恶性心包积液细胞蜡块联合基因检测在明确肿瘤来源及肺腺癌个体化治疗中的应用  

Application of malignant pericardial effusion cell wax block combined with gene detection in identifying the source of tumor and individualized treatment of lung adenocarcinoma

作　　者：张连美 朱亚宁[1] 孙苏安[1] ZHANG Lianmei;ZHU Yaning;SUN Su’an(Department of Pathology,Huai’an First Hospital Affiliated to Nanjing Medical University,Huai’an 223300,Jiangsu,China)

机构地区：[1]南京医科大学附属淮安第一医院病理科,江苏淮安2233000

出　　处：《癌症进展》2022年第1期21-25,共5页Oncology Progress

摘　　要：目的探讨恶性心包积液细胞蜡块联合基因检测在明确肿瘤来源及肺腺癌患者个体化治疗中的应用价值。方法选择50例恶性心包积液标本作为研究对象,制备细胞蜡块,进行苏木素-伊红(HE)染色,同时选择钙网膜蛋白(CR)、间皮细胞(MC)、肾母细胞瘤基因1(WT1)、癌胚抗原M2A单克隆抗体(D2-40)、尾型同源盒转录因子2(CDX2)、绒毛蛋白(villin)、黏蛋白5AC(MUC5AC)、甲状腺转录因子-1(TTF-1)、天冬氨酸肽酶A(napsin A)、细胞角蛋白7(CK7)、癌胚抗原(CEA)、神经细胞黏附分子(CD56)、嗜铬粒蛋白A(CgA)、突触素(Syn)、细胞角蛋白5/6(CK5/6)、p63、p40、p16、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)、GATA结合蛋白3(GATA3)、叉头框蛋白A1(FOXA1)、配对盒转录因子8(PAX8)、糖类抗原125(CA125)、广谱细胞角蛋白(p-CK)、上皮细胞膜抗原(EMA)、波形蛋白(vimentin)等抗体进行免疫组化分析。分别采用实时荧光定量聚合酶链反应(PCR)和逆转录聚合酶链反应(RT-PCR)分析肺腺癌来源的标本中表皮生长因子受体(EGFR)基因突变和棘皮动物微管相关样蛋白4-间变性淋巴瘤激酶(EML4-ALK)融合基因情况。结果共纳入50例恶性心包积液患者,根据其临床资料、细胞学特征及免疫组化结果分析恶性心包积液的组织来源及类型,结果显示,腺癌40例,鳞状细胞癌5例,小细胞癌4例,恶性间皮瘤l例,腺癌来源:肺30例,乳腺3例,消化道5例,卵巢2例。应用细胞蜡块进行肿瘤基因突变检测,发现30例肺腺癌患者的恶性心包积液细胞蜡块中,EGFR基因突变11例,其中19del突变5例、L858R突变6例,EML4-ALK融合基因1例,其余未见EGFR基因突变及EML4-ALK融合基因。结论恶性心包积液细胞蜡块联合基因检测可为肿瘤起源及分型提供线索,并有利于肺腺癌个体化治疗方案的制订。Objective To explore the application value of malignant pericardial effusion cell wax block combined with gene detection in identifying the source of tumor and individualized treatment of lung adenocarcinoma.Method A total of 50 samples of malignant pericardial effusion were selected as the research object.Cell wax blocks were prepared and stained with hematoxylin and eosin(HE).At the same time,calretinin(CR),mesothelial cell(MC),Wilms tumor 1(WT1),carcinoembryonic antigen M2 A monoclonal antibody(D2-40),caudate homeobox transcription factor 2(CDX2),villin,mucin 5 AC(MUC5 AC),thyroid transcription factor-1(TTF-1),napsin A,cytokeratin 7(CK7),carcinoembryonic antigen(CEA),neural cell adhesion molecule(CD56),chromogranin A(CgA),synapsin(Syn),cytokeratin 5/6(CK5/6),p63,p40,p16,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER2),GATA binding protein 3(GATA3),forkhead box A1(FOXA1),paired box 8(PAX8),carbohydrate antigen 125(CA125),pan cytokeratin(p-CK),epithelial membrane antigen(EMA),vimentin and other antibodies were analyzed by immunohistochemistry.Real time fluorescence quantitative polymerase chain reaction(PCR)and reverse transcription polymerase chain reaction(RT-PCR)were used to analyze the mutation of epidermal growth factor receptor(EGFR)gene and the fusion gene of echinoderm microtubule associated protein like 4(EML4)-anaplastic lymphoma kinase(ALK)in lung adenocarcinoma samples.Result 50 patients of malignant pericardial effusion were included in the study.The tissue origin and type of malignant pericardial effusion were analyzed according to its clinical data,cytological characteristics and immunohistochemical results.The result showed that there were 40 cases of adenocarcinoma,5 cases of squamous cell carcinoma,4 cases of small cell carcinoma,and l case of malignant mesothelioma.30 cases of adenocarcinoma from lung,3 cases from breast,5 cases from alimentary canal,2 cases from ovaries.Cell wax block was used to detect tumor gene mutation in 30 cases of lung aden

关 键 词：恶性心包积液 细胞蜡块 基因检测 个体化治疗 

分 类 号：R730[医药卫生—肿瘤]