Sheahan K, O'Brien M J, Burke B, Dervan P A, O'Keane J C, Gottlieb L S, Zamcheck N
Mallory Institute of Pathology, Boston, Massachusetts 02118.
Am J Clin Pathol. 1990 Aug;94(2):157-64. doi: 10.1093/ajcp/94.2.157.
To evaluate the role of carcinoembryonic antigen (CEA) in solving problems of tumor histogenesis in surgical pathology, monoclonal antibodies to four distinct epitopes of CEA (E-Z-EM) were applied to paraffin sections of 303 epithelial neoplasms from multiple sites. Two epitopes were CEA specific (D14 and B7.1), one was shared with nonspecific cross-reacting antigen (NCA) (B7.8), and the fourth (B18) was common to CEA, NCA, and biliary glycoprotein antigen (BGP). A sample of the tumors (n = 110) was also stained with a polyclonal anti-CEA (DAKO). Gastrointestinal adenocarcinomas, including esophageal and gastric (n = 19), small intestinal (n = 8), colorectal (n = 56), biliary tract (n = 8), and pancreatic adenocarcinomas (n = 14), were consistently positive with all five antibodies. Other predominantly gland-forming carcinomas tested, comprising lung (n = 22), ovary (n = 18), and endometrium (n = 12), were either invariably negative with all five antibodies (endometrial adenocarcinoma, non-mucinous ovarian adenocarcinoma) or demonstrated selective and variable positivity (lung: D14, 50%; ovarian mucinous: D14, 50%). Among large polygonal cell carcinomas (hepatocellular carcinoma, renal cell carcinoma, melanoma, and adrenal carcinoma), only hepatomas stained positively, showing a distinctive canalicular staining pattern with the B18 (BGP epitope) (55%) and polyclonal antibody (50%). In the small polygonal cell carcinoma category, true CEA positivity was rare in breast (D14, 10% and B7.1, 14%) and never seen in prostatic carcinomas and carcinoid tumors. A subset of these breast (8 of 42), prostate (4 of 22), and carcinoids (4 of 7) showed exclusive positivity for the B18 antibody (NCA/BGP epitope). Ovarian serous papillary carcinomas (n = 14), papillary carcinomas of thyroid (n = 12), transitional cell carcinomas of the bladder (n = 11), and mesotheliomas (n = 3) were negative with all monoclonal antibodies. Metastatic carcinomas (n = 74) showed a similar pattern of reactivity to primary tumors. The authors conclude that CEA immunostaining may assist in identifying the histogenesis of epithelial tumors in several morphologic categories; that differential reactivities of the CEA monoclonal antibody panel exceed those of the polyclonal antibody; and that the discriminating power of the monoclonal panel is related to whether (1) CEA is or is not produced or (2) NCA or BGP is produced without concomitant CEA production. There is little evidence to support a concept of site-specific CEA species.
为评估癌胚抗原（CEA）在解决外科病理学中肿瘤组织发生问题方面的作用，将针对CEA四个不同表位的单克隆抗体（E-Z-EM）应用于来自多个部位的303例上皮性肿瘤的石蜡切片。其中两个表位是CEA特异性的（D14和B7.1），一个与非特异性交叉反应抗原（NCA）共有（B7.8），第四个（B18）是CEA、NCA和胆汁糖蛋白抗原（BGP）所共有的。还使用多克隆抗CEA（DAKO）对110例肿瘤样本进行染色。胃肠道腺癌，包括食管和胃癌（19例）、小肠癌（8例）、结直肠癌（56例）、胆管癌（8例）和胰腺癌（14例），对所有五种抗体均呈持续阳性。所检测的其他主要为腺形成的癌，包括肺癌（22例）、卵巢癌（18例）和子宫内膜癌（12例），要么对所有五种抗体均始终呈阴性（子宫内膜腺癌、非黏液性卵巢腺癌），要么表现出选择性和可变的阳性（肺癌：D14，50%；卵巢黏液性癌：D14，50%）。在大的多边形细胞癌（肝细胞癌、肾细胞癌、黑色素瘤和肾上腺癌）中，只有肝癌呈阳性染色，对B18（BGP表位）（55%）和多克隆抗体（50%）显示出独特的小管状染色模式。在小的多边形细胞癌类别中，真正的CEA阳性在乳腺癌中很少见（D14，10%；B7.1，14%），在前列腺癌和类癌肿瘤中从未见过。这些乳腺癌（42例中的8例）、前列腺癌（22例中的4例）和类癌（7例中的4例）的一个亚组对B18抗体（NCA/BGP表位）呈排他性阳性。卵巢浆液性乳头状癌（14例）、甲状腺乳头状癌（12例）、膀胱移行细胞癌（11例）和间皮瘤（3例）对所有单克隆抗体均呈阴性。转移性癌（74例）显示出与原发性肿瘤相似的反应模式。作者得出结论，CEA免疫染色可能有助于识别几种形态学类别的上皮性肿瘤的组织发生；CEA单克隆抗体组的差异反应性超过多克隆抗体；单克隆抗体组的鉴别能力与以下因素有关：（1）是否产生CEA或（2）是否产生NCA或BGP而不伴随CEA产生。几乎没有证据支持位点特异性CEA种类的概念。
