Centeno Barbara A
Pathology Services, H. Lee Moffitt Cancer Center & Research Institute, Tampa FL 33612, USA.
Cancer Control. 2006 Jan;13(1):13-26. doi: 10.1177/107327480601300103.
The liver is the most frequent site of metastatic disease, and metastatic disease to the liver is far more common than primary liver carcinoma in the United States. Pathologic evaluation of biopsy samples is key to establishing a correct diagnosis for patient management. Morphologic and immunoperoxidase studies, which are the standard for pathologic practice, accurately classify most tumors. Subclassification of carcinoma of unknown primary remains problematic.
The author reviewed the literature for articles pertaining to liver biopsy, diagnosis of specific tumor types, utility of immunohistochemical markers, and microarray and proteomic analysis.
Sampling of liver lesions is best accomplished by combining fine-needle aspiration and needle core biopsy. Many malignancies have distinct morphologic and immunohistochemical patterns and can be correctly subclassified. Adenocarcinoma of unknown primary remains enigmatic since current immunohistochemical markers for this differential diagnosis lack specificity. Microarray analysis and proteomic analysis of tumors can provide distinct gene or protein expression profiles, respectively, for tumor classification. These technologies can be used with fine-needle aspiration and needle core biopsy samples.
Most metastatic malignancies in the liver may be correctly diagnosed using standard morphology and immunohistochemical techniques. However, subtyping of some carcinomas and identification of site of unknown primary remains problematic. New technologies may help to further refine our diagnostic capabilities.
肝脏是转移性疾病最常见的部位，在美国，肝脏转移性疾病远比原发性肝癌常见。活检样本的病理评估是为患者管理确立正确诊断的关键。形态学和免疫过氧化物酶研究是病理实践的标准方法，能准确分类大多数肿瘤。原发灶不明的癌的亚分类仍然存在问题。
作者查阅了相关文献，内容涉及肝活检、特定肿瘤类型的诊断、免疫组化标志物的效用以及微阵列和蛋白质组分析。
肝病变的取样最好通过细针穿刺抽吸和针芯活检相结合来完成。许多恶性肿瘤具有独特的形态学和免疫组化模式，能够正确地进行亚分类。原发灶不明的腺癌仍然难以明确诊断，因为目前用于这种鉴别诊断的免疫组化标志物缺乏特异性。肿瘤的微阵列分析和蛋白质组分析分别可为肿瘤分类提供独特的基因或蛋白质表达谱。这些技术可用于细针穿刺抽吸和针芯活检样本。
使用标准的形态学和免疫组化技术，大多数肝脏转移性恶性肿瘤可以得到正确诊断。然而，一些癌的亚型分类和原发灶不明部位的确定仍然存在问题。新技术可能有助于进一步提高我们的诊断能力。
