College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Hum Pathol. 2010 Mar;41(3):431-7. doi: 10.1016/j.humpath.2009.09.001. Epub 2009 Dec 1.
Cervical lymph node metastases from unknown primary sites account for approximately 3% to 9% of all head and neck malignant lesions. Squamous cell carcinoma is the most common type of cervical metastatic carcinoma. Our aim was to investigate the possibility of determining the site of primary tumors using an immunohistochemical diagnostic panel in metastatic cervical lymph nodes. Expression profiles of cytokeratins, 5/6; 8/18; 10; 13; 14; and 19, p16, and pRb were evaluated in 101 consecutive patients with cervical nodal metastasis who had undergone neck dissection to treat known head and neck squamous cell carcinoma (primary sites: 16, oral cavity; 38, oropharynx; 26, hypopharynx; 21, larynx). Cytokeratin 10 was more frequently expressed in oral cavity primary tumors, whereas cytokeratin 19 staining was more frequently observed in tumors originated from the pharynx and larynx. The expression of p16 and altered pRb status (0% or >50%) were more frequently observed in oropharynx primary tumors. To select the best subset among the 8 antibodies tested, classification and regression tree analysis was performed. The analysis correctly classified the four primary sites (25.0% of oral cavity, 89.5% of oropharynx, 30.8% of hypopharynx, and 57.1% of larynx) using 5 variables (histologic subtype, p16, cytokeratins 10 and 19, and pRb). The p16 was the single best predictor. The classification tree method using immunostaining profiles of p16, cytokeratins 10 and 19, or pRb may be helpful in the identification of the primary site of metastatic squamous cell carcinoma with occult primary.
原发灶不明的颈部淋巴结转移约占所有头颈部恶性肿瘤的 3%至 9%。鳞状细胞癌是颈部转移性癌最常见的类型。我们的目的是研究在转移性颈部淋巴结中使用免疫组织化学诊断试剂盒确定原发肿瘤部位的可能性。对 101 例接受颈淋巴结清扫术治疗已知头颈部鳞状细胞癌（原发部位：16 例口腔，38 例口咽，26 例下咽，21 例喉）的患者的连续病例进行了细胞角蛋白 5/6；8/18；10；13；14；19、p16 和 pRb 表达谱的评估。细胞角蛋白 10 在口腔原发肿瘤中表达更频繁，而细胞角蛋白 19 染色在源于咽和喉的肿瘤中更频繁观察到。p16 和改变的 pRb 状态（0%或>50%）在口咽原发肿瘤中更频繁观察到。为了在测试的 8 种抗体中选择最佳子集，进行了分类和回归树分析。分析使用 5 个变量（组织学亚型、p16、细胞角蛋白 10 和 19 以及 pRb）正确分类了四个原发部位（口腔 25.0%、口咽 89.5%、下咽 30.8%和喉 57.1%）。p16 是唯一最好的预测因子。使用免疫组化 p16、细胞角蛋白 10 和 19 或 pRb 染色谱的分类树方法可能有助于识别隐匿性原发灶的转移性鳞状细胞癌的原发部位。
