Christensen W N, Boitnott J K, Kuhajda F P
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Mod Pathol. 1989 Jan;2(1):8-12.
Hepatocellular carcinoma may share histologic features with a wide variety of epithelial tumors. To facilitate its pathologic diagnosis, clinical and pathologic material was reviewed from 62 patients with hepatocellular carcinoma and immunostaining was performed with polyclonal anti-carcinoembryonic antigen (pCEA), monoclonal anti-carcinoembryonic antigen (mCEA), anti-epithelial membrane antigen (EMA), and an antikeratin (KER AE1/AE3). Clinical information and follow-up were available for all patients from several sources. Cases with ambiguous clinical data or findings suggestive of metastatic carcinoma to the liver were excluded. In addition, the following tumors were immunostained and compared to hepatocellular carcinoma: 10 cholangiocarcinomas; 14 pancreatic adenocarcinomas; 4 gastric adenocarcinomas; 3 breast carcinomas; 5 renal carcinomas; 3 combined germ cell tumors of the testis; 3 adrenal cortical carcinomas; and 4 melanomas. The pCEA stained bile canaliculi in normal liver and in 39 of 62 (63%) hepatocellular carcinomas. This canalicular staining pattern of pCEA was unique to hepatocellular carcinoma. The mCEA (1 of 62, 1.6%) was almost always negative, and KER AE1/AE3 (9 of 59, 15.3%) was occasionally positive. The EMA stained 25 of 62 (40.3%). The adrenal cortical carcinomas and melanomas were negative for all antigens except rare pCEA and focal EMA staining in an adrenal tumor. Other carcinomas showed cytoplasmic pCEA (36 of 44, 81.8%), mCEA (40 of 46, 87.7%), EMA (41 of 43, 95.4%), and KER AE1/AE3 (42 of 44, 95.5%). Canalicular staining with pCEA is specific for hepatocellular carcinoma, while negativity with mCEA and KER AE1/AE3 is suggestive of hepatocellular differentiation.
肝细胞癌可能与多种上皮性肿瘤具有共同的组织学特征。为便于其病理诊断，我们回顾了62例肝细胞癌患者的临床和病理资料，并用多克隆抗癌胚抗原（pCEA）、单克隆抗癌胚抗原（mCEA）、抗上皮膜抗原（EMA）和抗角蛋白（KER AE1/AE3）进行免疫染色。所有患者的临床信息和随访资料均来自多个来源。排除临床资料不明确或提示肝转移性癌的病例。此外，对以下肿瘤进行免疫染色并与肝细胞癌进行比较：10例胆管癌；14例胰腺腺癌；4例胃腺癌；3例乳腺癌；5例肾癌；3例睾丸混合性生殖细胞肿瘤；3例肾上腺皮质癌；4例黑色素瘤。pCEA在正常肝脏和62例肝细胞癌中的39例（63%）中染色胆管。pCEA的这种胆管染色模式是肝细胞癌所特有的。mCEA（62例中的1例，1.6%）几乎总是阴性，KER AE1/AE3（59例中的9例，15.3%）偶尔阳性。EMA在62例中的25例（40.3%）中染色。肾上腺皮质癌和黑色素瘤除肾上腺肿瘤中罕见的pCEA和局灶性EMA染色外，所有抗原均为阴性。其他癌显示细胞质pCEA（44例中的36例，81.8%）、mCEA（46例中的40例，87.7%）、EMA（43例中的41例，95.4%）和KER AE1/AE3（44例中的42例，95.5%）。pCEA的胆管染色对肝细胞癌具有特异性，而mCEA和KER AE1/AE3阴性提示肝细胞分化。
