食管癌肉瘤的免疫组织化学研究

IMMUNOHISTOCHEMICAL ANALYSIS OF ESOPHAGEAL CARCINOSARCOMAS

目的 探讨食管癌肉瘤的组织发生学.方法 应用免疫组织化学LSAB法检测20例食管癌肉瘤的石蜡切片中Keratin,EMA,Vimentin,Actin,Desmin,Myoglobin,NSE,S-100,MAC 387,a1-AT,al-ACT和Lysozyme12种标记.结果癌肉瘤中的癌成份上皮性标记均为阳性.16例鳞癌Keratin +++,2例腺样囊性癌Keratin++,EMA++;1例粘液表皮样癌Keratin+++,EMA+;1例小细胞性未分化癌Keratin+,NSE十+,S-100++.肉瘤成份20例间叶性标记Vimentin+++,其中同时表达Actin++8例,又表达Desmin++6例,和Myoglobin++2例.另同时表达MAC387+十,S-100++,al-AT++,al-ACT++和Lysozme++6例.显示间叶肉瘤成份,同时伴有恶纤组、肌源性、神经纤维性、骨和软骨肉瘤等成份分化.20例癌肉瘤中肉瘤成份与上皮性和问叶性标记共同表达者11例.结论 免疫组化测定癌肉瘤中肉瘤成份上皮性和间叶性标记共同阳性者命名为肉瘤样癌是无可争议的.而瘤肉瘤中,癌成份和肉瘤成份分别表达上皮性和间叶性标记时,仍可沿用癌肉瘤的命名.如肉瘤成份完全显示上皮性标记的应属于低分化癌的范畴.对癌肉瘤中上皮性和问叶性分化谱系的认识,尚有待进一步验证.

PURPOSETo discuss the histogenesis of carcinosarcomas of the esophagus. METHODS Immunohis-tochemical staining was performed on formalin fixed, paraffin-embedded sections of 20 cases of carcino-sarcoma of esophagus to detect Keratin, EMA, Vimentin. Actin. Desmin. Myoglobin. NSE. S-100 protein. MAC387. αl-AT, αl-ACT and Lysozyme using LSAB method. RESULTS The results showed that (1) Staining for epithelial markers was positive in the carcinomatous components of all the 20 cases of carcinosarcoma. Staining for Keratin were highly positive(+-+) in 16 cases of squamous carcinomas; staining for Keratin ++. EMA ++ in two cases of adenoid cystic carcinomas: staining for Keratin +++, EMA + in one case of mucoepidermoid carcinoma: and staining for Keratin + NSE ++ S-100 -+ in one case of small cell undifferentiated carcinoma. (2) Staining for mesenchymal markers positive in the sarcomatous components. Staining for mesenchymal markers, Vimentin were high positive (+++) in 20 cases among whom staining for Actin ++ in 8 cases simultaneously. In the 8 cases, staining for Desmin + + in 6 cases and that for Myoglobin ++ 2 cases. Among the 20 cases, staining for Vimentin +++ MAC387 ++. S-100 ++. αl-AC ++, αl-ACT ++ and Lysozyme + + in 6 cases. The results showed that sarcomatous components were the components of mesenchymal sarcomas accompanied by the ingredient differentiated like malignant fibrous histocytoma. muscle, nervous fiber, bone and cartilage. Furthermore, staining for epithelial markers and that for mesenchymal markers were both positive in saromatous components of 11 cases. CONCLUSION The term sarcomatoid carcinoma was indisputably given to the tumor in which staining for epithelial markers and that for mesenchymal markers were both positive in the sarcomatous components of carcinosarcoma using immunohistochemical method, whereas when staining for epithelial markers and that for mesenchymal markers were respectively positive in carcinomatous components and sarcomatous components in carcinosarcoma. the term carcinosarcoma could still be adopted: and when staining for only epithelial markers was8positive in the sarcomatous components, the term poorly differentiated carcinoma was used. The spectrum between epithelial and mesenchymal differentiation in carcinosarcoma needs further test and verification.