请问各位前辈，现在在诊断自身免疫性肝炎方面，对肝穿的组织有没有适合做免疫组化的抗体？？在诊断过程中，汇管区浆细胞浸润不是太明显，不知是浆细胞不明显，还是就根本没浆细胞？？晚辈想标记浆细胞，用CD19,CD20,CD22行吗？？请教各位 
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- 肝脏病理科在免疫组化中的应用 欢迎大家讨论
肝脏病理学中免疫组化染色是很重要的。在Washington University虽然特殊染色作为最重要的依据（Masson, PAS, 铜/铁染色），CK19是最重要的免疫组化指标（观察小胆管的变化）。而 具体的免疫组化的应用根据诊断的目的，个人粗略的分类如下：
1.病毒性肝炎病变：病毒学的检测，如HBS-Ag，CMV，EBV等；
2.自身免疫性肝炎或肝脏移植：PBS的小胆管改变，CK19;
3.肝脏代谢应疾病：如范素等的染色；
4.肝脏肿瘤，CD34,CK，特异性标记物（ER\PR\MCU\TTF-1等）系列鉴别转移性肿瘤；
- 用心做事、真情做人！
先提供一篇文献再说：
Agrin and CD34 Immunohistochemistry for the Discrimination of Benign Versus Malignant Hepatocellular Lesions
Abstract
Agrin is a recently identified proteoglycan component of vascular and bile duct basement membranes in the liver. The selective deposition of agrin in hepatocellular carcinoma (HCC) microvessels versus sinusoidal walls prompted us to investigate the utility of agrin immunohistochemistry (IHC) in detecting malignant hepatocellular lesions. We focused on the differential diagnostic problems often presented by hepatocellular adenomas (HCAs) and dysplastic nodules. IHC for agrin was performed on 138 formalin-fixed, paraffin-embedded surgical specimens from 93 patients, including cirrhotic liver tissues (25), focal nodular hyperplasia (10), large regenerative nodules (8), low-grade (23) and high-grade (7) dysplastic nodules, small HCC (8), HCC (27), and HCA (30). Agrin immunostaining was compared with that of CD34 and, in selected cases, to glypican-3. The combination of agrin and CD34 sensitively (0.94) and specifically (0.93) identified lesions judged previously as malignant by histology. The majority of benign lesions were clearly agrin-negative, whereas the strength and extent of agrin IHC faithfully reflected dysplasia in atypical HCAs and in high-grade dysplastic nodules. Malignant lesions were uniformly positive. In conclusion, as agrin is highly selective for tumor blood vessels, IHC for agrin facilitates the discrimination of benign and malignant hepatocellular lesions. Moreover, whereas glypican-3 in some HCCs may appear in few scattered cells only, agrin is diffusely deposited in virtually all malignant lesions, which may prove advantageous in the evaluation of small specimens such as core biopsies.
The American Journal of Surgical Pathology:June2009 Volume33 Issue6 pp874-885
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