肝细胞癌与肝内胆管癌的免疫组化诊断

Evaluation of immunohistochemical markers for differential diagnosis of hepatocellular carcinoma from intrahepatic cholangiocarcinoma

目的评价一组免疫组化标志物在诊断和鉴别诊断肝细胞癌（HCC）和肝内胆管癌（ICC）中的价值。方法对手术切除的90例HCC和80例ICC分别进行石蜡包埋肝细胞1（Hep Par1）、多克隆性癌胚抗原（pCEA）、CD34、CD10、CD105、多药耐药相关蛋白3（MRP-3）、环氧合酶2（COX-2）、黏糖蛋白1（MUC-1）、水通道蛋白1（AQP-1）和CK19等10种抗体的免疫组化染色，比较其表达阳性率的差异性。结果HepPar1、pCEA、CD34、CD10、CD105、MRP-3和COX-2在HCC的表达阳性率分别为85．6％、82．2％、87．8％、18．9％、8．9％、11．1％和48．9％，MUC-1、AQP-1和CK19在ICC的表达阳性率分别为73．8％、65％和92．5％。结论HCC的一线诊断抗体由HepPar1和CD34组成，二线诊断抗体由pCEA和COX-2组成；ICC的一线诊断抗体由MUC-1和CK19组成，二线诊断抗体为AQP-1。

Objective To evaluate the significance of a panel of immunohistochemical markers for distinguishing bepatoceUular carcinoma （HCC） from intrahepatic eholangiocarcinoma （ICC）. Methods Ten markers including hepatocyte paraffin 1 （Hep Par 1 ）, polyelonal eareinoembryonie antigen （pCEA）, CD34, CD10, CD105, multidrug protein-3 （ MRP-3 ） , cyclooxygenase-2 （ COX-2 ） , mucinous glycoprotein-1 （ MUC-1 ）, aquaporin-1 （ AQP-1 ） and CK19 were immunohistochemically stained in the samples from 90 surgically resected HCC and 80 ICC, respectively, and the positive rate of their expression were compared statistically. Results The positive expression rates of Hep Par 1, pCEA, CD34, CD10, CD105, MRP-3, COX-2 were 85.6%, 82.2%, 87.8%, 18.9%, 8.9%, 11.1% and 48.9%, respectively, in HCC. While the positive expression rates of MUC-1, AQP-1 and CK19 were 73.8%, 65% and 92.5%, respectively, in ICC. Conduslon Based on our results, Hep Par 1 and CD34 can be used as the first line markers, and pCEA and COX-2 as the second line makers, for differential diagnosis of hepatocellular carcinoma from intrabepatic cholangiocarcinoma. While MUC-1 and CK19 can be used as the first line markers and AQP-1 as the second one for the differential diagnosis of intrahepatic cholangiocarcinoma from hepatoeellular carcinoma.