Ca15-3在乳腺外Paget病鉴别诊断中的价值

目的：探讨Ｃａ１５３ 在Ｐａｇｅｔ 病鉴别诊断中的价值。方法：对１１ 例阴囊Ｐａｇｅｔ 病回顾性地做Ｃａ１５３、ＥＭＡ、ＣＥＡ和ＨＭＢ４５ 免疫组化染色，并以４ 例Ｂｏｗｅｎ 病和１ 例恶性黑色素瘤做对照。结果：Ｃａ１５３ 、ＥＭＡ 在Ｐａｇｅｔ 病和大、小汗腺及皮脂腺均有较强的表达，４ 例Ｂｏｗｅｎ 病均无Ｃａ１５３ 表达，但其中２ 例有ＥＭＡ 表达。ＣＥＡ 在６ 例（５４．５ ％）Ｐａｇｅｔ 病中有表达。ＨＭＢ４５ 只在恶性黑色素瘤中表达。结论：Ｃａ１５３ 在Ｐａｇｅｔ 细胞的相对特异性表达提示它可作为Ｐａｇｅｔ 病与Ｂｏｗｅｎ 病鉴别诊断的标志物，其对诊断的敏感性与ＥＭＡ 相同，但特异性高于ＥＭＡ。同时还说明Ｐａｇｅｔ 病的发生可能与汗腺有关。

The value of Ca15-3 in differential diagnosis of Paget's disease

Objective: To probe the value of Ca15 3, an antibody to human milk fat globule membrane and to the membranous component of mammary cancer cells, in differential diagnosis of Paget's disease. Methods: A retrospective study of 11 cases of scrotal Paget's disease from 1984 to 1997 in our hospital was carried out, and 4 cases of Bowen's disease and 1 of malignant melanoma were studied as control. Ca15 3, EMA, CEA, HMB45 were immunostained in all cases. Results: Paget's cells stained strongly with antibodies Ca15 3 and EMA, and staining with Ca15 3 and EMA was also observed in the ductal and secretory portions of the eccrine and apocrine glands, and in the sebaceous gland cells. Staining with the antibody CEA was observed in 54.5% of the cases in Paget's disease, and none in Bowen's disease. Expression of EMA was also observed in 2 out of 4 cases in Bowen's disease. HMB45 was the only antigen expressed in malignant melanoma. Conclusion: Ca15 3 was specifically expressed in Paget's cells. This result demonstrated that Ca15 3 can be used as a marker in the differential diagnosis between Paget's disease and Bowen's disease. It has the same sensitivity as EMA and higher specificity than EMA in differential diagnosis. The coexpression of Ca15 3 in Paget cells and in cutaneous adenexal organs suggests that the origin of Paget cells may be the secretory cells of sweat glands.