Shah Sejal S, Chandan Vishal S, Wilbur David C, Khurana Kamal K
Department of Pathology, SUNY-Upstate Medical University, Syracuse, NY, USA.
Arch Pathol Lab Med. 2007 Sep;131(9):1373-7. doi: 10.5858/2007-131-1373-GFAPAC.
The cytologic distinction between pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) can be diagnostically challenging in aspirate smears. Hence a cytologic diagnosis of "atypical cytology" with a differential diagnosis including PA and ACC is occasionally rendered in a subset of salivary gland fine-needle aspirations.
To evaluate the role of glial fibrillary acidic protein (GFAP) and CD57 expression in cell block material obtained during fine-needle aspiration procedure in differentiating PA from ACC.
We performed GFAP and CD57 immunostains on formalin-fixed, paraffin-embedded cell block sections of 26 salivary gland fine-needle aspiration cases with the following cytologic diagnoses: (1) PA (10 cases); (2) atypical cytology, cannot exclude ACC (8 cases); and (3) ACC (8 cases).
All 10 (100%) cases with cytologic diagnoses of PA were positive for GFAP, and 8 (80%) of 10 cases were positive for CD57; tissue follow-up confirmed the diagnosis of PA in all cases. All 8 (100%) cases with cytologic diagnosis of ACC were negative for both GFAP and CD57; tissue follow-up confirmed the diagnoses of ACC in all cases. Of the 8 cases with diagnoses of atypical cytology, 4 (50%) were negative and 4 (50%) were positive for both GFAP and CD57. Subsequent tissue follow-up in these cases revealed 4 cases of ACC (all negative for GFAP and CD57) and 4 cases of PA (all positive for GFAP and CD57).
Our results show that positive staining for GFAP and CD57 serves as a useful adjunct for the diagnosis of PA and helps to reduce the uncertainty in challenging cases.
在细针穿刺涂片检查中，多形性腺瘤（PA）和腺样囊性癌（ACC）的细胞学鉴别诊断具有挑战性。因此，在一部分唾液腺细针穿刺检查中，偶尔会做出“非典型细胞学”的细胞学诊断，鉴别诊断包括PA和ACC。
评估胶质纤维酸性蛋白（GFAP）和CD57表达在细针穿刺过程中获取的细胞块材料中区分PA和ACC的作用。
我们对26例唾液腺细针穿刺病例的福尔马林固定、石蜡包埋细胞块切片进行了GFAP和CD57免疫染色，这些病例具有以下细胞学诊断结果：（1）PA（10例）；（2）非典型细胞学，不能排除ACC（8例）；（3）ACC（8例）。
所有10例（100%）细胞学诊断为PA的病例GFAP均呈阳性，10例中的8例（80%）CD57呈阳性；组织随访证实所有病例均为PA。所有8例（100%）细胞学诊断为ACC的病例GFAP和CD57均为阴性；组织随访证实所有病例均为ACC。在8例诊断为非典型细胞学的病例中，4例（50%）GFAP和CD57均为阴性，4例（50%）均为阳性。这些病例随后的组织随访显示4例为ACC（GFAP和CD57均为阴性）和4例为PA（GFAP和CD57均为阳性）。
我们的结果表明，GFAP和CD57阳性染色有助于PA的诊断，并有助于减少疑难病例中的不确定性。
