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- 膀胱肿块，怎么报告？
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本帖最后由 红胜火 于 2012-07-07 15:10:47 编辑
引用 4 楼 xyyyzgy 在 2012-07-07 13:08:27 的发言:
尿路上皮癌恒定表达CK20？本例CK20,CK7均阴性，坏死中有些是角化吗？要考虑鳞癌吗？尿路上皮癌和鳞癌有免疫组化指标可以鉴别吗？
这个问题很是关键。本例有层状角化，有鳞状上皮分化，而且有异型，免疫组化p63阳性，CK7阴性，提示可能为鳞癌。但泌尿道肿瘤比较特殊，鳞癌在这个部位的定义：Squamous cell carcinoma is defined as a malignant neoplasm derived from the urothelium that shows a pure squamous cell phenotype .When urothelial elements (including urothelial carcinoma in situ) are present the tumor should be classifi ed as urothelial carcinoma with squamous differentiation.
所以，在被电刀切的很难辨认细胞的情况下，还是诊断为尿路上皮癌伴鳞状分化为好！
这一例是恶性的吗？从细胞的异型性看，诊断恶性应该可以。
还有一个问题没有回答就点提交了。
尿路上皮癌与鳞癌的免疫组化鉴别很难。它们都会表达CK5/6、CKHMW、p63，但鳞癌好像一般不表达CK7，而CK7在尿路上皮癌中据文献所说表达率较高！这可能是鉴别点。请更多网友给出答案。
Arch Pathol Lab Med. 2001 Jul;125(7):921-3.
Cytokeratin 7 and cytokeratin 20 in primary urinary bladder carcinoma and matched lymph node metastasis.
Source
Department of Pathology, Indiana University School of Medicine, Indianapolis, Ind. 46202, USA.
Abstract
BACKGROUND:
-Cytokeratin 7 (CK7) and cytokeratin 20 (CK20) are 2 types of intermediate filament protein. Expression of CK7 is seen in the majority of primary urinary bladder carcinomas. CK20 is restricted to superficial and occasional intermediate cells of the normal urothelium of the bladder. Aberrant CK20 expression has been documented in urothelial carcinoma and has proved useful as an ancillary diagnostic aid for urinary bladder tumor. Our hypothesis is that the pattern of CK7 and CK20 expression in metastatic urothelial carcinoma duplicates the expression of the same markers in the primary tumors. Therefore, immunohistochemical staining of metastatic tumors for these 2 markers may be helpful for differential diagnosis in ambiguous metastatic tumor deposits.
OBJECTIVE:
-To determine the concordance of CK7 and CK20 expression in primary bladder urothelial carcinoma and the matched lymph node metastasis.
DESIGN:
-We studied 26 patients with lymph node metastases who underwent radical cystectomy and bilateral lymphadenectomy for bladder carcinoma. Immunohistochemical staining for CK7 and CK20 was performed on formalin-fixed paraffin-embedded tissues containing primary cancers and lymph node metastases.
RESULTS:
-In all cases, there was a concordant expression of CK20 in the primary cancer and its matched lymph node metastasis. Twelve cases (46%) showed positive CK20 immunoreactivity in the primary tumor and its matched lymph node metastases, whereas 14 cases (54%) were negative for CK20 in both the primary tumor and lymph node metastasis. All cases showed positive CK7 immunoreactivity in the primary cancers and matched lymph node metastases.
CONCLUSIONS:
-CK20 immunoreactivity is reliably observed in metastases from bladder cancer when the primary tumor expresses CK20.
J Cutan Pathol. 2010 Sep;37(9):966-72. Epub 2010 May 26.
CK7 expression in primary cutaneous squamous cell carcinoma.
Source
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. pulitzem@mskcc.org
Abstract
AIM:
To evaluate cytokeratin 7 (CK7) immunoreactivity in invasive primary cutaneous squamous cell carcinomas (SCCs).
METHODS:
Twenty-seven primary cutaneous SCCs from 25 patients were evaluated for tumor grade using hematoxylin and eosin-stained slides and for percentage and intensity of immunoreactivity for CK7. All cases exhibited features of SCC with an in situ component. No glandular or tubular differentiation was present. Staining intensity was graded on a scale of 0-3, with 0 indicating no reaction. Of immunoreactive cases, percentage of tumor staining and distribution of immunoreactivity was documented.
RESULTS:
Six of 27 SCCs (22%) exhibited immunostaining for CK7. Of those cases, three were poorly differentiated, exhibiting 2 to 3+ intensity in 5-15% of cells. Two were poorly differentiated, with 2 to 3+ intensity in 30-60% of cells. The remaining immunoreactive tumor was moderately differentiated, with 1+ intensity and 5% staining in an area of microinvasion.
CONCLUSION:
A subset of cutaneous SCCs, in particular, poorly differentiated tumors, may show focal-to-partial immunoreactivity for CK7. This is important to bear in mind when immunohistochemistry is used to distinguish SCC from simulants, such as porocarcinoma, or other adnexal carcinomas with squamous metaplasia.
这两篇文献对CK7在尿路上皮癌及鳞癌中的表达进行研究，值得一看。还有，大家注意没有，老外的文章很简单，就是研究一个问题，使用一个免疫组化手段，不像国内，动不动要去搞基因，好像没有基因就出不了、就不是好文章，没有基因就不能解决临床问题。
