Klappenbach R S, Kurman R J, Sinclair C F, James L P
Am J Clin Pathol. 1985 Aug;84(2):137-43. doi: 10.1093/ajcp/84.2.137.
A morphologic, histochemical, and immunocytochemical study of 20 cases of pure gastrointestinal carcinoids, adenocarcinomas, and mixed neoplasms composed of both elements, so-called composite carcinoma-carcinoid tumors (CCC), was undertaken in order to correlate the morphologic patterns with the immunocytochemical localization of carcinoembryonic antigen (CEA), serotonin, and a battery of polypeptide hormones (calcitonin, glucagon, insulin, gastrin, somatostatin, and adrenocorticotropin [ACTH]). Paraffin sections from five pure carcinoids, seven pure adenocarcinomas, and eight CCC from the stomach, small bowel, appendix, and colon were studied with mucicarmine, silver impregnation stains, and a peroxidase-anti-peroxidase technic. Of the eight CCC, all were mucin positive, four were argyrophilic, and three were argentaffin positive. CEA was present in all eight, serotonin in seven, and calcitonin in one. No other neurohormonal peptides were demonstrated. The distribution of serotonin and CEA generally corresponded to the morphologic pattern, but discordance was observed in two cases, i.e., serotonin was not always localized to areas of carcinoid and CEA not always confined to areas of carcinoma. All five pure carcinoids demonstrated intracytoplasmic localization of serotonin, whereas none contained intracytoplasmic CEA. In two cases, CEA was present within acinar lumens only. The seven colonic adenocarcinomas were argyrophil and argentaffin negative. All contained CEA within the cytoplasm and in gland lumens. None contained serotonin. None of the neurohormonal peptides was localized in either pure adenocarcinomas or carcinoids. This study reveals that among gastrointestinal neoplasms displaying morphologic patterns of adenocarcinoma and carcinoid, immunocytochemical localization of CEA and serotonin confirms their bidirectional differentiation and justifies the designation "composite carcinoma-carcinoid."
对20例纯胃肠道类癌、腺癌以及由这两种成分组成的混合性肿瘤（即所谓的复合癌-类癌肿瘤，CCC）进行了形态学、组织化学和免疫细胞化学研究，目的是将形态学模式与癌胚抗原（CEA）、血清素以及一系列多肽激素（降钙素、胰高血糖素、胰岛素、胃泌素、生长抑素和促肾上腺皮质激素[ACTH]）的免疫细胞化学定位相关联。对来自胃、小肠、阑尾和结肠的5例纯类癌、7例纯腺癌和8例CCC的石蜡切片进行了黏液卡红染色、银浸染染色和过氧化物酶-抗过氧化物酶技术研究。在8例CCC中，所有病例黏液均呈阳性，4例嗜银，3例亲银呈阳性。8例均存在CEA，7例存在血清素，1例存在降钙素。未显示其他神经激素肽。血清素和CEA的分布一般与形态学模式相符，但在2例中观察到不一致情况，即血清素并不总是定位于类癌区域，CEA也并不总是局限于癌区域。所有5例纯类癌均显示血清素的胞质内定位，而无一例含有胞质内CEA。在2例中，CEA仅存在于腺泡腔内。7例结肠腺癌嗜银和亲银均为阴性。所有病例的细胞质和腺腔内均含有CEA。无一例含有血清素。在纯腺癌或类癌中均未定位到任何神经激素肽。本研究表明，在显示腺癌和类癌形态学模式的胃肠道肿瘤中，CEA和血清素的免疫细胞化学定位证实了它们的双向分化，并证明了“复合癌-类癌”这一命名的合理性。
