黏液素在肝内胆管癌中的表达

Expression of mucin glycoproteins and cytokeratins in intrahepatic cholangiocarcinoma

目的比较不同类型黏液素蛋白（MUC1、MUC2、MUC5AC、MUC6）在肝内胆管癌诊断中的价值，并结合各种细胞角蛋白（CK7、CK19、CK20）的表达，寻求有效的免疫标记组合，与转移性结直肠癌相鉴别。方法选取标本肝内胆管癌100例，肝转移性结直肠癌21例。所有病例均采用EnVision法，进行MUC1、MUC2、MUC5AC、MUC6、CK7、CK19和CK20的免疫组织化学染色。结果MUC1、MUC2、MUC5AC、MUC6在肝内胆管癌中的表达率分别为61．0％、2．0％、22．0％、8．0％；在转移性结直肠癌中的表达率分别为57．1％、47．6％、19．0％、23．8％。CK7、CK19和CK20在肝内胆管癌中的表达率分别为73．0％、53．O％、15．0％；在转移性结直肠癌中表达率分别为14．3％、90．5％、85．7％。其中MUC2、MUC6、CK7、CK20的表达差异有统计学意义。结论黏液素和细胞角蛋白联合应用，在肝内胆管癌的诊断与鉴别诊断中具有一定的指导作用。MUC2-、MUC6-、CK7＋、CK20-提示为肝内胆管癌，而MUC2＋、MUC6＋、CK7-、CK20＋提示为转移性结直肠癌。

Objective To compare the immunoprofiles of intrahepatic cholangiocarcinoma and metastatic colorectal adenoearcinoma for mucin glycoproteins （including MUC1, MUC2, MUCSAC and MUC6） and cytokeratins （including CKT, CK19 and CK20） , and to assess their diagnostic value. Methods One hundred cases of intrahepatic cholangiocarcinoma and 21 cases of metastatic colorectal adenocarcinoma were enrolled into the study. Immunohistoehemical study for MUC1, MUC2, MUCSAC, MUC6, CKT, CK19 and CK20 was carried out in all cases by EnVision method. Results In intrahepatic cholangiocarcinoma, the expression rates of MUC1, MUC2, MUCSAC and MUC6 were 61.0%, 2. 0%, 22. 0% and 8. 0% respectively, as compared to 57. 1% , 47.6%, 19.0% and 23.8% respectively in metastatic colorectal adenocarcinoma. On the other hand, the expression rates of CK7, CK19 and CK20 in intrahepatic cholangiocareinoma were 73.0% , 53.0% and 15.0% respectively, in contrast to 14. 3%, 90. 5% and 85.7% respectively in metastatic eolorectal adenocareinoma. The difference in expressions of MUC2, MUC6, CK7 and CK20 carried statistical significance. Conclusions The immunoprofile for mucin glycoproteins and cytokeratins provides important clues in distinguishing between intrahepatic cholangiocarcinoma and metastatic colorectal adenocarcinoma to liver. The immunophenotype of MUC2-/MUC6-/CK7 ＋/CK20- indicates the diagnosis of intrahepatic eholangiocarcinoma, while MUC2 ＋/MUC6 ＋/CK7 -/CK20 ＋ suggests the possibility of metastatic colorectal adenocarcinoma.