一病人，两年前做食道癌根治术，现在出现双侧锁骨上淋巴结肿大，肺部占位（一个，有毛刺征），活检右侧锁骨下淋巴结示转移性低分化癌倾向于鳞癌，请问免疫组化能鉴别是肺来源还是食道来源的吗

 No.  you cannot tell the site of origin of SCC by immunohistochemistry.  The only way that maybe helpful is to review the oesophageal SCC slides to see if it is similar to the lymph node metastasis.

Virchow's node (on the left ) is originally described to represent gastric carcinoma metastasis.  However right supraclavicular lymph node tends to drain thoracic malignancies such as lung and oesophageal cancer.

Rarely oesophageal SCC is HPV related, but not very common in Chinese population.  A p16 maybe helpful in this senario.

谢谢了

 No.  you cannot tell the site of origin of SCC by immunohistochemistry.  The only way that maybe helpful is to review the oesophageal SCC slides to see if it is similar to the lymph node metastasis.

Virchow's node (on the left ) is originally described to represent gastric carcinoma metastasis.  However right supraclavicular lymph node tends to drain thoracic malignancies such as lung and oesophageal cancer.

Rarely oesophageal SCC is HPV related, but not very common in Chinese population.  A p16 maybe helpful in this senario.

免疫组化很难能告知你这个鳞状细胞癌的原发部位，可能只能把原来食道鳞癌的切片拿来同现在淋巴结转移性鳞癌进行比对一下看是是否形态上相同。 左侧锁骨上淋巴结通常为胃癌转移，但是右侧锁骨上淋巴结多为胸腔恶性肿瘤转移，如肺和食道肿瘤等。

比较少的食道鳞癌和人类乳头状病毒相关，在中国人口中也不常见，P16对你的病例可能会有些帮助。