Cina S J, Richardson M S, Austin R M, Kurman R J
Department of Pathology and Laboratory Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Mod Pathol. 1997 Mar;10(3):176-80.
Cytoplasmic carcinoembryonic antigen (CEA) positivity assists in the distinction of benign and malignant glandular lesions of the cervix, but some cases remain problematic. The accumulation of p53 protein and an increased proliferative index, as measured by the expression of Ki-67 antigen, have not been used as adjuncts to the diagnosis of these lesions. Immunohistochemical stains for CEA, p53 protein, and Ki-67 antigen were performed on 31 formalin-fixed, paraffin-embedded endocervical lesions including invasive adenocarcinoma, adenocarcinoma in situ, adenoma malignum, tunnel clusters, florid microglandular hyperplasia, mesonephric remnants, florid glandular hyperplasia, atypical glandular hyperplasia, and normal controls. Ki-67 antigen expression was quantitated as negligible, low, moderate, or high on the basis of the percentage (< 5%, 5-10%, 11-40%, > 40%, respectively) of glandular nuclei that were positive with MIB-1 antibody. Strong staining of more than 10% of the glandular epithelial nuclei was interpreted as positive for p53 protein overexpression. CEA positivity was determined by either diffuse or focal cytoplasmic staining of columnar epithelial cells equalling glycocalyceal staining in intensity. The combination of CEA positivity and a moderate-to-high proliferative index was limited to cases of invasive adenocarcinoma, adenoma malignum, and adenocarcinoma in situ, as compared with benign glandular lesions (P = 0.005). A high Ki-67 proliferative index and/or CEA positivity were features of malignant lesions rather than benign mimickers; there were no false positives or false negatives. Similarly, only malignant neoplasms shared a combination of p53 overexpression and CEA positivity (P = 0.043). The combination of cytoplasmic CEA positivity in glandular cells and a moderate-to-high Ki-67 proliferative index is diagnostic of malignancy in endocervical lesions. With the exception of florid microglandular hyperplasia, p53 expression is only seen in neoplastic lesions of the endocervix. An immunohistochemical battery consisting of MIB-1 (Ki-67), p53 protein, and CEA is useful in discriminating between benign and malignant endocervical lesions.
细胞质癌胚抗原（CEA）阳性有助于区分宫颈的良性和恶性腺性病变，但有些病例仍存在问题。p53蛋白的积累以及通过Ki-67抗原表达测量的增殖指数增加，尚未被用作这些病变诊断的辅助手段。对31例福尔马林固定、石蜡包埋的宫颈管病变进行了CEA、p53蛋白和Ki-67抗原的免疫组织化学染色，这些病变包括浸润性腺癌、原位腺癌、恶性腺瘤、隧道状细胞簇、旺炽性微小腺体增生、中肾残余、旺炽性腺体增生、非典型腺体增生以及正常对照。根据MIB-1抗体阳性的腺细胞核百分比（分别为<5%、5 - 10%、11 - 40%、>40%），将Ki-67抗原表达定量为可忽略不计、低、中或高。超过10%的腺上皮细胞核强染色被解释为p53蛋白过表达阳性。CEA阳性通过柱状上皮细胞弥漫性或局灶性细胞质染色确定，其强度等同于糖萼染色。与良性腺性病变相比，CEA阳性和中到高增殖指数的组合仅限于浸润性腺癌、恶性腺瘤和原位腺癌病例（P = 0.005）。高Ki-67增殖指数和/或CEA阳性是恶性病变而非良性模仿病变的特征；没有假阳性或假阴性。同样，只有恶性肿瘤同时具有p53过表达和CEA阳性（P = 0.043）。腺细胞中细胞质CEA阳性与中到高Ki-67增殖指数的组合可诊断宫颈管病变中的恶性肿瘤。除旺炽性微小腺体增生外，p53表达仅见于宫颈管的肿瘤性病变。由MIB-1（Ki-67）、p53蛋白和CEA组成的免疫组织化学检测组合有助于区分宫颈管的良性和恶性病变。
