AMACR／34βE12／p63鸡尾酒双染对诊断前列腺癌及癌前病变的价值

The value of using an AMACR/34βE12/p63 cocktail double staining for diagnosis of prostate carcinoma and precarcinomatous lesions

目的探讨AMACR／34BE12／p63鸡尾酒双染对诊断小灶性前列腺癌及癌前病变的价值。方法从2005年6月起对3个月内临床连续送检的105例前列腺穿刺活检标本,6例前列腺癌根治标本和19例经尿道和耻骨上摘除的良性前列腺增生标本总计130个病例,1030个组织块中需要用免疫组织化学辅助诊断的262个组织块分别作AMACE／34βE12／p63鸡尾酒双染,同时作这3个抗体的单项染色,并结合HE切片和临床资料观察结果作出诊断。结果鸡尾酒双染切片中前列腺癌和高级别上皮内瘤变(HGPIN)上皮细胞呈蓝黑色,良性腺体的基底细胞呈红色。癌的蓝黑色腺上皮周围无红色基底细胞围绕,HGPIN的蓝黑色腺上皮周围有间断或连续的红色基底细胞。共在214个(82％)组织块中发现前列腺癌,包括31处小灶性癌。64个(24％)组织块中发现HGPIN,包括局灶性HGPIN和小腺泡性HGPIN。1个组织块有不典型性腺瘤样增生。未发现上皮细胞AMACR阳性同时基底细胞34βE12和p63阴性的良性腺体。结论鸡尾酒双染有助于提高小灶性前列腺癌和HGPIN检出率。

Objective To investigate the value of using an AMACR/34βE12/p63 cocktail and double-staining for the diagnosis of small focal protatic carcinoma and precarcinomatous lesions. Methods A total of 130 consecutive cases were examined over a 3-month period, including 105 prostate needle biopsy samples, 6 radical prostatectomy specimens and 19 benign prostatic hyperplasia specimens which were excised transurethra or above pubis. 262 paraffin blocks of all the 1030 ones were stained with hematoxylin and eosin and by immunostains for AMACR, 34βE12, p63, and an antibody cocktail comprising all the three with double-chromogen reaction. The diagnoses were then made according to the immunostaining, HE staining and clinical information. Results In the sections stained by the 3-antibody cocktail, blue-black cytoplasmic staining was observed in the epithelial cells of prostatic carcinoma and high-grade prostatic intraepithelial neoplasia（HGPIN） the basal cells of benign glands were stained red. There were no red basal cells around the blue-black glandular epithelium of carcinoma, but discontinuous or consecutive red basal cells were present around the blue-black glandular epithelium of HGPIN. Prostatic carcinoma was found in 214 paraffin blocks （82%）, including 31 small focal carcinoma. HGPIN were observed in 64 paraffin blocks （24%）, including focal HGPIN and small gland alveolus HGPIN. AAH was found in one block. No benign glands were simultaneously positive for AMACR and negative for basal cell markers. Conclusion Inmmunohistochemistry studies using a 3-antibody cocktail and double staining can improve the detection rate of small focal prostatic carcinoma and HGPIN.