Ormsby A H, Haskell R, Jones D, Goldblum J R
Department of Anatomic Pathology, Cleveland Clinic Foundation, Ohio 44195, USA.
Mod Pathol. 2000 Jan;13(1):46-51. doi: 10.1038/modpathol.3880008.
Primary adenocarcinoma of the seminal vesicles is an extremely rare neoplasm. Because prompt diagnosis and treatment are associated with improved long-term survival, accurate recognition of this neoplasm is important, particularly when evaluating limited biopsy material. Immunohistochemistry can be used to rule out neoplasms that commonly invade the seminal vesicles, such as prostatic adenocarcinoma. Previous reports have shown that seminal vesicle adenocarcinoma (SVCA) is negative for prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PAP); however, little else is known of its immunophenotype. Consequently, we evaluated the utility of cancer antigen 125 (CA-125) and cytokeratin (CK) subsets 7 and 20 for distinguishing SVCA from other neoplasms that enter the differential diagnosis. Four cases of SVCA-three cases of bladder adenocarcinoma and a rare case of adenocarcinoma arising in a mullerian duct cyst-were immunostained for CA-125, CK7, and CK20. Three of four cases of SVCA were CA-125 positive and CK7 positive. All four cases were CK20 negative. All bladder adenocarcinomas and the mullerian duct cyst adenocarcinoma were CK7 positive and negative for CA-125 and CK20. In addition, CA-125 immunostaining was performed in neoplasms that commonly invade the seminal vesicles, including prostatic adenocarcinoma (n = 40), bladder transitional cell carcinoma (n = 32), and rectal adenocarcinoma (n = 10), and all were negative for this antigen. In conclusion, the present study has shown that the CK7-positive, CK20-negative, CA-125-positive, PSA/PAP-negative immunophenotype of papillary SVCA is unique and can be used in conjunction with histomorphology to distinguish it from other tumors that enter the differential diagnosis, including prostatic adenocarcinoma (CA-125 negative, PSA/PAP positive), bladder transitional cell carcinoma (CK20 positive, CA-125 negative), rectal adenocarcinoma (CA-125 negative, CK7 negative, CK20 positive), bladder adenocarcinoma (CA-125 negative), and adenocarcinoma arising in a mullerian duct cyst (CA-125 negative).
精囊原发性腺癌是一种极其罕见的肿瘤。由于及时诊断和治疗与改善长期生存率相关，准确识别这种肿瘤很重要，尤其是在评估有限的活检材料时。免疫组织化学可用于排除通常侵犯精囊的肿瘤，如前列腺腺癌。既往报道显示精囊腺癌（SVCA）前列腺特异性抗原（PSA）和前列腺特异性酸性磷酸酶（PAP）呈阴性；然而，对其免疫表型了解甚少。因此，我们评估了癌抗原125（CA-125）以及细胞角蛋白（CK）亚群7和20在鉴别SVCA与其他需鉴别诊断的肿瘤中的作用。对4例SVCA、3例膀胱腺癌以及1例罕见的苗勒管囊肿腺癌进行CA-125、CK7和CK20免疫染色。4例SVCA中有3例CA-125阳性且CK7阳性。4例均CK20阴性。所有膀胱腺癌和苗勒管囊肿腺癌均CK7阳性，CA-125和CK20阴性。此外，对通常侵犯精囊的肿瘤进行CA-125免疫染色，包括前列腺腺癌（n = 40）、膀胱移行细胞癌（n = 32）和直肠腺癌（n = 10），所有这些肿瘤该抗原均为阴性。总之，本研究表明乳头状SVCA的CK7阳性、CK20阴性、CA-125阳性、PSA/PAP阴性免疫表型是独特的，可结合组织形态学将其与其他需鉴别诊断的肿瘤区分开来，包括前列腺腺癌（CA-125阴性、PSA/PAP阳性）、膀胱移行细胞癌（CK20阳性、CA-125阴性）、直肠腺癌（CA-125阴性、CK7阴性、CK20阳性）、膀胱腺癌（CA-125阴性）以及苗勒管囊肿腺癌（CA-125阴性）。
