Kingston Elizabeth F, Goulding Helen, Bateman Adrian C
Department of Histopathology, The General Hospital, St Helier, Jersey, United Kingdom.
Dis Colon Rectum. 2007 Nov;50(11):1867-72. doi: 10.1007/s10350-007-9021-6.
This study was designed to test the hypothesis that highlighting vascular spaces with histochemical or immunohistochemical stains facilitates the identification of extramural and intramural vascular invasion in resected colorectal cancer specimens compared with routine hematoxylin and eosin staining.
Archival tumor sections from 50 resected colorectal cancers, in which extramural vascular invasion was not seen within the original tissue sections, were stained with hematoxylin and eosin, elastic van gieson histochemistry, and immunohistochemistry for CD31 and CD34. Two observers assessed the stained sections and the agreed incidence of vascular invasion using the four staining methods was compared.
Vascular invasion was more commonly identified in Dukes C (pTanyN1/2) (vascular invasion seen in 24 of 25 cases by at least 1 method) than Dukes B tumors (pT3/4N0) (vascular invasion seen in 14 of 25 cases by at least 1 method). Vascular invasion was identified in significantly more cases using elastic van gieson (24 cases; P = 0.0001), CD31 (18 cases; P = 0.0064), and CD34 (21 cases; P < 0.0001) than with hematoxylin and eosin alone (5 cases).
This study was novel in that it compared both histochemical and immunohistochemical methods for identifying vascular invasion in cases of colorectal cancer in which vascular invasion had not been identified during initial reporting. Highlighting of endothelium significantly increases the observed incidence of vascular invasion in colorectal cancer compared with hematoxylin and eosin alone. Elastic van gieson seemed sensitive for the presence of vascular invasion but with uncertain specificity. The possibility that these immunohistochemical methods may identify a subset of patients with colorectal cancer who may benefit from chemotherapy warrants further study.
本研究旨在验证以下假设：与常规苏木精和伊红染色相比，用组织化学或免疫组织化学染色突出显示血管腔隙有助于在切除的结直肠癌标本中识别壁外和壁内血管侵犯。
对50例切除的结直肠癌存档肿瘤切片进行苏木精和伊红染色、弹性范吉森组织化学染色以及CD31和CD34免疫组织化学染色，这些肿瘤在原始组织切片中未发现壁外血管侵犯。两名观察者对染色切片进行评估，并比较使用四种染色方法确定的血管侵犯一致发生率。
与杜克B期肿瘤（pT3/4N0）相比，杜克C期（pTanyN1/2）肿瘤中更常发现血管侵犯（至少一种方法在25例中有24例发现血管侵犯）（至少一种方法在25例中有14例发现血管侵犯）。与单独使用苏木精和伊红染色（5例）相比，使用弹性范吉森染色（24例；P = 0.0001）、CD31染色（18例；P = 0.0064）和CD34染色（21例；P < 0.0001）发现血管侵犯的病例明显更多。
本研究的新颖之处在于，它比较了组织化学和免疫组织化学方法在最初报告时未发现血管侵犯的结直肠癌病例中识别血管侵犯的情况。与单独使用苏木精和伊红染色相比，突出显示内皮细胞显著增加了结直肠癌中观察到的血管侵犯发生率。弹性范吉森染色似乎对血管侵犯的存在敏感，但特异性不确定。这些免疫组织化学方法可能识别出可能从化疗中获益的结直肠癌患者亚组，这一可能性值得进一步研究。
