Troxell Megan L, Masek Marilyn, Sibley Richard K
Department of Pathology, Stanford University Medical Center, Stanford, CA 94305, USA.
Appl Immunohistochem Mol Morphol. 2007 Jun;15(2):145-53. doi: 10.1097/01.pai.0000210420.45869.f4.
The separation of ductal papilloma from intraductal papillary carcinoma of the breast on hematoxylin and eosin stained sections often presents diagnostic difficulty. Immunohistochemical staining is often employed in diagnosis, historically with smooth muscle actin (SMA). In this study, the staining characteristics of a panel of myoepithelial markers (calponin, p63, P-cadherin), were compared with SMA, and the epithelial expression of CD44s was assessed in 99 papillary lesions. SMA, calponin, and p63 demonstrated myoepithelial cells in 61%, 63%, and 65% of papillary lesions, respectively. However, specificity was quite variable. Calponin-stained stromal myofibroblasts (35% of cases), vessel pericytes (92%), and endothelial cells (69%), though each to a lesser degree than SMA. Calponin also showed cross reactivity with epithelium in 18% of cases. p63 was almost completely restricted to myoepithelial cell nuclei, and did not stain vascular smooth muscle or myofibroblasts. However, p63 stained the epithelial component in one papillary carcinoma, a basal layer of cells in 1 biphasic invasive carcinoma, and the cytoplasm in 1 case. P-cadherin stained both epithelial and myoepithelial cells. The epithelial expression of CD44s and did not distinguish papillomas from papillary carcinomas. Thus, P-cadherin and CD44s are not useful in the characterization of papillary lesions. Given increased specificity as compared with SMA, the combination of p63 and calponin is recommended for analysis of breast papillary lesions.
在苏木精-伊红染色切片上，乳腺导管内乳头状瘤与导管内乳头状癌的鉴别诊断常常存在困难。免疫组织化学染色常用于诊断，过去常用平滑肌肌动蛋白（SMA）。在本研究中，将一组肌上皮标志物（钙调蛋白、p63、P-钙黏蛋白）的染色特征与SMA进行比较，并评估了99例乳头状病变中CD44s的上皮表达情况。SMA、钙调蛋白和p63分别在61%、63%和65%的乳头状病变中显示有肌上皮细胞。然而，特异性差异较大。钙调蛋白可使基质肌成纤维细胞（35%的病例）、血管周细胞（92%）和内皮细胞（69%）染色，尽管程度均低于SMA。钙调蛋白在18%的病例中还与上皮细胞有交叉反应。p63几乎完全局限于肌上皮细胞核，不染色血管平滑肌或肌成纤维细胞。然而，p63在1例乳头状癌的上皮成分、1例双相浸润性癌的基底细胞层以及1例的细胞质中呈阳性染色。P-钙黏蛋白可同时使上皮细胞和肌上皮细胞染色。CD44s的上皮表达无法区分乳头状瘤和乳头状癌。因此，P-钙黏蛋白和CD44s在乳头状病变的特征鉴别中无实用价值。鉴于与SMA相比特异性更高，推荐联合使用p63和钙调蛋白来分析乳腺乳头状病变。
