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A Limited Immunohistochemical Panel Can Subtype Hepatocellular Adenomas for Routine Practice.

一种有限的免疫组化模式常规实践分型肝腺瘤价值的探索。

Larson BK,Guindi M

Abstract

β-Catenin-activated hepatocellular adenomas have an elevated risk of harboring foci of hepatocellular carcinoma. Inflammatory adenomas also have an increased propensity for malignant transformation and are associated with a systemic inflammatory syndrome. Patients with these two adenoma subtypes benefit from excision. We assessed whether β-catenin-activated and inflammatory adenomas could be identified using a limited immunohistochemical panel.
Forty-six adenomas were assessed by morphology and β-catenin, serum amyloid A, and glutamine synthetase immunostains.
Morphologic examination produced a morphologic working diagnosis of inflammatory adenoma in 25 (54%) of 46 cases, β-catenin-activated adenoma in three (7%) of 46 cases, and 18 (39%) of 46 cases of other adenomas. After immunohistochemical staining, the morphologic diagnosis was confirmed in 15 (33%) of 46 and changed in 20 (43%) of 46, for a final distribution of 16 (35%) of 46 inflammatory adenomas, four (9%) of 46 β-catenin-activated adenomas, seven (15%) of 46 β-catenin-activated inflammatory adenomas, and 19 (41%) of 46 other adenomas.
Inflammatory and β-catenin-activated adenomas were readily identified by immunostaining patterns. These findings reinforce the necessity of immunohistochemistry in classifying adenomas, as assessing morphology alone often provided inaccurate subclassification. β-Catenin-activated and inflammatory adenomas can be accurately diagnosed using only a limited panel of widely available immunostains.

摘要

β-连环蛋白活化的肝腺瘤合并局灶肝细胞癌的危险性较高。炎症性肝腺瘤的恶性转化倾向也增加,并与全身炎症综合征相关。这两种腺瘤亚型的患者可以从手术切除中获益。我们评估了使用有限的免疫组化标记物组合识别β-连环蛋白活化的肝腺瘤和炎症性肝腺瘤的可能性。46个腺瘤进行了形态学和包括β-连环蛋白、血清淀粉样蛋白A和谷氨酰胺合成酶的免疫组化染色评估。单纯形态学检查给出诊断是25(54%)炎症性肝腺瘤,3(7%)β-连环蛋白活化的肝腺瘤,以及18(39%)其它类型的肝腺瘤。免疫组织化学染色后,15(33%)个腺瘤的形态学亚型诊断得到证实,20(43%)个形态学亚型诊断需要更改,最终的诊断是16(35%)个炎症性肝腺瘤,4(9%)个β-连环蛋白活化的肝腺瘤,7(15%)个β-连环蛋白活化的炎症性肝腺瘤,19(41%)个其它亚型的肝腺瘤。采用免疫组化染色技术可以很容易地识别出炎症性肝腺瘤和β-连环蛋白活化的肝腺瘤。这些发现强调了免疫组化染色对肝腺瘤分类的必要性,因为仅形态学常常不能准确地对肝腺瘤进行分类。

本研究表明仅用有限的免疫标记物组合就可以准确的诊断β-连环蛋白活化的肝腺瘤和炎症性肝腺瘤。


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