Department of Dermatology, Dermatopathology Section, Boston University School of Medicine, Boston, MA 02118, USA.
Hum Pathol. 2012 Aug;43(8):1265-72. doi: 10.1016/j.humpath.2011.10.005. Epub 2012 Jan 26.
The distinction of porocarcinoma from squamous cell carcinoma is clinically relevant but can often be a diagnostic dilemma. Current markers reported to be helpful in diagnosing porocarcinoma include carcinoembryonic antigen and cytokeratin 7; however, their expression has been demonstrated in 30% to 80% and 13% to 22% of squamous cell carcinoma cases, respectively. In this study, we assessed immunohistochemical expression of cytokeratin 7, cytokeratin 15, cytokeratin 19, CAM 5.2, carcinoembryonic antigen, and nestin in 67 cases (39 porocarcinomas and 28 moderately differentiated squamous cell carcinomas) to determine their use as histologic adjuncts. Expression of carcinoembryonic antigen, cytokeratin 19, cytokeratin 7, CAM 5.2, cytokeratin 15, and nestin was seen in 77%, 67%, 64%, 51%, 49%, and 13% of porocarcinomas, respectively; and in 57%, 18%, 26%, 32%, 30%, and 37% of squamous cell carcinomas, respectively. Of these, cytokeratin 19 was the most specific (specificity, 82%) in detecting porocarcinomas, and carcinoembryonic antigen was the most sensitive (sensitivity, 77%). By χ(2) test, statistically significant P values (<.05) were observed for cytokeratin 7, cytokeratin 19, and nestin in the distinction of porocarcinoma from squamous cell carcinoma. However, in a logistic regression and stepwise selection for predicting a porocarcinoma, statistical significance was observed only for cytokeratin 19 (P = .0003). In conclusion, we found cytokeratin 19 to be a helpful marker in the distinction of porocarcinoma from squamous cell carcinoma, although a focal staining pattern can be seen in a third of cases. The diagnostic sensitivity and specificity appear to be significantly improved using a selected panel of immunohistochemical stains that include cytokeratin 7, cytokeratin 19, and nestin.
腺癌与鳞状细胞癌的鉴别具有临床意义，但常常是诊断上的难题。目前报道有助于诊断腺癌的标志物包括癌胚抗原和细胞角蛋白 7；然而，它们的表达分别在 30%至 80%和 13%至 22%的鳞状细胞癌病例中被证实。在这项研究中，我们评估了细胞角蛋白 7、细胞角蛋白 15、细胞角蛋白 19、CAM 5.2、癌胚抗原和巢蛋白在 67 例病例（39 例腺癌和 28 例中分化鳞状细胞癌）中的免疫组织化学表达，以确定它们作为组织学辅助手段的用途。癌胚抗原、细胞角蛋白 19、细胞角蛋白 7、CAM 5.2、细胞角蛋白 15 和巢蛋白的表达分别见于 77%、67%、64%、51%、49%和 13%的腺癌病例，以及 57%、18%、26%、32%、30%和 37%的鳞状细胞癌病例。其中，细胞角蛋白 19 在检测腺癌方面特异性最高（特异性为 82%），癌胚抗原敏感性最高（敏感性为 77%）。通过卡方检验，在腺癌与鳞状细胞癌的鉴别中，细胞角蛋白 7、细胞角蛋白 19 和巢蛋白的差异有统计学意义（P<.05）。然而，在逻辑回归和逐步选择预测腺癌的情况下，只有细胞角蛋白 19 有统计学意义（P =.0003）。总之，我们发现细胞角蛋白 19 是区分腺癌与鳞状细胞癌的有用标志物，尽管有三分之一的病例存在局灶性染色模式。使用包括细胞角蛋白 7、细胞角蛋白 19 和巢蛋白在内的免疫组织化学染色选择组合，诊断敏感性和特异性显著提高。
