我的博文

病理诊断免疫组化 胃肠道、肝胆胰

2016-09-05 07:19  阅读(3358)  评论(0)  分类:专业

第一节 食管肿瘤

1.Barrett’s食管

阳性:CK20,MUCs,CDX2,P53

 

2.鳞状细胞癌(普通型)

阳性:CAM5.2,AE1/AE3,CK5/6,34βE12,CK14,P63(部分),CK19

阴性:CK7,CK20,WT-1,CD5,TTF-1

 

3.基底细胞样鳞癌

阳性:Bcl-2,CK5/6,CK13,CK14,CK19,P63,S-100

阴性:CAM5.2,AE1/AE3

 

4.腺癌

阳性:CK7,CK20

阴性:P63

 

5.腺样囊性癌

阳性:CAM5.2,AE1/AE3,CD117

(导管分化细胞) 34βE12,CEA

(肌上皮分化细胞) S-100,SMA,vimentin,P63

阴性:CgA,Syn

 

6.黏液表皮样癌

阳性:(鳞状上皮样区域) 34βE12,CK14,P63

(腺上皮区域) CK7,CEA

 

7.梭形细胞分化癌或肉瘤样癌

阳性:CAM5.2,AE1/AE3,vimentin

阴性:desmin

 

8.平滑肌瘤

阳性:SMA,desmin,MSA,calponin

阴性:CD34,CD117,S-100

 

9.平滑肌肉瘤

阳性:SMA,desmin,vimentin

阴性:CD34,CD117

 

10.胃肠道间质瘤

阳性:CD34,CD117,PDGFRA,DOG1,PKCθ

 

11.神经内分泌肿瘤

阳性:Syn,CgA,NSE,TTF-1,CD56

阴性:CK19,CK20,34βE12

 

12.横纹肌肉瘤

 

13.滑膜肉瘤

 

14.Kaposi肉瘤

阳性:CD31,CD34

 

15.颗粒细胞瘤

阳性:S-100,CD57,vimentin

阴性:desmin,CD34,CD117,CAM5.2,EMA,CEA

 

16.恶性黑色素瘤

阳性:vimentin,S-100,HMB45,MART/melan-A,tyrosinase

阴性:CK,CEA

 

17.淋巴瘤(大B细胞淋巴瘤和MALT淋巴瘤多见)

 

第二节 胃部肿瘤

1.胃腺癌

阳性:CAM5.2,Pan-CK,CK7,CK20,CK18,CK19,CDX2,CEA(部分),villin(部分),Her-2

阴性:CK5/6,vimentin,P63(鳞化区域可阳性),TTF-1,CA125(少量)

 

2.含神经内分泌分化的腺癌

阳性:CKs,CgA,Syn

阴性:CD56

 

3.印戒细胞癌

阳性:CDX2,CK20,CEA

阴性:GCDFP-15,ER

 

4.高分化神经内分泌肿瘤或小细胞癌

阳性:CgA,Syn,CDX2

阴性:CK20,TTF-1,CK5/6

 

5.肉瘤样癌

 

6.胃肠道间质瘤

阳性:CD117,CD34,CD99,SMA,HHF-35(25%-50%),CK18(10%)

阴性:Syn(<5%),desmin(2%),CgA,S-100

 

7.神经鞘瘤

阳性:S-100,CD57(Leu7),GFAP

阴性:CD117,CD34,SMA

 

8.纤维瘤病

阳性:vimentin,desmin,β-catenin

阴性:CD117,CD34(少量细胞可阳性)

 

9.孤立性纤维瘤

阳性:CD34,CD99,SMA,Bcl-2

阴性:CD117

 

10.肝样腺癌

阳性:AFP,Hepatocyte

 

11.绒毛膜癌

阳性:β-hCG,PLAP

 

第三节 小肠肿瘤

1.神经内分泌肿瘤

阳性:CgA,Syn,CD57,villin,CEA,CDX2,CK20(25%),somatostatin

阴性:CK7,TTF-1

 

2.GIST

阳性:CD117,CD34,Bcl-2,SMA,S-100(20%)

阴性:desmin,CgA

 

3.远端小肠腺癌(表型类似结肠癌)

阳性:CK18,CK19,CK20,CDX2,villin,MUC1,MUC5AC(33%)

阴性:CK7,CK5/6,P63,vimentin

 

4.壶腹部腺癌(表型类似胰胆管腺癌)

阳性:CK18,CK19,CK7(50%),CK20(50%),CDX2,MUC1,MUC5AC(33%)

阴性:CK5/6,P63,vimentin

 

第四节 阑尾肿瘤

1.神经内分泌肿瘤

阳性:CgA,Syn,E-cadherin,β-catenin,CK20,CDX2

阴性:CEA,CK7

 

2.不产生黏液的腺瘤及腺癌

阳性:CK20,CK7

 

3.产生黏液的腺瘤及腺癌

阳性:CK8,CK18,CK19,CK20,CDX2,villin,MUC2,MUC5A,MUC1(20%)

 

第五节 结直肠肿瘤

1.神经鞘瘤

阳性:S-100,GFAP,CD34

阴性:CD117

 

2.神经纤维瘤

阳性:S-100,neurofilament

阴性:CD117

 

3.GIST

阳性:CD117,CD34,CD99,SMA

阴性:GFAP,desmin,S-100,neurofilament

 

4.平滑肌瘤

阳性:SMA,MSA,desmin

阴性:CD117,CD34,S-100

 

5.神经内分泌肿瘤

(右半结肠)阳性:serotonin,CgA,Syn,CK20(50%),CK7(25%)

         阴性:S-100,TTF-1

(直乙结肠)阳性:CgA,Syn,PAP(少数)

         阴性:S-100,PSA,P504S

 

6.腺癌

阳性:CK20,CDX2,villin,MUC1,MUC2,S-100(<20%),PLAP(部分,膜阳性),CA125

阴性:CK7(5%可阳性),CgA,Syn,MUC5A,CK5/6,GCDF-15,TTF-1,HPC

 

7.高分化神经内分泌肿瘤

阳性:Syn,低分子量CK,CAM5.2,35βH11  (含有非角化鳞癌成分)34βE12,CK5/6,P63

阴性:CK20,CgA,CD57,CD117

 

8.肉瘤样癌

 

第六节 肛管肿瘤

1.鳞状细胞癌及其亚型

 

2.腺癌

阳性:CK7

阴性:CK20

 

3.Paget’s病

阳性:AE1/AE3,CK7,CK20(部分),CEA,GCDFP-15

阴性:34βE12,S-100

 

第七节 胰腺肿瘤

1.胰腺神经内分泌肿瘤

阳性:PGP9.5,CgA,Syn,CK8,CK18,CAM5.2,AE1/AE3(部分)

阴性:CK7,CK20,TTF-1,CDX2,HepPar1,Villin

 

2.低分化神经内分泌癌

阳性:CD56,CD57,CgA,Syn,calcitonin

 

3.导管内乳头状黏液性肿瘤

阳性:CK7,CDX2,MUC2,MUC5AC,DUPAN-2,CA19-9,hMLH1,hMLH2,hMLH6

阴性:CK20,CEA

 

4.黏液性囊性肿瘤

阳性:CK7,CK20,CA125,CA19-9,MUC5A,Smad4

(卵巢样间质区域)vimentin,SMA,MSA,ER(20%-80%),α-inhibin

阴性:MUC1,MUC2

 

5.浆液性囊腺瘤

阳性:AE1/AE3,EMA,MUC1,MUC6,CA19-9

阴性:CEA,CgA,Syn

 

6.导管腺癌

阳性:EMA,CAM5.2,CA19-9,CK19,CK7,CK20,MUC1,MUC4,MUC5A,CDX2,Smad4,CD5,CD7,mesothelin

部分阳性:CgA,Syn,CA125,villin,CK5/6

阴性:AFP,PAP,PSA,WT-1,TTF-1,MUC2,HPC,vimentin,ER,PR

 

7.浸润性黏液想腺癌

阳性:MUC2

阴性:CA125,MUC1

 

8.含破骨样巨细胞的未分化癌

阳性:pan-CK,vimentin,AE1/AE3,CAM5.2,35βH11,CK8,CK18,CK19

(破骨样巨细胞)CD68,LCA,CD71,α-1-antichymotrypsin

阴性:EMA,CEA,HMB45,MART-1

 

9.腺泡细胞癌

阳性:AE1/AE3,CAM5.2,CK7,CK8,CK19,trypsin,α-1-antichymotrypsin,Syn(10%-50%)

阴性:CEA,CgA,vimentin,AFP

 

10.实性假乳头状瘤

阳性:α-1-antichymotrypsin,vimentin,β-catenin

(部分表达)CK20,AE1/AE3,CAM5.2,CK7,CD10,Syn,ER,PR

阴性:EMA,CEA,AFP,CA19-9,S-100

 

11.血管周上皮样细胞瘤

阳性:actin,HMB45,Myo-D1

阴性:CD117,CD34,SMA,AE1/AE3,CAM5.2,CgA,Syn

 

第八节 肝及胆管肿瘤

1.胆汁性肝硬化及硬化性胆管炎

阳性:(小胆管上皮)CK7,CK19,CD31/CD34

 

2.肝细胞腺瘤

阳性:CK8,CK18,HPC

阴性:CK7,CK19,CK20,CA19-9,34βE12

 

3.胆管错构瘤及腺瘤

阳性:CK7,CK19

阴性:CK20,MUC1,CEA

 

4.肝母细胞瘤

阳性:AFP,CgA,CKs,vimentin

 

5.普通型肝细胞癌

阳性:CK8,CK18,CAM5.2,OSCAR,AFP(高级别肝细胞癌阴性),HPC,AE1/AE3(少数),CD56(弱),CD31/34(内皮细胞),EMA,CEA(胆管型)

阴性:CK7(少数阳性),CK20(20%阳性),CK17,CA19-9,Calretinin,α-inhibin,TTF-1,CgA,Syn,MART-1,CK5/6,ER

 

6.具有胆管分化的肝细胞癌

阳性:AE1/AE3,CK7,CK19,CEA

 

7.梭形细胞肝细胞癌

阳性:vimentin,CAM5.2,HPC

阴性:AFP

 

8.纤维板层型肝细胞癌

阳性:CK8,CK18,CAM5.2,HPC,CK7,AFP(20%),α-1-antichymotrypsin

 

9.胆管癌

阳性:CK7,CK8,CK18,CK19,CAM5.2,CA19-9,CEA,MOC-31,CDX2(75%),CK17(50%),CK20(20%)

阴性:HPC,AFP,Syn,GCDFP-15

 

10.梭形细胞胆管癌或肉瘤样癌

阳性:vimentin,CEA,低分子量角蛋白(CAM5.2,AE1/AE3,EMA)

阴性:AFP,S-100

 

11.混合性肝细胞-胆管癌

 

12.低分化/未分化癌

阳性:CK7,CK19

阴性:CEA,CA19-9,AFP,HPC

 

13.胆管囊腺瘤或癌

阳性:AE1/AE3,CA19-9,CEA,CK7,CK20,CA125,vimentin,SMA,desmin

 

14.神经内分泌肿瘤(低级别及高级别)


 

我要评论

共0条评论