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- Older women pelvic mesothelioma (cqz2)
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本帖最后由 于 2008-12-27 12:27:00 编辑
| 以下是引用天山望月在2008-12-17 20:05:00的发言：
谢谢Dr.zhao！您的病例太精彩！并请赐教！ 反复阅读此例，细胞圆形、立方状，浆淡红，排列呈腺泡样，细胞轻度异型，4、5楼图有乳头状的感觉，有钙化。 IHC 示： Calretinin弥漫（+），CK5/6弥漫（+），Mesothelin弥漫（+），BerEP4（-)，ER(-)支持间皮瘤的诊断。 WT1 +：肾母细胞瘤的标记，不知对间皮瘤的的诊断有何意义？ CK7+：在肺腺癌、乳腺癌、唾腺癌、胰腺癌、子宫颈管及内膜腺癌、间皮瘤，都成（+） MOC-31 -：胆管细胞癌此抗体阳性。不知对间皮瘤有何作用？用于鉴别诊断？ 综合分析诊断：盆腔间皮瘤。分化型乳头状间皮瘤？恶性间皮瘤？想请赵老师再提供较多的临床病史：肿瘤的范围等。 |
WT1 positive for mesothelioma. It may be useful or not for differential dx. It is useful for distinction of mesothelioma from endometrioid ca or other GI tumors et al, but not useful for distinction of mesothelioma from serous papillary ca (both positive).
CK+: No use. as you mentioned mesothelial cells and many others are positive
MOC-31. it is a good epithelial marker. Almost all mesotheliomas or mesothelial cells are negative. But remember no any IHC is 100% pos or negative. I once had a case -mesothelial cells in peritoneal fluid showing strong positivity for MOC-31 fluid. This is why we often need two mesothelial markers and two epithelial markers in peritoneal/pleural cytology.
You must be or will be an excellent pathologist becuse you study so hard and carefully.Hope most pathologists in China can do the same as you did.
Thanks
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本帖最后由 于 2008-12-03 04:46:00 编辑
IHC results:
F1 Calretinin
F2 CK5/6
F3 Mesothelin
F4. BerEP4
Others:
WT1 +
CK7+
MOC-31 -
ER-
Abin summaried well. Generally at least two mesothlial markers and two epithelial markers are needed for the differential dx.
Lesson: Always consider the possible differential dx and decide to order the IHC stains.
Final dx: mesothelioma
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When we have a case we must have differential diagnosis. In other words we must think many different possible diagnoses, then order the necessary IHC and rule out others.
You cannot just have a possible dx and order one stain. We as pathologists should consider and analyse questions more widely.
