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- 请各位老师看看这个是乳腺癌是肺转移来的吗？
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女 81岁 左侧乳房包块半月，左乳腺癌根治术后标本，剖开见大小见3*2.5*2.5CM，切面灰白质硬，肿瘤边界清， 肺部CT上见一
包块，CT考虑肺癌。
免疫组化：TTF-1(-) GCDF--15(-) CK7（++）CK18(+) CK20(-) villin（-） CEA(+) EMA(+) CK5/6(-) ER(-)PR(-) 是否为肺泡细胞癌乳腺转移？
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- 病理让疾病明明白白！
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Appl Immunohistochem Mol Morphol. 2012 Aug 20. [Epub ahead of print]
Applications and Limitations of Immunohistochemical Expression of "Napsin-A" in Distinguishing Lung Adenocarcinoma From Adenocarcinomas of Other Organs.
Source
Departments of *Pathology and Laboratory Medicine †Pathology, Tehran University of Medical Sciences, Hazrat Rasool-e-Akram Hospital, Tehran, Iran.
Abstract
BACKGROUND:: Distinguishing between primary lung adenocarcinoma and metastatic adenocarcinoma of lung before planning patient treatment is clinically important. Immunohistochemical markers play an important role in classification of primary lung tumors and are an effective method for separating metastatic tumors from primary pulmonary carcinoma. In this study, we evaluated the expression of Napsin-A in primary pulmonary carcinoma and some cases of nonpulmonary adenocarcinoma. MATERIALS AND METHODS:: The Napsin-A immunohistochemical evaluation was carried out using surgical specimens from 18 cases of adenocarcinoma, 19 cases of squamous cell carcinoma, 2 cases of large cell carcinoma, 1 case of bronchoalveolar carcinoma of lung, as well as 33 cases of renal cell carcinoma, 30 cases of thyroid neoplasm, 31 cases of colonic carcinoma, 31 cases of breast carcinoma, and 30 cases of endometrial adenocarcinoma. RESULTS:: For the primary lung carcinoma cases, all 18 cases of adenocarcinoma, 2 of the large cell carcinomas, and the 1 bronchioloalveolar carcinoma case were positive for Napsin-A. For the thyroid tumors, Napsin-A was positive in 14 cases of papillary carcinoma. Napsin-A was positive for 87.5% of papillary renal cell carcinoma cases and in 29.4% of clear cell carcinoma cases and for 1 chromophobe renal cell carcinoma case. Three out of 30 endometrial adenocarcinomas showed Napsin-A reactivity. All squamous cell carcinoma cases and adenocarcinomas of colon and breast were negative for Napsin-A. CONCLUSIONS:: Napsin-A is a useful marker for differentiating primary lung adenocarcinoma from squamous cell carcinoma. However, Napsin-A immunoreactivity has the potential to misguide a pathologist to conclude a metastasis from renal, thyroid, or endometrial carcinoma as a primary lung adenocarcinoma. Therefore, when there is a need to rule out lung metastasis from other organs, implementation of other biologically specific markers should be considered.
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Am J Clin Pathol. 2012 Nov;138(5):703-11. doi: 10.1309/AJCPKVBXTI9O3TEM.
Comparison of monoclonal napsin A, polyclonal napsin A, and TTF-1 for determining lung origin in metastatic adenocarcinomas.
Source
Dept of Pathology, State University of New York Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA. mukhopas@upstate.edu
Abstract
Thyroid transcription factor 1 (TTF-1) is currently the best immunohistochemical marker for carcinomas of lung origin. Our aim was to compare napsin A to TTF-1 for identifying pulmonary origin in metastatic adenocarcinoma and its mimics. One hundred fifty-five metastatic carcinomas (55 pulmonary, 100 nonpulmonary) were stained with monoclonal napsin A and TTF-1, and most also with polyclonal napsin A. The sensitivity of monoclonal napsin A, polyclonal napsin A, and TTF-1 for metastatic adenocarcinomas of pulmonary origin was 76%, 81%, and 82%, respectively. Two lung carcinomas were diffusely positive for monoclonal napsin A, but negative or equivocal for TTF-1. TTF-1 stained 9 of 100 nonpulmonary carcinomas (all thyroid), monoclonal napsin A stained 12 of 100 (4 sites), and polyclonal napsin A stained 27 of 91 (8 sites). Napsin A is expressed in a wider variety of metastatic nonpulmonary carcinomas than TTF-1, and the monoclonal antibody is more specific. Napsin A is a useful adjunct to TTF-1, because occasional lung adenocarcinomas are TTF-1 negative but napsin A positive.
