甲状腺转录因子-1、表面活性蛋白-B及细胞角蛋白对鉴别肺原发和转移性腺癌的意义

Use of thyroid transcription factor-1,surfacfant protein-B,cytokeratin 7 and cytokeratin 20 in discrimination between primary and metastatic adenocarcinomas of lung

目的 研究鉴别肺原发腺癌和肺转移性腺癌的一组免疫组化标记物。方法 对 72例肺叶切除标本 ,包括 4 2例肺原发腺癌和 30例肺转移性癌进行常规福尔马林固定 ,石蜡包埋切片 ,用免疫组化方法检测了甲状腺转录因子 1(TTF 1)、表面活性蛋白 (SP B)及细胞角蛋白 (CK7、CK2 0 )的表达。结果 TTF 1和SP B在肺原发腺癌中的表达率分别为 74 %和 5 2 %。两种抗体相结合 ,在肺原发腺癌中表达的阳性率和特异性分别为 79%和 94 %。肺原发腺癌CK7染色全部为阳性 ,CK7阳性 /CK2 0阴性者 2 4例 (5 7% ) ,CK7阳性 /CK2 0阳性者 18例。肺转移癌以结肠腺癌及乳腺癌为主。结肠腺癌CK2 0染色全部为阳性 :CK7阴性 /CK2 0阳性者 11例 (92 % ) ,CK7阳性 /CK2 0阳性者1例。乳腺癌对细胞角蛋白染色结果与肺原发腺癌相似 :CK7阳性 /CK2 0阴性者 4例 ,CK7阳性 /CK2 0阳性者 4例。联合 4种抗体染色结果 :肺原发腺癌以CK7阳性 /TTF 1或SP B阳性为主(79% ) ,肺转移性乳腺癌以CK7阳性 /TTF 1和SP B阴性为主 ,肺转移性结肠癌以CK2 0阳性 /CK7阴性 /TTF 1和SP B阴性为主 ,P均 <0 0 0 1。结论 联合使用TTF 1、SP B、CK7和CK2 0这一组抗体有助于鉴别肺原发腺癌和转移性腺癌 ,以及提示某些常见肺转移性腺癌的原发部位。

Objective To evaluate the utility of thyroid transcription factor-1 (TTF-1), surfacfant protein-B, (SP-B) cytokeratin 7 (CK7) and CK20 immunostaining in the discrimination between primary adenocarcinomas and metastatic adenocarcinomas. Methods Formalin fixed, paraffin embedded tissue blocks from 42 primary lung adenocarcinomas and 30 metastatic carcinomas resected during operation were immunostained with monoclonal antibodies to TTF-1, SP-B, CK7, and CK20. Results Positive immunostaining with TTF-1 and SP-B was noted in 74% and 52% of primary lung tumor, respectively. The positive immunostaining and specificity of such a combination for discriminating between primary and metastatic adenocarcinoma were 79% and 94%, respectively. All primary lung adenocarcinomas were CK7 positive, 24 (57%) were CK7 positive / CK20 negative and 18 were CK7 positive /CK20 positive in immunophenotype. Colon and breast were the most common sites of metastasis. All metastatic colorectal adenocarcinomas were CK20 positive, 11 (92%) were CK7 negative / CK20 positive and 1 was CK7 positive /CK20 positive in immunophenotype. The results of cytokeratin immunostaining in the metastatic breast tubular carcinomas were similar to those in the primary lung adenocarcinomas: 4 were CK7 positive/ CK20 negative and 4 were CK7 positive/ CK20 positive. CK7 positive, and TTF-1 or SP-B positive immunophenotype was seen in 33 (79%) primary lung tumors. A combination of CK7 negative, CK20 positive, and TTF-1 and SP-B negative was highly significantly associated with metastatic colorectal carcinomas compared with either primary lung adenocarcinomas or metastatic breast carcinomas (both P <0.001). A combination of CK7 positive, CK20 negative, and TTF-1 and SP-B negative was highly significantly associated with metastatic breast carcinomas compared with either primary lung adenocarcinomas or metastatic colorectal carcinomas (both P <0.001). Conclusion Use of a panel of antibodies including TTF-1, SP-B, CK7 and CK20 is helpful in discriminating between primary and metastatic adenocarcinomas of the lung and suggesting the primary sites of some metastatic adenocarcinomas.