Hilal BALTA, Betül GÜNDOĞDU, Nesrin GÜRSAN

HEPATOSELLÜLER KARSINOM, KOLANJIOSELLÜLER KARSINOM VE KOLON ADENOKARSINOM METASTAZLARININ AYIRICI TANISINDA İMMUNOHISTOKIMYASAL METODLAR

Giriş: Karaciğer insan vücüdunda metabolizma fonksiyonlarının yürütüldüğü temel organdır. Kanserleri dünyada kanserden ölüm sebebleri arasında 3.sırada yer alır. Metastazları en sık görülen malign tümörleridir. Primer malign tümörlerinden hepatosellüler karsinom (%80-90) ikinci sıklıkta,kolanjiokarsinom da 3. sıklıkta görülen malign tümörleridir (%10-15). Bu tümörlerin erken tanı alması, tedavinin erken planlanması açısından önemlidir. Geç evre hepatosellüler karsinom kolay tespit edilebilmesine rağmen büyük oranda tedavi edilememekte ve nüks izlenmektedir. Bundan dolayı ayırıcı tanıda daha sensitif ve spesifik antikorlar kullanarak, rutin uygulamada kullanılmakta olan diğer belirleyicilerin etkinliğini artırmak, daha erken tanıya ulaşmak gerekmektedir. Metot: Çalışmamızda 60 adet olguya ait biyopsi ve rezeksiyon materyallerinin parafin bloklarında immunohistokimyasal olarak Glypican-3, Agrin/CD34 kombinasyonu, CDX2 çalışıldı. Bulgular: Daha önce çalışılmış HepPar1, AFP, CEA, CD10, CK-19, CK-7, CK-20, CK-8, CK-18 ile kombine değerlendirildiğinde özellikle GPC-3’ün hepatosellüler karsinomda HepPar1 ve AFP’ye göre daha sensitif ve spesifik olduğu gözlendi. Ayrıca kolanjiosellüler karsinom ve kolon adenokarsinom metastatik tümörlerleriyle ayırıcı tanısında oldukça faydalı olduğu tespit edildi. Agrin’in hepatosellüler karsinomlu dokularda yeni damarlanma alanlarında izlenmesine rağmen kolanjiosellüler karsinom ve kolon adenokarsinom metastazlı dokularda izlenmemesi dikkatimizi çekti. CDX2 ile kolon adenokarsinom metastazlı dokularda boyanma gözlenirken, hepatosellüler karsinom ve kolanjiosellüler karsinomda çok az boyanma izlenmesi de ayırıcı tanıda önemli bir bulguydu. Sonuç: Bulgularımızın hepsini bir arada değerlendirdiğimizde, GPC-3, Agrin ve CDX2 oldukça sensitif ve spesifik belirleyicilerdir. Olguların erken tanılanmasını ve daha hızlı tedavi almasını sağlayıp, hastaların surveyini uzatması açısından rutinde de uygulanması gerekir.

Anahtar Kelimeler:

Hepatosellüler Karsinom, Kolanjiosellüler Karsinom, Kolon Adenokarsinom Metastazı, İmmunohistokimya, Glypican-3, Agrin, CDX2

NEW IMMUNOHİSTOCHEMİCAL METHODS IN THE DİFFERENTIAL DIAGNOSİS OF HEPATOCELLULAR CARCİNOMA, CHOLANGIOCELLULAR CARCİNOMA, AND COLON ADENOCARCINOMA METASTASES

Objectives: Liver is the main organ carrying out metabolic functions in the human body. The cause of death from cancer is the third among cancers in the world. Metastases are the most common malignant tumors in liver. Hepatocellular carcinoma, primary malignant tumors of the liver, is the second (80-90 %), and cholangiocellular carcinoma is the third (10-15 %) most common malignant tumor of liver. Early diagnosis in these tumors is important for early treatment planning. Although late-stage hepatocellular carcinoma is easily detectable, the treatment could not be avaliable in a large proportion and recurrence is frequently observed. Therefore, in the differential diagnosis using more sensitive and specific antibodies can increase the effectiveness of the other markers used in routine practice, and can achieve an earlier diagnosis. Methods: In our study, paraffin blocks of the biopsy and resection material of 60 cases were studied immunohistochemically with GPC-3, Agrin/CD34 combination, CDX2. Results: HepPar1, AFP, CEA, CD10, CK-19, CK-7, CK-20, CK-8 and CK-18 which are studied previously, were evaluated in combination with GPC-3 in hepatocellular carcinoma, and GPC-3 was found to be more sensitive and specific than HepPar1 and AFP. In the differential diagnosis of hepatocellular carcinoma from cholangiocellular carcinoma and metastatic adenocarcinoma of the colon, GPC-3 was also found to be very useful. Although in hepatocellular carcinoma tissues Agrin was observed in the new areas of vascularity, it was not observed in the areas of cholangiocellular carcinoma and tissues of metastatic colon adenocarcinoma. That has been followed in our attention. CDX2 staining was observed in tissues with metastatic adenocarcinoma of the colon, but it is very little in hepatocellular carcinoma and cholangiocellular carcinoma. This is an important finding in the differential diagnosis. Conclusion: Considered a combination of all of our findings, Glypican-3, Agrin/CD34 combination and CDX2 are very sensitive and specific markers of hepatocellular carcinoma. These markers must be applied in routine practice for early diagnosis and treatment, and for the extend of the survey in patients with hepatocellular carcinoma.

Keywords:

Hepatocellular Carcinoma, Cholangiocellular Carcinoma, Metastatic Adenocarcinoma of the Colon, Immunohistochemistry, Glypican-3, Agrin/CD34 combination, CDX2,

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