Pereira Telma C, Share Sarah M, Magalhães Albino V, Silverman Jan F
University of Brasilia, Brazil.
Appl Immunohistochem Mol Morphol. 2011 Jan;19(1):10-4. doi: 10.1097/PAI.0b013e3181ecaf1c.
To the workup of metastatic squamous cell carcinoma (SCC) of unknown primary, we studied an immunohistochemical panel including thyroid transcription factor (TTF-1), napsin A, villin, CDX-2, K903, CK5/6, p63, p16, CK7, and CK20. Using tissue microarray, we compared 194 SCC cases from the following sites: 35 lung, 34 skin, 14 cervix, 4 vagina, 16 vulva, 8 penis, 9 anus, 3 rectum, 10 esophagus, 4 bladder/urethra, and 57 SCC from various head and neck sites. p63 and K903 stained positively in 100% of cases, and CK5/6 in nearly 100% of cases, with the exception of 1 lung. CK7 was positive in 31.6% of all cases, with varying positivity according to the site. CK20 was negative in all cases except 1 lung. Napsin A was positive in 25.8% of lung, 7.7% of skin, 37.5% of penis, and 13.3% of tongue, and negative in all other sites. TTF-1 was positive only in 1 lung. p16 positivity ranged from 21.43% in vulva, to 75% in vagina and anus, and it was negative in lung, penis, bladder/urethra, and some head and neck. CDX-2 was negative in all cases except 1 vulva. Villin was negative in all cases. We conclude that immunohistochemistry has very limited value in determining the primary site of metastatic SCC. If lung is in the differential versus head and neck, esophagus, anorectal, or genital SCC, a panel including TTF-1, napsin A and p16 may be helpful, since positive TTF-1 and/or napsin A would favor lung primary, and positive p16 would favor an extrapulmonary site.
对于未知原发灶的转移性鳞状细胞癌（SCC）的检查，我们研究了一个免疫组织化学检测组合，包括甲状腺转录因子（TTF-1）、 napsin A、绒毛蛋白、CDX-2、K903、CK5/6、p63、p16、CK7和CK20。我们使用组织芯片比较了来自以下部位的194例SCC病例：35例肺、34例皮肤、14例宫颈、4例阴道、16例外阴、8例阴茎、9例肛门、3例直肠、10例食管、4例膀胱/尿道以及57例来自不同头颈部部位的SCC。p63和K903在所有病例中阳性率为100%，CK5/6除1例肺外几乎在所有病例中阳性率为100%。CK7在所有病例中的阳性率为31.6%，根据部位不同阳性率有所变化。CK20除1例肺外在所有病例中均为阴性。Napsin A在25.8%的肺、7.7%的皮肤、37.5%的阴茎和13.3%的舌中呈阳性，在所有其他部位均为阴性。TTF-1仅在1例肺中呈阳性。p16阳性率在外阴为21.43%，在阴道和肛门为75%，在肺、阴茎、膀胱/尿道以及一些头颈部部位为阴性。CDX-2除1例外阴病例外所有病例均为阴性。绒毛蛋白在所有病例中均为阴性。我们得出结论，免疫组织化学在确定转移性SCC的原发部位方面价值非常有限。如果在鉴别诊断中考虑肺与头颈部、食管、肛管直肠或生殖器SCC时，一个包括TTF-1、napsin A和p16的检测组合可能会有帮助，因为TTF-1和/或napsin A阳性支持肺原发，而p16阳性支持肺外部位。
