[1]张功学,丁　凯,齐　峰,等.胸腔积液细胞块免疫组织化学检测对疑似肺癌患者的诊断价值[J].新乡医学院学报,2018,35(2):129-132.[doi:10.7683/xxyxyxb.2018.02.012]
　ZHANG Gong-xue,DING Kai,QI Feng,et al.Diagnostic value of pleural effusion cell block immunohistochemical examination in patients with suspected lung cancer[J].Journal of Xinxiang Medical University,2018,35(2):129-132.[doi:10.7683/xxyxyxb.2018.02.012]
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胸腔积液细胞块免疫组织化学检测对疑似肺癌患者的诊断价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年2
页码:
129-132
栏目:
临床研究
出版日期:
2018-02-05

文章信息/Info

Title:
Diagnostic value of pleural effusion cell block immunohistochemical examination in patients with suspected lung cancer
作者:
张功学; 丁　凯; 齐　峰; 杨　阳; 詹义凤; 马　飞
（枣阳市第一人民医院　湖北文理学院附属医院病理科，湖北　枣阳　441200）
Author(s):
ZHANG Gong-xue; DING Kai; QI Feng; YANG Yang; ZHAN Yi-feng; MA Fei
（Department of Pathology，the First People′s Hospital of Zaoyang City，the Affiliated Hospital of Hubei University of Arts and Science，Zaoyang 441200，Hubei Province，China）
关键词:
胸腔积液; 肺癌; 免疫组织化学; 液基细胞学
Keywords:
pleural effusion; lung cancer; immunohistochemistry; liquid based cytology
分类号:
R734.2
DOI:
10.7683/xxyxyxb.2018.02.012
文献标志码:
A
摘要:
目的　探讨胸腔积液细胞块（PECB）免疫组织化学检测在疑似肺癌患者中的诊断价值。方法　选取2014年12月至2016年12月枣阳市第一人民医院收治的疑似肺癌并发胸腔积液患者86例，细胞形态学诊断采用液基细胞学（LBC）涂片，并对细胞块进行免疫组织化学检测，包括CK7、CK5/6、p53、甲状腺转录因子-1（TTF-1）、calretinin、CD56、雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体-2（HER-2）、癌胚抗原（CEA）、癌抗原125（CA125）、CD30、CK20，根据细胞形态学和临床资料进一步进行免疫标记染色。结果　LBC涂片检测结果显示，86例患者中，转移性腺癌61例，转移性低分化癌11例，转移性小细胞癌3例，转移性可能大细胞癌2例，转移性鳞状细胞癌3例，恶性肿瘤2例，可疑性恶性肿瘤4例。免疫组织化学结果显示，86例患者诊断为肺原发灶转移69例（肺腺癌61例，肺鳞状细胞癌2例，肺腺鳞癌1例，小细胞肺癌5例）、肺外起源的转移性腺癌5例（乳腺癌2例，前列腺癌1例，卵巢癌1例，胰腺癌1例）、转移性鳞状细胞癌3例（食管癌2例，宫颈癌1例）、转移性腺鳞癌2例（宫颈腺鳞癌1例，直肠腺鳞癌1例）、转移性可能大细胞癌2例、大细胞神经内分泌癌3例、间皮瘤1例、未明确诊断1例。69例原发性肺部肿瘤转移患者中，TTF-1和CK7阳性表达63例，CK20阳性表达2例，p53阳性表达2例，CK5/6、CD56、calretinin均阴性表达。5例肺外起源的转移性腺癌中，1例乳腺癌ER、PR和HER-2阳性表达，1例乳腺癌ER和PR阳性表达，1例前列腺癌CK5/6阳性表达，1例卵巢癌ER阳性表达，1例胰腺癌CEA和CA125阳性表达。3例转移性鳞状细胞癌中，2例食管癌CEA和p53阳性表达，1例宫颈癌ER阳性表达。2转移性腺鳞癌中，1例宫颈腺鳞癌PR和TTF-1阳性表达，1例直肠腺鳞癌CK7和CEA阳性表达。结论　PECB免疫组织化学检查可准确诊断原发灶和各亚型肺癌，进一步帮助确定肺外源性肿瘤部位。
Abstract:
Objective　To investigate the diagnostic value of pleural effusion cell block（PECB） immunohistochemical examination in patients with suspected lung cancer.Methods　Eighty-six patients with suspected lung cancer and pleural effusion were selected from December 2014 to December 2016 in the First People′s Hospital of Zaoyang City.Liquid based cytology （LBC） smear was used for the diagnosis of cell morphology.Immunohistochemical detection of cell blocks was carried out，including CK7，CK5/6，p53，thyroid transcription factor-1（TTF-1），calretinin，CD56，estrogen receptor（ER），progesterone receptor（PR），human epidermal growth factor receptor-2（HER-2），carcinoembryonic antigen（CEA），cancer antigen 125 （CA125） and calretinin.Immunologic marker staining was further carried out according to the cell morphology and clinical data.Results　LBC smear test showed that there were 61 cases of metastatic adenocarcinoma，11 cases of metastatic poorly differentiated carcinoma，3 cases of metastatic small cell carcinoma，2 cases of metastatic large cell carcinoma，3 cases of metastatic squamous cell carcinoma，2 cases of malignant tumor and 4 cases of suspicious malignant tumor in the 86 cases.Immunohistochemical results showed that there were 69 cases of primary lung metastases （including 61 cases of pulmonary adenocarcinoma，2 cases of lung squamous cell carcinoma，one case of lung adenosquamous carcinoma and 5 cases of small cell lung cancer），5 cases of metastatic adenocarcinoma of extrapulmonary origin（including 2 cases of breast cancer，one case of prostatic cancer，one case of ovarian cancer and one case of pancreatic cancer），3 cases of metastatic squamous cell carcinoma（including 2 cases of esophageal carcinoma and one case of cervical cancer），2 cases of metastatic adenosquamous carcinoma（including one case of adenosquamous carcinoma of cervix and one case of adenosquamous carcinoma of rectum），2 cases of metastatic large cell carcinoma，3 cases of large cell neuroendocrine carcinoma，1 case of mesothelioma，and 1 case without definite diagnosis in the 86 cases.In the 69 cases of primary lung tumor metastasis，there were 63 cases with positive expression of TTF-1 and CK7 protein，2 cases with positive expression of CK20 protein and 2 cases with positive expression of p53 protein.The expression of CK5/6，CD56 and calretinin protein was negative in the 69 cases.In the 5 cases of metastatic adenocarcinoma of extrapulmonary origin，there was 1 case of breast carcinoma with positive expression of ER，PR and HER-2 protein，1 cases of breast carcinoma with positive expression of ER and PR protein，1 cases of prostatic cancer with positive expression of CK5/6 protein，1 cases of ovarian cancer with positive expression of ER protein and 1 cases of pancreatic cancer with positive expression of CEA and CA125 protein.In the 3 cases of metastatic squamous cell carcinoma，there were 2 cases of esophageal cancer with positive expression of CEA and p53 protein and 1 case of cervical cancer with positive expression of ER protein.In the 2 metastatic adenosquamous carcinoma，there was 1 case of adenosquamous carcinoma of cervix with positive expression of PR and TTF-1 protein and 1 case of adenosquamous carcinoma of rectum with positive expression of CK7 and CEA protein.Conclusion　PECB immunohistochemical examination can accurately diagnose primary focus and subtype lung cancer，and further help to determine the location of the exogenous tumor.

参考文献/References:

［1］　SIEGEL R L，MILLER K D，JEMAL A.Cancer statistics，2016［J］.CA Cancer J Clin，2016，66（1）：7-30.
［2］　孟加榕，郭以河，张闽峰，等.肺癌胸水细胞块与组织学EGFR基因扩增检测对比研究［J］.现代肿瘤医学，2012，20（9）：1830-1833.
［3］　PORCEL J M，PALMA R，BIELSA S，et al.TTF-1 and napsin A on cell blocks and supernatants of pleural fluids for labeling malignant effusions［J］.Respirology，2015，20（5）：831-833.
［4］　LV M，LENG J H，HAO Y Y，et al.Expression and significance of MOC-31 and calretinin in pleural fluid of patients with lung cancer［J］.Diagn Cytopathol，2015，43（7）：527-531.
［5］　闫崴，朱翔，贺蓓，等.薄层液基细胞学检测法与常规细胞学检测法在恶性胸腔积液诊断中的价值［J］.武汉大学学报（医学版），2015，36（6）926-929.
［6］　BROWN A F，SIROHI D，FUKUOKA J，et al.Tissue-preserving antibody cocktails to differentiate primary squamous cell carcinoma，adenocarcinoma，and small cell carcinoma of lung［J］.Arch Pathol Lab Med，2013，137（9）：1274-1281.
［7］　KHAYYATA S，YUN S，PASHA T，et al.Value of p63 and CK5/6 in distinguishing squamous cell carcinoma from adenocarcinoma in lung fine-needle aspiration specimens［J］.Diagn Cytopathol，2009，37（3）：178-183.
［8］　杨新，王秋实，李艳青，等.细胞蜡块结合免疫组化有效提高胸水细胞学阳性检出率的临床研究［J］.现代肿瘤医学，2014，22（12）：2894-2897.
［9］　徐小艳，刘红伟，姜黄，等.联合检测细胞蜡块中的napsin A和甲状腺转录因子-1有助于肺腺癌胸水的诊断［J］.南方医科大学学报，2015，35（11）：1610-1613.
［10］　KIM J H，CHOI Y D，LEE J S，et al.Utility of thyroid transcription factor-1 and CDX-2 in determining the primary site of metastatic adenocarcinomas in serous effusions［J］.Acta Cytol，2010，54（3）：277-282.
［11］　KARGI A，GUREL D，TUNA B.The diagnostic value of TTF-1，CK5/6，and p63 immunostaining in classification of lung carcinomas［J］.Appl Immunohistochem Mol Morphol，2007，15（4）：415-420.
［12］　李晓娟，李秀娟.胸水液基细胞学联合细胞块及免疫组化对提示肿瘤细胞组织来源的临床价值［J］.中国临床实用医学，2016，7（5）：38-41.

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更新日期/Last Update: 2018-02-05