免疫组织化学方法在良恶性胸腹水鉴别诊断中的意义

目的：探讨胸腹水脱落细胞的石蜡包埋法，以及免疫组化在良恶性胸腹水鉴别诊断中的价值，找出适于这项诊断的最佳抗体。方法：对59例胸腹水脱落细胞进行石蜡包埋法，应用免疫组化SP法检测钙视网膜素(CAL)、癌胚抗原(CEA)、波形蛋白(VIM)、低分子量角蛋白(AEl)、高分子量角蛋白(AE3)的表达，并与常规涂片比较诊断结果。结果：在59例胸腹水中，常规涂片HE诊断阴性28例，可疑6例，恶性25例，应用脱落细胞石蜡包埋法 免疫组化检测鉴别出恶性积液29例，反应性积液30例。在28例肺癌中，CEA阳性率为100％。AEI为92.9％，而VIE和CAL则为阴性。结论：胸腹水脱落细胞石蜡包埋法结合免疫组化检测可提高阳性诊断率，CAI VIM CEA对癌细胞与问皮细胞的诊断有重要意义，AEl与AE3对鉴别鳞癌、腺癌有参考价值。

Significance of immunohistochemistry in diagnosis of malignant or benign pleural and peritoneal effusion

Objective To investigate the paraffin embedding of the pleural and peritoneal effusion and significance of immunohistochemistry in diagnosis. Methods With the applied of paraffin embedded in 59 cases of the pleural and peritoneal effusion,SP immunohistochemical technique was used to detect the expression of CAL, CEA, VIM, AE1 and AE3. All results were compared with that of cytological smears. Results In case with cytological smears,there were 28 cases negative,6 cases equivocal,25 cases malignant;while in cases with cytological paraffin embeddied and immunohistochemistry detection,there were 29 cases malignant and 30 cases reactive. In 28 adenocarcinoma, the positove rate of CEA aws 100%, AEI was 92.9%, VIE and CAL were negative. Conclusion With the application of paraffin embedding and immunohistochemistry in pleural and peritoneal effusion can improve their positivities. It showed that dection of CAL+VIM+CEA is of significance in differential dignosis of cancer and hyperplastic mesothelial cells,while AE1 and AE3 have some reference value in the differentiation of squamous cell carcinoma from adenocarcinoma in the effusion.