免疫组化在病理诊断中的应用及意义

免疫组化检查在病理诊断中的应用及其意义(一) 联合病理转贴自：本站原创点击数：3833一、病理外检中常用抗体标记上皮类标记AE1/AE3最常用 胞浆阳性着色，细丝状 与低、中分子量角蛋白反应 肝细胞为阴性，而胆管细胞阳性 用于确定肿瘤为上皮源性 胞浆阳性着色，细丝状 包含CK8 和CK18，主要染色神经内分泌细胞和腺上皮，正常鳞状上皮阴性 用于染小细胞癌 用于胸腺瘤和梭形细胞癌 用于肝细胞癌：AE1/AE3 - CAM5.2 +用于乳腺外的Pagets病 CK34BE胞浆阳性着色 鳞状上皮和鳞状细胞癌阳性 用于染前列腺的基底层细胞，鉴别浸润癌 用于染涎腺肿瘤的肌上皮 用于染Mallory 小体 EMA细胞膜/细胞浆阳性着色上皮标记的替代品浆细胞阳性，很好的内对照用于染滑膜肉瘤 EMA +用于大细胞分化不良性淋巴瘤 EMA +用于L&H 富于淋巴细胞的结节状何杰金用于脑膜瘤 EMA+ AE1/AE3 用于浆细胞瘤 常常 EMA +CK7 和CK20胞浆阳性着色 两者联合应用可鉴别很多种癌的原发部位 CK7 常常在胃肠道的癌为阴性 CK20 只有胃肠道癌和Merkel 细胞癌阳性 间皮细胞标记Calretinin细胞核和细胞浆阳性着色，核阳性着色为必需间皮强阳性，Sertoli和肥大细胞阳性用于鉴别间皮瘤（+）和腺癌（-），常加CEA用于鉴别梭形细胞间皮肉瘤（+）和其他的浆膜腔肉瘤（-）用于鉴别胸、腹水中的癌细胞和间皮细胞确定为间皮细胞，如大网膜内陷入的一团细胞或腺瘤样瘤神经元分化标记，如中枢神经细胞瘤帮助确诊心脏粘液瘤，几乎全为（+）白细胞标记非何杰金淋巴瘤大致分类CD20 （L26），CD3怀疑T 细胞淋巴瘤者加UCHL-1（CD45RO）怀疑浆细胞瘤者LCA（CD45RB）,CD79a, CD138小B 细胞淋巴瘤者，CD79a, CD43（MT1）LCA （CD45RB）几乎所有的白细胞（+ ） 有些淋巴母细胞淋巴瘤、大细胞分化不良性淋巴瘤、外周T 细胞淋巴瘤（- ） 经典Hodgkin 的R-S 细胞（-） 以往浆细胞瘤（-），现（+） HE 下明确的淋巴瘤不必要染LCA B细胞相关标记CD20 （L26）胞膜阳性着色，浆阳者不可判为阳性 各阶段B 细胞阳性，除了原始的前B 和非常成熟的浆母、浆细胞 用于染B 细胞淋巴瘤，除了小细胞、淋巴母细胞（不恒定）和浆细胞瘤（常-） 梭形细胞胸腺瘤（+） CD79a胞浆阳性着色，有/无核周聚集全B 细胞标记，包括浆母和浆细胞标记滤泡中心比mantle和滤泡间B要弱比CD20 贵得多用于鉴别淋巴母细胞淋巴瘤/白血病 弥漫性小B 细胞淋巴瘤/白血病 浆细胞瘤（常CD20而CD79a 50% +T细胞相关标记CD3 （polyclonal）胞浆阳性着色，核周凝聚，有时高尔基体也阳性 极好的T 细胞标记，与CD43 不同，髓系细胞和组织细胞不着色 极好的T 细胞和NK 淋巴瘤标记，虽然有些大细胞型T 细胞淋巴瘤阴性 CD43 （MT1）只有膜阳性才能判为阳性 T 细胞、T 细胞淋巴瘤、真性组织细胞肿瘤、粒细胞肉瘤阳性 一部分浆细胞瘤阳性 小B 细胞淋巴瘤阳性，这一特点可辅助表明增生的小淋巴细胞为肿瘤性！ EBV 感染的B 细胞阳性 UCHL-1（CD45RO）细胞膜阳性着色，有时Golgi 阳性，弥漫性胞浆阳性者非真阳性 阳性：正常/ 反应性的T 细胞，组织细胞、粒细胞肉瘤和T 细胞淋巴瘤 罕见情况下B 细胞淋巴瘤阳性 CD5细胞膜阳性着色 T 细胞阳性，但极少B 细胞也阳性 尤其用于慢性淋巴细胞性白血病和Mantle 淋巴瘤，而MALToma 和Marginal Zone 淋巴瘤阴性 用于鉴别胸腺癌（CD5+）和其他癌瘤 与激活相关的标记CD30 （Ki-I，Ber-H2）只有膜染色和Golgi体染色才是真阳性正常淋巴滤泡周单个的大细胞为阳性激活的淋巴细胞阳性：如传单、弓浆虫感染、Kikuchi淋巴结炎等、浆细胞也阳性用于大细胞分化不良性淋巴瘤用于一些传统的大细胞淋巴瘤外周T和B细胞淋巴瘤中的一些单个大细胞经典何杰金病中的R-S细胞，但非L&H细胞淋巴瘤样丘疹病等皮下CD30+的淋巴增生疾病一些浆细胞瘤胚胎性癌组织细胞标记CD68（PGM1）胞浆内颗粒状阳性着色 较好的组织细胞和单核细胞（包括浆样单核细胞）及其肿瘤的标记 有些非组织细胞也可阳性，包括：肾小管、粒细胞肉瘤、恶黑、血管瘤样恶纤组等 髓系细胞标记Myeloperoxidase 胞浆 阳性着色，常呈颗粒状 髓系细胞及其肿瘤的高度特异且敏感的标记 奇怪的是在Kikuchi 淋巴结炎和狼疮性坏死性淋巴结炎中，其中的组织细胞myeloperoxidase 也为 阳性 与淋巴瘤相关的标记ALK-1(Anaplastic lymphoma kinase-1) 胞核+ 胞浆阳性着色 用于大细胞分化不良性淋巴瘤，不能证实ALK1+ 与良好预后有关 用于一种罕见的大B 细胞细胞瘤，ALK1 阳性而CD20 阴性，但IgA 阳性 Bcl-2在核周围区阳性着色 在正常淋巴结，生发中心阴性，但mantle 和滤泡间细胞强阳性 在滤泡性淋巴瘤，（80% 病例 ）生发中心强阳性，阴性不能排除滤泡性淋巴瘤 也用于鉴别单核样B 细胞增生（- ）和单核样B 细胞淋巴瘤（+ ） 有人用于诊断孤立性纤维性肿瘤Cyclin-D1核阳性着色 主要用于Mantle 区淋巴瘤，几乎所有病例均为阳性，有些可能为弱阳性 与分化阶段相关的标记Tdt细胞核阳性着色 不成熟的T 或B 淋巴细胞标记，前T/ 前B 细胞 用于诊断淋巴母细胞淋巴瘤/ 白血病 诊断胸腺瘤（富于不成熟的T 细胞） 肌原性标记Desmin胞浆阳性着色 平滑肌/ 骨骼肌及其肿瘤的良好标记，肌纤维母细胞有时也阳性，但肌上皮阴性 一些间皮瘤阳性 desmoplastic small cell tumor MSA（Muscle-specific actin）胞浆阳性着色极好的肌源性标记用于 平滑肌、骨骼肌及其肿瘤 肌纤维母细胞及相关肿瘤（恶纤组、结节性筋膜炎等） 肌上皮及其肿瘤 血管周细胞肿瘤 一些间皮瘤血管原性标记CD31细胞膜阳性着色 内皮细胞、巨核系细胞/ 血小板阳性 有时浆细胞/ 浆细胞瘤阳性 主要用于诊断血管性肿瘤：特异且敏感 用于识别骨髓中不正常的巨核细胞 用于巨核细胞系白血病 CD34细胞膜+/-细胞浆阳性着色血管内皮/巨核细胞/血小板 +很好的血管标记，但特异性差多种肿瘤CD34阳性，包括：CD34阳性的肿瘤a) Some myeloid leukemias (especially the primitive ones).b) Vascular tumorsc) Solitary fibrous tumor; angiomyofibroblastomad) Hemangiopericytomae) Dermatofibrosarcoma protuberansf) Gastrointestinal stromal tumorg) Mammary myofibroblastomah) Epithelioid sarcomai) Spindle cell lipomaj) Scattered cells in peripheral nerve sheath tumorsk) Megakaryoblastic leukemia血管原性标记Factor VIII related antigen (F-VIII) 胞浆 阳性着色，常为颗粒状 内皮细胞、巨核系细胞/ 血小板阳性 主要用于血管原性肿瘤 特异性好，敏感性差 神经、神经内分泌及神经外胚层Syn细胞浆阳性着色 是神经和神经内分泌细胞很好的标记 特异性和敏感性均好 ParagangliomaPheochromocytomaNeuroblastomaOlfactory neuroblastomaGanglioneuromaGanglioneuroblastomaPNETParathyroid tumorMedullary thyroid carcinomaIslet cell tumorPituitary tumorCarcinoid tumorSmall cell carcinomaMerkel cell carcinomaThyroid follicular cell tumorAdrenocortical tumorCgA胞浆内颗粒状着色染神经内分泌细胞的分泌小泡，因此神经元和神经节细胞阴性神经内分泌非常特异性指标，敏感性较差，阳性信号取决于瘤细胞内神经内分泌颗粒的多少小细胞癌：信号少类癌、Merkel细胞癌、甲状旁腺腺瘤等强阳性神经性肿瘤可阳可阴GFAP （Glial fibrillary acidic protein ）胞浆阳性着色 星形细胞、室管膜细胞阳性，一些肌上皮阳性 星形细胞瘤、多形性胶质母细胞瘤、室管膜瘤和脉络丛乳头状瘤阳性，少突胶质细胞瘤常阴性；一些外周神经鞘瘤可阳性 涎腺多形性腺瘤常可阳性 乳腺的肌上皮有时也可阳性 S-100细胞核+/-细胞浆阳性着色，核阳性着色为必需用处非常多：glial cells, Schwann cells (astrocytoma, schwannoma, neurofibroma, malignant peripheral nerve sheath tumor). In benign nerve sheath tumors, almost all the tumor cells are positive; while in malignant peripheral nerve sheath tumor, usually only a fraction of the neoplastic cells are S100 positive. Note that S-100 protein antibody can also highlight the sustentacular cells that envelope the islands of tumor cells in paraganglioma and olfactory neuroblastoma. S-100Melanocytes and nevus cells (Melanocytic nevus, malignant melanoma, malignant melanoma of soft parts/clear cell sarcoma of tendons and aponeurosis) Myoepithelial cells Fat cells (Lipoma, liposarcoma) Cartilage cells (Chondroma, chondroblastoma, chondrosarcoma Histiocytes of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) Interdigitating dendritic cells and Langerhans cells (Langerhans cell histiocytosis, interdigitating dendritic cell sarcoma). Juvenile CML is often S-100 positive HMB45胞浆内颗粒状着色 恶性黑色素瘤和交界痣，而正常的痣细胞常为阴性 肾和肝的血管平滑肌脂肪瘤、肾被膜瘤 肺的淋巴管肌瘤病、糖瘤Melan-A胞浆内颗粒状着色 阳性表达的细胞包括：黑色素细胞、肾上腺皮质、性索（Leydig, granulosa）用于： 黑色素瘤 支持- 间质细胞瘤和颗粒细胞瘤 血管周细胞瘤 肾上腺皮质肿瘤 与乳腺癌相关的抗体ER细胞核阳性着色PR细胞核阳性着色 Ki-67细胞核阳性着色 G1, S, G2 and M phases of the cell cycle 阳性 Ki-67 index: 阳性细胞所占比例 P53细胞核阳性着色正常细胞因P53蛋白很快降解故阴性，而恶性肿瘤中因突变或存在使P53稳定的因素，故可阳性C-erBb2细胞膜阳性着色分级Herceptine 治疗还用于鉴别乳腺内/外的Pagets病和恶黑用于乳腺内/外Pagets病和表皮的一些透明细胞（Toker cell）用于显示Pagets病切缘是否干净激素类抗体Thyroglobulin 胞浆阳性着色极好的甲状腺滤泡上皮及肿瘤的标记，分化极差的甲状腺癌可阴性Calcitonin胞浆阳性着色极好的C细胞及髓样癌的标记，如CgA+则更支持髓样癌个别喉的类癌+PTH （parathyroid hormone）胞浆阳性着色甲状旁腺细胞及其肿瘤的标记 垂体腺瘤类激素 胞浆阳性着色 GH，PRL，TSH，FSH，ACTH，LHHCG胞浆阳性着色极好的滋养叶细胞及肿瘤的标记：绒癌、胚胎性癌等一些胃和膀胱的癌也可阳性PSA胞浆阳性极好的前列腺癌标记有时膀胱和尿道周的癌也可阳性TTF-1（thyroid transcription factor-1）单纯的核阳性着色正常情况下只有甲状腺和肺泡上皮细胞阳性，大的支气管上皮阴性在肿瘤中：主要用于确定肿瘤来源于肺或甲状腺AFP胞浆+/- 核阳性 成熟组织中阴性，而胚胎性肝、胃肠道、神经上皮成分中+用于诊断肝细胞癌和肝母细胞瘤 用于诊断胚胎性癌和卵黄囊瘤 用于显示不成熟畸胎瘤中的神经上皮成分 其他抗体CD99细胞膜阳性着色正常存在于不成熟T细胞（胸腺细胞）和胰岛细胞用于T淋巴母细胞淋巴瘤/白血病胸腺瘤（淋巴组织成分+）尤文氏肉瘤和PNET间叶性软骨肉瘤颗粒细胞瘤和支持细胞（Sertoli）瘤孤立性纤维性肿瘤其他：滑膜肉瘤、血管周细胞瘤、脑膜瘤等CD117 （c-Kit）胞膜阳性着色+/- 胞浆阳性，胞膜为必需 正常时胃肠道的Cajal 细胞、黑色素细胞、肥大细胞阳性 用于诊断GIST用于诊断mastocytosis用于诊断精原细胞瘤/ 无性细胞瘤 Inhibin胞浆内，常呈颗粒状着色用于诊断性索间质肿瘤：颗粒细胞瘤、Sertoli-Leydig细胞瘤用于诊断肾上腺皮质肿瘤BRST-2（Gross cystic disease fluid protein-15, GCDFP-15）用于确定肿瘤来源于乳腺 少部分汗腺、涎腺或其他肿瘤也可+CEA细胞膜+/- 细胞浆阳性着色 几乎所有的腺癌为阳性 用于诊断乳腺/ 乳腺外的Pagets 病，+ 而恶黑-显示涎腺或汗腺肿瘤中的腺体成分 用于鉴别腺癌和间皮瘤 用于诊断甲状腺髓样癌，尤其是小细胞型 用于诊断肝细胞癌前列腺癌的免疫组化表型AE1/AE3 +PSA +P504S +CK34BE -P63 免疫组化检查在病理诊断中的应用及其意义(二) 联合病理整理转贴自：中杉生物公司交流资料点击数：4071二、免疫组化在病理诊断中的应用（一）免疫组织化学在外科病理诊断中的重要性 免疫组织化学染色技术发展到今天，已经成为外科病理诊断中必不可少的手段，如同组织化学染色一PAS、网染等一样，同时也是提高诊断水平、为临床提供诊疗依据，预测治疗效果和预后，减少医疗纠纷的重要手段。（二）免疫组化在病理诊断中的应用 1原发性肿瘤的组织来源、确诊及转移性肿瘤原发部位的判定，常见举例如下：类癌 (CgA+、NSE+、CK+)副神经节瘤 (CK-、S-100+、SYN+、CgA+) 甲状腺髓样癌 (Cacitonin+、thyroglobulin-)甲状腺乳头状癌 (Cacitonin-、thyroglobulin+)原始神经外胚叶肿瘤 (CD99+、NSE+、SYN+、NF+、LCA、Desmin)淋巴瘤的各种组织学类型 如各种T细胞、B细胞等标记物恶性黑色素瘤 (HMB45+、Melan-A+)血管平滑肌脂肪瘤(平滑肌成分HMB45+)，肺泡细胞癌、肺小细胞癌 (TTF-1-) 前列腺癌 (PSA+、CK34BE12-)胶质瘤 (GFAP+)胃肠道腺癌 (CK20+、CK7-)胸腺瘤 (CD5+) 胃肠道间质瘤 (CD34+、CDll7+)Merkel细胞癌 (CK2 0阳性)卵巢上皮性肿瘤及颗粒细胞瘤 (CK20-、CK7+)转移性鳞癌 (CK56+)间皮细胞 (Calretinin+)。 2检测肿瘤组织的转移潜能 NM23-H1、CD44v6、MMP 3. 病原微生物的检测 HPV、EBV、HBsAg、HBcAg、HCV、CMV4. 激素受体判定预后及治疗反应 乳腺癌常用指标PR、ER、PS2，子宫内膜癌、卵巢癌、 膀胱癌及脑膜瘤等均表达PR、ER，脑膜瘤还表达AR，对肿瘤的临床治疗方案的确定提供依据。5评价肿瘤增殖活性 Ki-67、PCNA，对肿瘤的分化、肿瘤的复发等提供参考依据。6提高微小转移癌灶的发现率 淋巴结中微小转移癌的发现有时非常困难，但用CK(AEIAE3)标记淋巴结可有效提高阳性检出率，客观评价预后。7化疗药物敏感性检测对肿瘤治疗的指导 MDR-1、GST-n、TopoII、MRP、LRP等的联合免疫组化标定。8判定肿瘤分期及肿瘤的鉴别诊断 CK34BEl2是前列腺腺体基底细胞的特异性标记抗体，可鉴别前列腺上皮内病变或前列腺癌；肌动蛋白actin（smooth muscle actin平滑肌肌动蛋白简称称SMA）可显示乳腺的肌上皮细胞，常用于乳腺原位癌或浸润癌、硬化性腺病与浸润性管状腺癌、导管内癌是否有浸润癌成分等鉴别。9诊断困难时的诊断作用 (1)活检组织挤压严重或分化较低时，如胃镜活检组织，可用CEA、CK、LCA、CD34等进行免疫组化染色进行鉴别。 (2) 腹腔积液中间皮细胞和腺癌的鉴别：Calretinin、CEA、CK20等。 (3)宫内孕和宫外孕的诊断，当未发现绒毛时，CK(AEl/AE3)是很好的特异性标记物。因蜕膜组织“染色阴性，而浸润其中的滋养叶细胞则CK阳性，即可明确诊断。 在多年外科病理诊断中，大家公认：免疫组化不是万能的，存在着如特异性或敏感性等问题，但在外科病理诊断上的作用却是实实在在的，关键在于怎样应用。免疫组化检查在病理诊断中的应用及其意义(三) 联合病理整理转贴自：中杉生物公司交流资料点击数：2511三、人体常见细胞的免疫组化特性Lymph Node Germinal center B cells CD45+; CD20+; CD79a+ (weak); CD5-; CD10+; Ig+ (IgG, IgM or IgA, but not IgD); Light chain+; bcl-2-; bcl-6+; proliferating cases in dark zone well highlighted by Ki67 Mantle zone B cells: CD45+; CD20+; CD79a+; IgD+; IgM+; IgG-; IgA-; Light chain+; bcl-2+; CD5-; CD10-; bcl-6- Marginal zone B cells and monocytoid B cells CD45+; CD20+; CD79a+; IgM+; IgD-/+; CD5-; bcl-2-; bcl-6- Interfollicular B cells CD45+; CD20+; CD79a+; Ig+ (IgD, IgM, IgG or IgA); Light chain+; bcl-2+; bcl-6-; activated B cells may express CD30; EBV-infected B cell may upregulate CD43 Plasma cells CD45-/+; CD20-; CD79a+/-; Ig+; CD138+; EMA+/- T cells CD3+; CD45RO+; CD43+; mostly TCR-?, sometimes TCR-?; CD4+ or CD8+; subpopulation can express cytolytic molecules (granzyme B, TIA1, perforin) T cells in germinal center CD3+; CD45RO+; CD43+; CD57+; CD4+;CD8- NK cells: CD45+; surface CD3-; cytoplasmic CD3+; CD43+; CD45RO+; CD56+; CD57+/-; Granzyme B+; TIA1+; Perforin+ Follicular dendritic cells CD45-; CD21+; CD35+; FDC+; CD23 (subpopulation)+; S100-/+; CD1a-; lysozyme-; HLA-DR+ Interdigitating dendritic cells CD45+; S100+; CD68-/+; CD1a-/+; lysozyme-/+; HLA-DR+; CD43+ Langerhans cells CD45+; S100+; CD68-/+; CD1a+; lysozyme-/+; HLA-DR+ Histiocytes CD45+; S100-; CD68+; CD1a-; lysozyme+; HLA-DR+; CD43+ Spleen Lymphocytes Either B cells or T cells (see Lymph node) Splenic sinus lining cells Factor VIII+; CD31-/+; CD34-/+; CD8+; lysozyme+; CD68-/+ Splenic pulp cords Rich in CD68+ cells Thymus Thymic epithelial cells CK+ (esp. CAM5.2+, but 34?E12 shows up the epithelium of the medulla much better) Thymic T lymphocytes in cortex CD45+; CD3+; TdT+; CD1a+; CD99+; high Ki67 index Thymic T lymphocytes in medulla CD45+; CD3+; TdT-; CD1a-; CD99- Thymic B lymphocytes in medulla CD45+; CD20+ (sometimes with asteroid appearance); CD79a+ Skin and mucosal tissues and parenchymal organs Epithelium CK+ (glandular epithelium tends to express low molecular weight CK; and some epithelial cells may express specific CK subtypes); vimentin-/+; BerEP4+/-; EMA+/-; E-cadherin+/- Special types of epithelium * Skin epidermis - 34?E12+, CAM5.2-, CK5/6+ * Prostatic acini and ducts - PSA+ * Breast with apocrine change - Brst2+ * Glandular epithelium - CEA may be positive (luminal); EMA often positive (esp. luminal) * Pneumocytes - Surfactant/PE10+, TTF1+ * Liver cells - CK+; HEP-PAR1+; CAM5.2+; AE1/AE3-; polyclonal CEA or CD10 in canalicular pattern; albumin+ * Bile ducts - CK+;CAM5.2+; AE1/AE3+, HEP-PAR1- Myoepithelium CK+; CK14+; High molecular weight CK+; Actin+; calponin+; S100-/+; GFAP-/+; Vimentin+ Basal cells of prostate CK+; CK14+; Actin-; S100- Melanocytes S100+; Vimentin+; HMB45- (some junctional melanocytes can be +); CK-; c-kit+ Merkel cells CK+; CK20+; synaptophysin+; chromogranin+; NSE+; neurofilament+ Mesenchymal cells Fibroblasts Vimentin+; Actin-; Desmin-; CK- Myofibroblasts Vimentin+; Actin+; Desmin-/+; CK-/+ Smooth muscle Vimentin+; Actin+; Desmin+; CK-/+ Interstitial dendritic cells Vimentin+; CD34+; Actin-/+; Desmin- Endothelium Factor VIII related antigen+; CD31+; CD34+; Vimentin+ Pericytes Factor VIII related antigen-; CD31-; CD34-; vimentin+; Actin+; Desmin- Fat cells Vimentin+; S100+ Cartilage cells Vimentin+; S100+; GFAP+/- Skeletal muscle Vimentin+; Actin+/-; Desmin+; Myoglobin+; MyoD1- (positive only in primitive or fetal muscle cells); Myogenin- (positive only in primitive or fetal muscle cells); S100-/+ (weak staining); CD56-/+ (positive in damaged muscle) Endometrial stromal cells CK-; Vimentin+; Actin+/-; Desmin-/+; S100-; CD10+ Mesothelial cells Mesothelial cells CK+; CK5/6+; Vimentin+; Calretinin+; HBME1+; N-cadherin+; E-cadherin-; CEA-; BerEP4-; LeuM1-; Desmin -/+ (occasional) Neuroendocrine and endocrine organsThyroid follicular cells CK+; Thyroglobulin+; TTF1+; Chromogranin-; Synaptophysin-; NSE- Thyroid C cells CK+; Calcitonin+; TTF1+; Chromogranin+; Synaptophysin+; NSE+; CEA+ Parathyroid CK+; Parathyroid hormone+; TTF1-; Chromogranin+;Synaptophysin+; NSE+; Neurofilament+ Islet cells CK+; Synaptophysin+; Chromogranin+; NSE+; Various hormones+ Pituitary cells CK+; Synaptophysin+; Chromogranin+; NSE+; Various hormones+ Adrenal cortical cells CK+/-; Synaptophysin-; Chromogranin-; NSE-; melan-A+/-; inhibin+/- Dispersed neuroendocrine cells CK+; Synaptophysin+; Chromogranin+; NSE+; Various hormones+ Central and peripheral nervous system Neurons and ganglion cells CK-; Neurofilament+; NSE+; Synaptophysin+; Chromogranin-/+; Calretinin+/-; GFAP- Nerve fibers (CNS or peripheral) CK-; Neurofilament+; NSE+; Synaptophysin+; Chromogranin-/+; GFAP-; Leu7+ Astrocytes CK-, GFAP+; S100+; Vimentin+; Synaptophysin-; Neurofilament- Oligodendroglial cells CK-, GFAP-; S100+; Leu7+/-; Synaptophysin-; Neurofilament- Ependymal cells CK-/+; GFAP+; Vimentin+; EMA+/- Choroid plexus cells CK+; Transthyretin+; GFAP+/-; BerEP4-; CEA-; S100+/- Schwann cells CK-, S100+; GFAP-/+; Vimentin+; Neurofilament-; EMA- Perineurial cells and meningeal cells CK-, S100-; GFAP-; EMA+; Vimentin+ Paraganglion chief cells and adrenal medulla cells CK-; Synaptophysin+; Chromogranin+; NSE+; Neurofilament+; S100- Sustentacular cells CK-, S100+; GFAP-/+; Synaptophysin-; Neurofilament+ Gonads Sertoli cells CK+/-; CD99+; Inhibin+; CD56-/+ Leydig cells CK-; Synaptophysin-; CD56-/+; Inhibin+; Melan A+/- Granulosa cells CK-; Vimentin+; CD99+; Inhibin+; Melan A+/- Germ cell (spermatogonia, ovum) CK-; PLAP-; c-kit+ Placenta Syncytiotrophoblast CK+; HCG+ Cytotrophoblast CK+; HCG- Intermediate trophoblast CK+; HCG-/+; HPL+ Decidual cells CK-; Vimentin+ Bone marrow Granulocytic series cells CD45+; Myeloperoxidase+; KP1/CD68+; PGM1/CD68-; lysozyme+ Monocytic series cells CD45+; Myeloperoxidase-; KP1/CD68+; PGM1/CD68+; lysozyme+ Red cell series Glycophorin A+ Megakaryocytes and platelets Factor VIII-related antigen+; CD31+; CD34+ 免疫组化检查在病理诊断中的应用及其意义(四) 联合病理整理转贴自：中杉生物公司交流资料点击数：2843四、上皮及间皮类常用标记抗体EPITHELIAL AND MESOTHELIAL MARKERSCK (MNF 116)-MNF-116 is a pan-cytokeratin antibody.-Source: Dakopatts.-Dilution 1:50.-Antigen retrieval method: HIER (pressure cooking) using EDTA.-Staining pattern: Cytoplasmic, typically fibrillary, with or without accentuation beneath the cell membrane or in paranuclear region. A diffuse flocculent pattern in the cytoplasm is often produced by endogenous biotin rather than real staining.-This is an excellent antibody which reacts with a broad spectrum of cytokeratins of different molecular weights (including cytokeratins 5, 6, 8, 17, and possibly 19), i.e. it is considered a pan-cytokeratin antibody (although this antibody may not cover the cytokeratins of very low M.W. or very high M.W. well). This antibody will stain up practically all histological types of epithelial tumor, including glandular tumors, undifferentiated carcinomas, keratinizing squamous cell carcinoma, neuroendocrine carcinomas, small cell carcinomas and hepatocellular carcinomas. -For general purposes, it is adequate to order CK alone to detect epithelial differentiation. Order the following cytokeratin antibodies with more restricted reactivities only in selected circumstances, e.g. hepatocellular carcinoma versus other carcinoma types; small cell carcinoma. May consider replacing CK with CAM5.2 for suspected small cell carcinoma.-Main applications of pan-CK:a) Diagnosis of undifferentiated malignant neoplasmb) For mucosal sites, diagnosis of subtle carcinoma through demonstration of positive cells that are not part of the normal epithelial architecturec) Detection of occult carcinoma in lymph node, bone or bone marrowd) Diagnosis of certain types of mesenchymal tumors, e.g. synovial sarcoma, chordomaAE1/AE3 (pan-cytokeratin)-A mixture of two anti-cytokeratin monoclonal antibodies AE1 and AE3.-Source: Biogenex.-Dilution 1: 400.-Antigen retrieval method: HIER (pressure cooking) using EDTA.-Staining pattern: Cytoplasmic, typically fibrillary, with or without accentuation beneath the cell membrane or in paranuclear region. -This antibody combination reacts with both low and intermediate M.W. cytokeratins, although it does not stain high M.W. cytokeratins well in paraffin sections.-In the liver, the hepatocytes are typically negative, while the bile ducts are positive.CAM 5.2 -Monoclonal antibody against low M.W. cytokeratin (including CK8 and CK18).-Source: Becton-Dickinson.-Dilution 1:8.-Antigen retrieval method: HIER (pressure cooking) using EDTA.-Staining pattern: Cytoplasmic, typically fibrillary, with or without accentuation beneath the cell membrane or in paranuclear region. A monoclonal antibody that stains low M.W. cytokeratin best, particularly neuroendocrine cells and glandular epithelium. It does not stain the normal stratified squamous epithelium. In the liver, both the hepatocytes and bile ducts are positive. Stains most epithelial tumors, and particularly useful for neuroendocrine tumors (e.g. small cell carcinoma), hepatocellular carcinoma and renal cell carcinoma.-In fact, a combination of CAM 5.2 and AE1/AE3 is helpful for suggesting a diagnosis of hepatocellular carcinoma if CAM 5.2 is positive (cell membrane staining) and AE1/AE3 is negative.-Major applications:a) May use CAM5.2 instead of CK for small cell carcinoma and neuroendocrine carcinomasb) May consider using CAM5.2 in addition to CK for thymomas and spindle cellcarcinomasc) Aid in diagnosis of hepatocellular carcinomad) Diagnosis of mammary and extramammary Pagets disease34bE12-Monoclonal antibody against high M.W. cytokeratin, including cytokeratins 1, 5, 10 and 14.-Source: Dakopatts-Dilution 1:10-Antigen retrieval method: HIER (pressure cooking) using EDTA.-Staining pattern: Cytoplasmic, typically fibrillary, with or without accentuation beneath the cell membrane or in paranuclear region.-This antibody stains stratified squamous epithelium and squamous cell carcinomas particularly well.-Major applications:a) 34 E12 stains the basal cells of the prostate, i.e. normal/reactive acini or PIN versus invasive adenocarcinomab) Staining the myoepithelial cells of salivary glands (hence of some value in study of salivary gland tumors, although neoplastic myoepithelial cells may show inconsistent CK14 reactivity).c) Staining Mallory hyaline.Epithelial membrane antigen (EMA)-Monoclonal antibody E29.-Source: Dakopatts.-Dilution 1:10 -Antigen retrieval method: HIER (pressure cooking) using EDTA.-Staining pattern: Cell membrane and/or cytoplasm-A marker for epithelial cells. However, since it does not stain carcinomas as consistently as the cytokeratin antibodies, it is generally not as useful for detection of epithelial differentiation. Nonetheless, this may be used as an additional e