Tot T
Department of Pathology and Clinical Cytology, Central Hospital, Falun, Sweden.
Cancer. 1999 Jan 1;85(1):171-7. doi: 10.1002/(SICI)1097-0142(19990101)85:1<171::AID-CNCR24>3.0.CO;2-V.
Metastatic adenocarcinoma in the liver with an unidentified primary tumor site is a common clinical problem. Pathologists often are asked to identify the primary tumor site. The histologic picture itself usually is not helpful, because the histology may be similar in the metastases of tumors with different primary localizations. Immunohistochemistry can be helpful, but the previously recommended antibody panels are too complicated for everyday use.
A simple immunohistochemical algorithm with two monoclonal cytokeratin (CK) antibodies, CK20 and CK7, was tested on 93 autopsy cases of adenocarcinomas metastatic to the liver. Sections of the liver metastases were stained automatically and evaluated as negative (no staining), focally positive, or diffusely positive. Statistical comparison of the staining results for a single antibody was calculated as an odds ratio.
Thirty-six of 93 (39%) metastases proved to be CK20 positive (+). In this group, the CK20+/CK7 negative (-) pattern was highly characteristic for colorectal localization of the primary tumor, having been observed 17 of 21 of the cases (81%). The CK20+/CK7+ pattern of the metastatic liver adenocarcinomas was highly suggestive of primary localization in the pancreas or biliary tract (11 of 14 cases; 79%). Exclusion of the tumors originating in the stomach raised these values to 94% and 92%, respectively. The statistically calculated predicted probability of primary tumor site being in the colon or rectum for CK20+/CK7- metastasis was 78,41%, the probability of a primary tumor being located in the pancreas or biliary tract was 74,85%, if calculated for the whole study group.
The tested simple algorithm proved to be useful in CK20 positive (+) cases, predicting a primary tumor localization in the colon, rectum, pancreas, or biliary tract with high accuracy. The CK20- group was too heterogeneous to be classified adequately by these two antibodies.
肝脏转移性腺癌且原发肿瘤部位不明是常见的临床问题。病理学家常被要求确定原发肿瘤部位。组织学图像本身通常并无帮助，因为不同原发部位肿瘤的转移灶组织学表现可能相似。免疫组化可能有用，但先前推荐的抗体组合对于日常应用而言过于复杂。
采用一种简单的免疫组化方法，使用两种单克隆细胞角蛋白（CK）抗体CK20和CK7，对93例肝脏转移性腺癌尸检病例进行检测。肝转移灶切片自动染色，并评估为阴性（无染色）、局灶阳性或弥漫阳性。计算单一抗体染色结果的统计学比较作为优势比。
93例转移灶中有36例（39%）CK20阳性（+）。在该组中，CK20+/CK7阴性（-）模式对于原发肿瘤的结肠定位具有高度特征性，21例中有17例（81%）观察到该模式。转移性肝腺癌的CK20+/CK7+模式高度提示原发部位在胰腺或胆道（14例中有11例；79%）。排除起源于胃的肿瘤后，这些值分别升至94%和92%。对于CK20+/CK7-转移，统计学计算得出原发肿瘤部位在结肠或直肠的预测概率为78.41%，对于整个研究组计算得出原发肿瘤位于胰腺或胆道的概率为74.85%。
所测试的简单方法在CK20阳性（+）病例中被证明是有用的，能够高精度预测原发肿瘤位于结肠、直肠、胰腺或胆道。CK20阴性组过于异质，无法通过这两种抗体进行充分分类。
