The diagnostic value of pCEA, mCEA, AFP and CK19 in differentiating primary and metastatic carcinoma of liver

Year 2016, Volume: 5 Issue: 1, 39 - 46, 01.01.2016

Hesna Müzeyyen Astarcı Gülzade Özyalvaçlı Ayşe Sertçelik

https://doi.org/10.5505/abantmedj.2016.94557

Abstract

INTRODUCTION: Hepatocellular carcinoma HCC represent tumors that originate from hepatocytes or show hepatocellular differentiation, constituting 80-85% of primary malignant tumors of liver. Metastatic carcinomas are mostly seen in liver, as well. However, differential diagnosis of primary and metastatic tumors can be difficult especially while evaluating tru-cut biopsies. In this study, we evaluated immunohistochemical expression profiles of CK19, AFP, mCEA and pCEA in patients with HCC, cholangiocellular carcinoma CCC and metastatic adenocarcinoma diagnosed based on histopathological, clinical and radiological findings. METHODS: : A total of 75 cases 39 HCC, 3 CCC and 33 metastatic adenocarcinoma were included. Immunohistochemical staining pCEA, mCEA, AFP and CK19 were performed on needle biopsy samples larger than 15 mm and wedge resection materials.RESULTS: Mean age of HCC patients was 49, 5 range 15-75 and male/female ratio was 3.8: 1. Six 15.2% cases of HCC were classified as grade I, 22 56.4% as grade II, 9 23% as grade III and 2 5.4% as grade IV. CCC patients were male and mean age was 44. AFP was negative in 3 CCC cases. Of 33 cases with metastatic adenocarcinoma, male / female ratio was 1: 1. And mean age was 54.2 range 37-74 . CK19 was stained positive in 23 cases. Tumors originating from pancreas and gallbladder showed diffuse positivity. DISCUSSION AND CONCLUSION: CK19 was found to be an important marker in differentiating HCC and CCC. However, it cannot be used in differential diagnosis of CCC and metastatic adenocarcinoma. Canalicular staining of pCEAin HCC is useful in differentiating HCC and metastatic adenocarcinomas. On the contrary, mCEA is strongly expressed in metastatic adenocarcinomas, suggesting it also could be a useful marker in differentiating HCC and metastatic adenocarcinomas. Due to low sensitivity and specificity of AFP expression, it cannot be used as a reliable marker in differential diagnosis of HCC and metastatic tumors.

Keywords

Hepatocellular Carcinoma, Immunohistochemistry, Cholangiocellular Carcinoma, metastatic

Karaciğerin primer ve metastatik karsinomlarının ayrımında pCEA, mCEA, AFP ve CK19' un tanısal değeri

Abstract

GİRİŞ ve AMAÇ: Hepatosellüler karsinom HCC hepatositlerden köken alan ya da hepatosellüler diferansiyasyon gösteren, primer karaciğer tümörlerinin %80-85’ini oluşturan malign tümördür. Karaciğerin primer ve metastatik malign tümörlerinin ayırıcı tanısında özellikle tru–cut biopsilerde tanısal güçlükle karşılaşılmaktadır. Karaciğer, metastatik karsinomların en fazla izlendiği organ olması nedeni ile bu ayrımın kesin bir şekilde yapılması önem kazanmaktadır. Bu çalışmada, klinik ve radyolojik bulgular eşliğinde histopatolojik olarak tanı almış primer HCC, kolanjiosellüler karsinoma KCC ve metastatik adenokarsinomlarda immunohistokimyasal CK19, AFP, mCEA ve pCEA’nın boyanma profilleri araştırılmıştır.YÖNTEM ve GEREÇLER: 39 hepatosellüler karsinom, 33 metastatik adenokarsinom ve 3 KCC ait olmak üzere toplam 75 olgunun 15 mm’den büyük iğne biyopsileri ve wedge rezeksiyon materyalleri çalışmaya dahil edildi. Olgulara immünhistokimyasal olarak pCEA, mCEA, AFP ve CK19 uygulandı.BULGULAR: 39 HCC olgusunun yaş ortalaması 49,5 15-75 tespit edilmiş olup, erkek/kadın oranı 3,8: 1 dir. HCC olgularının 6’sı grade I %15.2 , 22’si grade II %56.4 , 9’u grade III %23 , 2’si grade IV %5.4 idi. Üç KCC olgumuzda yaş ortalaması 44 olup, 3’ü de erkektir. Üç olguda da AFP’nin negatif olması dikkat çekicidir. 33 metastatik karaciğer tümörünün kadın/erkek oranı 1: 1dir. Yaş ortalaması 54.2 37-74 idir. CK19, 23 %60.6 olguda pozitif olarak bulunmuştur. Pankreas ve safra kesesi kaynaklı metastatik tümörlerin hepsinde yaygın pozitiflik saptanmıştır.TARTIŞMA ve SONUÇ: CK19, HCC ve KCC ayırıcı tanısında önemli bir belirleyiciyken metastatik adenokarsinom ve KCC ayrımında yardımcı değildir. pCEA’nın HCC’lerde kanaliküler tipte boyanması HCC’ye özgü bir boyanma olarak metastatik adenokarsinomlardan ayrımında önemlidir. mCEA ise metastatik adenokarsinomlarda kuvvetli intrasitoplazmik ekspresyon gösterdiğinden HCC ve metastaz ayrımında yardımcı bir markerdir. AFP ekspresyonunun spesifite ve sensitivitesi düşük olduğundan metastaz ve HCC ayırıcı tanısında çok faydalı değildir.

Keywords

Hepatosellüler Karsinom, İmmunohistokimya, Kolanjiosellüler Karsinom, metastatik

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