Damiani S, Ludvikova M, Tomasic G, Bianchi S, Gown A M, Eusebi V
Department of Oncology, University of Bologna, Italy.
Virchows Arch. 1999 Mar;434(3):227-34. doi: 10.1007/s004280050332.
A retrospective study was made of 38 selected brest tumours with a poorly differentiated in situ duct component. These were classified on haematoxylin and eosin (H&E) as ductal carcinoma in situ (DCIS; 10 cases), DCIS with invasion (17 cases) and DCIS with features suggestive of for stromal invasion (11 cases). The last were these lesions composed of neoplastic ducts with irregular outlines and a myoepithelial layer that was not clearly evident or large neoplastic ducts growing close together or surrounded by inflammatory desmoplastic stroma. Cases of DCIS involving areas of sclerosing adenosis were included in this category. Consecutive sections obtained from each case were studied with a panel of antibodies against myoepithelial cells (alpha smooth muscle actin and calponin) and basal lamina (BL) components (laminin and type IV collagen). It was found that in situ lesions showed well-formed basal lamina and/or an evident myoepithelial layer. These features were lacking in the invasive areas. Nine of the 11 cases with suggestive features of stromal invasion were reclassified as invasive duct carcinoma (5 cases)and DCIS (4 cases), according to the absence or presence of a continuous myoepithelial layer and/or basal lamina. In 2 such cases immunohistochemistry yielded equivocal results and the label "suggestive of invasion" was therefore pertinent. Immunohistochemistry facilitates the diagnosis of breast DCIS; myoepithelial and basal lamina markers are useful in differentiating microinvasive from in situ ductal carcinomas of the breast.
对38例具有低分化原位导管成分的精选乳腺肿瘤进行了回顾性研究。这些肿瘤在苏木精和伊红（H&E）染色下被分类为原位导管癌（DCIS；10例）、伴有浸润的DCIS（17例）和具有提示间质浸润特征的DCIS（11例）。最后一组病变由轮廓不规则且肌上皮层不明显的肿瘤性导管组成，或者由紧密相邻生长或被炎性促纤维增生性间质包围的大肿瘤性导管组成。累及硬化性腺病区域的DCIS病例也包括在这一类中。从每个病例获取的连续切片用一组针对肌上皮细胞（α平滑肌肌动蛋白和钙调蛋白）和基底膜（BL）成分（层粘连蛋白和IV型胶原）的抗体进行研究。结果发现，原位病变显示基底膜形成良好和/或肌上皮层明显。这些特征在浸润区域缺乏。根据连续肌上皮层和/或基底膜的有无，11例具有间质浸润提示特征的病例中有9例被重新分类为浸润性导管癌（5例）和DCIS（4例）。在2例此类病例中，免疫组化结果不明确，因此“提示浸润”这一标签是恰当的。免疫组化有助于乳腺DCIS的诊断；肌上皮和基底膜标志物在区分乳腺微浸润性原位导管癌方面很有用。
