摘要
目的探讨细胞蜡块在晚期腺癌诊断及肺腺癌个体化治疗中的应用价值。方法收集细胞学制片后剩余的细胞标本制备蜡块,行HE染色;同时选择TTF1、Napsin A、CK7、CK20、Villin、CDX2等抗体,对来源不明的肿瘤细胞进行免疫组化标记,并对明确诊断肺腺癌的病例,采用ARMS法检测EGFR基因突变。结果 72例患者中,64例有恶性细胞,8例有异型腺样细胞。64例恶性细胞中腺癌50例,鳞状细胞癌4例,小细胞癌8例,膀胱癌1例,白血病1例。不同组织类型的肿瘤细胞在石蜡切片中具有特征性表现,腺癌细胞呈腺样、乳头状或单个散在排列;鳞状细胞癌呈典型组织学表现,可见细胞间桥;小细胞癌的形态与细胞涂片相似。50例腺癌的免疫组化结果及临床证实为肺腺癌29例,胃腺癌4例,大肠癌3例,卵巢腺癌5例,乳腺癌2例,胆囊癌1例,睾丸卵黄囊瘤转移1例;1例临床提示肺占位,但免疫组化标记不表达任何抗体;4例起源不明。8例异型腺样细胞的免疫组化标记显示异型细胞为增生的间皮细胞。29例肺腺癌中,22例采用ARMS法进行EGFR基因检测,结果显示EXON-19 E746_A750del(1)(2)突变和EXON-21 L858R突变各5例,突变阳性率为45.4%(10/22)。结论利用细胞学剩余标本制备蜡块,结合免疫组化标记和分子病理技术有助于晚期肿瘤的诊断,并为个体化治疗方案的选择提供帮助。
Purpose To investigate the clinical value of cell block in the diagnosis of advanced cancer and the individualized treatment of non-small cell lung cancer. Methods The cell block was produced using the cytological specimen remains after routine smear. HE staining was preformed, while immunohistochemical method was used to detect the expression of an appropriate set of antibodies （TTF1, Napsin A, CKT, CK20, Villin, and CDX2） , in the tumor cells of unknown origin. The EGFR gene was detected by ARMS in lung adenocarcinoma. Results In 72 patients, 64 cases were found cancer cells and 8 cases were atypical glandular cells on the cell smear and cell block sections. Among of 64 malignant cases, 50 cases were adenocarcinoma, 4 cases of squamous cell carcinoma, 8 cases of small cell carcinoma, one case of bladder cancer and one case of leukemia. The cancer cell presented different pattern accord- ing to the histological classification in the cell block. The adenocarcinoma cells arranged in glandular, papillary patterns or diffuse sin- gle cell. The squamous cell carcinomas displayed intercellular bridges which were the typical features of squamous cells. The morpholo- gy of small cell carcinoma in cell block was similar to that in the cytological smear. According to the clinical history and immnohisto- chemical staining, the 50 adenocm＇cinomas included 29 cases of lung adenocarcinom, 4 gastric adenocarcinoma, 3 colon cancer, 5 ova- ry carcinoma, 2 breast cancer, 1 gallbladder, and 1 yolk sac tumor from testes. 1 case showed negative for every antibody, although there was a space-occupying lesion in his lung. 4 cases did not find the original site. 8 cases of atypical glandular cells were identified as hyperplasia of mesothelial cells by inmmunohistochmical staining. In 22 cases of lung cancer, EGFR gene test showed the mutations of EXON-19 E746_A750del （ 1 ） （2） and mutation of EXON- 21 L858R in five cases, respectively, and the mutation rate was 45.4% （10/22）. Conclusion The cell block, combined with immunohistochemical staining and molecular techniques, helps the diagnosis of advanced cancer and individualized treatment option, of non-small cell lung carcinoma
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2014年第2期166-170,共5页
Chinese Journal of Clinical and Experimental Pathology
