistochemistry was used to examine two recent cases of urothelial carcinomas presenting as renal tumors. Tissues were stained for CK7 and CK20 and the expression compared between the tumor and benign tissue. RESULTS: Both cases showed solid renal masses that clinically and radiographically could have been of renal cell origin, but subsequently were confirmed histologically to be extensive renal involvement by urothelial carcinoma. The tumors coexpressed both CK7 and CK20, which is the expected profile for carcinomas of urothelial but not renal origin. CONCLUSIONS: The results of the current study show that coexpression of CK7 and CK20 is a useful diagnostic aid in the differential diagnosis of epithelial kidney tumors of urothelial cell versus renal cell origin.     

Sarcomatoid carcinoma of the urinary bladder: a case report with immunohistochemical and molecular genetic analysis

The author reports a rare case of sarcomatoid carcinoma with an emphasis on immunohistochemical features. A 79-year-old man was admitted to our hospital because of hematuria. An endoscopy revealed a large polypoid tumor in the bladder, and urine cytology demonstrated malignant cells. A cystectomy was performed. The patient is now alive without metastasis 4 months after the operation. Grossly, a large polypoid tumor (5 × 6 × 5 cm) was present in the bladder. Microscopically, the tumor consisted of high-grade transitional cell carcinoma element (10% in area) and sarcomatoid element (90% in area). There was a gradual transition between the two. The tumor cells were invaded into peribladder tissue (pT3b). Immunohistochemically, the sarcomatoid element was positive for four types of pancytokeratins, high-molecular weight cytokeratin (CK), CK5/6, CK7, CK18, CK19, epithelial membrane antigen (EMA), vimentin, p53 protein, p63, Ki-67 (labeling = 92%), neuron-specific enolase (NSE), and platelet-derived growth factor receptor-α (PDGFRA). It was negative for CK14, CK20, melanosome, carcinoembryonic antigen (CEA), desmin, S100 protein, myoglobin, α-smooth muscle antigen (ASMA), CD34, chromogranin, synaptophysin, CD56, CD68, and KIT. The transitional cell carcinoma element showed similar immunoreactivity except for negative CK5/6, positive CK20, and negative vimentin. A molecular genetic analysis of KIT gene (exons 9, 11, 13, and 17) and PDGFRA (exons 12 and 18) gene with the use of PCR-direct sequencing showed no mutations. The present case is the first report of sarcomatoid carcinoma of the urinary bladder demonstrating extensive immunohistochemistry and mutational status of KIT and PDGFRA genes. The sarcomatoid carcinoma in the present case may be derived from sarcomatous differentiation of high-grade transitional cell carcinoma.     

检测尿脱落细胞CK20表达的临床意义

目的探讨尿路移行细胞癌(TCC)患者尿脱落细胞CK20的表达及其意义.方法采用逆转录聚合酶链反应(RT-PCR)检测38例TCC患者、6例泌尿系非移行细胞癌肿瘤患者、14例泌尿科非肿瘤患者以及7例健康志愿者尿脱落细胞CK20表达.以GAPDH作为内参照.结果38例TCC患者中33例尿脱落细胞CK20阳性表达,阳性率为86.8%.6例泌尿系非移行细胞癌肿瘤患者、14例泌尿科非肿瘤患者以及7例健康志愿者尿脱落细胞CK20表达阴性.结论检测尿脱落细胞CK20表达诊断TCC敏感性和特异性高,可作为TCC筛查的方法之一.     

流式细胞术检测肺癌瘤组织和外周血角蛋白阳性细胞表达

[目的]探讨肺癌患者瘤组织和外周血角蛋白(cytokeratin,CK)阳性细胞的表达及其临床意义.[方法]采用流式细胞术检测和分析了43例肺癌患者瘤组织和外周血CK 细胞的表达情况.[结果]肺癌患者瘤组织和外周血CK 细胞检出率均显著高于相应对照组(P＜0.01或P＜0.05),且两者呈良好的正相关(r=0.325,P＜0.05).肿瘤患者CK 细胞检出率与肿瘤患者性别、年龄无关(P＞0.05);而与肿瘤临床分期、病理分级、瘤灶数、肿瘤大小、转移情况以及癌细胞倍体类型、增殖活性和凋亡水平密切相关(P＜0.05或P＜0.01).[结论]CK 细胞表达水平与患者临床生物学行为及瘤细胞生物学特性关系十分密切;CK 细胞可以作为肺癌的诊断、恶性度判断、微转移及患者预后估计的标志物.     

扁桃体原发性恶性肿的临床病理分析

目的：对25例扁桃体原发性肿瘤的临床病理特征,进行分析研究。方法：收集25例经临床病理证实的扁桃体原发性恶性肿瘤患者的临床资料,复习有关病理组织常规切片,部分病例标本进行免疫组织化学染色、显微镜观察分析。结果：鳞状细胞癌7例,恶性弥漫性非霍奇金淋巴瘤17例,血管肉瘤1例;淋巴瘤白细胞共同抗原（CD45）均为阳性表达,大多为B细胞来源,而细胞角蛋白（CK）均为阴性;鳞癌CK均为阳性表达,而CD45和波形蛋白（Vimntin)均为阴性;血管肉瘤表达F8和Vimentin。结论：扁桃体原发性恶性肿瘤以弥漫性非霍奇金淋巴瘤最为常见,其次是鳞癌,最后确诊要依靠病理形态学及免疫组织化学来证实,并采取综合治疗。