胸腹水细胞块的免疫细胞化学研究

目的]行多项胸腹水细胞块的免疫细胞化学检测,探索一组鉴别良恶性及肿瘤起源的有价值的常规一抗试剂组.方法]收集胸腹水标本制成细胞块,HE染色筛检出间皮细胞反应性增生及可疑恶性或查见恶性细胞的病例59例.免疫细胞化学方法采用SP法,一抗用HBME-1、钙网膜蛋白(CR)、E-cad、CD44、CK7、CK20,腹水加做CA19-9(女性加做CA125),胸水加做TTF-1.结果]HBME-1在间皮瘤中表达57.1%(4/7)、转移腺癌中表达51.1%(23/45);钙网膜蛋白在间皮瘤中表达100%、腺癌中未表达;E-cad( )见于96.4%(53/55)恶性肿瘤;CD44( )见于反应性增生及恶性间皮瘤;TTF-1在肺癌中表达80.6%(25/31)、非肺源性未见表达;CK7( )在转移腺癌中表达86.7%(39/45),无特异性;CK20( )在肠癌中表达100%,CK7(-)/CK20( )具肠源性特异性;CA19-9在胃肠癌中表达100%,间皮瘤中亦表达2/7;CA125在卵巢癌表达75.0%(3/4),特异性100%.结论]E-cad鉴别良恶性胸腹水;CR鉴别是否间皮起源、TTF-1鉴别肺源性、CK7/CK20鉴别肠源性转移癌具有特异性及敏感性特点,它们可作为常规一抗鉴别良恶性及肿瘤起源.CA125鉴别卵巢癌具有相同特点,可作为女性患者腹水常规一抗.

Immunocytochemical Study of the Cell Blocks from Pleural Effusion and Ascite

s:To explore the most valuable reagent panel for differentiating malignancies from benign diseases and their origins by examining cell blocks from pleural effusions and ascites with immunocytochemical methods. The samples of pleural effusions and ascites were collected and made into cell blocks.Fifty-nine cases of the reactive proliferative mesothelial cells and malignant and suspicious malignant cells were selected by HE staining.SP immunohistochemical technique was used to detect the expression of HBME-1, CR, E-cad, CD44, CK7, CK20, and TTF-1 in specimens from pleural effusions addition, CA19-9 and CA125 in female ascites. The positive rate of HBME-1 was 57.1%(4/7) in mesotheliomas and 51.5%(23/45) in metastasis adenocarcinomas respectively. CR was expressed in all mesothelial cells and not expressed in adenocarcinomas. E-cad was expressed in 53/55(96.4%) cases with malignant tumors.CD44 was expressed in reactive proliferation and 7/7cases of malignant mesothelial cells. TTF-1 was positive in 80.6%(25/31)cases with lung cancer and negative in all non-pulmonary. The positive rate of CK7 was 86.7%(39/45) in metastasis adenocarcinomas but without specificity, CK20( ) was detected in all intestinal cancer and the pattern of CK7(-)/CK20( ) had specificity of intestinal origin;CA19-9 was seen in all gastrointestinal cancer and 2/7 cases of mesothelioma;The 3/4(75.0%)cases of ovarian cancer expressed CA125, specificity was 100%.Conclusion]E-cad can be used to differentiate malignancies from benign pleural effusions and ascites;CR can be used as a marker for mesothelium origin;TTF ,for lung origin,and CK7/CK20 ,for intestinal origin.They have the features of high specificity and sensitivity, so they can be used as the routine primary antibodies for differentiating malignancies from benign disease.CA125 had the same implication in ovarian cancer and can be used as the routine primary antibody for female's ascties.