细胞块联合免疫组化检测对胸腔积液中腺癌与间皮的鉴别作用

Differentiation between adenocarcinoma cells and mesothelial cells in pleural effusion by cell block technique combined with immunohistochemistry

目的探讨细胞块联合免疫组化在胸腔积液中鉴别腺癌细胞与增生性间皮细胞的应用价值。方法选择2017年1月至2020年5月昆山市第一人民医院病理科169例胸腔积液标本,采用离心沉淀细胞块包埋,石蜡切片观察细胞学形态,并采用免疫组化方法检测波形蛋白(Vimentin)、细胞角蛋白5/6(CK5/6)、肾母细胞瘤基因(WT-1)、钙网膜蛋白(Calretinin)、癌胚抗原(CEA)、细胞角蛋白7(CK7)、人类全癌上皮相关糖蛋白2(MOC-31)、上皮特异抗原(Ber-Ep4)的表达。结果169例标本中,细胞石蜡切片联合免疫标记诊断结果为转移性腺癌105例,反应性增生间皮细胞64例。CEA、CK7、MOC-31、Ber-Ep4在腺癌中的阳性表达率分别为81.0%、66.7%、90.5%、81.9%;而在增生性间皮中,阳性表达率仅为6.3%、12.5%、4.7%、7.8%。Vimentin、CK5/6、WT1、Calretinin在增生性间皮中,阳性表达率分别为87.5%、84.3%、92.2%、90.6%;而在转移性腺癌中,阳性表达率仅为28.6%、17.1%、14.3%、4.8%。腺癌细胞与增生的间皮细胞对上述8种抗体的表达有统计学意义(P<0.05)。结论细胞块联合免疫组化对胸腔积液鉴别腺癌细胞与反应性增生间皮细胞有显著意义,在临床病理细胞学诊断中有很高的应用价值。

Objective To explore the application value of cell block technique combined with immunohistochemistry in differentiating adenocarcinoma cells from proliferative mesothelial cells in pleural effusion.Methods A total of 169 pleural effusion specimens were collected from the Department of Pathology of the First People’s Hospital of Kunshan from January 2017 to May 2020.Cell blocks were prepared by centrifugal precipitation and embedding and paraffin sections were used to observe the cytological morphology.Expression of vimentin,cytokeratin 5/6(CK5/6),Wilms’tumor gene(WT-1),calretinin,carcinoembryonic antigen(CEA),cytokeratin 7(CK7),human pancarcinomaassociated epithelial glycoprotein-2(MOC-31)and epithelial specific antigen(Ber-Ep4)was detected by immunohistochemistry.Results Among 169 specimens,105 cases of metastatic adenocarcinoma and 64 cases of reactive mesothelial proliferation were diagnosed by cell paraffin section combined with immunolabeling.The positive expression rates of CEA,CK7,MOC-31,and Ber-Ep 4 in adenocarcinoma were 81.0%,66.7%,90.5%,and 81.9%respectively,while in hyperplastic mesothelium,the positive expression rates were only 6.3%,12.5%,4.7%,and 7.8%.The positive expression rates of Vimentin,CK5/6,WT 1,and Calretinin were 87.5%,84.3%,92.2%,and 90.6%respectively,while in metastatic adenocarcinoma,the positive expression rates were 28.6%,17.1%,14.3%,and 4.8%.There were significant differences in the expression of these 8 antibodies above-mentioned between adenocarcinoma cells and proliferative mesothelial cells(P<0.05).Conclusion Cell block technique combined with immunohistochemistry has significant effects in differentiating adenocarcinoma cells from reactive proliferative mesothelial cells in pleural effusion,and has high application value in clinical pathological and cytological diagnosis.