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目的探讨浆膜腔积液中转移性腺癌与反应性间皮细胞增生的鉴别。方法选取胸、腹水转移癌48例及反应性间皮细胞增生30例,采用常规涂片HE染色观察两者形态学特点,并应用免疫细胞化学SP法检测HBME-1c、alretinin、E-cadherin、MOC-31和BerEP4的表达。结果腺癌和间皮细胞两者形态各有特点,但是分化好的腺癌和明显增生的间皮细胞仅从常规涂片难以鉴别;免疫细胞化学显示反应性间皮细胞HBME-1和calretinin阳性率为86.7%和76.7%;而腺癌细胞只有少量表达,特异性高达95.8%和100%。MOC-31、E-cadherin和BerEP4对转移性腺癌细胞阳性率为70.8%、77.1%和88.4%,间皮细胞表达很少,特异性分别为90%、93.3%、93%。两者对5种抗体的表现差异显著。结论应用常规涂片和免疫细胞化学相结合的方法对鉴别转移性腺癌和间皮细胞增生有很大的帮助,最好应用一组抗体综合分析判断,HBME-1、Calretinin、E-cadherin、MOC-31及BerEP4是目前非常有效的组合。
Objective To investigate the differential diagnosis of metastatic adenocarcinoma and reactive mesothelial cell hyperplasia in serosal effusion. Methods Forty-eight patients with metastatic carcinoma of the thoracic and ascitic fluid and 30 cases of reactive mesothelial cell hyperplasia were selected. Morphological characteristics were observed by routine smear HE staining. The expressions of HBME-1c, alretinin, E-cadherin, MOC-31 and BerEP4 expression. Results The morphology of adenocarcinoma and mesothelial cells both had their own characteristics. However, well-differentiated adenocarcinoma and obviously proliferating mesothelial cells were difficult to identify only by conventional smears. Immunocytochemistry showed that HBME-1 and calretinin were positive in reactive mesothelial cells The rates were 86.7% and 76.7%, respectively. However, only a few adenocarcinoma cells were expressed with a specificity of 95.8% and 100%. The positive rates of MOC-31, E-cadherin and BerEP4 in metastatic adenocarcinoma cells were 70.8%, 77.1% and 88.4%, respectively. The expression of mesothelial cells in MOC-31, E-cadherin and BerEP4 cells was very low with specificities of 90%, 93.3% and 93%, respectively. The two pairs of five kinds of antibodies showed significant differences. Conclusion The combination of conventional smear and immunocytochemistry is very helpful in differentiating metastatic adenocarcinoma and mesothelial cell proliferation. It is advisable to use a set of antibodies to analyze HBME-1, Calretinin, E-cadherin, MOC -31 and BerEP4 are currently very effective combinations.