Porcell A I, De Young B R, Proca D M, Frankel W L
The Ohio State University Medical Center, Columbus 43210, USA.
Mod Pathol. 2000 Jul;13(7):773-8. doi: 10.1038/modpathol.3880134.
Distinguishing hepatocellular carcinoma (HCC) from metastatic adenocarcinoma (MA) and cholangiocarcinoma (CC) can, at times, be difficult and sometimes requires immunohistochemical analysis. Recently, MOC31, an antibody directed against a cell surface glycoprotein, has been shown to be useful in separating HCC from both MA and CC; however, no study has compared MOC31 and other frequently used immunostains. We compare MOC31 with other commonly used immunostains for HCC, MA, and CC. Formalin-fixed, paraffin-embedded tissue sections from 57 previously characterized hepatic neoplasms (13 HCC, 14 CC, 3 combined HCC-CC, and 27 MA) were immunostained with antibodies directed against MOC31, cytokeratin (CK) 7, CK20, alpha-fetoprotein (AFP), polyclonal carcinoembryonic antigen, Ber-EP4, and Factor XIII-A. Two pathologists reviewed slides, and positivity was defined as more than 1% of cells staining with the appropriate pattern. Positive MOC31 immunostaining was seen in 0 of 13 HCC, 13 of 14 CC, 3 of 3 HCC-CC, and 27 of 27 MA; the staining was strong and diffuse. CK20 reactivity was observed in 0 of 13 HCC, 2 of 14 CC, 0 of 3 HCC-CC, and 12 of 27 MA; CK7 immunostained 4 of 13 HCC, 13 of 14 CC, 3 of 3 HCC-CC, and 15 of 27 MA; AFP was detected in 4 of 13 HCC and 2 of 3 HCC-CC, whereas all CC and MA were negative; polyclonal carcinoembryonic antigen showed immunoreactivity in 12 of 13 HCC and 3 of 3 HCC-CC in a canalicular pattern, whereas diffuse positivity was identified in 13 of 14 CC and 26 of 27 MA; Ber-EP4 immunostained 1 of 13 HCC, 14 of 14 CC, 2 of 3 HCC-CC, and 26 of 27 MA; and Factor XIII-A was negative in all HCC, CC, and MA. MOC31 expression distinguished HCC from adenocarcinoma in 56 of 57 cases. AFP was specific for HCC but was not sensitive. CK7 and CK20 have limited utility in distinguishing HCC from CC or MA, and Factor XIII-A is not useful. Ber-EP4 staining was similar to MOC31, but one HCC did stain with Ber-EP4. Polyclonal CEA yields similar numerical results as MOC31, but the focal nature of the staining and occasional difficulty in evaluating the pattern can make interpretation problematic. We conclude that MOC31 should be a component of the immunohistochemical panel to distinguish HCC from CC and MA.
有时，区分肝细胞癌（HCC）与转移性腺癌（MA）及胆管癌（CC）可能会很困难，有时需要进行免疫组织化学分析。最近，MOC31（一种针对细胞表面糖蛋白的抗体）已被证明在区分HCC与MA和CC方面很有用；然而，尚无研究比较MOC31与其他常用免疫染色剂。我们比较了MOC31与其他常用于HCC、MA和CC的免疫染色剂。对57例先前已明确特征的肝脏肿瘤（13例HCC、14例CC、3例HCC-CC合并肿瘤和27例MA）的福尔马林固定、石蜡包埋组织切片，用针对MOC31、细胞角蛋白（CK）7、CK20、甲胎蛋白（AFP）、多克隆癌胚抗原、Ber-EP4和因子ⅩⅢ-A的抗体进行免疫染色。两位病理学家检查了切片，阳性定义为以适当模式染色的细胞超过1%。13例HCC中0例MOC31免疫染色呈阳性，14例CC中13例呈阳性，3例HCC-CC中3例呈阳性，27例MA中27例呈阳性；染色强烈且弥漫。13例HCC中0例观察到CK20反应性，14例CC中2例呈阳性，3例HCC-CC中0例呈阳性，27例MA中12例呈阳性；CK7免疫染色13例HCC中4例呈阳性，14例CC中13例呈阳性，3例HCC-CC中3例呈阳性，27例MA中15例呈阳性；13例HCC中4例及3例HCC-CC中2例检测到AFP，而所有CC和MA均为阴性；多克隆癌胚抗原在13例HCC中的12例及3例HCC-CC中的3例呈小管状模式的免疫反应性，而14例CC中的13例及27例MA中的26例呈弥漫性阳性；13例HCC中的1例、14例CC中的14例、3例HCC-CC中的2例及27例MA中的26例Ber-EP4免疫染色呈阳性；因子ⅩⅢ-A在所有HCC、CC和MA中均为阴性。在57例病例中的56例中，MOC31表达可区分HCC与腺癌。AFP对HCC具有特异性，但不敏感。CK7和CK20在区分HCC与CC或MA方面效用有限。因子ⅩⅢ-A无用。Ber-EP4染色与MOC31相似，但有1例HCC被Ber-EP4染色。多克隆CEA产生的数值结果与MOC31相似，但染色的局灶性以及偶尔在评估模式方面的困难可能会使解读出现问题。我们得出结论，MOC31应成为区分HCC与CC和MA的免疫组织化学检测组合的一部分。
