Jordon D, Jagirdar J, Kaneko M
Department of Pathology, Veterans Administration Medical Center, Bronx, New York 10468.
Am J Pathol. 1989 Nov;135(5):931-7.
Despite major advances in the differential diagnosis of mesotheliomas versus adenocarcinomas, a certain percentage defy diagnosis. Several markers such as keratin, carcinoembryonic antigen, Leu-M1, milk fat globulin, and antibody against tumor-associated glycoprotein Tag-72 (B72.3) have been used to distinguish them. In this study, blood group antigens, namely Lewisx and Lewisy, known to be expressed in a number of adenocarcinomas of diverse origin were used in the differential diagnosis of 30 samples from 18 mesotheliomas and 18 primary lung adenocarcinomas. Adenocarcinomas showed strong diffuse homogeneous staining, membranous staining, or both for Lewisy in 100% of cases irrespective of differentiation. Lewisx was expressed in 78% of adenocarcinomas with a wide variation in distribution of staining. Mesotheliomas did not show the diffuse homogeneous staining pattern but showed a markedly distinctive granular staining in the cytoplasm of rare cells in 23% of Lewisy and 20% of Lewisx cases, which was interpreted as negative. In conclusion, Lewisy is a sensitive marker for adenocarcinomas in that it stains 100% of cases and is a specific marker in the differential diagnosis of mesotheliomas and adenocarcinomas.
尽管在间皮瘤与腺癌的鉴别诊断方面取得了重大进展，但仍有一定比例的病例难以确诊。已经使用了多种标志物，如角蛋白、癌胚抗原、Leu-M1、乳脂肪球蛋白以及抗肿瘤相关糖蛋白Tag-72（B72.3）的抗体来区分它们。在本研究中，已知在多种来源的许多腺癌中表达的血型抗原，即Lewisx和Lewisy，被用于对来自18例间皮瘤和18例原发性肺腺癌的30个样本进行鉴别诊断。腺癌在100%的病例中显示Lewisy呈强弥漫性均匀染色、膜染色或两者兼有，与分化程度无关。78%的腺癌表达Lewisx，染色分布差异很大。间皮瘤未显示弥漫性均匀染色模式，但在23%的Lewisy病例和20%的Lewisx病例中，罕见细胞的细胞质中显示出明显独特的颗粒状染色，这被解释为阴性。总之，Lewisy是腺癌的敏感标志物，因为它在100%的病例中染色，并且在间皮瘤和腺癌的鉴别诊断中是特异性标志物。
