这次我的诊断思路正确吗?请赵老师指正。
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- 81 y male pleural effusion (cqz-C16)
This case is very special one. Most of the cells are sigle or isolated with same cell population. They have classic features of mesothelial cells. . The key to pick up this case is too many cells. You can imagin It is very easy to miss the case if there are only a few tumor cells present.
Wish every one knows the priciple for pleural or peritoneal fluid cytology: Do some basic stains (Ber-EP4 and calretinin) to distinguish epithelial cells from mesothelial cells if you are not sure the dx.
This is for this case.
Thank people to read and discuss the case, especially Dr. viivi薇 .
| 以下是引用viivi薇在2010-9-4 14:55:00的发言：
如果只能选择3种标记物，第一个选择TTF-1，它主要表达于甲状腺腺上皮和肺的上皮细胞中 第二个选择是CK7和CK20联合使用标记。 赵老师，谢谢您的家庭作业。 |
Very done. I would do these three stains first.
CK7/ck20 stains are very useful for many purposes. We use these two stains for most cases for unknown primary in both cytology and surgical cases.
Should stain TTF1 for this case.
Can you tell us why?
| 以下是引用viivi薇在2010-9-4 14:37:00的发言：
thanks,Dr.zhao,I am not only interested that case,I want to learn knowledge of cytopathology from this case. I am not sure if it is a normal case of adenocarcinoma,maybe we can make some ICC makers for it to find a correct result. |
viivi薇 : After we know this is a metastatic ca, we must continue to work on the case and try to figure out the origin of the tumor. It is our duty to provide the correct and detailed information to clinicians and patients. Of cause often we cannot tell the exact origin in clinical practice. However we should try to or at least give some clues or suggestion.
Question No. 2
If you can only do three stains, tell us what three markers you will stain? I will come here to check the home work. If others want to make your suggestion you are welcome too.
thanks, cz
| 以下是引用viivi薇在2010-9-3 12:35:00的发言： 谢谢赵老师的指正，关于Calretinin and Ber-EP4在ICC标记物中的意义，我是查找国内的一本参考资料--《免疫组织化学病理诊断》P90中的表8-2找到的，谢谢赵老师告诉我这两种标记物正确的意义所在，现在从免疫组化的结果考虑转移性腺癌，赵老师，这次我对了吗？ |
Seem that only you are interested to this case. We can have one to one talk.
You are right.Suppose that I am your attending and your are my resident (truely you can be my teacher)
Do you think it is a normal case of adenocarcinoma based on the cytology?
Thank your explanation.
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如果整张涂片观察Calretinin呈局灶阳性，Ber-EP4强阳性，就考虑肺腺癌；如果整张涂片Calretinin为阴性，则考虑乳腺癌. Above is not correct. Both lung and breast cancers (almost all epithelial tumors) are positive for Ber-EP4 and negative for calretinin. Ber-EP4 and calretinin are only used for distinguish epithelial cells from mesothelial cells. They cannot tell the origins and the nature of the cells (benign or malignant). Of cause generally speaking if you find epithelial cells in 腹水 或pleural fluid are metastatic tumors. Above are basic stain priniciple in fluid IHC. for your reference |
