Andrew M. Bellizzi, MD (USCAP 2025)
Clinical Professor of Pathology
Director of GI Pathology
Co-Director of Immunopathology Laboratory
Department of Pathology
Carver College of Medicine
University of lowa
免疫组化染色套餐（Panel）
CK7、CK20、CDX2、TTF1
GATA3（女性）
CK20/CDX2阳性，且染色强度一致/均匀（homogeneous）
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提示来源于下消化道（空肠、回肠、结直肠）
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建议加做：SATB2、错配修复蛋白（MLH1、PMS2、MSH2、MSH6）
CK20/CDX2阳性，且染色强度不均匀/异质性（heterogeneous）
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提示来源于上消化道（食管、胃、十二指肠）及胰胆管
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建议加做：SMAD4/DPC4、BAP1、Albumin原位杂交、HER2、错配修复蛋白（MLH1、PMS2、MSH2、MSH6）
TTF1阳性
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肺腺癌
GATA3阳性
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乳腺癌
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建议加做：ER、PR、HER2
仅CK7阳性，建议加做：
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NapsinA：排除肺腺癌
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PAX8、SOX17：排除苗勒氏管腺癌
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SOX10、TRPS1：排除三阴型乳腺癌
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CDH17：排除消化道/胰胆管腺癌
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SMAD4：排除胰胆管腺癌
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Albumin原位杂交、BAP1：排除肝内胆管癌
CK7/CK20阴性（双阴性），建议加做：
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HepPar1、GPC3、ARG1：排除肝细胞癌
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Albumin原位杂交：排除肝细胞癌和肝内胆管癌
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SF1：排除肾上腺皮质癌
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PSA、NKX3.1：排除前列腺腺癌
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根据实际情况可以选择更多的免疫组化染色
Loss of SMAD4/DPC4 seen in approximately 55% of pancreatic ductal adenocarcinomas.
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约55%胰腺导管腺癌出现SMAD4/DPC4免疫组化表达缺失
Negative staining for BAP1 (defined as completely absent nuclear staining in the presence of positive internal controls in nonneoplastic cells) occurred in 55 ICCs (26%).
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26%肝内胆管癌（iCC）出现BAP1免疫组化表达缺失
All ICC with BAP1 loss corresponded to small-duct type ICC.
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BAP1表达缺失的所有肝内胆管癌均为小胆管型iCC
Albumin RNA in situ hybridization was positive in 71% of SD and 18% of LD.
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Albumin（白蛋白）原位杂交阳性见于71%小胆管型肝内胆管癌和18%大胆管型肝内胆管癌
Albumin RNA ISH does not differentiate iCC from hepatocellular carcinoma.
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Albumin（白蛋白）原位杂交无法鉴别“肝内胆管癌”与“肝细胞癌”
CDH17 is a specific and more sensitive marker in the gastrointestinal tract than CK20 and CDX2.
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CDH17是一种特异的且敏感性高于CK20和CDX2的胃肠道腺癌标记物