乳腺癌切除标本内导管内增生性病变的免疫表型观察  

Immunophenotypes of intraductal proliferative lesions in resected specimen of breast carcinoma

作　　者：陈婷婷[1] 孟刚[1] 龚西騟[1] 

机构地区：[1]安徽医科大学病理学教研室,合肥230032

出　　处：《临床与实验病理学杂志》2006年第1期11-18,共8页Chinese Journal of Clinical and Experimental Pathology

基　　金：安徽医科大学博士专项基金

摘　　要：目的探讨乳腺癌切除标本内导管内增生性病变的形态和免疫表型特点及其与浸润癌的关系。方法筛选出浸润性导管癌切除标本内有较多癌旁组织的病例36例和同期乳腺良性病变28例(对照组),选用CK5、CK34βE12、S100蛋白、SMA、CK8、Ecad、cerbB2等7种抗体做免疫组化染色。结果乳癌组36例中28例伴导管内增生性病变,单纯或复合出现的病变包括:普通性导管增生7例,柱状细胞病变12例,不典型导管增生4例,导管原位癌24例,伴两种以上病变者10例,4种病变同时存在者2例。对照组中计普通性导管增生23例,柱状细胞病变9例。免疫组化提示CK5在旺炽型UDH中腺系上皮细胞有大量表达,不典型导管增生、导管原位癌及浸润性导管癌中其表达明显降低直至完全失表达;CK34βE12表达类似于CK5,但较CK5为强,二者并不完全重合;S100蛋白表达于肌上皮细胞和增生的腺系上皮细胞,其在UDH的腺系上皮中的表达近似于CK34βE12,却不表达SMA;在24例高级DCIS中,11例肌上皮对S100蛋白的反应性先消失,但对SMA仍呈强反应;Ecad在导管原位癌、浸润性导管癌中出现再表达和(或)阳性等级升高;cerbB2在高级DCIS和IDC中呈清晰的膜表达。结论77.87%浸润性导管癌伴有不同的导管内增生性病变,这些病变不仅形态学表现不同,且免疫表型有异,可据此协助诊断与鉴别诊断。仅据对活检诊断的导管内增生性病变患者长期随访而得出的后来发生浸润性乳腺癌危险度的结论,与当初诊断的病变并无直接相关,而更可能与当初残留或后来发生的导管内增生性病变有关。Purpose To explore the morphologic and immunophenotypic characteristics of intraductal proliferative lesions in resected specimen of breast carcinoma and their correlation with invasive carcinoma. Methods 36 cases of breast carcinoma with much tissues beside the carcinoma in resected specimen and 26 cases of benign lesions in breast were randomly selected at the same period. Expression was detected by immunohistochemical staining using antibodies to CKS, CK34βE12, S-100 protein, SMA, CK8, E-cad and c- erbB-2. Results Among the 36 cases in the group of breast carcinoma, 28 cases had intraductal proliferative lesions, separate or multiple, including 7 cases of UDH, 12 cases of CCC, 4 cases of ADH ,24 cases of DCIS, 10 cases with the lesions more than two, 2 cases with all four lesions ; 23 cases of UDH and 9 CCCs were contained in the control group. Immunohistochemical staining showed that CK5 was much expressed in glandular epithelial cells of florid UDH, and the expression decreased obviously to lost completely in ADH, DCIS and IDC. CK34βE12 expression was alike to CKS, but strongly than CKS, and both of them did not overlap completely. S-100 protein expressed in myoepithelial cells and proliferating glandular epithelial cells, which was alike to CK34βE12, but was negative for SMA. The myoepithelial ceils were lost in reactivity to S-100 protein in 11 of 24 cases of DCIS of grade III, but kept strong positive for SMA. E-cad reappeared in DCIS and IDC, and/or the positive grades ascended, c-erbB-2 expressed clearly at membrane in DCIS of grade Ⅲ and IDC. Conclusions 77. 87% IDC accompanies various intraductal proliferative lesions. Not only the morphologic changes but also immunophenotypic characteristics are different in the lesions, and the diagnosis and differential diagnosis may be made based on the above characteristics. The fact of the risk for subsequent development of invasive breast cancer from long-term follow-up studies in patients with intraductal proliferative lesions that are only treated by bio

关 键 词：乳腺肿瘤 导管内增生性病变 免疫组织化学 

分 类 号：R737.9[医药卫生—肿瘤]