Flint A, Lloyd R V
Department of Pathology, University of Michigan, Hospitals, Ann Arbor.
Arch Pathol Lab Med. 1992 Jan;116(1):39-42.
Pulmonary metastases may develop in patients with colonic carcinoma. Histopathologic separation of a solitary colonic metastasis from a primary pulmonary adenocarcinoma may be problematic. With the use of a polyclonal antibody to carcinoembryonic antigen, a monoclonal antibody to cytokeratin (CAM 5.2), and a monoclonal carcinoembryonic antigen antibody (D-14), we compared 23 colonic carcinomas metastatic to the lung with 24 primary pulmonary adenocarcinomas. Both carcinomas manifested similar histologic features. However, foci of "dirty necrosis" were common in all but one of the colonic neoplasms, and foci were observed in only four of the primary lung carcinomas. The polyclonal carcinoembryonic antigen antibody did not distinguish metastatic colonic carcinoma from primary pulmonary adenocarcinoma. All colonic tumors stained with D-14, while three primary pulmonary adenocarcinomas stained diffusely, and eight stained focally. Staining with D-14 will not absolutely distinguish colonic from pulmonary adenocarcinoma. However, positive D-14 staining and the presence of dirty necrosis should identify most colonic carcinomas. True-negative D-14 staining practically excludes a colonic origin.
结肠癌患者可能会发生肺转移。孤立性结肠转移瘤与原发性肺腺癌的组织病理学鉴别可能存在问题。我们使用了一种针对癌胚抗原的多克隆抗体、一种针对细胞角蛋白的单克隆抗体（CAM 5.2）以及一种癌胚抗原单克隆抗体（D-14），对23例肺转移结肠癌与24例原发性肺腺癌进行了比较。两种癌表现出相似的组织学特征。然而，“脏坏死”灶在除1例之外的所有结肠肿瘤中都很常见，而在原发性肺癌中仅在4例中观察到。多克隆癌胚抗原抗体无法区分转移性结肠癌与原发性肺腺癌。所有结肠肿瘤D-14染色阳性，而3例原发性肺腺癌呈弥漫性染色，8例呈局灶性染色。D-14染色不能绝对区分结肠腺癌与肺腺癌。然而，D-14染色阳性及存在脏坏死应可识别大多数结肠癌。D-14染色真阴性实际上可排除结肠起源。
