浆膜腔积液中转移癌原发部位的细胞学研究  

Determining the primary site of metastatic adenocarcinoma in serous fluid: a cytological study

作　　者：方芳[1] 杨丽[1] 苏希来[1] 贺青[1] 刘冬戈[1] 林凤如[1] 马正中[1] 

机构地区：[1]北京医院病理科,100730

出　　处：《中华病理学杂志》2005年第10期641-645,共5页Chinese Journal of Pathology

摘　　要：目的探讨能检测浆膜腔转移性腺癌原发部位的有效方法。方法对89例浆膜腔转移性腺癌行常规HE染色,其中肺癌40例、乳腺癌6例、卵巢癌21例、胃肠及胰腺癌22例,从癌细胞群等18个形态学方面进行观察。其中75例采用免疫细胞化学SP法检测了CA125、CA199、SPB、甲状腺转录因子(TTF)1的表达。结果通过形态学对比研究发现不同原发部位的转移癌的癌细胞总量、细胞群大小、细胞群与单个细胞的比例、细胞群形态及涂片背景等方面各有一些特点:肺癌、乳腺癌中小细胞群各占95%、100%;卵巢癌多以大群存在,占85.7%,并且在涂片中癌细胞数量较多,以群团为主;部分胃肠癌(45.5%)在涂片中数量较少,并以单个散在为主(40.9%);肺癌及卵巢癌中都可见沙砾体。SPB、TTF1可以用来支持在浆膜腔转移性肺腺癌的来源,CA125阳性支持卵巢癌来源。CA199在各组癌中都有表达,无明显统计学差异。但若用于腹水,对胃肠、胰腺来源的肿瘤还是有帮助的。结论浆膜腔转移性腺癌的形态学观察、辅以免疫细胞化学染色和基本临床资料三者结合对推测原发部位很有意义。Objective To explore cytological parameters that may identify the primary sites of metastatic adenocarcinomas in serous fluid. Methods Serous fluid specimens from 89 cases of metastatic adenocarcinomas （40 metastatic adenocarcinomas of lung, 6 metastatic adenocarcinomas of breast, 21 metastatic ovary adenocarcinomas, 22 metastatic gastrointestinal and pancreatic adenocarcinomas ） were studied by using multiple morphologic parameters. Immunocytochemical S-P method was used to detect the expression of CA125, CA199, SPB and TTF-1 in 75 cases. Results Metastatic adenocarcinomas of different primary sites displayed certain different morphologic features, including the total amount of tumor cells, size of clusters, ratio of clusters over single cells, configuration of tumor clusters and the background of the smear. Cell clusters of small to medium sizes represented 95% and 100% in the metastatic adenocarcinomas of lung and breast, respectively. Most of the ovarian metastatic adenocarcinomas （85.7%） presented some large cell clusters and larger amount of cells, whereas certain metastatic gastrointestinal and pancreatic adenocarcinomas （45.5%） presented smaller number of cells and predominantly to be single cell in distribution （40. 9% ）. Psammoma bodies were found in metastatic adenocarcinomas of lung and ovary. SPB and TTF-1 expression supported the diagnosis of adenocarcinoma of pulmonary origin. CA125 expression supported an ovarian origin. Although CA199 was seen in all groups of metastatic adenocarcinomas, nevertheless, its appearance in tumor cells in ascitic fluid specimens supported gastrointestinal and pancreatic origins. Conclusion Morpho-logic features of the cytological smear, immunohistochemical staining and clinical history are equally important in determining the primary sites of metastatic adenocarcinomas in serous fluid.

关 键 词：胸腔积液 腹水液 肿瘤转移 细胞学 

分 类 号：R730.4[医药卫生—肿瘤]