| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- 食管贲门交界处病变
| 以下是引用benben520sps在2011-5-18 22:23:00的发言：
我们上周诊断了一例基底细胞样鳞癌，很少见得，主要是看它的HE特征，癌巢周围的细胞栅栏样排列，没有和经典的低分化鳞癌区分开来。 还有一点bcl-2在基底细胞样鳞癌里阳性是特异的吗？？？？ |
bcl-2抗体的敏感虽然高，但其应用的特异性不是同样的高，在一些淋巴瘤、癌和软组织肿瘤中都可表达。bcl-2的表达主要与某些细胞的增殖和细胞周期进程相关。因此，bcl-2对于基底细胞鳞癌不是特异的。
除了针对病原微生物的一些抗体外，任何抗体不管敏感性有多好，但其特异性都是相对的，这就是做肿瘤鉴别诊断时需要抗体套餐的理由所在。
以上如有不妥请指正。谢谢！
- 王军臣
-
benben520sps 离线
- 帖子：1045
- 粉蓝豆：568
- 经验：1254
- 注册时间：2009-07-28
- 加关注 | 发消息
| 以下是引用曹大夫在2011-5-11 2:46:00的发言： 小细胞癌是可以p63阳性的，我们昨天还有一例肺的小细胞癌是弥漫性的p63阳性。basaloid squamous cell carcinoma 不会是34be12 和ck5/6 阴性。 |
谢谢曹大夫的精辟点评！
欢迎曹大夫加盟国内！
欢迎来本专栏！
谢谢！
- 王军臣
-
小细胞癌是可以p63阳性的，我们昨天还有一例肺的小细胞癌是弥漫性的p63阳性。basaloid squamous cell carcinoma 不会是34be12 和ck5/6 阴性。
其实还有一个简单的IHC可做：就是pan-cytokeratin (AE1/3), 小细胞癌会出现perinuclear dot-like 染色。
至于是原发还是肺来源的，形态学本身和免疫组化学无法解决，因为其他部位的小细胞癌也可以TTF1阳性，当然TTF1阴性则更倾向于原发于食管的，因为肺的小细胞癌症是90%以上TTF1阳性。
以下文献采用样本配对评价了TTF-1和P63表达对小细胞性肺癌（13例）和肺低分化鳞状细胞癌（13例）的鉴别诊断意义。免疫组化标记结果显示，所有小细胞癌表达P63阴性(13/13)，而表达TTF-1呈阳性（12/13，即阳性率达92%)。相反，所有低分化鳞癌（13/13）表达P63阳性，不表达TTF-1。
结合这一文献，我们是不是要看看TTF-1的表达情况。如果本例TTF-1也是阳性，那我们还要进一步做工作来鉴别诊断。
Mod Pathol. 2006 Aug;19(8):1117-23. Epub 2006 May 5.
TTF-1 and p63 for distinguishing pulmonary small-cell carcinoma from poorly differentiated squamous cell carcinoma in previously pap-stained cytologic material.
Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston Medical School, Houston, 77030, USA.
Abstract
In histology and cell block sections, antibodies to thyroid transcription factor-1 (TTF-1) and p63 have been demonstrated to be useful markers for distinguishing between small-cell lung carcinoma and poorly differentiated pulmonary squamous cell carcinoma. In this study, we assessed the utility of TTF-1 and p63, as an antibody panel, for differentiating between these two neoplasms in previously Papanicolaou (Pap)-stained cytologic smears and cytospin slides. Twenty-six lung carcinomas (13 small-cell lung carcinomas, 13 poorly differentiated pulmonary squamous cell carcinomas) were evaluated. One or two previously 95% ethanol-fixed, Pap-stained smears or cytospin slides were selected from each case. The cytologic material from these slides was transferred to positively charged slides. Unstained recuts were obtained from the corresponding histologic specimens or cell blocks. Immunohistochemical staining for TTF-1 and p63 was performed on the paired samples from each tumor. All (13/13) small-cell lung carcinomas were negative for p63 and 92% (12/13) were positive for TTF-1. Conversely, all (13/13) poorly differentiated pulmonary squamous cell carcinomas expressed p63 and did not express TTF-1. Immunoreactivity for p63 was also noted in bronchial reserve cells and metaplastic squamous cells. The immunostaining results obtained from the cytology slides were concordant with those of the histology or cell block sections in all cases. The results of this study show that TTF-1 and p63 immunostaining can be successfully applied to previously Pap-stained cytologic material, as an antibody panel, to facilitate pathologic differentiation between small-cell lung carcinomas and poorly differentiated pulmonary squamous cell carcinomas. p63 immunostaining, however, must be interpreted in conjunction with cytomorphology to distinguish between poorly differentiated pulmonary squamous cell carcinomas and benign cellular constituents of the lung
- 王军臣
