Si Michael W, Jagirdar Jaishree, Zhang Yan-Jin, Gao Shou-Jiang, Yeh I-Tien
Department of Pathology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA.
Appl Immunohistochem Mol Morphol. 2005 Mar;13(1):61-5. doi: 10.1097/00129039-200503000-00010.
In transbronchial biopsies, Kaposi sarcoma (KS) is difficult to correctly diagnose by H&E staining due to the inherent vascular nature of the lung tissue, coupled with the subtle nature of the changes in early KS. Since KS-associated herpesvirus (KSHV) has been found in all clinical forms of KS, the detection of KSHV genomic DNA sequences and/or viral products may be helpful in the diagnosis of pulmonary KS. From their files during the past 10 years, the authors identified ten HIV/AIDS patients who were positive for KS in transbronchial biopsies and four HIV/AIDS patients with KS-negative transbronchial biopsies. Immunohistochemistry with antibodies against the latency-associated nuclear antigen (LANA-1 or LNA) of KSHV was performed. Nested polymerase chain reactions (PCR) with KSHV ORF-K1 or -K9 were performed in all cases, and the KSHV sequences were detected in 9/10 (90%) KS cases. Immunohistochemical analysis was able to detect 4/10 (40%) cases. One case was negative by both PCR and immunohistochemistry. Of the five KS cases that were not diagnosed definitively ("consistent with" or "suspicious for"), two were confirmed by both immunoreactivity and PCR. One of the negative control cases was positive for KSHV by PCR but not by immunohistochemistry. The patient was thereafter found to have a clinical history of pulmonary KS at another hospital. In conclusion, in transbronchial biopsies of the lung suspicious for KS, PCR is the most sensitive technique available for clinical diagnosis of KS. Immunohistochemistry analysis might be helpful in difficult pulmonary KS cases.
在经支气管活检中，由于肺组织固有的血管特性，再加上早期卡波西肉瘤（KS）变化的细微性质，通过苏木精-伊红（H&E）染色很难正确诊断KS。由于在KS的所有临床形式中均发现了KS相关疱疹病毒（KSHV），因此检测KSHV基因组DNA序列和/或病毒产物可能有助于肺KS的诊断。作者从他们过去10年的档案中，确定了10例经支气管活检KS呈阳性的HIV/AIDS患者和4例经支气管活检KS呈阴性的HIV/AIDS患者。使用针对KSHV潜伏相关核抗原（LANA-1或LNA）的抗体进行免疫组织化学检测。所有病例均进行了针对KSHV ORF-K1或-K9的巢式聚合酶链反应（PCR），在9/10（90%）的KS病例中检测到了KSHV序列。免疫组织化学分析能够检测出4/10（40%）的病例。有1例通过PCR和免疫组织化学检测均为阴性。在5例未明确诊断（“符合”或“可疑”）的KS病例中，有2例通过免疫反应性和PCR得到确诊。其中1例阴性对照病例通过PCR检测KSHV呈阳性，但免疫组织化学检测为阴性。该患者随后在另一家医院被发现有肺KS的临床病史。总之，在怀疑为KS的肺经支气管活检中，PCR是可用于KS临床诊断的最敏感技术。免疫组织化学分析可能有助于诊断困难的肺KS病例。
