沉渣包埋联合免疫组化在胸水转移性肺腺癌与胸膜恶性间皮瘤鉴别诊断中的应用

Application of immunohistochemistry in differential diagnosis of adenocarcinoma from mesothelioma with paraffin-embedded sediment of plural fluid cytology

目的探讨胸水沉渣包埋联合免疫组化方法在胸水转移性肺腺癌和胸膜恶性间皮瘤诊断及鉴别诊断中的应用价值。方法采用常规细胞涂片法和沉渣包埋联合免疫组化法对比62例患者胸水,免疫组化选用CEA、TTF-1、mesothelial cell(MC)、calretinin(CR)、vimentin、AE1/AE3和CK7抗体进行染色。结果常规涂片法诊断:转移性腺癌39例、恶性肿瘤细胞7例、可疑癌瘤细胞16例;沉渣包埋联合免疫组化法诊断:转移性腺癌54例、恶性间皮瘤8例。免疫组化示转移性腺癌CEA(81.5%)和TTF-1(81.5%)(+);恶性间皮瘤MC(87.5%)、CR(100%)和vimentin(100%)(+)。结论沉渣包埋联合免疫组化法在胸水转移性肺腺癌和胸膜恶性间皮瘤病理诊断分型方面明显优于常规细胞涂片法;CEA、TTF-1、MC、CR和vimentin抗体组合检测对胸水转移性肺腺癌与胸膜恶性间皮瘤的鉴别诊断具有重要意义。

Objective To discuss the value of the combined use of paraffin-embedded sediment sections and immunohistochemistry in differential diagnosis of metastasized adenocarcinoma from mesothelioma. Methods 62 cases were involved in this study. Cytological smears, sediment sections with CEA, TTF-1, mesothelial cell （MC） , calrentinin （CR） , vimentin, AEI/AE3, CK7 immunohistochemical assay were used. Results 39 cases of adenocarcinomas, 7 cases with malignant cells and 16 cases of undefined cells were diagnosed in cytological smears. 54 cases and 8 cases were definitely diagnosed as adenocarcinoma and mesothelioma, respectively, through sediment sections with immunohistochemical staining. The positive rate of CEA and TTF-1 in adenocarcinoma was 81.5% , 81.5% , respectively, whereas MC （ 87.5% ）, CR （ 100% ） and vimentin （ 100% ）, respectively, in mesothelioma. Conclusion The sediment sections combined with immunohistochemistry is more effective method in the differential diagnosis of malignant pleural fluid. Combined use of CEA, TTF-1, MC, CR and vimentin antibodies has a significant value in the differential diagnosis of adenocarcinoma from malignant mesothelioma.