免疫組化在病理診斷中的應(yīng)用及意義.doc

免疫組化檢查在病理診斷中的應(yīng)用及其意義(一)作者：聯(lián)合病理轉(zhuǎn)貼自：本站原創(chuàng)點(diǎn)擊數(shù)：3833一、病理外檢中常用抗體標(biāo)記上皮類(lèi)標(biāo)記AE1/AE3最常用 胞漿陽(yáng)性著色，細(xì)絲狀 與低、中分子量角蛋白反應(yīng) 肝細(xì)胞為陰性，而膽管細(xì)胞陽(yáng)性 用于確定腫瘤為上皮源性 CAM 5.2胞漿陽(yáng)性著色，細(xì)絲狀 包含CK8 和CK18，主要染色神經(jīng)內(nèi)分泌細(xì)胞和腺上皮，正常鱗狀上皮陰性 用于染小細(xì)胞癌 用于胸腺瘤和梭形細(xì)胞癌 用于肝細(xì)胞癌：AE1/AE3 - CAM5.2 +用于乳腺外的Pagets病 CK34BE胞漿陽(yáng)性著色 鱗狀上皮和鱗狀細(xì)胞癌陽(yáng)性 用于染前列腺的基底層細(xì)胞，鑒別浸潤(rùn)癌 用于染涎腺腫瘤的肌上皮 用于染Mallory 小體 EMA細(xì)胞膜/細(xì)胞漿陽(yáng)性著色上皮標(biāo)記的替代品漿細(xì)胞陽(yáng)性，很好的內(nèi)對(duì)照用于染滑膜肉瘤 EMA +用于大細(xì)胞分化不良性淋巴瘤 EMA +用于L&H 富于淋巴細(xì)胞的結(jié)節(jié)狀何杰金用于腦膜瘤 EMA+ AE1/AE3 用于漿細(xì)胞瘤 常常 EMA +CK7 和CK20胞漿陽(yáng)性著色 兩者聯(lián)合應(yīng)用可鑒別很多種癌的原發(fā)部位 CK7 常常在胃腸道的癌為陰性 CK20 只有胃腸道癌和Merkel 細(xì)胞癌陽(yáng)性 間皮細(xì)胞標(biāo)記Calretinin細(xì)胞核和細(xì)胞漿陽(yáng)性著色，核陽(yáng)性著色為必需間皮強(qiáng)陽(yáng)性，Sertoli和肥大細(xì)胞陽(yáng)性用于鑒別間皮瘤（+）和腺癌（-），常加CEA用于鑒別梭形細(xì)胞間皮肉瘤（+）和其他的漿膜腔肉瘤（-）用于鑒別胸、腹水中的癌細(xì)胞和間皮細(xì)胞確定為間皮細(xì)胞，如大網(wǎng)膜內(nèi)陷入的一團(tuán)細(xì)胞或腺瘤樣瘤神經(jīng)元分化標(biāo)記，如中樞神經(jīng)細(xì)胞瘤幫助確診心臟粘液瘤，幾乎全為（+）白細(xì)胞標(biāo)記非何杰金淋巴瘤大致分類(lèi)CD20 （L26），CD3懷疑T 細(xì)胞淋巴瘤者加UCHL-1（CD45RO）懷疑漿細(xì)胞瘤者LCA（CD45RB）,CD79a, CD138小B 細(xì)胞淋巴瘤者，CD79a, CD43（MT1）LCA （CD45RB）幾乎所有的白細(xì)胞（+ ） 有些淋巴母細(xì)胞淋巴瘤、大細(xì)胞分化不良性淋巴瘤、外周T 細(xì)胞淋巴瘤（- ） 經(jīng)典Hodgkin 的R-S 細(xì)胞（-） 以往漿細(xì)胞瘤（-），現(xiàn)（+） HE 下明確的淋巴瘤不必要染LCA B細(xì)胞相關(guān)標(biāo)記CD20 （L26）胞膜陽(yáng)性著色，漿陽(yáng)者不可判為陽(yáng)性 各階段B 細(xì)胞陽(yáng)性，除了原始的前B 和非常成熟的漿母、漿細(xì)胞 用于染B 細(xì)胞淋巴瘤，除了小細(xì)胞、淋巴母細(xì)胞（不恒定）和漿細(xì)胞瘤（常-） 梭形細(xì)胞胸腺瘤（+） CD79a胞漿陽(yáng)性著色，有/無(wú)核周聚集全B 細(xì)胞標(biāo)記，包括漿母和漿細(xì)胞標(biāo)記濾泡中心比mantle和濾泡間B要弱比CD20 貴得多用于鑒別淋巴母細(xì)胞淋巴瘤/白血病 彌漫性小B 細(xì)胞淋巴瘤/白血病 漿細(xì)胞瘤（常CD20而CD79a 50% +T細(xì)胞相關(guān)標(biāo)記CD3 （polyclonal）胞漿陽(yáng)性著色，核周凝聚，有時(shí)高爾基體也陽(yáng)性 極好的T 細(xì)胞標(biāo)記，與CD43 不同，髓系細(xì)胞和組織細(xì)胞不著色 極好的T 細(xì)胞和NK 淋巴瘤標(biāo)記，雖然有些大細(xì)胞型T 細(xì)胞淋巴瘤陰性 CD43 （MT1）只有膜陽(yáng)性才能判為陽(yáng)性 T 細(xì)胞、T 細(xì)胞淋巴瘤、真性組織細(xì)胞腫瘤、粒細(xì)胞肉瘤陽(yáng)性 一部分漿細(xì)胞瘤陽(yáng)性 小B 細(xì)胞淋巴瘤陽(yáng)性，這一特點(diǎn)可輔助表明增生的小淋巴細(xì)胞為腫瘤性！ EBV 感染的B 細(xì)胞陽(yáng)性 UCHL-1（CD45RO）細(xì)胞膜陽(yáng)性著色，有時(shí)Golgi 陽(yáng)性，彌漫性胞漿陽(yáng)性者非真陽(yáng)性 陽(yáng)性：正常/ 反應(yīng)性的T 細(xì)胞，組織細(xì)胞、粒細(xì)胞肉瘤和T 細(xì)胞淋巴瘤 罕見(jiàn)情況下B 細(xì)胞淋巴瘤陽(yáng)性 CD5細(xì)胞膜陽(yáng)性著色 T 細(xì)胞陽(yáng)性，但極少B 細(xì)胞也陽(yáng)性 尤其用于慢性淋巴細(xì)胞性白血病和Mantle 淋巴瘤，而MALToma 和Marginal Zone 淋巴瘤陰性 用于鑒別胸腺癌（CD5+）和其他癌瘤 與激活相關(guān)的標(biāo)記CD30 （Ki-I，Ber-H2）只有膜染色和Golgi體染色才是真陽(yáng)性正常淋巴濾泡周單個(gè)的大細(xì)胞為陽(yáng)性激活的淋巴細(xì)胞陽(yáng)性：如傳單、弓漿蟲(chóng)感染、Kikuchi淋巴結(jié)炎等、漿細(xì)胞也陽(yáng)性用于大細(xì)胞分化不良性淋巴瘤用于一些傳統(tǒng)的大細(xì)胞淋巴瘤外周T和B細(xì)胞淋巴瘤中的一些單個(gè)大細(xì)胞經(jīng)典何杰金病中的R-S細(xì)胞，但非L&H細(xì)胞淋巴瘤樣丘疹病等皮下CD30+的淋巴增生疾病一些漿細(xì)胞瘤胚胎性癌組織細(xì)胞標(biāo)記CD68（PGM1）胞漿內(nèi)顆粒狀陽(yáng)性著色 較好的組織細(xì)胞和單核細(xì)胞（包括漿樣單核細(xì)胞）及其腫瘤的標(biāo)記 有些非組織細(xì)胞也可陽(yáng)性，包括：腎小管、粒細(xì)胞肉瘤、惡黑、血管瘤樣惡纖組等 髓系細(xì)胞標(biāo)記Myeloperoxidase 胞漿 陽(yáng)性著色，常呈顆粒狀 髓系細(xì)胞及其腫瘤的高度特異且敏感的標(biāo)記 奇怪的是在Kikuchi 淋巴結(jié)炎和狼瘡性壞死性淋巴結(jié)炎中，其中的組織細(xì)胞myeloperoxidase 也為 陽(yáng)性 與淋巴瘤相關(guān)的標(biāo)記ALK-1(Anaplastic lymphoma kinase-1) 胞核+ 胞漿陽(yáng)性著色 用于大細(xì)胞分化不良性淋巴瘤，不能證實(shí)ALK1+ 與良好預(yù)后有關(guān) 用于一種罕見(jiàn)的大B 細(xì)胞細(xì)胞瘤，ALK1 陽(yáng)性而CD20 陰性，但I(xiàn)gA 陽(yáng)性 Bcl-2在核周?chē)鷧^(qū)陽(yáng)性著色 在正常淋巴結(jié)，生發(fā)中心陰性，但mantle 和濾泡間細(xì)胞強(qiáng)陽(yáng)性 在濾泡性淋巴瘤，（80% 病例 ）生發(fā)中心強(qiáng)陽(yáng)性，陰性不能排除濾泡性淋巴瘤 也用于鑒別單核樣B 細(xì)胞增生（- ）和單核樣B 細(xì)胞淋巴瘤（+ ） 有人用于診斷孤立性纖維性腫瘤Cyclin-D1核陽(yáng)性著色 主要用于Mantle 區(qū)淋巴瘤，幾乎所有病例均為陽(yáng)性，有些可能為弱陽(yáng)性 與分化階段相關(guān)的標(biāo)記Tdt細(xì)胞核陽(yáng)性著色 不成熟的T 或B 淋巴細(xì)胞標(biāo)記，前T/ 前B 細(xì)胞 用于診斷淋巴母細(xì)胞淋巴瘤/ 白血病 診斷胸腺瘤（富于不成熟的T 細(xì)胞） 肌原性標(biāo)記Desmin胞漿陽(yáng)性著色 平滑肌/ 骨骼肌及其腫瘤的良好標(biāo)記，肌纖維母細(xì)胞有時(shí)也陽(yáng)性，但肌上皮陰性 一些間皮瘤陽(yáng)性 desmoplastic small cell tumor MSA（Muscle-specific actin）胞漿陽(yáng)性著色極好的肌源性標(biāo)記用于 平滑肌、骨骼肌及其腫瘤 肌纖維母細(xì)胞及相關(guān)腫瘤（惡纖組、結(jié)節(jié)性筋膜炎等） 肌上皮及其腫瘤 血管周細(xì)胞腫瘤 一些間皮瘤血管原性標(biāo)記CD31細(xì)胞膜陽(yáng)性著色 內(nèi)皮細(xì)胞、巨核系細(xì)胞/ 血小板陽(yáng)性 有時(shí)漿細(xì)胞/ 漿細(xì)胞瘤陽(yáng)性 主要用于診斷血管性腫瘤：特異且敏感 用于識(shí)別骨髓中不正常的巨核細(xì)胞 用于巨核細(xì)胞系白血病 CD34細(xì)胞膜+/-細(xì)胞漿陽(yáng)性著色血管內(nèi)皮/巨核細(xì)胞/血小板 +很好的血管標(biāo)記，但特異性差多種腫瘤CD34陽(yáng)性，包括：CD34陽(yáng)性的腫瘤a) Some myeloid leukemias (especially the primitive ones).b) Vascular tumorsc) Solitary fibrous tumor; angiomyofibroblastomad) Hemangiopericytomae) Dermatofibrosarcoma protuberansf) Gastrointestinal stromal tumorg) Mammary myofibroblastomah) Epithelioid sarcomai) Spindle cell lipomaj) Scattered cells in peripheral nerve sheath tumorsk) Megakaryoblastic leukemia血管原性標(biāo)記Factor VIII related antigen (F-VIII) 胞漿 陽(yáng)性著色，常為顆粒狀 內(nèi)皮細(xì)胞、巨核系細(xì)胞/ 血小板陽(yáng)性 主要用于血管原性腫瘤 特異性好，敏感性差 神經(jīng)、神經(jīng)內(nèi)分泌及神經(jīng)外胚層Syn細(xì)胞漿陽(yáng)性著色 是神經(jīng)和神經(jīng)內(nèi)分泌細(xì)胞很好的標(biāo)記 特異性和敏感性均好 ParagangliomaPheochromocytomaNeuroblastomaOlfactory neuroblastomaGanglioneuromaGanglioneuroblastomaPNETParathyroid tumorMedullary thyroid carcinomaIslet cell tumorPituitary tumorCarcinoid tumorSmall cell carcinomaMerkel cell carcinomaThyroid follicular cell tumorAdrenocortical tumorCgA胞漿內(nèi)顆粒狀著色染神經(jīng)內(nèi)分泌細(xì)胞的分泌小泡，因此神經(jīng)元和神經(jīng)節(jié)細(xì)胞陰性神經(jīng)內(nèi)分泌非常特異性指標(biāo)，敏感性較差，陽(yáng)性信號(hào)取決于瘤細(xì)胞內(nèi)神經(jīng)內(nèi)分泌顆粒的多少小細(xì)胞癌：信號(hào)少類(lèi)癌、Merkel細(xì)胞癌、甲狀旁腺腺瘤等強(qiáng)陽(yáng)性神經(jīng)性腫瘤可陽(yáng)可陰GFAP （Glial fibrillary acidic protein ）胞漿陽(yáng)性著色 星形細(xì)胞、室管膜細(xì)胞陽(yáng)性，一些肌上皮陽(yáng)性 星形細(xì)胞瘤、多形性膠質(zhì)母細(xì)胞瘤、室管膜瘤和脈絡(luò)叢乳頭狀瘤陽(yáng)性，少突膠質(zhì)細(xì)胞瘤常陰性；一些外周神經(jīng)鞘瘤可陽(yáng)性 涎腺多形性腺瘤?？申?yáng)性 乳腺的肌上皮有時(shí)也可陽(yáng)性 S-100細(xì)胞核+/-細(xì)胞漿陽(yáng)性著色，核陽(yáng)性著色為必需用處非常多：glial cells, Schwann cells (astrocytoma, schwannoma, neurofibroma, malignant peripheral nerve sheath tumor). In benign nerve sheath tumors, almost all the tumor cells are positive; while in malignant peripheral nerve sheath tumor, usually only a fraction of the neoplastic cells are S100 positive. Note that S-100 protein antibody can also highlight the sustentacular cells that envelope the islands of tumor cells in paraganglioma and olfactory neuroblastoma. S-100Melanocytes and nevus cells (Melanocytic nevus, malignant melanoma, malignant melanoma of soft parts/clear cell sarcoma of tendons and aponeurosis) Myoepithelial cells Fat cells (Lipoma, liposarcoma) Cartilage cells (Chondroma, chondroblastoma, chondrosarcoma Histiocytes of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) Interdigitating dendritic cells and Langerhans cells (Langerhans cell histiocytosis, interdigitating dendritic cell sarcoma). Juvenile CML is often S-100 positive HMB45胞漿內(nèi)顆粒狀著色 惡性黑色素瘤和交界痣，而正常的痣細(xì)胞常為陰性 腎和肝的血管平滑肌脂肪瘤、腎被膜瘤 肺的淋巴管肌瘤病、糖瘤Melan-A胞漿內(nèi)顆粒狀著色 陽(yáng)性表達(dá)的細(xì)胞包括：黑色素細(xì)胞、腎上腺皮質(zhì)、性索（Leydig, granulosa）用于： 黑色素瘤 支持- 間質(zhì)細(xì)胞瘤和顆粒細(xì)胞瘤 血管周細(xì)胞瘤 腎上腺皮質(zhì)腫瘤 與乳腺癌相關(guān)的抗體ER細(xì)胞核陽(yáng)性著色PR細(xì)胞核陽(yáng)性著色 Ki-67細(xì)胞核陽(yáng)性著色 G1, S, G2 and M phases of the cell cycle 陽(yáng)性 Ki-67 index: 陽(yáng)性細(xì)胞所占比例 P53細(xì)胞核陽(yáng)性著色正常細(xì)胞因P53蛋白很快降解故陰性，而惡性腫瘤中因突變或存在使P53穩(wěn)定的因素，故可陽(yáng)性C-erBb2細(xì)胞膜陽(yáng)性著色分級(jí)Herceptine 治療還用于鑒別乳腺內(nèi)/外的Pagets病和惡黑用于乳腺內(nèi)/外Pagets病和表皮的一些透明細(xì)胞（Toker cell）用于顯示Pagets病切緣是否干凈激素類(lèi)抗體Thyroglobulin 胞漿陽(yáng)性著色極好的甲狀腺濾泡上皮及腫瘤的標(biāo)記，分化極差的甲狀腺癌可陰性Calcitonin胞漿陽(yáng)性著色極好的C細(xì)胞及髓樣癌的標(biāo)記，如CgA+則更支持髓樣癌個(gè)別喉的類(lèi)癌+PTH （parathyroid hormone）胞漿陽(yáng)性著色甲狀旁腺細(xì)胞及其腫瘤的標(biāo)記 垂體腺瘤類(lèi)激素 胞漿陽(yáng)性著色 GH，PRL，TSH，F(xiàn)SH，ACTH，LHHCG胞漿陽(yáng)性著色極好的滋養(yǎng)葉細(xì)胞及腫瘤的標(biāo)記：絨癌、胚胎性癌等一些胃和膀胱的癌也可陽(yáng)性PSA胞漿陽(yáng)性極好的前列腺癌標(biāo)記有時(shí)膀胱和尿道周的癌也可陽(yáng)性TTF-1（thyroid transcription factor-1）單純的核陽(yáng)性著色正常情況下只有甲狀腺和肺泡上皮細(xì)胞陽(yáng)性，大的支氣管上皮陰性在腫瘤中：主要用于確定腫瘤來(lái)源于肺或甲狀腺AFP胞漿+/- 核陽(yáng)性 成熟組織中陰性，而胚胎性肝、胃腸道、神經(jīng)上皮成分中+用于診斷肝細(xì)胞癌和肝母細(xì)胞瘤 用于診斷胚胎性癌和卵黃囊瘤 用于顯示不成熟畸胎瘤中的神經(jīng)上皮成分 其他抗體CD99細(xì)胞膜陽(yáng)性著色正常存在于不成熟T細(xì)胞（胸腺細(xì)胞）和胰島細(xì)胞用于T淋巴母細(xì)胞淋巴瘤/白血病胸腺瘤（淋巴組織成分+）尤文氏肉瘤和PNET間葉性軟骨肉瘤顆粒細(xì)胞瘤和支持細(xì)胞（Sertoli）瘤孤立性纖維性腫瘤其他：滑膜肉瘤、血管周細(xì)胞瘤、腦膜瘤等CD117 （c-Kit）胞膜陽(yáng)性著色+/- 胞漿陽(yáng)性，胞膜為必需 正常時(shí)胃腸道的Cajal 細(xì)胞、黑色素細(xì)胞、肥大細(xì)胞陽(yáng)性 用于診斷GIST用于診斷mastocytosis用于診斷精原細(xì)胞瘤/ 無(wú)性細(xì)胞瘤 Inhibin胞漿內(nèi)，常呈顆粒狀著色用于診斷性索間質(zhì)腫瘤：顆粒細(xì)胞瘤、Sertoli-Leydig細(xì)胞瘤用于診斷腎上腺皮質(zhì)腫瘤BRST-2（Gross cystic disease fluid protein-15, GCDFP-15）用于確定腫瘤來(lái)源于乳腺 少部分汗腺、涎腺或其他腫瘤也可+CEA細(xì)胞膜+/- 細(xì)胞漿陽(yáng)性著色 幾乎所有的腺癌為陽(yáng)性 用于診斷乳腺/ 乳腺外的Pagets 病，+ 而惡黑-顯示涎腺或汗腺腫瘤中的腺體成分 用于鑒別腺癌和間皮瘤 用于診斷甲狀腺髓樣癌，尤其是小細(xì)胞型 用于診斷肝細(xì)胞癌前列腺癌的免疫組化表型AE1/AE3 +PSA +P504S +CK34BE -P63 免疫組化檢查在病理診斷中的應(yīng)用及其意義(二)作者：聯(lián)合病理整理轉(zhuǎn)貼自：中杉生物公司交流資料點(diǎn)擊數(shù)：4071二、免疫組化在病理診斷中的應(yīng)用（一）免疫組織化學(xué)在外科病理診斷中的重要性 免疫組織化學(xué)染色技術(shù)發(fā)展到今天，已經(jīng)成為外科病理診斷中必不可少的手段，如同組織化學(xué)染色一PAS、網(wǎng)染等一樣，同時(shí)也是提高診斷水平、為臨床提供診療依據(jù)，預(yù)測(cè)治療效果和預(yù)后，減少醫(yī)療糾紛的重要手段。（二）免疫組化在病理診斷中的應(yīng)用 1原發(fā)性腫瘤的組織來(lái)源、確診及轉(zhuǎn)移性腫瘤原發(fā)部位的判定，常見(jiàn)舉例如下：類(lèi)癌 (CgA+、NSE+、CK+)副神經(jīng)節(jié)瘤 (CK-、S-100+、SYN+、CgA+) 甲狀腺髓樣癌 (Cacitonin+、thyroglobulin-)甲狀腺乳頭狀癌 (Cacitonin-、thyroglobulin+)原始神經(jīng)外胚葉腫瘤 (CD99+、NSE+、SYN+、NF+、LCA、Desmin)淋巴瘤的各種組織學(xué)類(lèi)型 如各種T細(xì)胞、B細(xì)胞等標(biāo)記物惡性黑色素瘤 (HMB45+、Melan-A+)血管平滑肌脂肪瘤(平滑肌成分HMB45+)，肺泡細(xì)胞癌、肺小細(xì)胞癌 (TTF-1-) 前列腺癌 (PSA+、CK34BE12-)膠質(zhì)瘤 (GFAP+)胃腸道腺癌 (CK20+、CK7-)胸腺瘤 (CD5+) 胃腸道間質(zhì)瘤 (CD34+、CDll7+)Merkel細(xì)胞癌 (CK2 0陽(yáng)性)卵巢上皮性腫瘤及顆粒細(xì)胞瘤 (CK20-、CK7+)轉(zhuǎn)移性鱗癌 (CK56+)間皮細(xì)胞 (Calretinin+)。 2檢測(cè)腫瘤組織的轉(zhuǎn)移潛能 NM23-H1、CD44v6、MMP 3. 病原微生物的檢測(cè) HPV、EBV、HBsAg、HBcAg、HCV、CMV4. 激素受體判定預(yù)后及治療反應(yīng) 乳腺癌常用指標(biāo)PR、ER、PS2，子宮內(nèi)膜癌、卵巢癌、 膀胱癌及腦膜瘤等均表達(dá)PR、ER，腦膜瘤還表達(dá)AR，對(duì)腫瘤的臨床治療方案的確定提供依據(jù)。5評(píng)價(jià)腫瘤增殖活性 Ki-67、PCNA，對(duì)腫瘤的分化、腫瘤的復(fù)發(fā)等提供參考依據(jù)。6提高微小轉(zhuǎn)移癌灶的發(fā)現(xiàn)率 淋巴結(jié)中微小轉(zhuǎn)移癌的發(fā)現(xiàn)有時(shí)非常困難，但用CK(AEIAE3)標(biāo)記淋巴結(jié)可有效提高陽(yáng)性檢出率，客觀評(píng)價(jià)預(yù)后。7化療藥物敏感性檢測(cè)對(duì)腫瘤治療的指導(dǎo) MDR-1、GST-n、TopoII、MRP、LRP等的聯(lián)合免疫組化標(biāo)定。8判定腫瘤分期及腫瘤的鑒別診斷 CK34BEl2是前列腺腺體基底細(xì)胞的特異性標(biāo)記抗體，可鑒別前列腺上皮內(nèi)病變或前列腺癌；肌動(dòng)蛋白actin（smooth muscle actin平滑肌肌動(dòng)蛋白簡(jiǎn)稱(chēng)稱(chēng)SMA）可顯示乳腺的肌上皮細(xì)胞，常用于乳腺原位癌或浸潤(rùn)癌、硬化性腺病與浸潤(rùn)性管狀腺癌、導(dǎo)管內(nèi)癌是否有浸潤(rùn)癌成分等鑒別。9診斷困難時(shí)的診斷作用 (1)活檢組織擠壓嚴(yán)重或分化較低時(shí)，如胃鏡活檢組織，可用CEA、CK、LCA、CD34等進(jìn)行免疫組化染色進(jìn)行鑒別。 (2) 腹腔積液中間皮細(xì)胞和腺癌的鑒別：Calretinin、CEA、CK20等。 (3)宮內(nèi)孕和宮外孕的診斷，當(dāng)未發(fā)現(xiàn)絨毛時(shí)，CK(AEl/AE3)是很好的特異性標(biāo)記物。因蛻膜組織“染色陰性，而浸潤(rùn)其中的滋養(yǎng)葉細(xì)胞則CK陽(yáng)性，即可明確診斷。 在多年外科病理診斷中，大家公認(rèn)：免疫組化不是萬(wàn)能的，存在著如特異性或敏感性等問(wèn)題，但在外科病理診斷上的作用卻是實(shí)實(shí)在在的，關(guān)鍵在于怎樣應(yīng)用。免疫組化檢查在病理診斷中的應(yīng)用及其意義(三)作者：聯(lián)合病理整理轉(zhuǎn)貼自：中杉生物公司交流資料點(diǎn)擊數(shù)：2511三、人體常見(jiàn)細(xì)胞的免疫組化特性Lymph Node Germinal center B cells CD45+; CD20+; CD79a+ (weak); CD5-; CD10+; Ig+ (IgG, IgM or IgA, but not IgD); Light chain+; bcl-2-; bcl-6+; proliferating cases in dark zone well highlighted by Ki67 Mantle zone B cells: CD45+; CD20+; CD79a+; IgD+; IgM+; IgG-; IgA-; Light chain+; bcl-2+; CD5-; CD10-; bcl-6- Marginal zone B cells and monocytoid B cells CD45+; CD20+; CD79a+; IgM+; IgD-/+; CD5-; bcl-2-; bcl-6- Interfollicular B cells CD45+; CD20+; CD79a+; Ig+ (IgD, IgM, IgG or IgA); Light chain+; bcl-2+; bcl-6-; activated B cells may express CD30; EBV-infected B cell may upregulate CD43 Plasma cells CD45-/+; CD20-; CD79a+/-; Ig+; CD138+; EMA+/- T cells CD3+; CD45RO+; CD43+; mostly TCR-?, sometimes TCR-?; CD4+ or CD8+; subpopulation can express cytolytic molecules (granzyme B, TIA1, perforin) T cells in germinal center CD3+; CD45RO+; CD43+; CD57+; CD4+;CD8- NK cells: CD45+; surface CD3-; cytoplasmic CD3+; CD43+; CD45RO+; CD56+; CD57+/-; Granzyme B+; TIA1+; Perforin+ Follicular dendritic cells CD45-; CD21+; CD35+; FDC+; CD23 (subpopulation)+; S100-/+; CD1a-; lysozyme-; HLA-DR+ Interdigitating dendritic cells CD45+; S100+; CD68-/+; CD1a-/+; lysozyme-/+; HLA-DR+; CD43+ Langerhans cells CD45+; S100+; CD68-/+; CD1a+; lysozyme-/+; HLA-DR+ Histiocytes CD45+; S100-; CD68+; CD1a-; lysozyme+; HLA-DR+; CD43+ Spleen Lymphocytes Either B cells or T cells (see Lymph node) Splenic sinus lining cells Factor VIII+; CD31-/+; CD34-/+; CD8+; lysozyme+; CD68-/+ Splenic pulp cords Rich in CD68+ cells Thymus Thymic epithelial cells CK+ (esp. CAM5.2+, but 34?E12 shows up the epithelium of the medulla much better) Thymic T lymphocytes in cortex CD45+; CD3+; TdT+; CD1a+; CD99+; high Ki67 index Thymic T lymphocytes in medulla CD45+; CD3+; TdT-; CD1a-; CD99- Thymic B lymphocytes in medulla CD45+; CD20+ (sometimes with asteroid appearance); CD79a+ Skin and mucosal tissues and parenchymal organs Epithelium CK+ (glandular epithelium tends to express low molecular weight CK; and some epithelial cells may express specific CK subtypes); vimentin-/+; BerEP4+/-; EMA+/-; E-cadherin+/- Special types of epithelium * Skin epidermis - 34?E12+, CAM5.2-, CK5/6+ * Prostatic acini and ducts - PSA+ * Breast with apocrine change - Brst2+ * Glandular epithelium - CEA may be positive (luminal); EMA often positive (esp. luminal) * Pneumocytes - Surfactant/PE10+, TTF1+ * Liver cells - CK+; HEP-PAR1+; CAM5.2+; AE1/AE3-; polyclonal CEA or CD10 in canalicular pattern; albumin+ * Bile ducts - CK+;CAM5.2+; AE1/AE3+, HEP-PAR1- Myoepithelium CK+; CK14+; High molecular weight CK+; Actin+; calponin+; S100-/+; GFAP-/+; Vimentin+ Basal cells of prostate CK+; CK14+; Actin-; S100- Melanocytes S100+; Vimentin+; HMB45- (some junctional melanocytes can be +); CK-; c-kit+ Merkel cells CK+; CK20+; synaptophysin+; chromogranin+; NSE+; neurofilament+ Mesenchymal cells Fibroblasts Vimentin+; Actin-; Desmin-; CK- Myofibroblasts Vimentin+; Actin+; Desmin-/+; CK-/+ Smooth muscle Vimentin+; Actin+; Desmin+; CK-/+ Interstitial dendritic cells Vimentin+; CD34+; Actin-/+; Desmin- Endothelium Factor VIII related antigen+; CD31+; CD34+; Vimentin+ Pericytes Factor VIII related antigen-; CD31-; CD34-; vimentin+; Actin+; Desmin- Fat cells Vimentin+; S100+ Cartilage cells Vimentin+; S100+; GFAP+/- Skeletal muscle Vimentin+; Actin+/-; Desmin+; Myoglobin+; MyoD1- (positive only in primitive or fetal muscle cells); Myogenin- (positive only in primitive or fetal muscle cells); S100-/+ (weak staining); CD56-/+ (positive in damaged muscle) Endometrial stromal cells CK-; Vimentin+; Actin+/-; Desmin-/+; S100-; CD10+ Mesothelial cells Mesothelial cells CK+; CK5/6+; Vimentin+; Calretinin+; HBME1+; N-cadherin+; E-cadherin-; CEA-; BerEP4-; LeuM1-; Desmin -/+ (occasional) Neuroendocrine and endocrine organsThyroid follicular cells CK+; Thyroglobulin+; TTF1+; Chromogranin-; Synaptophysin-; NSE- Thyroid C cells CK+; Calcitonin+; TTF1+; Chromogranin+; Synaptophysin+; NSE+; CEA+ Parathyroid CK+; Parathyroid hormone+; TTF1-; Chromogranin+;Synaptophysin+; NSE+; Neurofilament+ Islet cells CK+; Synaptophysin+; Chromogranin+; NSE+; Various hormones+ Pituitary cells CK+; Synaptophysin+; Chromogranin+; NSE+; Various hormones+ Adrenal cortical cells CK+/-; Synaptophysin-; Chromogranin-; NSE-; melan-A+/-; inhibin+/- Dispersed neuroendocrine cells CK+; Synaptophysin+; Chromogranin+; NSE+; Various hormones+ Central and peripheral nervous system Neurons and ganglion cells CK-; Neurofilament+; NSE+; Synaptophysin+; Chromogranin-/+; Calretinin+/-; GFAP- Nerve fibers (CNS or peripheral) CK-; Neurofilament+; NSE+; Synaptophysin+; Chromogranin-/+; GFAP-; Leu7+ Astrocytes CK-, GFAP+; S100+; Vimentin+; Synaptophysin-; Neurofilament- Oligodendroglial cells CK-, GFAP-; S100+; Leu7+/-; Synaptophysin-; Neurofilament- Ependymal cells CK-/+; GFAP+; Vimentin+; EMA+/- Choroid plexus cells CK+; Transthyretin+; GFAP+/-; BerEP4-; CEA-; S100+/- Schwann cells CK-, S100+; GFAP-/+; Vimentin+; Neurofilament-; EMA- Perineurial cells and meningeal cells CK-, S100-; GFAP-; EMA+; Vimentin+ Paraganglion chief cells and adrenal medulla cells CK-; Synaptophysin+; Chromogranin+; NSE+; Neurofilament+; S100- Sustentacular cells CK-, S100+; GFAP-/+; Synaptophysin-; Neurofilament+ Gonads Sertoli cells CK+/-; CD99+; Inhibin+; CD56-/+ Leydig cells CK-; Synaptophysin-; CD56-/+; Inhibin+; Melan A+/- Granulosa cells CK-; Vimentin+; CD99+; Inhibin+; Melan A+/- Germ cell (spermatogonia, ovum) CK-; PLAP-; c-kit+ Placenta Syncytiotrophoblast CK+; HCG+ Cytotrophoblast CK+; HCG- Intermediate trophoblast CK+; HCG-/+; HPL+ Decidual cells CK-; Vimentin+ Bone marrow Granulocytic series cells CD45+; Myeloperoxidase+; KP1/CD68+; PGM1/CD68-; lysozyme+ Monocytic series cells CD45+; Myeloperoxidase-; KP1/CD68+; PGM1/CD68+; lysozyme+ Red cell series Glycophorin A+ Megakaryocytes and platelets Factor VIII-related antigen+; CD31+; CD34+ 免疫組化檢查在病理診斷中的應(yīng)用及其意義(四)作者：聯(lián)合病理整理轉(zhuǎn)貼自：中杉生物公司交流資料點(diǎn)擊數(shù)：2843四、上皮及間皮類(lèi)常用標(biāo)記抗體EPITHELIAL AND MESOTHELIAL MARKERSCK (MNF 116)-MNF-116 is a pan-cytokeratin antibody.-Source: Dakopatts.-Dilution 1:50.-Antigen retrieval method: HIER (pressure cooking) using EDTA.-Staining pattern: Cytoplasmic, typically fibrillary, with or without accentuation beneath the cell membrane or in paranuclear region. A diffuse flocculent pattern in the cytoplasm is often produced by endogenous biotin rather than real staining.-This is an excellent antibody which reacts with a broad spectrum of cytokeratins of different molecular weights (including cytokeratins 5, 6, 8, 17, and possibly 19), i.e. it is considered a pan-cytokeratin antibody (although this antibody may not cover the cytokeratins of very low M.W. or very high M.W. well). This antibody will stain up practically all histological types of epithelial tumor, including glandular tumors, undifferentiated carcinomas, keratinizing squamous cell carcinoma, neuroendocrine carcinomas, small cell carcinomas and hepatocellular carcinomas. -For general purposes, it is adequate to order CK alone to detect epithelial differentiation. Order the following cytokeratin antibodies with more restricted reactivities only in selected circumstances, e.g. hepatocellular carcinoma versus other carcinoma types; small cell carcinoma. May consider replacing CK with CAM5.2 for suspected small cell carcinoma.-Main applications of pan-CK:a) Diagnosis of undifferentiated malignant neoplasmb) For mucosal sites, diagnosis of subtle carcinoma through demonstration of positive cells that are not part of the normal epithelial architecturec) Detection of occult carcinoma in lymph node, bone or bone marrowd) Diagnosis of certain types of mesenchymal tumors, e.g. synovial sarcoma, chordomaAE1/AE3 (pan-cytokeratin)-A mixture of two anti-cytokeratin monoclonal antibodies AE1 and AE3.-Source: Biogenex.-Dilution 1: 400.-Antigen retrieval method: HIER (pressure cooking) using EDTA.-Staining pattern: Cytoplasmic, typically fibrillary, with or without accentuation beneath the cell membrane or in paranuclear region. -This antibody combination reacts with both low and intermediate M.W. cytokeratins, although it does not stain high M.W. cytokeratins well in paraffin sections.-In the liver, the hepatocytes are typically negative, while the bile ducts are positive.CAM 5.2 -Monoclonal antibody against low M.W. cytokeratin (including CK8 and CK18).-Source: Becton-Dickinson.-Dilution 1:8.-Antigen retrieval method: HIER (pressure cooking) using EDTA.-Staining pattern: Cytoplasmic, typically fibrillary, with or without accentuation beneath the cell membrane or in paranuclear region. A monoclonal antibody that stains low M.W. cytokeratin best, particularly neuroendocrine cells and glandular epithelium. It does not stain the normal stratified squamous epithelium. In the liver, both the hepatocytes and bile ducts are positive. Stains most epithelial tu