胸水細(xì)胞蠟塊結(jié)合免疫組織化學(xué)技術(shù)在晚期肺腺癌中的應(yīng)用

俞嬌　施永勝　郭閃閃

[摘要] 目的 分析胸水細(xì)胞蠟塊結(jié)合免疫組織化學(xué)在肺腺癌中的應(yīng)用。 方法 收集東陽市中醫(yī)院2008年6月～2015年12月7年間50例可疑惡性胸水樣本，分析其臨床病史、涂片、細(xì)胞蠟塊切片、免疫組織化學(xué)及基因檢測等資料。 結(jié)果 50例可疑惡性胸水患者，增生反應(yīng)性間皮細(xì)胞4例，確診惡性腫瘤46例，其中肺腺癌27例，其他組織來源及組織類型19例，與細(xì)胞學(xué)常規(guī)涂片相比，細(xì)胞蠟塊切片鏡下可見背景干凈，染色對比清晰，細(xì)胞數(shù)目明顯增多、厚薄均勻，且可以尋找組織來源及基因檢測。 結(jié)論 細(xì)胞蠟塊結(jié)合免疫組織化學(xué)技術(shù)極大地提高了胸水細(xì)胞學(xué)的診斷準(zhǔn)確率及明確組織來源；同時為腫瘤精準(zhǔn)醫(yī)療提供了平臺，值得推廣。

[關(guān)鍵詞] 胸水；免疫組織化學(xué)；腺癌；細(xì)胞塊

[中圖分類號] R734.2 [文獻(xiàn)標(biāo)識碼] B [文章編號] 1673-9701（2018）19-0135-04

Application of pleural effusion cell wax block combined with immunohistochemistry in advanced lung adenocarcinoma

YU Jiao1 SHI Yongsheng1 GUO Shanshan1 CHEN Yan2

1.Department of Pathology， Dongyang Traditional Chinese Medicine Hospital， Dongyang 322100， China； 2.Department of Pathology， Dongyang People's Hospital， Dongyang 322100， China

[Abstract] Objective To analyze the application of pleural effusion cell wax block combined with immunohistochemistry in lung adenocarcinoma. Methods 50 cases of suspected malignant pleural effusion from June 2008 to December 2015 were collected from Dongyang Traditional Chinese Hospital. The clinical history， smears， cell wax block， immunohistochemistry and gene detection were analyzed. Results There were 4 cases of proliferative reactive mesothelial cells and 46 cases of diagnosed malignant tumors in 50 cases of suspected malignant pleural effusion. Among them， 27 cases were lung adenocarcinoma and 19 cases were from other tissue sources and tissue types. Compared with that of cytological routine smears， the background of cell wax block was clean under the microscope， and the staining contrast was clear； the number of cells was obviously increased； the thickness was even； the tissue source and gene detection could be found. Conclusion The cell wax immunohistochemistry technique greatly improves the diagnostic accuracy of pleural effusion cytology and clarifies the source of tissue. At the same time， it provides a platform for accurate tumor treatment and is worthy of promotion.

[Key words] Pleural effusion； Immunohistochemistry； Adenocarcinoma； Cell mass

胸水細(xì)胞學(xué)樣本具有可多次重復(fù)取得、損傷小、檢查時間短等優(yōu)點(diǎn)，在臨床實(shí)際工作中較廣泛應(yīng)用于中晚期惡性腫瘤的檢查，而普通胸水細(xì)胞學(xué)涂片很難為臨床醫(yī)師提供惡性腫瘤的發(fā)病部位、腫瘤的病理組織學(xué)類型、預(yù)測預(yù)后以及與治療相關(guān)有價(jià)值的信息，甚至部分患者難以明確診斷。近年來隨著腫瘤精準(zhǔn)醫(yī)療的不斷深入，應(yīng)用組織病理學(xué)樣本進(jìn)行腫瘤基因或免疫組織化學(xué)腫瘤蛋白表達(dá)的檢測，已成為指導(dǎo)臨床靶向治療或預(yù)測化療藥物療效的最可靠方法之一，近年來特別是肺腺癌尤其有臨床指導(dǎo)意義，但對于晚期肺腺癌患……