教你看懂病理免疫组化报告单-胃肠道、肝胆胰肿瘤部分

健康界2021-04-29

胃肠道、肝胆胰肿瘤


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)
 
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

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
 
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%)
 
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CKCAM5.235 β H11  (含有非角化鳞癌成分)34βE12CK5/6P63
阴性:CK20CgACD57CD117
8.肉瘤样癌
 
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
 
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.浸润性黏液性腺癌
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
 
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/CD3 4
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)