血清AFP阴性肝细胞肝癌免疫组化诊断谱研究

Application of immunohistochemical spectrum in diagnosis and differential diagnosis of hepatocellular carcinoma with negative serum AFP

目的探讨Hep Par1等抗体在诊断血清AFP阴性肝细胞肝癌(HCC)及鉴别肝内胆管细胞癌(ICC)、肝转移性腺癌(MAC)中的意义。方法选取手术切除100例血清AFP阴性HCC、30例ICC及36例MAC(胃腺癌30例、肺腺癌6例)石蜡标本,根据Hep Par1等抗体的染色、表达率、金标准诊断、综合性能计分(CCS)筛选免疫组化诊断谱。结果血清AFP阴性HCC中,Hep Par1胞浆染色(CCS≥8);CD34血管均匀染色(CCS=9);CD10(CCS=8)及CEA毛细胆管染色。ICC、MAC中,CK19(ICC中CCS=7)、CK7(MAC中CCS=7)胞浆染色,CEA膜浆染色。结论诊断血清AFP阴性HCC联用CD34与Hep Par1(或CD10、CEA);鉴别诊断ICC、MAC分别加用CK19、CK7。

Objective To investigate the significance of hepatocyte paraffin-1 （Hep Par-1）,cluster of differentiation 34 （CD34）,cluster of differentiation 10 （CD10）,carcinoembryonic antigen （CEA） and cytokeratin （CK） expression in the diagnosis of hepatocellular carcinoma with negative serum AFP and in the differential diagnosis among AFP （-） HCC,intrahepatic cholangiocellular carcinoma （ICC） and metastatic adenocarcinoma （MAC）.Methods Paraffin-embedded surgical specimens were collected from 100 patients with AFP （-） HCC ,30 ICC patients and 36 MAC patients at Nantong Tumor Hospital from 1989 to 2009.All specimens were stained immunohistochemically for Hep Par 1,CD34,CD10,CEA and Cytokeratin,with the stain and expression,the immunohistochemical spectrum was organized according to gold standard and comprehensive capacity score （CCS）.Results There were statistically significant differences in the positive expression rates of Hep Par 1,CD34,CD10,CK7 and CK19 in AFP（-） HCC,ICC and MAC （all P0.01）.In AFP（-） HCC,Hep Par 1 staining showed uniform brown granular staining in cytoplasm,the CCS was 9 and 8 scores,CD34 staining showed uniform brown twig-like staining in the blood vessels,the CCS was 9 scores.CD10 and CEA staining showed bile duct staining,the CCS of CD10 was 8 scores,the CCS of CEA was 6 and 5 scores.The expression of CK was mostly negative,the CCS of CK20 was 7.In ICC,the expression of Hep Par 1,CD34 and CD10 was mostly negative.CEA showed membranous cytoplasmic staining,CK7 and CK19 showed cytoplasmic granular staining,the CCS of CK19 and CK20 was 7 scores.In MAC,the expression of Hep Par 1 was negative or showed weakly cytoplasmic staining.CEA showed membranous cytoplasmic staining.The expression of CD34,CD10 and CK20 was mostly negative.The expression of CK7,CK20 and CK19 was granular staining in cytoplasm,the CCS was 7 scores.Conclusion The immunohistochemical spectrum in diagnosis and differential diagnosis of AFP （-） HCC was composed as following,Hep Par 1 and CD34 can be used as the firstline antibodies in the initial screening diagnosis of AFP （-） HCC combined with may （or second-line antibody CD10 and CEA）,for the further differentiation of ICC,CK19 can be used as the second-line antibody,for the further differentiation of MAC,CK7 can be used as the second-line antibody.