标题：CD34免疫组化染色在高分化肝细胞癌诊断中的意义

      作者：丁莉利，杨丞，陈建娜    (海南医学院病理学教研室，海南 海口 571199)

      卷次： 2018年29卷11期

      【摘要】 目的 探讨CD34染色阳性的微血管分布在高分化肝细胞癌、肝硬化、肝局灶性结节状增生和正常肝组织中的诊断及鉴别诊断的意义。方法 研究对象均来自海南医学院第一附属医院2013年1月至2016年12月经手术切除且诊断明确的标本。应用免疫组织化学方法(EnVision法)对27例高分化肝细胞癌及其癌旁肝硬化组织、10例肝局灶性结节状增生及其病灶旁正常肝组织行CD34抗体标记，分析CD34染色阳性的微血管在高分化肝细胞癌、肝硬化、肝局灶性结节状增生和正常肝组织中的分布。结果 CD34染色阳性的微血管在高分化肝细胞癌中呈弥漫而均匀分布，在肝局灶性结节状增生中呈“地图样”分布，肝硬化和正常肝组织的肝窦内皮细胞CD34染色均呈阴性；CD34染色阳性的微血管在组织中的分布范围，高分化肝细胞癌均>50%、且85.2% (23/27)的高分化肝细胞癌>75%，肝局灶性结节状增生均>25%、且70% (7/10)的肝局灶性结节状增生在26%~50%，肝硬化结节和正常肝组织均≤25%，CD34染色阳性的微血管在高分化肝细胞癌中的分布范围分别与肝局灶性结节状增生、肝硬化结节、正常肝组织的比较差异均有显著统计学意义(P<0.01)。结论 CD34可作为鉴别高分化肝细胞癌与肝硬化结节及肝局灶性结节状增生的有用指标，但CD34染色阳性的微血管在高分化肝细胞癌和肝局灶性结节状增生中的分布有一定交叉性，因此在肝穿刺活检诊断时应审慎判读CD34染色结果。
      【关键词】 肝细胞癌；CD34；免疫组化；诊断；鉴别诊断
      【中图分类号】 R735.7 【文献标识码】 A 【文章编号】 1003—6350（2018）11—1507—03

Diagnostic value of CD34 immunohistochemical staining in well-differentiated hepatocellular carcinoma.DING Li-li, YANG Cheng, CHEN Jian-na.
Department of Pathology, Hainan Medical College, Haikou 571199, Hainan,CHINA
【Abstract】 Objective To investigate the CD34 expression pattern in well-differentiated hepatocellular carci-noma (w-HCC), focal nodular hyperplasia (FNH), liver cirrhosis, normal liver tissues and their clinic significance.Methods The subjects in the study were excised and diagnosed in the First Affiliated Hospital of Hainan MedicalCollege from January 2013 to December 2016. CD34 immunohistochemical staining (EnVision) was used to detect thedistribution of microvessels in 27 cases of w-HCC and its adjacent cirrhosis tissues and 10 cases of FNH and its adja-cent normal liver tissues. Results Of CD34 stained microvessel distribution pattern, w-HCC showed a diffuse anduniform distribution, and FNH showed a“map like”distribution. The CD34 staining of hepatic sinusoidal endothelialcells in liver cirrhosis and normal liver tissue was negative. Of CD34 stained microvessel distribution range, w-HCCwas more than 50% and 85.2% (23/27) of w-HCC was more than 75%, with FNH more than 25%, 70% (7/10) of FNHin 26%-50%, and liver cirrhosis and normal liver tissues less than 25%. The distribution of CD34 stained microves-sels in w-HCC was significantly different from those in FNH, cirrhosis nodules and normal liver tissues (P<0.01).Conclusion CD34 could be used as a valuable auxiliary diagnostic marker for the differentiation among w-HCC, FNHand liver cirrhosis. The distribution of CD34 stained microvessels in w-HCC and FNH is overlapped, and the results ofCD34 staining in liver biopsy should be carefully interpreted.
      【Key words】 Hepatocellular carcinoma; CD34; Immunohistochemistry; Diagnosis; Differential diagnosis·论 著·doi:10.3969/j.issn.1003-6350.2018.11.008