Brumm C, Schulze C, Charels K, Morohoshi T, Klöppel G
Institute of Pathology, University of Hamburg, FRG.
Histopathology. 1989 May;14(5):503-13. doi: 10.1111/j.1365-2559.1989.tb02186.x.
One hundred benign and malignant primary liver tumours were screened immunocytochemically for alpha-fetoprotein (AFP), alpha 1-antitrypsin, alpha-human chorionic gonadotropin, carcinoembryonic antigen (CEA), keratin and vimentin. Alpha-fetoprotein was found in 16/63 (24%) hepatocellular carcinomas and in two hepatoblastomas. When comparing tissue positivity for AFP with tumour differentiation, grade 1 hepatocellular carcinomas were found to be negative, while 21% of grade 2, 36% of grade 3 and 16% of grade 4, respectively, stained positively. Alpha-fetoprotein positive cells were present in 9/10 hepatocellular carcinomas with serum levels exceeding 5000 ng/ml, but were absent in 17 tumours with serum AFP levels below 5000 ng/ml. All tumours other than hepatocellular carcinomas and hepatoblastomas were AFP negative. Carcinoembryonic antigen was present in 72% of cholangiocarcinomas, but was demonstrated in only one hepatocellular carcinoma. This exception was a combined hepatocellular-cholangiocarcinoma in which CEA expression was restricted to the cholangiocellular part. Alpha 1-antitrypsin was found in 4/63 hepatocellular carcinomas, in 2/2 fibrolamellar carcinomas and in 2/18 cholangiocarcinomas. Alpha-human chorionic gonadotropin was detected in one hepatocellular carcinoma and was strongly expressed in both fibrolamellar carcinomas. Weak staining for keratin was seen in most tumours with hepatocellular differentiation. All cholangiocarcinomas, in contrast, were strongly labelled with the keratin antibody. Co-expression of keratin and vimentin was observed in seven poorly differentiated hepatocellular carcinomas and three cholangiocarcinomas as well as in the two hepatoblastomas. The findings suggest that AFP is a diagnostic but rather insensitive immunocytochemical marker for hepatocellular differentiation in malignant liver tumours; CEA and keratin may help in discriminating cholangiocarcinomas from hepatocellular carcinomas.
采用免疫细胞化学方法对100例原发性良恶性肝肿瘤进行甲胎蛋白（AFP）、α1抗胰蛋白酶、α人绒毛膜促性腺激素、癌胚抗原（CEA）、角蛋白和波形蛋白检测。63例肝细胞癌中有16例（24%）及2例肝母细胞瘤检测到AFP。比较AFP组织阳性与肿瘤分化程度，发现1级肝细胞癌为阴性，而2级的21%、3级的36%和4级的16%分别呈阳性染色。血清水平超过5000 ng/ml的10例肝细胞癌中有9例存在AFP阳性细胞，而血清AFP水平低于5000 ng/ml的17例肿瘤中未发现AFP阳性细胞。除肝细胞癌和肝母细胞瘤外，所有肿瘤AFP均为阴性。72%的胆管癌检测到CEA，但仅1例肝细胞癌检测到CEA。该例外病例为肝细胞-胆管细胞混合型癌，其中CEA表达仅限于胆管细胞部分。63例肝细胞癌中有4例、2例纤维板层癌中有2例及18例胆管癌中有2例检测到α1抗胰蛋白酶。1例肝细胞癌检测到α人绒毛膜促性腺激素，2例纤维板层癌均呈强阳性表达。大多数具有肝细胞分化的肿瘤可见角蛋白弱阳性染色。相反，所有胆管癌均被角蛋白抗体强烈标记。7例低分化肝细胞癌、3例胆管癌及2例肝母细胞瘤观察到角蛋白和波形蛋白共表达。这些结果表明，AFP是恶性肝肿瘤中肝细胞分化的一种诊断性但相当不敏感的免疫细胞化学标志物；CEA和角蛋白可能有助于鉴别胆管癌与肝细胞癌。
