目的:肝内胆管癌(iCCA)分为小导管和大导管类型。这两种亚型在各种临床病理特征和可能的细胞起源和癌变途径方面表现出明显的差异。然而,鉴别诊断有时可能很困难。给定IV型中间灯丝,Nestin,可能是联合肝细胞胆管癌(cHCC-CCA)和小导管型iCCAs的候选诊断标志物,本研究讨论了nestin作为小导管和大导管类型的iCCA之间的鉴别诊断标志物的意义.
方法:在36例小导管型iCCA患者的切片中免疫组织化学评估了Nestin的表达,30采用大风管型iCCA,和27例肝外胆管癌(CCA)。在小导管型iCCAs中研究了Nestin的表达及其与临床病理特征和遗传改变的关系。
结果:在17个小导管型iCCAs中检测到Nestin表达(47.2%),一个大导管型iCCA(3.8%)和零肝外CCA。Nestin在小导管型iCCA患者中的表达明显高于大导管型iCCA和肝外CCA患者(p<0.01)。在10例肝脏活检中,所有具有巢蛋白表达的样本均为小导管型iCCAs。巢蛋白阳性小导管型iCCAs的特点是组织学分级较高,与Nestin阴性小导管型ICCAs相比(p<0.01)。巢蛋白阳性小导管型iCCAs倾向于有2个或更多的遗传改变,但无统计学差异(p>0.05)。
结论:不同的巢蛋白表达可能反映了小导管型iCCA和大导管型/肝外CCA之间的差异,可能是小导管型iCCA的有用诊断标志物。
OBJECTIVE: Intrahepatic cholangiocarcinoma (iCCA) is subclassified into small and large duct types. These two subtypes show distinct differences in various clinicopathological features and possible cell origin and pathways of carcinogenesis, however, a differential diagnosis may be sometimes difficult. Given the type IV intermediate filament, Nestin, may be a candidate diagnostic marker for combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and small duct type iCCAs, the significance of nestin as a differential diagnostic marker between small and large duct types of iCCAs was addressed in the present study.
METHODS: Nestin expression was immunohistochemically assessed in the sections from 36 patients with small duct-type iCCA, 30 with large duct-type iCCA, and 27 with extrahepatic cholangiocarcinoma (CCA). Nestin expression and its relationship with clinicopathological features and genetic alterations were investigated in small duct type iCCAs.
RESULTS: Nestin expression was detected in 17 small duct type iCCAs (47.2%), one large duct type iCCA (3.8%) and zero extrahepatic CCA. Nestin expression was significantly more frequent in the patients with small duct type iCCAs than in those with large duct type iCCA and extrahepatic CCA (p < 0.01). In 10 liver biopsies, all samples with nestin expression were small duct type iCCAs. Nestin-positive small duct type iCCAs were characterized by a higher histological grade, compared to Nestin-negative small duct type iCCAs (p < 0.01). Nestin-positive small duct type iCCAs tended to have 2 or more genetic alterations, but there was no statistic difference (p > 0.05).
CONCLUSIONS: Different nestin expression may reflect differences between small duct type iCCA and large duct type/extrahepatic CCA and may be a useful diagnostic marker for small duct type iCCAs.