Lan Zhihua, Zhang Jing, Yang Fang, Ma Xin, He Rongfang
Department of Pathology, The First Affiliated Hospital of Hengyang Medical School, Hengyang, China.
Department of Anorectal Surgery in Traditional Chinese Medicine, The First Affiliated Hospital of Hengyang Medical School, Hengyang, China.
Cytojournal. 2024 Jun 25;21:20. doi: 10.25259/Cytojournal_10_2024. eCollection 2024.
This study aimed to explore the efficacy of immunocytochemistry in diagnosing abdominopelvic washings (APWs) and evaluate the superiority of cytology combined with immunocytochemistry over cytology alone.
Data on APW cytology and available cell blocks from patients who underwent radical surgery for endometrial cancer between January 2021 and December 2022 were reviewed. Cytology was re-evaluated according to a five-tier system. Immunocytochemistry analysis for targets such as Sry box transcription factor 1(SOX17), Paired box gene 2 (Pax-2) protein, Phosphatase and tensin (PTEN), and β-catenin was performed on each case with non-negative cytology. Mismatch repair (MMR) protein and P53 immunocytochemistry analyses were performed using cell blocks from cases with abnormal MMR or P53 expression in their primary lesion. The accuracies of cytology combined with immunocytochemistry and cytology alone were calculated.
Overall, 126 patients were included in this study, 18 of whom demonstrated non-negative cytology of APW. Cell blocks were successfully prepared for 16 cases. SOX17 positivity was observed in 16 cases, including 1 of serous carcinoma, 1 of clear cell carcinoma, and 14 of endometrioid carcinoma (EC). Loss of Pax-2 and PTEN expression was observed in the APWs of the 14 patients with EC. MMR deficiency was noted in two patients with EC, and P53 mutation was noted in another two patients with EC. Compared with 10 metastatic carcinomas (10/18, 55.56%) diagnosed by cytology alone, 15 malignant APWs (15/18, 83.33%) were confirmed through combination cytology and immunocytochemistry. APWs were more likely to be observed in cases with more than half myometrial invasion than those with no or less than half myometrial invasion ( = 0.0067). The probability of malignant APW occurrence was slightly elevated in cases of EC exhibiting microcystic, elongated, and fragmented(MELF) infiltrative growth ( = 0.039).
SOX17 is a useful Müllerian marker for distinguishing endometrial epithelium in APW. Loss of Pax-2 and PTEN expression offers evidence of metastatic endometrial carcinoma. Furthermore, positive APWs retained molecular features similar to primary lesions. The use of multiple immunocytochemical markers can effectively enhance the diagnostic efficiency of APWs.
本研究旨在探讨免疫细胞化学在诊断腹盆腔冲洗液（APW）中的效能，并评估细胞学联合免疫细胞化学相对于单纯细胞学的优越性。
回顾了2021年1月至2022年12月期间接受子宫内膜癌根治性手术患者的APW细胞学数据及可用的细胞块。根据五级系统对细胞学进行重新评估。对每例细胞学结果为非阴性的病例进行免疫细胞化学分析，检测Sry盒转录因子1（SOX17）、配对盒基因2（Pax-2）蛋白、磷酸酶和张力蛋白同源物（PTEN）以及β-连环蛋白等靶点。对原发灶中错配修复（MMR）蛋白或P53表达异常的病例，使用其细胞块进行MMR蛋白和P53免疫细胞化学分析。计算细胞学联合免疫细胞化学和单纯细胞学的准确率。
本研究共纳入126例患者，其中18例APW细胞学结果为非阴性。成功为16例制备了细胞块。16例观察到SOX17阳性，包括1例浆液性癌、1例透明细胞癌和14例子宫内膜样癌（EC）。14例EC患者的APW中观察到Pax-2和PTEN表达缺失。2例EC患者存在MMR缺陷，另外2例EC患者存在P53突变。与单纯细胞学诊断的10例转移癌（10/18，55.56%）相比，细胞学联合免疫细胞化学确诊了15例恶性APW（15/18，83.33%）。与无肌层浸润或肌层浸润不足一半的病例相比，肌层浸润超过一半的病例更易观察到APW（P = 0.0067）。EC表现为微囊状、细长形和碎片化（MELF）浸润性生长的病例中，恶性APW发生的概率略有升高（P = 0.039）。
SOX17是区分APW中子宫内膜上皮的有用苗勒氏管标志物。Pax-2和PTEN表达缺失为转移性子宫内膜癌提供了证据。此外，阳性APW保留了与原发灶相似的分子特征。使用多种免疫细胞化学标志物可有效提高APW的诊断效率。
