Jalali Mehri, Krishnamurthy Savitri
Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA.
Diagn Cytopathol. 2005 Aug;33(2):78-82. doi: 10.1002/dc.20310.
We studied the immunoreactivity of three antibodies--A103, calretinin, and inhibin alpha in destained Papanicolaou (Pap) smears and cell-blocks of 40 fine-needle aspiration biopsy cases of adrenocortical lesions (35 cases of hyperplasia/adenoma and 5 cases of carcinoma). Five cases of carcinoma (4) and melanoma (1) metastases to the adrenal gland and five cases of renal-cell carcinoma were also included for comparison. In benign adrenocortical lesions, A103 staining was noted in 82% of the destained Pap smears and in 92% of cell-blocks. In malignant adrenocortical lesions, A103 staining was noted in 50% of the destained Pap smears and in 80% of cell-blocks. In comparison, calretinin staining was noted in 6% and 50% of destained smears and in 78% and 60% of the cell-blocks of benign and malignant adrenocortical lesions. Inhibin alpha was not positive in any of the smears and showed the lowest level of positivity in the cell-block sections, namely in 11% of the benign lesions and 25% of the malignant lesions. The sensitivity of A103 was 90% on cell-blocks and 74% on smears, that of calretinin 75% on cell-blocks and 11% on smears, and that of inhibin alpha, 13% on cell-blocks alone. The specificity of A103 was lower than the other two makers, 90% vs. 100% because of positivity in metastatic melanoma in the adrenal gland. Our data show A103 to be the immunomarker with the highest sensitivity for identifying cells of adrenocortical origin in destained Pap's smears and cell-block sections with, however, a lower specificity when compared with calretinin and inhibin alpha. Calretinin is comparable in sensitivity with A103 on cell-block sections alone and not on smears. The results of this study suggest that if metastatic melanoma in adrenal gland is not a consideration then A103 is the marker of choice for identifying cells of adrenocortical origin in the limited material available for diagnostic purposes in cytology specimens.
我们研究了三种抗体——A103、钙视网膜蛋白和抑制素α在40例肾上腺皮质病变细针穿刺活检病例（35例增生/腺瘤和5例癌）脱色巴氏涂片和细胞块中的免疫反应性。还纳入了5例肾上腺转移癌（4例癌和1例黑色素瘤转移）及5例肾细胞癌用于比较。在良性肾上腺皮质病变中，82%的脱色巴氏涂片和92%的细胞块可见A103染色。在恶性肾上腺皮质病变中，50%的脱色巴氏涂片和80%的细胞块可见A103染色。相比之下，良性和恶性肾上腺皮质病变的脱色涂片分别有6%和50%可见钙视网膜蛋白染色，细胞块分别有78%和60%可见。抑制素α在任何涂片均为阴性，在细胞块切片中的阳性率最低，良性病变为11%，恶性病变为25%。A103在细胞块上的敏感性为90%，在涂片上为74%；钙视网膜蛋白在细胞块上为75%，在涂片上为11%；抑制素α仅在细胞块上为13%。A103的特异性低于其他两种标志物，分别为90%和100%，因为肾上腺转移黑色素瘤呈阳性。我们的数据显示，A103是在脱色巴氏涂片和细胞块切片中识别肾上腺皮质来源细胞敏感性最高的免疫标志物，然而，与钙视网膜蛋白和抑制素α相比，其特异性较低。仅在细胞块切片上，钙视网膜蛋白的敏感性与A103相当，在涂片上则不然。本研究结果表明，如果不考虑肾上腺转移黑色素瘤，那么在细胞学标本中用于诊断目的的有限材料中，A103是识别肾上腺皮质来源细胞的首选标志物。
