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BSEP and MDR3: Useful Immunohistochemical Markers to Discriminate Hepatocellular Carcinomas From Intrahepatic Cholangiocarcinomas and Hepatoid Carcinomas.

肝细胞癌与肝内胆管细胞癌和肝样癌的鉴别中BSEP 和MDR3是一种非常有用的免疫组化标记物

Fujikura K,Yamasaki T,Otani K,Kanzawa M,Fukumoto T,Ku Y,Hirose T,Itoh T,Zen Y

Abstract

We herein examined the immunohistochemical expression of 2 hepatocyte-specific transporters (bile salt export pump [BSEP] and multidrug-resistance protein 3 [MDR3]) in hepatocellular carcinomas (HCCs, n=54), intrahepatic cholangiocarcinomas (n=34), combined hepatocellular and cholangiocarcinomas (n=23), and hepatoid carcinomas originated from extrahepatic organs (n=27) to compare their diagnostic values with those of arginase-1 (ARG1) and hepatocyte paraffin-1 (HepPar-1). BSEP was expressed in 91% of HCCs and MDR3 in 83%. Although their sensitivities were slightly lower than those of ARG1 (96%) and HepPar-1 (93%), the 2 transporters appeared to be more specific for HCCs. ARG1 and HepPar-1 were expressed in intrahepatic cholangiocarcinomas (9% and 6%) and hepatoid carcinomas (22% and 44%, respectively), whereas BSEP and MDR3 were entirely negative in these neoplasms, except for 1 case of BSEP-positive hepatoid carcinoma of the esophagus. The highly specific expression of BSEP and MDR3 in hepatocytes was recapitulated in additional examinations of combined hepatocellular and cholangiocarcinomas, in which the expression of the transporters was restricted to morphologically hepatocellular areas. In contrast, ARG1 and HepPar-1 were also variably positive in areas of biliary or indeterminate differentiation. We also applied BSEP and MDR3 immunohistochemistry to 8 biopsy cases of poorly differentiated primary liver cancer, in which the original diagnosis was not conclusive. The diagnosis of HCC was retrospectively suggested in 2 cases expressing both BSEP and MDR3. In conclusion, given the highly specific expression of BSEP and MDR3 in HCCs, immunohistochemistry for these transporters will be useful not only for determining hepatocellular differentiation in primary liver cancers but also for discriminating HCCs from hepatoid carcinomas.

摘要

本文作者研究了2种肝细胞特异性转运蛋白:胆汁盐输出蛋白(BSEP)多药耐药蛋白3(MDR3)在肝细胞癌(HCCs, n=54)、肝内胆管细胞癌(n=34)、混合性肝细胞和胆管细胞癌(n=23)及起源于肝外器官的肝样癌(n=27)中免疫组织化学表达情况,并比较它们与精氨酸酶1(ARG1)、HepPar-1在这些肿瘤中的诊断价值。

结果表明:91%的HCCs表达BSEP,83%的HCCs表达MDR3;与ARG1 (96%)和HepPar-1 (93%)相比,尽管它们的敏感性稍差,然而这两种转录蛋白对于HCCs的诊断更加特异。ARG1和HepPar-1在肝内胆管细胞癌中的表达分别为9%、6%,在肝样癌中的表达率分别为22%、44%;除了1例发生在食管的肝样癌BSEP阳性外,BSEP和MDR3在这些肿瘤中完全阴性。BSEP和MDR3在肝细胞癌中的高特异性表达,并且在混合性肝细胞和胆管细胞癌中,它们的表达局限在形态学为肝细胞癌的区域。相反,ARG1和HepPar-1在胆管或不确定分化的区域不定的阳性。

作者同时在8例分化差的原发性肝癌活检组织中检测了BSEP 和MDR3的表达,这些病例的最初诊断并不确定,2例同时表达BSEP 和MDR3,提示为HCC。

总之,由于BSEP 和MDR3在HCCs中的高特异性表达,它们不仅在原发性肝癌中提示肝细胞分化非常有帮助,而且在HCCs和肝样癌的鉴别诊断中非常有作用

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