Ayşegül EYLEN, Ayşegül ŞENTÜRK, Mükremin ER, H. Canan HASANOĞLU, Gökhan AYKUN, Olcay KANDEMİR

Akciğer ile akciğer dışı adenokanserlerin ayırıcı tanısında immünhistokimyasal belirteçlerin değeri

Amaç: Akciğer adenokarsinomun histopatolojik olarak ayırıcı tanısının yapılamadığı durumlarda immünhistokimyasal boyama gerekebilir. Çalışmamızda; akciğer ile akciğer dışı adenokanserlerin ayırıcı tanısında immünhistokimyasal yöntemlerin ne ölçüde faydalı olduğunu tespit etmeye çalıştık. Materyal ve Metot: Çalışmamıza 24 akciğer adenokar-sinomu, 20 gastrointestinal sistem adenokarsinomu (GİSA), 10 papiller tiroid karsinomu (PTK), 10 prostat adenokarsinomu (PA) ve 10 meme invaziv duktal karsinomu (MİDK) olguları alındı. Patoloji preparatları immü-nohistokimyasal olarak CK7, CK20, TTF-1, tiroglobulin ve p53 immün belirteçleri ile boyandı ve immünoreaktivi-teleri yönünden birbirleriyle karşılaştırıldı. Bulgular: Akciğer adenokarsinomlarının, PTK'ların, MİDK'ların %100'ü ve GİSA'larının %15'i CK7 ile pozitif immün boyanma gösterirken, PA'nın hiçbirinde CK7 ile boyanma gözlenmedi. GİSA'nın %75'inde ve PA'nın %10'unda CK20 ile pozitif immün boyanma görülürken, diğer malignitelerde boyanma gözlenmedi. PTK'larının hepsinde tiroglobulin ite pozitif immün boyanma görülürken, tiroid dışı diğer adenokarsinomların hiçbirinde immün boyanma gözlenmedi. PTK'nın hepsinde (%100), akciğer adenokarsinomlarının %83,3'ünde, MİDK'nın %20'sinde, GİSA'nın %15'inde ve PA'nın %10'nunda TTF-1 ile pozitif boyanma gözlendi. Akciğer adenokarsinomlarının %87,5'inde, GİSA'nın %85'inde, PTK'nın %90'ında ve MİDK'nın %80'inde p53 ile pozitif immün boyanma görüldü. PA'nın hiçbirinde p53 ile boyanma görülmedi. Sonuç: Akciğer adenokanseri ile GİSA ayırıcı tanısında CK7+CK20 boyanma panelinin duyarlılığı %100, özgüllüğü %90 olarak bulundu. PTK'nın, akciğer ve diğer adeno-kanserlerden ayırıcı tanısında tiroglobulinin duyarlılığı ve özgüllüğü %100 olarak bulundu. Akciğer adenokarsi-nomları ile MİDK ayırıcı tanısında TTF-1'in duyarlılığı %83,3 özgüllüğü %80 bulundu. p53, PA'yı dışlayan bir belirteç olarak değerlendirildi.

Utility of immunohistochemical markers in the differential diagnosis of adenocarcinomas

Aim: When differential diagnosis of adenocarcinoma in the lung can not be made, immunohistochemical staining may be necessary. In this study, utility of immunohistochemical staining in the differential diagnosis of adenocarcinomas was evaluated. Material and Method: Twenty-four lung adenocarcinoma, 20 gastrointestinal adenocarcinoma (GISA), 10 papillary thyroid carcinoma (PTC), 10 prostate adenocarcinoma (PA) and 10 breast invasive ductal adenocarcinoma (IDC) were enrolled to the study. The pathology slides of cases in the study were stained with immunohistochemical markers (CK7, CK20, TTF-1, thyroglobulin, p53). Results: CK7 immunostaining was seen in 100% of lung adenocarcinomas, PTAs, IDCs and 15% of GISAs, whereas none of the PAs were positive. CK20 immunostaining was seen in 75% of GISAs and 10% of PAs whereas none of the lung adenocarcinomas, IDCs and PTCs showed immunostaining. Thyroglobulin staining was seen in all PTCs, whereas none of the non-thyroid adenocarcinomas showed immunostaining. TTF-1 staining was observed in 100% of PTCs, 83.3% of lung adenocarcinomas, 20% of IDCs, 15% of GISAs and 10% of PAs. p53 immunostaining was seen in 87.5% of lung adenocarcinomas, 85% of GISAs, 90% of PTCs and 80% of IDCs; p53 staining was not observed in PAs. Conclusion: CK7+CK20 staining panels sensitivity and specificity were found to be 100%, 90% respectively in the differential diagnosis of lung and GISA. Thyroglobulins sensitivity and specificity was 100% in the differential diagnosis of PTC versus other adenocarcinomas. In the differential diagnosis of lung adenocarcinomas from IDC, TTF-1 marker had 80% sensitivity and 83.3% specificity. p53 was considered as a marker of exclusion of PA.

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