摘要
目的探讨液基细胞学（TCT）、细胞块及免疫组化对判断胸水中恶性肿瘤细胞组织来源的应用价值。方法选取运城市中心医院2013年1月至2016年6月临床送检113例胸水经液基细胞学检查初诊为恶性肿瘤或可疑恶性肿瘤后，通过离心收集沉渣细胞后制作石蜡块后，选择99例进行免疫组化检查。原液基细胞学拟诊为有恶性肿瘤的胸水共制作细胞蜡块113例，99例行免疫组化检查的细胞块先通过CK7、CK20、villin免疫组化染色确定肿瘤来源方向，然后有针对性的分别挑选TTF-1、NapsinA、CK5／6、p63、CR、Syn、CgA、CA125、GCDFP-15、ER、PR、CDX-2等多项抗体免疫组化染色。结果原液基细胞学拟诊为腺癌94例中经免疫组化仍诊断为腺癌共92例，其中来源肺70例，乳腺2例，卵巢6例，消化道8例，腹膜浆液性乳头状癌1例，来源不明5例；另有2例原液基细胞学拟诊为腺癌通过免疫组化分别重新诊断为增生间皮细胞和间皮肿瘤。液基细胞学、细胞块及免疫组化诊断一致的鳞状细胞癌2例，小细胞癌3例。免疫组化对胸水中腺癌细胞组织来源的判断敏感性为94．6％，特异性为100％，优于组织学检查。结论将胸水制作细胞块进行免疫组化检查，不仅能保存胸水中的肿瘤细胞，且通过离心将肿瘤细胞聚集，提高细胞病理学诊断阳性检出率，有利于肿瘤细胞的鉴别诊断及其组织器官来源的分析判断，并进一步行基因突变检测和分子靶向治疗，帮助患者延长生命，减少患者痛苦，提高其生活质量，具有重要临床价值。
Objective To investigate application values of Liquid-based cytology（TCT）, cell block and immunohistochemical on estimating sources of malignant tumor cells in hydrothorax. Methods Collect 113 cases of Pleural effusion by Liquid-based cytology that are tentatively diagnosed as malignant tumor or suspected malignancies from January 2013 to June 2016 in Yuncheng Central Hospital. Through centrifuging to collect sediment cells and make paraffin block, 99 cases are selected for immunohistochemical examinations, through the CK7,CK20 and villin immunohistochemical staining determine the direction of the source of tumor, then targeted choose the TTF-1,NapsinA,CK5/6,p63,CR,Syn,CgA,CA125,GCD FP- 15,ER,PR and CDX-2 antibody to immunohistochemical staining. Results Among 94 cases of adenocarcinomas by TCT, 92 cases are still diagnosed as adenocarcinomas by immunohistochemistry. In addition, tumours sources of 92 cases are as following： 70 cases are from lung, 2 cases are from breast, 6 cases are from ovary, 8 cases are from alimentary canal, 1 case is from peritoneal serouspapillary carcinoma, and 5 cases are unknown sources. The other 2 cases are definitely diagnosed as reactive mesothelial cells and tumors of mesothelium respectively. The same diagnostic results of squamous-cell carcinoma and small cell carcinoma by TCT, cell block and Immunohistochemistry are 2 cases and 3 case respectively. The sensitivity and idiosyncrasy of Immunohistochemistry on determining the direction of tumours sources are 94.6% and 100% respectively, which are better than histological examination. Conclusions Making hydrothorax into cell blocks for immunohistochemical examination not only save tumor cells in hydrothorax, but also gatheringand collecting tumor cells by centrifuge improves positive detection rate of cellular pathology and contributes to differential diagnosis of tumour cell, analysis of tissues sources, gene mutations detection and molecular targeted therapy. Therefore, it is significant to prolong patients＇lives, lessen
出处
《中国临床实用医学》
2016年第5期38-41,共4页
China Clinical Practical Medicine
