细胞蜡块在恶性胸水诊断和个体化治疗中的应用价值

Value of cell blocks in the diagnosis and individualized treatment of malignant pleural effusion

目的探讨细胞蜡块结合免疫组化技术在恶性胸水诊断中的作用,并分析肺腺癌恶性胸水细胞蜡块在EGFR和ALK检测中应用价值。方法收集46例恶性胸水制作的细胞蜡块及对其进行免疫组化标记,镜下查看各恶性肿瘤的细胞学形态特点,并结合免疫组化标记进行诊断及鉴别诊断;收集确诊为肺腺癌的恶性胸水细胞蜡块,ARMS法检测EGFR突变,FISH法检测ALK基因重排。结果细胞蜡块玻片肿瘤细胞含量增加,见异型肿瘤细胞呈团簇状,核大、染色质粗糙,部分可见脱落的原始组织学特征;46例恶性胸腔积液结合免疫组化结果肺腺癌27例,肺小细胞癌3例,鳞状细胞癌4例,乳腺癌6例,淋巴瘤3例,间皮瘤1例,卵巢癌2例。21例接受基因检测的病例中,EGFR突变率47.6%(10/21),其中EGFR-19del突变5例,EGFR-L858R突变4例,ins插入突变1例;ALK基因重排率9.5%(2/21)。结论细胞蜡块结合免疫组化技术不仅能明确恶性胸腔积液的性质,更能够确定肿瘤的原发部位。胸水细胞蜡块是肺腺癌合适的基因检测标本,能为临床的个体化治疗提供帮助。

Objective To explore the role of cell blocks combined with immunohistochemical examination in the diagnosis of malignant pleural effusion(MPE),and to analyze the value of MPE cell blocks of lung adenocarcinoma in the detection of EGFR and ALK.Methods 46 cases of MPE based cell blocks were collected for immunohistochemical staining.The cell morphology was examined under a light microscope,and combined with immunohistochemical method to detect the expression for differential diagnosis.The MPE cell blocks were collected from patients diagnosed as lung adenocarcinoma,and EGFR mutation was detected by ARMS and ALK rearrangement was detected by FISH.Results The tumor cells were increased in cell blocks and exhibited clustering structure,large nuclei and rough chromatin.Cell blocks were concentrical and maintained their original cytological structure.Among 46 MPE cases,27 cases were lung adenocarcinoma,3 cases were lung small cell carcinoma,4 cases were lung squamous cell carcinoma,6 cases were breast carcinoma,3 cases of lymphoma,1 case was mesothelioma,and 2 cases were ovarian origin.21 cases received gene testing.EGFR mutation rate was 47.6%(10/21),among which 5 cases were EGFR-19 del mutation,4 cases were EGFR-L858 R mutations,and 1 case was ins insertion mutation;ALK rearrangement rate was 9.5%(2/21).Conclusion Cell blocks combined with immunohistochemical technique can not only clarify the nature of MPE but also determine the primary site of tumor.The pleural fluid cell block is a suitable genetic test specimen for lung adenocarcinoma,which can provide help for clinical individualized treatment.