Pleural, pericardial and ascitic fluid cell morphology

 

1. ü°­ÀÇ ÇØºÎÇÐÀû ±¸Á¶¿Í ¿©Ãâ¾×

   È丷°­(pleural cavity)Àº Æó¿Í Ç÷°üÀ» ½Î°í ÀÖ´Â È丷(visceral pleura)°ú °¡½¿º®À» ½Î´Â È丷(parietal pleura) »çÀÌ¿¡ ÀÖ´Â ¼Ò·®ÀÇ Àå¾×¼º ¾×ü¸¦ °¡Áø ±¸Á¶·Î µÇ¾î ÀÖ°í À̵é È丷Àº ÇÑÃþÀÇ ÁßÇǼ¼Æ÷(mesothelial cell)·Î µ¤ÇôÀÖ´Ù. ½É¸·°­(pericardial cavity)Àº ½ÉÀåÀ» ½Î°í ÀÖ´Â 2°ãÀÇ À帷 »çÀÌ¿¡ ¼Ò·®ÀÇ Àå¾×À» ´ãÀº ±¸Á¶·Î ½É±ÙÀÇ ¼öÃà°ú ÀÌ¿ÏÀ» ¿ëÀÌÇÏ°Ô ÇÑ´Ù. º¹¸·°­(peritoneal cavity) ¿ª½Ã ³»Àå, °ñ¹Ý ¹× º¹º®À» °ÉÃÄ µ¤ÇôÁø À帷 »çÀÌ¿¡ ¼Ò·®ÀÇ Àå¾×À» ÇÔÀ¯Çϰí ÀÖ´Â ±¸Á¶·Î Àå±âÀÇ ¿øÇÒÇÑ ¿òÁ÷ÀÓÀ» µ½´Â´Ù.

   ¿©·¯ º´ÀûÀÎ ÀÌÀ¯·Î À̵é ü°­³» ¾×ü°¡ Áõ°¡ÇÏ´Â °ÍÀ» À¯Ãâ(effusion)À̶ó°í Çϸç ÀÌ´Â ´ÙÀ½ÀÇ µÎ °¡Áö·Î ±¸ºÐÇÒ ¼ö ÀÖ´Ù. ¿©Ãâ¾×(transudate)À̶õ ¸ð¼¼Ç÷°üÀÇ hydrostatic pressure¿Í Ç÷Àå »ïÅõ¾ÐÀÇ º¯È­·Î ÀÎÇØ Ç÷ÀåÀÌ Ã¼°­³»·Î À̵¿ÇÏ¿© »ý¼ºµÇ¸ç ´Ü¹éÁúÀ̳ª lactic dehydrogenaseÀÇ ÇÔÀ¯·®ÀÌ ³·´Ù. »ïÃâ¾×(exudate)À̶õ ¸ð¼¼Ç÷°üÀÇ Åõ°ú¼ºÀÌ Áõ°¡µÇ¾î ¹éÇ÷±¸¿Í ´Ü¹éÁúÀ» ¸¹Àº ÇÔÀ¯ÇÑ Ç÷ÀåÀÌ Ã¼°­³»·Î À̵¿ÇÏ¿© »ý±â´Âµ¥ ÁÖ·Î °¨¿°, ¿°Áõ, â»ó ¹× Á¾¾çÀ¸·Î ÀÎÇØ ¹ß»ýÇÑ´Ù.  

2. °Ëü äÃë ¹× Á¶ÀÛ

   À¯Ãâ¾×Àº Áø´Ü ¶Ç´Â Ä¡·á ¸ñÀûÀ¸·Î ¹Ù´ÃÀ» ÅëÇØ ÀÎÀ§ÀûÀ¸·Î ÀÎü ¹ÛÀ¸·Î »©³»´Âµ¥ À̸¦ ü°­ÃµÂ÷(thoracentesis, pericardiocentesis, paracentesis)¶ó ÇÑ´Ù. ü¾×¼¼Æ÷°Ë»ç¸¦ À§Çؼ­´Â heparin ¶Ç´Â EDTA Ç×ÀÀ°íÁ¦¸¦ »ç¿ëÇÏ¸ç ³ÃÀ庸°üÇϸé 48½Ã°£±îÁö ¼¼Æ÷ÇüŰ¡ º¸Á¸µÈ´Ù. ¼¼Æ÷ °¨º°À» À§ÇÑ slide Á¦ÀÛÀº 20¹è ÀÌ»ó ¼¼Æ÷¸¦ ³óÃàÇÒ ¼ö ÀÖ´Â ¼¼Æ÷¿ø½ÉºÐ¸®(cytocentrifuge) ¹æ¹ýÀÌ wedge smearº¸´Ù ¿ì¼öÇÏ´Ù. ¼¼Æ÷¿ø½ÉºÐ¸®±â »ç¿ëÇÒ ¶§´Â ¼¼Æ÷¼ö°¡ ³Ê¹« ¸¹À¸¸é ¼¼Æ÷µéÀÌ ¹¶Ä¡°í °úµµÇÏ°Ô ¿°»öµÉ ¼ö ÀÖÀ¸¹Ç·Î ÀûÀýÇÑ ¼¼Æ÷¼ö(WBC < 500/uL, RBC < 5,000/uL)°¡ µÇµµ·Ï »ý¸®½Ä¿°¼ö·Î Èñ¼®ÇÏ´Â °ÍÀÌ ÇÊ¿äÇÏ´Ù. Åë»óÀûÀ¸·Î Wright-Giemsa ¿°»öÀ» »ç¿ëÇϸç, ÇÊ¿ä½Ã Papanicolaou ¿°»öÀ̳ª cell blockÀ» Á¦ÀÛÇÒ ¼öµµ ÀÖ´Ù.

3. ü°­¾×¿¡¼­ °üÂûµÇ´Â ¼¼Æ÷

1) ÁßÇǼ¼Æ÷(mesothelial cell)

   Ã¼°­À» ½Î°í ÀÖ´Â ÁßÇǼ¼Æ÷ÃþÀÌ ¿°ÁõÀ¸·Î Áõ½ÄµÇ¸é ÀϺΰ¡ ü°­¾×³»·Î ¶³¾îÁø´Ù. À̵éÀº Å©±â°¡ 15-25 um Á¤µµ·Î µÕ±Û°í Áß¾Ó¿¡ À§Ä¡ÇÑ ÇÙ°ú ÇÙ¼Òü¸¦ °¡Áö¸ç, ¼¼Æ÷ÁúÀº dzºÎÇϰí Ǫ¸£¸ç perinuclear pallor zoneÀÌ º¸À̱⵵ ÇÑ´Ù. ÁßÇǼ¼Æ÷°¡ Áý´ÜÀ¸·Î °üÂûµÉ °æ¿ì ¼¼Æ÷»çÀÌ¿¡ ¾à°£ÀÇ °£°Ý(windows)À» µÎ°í ¹è¿­µÇÁö¸¸, ¶§·Î´Â ÆÇ»ó(flat sheet), À¯µÎ»ó(papillary) ¶Ç´Â 3Â÷¿øÀû µ¢¾î¸®·Î º¸À̱⵵ ÇϹǷΠÀüÀ̾ϰúÀÇ °¨º°ÀÌ ¸Å¿ì °ï¶õÇÒ ¼öµµ ÀÖ´Ù. PAS ¿°»öÀ» ½ÃÇàÇϸé ÁßÇǼ¼Æ÷´Â ¼¼Æ÷¸·¿¡ ¿¬Çؼ­ ¾ç¼º¹ÝÀÀÀ» º¸À̳ª ÀüÀÌ¾Ï Æ¯È÷ ¼±¾ÏÀÇ °æ¿ì ¼¼Æ÷Áú³»¿¡ ¾ç¼º¹ÝÀÀÀ» º¸À̹ǷΠ°¨º°¿¡ µµ¿òÀÌ µÈ´Ù.

   ÁßÇǼ¼Æ÷ÀÇ º¯¼ºÀÌ ÀϾ¸é ÇÙÀÌ ³óÃà(pyknosis), ºØ±«(karyorrhexis)µÇ¸ç ¼¼Æ÷Áú³» ´Ù¾çÇÑ ºÀÀÔü(inclusion)¸¦ °¡Áø´Ù. ¿À·¡ Áö¼ÓµÈ À¯Ãâ¾×¿¡¼­´Â ÁßÇǼ¼Æ÷ÀÇ ¼¼Æ÷Áú³» °øÆ÷µéÀÌ ¼­·Î ºÙ¾î ÇÙÀ» ÇÑÂÊÀ¸·Î ¹Ð¾î³½ ¹ÝÁö¸ð¾ç(signet-ring)ÀÇ ¼¼Æ÷°¡ º¸À̱⵵ ÇÑ´Ù. ÁßÇǼ¼Æ÷´Â Æó·Å, Æó°æ»ö, ¾Ç¼ºÁ¾¾ç µî ´Ù¾çÇÑ ¿øÀÎÀ¸·Î Áõ°¡ÇÏÁö¸¸ °áÇÙ¼º ´Á¸·¿°(tuberculous pleurisy)ÀÇ °æ¿ì´Â ¼¶À¯¼º »ïÃâ¾×(fibrinous exudate)ÀÌ È丷À» µ¤°í ÀÖ¾î ÁßÇǼ¼Æ÷ÀÇ Å»¶ôÀÌ Àß ÀϾÁö ¾Ê´Â´Ù.  

2) Á¶Á÷±¸(histiocyte)

   Á¶Á÷±¸´Â Å©±â°¡ 15-20 um·Î µÕ±Û°Å³ª ¿±»ó, ÄáÆÏ¸ð¾çÀÇ ÁÖ¸§Áø ÇÙ°ú °æ°è°¡ ºÒÈ®½ÇÇÏ°í °øÆ÷°¡ ¸¹Àº ¼¼Æ÷ÁúÀ» °¡Áø´Ù. ´Ü±¸(monocyte)³ª ÁßÇǼ¼Æ÷°¡ Á¶Á÷±¸·Î º¯ÇüµÇ´Â °ÍÀ¸·Î »ý°¢µÇ°í ÀÖÀ¸¸ç ÁßÇǼ¼Æ÷¿Í Á¶Á÷±¸¿ÍÀÇ °¨º°Àº ÀÓ»óÀûÀ¸·Î Áß¿äÇÏÁö ¾Ê´Ù. Á¶Á÷±¸´Â À̹°ÁúÀ» ޽ÄÇÏ´Â ¼ºÁúÀÌ Àִµ¥ ޽ÄÇÑ ¹°Áú¿¡ µû¶ó lipophage(ÁöÁú), neutrophage(Áß¼º±¸), erythrophage(ÀûÇ÷±¸), siderophage(hemosiderin »ö¼Ò)·Î ºÒ¸°´Ù.        

3) ¸²ÇÁ±¸(lymphocyte), ÇüÁú¼¼Æ÷(plasma cell)

   ¼º¼÷¸²ÇÁ±¸°¡ ÁÖ¸¦ ÀÌ·ç¸ç Å©°í dzºÎÇϸç È£¿°¼º ¼¼Æ÷Áú°ú ¶Ñ·ÇÇÑ ÇÙ¼Òü¸¦ °®´Â ¹ÝÀÀ¼º ¸²ÇÁ±¸(reactive lymphocyte)°¡ ¼¼Æ÷ºÐ¿­À» ÇÏ´Â °æ¿ìµµ °üÂûµÉ ¼ö Àִµ¥ ¾Ç¼ºÁ¾¾ç°ú °¨º°ÀÌ ÇÊ¿äÇÏ´Ù. ¸²ÇÁ±¸°¡ ´Ù¸¥ ¿°Áõ¼¼Æ÷ÀÇ È¥ÇÕ¾øÀÌ ´ÜÀϼ¼Æ÷·Î ´Ù·® ³ªÅ¸³ª¸é °áÇÙ, ¾Ç¼º¸²ÇÁÁ¾, ¸²ÇÁ±¸¼º ¹éÇ÷º´À» ÀǽÉÇØ¾ßÇϸç ÀÌ °æ¿ì CD45(leukocyte common antigen) ¿°»öÀÌ µµ¿òÀÌ µÉ ¼ö ÀÖ´Ù.  ÇüÁú¼¼Æ÷´Â ·ù¸¶Ä¡½º¼º°üÀý¿°, ¾Ç¼ºÁ¾¾ç, °áÇÙ ¹× ¸²ÇÁ±¸Áõ´ÙÁõ°ú µ¿¹ÝÇÏ¿© °üÂûµÉ ¼ö ÀÖ´Ù.

4) Áß¼º±¸(neutrophil)

   ¼¼±Õ¼º Æó·Å, Æó°æ»ö, ÃéÀå¿° µîÀ¸·Î È­³ó¼º »ïÃâ¾×ÀÌ ¹ß»ýÇÏ´Â °æ¿ì ´Ù¼öÀÇ Áß¼º±¸°¡ °üÂûµÈ´Ù. »ïÃâ¾×ÀÌ Áö¼ÓµÇ¸é Áß¼º±¸³» °ú¸³ÀÌ ¼Ò½ÇµÇ°í ÇÙÀÌ ³óÃàµÇ¾î À¯ÇÙÀûÇ÷±¸¿Í À¯»çÇÏ°Ô º¸À̱⵵ ÇÑ´Ù.

6) È£»ê±¸(eosinophil), È£¿°±â±¸(basophil), ºñ¸¸¼¼Æ÷(mast cell)

   À¯Ãâ¾×³» È£»ê±¸°¡ Áõ°¡ÇÏ´Â °æ¿ì´Â ±âÈä, ±â»ýÃæ°¨¿°, ¿°Áõ, Æó°æ»ö, ÀÚ°¡¸é¿ªÁúȯ, ¾Ç¼ºÁ¾¾ç µîÀÌ ÀÖ´Ù. È£»ê±¸°¡ Áõ°¡ÇÏ´Â °æ¿ì¿¡ È£¿°±â±¸³ª ºñ¸¸¼¼Æ÷°¡ ÇÔ²² °üÂûµÇ±âµµ ÇÑ´Ù.

7) ±âŸ ºñÁ¾¾ç ¼¼Æ÷

   Ã¼°­¾× õÀڽà ¹Ù´ÃÀÌ ÀÎÁ¢ÇÑ Àå±â¸¦ °üÅëÇßÀ» °æ¿ì ÀÌ»óÇÑ ¸ð¾çÀÇ ºñÁ¾¾ç¼º ¼¼Æ÷¸¦ ¾òÀ» ¼ö ÀÖ´Ù. °£¼¼Æ÷(liver cell)´Â µÕ±Û¸é¼­ °¡¿îµ¥ À§Ä¡ÇÑ ÇÙ°ú dzºÎÇÑ ¼¼Æ÷ÁúÀ» °¡Áø Å« ¼¼Æ÷·Î ´Üµ¶ ¶Ç´Â Áý´ÜÀûÀ¸·Î Á¸ÀçÇÏ¸ç ¼¼Æ÷Áú¿¡ ÀÛÀº Å©±âÀÇ ³ì»öÀ¸·Î ¿°»öµÇ´Â Ư¡ÀûÀÎ ´ãÁóÀÇ Ä§ÂøÀÌ °üÂûµÇ±âµµ ÇÑ´Ù. ±âŸ ³»ÇǼ¼Æ÷(endothelial cell), ÆíÆò»óÇǼ¼Æ÷(squamous epithelial cell), Áö¹æ¼¼Æ÷(fat cell) µîÀÌ °üÂûµÉ ¼öµµ ÀÖ´Ù.

8) ¾Ç¼º¼¼Æ÷(malignant cell)

   ´ëºÎºÐÀÇ ¾Ç¼º¼¼Æ÷´Â Å©±â°¡ Å©°í, ÇÙ/¼¼Æ÷Áú ºñÀ²ÀÌ ³ô°í, ºÒ±ÔÄ¢Çϸ鼭 ³ó¿°µÈ ÇÙ, Å©°í ºÒ±ÔÄ¢ÇÑ ÇÙ¼Òü¿Í ¿Õ¼ºÇÑ ¼¼Æ÷ºÐ¿­À» Ư¡À¸·Î ÇÏÁö¸¸ ¿¹¿Ü°¡ ¸¹´Ù(Table 1). ¼¼Æ÷ÀÇ Å©±â°¡ ÀÛÀº ¾Ç¼ºÁ¾¾çÀ¸·Î´Â ¾Ç¼º¸²ÇÁÁ¾(malignant lymphoma), ½Å°æ¾Æ¼¼Æ÷Á¾(neuroblastoma), Wilms Á¾¾ç, Æó³ª À¯¹æÀÇ ¼Ò¼¼Æ÷¾Ï(small cell carcinoma) µîÀ̸ç, Á¡¾×ºÐºñ¼º ¼±¾Ï(mucin producing adenocarcinoma)¿Í ÆíÆò¼¼Æ÷¾Ï(squamous cell carcinoma)¿¡¼­ ¼¼Æ÷ÁúÀº dzºÎÇÏ´Ù. µå¹°°Ô ¼¼Æ÷ºÐ¿­ÀÌ ÁßÇǼ¼Æ÷³ª Á¶Á÷±¸¿¡¼­µµ ³ªÅ¸³¯ ¼ö ÀÖÀ¸¹Ç·Î ÁÖÀǸ¦ ¿äÇÑ´Ù.

4. ü°­³» ¾Ç¼ºÁ¾¾ç

1) ºÎÀ§º° ÈçÈ÷ ¹ß»ýÇÏ´Â ¾Ç¼ºÁ¾¾ç

   Èä°­ -  ¼ºÀγ²ÀÚ : Æó¾Ï, ¼ÒÈ­±â°è¾Ï, ¾Ç¼º¸²ÇÁÁ¾

           ¼ºÀο©ÀÚ : À¯¹æ¾Ï, Æó¾Ï, ³­¼Ò¾Ï, ¼ÒÈ­±â°è¾Ï, ¾Ç¼º¸²ÇÁÁ¾

   º¹°­ -  ¼ºÀγ²ÀÚ : ¼ÒÈ­±â°è¾Ï, ¾Ç¼º¸²ÇÁÁ¾

           ¼ºÀο©ÀÚ : ³­¼Ò¾Ï, ÀڱþÏ, À¯¹æ¾Ï, ¼ÒÈ­±â°è¾Ï, ¾Ç¼º¸²ÇÁÁ¾

   ¼Ò¾Æ : ¹éÇ÷º´, ¾Ç¼º¸²ÇÁÁ¾, small round cell tumor(neuroblastoma, Wilm's tumor, rhabdomyosarcoma, Ewing's tumor)

2) ¼Ò¼¼Æ÷¾Ï(small cell carcinoma)

   Æó³ª À¯¹æÀÇ ¼Ò¼¼Æ÷¾ÏÀº ªÀº »ç½½ ¶Ç´Â µ¢¾î¸®¸¦ ÀÌ·ç¾î ¹è¿­ÇÏ¸ç ¼¼Æ÷ÀÇ Å©±â°¡ ºñ±³Àû ÀÛ°í(20umÀÌÇÏ), ³ó¿°µÈ ÇÙ°ú Á¢ÇôÁø ÇÙ¸·, ºÒºÐ¸íÇÑ ÇÙ¼Òü, ÀûÀº ¾çÀÇ ¼¼Æ÷ÁúÀ» °¡Áö°í ÀÖ¾î ½Å°æ¾Æ¼¼Æ÷Á¾À̳ª ¸²ÇÁ±¸¼º ¹éÇ÷º´°ú °¨º°À» ¿äÇÑ´Ù. ¶§·Î´Â ÇÙÁÖÀ§·Î blue body¶ó°í ÇÏ¿© º¯¼º ¶Ç´Â Ž½ÄµÈ ¹°ÁúÀÌ º¸À̱⵵ ÇÑ´Ù.   

3) ¼±¾Ï(adenocarcinoma)

   ¼±¾ÏÀº ´Ù¼öÀÇ ¼¼Æ÷Áý´ÜÀ» µ¿¹ÝÇϰí À¯µÎ»ó(papillary) ¶Ç´Â ¼±»ó(glandular) ±¸Á¶¸¦ ÀÌ·ç¸ç, ¼¼Æ÷°¡ Å©°í dzºÎÇÑ ¼¼Æ÷Áú³» Á¡¾×À» °®´Â ¸¹Àº °øÆ÷°¡ °üÂûµÈ´Ù.  

4) ¾Ç¼ºÁßÇÇÁ¾(malignant mesothelioma)

    ¾Ï¼¼Æ÷°¡ Çϳª¾¿ ¶Ç´Â µ¢¾î¸®·Î °üÂûµÇ¸ç ¾ç¼º ÁßÇǼ¼Æ÷¿Í À¯»çÇÑ °ÍºÎÅÍ Å©°í ºÒ±ÔÄ¢ÇÑ ÇÙÀ» °¡Áø °Í±îÁö ´Ù¾çÇÏ°Ô ¼¯¿© ÀÖ¾î ¼±¾Ï°ú °¨º°ÀÌ ÇÊ¿äÇÏ´Ù. ¾Ç¼ºÁßÇÇÁ¾ÀÇ °æ¿ì´Â ¼¼Æ÷Áú³» ÀÛ°í ºÒ±ÔÄ¢ÇÑ Å©±âÀÇ °øÆ÷°¡ ÁÖ·Î ÇÙÁÖÀ§¿¡ À§Ä¡Çϳª ¼±¾Ï¿¡¼­´Â ¼¼Æ÷Áú³» °øÆ÷°¡ ¹«ÀÛÀ§(random)·Î ºÐÆ÷ÇÑ´Ù.  

5) ¾Ç¼º¸²ÇÁÁ¾(malignant lymphoma)

   ¾Ç¼º¸²ÇÁÁ¾ÀÇ ¾ÆÇü¿¡ µû¶ó ¸ð¾çÀÌ ´Ù¾çÇѵ¥ ÀϹÝÀûÀ¸·Î ¼¼Æ÷°¡ Çϳª¾¿ ¶³¾îÁ®ÀÖ°í ¼¼Æ÷¼ÛÀ̸¦ ÀÌ·çÁö ¾Ê¾Æ °íÇü¾Ï°ú °¨º°ÀÌ °¡´ÉÇÏ´Ù. Large cell lymphoma´Â undifferentiated carcinoma¿Í °¨º°ÀÌ ÇÊ¿äÇѵ¥ CD45 ¾ç¼ºÀÎ °æ¿ì ¸²ÇÁÁ¾À¸·Î ½±°Ô °¨º°ÀÌ °¡´ÉÇÏ´Ù. ¹ÝÀÀ¼º ¸²ÇÁ±¸ Áõ°¡¿Í ¾Ç¼º¸²ÇÁÁ¾°úÀÇ °¨º°ÀÌ ¾î·Á¿î °æ¿ì À¯¼¼Æ÷ºÐ¼®±â¸¦ ÀÌ¿ëÇÑ ¸é¿ªÇ¥ÇöÇü °Ë»ç·Î °¨º°ÇÒ ¼ö ÀÖÀ¸¸ç, ¾Ç¼º¸²ÇÁÁ¾ÀÇ ¾ÆÇü±îÁö ºÐ¼®ÇÒ ¼ö ÀÖ´Ù.

6) ±âŸ

   ±âŸ ÆíÆò»óÇǾÏÀ̳ª À°Á¾(sarcoma) µîÀÌ ¹ß°ßµÉ ¼ö ÀÖÀ¸³ª Ư¡ÀûÀÎ ÇüŸ¦ °¡ÁöÁö´Â ¾Ê´Â´Ù. Æó¾Ï¿¡¼­ ÆíÆò»óÇǾÏÀº ´ëºÎºÐ nonkeratinizedÇüÀ¸·Î ¼±¾Ï°ú À¯»çÇÏ¿© °¨º°À» ¿äÇÑ´Ù. À°Á¾Àº ´Ù¾çÇÑ ÇüÅ·Π´ÙÇÙ¼¼Æ÷ ȤÀº ¹æÃßÇü ¸ð¾çÀÇ ¼¼Æ÷µé·Î °üÂûµÈ´Ù.

5. ¸é¿ªÈ­Çп°»ö

   Æ¯¼ö¿°»öÀ¸·Î´Â PAS ¹× mucicarmine ¿°»öÀÌ ÁßÇǼ¼Æ÷¿Í Á¡¾×ºÐºñ¼º ¼±¾Ï °¨º°½Ã À¯¿ëÇÏ°Ô ÀÌ¿ëµÉ ¼ö ÀÖ´Ù. ÁßÇǼ¼Æ÷¿Í ¾Ç¼ºÁ¾¾ç°úÀÇ °¨º°À» µ½±â À§ÇØ ¿©·¯ ´ÜŬ·ÐÇ×üÀÇ À¯¿ë¼ºÀÌ º¸°íµÈ ¹Ù Àִµ¥, epithelial membrane antigen(EMA), Ber-EP4, MOC 31, CEA, CD15 µîÀº ÁßÇǼ¼Æ÷¿¡¼­´Â À½¼ºÀÌ°í ¼±¾Ï¿¡¼­ ÈçÈ÷ ¾ç¼ºÀ» º¸ÀδÙ(Table 2). ÇüÅÂÇÐÀûÀ¸·Î À¯»çÇÑ ¾Ç¼º¸²ÇÁÁ¾°ú Ewing À°Á¾, Ⱦ¹®±ÙÀ°Á¾(rhabdomyosarcoma), Wilms Á¾¾ç, ½Å°æ¾Æ¼¼Æ÷Á¾À» °¨º°Çϱâ À§Çؼ­´Â leukocyte common antigen, EMA, neuron-specific enolase(NSE) ¿°»öÀÌ À¯¿ëÇÏ´Ù(Table 3).

 

 

 

Table 1. Morphological features distinguishing mesothelial cells from malignant cells

Feature

Mesothelial cell

Malignant cells

Cell size

10-20¥ìm

often large, giant

Cell shape

round to oval

aberrant

Nuclear outline

usually smooth

often irregular

Nuclear molding

usually absent

may be present

Nucleoli

usually small

may be large & angulated

Chromatin

even chromatin pattern

variable chromatin pattern

Cytoplasm

basophilic, perinuclear halo

variable


smooth, ruffled membrane

cytoplasmic tags

Cell clumps

single or flat clusters

three-dimensional clumps


clear space between cells(windows)

(tumor balls)

PAS stain

fine granules at periphery

large droplet

Mucicarmine

negative

positive in adenocarcinoma

Multinucleated cells

sparse

may be seen

 

 

Table 2. Immunocytochemical characteristics of malignant cells and mesothelial cells

 

Cytokeratin

Desmin

EMA

MOC31

Ber-EP4

Adenocarcinoma

+

-

+

+

+

Malignant mesothelioma

+

-

+

-

-

Mesothelial cells

+

+

-*

-

-

    * occasionally weakly positive; EMA, epithelial membrane antigen.


 

Table 3. Immunocytochemical markers in small round cell tumors


Keratin

Vimentin

NF

Desmin

Actin

LCA

NSE

Neuroblastoma

-

+

+**

-

-

-

+

Lymphoma

-

+

-

-

-

+

-

Rhabdonmyosarcoma

-

+

-

+

+

-

+/-

Small cell carcinoma

+

-

+/-

-

-

-

+

Ewing's sarcoma

+*

+

-

-

-

-

+/-

Wilms's tumor

+***

+

-

-

-

-

-

     

    *, rare; **, may be seen on frozen sections only; +/-, variable immunoreactivity;

    ***, positive in tubular component; NF, neurofilament; LCA, leukocyte common

    antigen; NSE, neuron-specific enolase.


 

Âü°í¹®Çå

 

    1. Kjeldsberg CR, et al. Body fluids. 3rd ed. Chicago: ASCP press, 1993:159-253.

    2. Mckenzie SB. Textbook of hematology. 2nd ed. Baltimore: Williams & Wilkins, 1996: 453-75.

    3. Naib ZM, et al. Cytopathology. 4th ed. Little, Brown and Company, 1996:279-310.

    4. ´ëÇÑÀÓ»óº´¸®ÇÐȸ. ÀÓ»óº´¸®ÇÐ. 3ÆÇ. °í·ÁÀÇÇÐ, 2001:293-9.

    5. Cornbleet PJ. Wright-Giemsa cytology of body fluids. Lab Med 1998;29:26-31.

    6. Chen LM, et al. The role of conventional cytology, immunocytochemistry, and flow cytometric DNA ploidy in the evaluation of body cavity fluids. Am J Clin Pathol 1998;109:712-21.

 

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