Wilander E, Scheibenpflug L, Eriksson B, Oberg K
Department of Pathology, University Hospital, Uppsala, Sweden.
Acta Oncol. 1991;30(4):469-75. doi: 10.3109/02841869109092403.
The classical (mid-gut) carcinoids of the intestinal tract display a characteristic light microscopic morphology. However, sometimes intestinal tumours are seen resembling carcinoids and differential diagnostic difficulties arise. In the present study silver stains and immunoreactivities to chromogranin A + B, cytokeratins and epithelial membrane antigen (EMA) were evaluated as diagnostic adjuncts in six classical carcinoids and six intestinal carcinomas with carcinoid-like features. All classical carcinoids were argentaffin and argyrophil and contained a majority cell population with chromogranin immunoreactivity while only one carcinoid-like carcinoma was chromogranin-immunoreactive and the stained cells in that case represented a minority of the tumour cell population. The cytokeratins were shown to be non-discriminatory. However, EMA expression occurred in five intestinal carcinomas and in the majority of the tumour cells of four of these cases, while only one classical carcinoid displayed a few EMA positive cells. Thus, silver stains in combination with chromogranin A + B and EMA appears to be of value to discriminate between classical carcinoids and carcinoid-like intestinal carcinomas. Further when intestinal carcinoids and carcinoid-like carcinomas are diagnosed with the aid of various tumour markers both qualitative and quantitative considerations must be made.
肠道的经典型（中肠）类癌具有特征性的光镜形态。然而，有时会见到类似类癌的肠道肿瘤，从而产生鉴别诊断困难。在本研究中，对6例经典型类癌和6例具有类癌样特征的肠道癌进行了银染以及嗜铬粒蛋白A + B、细胞角蛋白和上皮膜抗原（EMA）免疫反应性评估，作为诊断辅助手段。所有经典型类癌均为亲银性和嗜银性，且含有多数具有嗜铬粒蛋白免疫反应性的细胞群，而只有1例类癌样癌具有嗜铬粒蛋白免疫反应性，且该病例中染色细胞仅占肿瘤细胞群的少数。结果显示细胞角蛋白无鉴别意义。然而，EMA表达出现在5例肠道癌中，其中4例的大多数肿瘤细胞呈EMA阳性，而只有1例经典型类癌有少数EMA阳性细胞。因此，银染结合嗜铬粒蛋白A + B和EMA似乎有助于鉴别经典型类癌和类癌样肠道癌。此外，当借助各种肿瘤标志物诊断肠道类癌和类癌样癌时，必须同时考虑定性和定量因素。
