去黑色素法在免疫组织化学中的应用

在有色素的黑色素瘤免疫组织化学鉴别诊断和研究中 ,常遇到的问题是经免疫组织化学 DAB显色后的切片 ,其棕黄色结果是抗原表达还是黑色素的沉集很难区别 ,有必要除去黑色素 ,否则将导致错误的结论。选择什么样的去黑色素方法 ,去色素后对免疫组织化学有无影响以及是否需要进行抗原修复等问题有待摸索 ,为此 ,我们特对 15例有色素和 13例无色素性黑色素瘤进行了实验比较 ,现报道如下 :材料和方法1　材料 :选取我科病理诊断为黑色素瘤的病例 2 8例 ,其中有色素的 15例 ,无色素的 13例 ,常规 10 %福尔马林固定 ,石蜡包埋切片 ,切片厚 4um,共 …     

神经皮肤黑变病中黑色素的来源初探

目的探讨食蟹猴神经皮肤黑变病（NCM）中黑色素的来源。方法收集北京协和医学院比较医学中心病理室食蟹猴神经皮肤黑变病的病理学标本一例,复习其病理切片并辅助免疫组化及电镜技术对黑色素的来源做进一步探讨。结果皮肤病理检查显示真皮内黑色素主要由黑色素细胞产生,黑色素细胞CD31免疫组化染色阴性。脑膜的组织病理学显示脑膜下黑色素主要由黑色素细胞产生,黑色素细胞CD31免疫组化染色阴性。脑实质的组织病理学显示其黑色素由黑色素细胞和血管内皮细胞产生,CD31免疫组化染色显示含有黑色素的血管内皮细胞呈阳性着色。电镜检查结果同样显示血管内皮细胞内可见黑色素小体沉积。结论我们在世界上首次揭示了食蟹猴NCM大脑中血管内皮细胞可产生黑色素,这给内皮细胞增加了一项新的功能。     

微波免疫组织化学技术在宫颈癌涂片快速诊断中的应用

本文应用微波免疫组化ＡＢＣ技术检测了６７例宫颈涂片细胞中ＥＭＡ的分布。结果,Ｉ～Ｖ级宫颈涂片ＥＭＡ阳性率分别为３０％（３／１０）、５０％（５／１０）、７０％（７／１０）、９３．７％（１５／１６）和９５．２％（２０／２１）。Ⅰ、Ⅱ级与Ⅲ级,Ⅲ级与Ⅳ、Ⅴ级ＥＭＡ阳性率均有显著差异性（Ｐ＜０．０５）。结果提示：ＥＭＡ可作为宫颈涂片细胞的分化标志,有助于良恶性细胞的鉴别。同时对形态学不够恶性而ＥＭＡ呈强阳性者,有潜在恶变的物质基础。在抗体稀释度相同时,微波免疫组化较常规免疫组化具有特异性染色深。背景浅,反应时间显著缩短等特点。     

人原发性肝细胞肝癌中丙型肝炎病毒C_（33c）抗原及HBxAg的分布及意义

作者应用抗ＨＣＶＮＳ３区Ｃ３３ｃ抗原２Ｂ６株单克隆抗体和抗ＨＢｘＡｇ多克隆抗体,采用ＡＢＣ法对１０２例人原发性肝细胞肝癌（ＰＨＣ）组织进行了ＨＣＶ及ＨＢＶ抗原定位研究。ＨＣＶＣ３。抗原及ＨＢｘＡｇ在ＰＨＣ中的阳性检出率分别是８１．４％及７４．５％,Ｃ３３ｃ抗原或ＨＢｘＡｇ阳性占所检病例９４．１％,相同病例二者同时阳性为６１．８％。１０２例ＰＨＣ中５０例有癌旁肝组织,其Ｃ３３ｃ抗原和ＨＢｘＡｇ的阳性检出率分别是６２％和９２％。ＨＣＶＣ３３ｃ抗原定位于肝癌细胞的胞浆内,胞核未见阳性信号。Ｃ３３ｃ抗原阳性细胞在ＰＨＣ中呈散在、局灶分布为主,在癌旁肝组织呈弥漫分布为主。本文结果提示ＨＣＶ感染在ＰＨＣ的发生中可能起重要作用。     

HCVE2／NS1相对保守区多肽体外诱导慢丙肝患者PBMC增殖反应的研究

为了解ＨＣＶ感染后细胞免疫在其中的作用,对３１例慢丙肝及２０例正常献血员以ＭＴＴ法检测外周血单核细胞（ＰＢＭＣ）对ＨＣＶＥ２／ＮＳ１相对保守区多肽抗原及Ｃ２２、ＮＳ５的增殖反应。结果表明与正常人相比,慢性丙型肝炎患者ＰＢＭＣ对ＨＣＶＣ２２、Ｅ２／ＮＳ１抗原有明显的增殖反应（Ｐ＜００５）,而对ＮＳ５无明显增殖,其中以Ｃ２２抗原性最强。作者认为慢性丙型肝炎患者存在针对与ＨＣＶ相关抗原的细胞免疫,这种细胞免疫不能消除ＨＣＶ感染,而且与疾病的状态无关。     

丙肝病毒IgM抗体检测方法的初步研究

选择东燃公司的重组结构区和非结构区抗原建立的抗ＨＣＶ－ＩｇＭ检测方法,简便、快速、特异性强、重复性好、敏感性高。只在丙肝病人组检出而健康献血员均为阴性,与抗ＨＡＶ、ＨＢＶ的ＩｇＭ抗体无交叉反应,且排除了ＲＦ干扰和ＩｇＧ占位引起的假阳性和假阴性,适用于抗ＨＣＶ－ＩｇＭ的临床检测。对２４例丙肝病人的抗ＨＣＶ－ＩｇＭ检测结果显示,急性丙肝病人血清抗ＨＣＶ－ＩｇＭ检出率较高（７５％,６／８）,且随ＡＬＴ正常而消失或滴度下降。慢性病人抗ＨＣＶ－ＩｇＭ检出率为５６．３％（９／１６）,其中７例ＩｇＭ持续阳性者为慢性活动性丙肝,说明慢性病人抗ＨＣＶ－ＩｇＭ与疾病的活动性密切相关。结果提示抗ＨＣＶ－ＩｇＭ的检测在急性肝炎的诊断及慢性丙肝的预后和转归上具有临床意义。     

从病人外周血单个核细胞中检测HHV—6：分离培养和基因扩增

收集婴幼儿急疹及淋巴系统增生性疾病患者外周血单个核细胞进行体外培养,从７例婴幼儿急疹及２例淋巴系统增生性疾病患者中分离出一种病毒,此病毒能在ＰＨＡ激活的人脐血单个核细胞中传代生长,产生典型ＣＰＥ：形成气球样巨细胞。电镜下观察,感染细胞中可见直径１８０ｎｍ左右,有包膜,疱疹样病毒颗粒;血清学试验证明分离株与ＨＳＶ－１,２、ＨＣＭＶ、及ＥＢＶ无抗原交叉,而与ＨＨＶ－６ＧＳ株间存在抗原一致性;多聚酶链反     

血清中乙肝病毒-前S2蛋白检测的临床价值

采用双抗体夹心法对１０８例血清标本进行了乙肝病毒—前Ｓ２蛋白（ＨＢＶ—前Ｓ２蛋白）检测（其中“大三阳”者４８例,“小三阳”者４０例,正常健康对照２０例）。结果显示：４８例“大三阳”者中,前Ｓ２蛋白阳性者４５例,阳性率为９３８％（４５／４８）;４０例“小三阳”者中,前Ｓ２蛋白阳性者２１例,阳性率５２５％（２１／４０）;２０例正常健康对照中无一例阳性。本次结果表明：血清ＨＢＶ—前Ｓ２蛋白在“大三阳”和“小三阳”中的检出率明显不同,二者存在着非常显著的差异（Ｐ＜００５）。同时,本次结果还显示：血清前Ｓ２蛋白阳性与血清抗ＨＢＶ—ＩｇＭ阳性及ＡＬＴ升高密切相关。提示：前Ｓ２蛋白可作为ＨＢＶ复制的一个新指标,并可作为临床对乙肝病人进行诊断、观察复制情况、判断传染性强弱、评价治疗效果、判断预后的一项常规指标。     

用人工合成的丁型肝炎病毒抗原多肽检测丁肝病毒IgM抗体及其初步应用

用人工合成的丁型肝炎病毒抗原（ＨＤＶ－Ａｇ）肽建立了检测抗ＨＤＶ－ＩｇＭ抗体的ＥＬＩＳＡ方法,本法操作简便、快速,重复性好,特异性强,与抗ＨＡＶ－ＩｇＭ、抗Ｈｋ－ＩｇＭ、抗ＨＢｓ－ＩｇＭ、抗ＨＣＶ－ＩｇＩ、抗ＣＭＶ－ＩｇＭ、抗ＲＶ－ＩｇＭ、类风湿因子（ＲＦ）及抗核抗体（ＡＮＡ）阳性血清均不起反应,且可被２－巯基乙醇阻断而不起反应。经初步临床应用,３１例正常人血清抗ＨＤＶ－ＩｇＭ全部阴性,２８例慢活肝患者检出率为３２．１％（９／２８）,１７例慢迁肝患者血清阳性率为１１．８％（２／１７）１８例肝癌和肝硬化病人血清阳性率为２２．２％（４／１８）这三组病人与正常对照者相比较均有显著性差异（Ｐ＜０．００１）。此外,抗ＨＤＶ－ＩｇＭ阳性血清的ＡＬＴ值均明显高于正常参考范围,提示在ＨＤＶ感染过程中,患者肝细胞进一步受损。实验结果证明,抗ＨＤＶ－ＩｇＭ是诊断ＨＤＶ感染的重要指标,对ＨＤＶ感染早期诊断具有重要价值。     

饲喂黄曲霉毒素B_1大鼠肝中AFB_1-DNA加合物的免疫组织化学研究

应用免疫组织化学ＳＰ法对４例饲喂黄曲霉毒素Ｂ１的Ｗｉｓｔａｒ大鼠肝组织中ＡＦＢ１－ＤＮＡ加合物的染色及常规ＨＥ染色发现,４例肝细胞核均出现异型性,但未见肝细胞坏死、增生灶及肝细胞癌;免疫组化揭示部分肝细胞核出现棕黄色、不均质状的ＡＦＢ１－ＤＮＡ加合物,阳性细胞数占１０～８５％。结果提示免疫组织化学方法可作为一种ＡＦＢ１的定位方法,ＡＦＢ１在动物致癌过程中ＡＦＢ１－ＤＮＡ加合物可能具有启动作用     

The usefulness of c-Kit in the immunohistochemical assessment of melanocytic lesions

C-Kit (CD117), the receptor for the stem cell factor, a growth factor for melanocyte migration and proliferation, has shown differential immunostaining in various benign and malignant melanocytic lesions. The purpose of this study is to compare c-Kit immunostaining in benign nevi and in primary and metastatic malignant melanomas, to determine whether c-Kit can aid in the differential diagnosis of these lesions. c-Kit immunostaining was performed in 60 cases of pigmented lesions, including 39 benign nevi (5 blue nevi, 5 intradermal nevi, 3 junctional nevi, 15 cases of primary compound nevus, 11 cases of Spitz nevus), 18 cases of primary malignant melanoma and 3 cases of metastatic melanoma. The vast majority of nevi and melanomas examined in this study were positive for c-Kit, with minimal differences between benign and malignant lesions. C-Kit cytoplasmatic immunoreactivity in the intraepidermal proliferating nevus cells, was detected in benign pigmented lesions as well as in malignant melanoma, increasing with the age of patients (P=0.007) in both groups. The patient's age at presentation appeared to be the variable able to cluster benign and malignant pigmented lesions. The percentage of c-Kit positive intraepidermal nevus cells was better associated with age despite other variables (P=0.014). The intensity and percentage of c-Kit positivity in the proliferating nevus cells in the dermis was significantly increased in malignant melanocytic lesions (P=0.015 and P=0.008) compared to benign lesions (compound melanocytic nevi, Spitz nevi, intradermal nevi, blue nevi). Immunostaning for c-Kit in metastatic melanomas was negative. Interestingly in two cases of melanoma occurring on a pre-existent nevus, the melanoma tumor cells showed strong cytoplasmatic and membranous positivity for c-kit, in contrast with the absence of any immunoreactivity in pre-existent intradermal nevus cells. C-Kit does not appear to be a strong immunohistochemical marker for distinguishing melanoma from melanocytic nevi, if we consider c-Kit expression in intraepidermal proliferating cells. The c-Kit expression in proliferating melanocytes in the dermis could help in the differential diagnosis between a superficial spreading melanoma (with dermis invasion) and a compound nevus or an intradermal nevus. Finally, c-Kit could be a good diagnostic tool for distinguishing benign compound nevi from malignant melanocytic lesions with dermis invasion and to differentiate metastatic melanoma from primary melanoma.     

Comparative Histopathology of Grey‐Horse‐Melanoma and Human Malignant Melanoma

Equine melanoma shows striking features particularly with regard to clinical development in grey horses: in contrast to malignant melanoma in humans and in solid coloured horses that are characterized by early onset of metastasis, pigment cell tumours display almost benign clinical features in ageing grey horses. Through evolution, grey horses appear to be in a favourable position in regard to the biological behaviour of melanomas. Yet unknown factors inhibiting or retarding early melanoma metastasis may be responsible for this phenomenon. In this study, immunostaining profiles and histopathologic patterns of equine vs. human melanotic tumours were compared. In addition, the expression of melanoma markers currently used in human melanoma detection and characterization were evaluated for their applicability in equine melanoma diagnosis. Immunohistopathologic investigations revealed that benign grey horse melanomas share common features with human blue nevi and with human malignant desmoplastic melanomas, whereas their resemblance to other types of human cutaneous malignant melanomas is less pronounced. Our data equally underline that S‐100, proliferating cell nuclear antigen (PCNA), HMB‐45, Ki‐67, T‐311 and CD44 can serve as reliable markers for horse melanomas. Further investigations aiming at identifying factors retarding metastasis in affected grey horses are needed, as they may contribute to the development of novel treatment strategies for human malignant melanoma.     

Anti-melanoma monoclonal antibody HMB45 identifies an oncofetal glycoconjugate associated with immature melanosomes.

The anti-melanoma monoclonal antibody HMB45 is widely used in diagnostic pathology owing to its great specificity and sensitivity in identifying pigmented tumors such as malignant melanoma. However, little is known regarding the nature of the antigen(s) recognized by this antibody. In the observations reported here, the HMB45-defined antigen was identified in another pigmented tissue, the retinal pigment epithelium (RPE). A series of immunocytochemical studies demonstrated transient reactivity of the prenatal and infantile human RPE with antibody HMB45; adult RPE is non-reactive with the antibody. By immunoelectron microscopy, the antibody was demonstrated to react with immature melanosomes. Pre-treatment of deparaffinized tissue sections with neuraminidase completely eliminated HMB45 immunoreactivity, suggesting that the antigen(s) recognized is a sialated glycoconjugate. Mannosidase or N-acetylglucosaminidase pre-treatment had no effect on immunoreactivity. Thus, HMB45 may identify an oncofetal antigen present in cutaneous melanocytes, RPE, and melanoma cells, and changes in immunoreactivity with maturation or malignant transformation may be a function of post-translational modification.     

Comparison of immunohistochemical labelling of melanocyte differentiation antibodies melan-A, tyrosinase and HMB 45 with NKIC3 and S100 protein in the evaluation of benign naevi and malignant melanoma

A panel of three melanocyte differentiation antibodies has been compared with anti-S100 protein and NKIC3 in an assessment of benign and malignant melanocytic lesions.Anti-polyclonal S100 protein labelled all cases of primary cutaneous malignant melanoma, metastatic melanoma, desmoplastic melanoma and myxoid melanomas. In addition all benign and dysplastic naevi were positive. Conversely, HMB 45 was the least sensitive marker, labelling 24/31 primary cutaneous melanomas, 14/24 metastatic melanomas and only 1/6 desmoplastic melanomas. In the case of naevi, only junctional forms labelled consistently. Results for anti-melan-A and anti-tyrosinase were similar, although anti-tyrosinase proved slightly more sensitive in cases of malignant melanoma. NKIC3 revealed similar results to anti-tyrosinase, but had the disadvantage of reduced selectivity.It is concluded that anti-tyrosinase and anti-melan-A are useful additions to the panel of melanocytic monoclonal antibodies. In addition, both antibodies appear to have greater sensitivity for malignant melanoma than the conventionally used HMB 45 and could be considered as supportive markers to polyclonal anti-S100 protein in the diagnosis of malignant melanoma.     

Protein S-100 immunostaining as a diagnostic tool for DMBA-induced melanotic lesions

In the present study we demonstrate immunohistochemically the presence of S-100 protein in numerous melanotic and amelanotic lesions (benign, premalignant and malignant) induced in albino guinea-pigs on topical application of the carcinogen. Positive staining was also present in all their amelanotic metastases. We reiterate the value of this stain in the diagnosis of melanomas, in particular amelanotic melanomas.     

HMB-45 staining for cytology of primary melanoma of the vagina. A case report

BACKGROUND: Malignant melanoma in the vagina is very rare, but its diagnosis is usually easy if a melanin pigment is present. With cytodiagnosis, however, it is difficult to differentiate amelanotic melanoma or scantily pigmented melanoma from other conditions. In the present case, monoclonal antibody HMB-45, the efficacy of which has been established in histologic studies, was used in the cytodiagnosis of amelanotic melanoma in the vagina. CASE: A woman, aged 78 years, presented with a brownish, nodular tumor, diameter 3 cm, in the vagina. Scraping smears with Papanicolaou staining showed nonepithelial malignant cells without granules suggesting melanin. Smears stained with HMB-45 showed positive immunoreactivity. The diagnosis underwent histologic confirmation of amelanotic melanoma on the initial biopsy. CONCLUSION: Cytodiagnosis was made with HMB-45, which proved very effective in the differential cytodiagnosis of amelanotic melanoma and scantily pigmented melanoma, particularly because it obviated the need for tissue invasion.     

Melanoma metastatic to the breast: utility of fine needle aspiration and immunohistochemistry

OBJECTIVE: To describe the morphologic spectrum of metastatic malignant melanoma (MM) cells involving the breast and to explore the diagnostic utility of HMB45, Mart-1, Melan-A and T311 (antityrosinase) antibodies in fine needle aspiration material of MM metastatic to the breast. STUDY DESIGN: Cytologic material from 21 cases (18 women) was reviewed for cytomorphology (epithelioid, spindled, mixed) and immunocytochemical staining attributes for Mart-1, HMB45, T311, Melan-A and cytokeratin based on tissue availability. RESULTS: Seventeen cases (81%) demonstrated epithelioid cell morphology, with 14% exhibiting mixed and 5% spindled morphologies. All 21 cases (100%) were immunoreactive with Mart-1 antibody, with 81% (17/21) immunoreactive for HMB45. In 38% of cases there was a similar percentage of cells immunoreactive for Mart-1 and HMB45, while 48% showed a higher percentage of cells immunoreactive for MART-1 than HMB45. Immunoreactivity with T311 was seen in 8 of 11 cases tested (73%). All six cases tested (100%) were immunoreactive with Melan-A. Staining for cytokeratin was negative in all eight cases tested. CONCLUSION: Because the majority of MM metastatic to the breast shows epithelioid cell morphology, it may mimic primary breast carcinoma. Mart-1 should be part of the immunocytochemical panel utilized to confirm the diagnosis of MM metastatic to the breast.     

23例鼻腔鼻旁窦恶性黑色素瘤临床病理分析

目的研究鼻腔鼻旁窦恶性黑色素瘤的临床及病理特征。方法采用免疫组化SP方法对23例鼻腔鼻旁窦恶性黑色素瘤的临床及病理进行分析。结果23例鼻腔鼻旁窦恶性黑色素瘤中,男性15例（65．2％）,女性8例（34．8％）;最大年龄80岁,最小年龄45岁,平均年龄57岁;位于鼻腔19例（82．6％）,鼻旁窦4例（17．4％）,临床表现全部为鼻肿物;病理组织学类型,小圆细胞型12例（52．2％）,上皮样细胞型8例（34．8％）,梭形细胞型2例（8．7％）,多形性细型胞1例（4．3％）;含有黑色素13例（56．5％）,无黑色素10例（43．5％）;免疫组化染色,Vimentin,23例全部呈阳性反应,阳性率为100％,S—100和HMB45呈阳性反应的部为21例;阳性率都为91．3％,MelanA 19例呈阳性反应,阳性率占82．6％。结论23例鼻腔鼻窦恶性黑色素瘤,临床主要表现为鼻肿物,发病部位大多数在鼻腔,联合应用S-100,HMB45和Melan A弥漫阳性在与其组织学相似的肿瘤鉴别中是诊断鼻腔鼻窦恶性黑色素瘤的重要标准。     

Sensitivity and positive predictive values of presurgical clinical diagnosis of excised benign and malignant skin tumors: a prospective study of 835 lesions in 778 patients.

This article reports on the sensitivity and positive predictive value of clinical diagnosis of benign and malignant skin tumors by expert plastic surgeons in an Israeli clinic. Most published reports have focused on the sensitivity of clinicians' diagnoses, a general measure of the physician's skill that does not predict the rate of accuracy of a physician's diagnoses. Our study of 835 lesions in 778 patients, one of the largest Israeli series, assesses the clinical diagnosis of malignant and benign skin tumors and is one of the few that provide information on the positive predictive value, the measure that is of interest to both physicians and patients. The majority of tumors were benign (56.8 percent), 31.6 percent were malignant, and 11.6 percent were premalignant. Among the 474 benign lesions, 46 percent were nevi. The most common nevi subclass was compound nevi (53 percent), 9 percent of the nevi were dysplastic, and 5 percent were blue nevi. The most common malignant tumor was basal cell carcinoma, accounting for 78 percent of malignant tumors.Although sensitivity for clinical diagnosis of malignancy was 91.3 percent, the positive predictive value for clinical diagnosis of malignancy was 71.3 percent. The sensitivity rate for clinically diagnosing premalignant tumors was 42.3 percent, whereas the positive predictive value for these diagnoses was higher (64.1 percent). The sensitivity rate for diagnosis of all benign lesions was 85.9 percent, and the positive predictive value was 94.2 percent. The sensitivity rate for diagnosis of all nevi was 87.6 percent, and the positive predictive value was 85.7 percent: i.e., only seven of the 218 pathologically proven diagnoses of nevi (3.2 percent) were falsely diagnosed as malignant lesions. Even more interestingly, five of the 223 clinical diagnoses of nevi (2.2 percent) were pathologically proven to be malignant melanomas, and seven were found to be premalignant lesions (3.1 percent). It was concluded that publications which report only on the sensitivity neglect to provide information of interest regarding the positive predictive value. Often, positive predictive value is qualitatively different from the sensitivity, and thus relying only on the sensitivity may lead to incorrect evaluation of a clinical judgment, which may result in erroneous surgical decisions.