粘附分子相关蛋白在浆膜腔积液脱落细胞学中的表达意义

The expression signifcance of adhesion related protein in the exfolative cytology of serous effusion

目的:探讨粘附分子相关蛋白E-cadherin、CD44在浆膜腔积液脱落细胞学中的表达情况及其病理诊断意义。方法:收集浆膜腔积液标本制作成的细胞块,结合病史及HE筛检出间皮细胞反应性增生30例、转移癌123例及恶性间皮瘤11例。免疫细胞化学方法用SP法,评估用半定量分析法。结果:当以阳性面积>25%为准时,E-cadherin阳性见于95.52%(128/134)的恶性肿瘤细胞(P<0.005);CD44s阴性见于87.31%(117/134)恶性肿瘤(P<0.005);E-cadherin+/CD44-见于91.87%(113/123)转移癌(P<0.005)。当以阳性面积>10%为阳性时,E-cadherin阳性见于98.51%(132/134)的恶性肿瘤细胞;CD44阴性见于83.58%(112/134)恶性肿瘤细胞;E-cadherin+/CD44-见于89.43%(110/123)转移癌和9.09%(1/11)间皮瘤(P均<0.005)。单用E-cadherin+且以阳性面积>10%为准时与联用E-cadherin+/CD44-且以阳性面积>25为准时的比较差异有统计学意义(P<0.01)。结论:E-cadherin+、CD44-、E-cadherin+/CD44-模式提示恶性肿瘤,在浆膜腔积液脱落细胞学的诊断中有重要帮助,但以单用E-cadherin且以阳性面积>10%为准时其敏感性及特异性更高。

Objective： To explore the expression and pathological diagnostic significance of adhesion related protein, E-cadherin and CD44, in the exfolative cytology of the serous effusion. Methods：The samples of serous effusions were collected and made into cytoblocks. A total of 30 reactive proliferative mesothelial cell cases, 123 metastatic carcinoma cases and 11 malignant mesotheliomas were detected according to HE staining results and medical history. SP technique was used as immunochemical method, and immunocytochemistry was used for semiquatative analysis. Results. According to the criterion of positive area 〉25%, positive E-cadherin and negative CD44s was shown in 95. 52% （128/134） and 87.31% （117/134） malignant tumor cell cases （P both 〈0. 005）, respectively, coexistence of the two was presented in 91.87% （113/123） cases of metastatic carcinomas（P〈0. 005）. When applying the criterion of positive area 〉10%, positive E-cadherin and negative CD44 were shown in 98.51% （132/134） and 83.58% （112/134）cases of malignant tumor cell, respectively（P〈0. 005）, while coexistence of the two was presented in 89.43% （110/123） cases of metastatic carcinomas （P〈0.005） and 9. 09%（1/11） case of mesothelioma. Results were significant different when the criterion was positive E cadherin（positive area 10%）comparing with results under the criterion of coexistence of positive E-cadherin and negative CD44 （positive area〉25 %（P〈0.01）. Conclusions. Presence of positive E-cadherin and negative CD44, both a lone and in combination can help to diagnose malignant tumors, specifically, the criterion of positive E cadherin （positive area〉10%） shows higher sensitivity and specificity.