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目的 :探讨肺大细胞未分化癌的各种分化表型以及不同分化表型与淋巴结转移及预后的关系。方法 :采用光镜、电镜及免疫组化方法对 32例肺大细胞癌手术标本进行观察 ,所有抗体分别为细胞角蛋白AE3[CK(AE3) ]、细胞角蛋白 18(CK18)、突触素 (Syn)及嗜铬颗粒蛋白A(CgA)。结果 :免疫组化为各抗体阳性表达率为CK186 8.75 %、CK (AE3) 18.75 %、Syn4 0 .6 3%、CgA31.2 8%、CK18和Syn(或CgA)阳性率 9.36 %、CK(AE3)和Syn(或CgA)阳性率 6 .2 5 %、腺鳞分化阳性率 3.13% ;电镜结果为具有鳞癌、腺癌及神经内分泌分化特征的分别占 2 5 .0 0 %、87.5 0 %、31.2 8%、其中具有鳞癌和神经内分泌分化的有 3例 (9.38% ) ,具有腺癌和神经内分泌分化的有 5 (15 .6 2 % )例 ,具有腺鳞分化的 2 (6 .2 5 % )例。结论 :肺大细胞癌在HE染色观察虽然属于未分化癌范围 ,但电镜和免疫组化仍可确定其有不同程度的分化表型。
OBJECTIVE: To investigate the differential phenotypes of undifferentiated lung cancer and the relationship between different phenotypes and lymph node metastasis and prognosis. Methods: 32 cases of large cell lung cancer were observed by light microscope, electron microscope and immunohistochemistry. All the antibodies were cytokeratin AE3 [CK (AE3)], cytokeratin 18 (CK18), synaptophysin (Syn) and Chromogranin A (CgA). Results: The positive rate of each antibody was CK186 8.75%, CK (AE3) 18.75%, Syn4 0 .6 3%, CgA31.2 8%, CK18 and Syn (or CgA) AE3), Syn (or CgA) positive rate was 2.52%, adenosquamous cell differentiation positive rate was 3.13%. The results of electron microscopy showed squamous cell carcinoma, adenocarcinoma and neuroendocrine differentiation accounted for 25.0%, 87.5% %, 31.28%. There were 3 cases (9.38%) with squamous cell carcinoma and neuroendocrine differentiation, 5 (15.62%) cases with adenocarcinoma and neuroendocrine differentiation, 2 (6 .2 5%) cases. Conclusion: The observation of HE staining of pulmonary large cell carcinoma is undifferentiated, but the differentiated phenotypes can still be determined by electron microscopy and immunohistochemistry.