肉瘤样癌形态学及免疫组化观察  

Morphological characteristics and immunohistochemical expression of the sarcomatoid cancer

作　　者：侯德法[1] 孟刚[1] 郝大海[2] 

机构地区：[1]安徽医科大学病理学教研室,合肥230032 [2]安徽省阜阳市肿瘤医院病理科,阜阳236000

出　　处：《安徽医科大学学报》2008年第6期627-630,共4页Acta Universitatis Medicinalis Anhui

摘　　要：目的观察不同部位肉瘤样癌病理形态学特点及免疫表型特征,探讨肉瘤样癌的诊断思路和诊断要点。方法收集45例肉瘤样癌,光镜下观察其各种形态特征,应用免疫组化检测肉瘤样癌CK、EMA、S-100蛋白、Desmin、SMA及Vimentin等的表达情况。结果肉瘤样癌可发生于任何可发生癌的部位,几乎可见于任何类型的癌;大体形态各异,位于黏膜皮肤者常表现为息肉状;镜下可表现为各种类型肉瘤样图象,癌的特点表现为:成分少、分化高、部分仅仅表现为上皮内瘤变而无浸润癌成份。肉瘤样癌中癌的成份CK或EMA(+)阳性率为100%,而肉瘤样成分CK阳性率为26%,EMA阳性率为17.9%。结论肉瘤样癌形态学结构复杂,可表现为各种类型肉瘤样图象;CK、EMA阳性表达率低。诊断要点:①可发生癌的部位,若发现肉瘤样结构,均应考虑到肉瘤样癌;②肉瘤样成分应>50%;③诊断中应在上皮成分与肉瘤样成分移行区域多取材仔细寻找浸润癌、原位癌成分;④CK、EMA阳性表达不应作为确诊肉瘤样癌的唯一依据,上皮指标阴性不能作为排除肉瘤样癌的依据。Objective To discuss the standard of sarcomatoid cancer diagnosis by observing the sarcomatoid cancer pathology and morphological characteristics and immunohistochemical expression. Methods Forty-five cases of sarcomatoid cancer were observed on morphological characteristics, expressions of CK, EMA, S-100, Desmin, SMA and Vim in sarcomatoid cancer were examined by immunohistochemical expression. Results Sarcomatoid cancer widely distributed could occur in many locations, and could be found in almost all types of cancer. Sarcomatoid cancer, in the skin or mucous membrane, looked like polypus, and could be expressed as various types of sarcomatoid images, such as ： large piece of well-differentiation, only showed intraepithelial neoplasia without the element of cancer, some of the element of cancer, could not be found cancer in the microscope. Sarcomatoid cancer of the immune phenotype, the element of cancer had no special immune phenotype with CK and EMA （ ＋ ） 100% and sarcomatoid immune phenotype of complex and varied. CK （AE1/AE2） （ ＋ ） 26% ,EMA17.9%. Conclusion 1. Sarcomatoid cancer have complex morphology structure, diversity performance and complicated immune phenotype. 2. Diagnostic criteria： ① If sarcoma-like structure is observed in the site of cancer it should be taken account of sarcomatoid cancer; after completely excluding sarcomatoid cancer, sarcoma could be dignosed. ② Sarcomatoid elements should be more than 50%, if the ratio of tissue sarcoma is too small to be diagnosed easily. ③ Pay attention to the diagnosis of many subjects, carefully looking for cancer, carcinoma in situ and non-typical elements, particularly, to find transitional region between the two regions.④ CK, EMA positive expression should not be used alone as sarcomatoid cancer diagnosed.

关 键 词：免疫组织化学 

分 类 号：R730.261[医药卫生—肿瘤] R730.4[医药卫生—临床医学]