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Cytokeratin 17: an adjunctive marker of invasion in squamous neoplastic lesions of the anus.

CK17:肛管鳞状上皮肿瘤性病变侵袭性的一种辅助标记。

Nazarian RM,Primiani A,Doyle LA,Linskey KR,Duncan LM,Odze RD,Zukerberg LR

Abstract

Diagnosing anal squamous cell carcinoma (SCC), which is often preceded by anal intraepithelial neoplasia (AIN), may be challenging in small biopsies. Cytokeratin 17 (CK17) is a basal/myoepithelial cell keratin induced in activated keratinocytes and associated with disease progression in SCC of the uterine cervix, esophagus, and oral cavity. We investigated the utility of CK17 in diagnosing invasion in anal squamous neoplastic lesions. Immunohistochemical staining for CK17 was evaluated in 11 AINs, 12 invasive SCCs, 8 invasive SCCs with basaloid features (BSCC), and 2 invasive pure basaloid carcinomas. The pattern of staining was scored as surface/central, peripheral/rim, diffuse, or absent. All cases of invasive SCC and BSCC stained positive for CK17. Eleven of 12 (92%) SCCs showed diffuse staining, and 1 of 12 (8%) showed peripheral staining. Six of 8 (75%) BSCCs showed diffuse staining, and 2 of 8 (25%) showed peripheral staining. Both pure basaloid carcinomas were negative for CK17. One of 11 (9%) AINs was diffusely positive for CK17; all other AINs had surface or absent CK17. Of the 6 patients with concurrent AIN and invasive carcinoma, superficial expression of CK17 was present in 1 AIN, whereas all invasive components showed diffuse staining. The sensitivity and specificity of CK17 for identifying invasion in SCC and BSCC was 100% and 91%, respectively. Peripheral or diffuse staining for CK17 is a useful marker of invasion in anal squamous neoplastic lesions. A potential pitfall in the utility of CK17 is that the pure basaloid variant of anal carcinoma is negative for CK17.

摘要

 对于那些由肛管上皮内肿瘤恶变而来的肛管鳞状细胞癌的诊断,在小活检中可能遭遇到挑战。CK17是一种在激活的角质细胞内诱导表达的基底/肌上皮细胞角蛋白,并与宫颈、食管和口腔鳞状细胞癌的病程进展有关。我们研究了CK17在诊断肛管鳞状上皮肿瘤性病变侵袭性中的实用性。对11例肛管上皮内肿瘤,12例侵袭性鳞状细胞癌,8例伴有基底细胞样特征的侵袭性鳞状细胞癌和2例侵袭性单纯性基底细胞样癌中的CK17免疫组化染色进行判读。染色以表面/中央,外周/边缘,弥漫或缺失来进行评分。所有的侵袭性鳞癌及伴有基底细胞样特征的侵袭性鳞癌CK17染色呈阳性。11/12(92%)鳞状细胞癌表现为弥漫阳性,1/12(8%)表现为边缘着色。所有单纯的基底细胞样癌CK17阴性。1/11(9%)肛管上皮内肿瘤CK17弥漫阳性。所有其他的肛管上皮内肿瘤CK17表达局限于表面或者不表达。在6例同时有肛管上皮内肿瘤和侵袭性癌的患者中,1例肛管上皮内肿瘤CK17的表达局限于浅表,而所有侵袭性成分弥漫着色。应用CK17识别鳞状细胞癌和基底细胞样鳞状细胞癌中的侵袭性,其特异性和敏感性分为、别为100%和91%,而CK17是边缘着色还是弥漫着色则是识别肛管鳞状上皮肿瘤性病变侵袭性的有效标记。而CK17的应用中一个潜在的陷阱是肛管癌的单纯性基底细胞样变异型CK17阴性表达。

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