Department of Surgical Pathology; Division of Cytopathology, Tata Memorial Center, HBNI University, Mumbai, Maharashtra, India.
Department of Surgical Pathology, Tata Memorial Center, HBNI University, Mumbai, Maharashtra, India.
Indian J Pathol Microbiol. 2020 Jul-Sep;63(3):427-434. doi: 10.4103/IJPM.IJPM_858_19.
One of the common indications of ascitic fluid examination in gynecological oncopathology is the detection and classification of malignant cells, especially in cases of clinically suspicious tubo-ovarian masses. The present study was undertaken to assess and validate the diagnostic utility of cell blocks (CBs) and compare its results with the corresponding conventional smears, prepared from effusion samples. CBs were prepared by thromboplastin technique in 220 cases. In 208 cases, diagnostic concordance between results obtained from smears and corresponding CBs was evaluated. Various antibody markers were tested, as per individual case. The average age of patients was 52.2 years. Positive immunohistochemical (IHC) staining for various markers was observed in 182 cases (82.7%) The most frequently positive antibody marker was PAX8 (101/134), followed by p53 (85/92) [mutation type (either diffusely positive or completely negative)], WT1 (tumor cells) (80/112), calretinin (2/87) (diffuse), BerEP4 (21/49), CA125 (21/24), CK7 (31/39) and CK20 and CDX2, together (5/16). Various other IHC markers utilized, including their positive expression, were TTF1 (1/10), p40 (3/3), p63 (2/4), ER (21/29), HBME1 (1/7), GATA3 (1/4), and MIC2 (1/1). Complete diagnostic concordance between CBs and smears was observed in 170/208 cases (81.7%). There were 20 major discordances, 10 minor and 8 cases with sampling errors. IHC was useful in classifying 158/182 (86.8%) cases, including serous or Müllerian adenocarcinoma (n = 123), mostly high-grade (121); metastatic squamous carcinoma (3); gastrointestinal-type adenocarcinoma (8); pulmonary adenocarcinoma (1); breast adenocarcinoma (1); Ewing sarcoma (1); and mesothelioma (2). CBs are complementary to smears in the detection of gynecological malignancies, mostly high-grade serous adenocarcinomas. These provide an opportunity for testing several IHC markers, for a precise diagnosis, including in various uncommon case scenarios, associated with significant therapeutic implications.
在妇科肿瘤病理学中，腹水检查的一个常见指征是检测和分类恶性细胞，特别是在临床上可疑的卵巢-输卵管肿块的情况下。本研究旨在评估和验证细胞块（CBs）的诊断效用，并将其结果与来自渗出液样本的相应常规涂片进行比较。在 220 例病例中，通过组织凝血活酶技术制备 CBs。在 208 例病例中，评估了从涂片和相应 CBs 获得的结果之间的诊断一致性。根据个别病例测试了各种抗体标志物。患者的平均年龄为 52.2 岁。在 182 例（82.7%）中观察到各种标记物的阳性免疫组化（IHC）染色。最常阳性的抗体标记物是 PAX8（101/134），其次是 p53（85/92）[突变类型（弥漫阳性或完全阴性）]，WT1（肿瘤细胞）（80/112），钙视网膜蛋白（2/87）（弥漫），BerEP4（21/49），CA125（21/24），CK7（31/39）和 CK20 和 CDX2 （5/16）。利用了其他各种 IHC 标记物，包括其阳性表达，包括 TTF1（1/10），p40（3/3），p63（2/4），ER（21/29），HBME1（1/7），GATA3（1/4）和 MIC2（1/1）。在 208 例病例中，CBs 和涂片之间观察到完全诊断一致的有 170/208 例（81.7%）。有 20 个主要不相符，10 个次要不相符和 8 个样本误差。IHC 有助于分类 158/182 例（86.8%）病例，包括浆液性或 Müllerian 腺癌（n = 123），大多数为高级别（121）；转移性鳞状细胞癌（3）；胃肠道型腺癌（8）；肺腺癌（1）；乳腺腺癌（1）；尤文肉瘤（1）；间皮瘤（2）。CBs 在检测妇科恶性肿瘤方面与涂片互补，主要是高级别浆液性腺癌。这为测试几个 IHC 标志物提供了机会，以便做出精确诊断，包括在各种罕见的情况下，这具有重要的治疗意义。
