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病理诊断免疫组化 胃肠道、肝胆胰

2016-09-05 07:19  阅读(3076)  评论(0)  分类:专业

第一节 食管肿瘤

1.Barrett’s食管

阳性:CK20MUCsCDX2P53

 

2.鳞状细胞癌(普通型)

阳性:CAM5.2AE1/AE3CK5/634βE12CK14P63(部分)CK19

阴性:CK7CK20WT-1CD5TTF-1

 

3.基底细胞样鳞癌

阳性:Bcl-2CK5/6CK13CK14CK19P63S-100

阴性:CAM5.2AE1/AE3

 

4.腺癌

阳性:CK7CK20

阴性:P63

 

5.腺样囊性癌

阳性:CAM5.2AE1/AE3CD117

(导管分化细胞) 34βE12CEA

(肌上皮分化细胞) S-100SMAvimentinP63

阴性:CgASyn

 

6.黏液表皮样癌

阳性:(鳞状上皮样区域) 34βE12CK14P63

(腺上皮区域) CK7CEA

 

7.梭形细胞分化癌或肉瘤样癌

阳性:CAM5.2AE1/AE3vimentin

阴性:desmin

 

8.平滑肌瘤

阳性:SMAdesminMSAcalponin

阴性:CD34CD117S-100

 

9.平滑肌肉瘤

阳性:SMAdesminvimentin

阴性:CD34CD117

 

10.胃肠道间质瘤

阳性:CD34CD117PDGFRADOG1PKCθ

 

11.神经内分泌肿瘤

阳性:SynCgANSETTF-1CD56

阴性:CK19CK2034βE12

 

12.横纹肌肉瘤

 

13.滑膜肉瘤

 

14.Kaposi肉瘤

阳性:CD31CD34

 

15.颗粒细胞瘤

阳性:S-100CD57vimentin

阴性:desminCD34CD117CAM5.2EMACEA

 

16.恶性黑色素瘤

阳性:vimentinS-100HMB45MART/melan-Atyrosinase

阴性:CKCEA

 

17.淋巴瘤(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:CAM5.2Pan-CKCK7CK20CK18CK19CDX2CEA(部分)villin(部分)Her-2

阴性:CK5/6vimentinP63(鳞化区域可阳性)TTF-1CA125(少量)

 

2.含神经内分泌分化的腺癌

阳性:CKsCgASyn

阴性:CD56

 

3.印戒细胞癌

阳性:CDX2CK20CEA

阴性:GCDFP-15ER

 

4.高分化神经内分泌肿瘤或小细胞癌

阳性:CgASynCDX2

阴性:CK20TTF-1CK5/6

 

5.肉瘤样癌

 

6.胃肠道间质瘤

阳性:CD117CD34CD99SMAHHF-35(25%-50%)CK18(10%)

阴性:Syn(<5%)desmin(2%)CgAS-100

 

7.神经鞘瘤

阳性:S-100CD57(Leu7)GFAP

阴性:CD117CD34SMA

 

8.纤维瘤病

阳性:vimentindesminβ-catenin

阴性:CD117CD34(少量细胞可阳性)

 

9.孤立性纤维瘤

阳性:CD34CD99SMABcl-2

阴性:CD117

 

10.肝样腺癌

阳性:AFPHepatocyte

 

11.绒毛膜癌

阳性:β-hCGPLAP

 

第三节 小肠肿瘤

1.神经内分泌肿瘤

阳性:CgASynCD57villinCEACDX2CK20(25%)somatostatin

阴性:CK7TTF-1

 

2.GIST

阳性:CD117CD34Bcl-2SMAS-100(20%)

阴性:desminCgA

 

3.远端小肠腺癌(表型类似结肠癌)

阳性:CK18CK19CK20CDX2villinMUC1MUC5AC(33%)

阴性:CK7CK5/6P63vimentin

 

4.壶腹部腺癌(表型类似胰胆管腺癌)

阳性:CK18CK19CK7(50%)CK20(50%)CDX2MUC1MUC5AC(33%)

阴性:CK5/6P63vimentin

 

第四节 阑尾肿瘤

1.神经内分泌肿瘤

阳性:CgASynE-cadherinβ-cateninCK20CDX2

阴性:CEACK7

 

2.不产生黏液的腺瘤及腺癌

阳性:CK20CK7

 

3.产生黏液的腺瘤及腺癌

阳性:CK8CK18CK19CK20CDX2villinMUC2MUC5AMUC1(20%)

 

第五节 结直肠肿瘤

1.神经鞘瘤

阳性:S-100GFAPCD34

阴性:CD117

 

2.神经纤维瘤

阳性:S-100neurofilament

阴性:CD117

 

3.GIST

阳性:CD117CD34CD99SMA

阴性:GFAPdesminS-100neurofilament

 

4.平滑肌瘤

阳性:SMAMSAdesmin

阴性:CD117CD34S-100

 

5.神经内分泌肿瘤

(右半结肠)阳性:serotoninCgASynCK20(50%)CK7(25%)

         阴性:S-100TTF-1

(直乙结肠)阳性:CgASynPAP(少数)

         阴性:S-100PSAP504S

 

6.腺癌

阳性:CK20CDX2villinMUC1MUC2S-100(<20%)PLAP(部分,膜阳性)CA125

阴性:CK7(5%可阳性)CgASynMUC5ACK5/6GCDF-15TTF-1HPC

 

7.高分化神经内分泌肿瘤

阳性:Syn,低分子量CKCAM5.235βH11  (含有非角化鳞癌成分)34βE12CK5/6P63

阴性:CK20CgACD57CD117

 

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

阳性:AE1/AE3CK7CK20(部分)CEAGCDFP-15

阴性:34βE12S-100

 

第七节 胰腺肿瘤

1.胰腺神经内分泌肿瘤

阳性:PGP9.5CgASynCK8CK18CAM5.2AE1/AE3(部分)

阴性:CK7CK20TTF-1CDX2HepPar1Villin

 

2.低分化神经内分泌癌

阳性:CD56CD57CgASyncalcitonin

 

3.导管内乳头状黏液性肿瘤

阳性:CK7CDX2MUC2MUC5ACDUPAN-2CA19-9hMLH1hMLH2hMLH6

阴性:CK20CEA

 

4.黏液性囊性肿瘤

阳性:CK7CK20CA125CA19-9MUC5ASmad4

(卵巢样间质区域)vimentinSMAMSAER(20%-80%)α-inhibin

阴性:MUC1MUC2

 

5.浆液性囊腺瘤

阳性:AE1/AE3EMAMUC1MUC6CA19-9

阴性:CEACgASyn

 

6.导管腺癌

阳性:EMACAM5.2CA19-9CK19CK7CK20MUC1MUC4MUC5ACDX2Smad4CD5CD7mesothelin

部分阳性:CgASynCA125villinCK5/6

阴性:AFPPAPPSAWT-1TTF-1MUC2HPCvimentinERPR

 

7.浸润性黏液想腺癌

阳性:MUC2

阴性:CA125MUC1

 

8.含破骨样巨细胞的未分化癌

阳性:pan-CKvimentinAE1/AE3CAM5.235βH11CK8CK18CK19

(破骨样巨细胞)CD68LCACD71α-1-antichymotrypsin

阴性:EMACEAHMB45MART-1

 

9.腺泡细胞癌

阳性:AE1/AE3CAM5.2CK7CK8CK19trypsinα-1-antichymotrypsinSyn(10%-50%)

阴性:CEACgAvimentinAFP

 

10.实性假乳头状瘤

阳性:α-1-antichymotrypsinvimentinβ-catenin

(部分表达)CK20AE1/AE3CAM5.2CK7CD10SynERPR

阴性:EMACEAAFPCA19-9S-100

 

11.血管周上皮样细胞瘤

阳性:actinHMB45Myo-D1

阴性:CD117CD34SMAAE1/AE3CAM5.2CgASyn

 

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)CK7CK19CD31/CD34

 

2.肝细胞腺瘤

阳性:CK8CK18HPC

阴性:CK7CK19CK20CA19-934βE12

 

3.胆管错构瘤及腺瘤

阳性:CK7CK19

阴性:CK20MUC1CEA

 

4.肝母细胞瘤

阳性:AFPCgACKsvimentin

 

5.普通型肝细胞癌

阳性:CK8CK18CAM5.2OSCARAFP(高级别肝细胞癌阴性)HPCAE1/AE3(少数)CD56()CD31/34(内皮细胞)EMACEA(胆管型)

阴性:CK7(少数阳性)CK20(20%阳性)CK17CA19-9Calretininα-inhibinTTF-1CgASynMART-1CK5/6ER

 

6.具有胆管分化的肝细胞癌

阳性:AE1/AE3CK7CK19CEA

 

7.梭形细胞肝细胞癌

阳性:vimentinCAM5.2HPC

阴性:AFP

 

8.纤维板层型肝细胞癌

阳性:CK8CK18CAM5.2HPCCK7AFP(20%)α-1-antichymotrypsin

 

9.胆管癌

阳性:CK7CK8CK18CK19CAM5.2CA19-9CEAMOC-31CDX2(75%)CK17(50%)CK20(20%)

阴性:HPCAFPSynGCDFP-15

 

10.梭形细胞胆管癌或肉瘤样癌

阳性:vimentinCEA,低分子量角蛋白(CAM5.2AE1/AE3EMA)

阴性:AFPS-100

 

11.混合性肝细胞-胆管癌

 

12.低分化/未分化癌

阳性:CK7CK19

阴性:CEACA19-9AFPHPC

 

13.胆管囊腺瘤或癌

阳性:AE1/AE3CA19-9CEACK7CK20CA125vimentinSMAdesmin

 

14.神经内分泌肿瘤(低级别及高级别)


 

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