Oyama T, Maluf H, Koerner F
Department of Pathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Fruit Street, Boston, MA, 02114, USA.
Virchows Arch. 1999 Oct;435(4):413-21. doi: 10.1007/s004280050419.
Evidence from many studies has established the neoplastic potential of ductal carcinoma in situ, but the origin and the morphological characteristics of the early stages of this proliferation remain unidentified. Workers writing in the early twentieth century observed a cystic transformation of lobules and proposed that it represented one such early stage, and contemporary European and Japanese pathologists have reached the same conclusion. We describe the characteristics of this cystic transformation, which we call us "atypical cystic lobules," and present evidence to support the proposal that the alteration is a step in the formation of low-grade ductal carcinoma in situ. Atypical cystic lobules are a proliferation of luminal cells showing low-grade cytological atypia without architectural atypia. The study group comprised 21 cases of atypical cystic lobules from specimens also showing conventional low-grade ductal carcinoma in situ or lobular neoplasia. Immunohistochemical staining for hormone receptors, keratin 19, and cyclin D1 revealed that atypical cystic lobules demonstrated a consistent immunophenotype, which differs from the pattern shown by normal lobules and benign lesions and matches that of low-grade ductal carcinoma in situ. In about 40% of the cases, atypical cystic lobules merged with fully established micropapillary/cribriform ductal carcinoma in situ. The similarities in the cytological and immunohistochemical features and the proximity of the two types of proliferation suggest that atypical cystic lobules represent an early stage in the formation of certain types of low-grade ductal carcinoma in situ.
许多研究的证据已证实导管原位癌具有肿瘤形成潜能，但这种增殖早期阶段的起源和形态特征仍不明晰。二十世纪初的研究者观察到小叶的囊性转化，并提出这代表了这样一个早期阶段，当代欧洲和日本的病理学家也得出了相同结论。我们描述了这种囊性转化的特征，我们将其称为“非典型性囊性小叶”，并提供证据支持该改变是低级别导管原位癌形成过程中的一个步骤这一观点。非典型性囊性小叶是一种管腔细胞的增殖，表现为低级别细胞学非典型性，而无结构异型性。研究组包括21例非典型性囊性小叶病例，其标本中还显示有传统的低级别导管原位癌或小叶肿瘤。对激素受体、细胞角蛋白19和细胞周期蛋白D1进行免疫组化染色显示，非典型性囊性小叶呈现出一致的免疫表型，这与正常小叶和良性病变所显示的模式不同，而与低级别导管原位癌的模式相符。在约40%的病例中，非典型性囊性小叶与完全形成的微乳头/筛状导管原位癌融合。细胞学和免疫组化特征的相似性以及这两种增殖类型的相近性表明，非典型性囊性小叶代表了某些类型低级别导管原位癌形成的早期阶段。
