Wee A, Nilsson B
Department of Pathology, National University Hospital, National University of Singapore, Republic of Singapore.
Acta Cytol. 1997 Jul-Aug;41(4):1147-55. doi: 10.1159/000332837.
To assess the usefulness of bile canalicular polyclonal carcinoembryonic antigen (pCEA) immunostaining in fine needle aspiration biopsy (FNAB) diagnosis of hepatocellular carcinoma (HCC).
Hepatic FNAB with cell blocks of 72 confirmed and 6 possible HCC and 23 non-HCC malignancies (controls) were analyzed. Sections were stained with antibody to pCEA using the streptavidin biotin-immunoperoxidase method and results correlated with tumor grade and other parameters used in HCC diagnosis.
Canalicular pCEA staining was observed in 60 (83%) of the 72 HCC. This category comprised 29%, 31%, 36% and 4% grade 1-4 tumors, including 7 small cell, 4 clear cell and 1 giant cell variants. With increasing anaplasia, the canaliculi became infrequent, irregularly distributed, and increasingly distorted and interrupted. Canalicular staining helped distinguish clear and small cell variants from metastatic renal cell carcinomas and neuroendocrine tumors, respectively. Of the six problematic cases, one was confirmed to be HCC with plasmacytoid features and five to be adenocarcinomas, of which three could have been combined hepatocellular-cholangiocarcinomas. Liver cell dysplasia also displayed an abnormal canalicular pattern. No cytoplasmic staining was seen in pure HCC.
pCEA immunostaining cannot separate malignant, dysplastic or benign hepatocytes. It is usually not required in cytodiagnosis of most HCC. However, it is most helpful in confirming atypical variants of HCC, which may mimic other tumors.
评估胆管多克隆癌胚抗原（pCEA）免疫染色在细针穿刺活检（FNAB）诊断肝细胞癌（HCC）中的作用。
对72例确诊的和6例可能的HCC以及23例非HCC恶性肿瘤（对照）的肝细针穿刺活检及细胞块进行分析。采用链霉亲和素生物素免疫过氧化物酶法用抗pCEA抗体对切片进行染色，并将结果与肿瘤分级及HCC诊断中使用的其他参数相关联。
72例HCC中有60例（83%）观察到胆管pCEA染色。此类包括1 - 4级肿瘤的29%、31%、36%和4%，其中包括7例小细胞、4例透明细胞和1例巨细胞变体。随着间变程度增加，胆管变得稀少、分布不规则且越来越扭曲和中断。胆管染色有助于分别将透明细胞和小细胞变体与转移性肾细胞癌和神经内分泌肿瘤区分开来。在6例疑难病例中，1例被确诊为具有浆细胞样特征的HCC，5例为腺癌，其中3例可能是肝细胞 - 胆管细胞癌合并症。肝细胞发育异常也表现出异常的胆管模式。在纯HCC中未见胞质染色。
pCEA免疫染色不能区分恶性、发育异常或良性肝细胞。在大多数HCC的细胞诊断中通常不需要。然而，它在确认可能模仿其他肿瘤的HCC非典型变体方面最有帮助。
