第29章 免疫组化入门（A Primer on Immunostains）

The use of immunostains is a highly complex field in and of itself, and most residents will need to invest in a specialized text at some point. This chapter is meant as an introduction to the most commonly used stains so that you can at least follow the thread of conversation when the acronyms begin to fly. Stains are organized by the organ system in which they are most often used.

免疫组化染色及其应用都是非常复杂的，大多数住院医生都需要时常翻阅一本专门的教材。本章旨在介绍最常用的免疫组化指标，帮你及时了解及应用这些缩写词。按器官系统排列，介绍最常用的免疫组化标记物。

（译注：表中带*为译者补充的新抗体，带#为译者补充的表。(c)=(cytoplasmic)；(m)=(membranous)；(n)=(nuclear)；(c&m)=(cytoplasmic and membranous)；(cm)=(cytoplasmic or membranous)；(n&c)=(nuclear and cytoplasmic)）

血管（内皮）Blood Vessels (Endothelium)

DFSP, dermatofibrosarcoma protuberans隆突性皮肤纤维肉瘤; GIST, gastrointestinal stromal tumor胃肠道间质瘤; SFT, solitary fibrous tumor孤立性纤维性肿瘤.

脑和脑膜Brain and Meninges

GBM, glioblastoma multiforme多形性胶质母细胞瘤; MPNST, malignant peripheral nerve sheath tumor恶性周围神经鞘瘤; NSE， neuronal-specific enolase神经元特异性烯醇化酶. 

乳腺Breast

SMMHC, smooth muscle myosin-heavy chain平滑肌肌球蛋白重链 

细胞角蛋白Cytokeratins

#补充表1：CK7、CK20和Villin联用

#补充表2：CK-L和CK-H联用

生殖细胞和睾丸Germ Cell and Testis

ALCL, anaplastic large cell lymphoma间变性大细胞淋巴瘤; GIST, gastrointestinal stromal tumor胃肠道间质瘤; HCC, hepatocellular carcinoma肝细胞癌. 

妇科Gynecologic

EIC, endometrial intraepithelial carcinoma子宫内膜上皮内癌; HPV, human papillomavirus人乳头瘤病毒; HSIL, high-grade squamous intraepithelial lesion高度鳞状上皮内病变; PSTT, placental site trophoblastic tumor胎盘部位滋养细胞肿瘤.

血液病理Heme Path

ALCL, anaplastic large cell lymphoma间变性大细胞淋巴瘤; ALL, acute lymphocytic leukemia急性淋巴细胞白血病; AML, acute myeloid leukemia急性髓系白血病; CML, chronic myeloid leukemia慢性髓系白血病; DLBCL, diffuse large B-cell lymphoma弥漫大B细胞淋巴瘤; FCC, follicular center cell lymphoma滤泡中心细胞淋巴瘤; HD, Hodgkin’s disease霍奇金病; LBL, lymphoblastic lymphoma淋巴母细胞淋巴瘤; MALT, mucosa-associated lymphoid tissue粘膜相关淋巴组织; RS, ReedSternberg cells ReedSternberg细胞; SLL/CLL, small lymphocytic lymphoma/chronic lymphocytic leukemia小淋巴细胞淋巴瘤/慢性淋巴细胞白血病. 

肾脏和膀胱Kidney and Bladder

RCC, renal cell carcinoma肾细胞癌; TCC, transitional cell (urothelial) carcinoma移行细胞（尿路上皮）癌. 

肝脏、胰腺和其他胃肠道疾病Liver, Pancreas, and Other Gastrointestinal

Note: There are no immunostains that can differentiate well-differentiated HCC from normal liver tissue; the HCC stains are used to demonstrate hepatic differentiation in ambiguous or metastatic tumors.

注：没有免疫染色可以区分高分化HCC和正常肝组织；HCC染色用于显示不明确的肿瘤或转移性肿瘤的肝分化。

APC, activated protein C活化蛋白C; HCC, hepatocellular carcinoma肝细胞癌; mCEA, monoclonal carcinoembryonic antigen单克隆癌胚抗原; pCEA, polyclonal carcinoembryonic antigen多克隆癌胚抗原. 

肺Lungs

黑色素瘤Melanoma(MM)

MM, malignant melanoma恶性黑色素瘤 

神经内分泌和内分泌Neuroendocrine and Endocrine

（译注：CD56也是很好的神经内分泌标记物。NSE因为特异性差已经很少使用） 

前列腺Prostate

TCC, transitional cell (urothelial) carcinoma移行细胞(尿路上皮)癌  

软组织Soft Tissue

DFSP, dermatofibrosarcoma protuberans隆突性皮肤纤维肉瘤; GIST, gastrointestinal stromal tumor胃肠道间质瘤; MFH, malignant fibrous histiocytoma恶性纤维组织细胞瘤; MPNST, malignant peripheral nerve sheath tumor恶性周围神经鞘瘤; PEComa, perivascular epithelioid cell tumor血管周上皮样细胞瘤; PNET, primitive neuroectodermal tumor原始神经外胚层肿瘤; SFT, solitary fibrous tumor孤立性纤维性肿瘤. 

甲状腺Thyroid

鉴别诊断Differential Diagnoses

Spindle cell tumor梭形细胞肿瘤：

Differential diagnosis includes neural, muscle, fibrous, vascular, or other sarcoma, plus carcinoma and melanoma. Panel: S100, AE1/AE3, actins, desmin, CD34, CD117.

鉴别诊断包括神经、肌肉、纤维、血管或其他肉瘤，以及癌和黑色素瘤。选用的抗体组合（套餐）：S100，AE1/AE3，actins，desmin，CD34，CD117。

Big pink cell tumor大的粉红色细胞瘤：

Differential diagnosis includes melanoma, adrenal cortical carcinoma, renal cell carcinoma, hepatocellular carcinoma, thyroid Hürthle cell carcinoma, parathyroid, Leydig cell tumor.

鉴别诊断包括黑色素瘤、肾上腺皮质癌、肾细胞癌、肝细胞癌、甲状腺Hürthle细胞癌、甲状旁腺、Leydig细胞瘤。

Small round blue cell tumor小圆蓝细胞瘤：

Differential diagnosis includes small cell carcinoma, Merkel cell, lymphoma, primitive neuroectodermal tumor/Ewing’s sarcoma, alveolar rhabdomyosarcoma, desmoplastic small cell tumor, neuroblastoma, Wilms’ tumor. Panel: CD45, CD99, desmin, NSE, CK20, chromogranin, myogenin, CD79a, TdT, WT-1, cytokeratin.

鉴别诊断包括小细胞癌、默克尔细胞癌、淋巴瘤、原始神经外胚层肿瘤/尤因肉瘤、腺泡状横纹肌肉瘤、促结缔组织增生性小圆细胞肿瘤、神经母细胞瘤、肾母细胞瘤。选用的抗体组合（套餐）：CD45、CD99、desmin、NSE、CK20、chromogranin、myogenin、CD79a、TdT、WT-1、CK。

Alveolar pattern tumor腺泡模式肿瘤：

Differential diagnosis includes renal cell carcinoma, alveolar rhabdomyosarcoma, alveolar soft parts sarcoma, pheochromocytoma, granular cell tumor, melanoma.

鉴别诊断包括肾细胞癌、腺泡状横纹肌肉瘤、腺泡状软组织肉瘤、嗜铬细胞瘤、颗粒细胞瘤、黑色素瘤。

Clear cell tumor透明细胞肿瘤：

Differential diagnosis includes renal cell carcinoma, clear cell follicular thyroid carcinoma, clear cell lung carcinoma, clear cell hepatocellular carcinoma, adrenocortical carcinoma, malignant melanoma.

鉴别诊断包括肾细胞癌、透明细胞甲状腺滤泡性癌、透明细胞肺癌、透明细胞肝细胞癌、肾上腺皮质癌、恶性黑色素瘤。

#补充表3：未分化癌鉴别诊断选用的一线抗体

参考书目Bibliography

The following is a list of textbooks that were used in the writing of this book and that were generally helpful during my residency training. This is by no means a complete listing of recommended books.

以下是我在写这本书时使用的教科书清单，这些教科书在我的住院医师培训期间通常都是有帮助的。这绝不是推荐书籍的完整清单。

大外科病理教科书General Surgical Pathology Texts

Diagnostic Histopathology of Tumors. Christopher D.M. Fletcher. New York: Churchill Livingstone; 2nd ed., 2000.

Differential Diagnosis in Surgical Pathology. Meryl H. Haber, Paolo Gattuso, Odile David, and Daniel J. Spitz. Philadelphia: Saunders; 1st ed., 2002.

Histology for Pathologists. Stacey E. Mills. Philadelphia: Lippincott Williams & Wilkins; 3rd ed., 2006.

Rosai and Ackerman’s Surgical Pathology. Juan Rosai. St. Louis: Mosby; 9th ed., 2004.

Sternberg’s Diagnostic Surgical Pathology. Stacey E. Mills, Darryl Carter, Joel K. Greenson, Harold A. Oberman, and Victor E. Reuter. Philadelphia: Lippincott Williams & Wilkins; 4th ed., 2004.

Surgical Pathology Dissection: An Illustrated Guide. William H. Westra, Ralph H. Hruban, Timothy H. Phelps, Christina Isacson, and Fred Askin. New York: Springer; 2nd ed., 2003.

器官或系统特殊教科书Organ- or System-Specific Texts

Atlas of Breast Pathology (Atlases in Diagnostic Surgical Pathology). Steven G. Silverberg. Philadelphia: Saunders; 1st ed., 2002.

Atlas of Gynecologic Surgical Pathology (Atlases in Diagnostic Surgical Pathology). Philip B. Clement and Robert H. Young. Philadelphia: Saunders; 2000.

Biopsy Interpretation of the Gastrointestinal Tract Mucosa (Biopsy Interpretation Series). Elizabeth A. Montgomery. Philadelphia: Lippincott Williams & Wilkins; 2005.

Bladder Biopsy Interpretation (Biopsy Interpretation Series). Jonathan I. Epstein, Mahul B. Amin, and Victor E. Reuter. Philadelphia: Lippincott Williams & Wilkins; 2003.

Blaustein’s Pathology of the Female Genital Tract. Robert J. Kurman. New York: Springer; 5th ed., 2002.

Pathology and Genetics of Tumours of the Breast and Female Genital Organs (WHO/IARC Classification of Tumours Series). F. Tavassoli and P. Devilee, eds. Lyon: IARC Press; 2003.

Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues (WHO/IARC Classification of Tumours Series). E.S. Jaffe, N.L. Harris, H. Stein, and J.W. Vardiman, eds. Lyon: IARC Press; 2001.

Pathology and Genetics of Tumours of the Soft Tissues and Bones (WHO/IARC Classification of Tumours Series). C.D.M. Fletcher, K. Unni, and K. Mertens, eds. Lyon: IARC Press; 2003.

Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs (WHO/IARC Classification of Tumours Series). N. Eble, G. Sauter, J.I. Epstein, and I.A. Sesterhenn, eds. Lyon: IARC Press; 2004.

Prostate Biopsy Interpretation. Jonathan I Epstein and Ximing J. Yang. Philadelphia: Lippincott Williams & Wilkins; 3rd ed., 2002 (4th ed. now available).

Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas. Robert Odze, John Goldblum, and James Crawford. Philadelphia: Saunders; 1st ed., 2003.

Surgical Pathology of the Nervous System and Its Coverings. Peter C. Burger, Bernd W. Scheithauer, and F. Stephen Vogel. Philadelphia: Churchill Livingstone; 4th ed., 2002.

来源：

The Practice of Surgical Pathology：A Beginner’s Guide to the Diagnostic Process

外科病理学实践：诊断过程的初学者指南

Diana Weedman Molavi, MD, PhD

Sinai Hospital, Baltimore, Maryland

ISBN: 978-0-387-74485-8 e-ISBN: 978-0-387-74486-5

Library of Congress Control Number: 2007932936

© 2008 Springer Science+Business Media, LLC

仅供学习交流，不得用于其他任何途径。如有侵权，请联系删除