Hurlimann J, Gardiol D
Department of Pathology, University of Lausanne, Switzerland.
Am J Surg Pathol. 1991 Mar;15(3):280-8. doi: 10.1097/00000478-199103000-00008.
Immunohistochemical techniques were used to study 177 hepatic tumors (hepatocarcinoma, cholangiocarcinoma, hepatocholangiocarcinoma, adenocarcinoma of unknown origin, and metastatic carcinoma). Phenotypes suggestive of hepatocarcinoma included keratins 8 and 18, factor XIII a, alpha-fetoprotein. C-reactive protein, carcinoembryonic antigen (CEA) cross-reacting antigen; those in effect that excluded hepatocarcinoma were keratins 1, 5, 10, 11, 19, true CEA. C-reactive protein, used for the first time, proved to be a fairly sensitive and specific marker. Factor XIII a, which was thought to be synthesized only by histiocytes, was also present in hepatocytes. Immunohistochemistry appears to be an important tool in the diagnosis of hepatic tumors. As a result of this study, 32 cases were reclassified; several were found to be intermediate between hepatocarcinoma and cholangiocarcinoma. Sixteen cases apparently were true hepatocholangiocarcinomas. In 12 cases of hepatocarcinoma, some tumor cells expressed keratins of bile duct type. It was impossible to differentiate immunohistochemically cholangiocarcinoma from metastatic carcinoma, except in two cases with breast tissue markers.
采用免疫组织化学技术研究了177例肝脏肿瘤（肝细胞癌、胆管癌、肝内胆管癌、原发灶不明的腺癌及转移癌）。提示肝细胞癌的表型包括角蛋白8和18、凝血因子XIII a、甲胎蛋白、C反应蛋白、癌胚抗原（CEA）交叉反应抗原；而排除肝细胞癌的表型有角蛋白1、5、10、11、19、真性CEA。首次应用的C反应蛋白被证明是一种相当敏感且特异的标志物。凝血因子XIII a以往认为仅由组织细胞合成，在肝细胞中也有表达。免疫组织化学似乎是肝脏肿瘤诊断中的一项重要工具。通过本研究，32例病例得到重新分类；发现数例处于肝细胞癌和胆管癌之间的中间类型。16例显然是真性肝内胆管癌。在12例肝细胞癌中，部分肿瘤细胞表达胆管型角蛋白。除2例有乳腺组织标志物的病例外，免疫组织化学方法无法区分胆管癌与转移癌。
