Department of Surgery, Helsingborg Hospital, SE-251 87, Helsingborg, Sweden; Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, SE-221 00 Lund, Sweden.
Department of Genetics and Pathology, Division of Laboratory Medicine, Region Skåne, SE-221 85 Lund, Sweden.
Hum Pathol. 2019 Feb;84:221-230. doi: 10.1016/j.humpath.2018.10.009. Epub 2018 Oct 31.
Correct diagnosis of pulmonary tumors is essential for treatment decision and often relies on immunohistochemical markers. We stained tissue microarrays from resected primary lung cancer (n = 665) and pulmonary metastases (n = 425) for CK7, CK20, CDX2, CK5, p40, p63, TTF-1, napsin A, GATA3, and PAX8 to systematically assess the diagnostic value of these markers. Primary lung adenocarcinomas expressed TTF-1 in 90% and napsin A in 84% of the cases, whereas 10% were positive for p63, 7% for CDX2, 2% for CK20, and 2% for GATA3. Only 68% of the lung adenocarcinomas were positive for CK7, TTF-1, and napsin A and negative for all other markers. Primary lung squamous cell carcinomas expressed CK5, p40, and p63 in 94%-97% of cases, whereas 44% were positive for CK7, 20% for GATA3, 7% for CDX2, and 3% for TTF-1. Rare cases expressed PAX8, CK20, or napsin A. Pulmonary metastases of colorectal cancer were positive for CK20 in 83% and CDX2 in 99% of the cases. Rare cases expressed CK7, p63, or PAX8, whereas 4% expressed TTF-1. Pulmonary metastases of renal cell carcinomas were positive for PAX8 in 74%, napsin A in 7%, and CK7 in 7% of the cases. Pulmonary metastases of breast cancer were positive for GATA3 in 93% and CK7 in 78% of the cases, whereas 15% expressed CK5. Information on expression and patterns of immunohistochemical markers facilitates histopathological diagnostics. Evidently, unusual immune profiles occur and may lead to incorrect diagnosis.
准确诊断肺部肿瘤对于治疗决策至关重要,而这通常依赖于免疫组织化学标志物。我们对切除的原发性肺癌(n=665)和肺转移瘤(n=425)的组织微阵列进行了 CK7、CK20、CDX2、CK5、p40、p63、TTF-1、napsin A、GATA3 和 PAX8 的免疫染色,以系统评估这些标志物的诊断价值。原发性肺腺癌病例中,90%的病例表达 TTF-1,84%的病例表达 napsin A,而 10%的病例表达 p63,7%的病例表达 CDX2,2%的病例表达 CK20,2%的病例表达 GATA3。仅有 68%的肺腺癌病例 CK7、TTF-1 和 napsin A 阳性,而其他标志物均阴性。原发性肺鳞癌病例中,94%-97%的病例表达 CK5、p40 和 p63,而 44%的病例表达 CK7,20%的病例表达 GATA3,7%的病例表达 CDX2,3%的病例表达 TTF-1。极少数病例表达 PAX8、CK20 或 napsin A。结直肠癌的肺转移瘤病例中,83%的病例 CK20 阳性,99%的病例 CDX2 阳性。极少数病例 CK7、p63 或 PAX8 阳性,而 4%的病例 TTF-1 阳性。肾细胞癌的肺转移瘤病例中,74%的病例 PAX8 阳性,7%的病例 napsin A 阳性,7%的病例 CK7 阳性。乳腺癌的肺转移瘤病例中,93%的病例 GATA3 阳性,78%的病例 CK7 阳性,而 15%的病例 CK5 阳性。免疫组织化学标志物的表达和模式信息有助于组织病理学诊断。显然,不常见的免疫表型会出现,并可能导致误诊。