浆膜腔积液中转移性腺癌与间皮细胞的病理学研究

Cytopathological differential diagnosis between reactive mesothelial cells and metastatic adenocarcinoma in serous effusion

目的探讨浆膜腔积液中转移性腺癌与反应性间皮细胞增生的鉴别。方法选取胸、腹水转移癌48例及反应性间皮细胞增生30例,采用常规涂片HE染色观察两者形态学特点,并应用免疫细胞化学SP法检测HBME-1c、alretinin、E-cadherin、MOC-31和BerEP4的表达。结果腺癌和间皮细胞两者形态各有特点,但是分化好的腺癌和明显增生的间皮细胞仅从常规涂片难以鉴别;免疫细胞化学显示反应性间皮细胞HBME-1和calretinin阳性率为86.7%和76.7%;而腺癌细胞只有少量表达,特异性高达95.8%和100%。MOC-31、E-cadherin和BerEP4对转移性腺癌细胞阳性率为70.8%、77.1%和88.4%,间皮细胞表达很少,特异性分别为90%、93.3%、93%。两者对5种抗体的表现差异显著。结论应用常规涂片和免疫细胞化学相结合的方法对鉴别转移性腺癌和间皮细胞增生有很大的帮助,最好应用一组抗体综合分析判断,HBME-1、Calretinin、E-cadherin、MOC-31及BerEP4是目前非常有效的组合。

Objective To study the differential diagnosis between reactive mesothelial cells and adenocarcinoma in pleural and peritoneal effusion. Methods 48 cases of metastatic adenocarcinoma and 30 cases of reactive mesothelium in serous effusions were collected and prepared for HE stained smears and cell blocks. The morphology of two types of cells were observed and the expression of HBME-1, calretinin, E-cadherin, MOC-31 and BerEP4 were detected by immunocytochemical S-P method. Results The morphological characteristics of metastatic adenocarcinoma cells and reactive mesothelial cells in serous effusions were different and it was however difficult to distinguish well-differentiated adenocarcinomas from markedly hyperplastic reactive mesothelial cells, just based on the smear characteristics. The positive rates of HBME-1 and calretinin for reactive mesothelial cells were 86.7% and 76.7%, and the specificities were 95.8% and 100%, respectively. And the positive rates of MOC-31, Ecadherin and BerEp4 for metastatic adenocarcinomas were 70.8%, 77.1% and 88.4%, and the specificities were 90%, 93.3% and 93 %, respectively. The differences between reactive mesothelial cells and adenocarcinoma were statistically significant （ P〈0.05）. Conclusions The combination of HE staining and immunocytochemistry on smear is great helpful for differential diagnosis of metastatic adenocarcinomas from mesothelial cells, especially adopting a panel of antibodies. It is very useful in differential diagnosis with antibody combination： HBME-1, ealretinin, E-cadherin, MOC-31 and BerEP4.