恶性胸腔积液细胞块105例临床病理分析  

Clinicopathological analysis of malignant pleural effusion cell masses from 105 cases

作　　者：孙龙 宋一帆 Sun Long;Song Yifan(Department of Pathology,Qidong People's Hospital,Qidong Hospital Affiliated to Nantong University,Qidong 226200,Jiangsu Province,China)

机构地区：[1]南通大学附属启东医院启东市人民医院病理科,226200

出　　处：《中国基层医药》2021年第6期830-834,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:分析恶性胸腔积液(胸水)的病理类型、组织来源及临床特点。方法:选取启东市人民医院2017年5月至2019年10月经液基细胞学检查发现异型细胞后制成细胞块并行免疫组织化学检查、明确诊断为恶性胸水的细胞块105例,分析病理形态特征、免疫组织化学特点及临床特点。结果:胸水恶性细胞经免疫组化证实为肺腺癌来源的共94例,占89.52%,甲状腺转录因子1(TTF-1)、天冬氨酸蛋白酶A(Napsin A)、癌胚抗原(CEA)阳性;肺小细胞癌来源1例,占0.95%,神经细胞黏附分子1(CD56)、突触素(Syn)阳性;肺鳞状细胞癌来源2例,占1.90%,细胞角蛋白5/6(CK5/6)、P40阳性;卵巢来源腺癌1例,占0.95%,癌抗原125(CA125)阳性;乳腺来源腺癌4例,占3.81%,雌激素受体(ER)、孕激素受体(PR)、囊泡病液蛋白15(GCDFP-15)阳性;胃肠道来源腺癌2例,占1.90%,肠特异性转录因子2(CDX-2)阳性;胰腺来源腺癌1例,占0.95%,癌抗原19-9(CA199)阳性。结论:肺腺癌是引起恶性胸水的最常见原因,TTF-1、NapsinA、CEA对于肺腺癌来源的肿瘤细胞呈阳性表达,3种标志物联合应用有助于明确诊断,同时应与其他类型肺癌及其他部位来源的肿瘤鉴别。Objective To analyze the pathological types,tissue sources and clinical features of malignant pleural effusion.Methods Cell masses were collected from 105 cases of malignant pleural effusion diagnosed by immunohistochemical examination after liquid-based cytology between May 2017 and October 2019 in Qidong People's Hospital,China.The pathological,morphological,immunohistochemical and clinical characteristics of the cell masses were analyzed.Results Immunohistochemistry results showed that pleural effusion malignant cells were from lung adenocarcinoma tissue in 94(89.52%)cases because they were positive for thyroid transcription factor-1,Napsin A and carcinoembryonic antigen,from small cell lung cancer tissue in one(0.95%)case because they were positive for neural cell adhesion molecule 1 and synaptophysin,from lung squamous cell carcinoma tissue in 2(1.90%)cases because they were positive for cytokeratin 5/6 and P40,from ovarian adenocarcinoma tissue in 1(0.95%)case because they were positive for CA125,from breast adenocarcinoma tissue in 4(3.81%)cases because they were positive for estrogen receptor,progesterone receptor and gross cystic disease fluid protein 15,from the gastrointestinal tract adenocarcinoma tissue in 2(1.90%)case because they were positive for caudal-type homeobox 2,and from the pancreatic adenocarcinoma tissue in 1(0.95%)case because they were positive for cancer antigen 19-9(CA199).Conclusion Lung adenocarcinoma is the most common cause of malignant pleural effusion.Lung adenocarcinoma cells are positive for thyroid transcription factor-1,Napsin A and carcinoembryonic antigen.The combined use of the three markers can help the diagnosis of lung adenocarcinoma.In addition,lung adenocarcinoma should be differentiated from other types of lung cancer and the tumors from other regions.

关 键 词：胸腔积液 恶性 肺肿瘤 腺癌 免疫组织化学 组织细胞学制备技术 肿瘤标记 生物学 诊断 鉴别 病理学 临床 

分 类 号：R734.2[医药卫生—肿瘤]