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目的：探讨胸（腹）水疑难病例的病理诊断。方法：采用免疫细胞化学方法，分析１３０个病例。以诊断为癌的３１例和仅有间皮细胞的３０例为研究样本，相互对照，找出规律，再以此规律分析诊断为异型间皮细胞／可疑癌细胞的６９例，鉴别出癌细胞和间皮细胞。结果：３０例间皮细胞组ＣＡＬ ２８例（＋）（９３．３３％），ＶＩＭ ２７例（＋）（９０．００％），而ＣＥＡ无 １例阳性（０），ＥＭＡ ２例（＋）（６．６７％）。 ３１例癌细胞组，ＣＡＬ ５例（＋）（１６．１３％），ＶＩＭ ７例（＋）（２２．５８％），ＣＥＡ２９ 例（＋）（９３．５５％），ＥＭＡ ２６例（＋）（８３．８９％）。经χ２检测 Ｐ＜０．０１有显著差异。结合临床情况，ＣＡＬ或 ＣＡＬ＋ＶＩＭ 阳性为间皮源细胞；ＣＥＡ或ＣＥＡ＋ＥＭＡ阳性为上皮源性细胞。６９例异型间皮细胞／可疑癌细胞组４种抗体标记后，５６例可确定其中的细胞是否为病细胞，另有７例，结合ＨＥ涂片及临床资料，也能诊断。诊断率达８１．１６％～９１．３０％。结论：ＩＣＣ技术是解决胸（腹）水疑难病例病理诊断的重要手段；依据形态学确定“异型间皮细胞”不妥，提倡ＩＣＣ标记；ＣＡＩ＋ＣＥＡ或 ＣＡＬ＋ＶＩＭ＋ＣＥＡ＋ＥＭＡ的联合应用，对
Objective: To investigate the pathological diagnosis of difficult cases of thoracic (abdominal) water. Methods: 130 cases were analyzed using immunocytochemistry. Thirty-one cases diagnosed as cancer and thirty cases with only mesothelial cells were used as research samples to compare with each other to find out the regularity. Then, 69 cases of abnormal mesothelial cells/suspicious cancer cells were analyzed by this rule to identify cancer cells. And mesothelial cells. Results: There were 28 cases (+) (93.33%) of CAL in 30 cases of mesothelial cells and 27 cases (+) (90.00%) of VIM, while none of CEA was positive (0), and EMA was 2 (+). (6.67%). 31 cases of cancer cells, 5 cases of CAL (+) (16.13%), 7 cases of VIM (+) (22.58%), 29 cases of CEA (+) (93.55%), 26 cases of EMA (+) (83.89%). There was a significant difference in P<0.01 detected by χ2. In combination with clinical conditions, CAL or CAL+VIM is positive for mesothelial-derived cells; CEA or CEA+EMA is positive for epithelial-derived cells. After being labeled with 4 antibodies in 69 heterotypic mesothelial/suspicious cancer cell lines, 56 of them could be used to determine whether the cells were diseased cells. In addition, 7 cases were also diagnosed with HE smears and clinical data. The diagnostic rate was 81.16% to 91.30%. Conclusion: ICC technique is an important method to solve the pathological diagnosis of difficult cases of thoracic (abdominal) water; according to morphology, it is inappropriate to identify "alterotypic mesothelial cells” and advocate ICC marker; combined application of CAI+CEA or CAL+VIM+CEA+EMA,