Ordóñez N G
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Am J Surg Pathol. 1989 Apr;13(4):276-91.
Despite numerous histochemical, ultrastructural, and immunohistochemical studies, differentiation between malignant epithelial pleural mesothelioma and adenocarcinoma of the lung remains extremely difficult. Although there is general agreement that immunohistochemical methods can aid in this distinction, some studies have produced conflicting results with some of the proposed markers for mesothelioma. To obtain comparable and reproducible results, 19 unequivocal epithelial mesotheliomas and 23 unequivocal primary lung adenocarcinomas were studied by the avidin-biotin-peroxidase complex method on formalin-fixed, paraffin-embedded tissue specimens. Well-characterized, commercially available antibodies to carcinoembryonic antigen (CEA), a high- and low-molecular-weight keratin, vimentin, epithelial membrane antigen, human milk fat globule, Leu-M1, TAG-72 (identified by monoclonal antibody B72.3), beta 1 pregnancy-specific glycoprotein (SP1), human placental lactogen, secretory component (SC), CA19-9, and S-100 protein were used. Twenty-one adenocarcinomas (91.3%) reacted for CEA, 14 (60.9%) for Leu-M1, 14 (60.9%) for SC, nine (39.1%) for CA19-9, and eight (34.8%) for SP1; no mesotheliomas stained for any of these markers. Nineteen adenocarcinomas (82.6%) and one mesothelioma (5.3%) reacted with B72.3. Adenocarcinomas and mesotheliomas did not significantly vary in reaction to the remaining antibodies. None of the antibodies used was specific for mesothelioma, but CEA was the single most useful marker. One of the two adenocarcinomas negative for CEA was positive for TAG-72, Leu-M1, and SC, and the only B72.3-positive mesothelioma was negative for CEA, Leu-M1, SC, CA19-9, and SP1. These findings indicate that greater sensitivity in differentiating mesothelioma and adenocarcinoma can be achieved by immunostaining for both CEA and one or more of the markers TAG-72 (B72.3), Leu-M1, SC (these three have the highest sensitivity and specificity after CEA), CA19-9, and SP1.
尽管进行了大量的组织化学、超微结构和免疫组织化学研究，但恶性上皮性胸膜间皮瘤与肺腺癌之间的鉴别仍然极为困难。虽然人们普遍认为免疫组织化学方法有助于这种区分，但一些研究对于一些提议的间皮瘤标志物得出了相互矛盾的结果。为了获得可比且可重复的结果，采用抗生物素蛋白-生物素-过氧化物酶复合物法，对19例明确的上皮性间皮瘤和23例明确的原发性肺腺癌的福尔马林固定、石蜡包埋组织标本进行了研究。使用了特征明确的市售抗癌胚抗原（CEA）、高分子量和低分子量角蛋白、波形蛋白、上皮膜抗原、人乳脂肪球、Leu-M1、TAG-72（由单克隆抗体B72.3识别）、β1妊娠特异性糖蛋白（SP1）、人胎盘催乳素、分泌成分（SC）、CA19-9和S-100蛋白的抗体。21例腺癌（91.3%）对CEA呈阳性反应，14例（60.9%）对Leu-M1呈阳性反应，14例（60.9%）对SC呈阳性反应，9例（39.1%）对CA19-9呈阳性反应，8例（34.8%）对SP1呈阳性反应；无间皮瘤对这些标志物中的任何一种呈染色阳性。19例腺癌（82.6%）和1例间皮瘤（5.3%）与B72.3发生反应。腺癌和间皮瘤对其余抗体的反应无显著差异。所用抗体均无对间皮瘤具有特异性的，但CEA是唯一最有用的标志物。2例CEA阴性的腺癌中有1例对TAG-72、Leu-M1和SC呈阳性反应，唯一1例B72.3阳性的间皮瘤对CEA、Leu-M1、SC、CA19-9和SP1呈阴性反应。这些发现表明，通过对CEA以及TAG-72（B72.3）、Leu-M1、SC（这三种在CEA之后具有最高的敏感性和特异性）、CA19-9和SP1中的一种或多种标志物进行免疫染色，在鉴别间皮瘤和腺癌时可获得更高的敏感性。
