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- 后腹膜病例-地坛
Glypican-3 (GPC3) 是一种参与细胞增生、迁移运动和调节细胞生存的糖蛋白，在一系列组织和多器官多种肿瘤中均有表达，例如肝癌、胃癌、肺癌、睾丸生殖细胞肿瘤、恶黑、间皮瘤、卵巢癌、乳腺癌、甲状腺癌、胰腺癌、泌尿系肿瘤等肿瘤中表达。
是不是应该注意到CK阴性而CAM5.2阳性，提示不是一般的上皮来源。另外加上Vimentin阳性，需要在思考。
本例肿瘤主要位于腹膜后，肾、胰来源、神经内分泌来源、生殖细胞来源也要考虑，透明细胞软组织肿瘤也应考虑纳入鉴别诊断。需要增加相关的主要标记。
- 王军臣
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This is a high grade and undifferentiated metastatic carcinoma of non-small cell type and of unclear primary anatomic/histologic origin. I do not think this is metastatic hepatocellular carcinoma, alveolar soft part sarcoma, melanoma, or classic Hodgkin lymphoma. Dendritic cell sarcoma and malignant mesothelioma are unlikely, but deserve to be ruled out by immunohistochemistry. It is very difficult to guess the primary origin, since this type of undifferentiated malignancy can be seen rarely in many organs, including kidney, pancreas, thyroid, testicle, liver and lung. I appreciate your sharing this challenging case, and look forward to any pertinent follow-up.
聞道有先後,術業有專攻
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本帖最后由 于 2010-12-09 06:46:00 编辑
| 以下是引用xljin8在2010-12-9 6:42:00的发言：
Shirakawa H, Suzuki H, Shimomura M, Kojima M, Gotohda N, Takahashi S, Nakagohri T, Konishi M, Kobayashi N, Kinoshita T, Nakatsura T. Glypican-3 expression is correlated with poor prognosis in hepatocellular carcinoma. Cancer Sci. 2009;100(8):1403-7.
The relationship between overexpression of glypican (GPC)-3 that is specific for hepatocellular carcinoma (HCC) and the prognosis has not yet been clarified. We attempted to determine the expression profile of GPC3 in association with the clinicopathological factors by immunohistochemical analysis in HCC patients and investigated the potential prognostic value of GPC3 by comparing the survival rate between the GPC3-positive and GPC3 negative HCC patients. Primary HCC tissue samples (n = 107)obtained from patients who had undergone hepatectomy between 2000 and 2001 were analyzed. GPC3 expression was less frequently observed in well-differentiated HCC than in moderately and poorly differentiated HCC, the difference in the frequency being statistically significant. GPC3-positive HCC patients had a significantly lower 5-year survival rate than the GPC3-negative HCC patients (54.5 vs 87.7%, P = 0.031). Among 80 of the 107 (74.6%) patients with initial treatment who underwent hepatectomy, none of GPC3-negative HCC patients (n = 16, 20.0%) died during the follow-up period. No deaths were noted in the GPC3-negative HCC patients among the 71 (88.7%) patients with moderately and poorly differentiated HCC. Multivariate analysis identified GPC3 expression (P = 0.034) as an independent prognostic factor for the overall survival. We showed that GPC3 expression is correlated with a poor prognosis in HCC patients. |
- xljin8
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本帖最后由 于 2010-12-11 05:47:00 编辑
临床病理特点：
1）年轻男性，腹腔多发性肿瘤。
2）形态学符合多形性恶性肿瘤。
3）IHC标记：肿瘤细胞Cam5.2+Vimentin+GPC-3+、SMA-Desmin-CD34-间皮细胞-； 间质细胞LCA+CD68+。
鉴别诊断需考虑：
1）恶性间皮瘤，增加标记：CK5/6、Calretinin、WT-1、D2-40、P16；
2）GIST， 但是Cam5.2 +难解释。可增加标记除外：Dog-1、CD117、CD34、Nestin。
3）经典性HL， 淋巴细胞消减型。Cam-5.2+难解释。增加标记除外：CD15、CD30。
4）多形性未分化肉瘤/MFH。须除外其他类型后考虑。
5）转移性肉瘤样肝细胞癌（差分化肝细胞癌）。根据：Cam5.2+、GPC-3+。要了解血浆AFP、是否存在肝硬化、肝脏影像学。
鉴别诊断中最好增加标记：
HepPar1、 CEA-多抗、CK8/18、AFP、HMB-45、EMA、CEA、CDX-2。
谢谢！
- xljin8
