Sangoi Ankur R, Higgins John P, Rouse Robert V, Schneider Anne G, McKenney Jesse K
Department of Pathology, Stanford University, Stanford, CA 94305, USA.
Mod Pathol. 2009 May;22(5):660-7. doi: 10.1038/modpathol.2009.16. Epub 2009 Mar 6.
On the basis of recent clinical studies, some urologic oncologists do not offer bladder-sparing therapy for patients diagnosed with micropapillary carcinoma of the urinary bladder, even in the setting superficially invasive disease. Unfortunately, the distinction of invasive micropapillary carcinoma from typical invasive urothelial carcinoma with prominent retraction artifact may be difficult in some cases. In this study, we compared the immunophenotype of invasive micropapillary carcinoma to invasive urothelial carcinoma with retraction artifact using antibodies previously reported as specific for micropapillary carcinoma. Immunohistochemical staining was performed on 24 invasive micropapillary carcinomas of the urinary tract and 24 case controls of invasive urothelial carcinoma with retraction artifact using monoclonal antibodies MUC1, CA125, and Her2Neu. The staining extent and intensity for MUC1 and CA125 were scored on one representative section per case. Immunostaining for Her2Neu was scored based on the 2007 CAP/ASCO guidelines for breast carcinoma. Basal ('reverse-apical') MUC1 staining was identified in 23 of the 24 (96%) invasive micropapillary carcinomas and in 15 of the 24 (63%) invasive urothelial carcinomas with retraction artifact (P=0.0102). Membranous reactivity with CA125 was seen in 8 of the 24 (33%) invasive micropapillary carcinomas and in 3 of the 24 (13%) invasive urothelial carcinomas with retraction artifact (P=0.1681). Positive (3+) membranous Her2Neu staining was present in 6 of 24 (25%) invasive micropapillary carcinomas and in 2 of the 24 (8%) invasive urothelial carcinomas with retraction artifact (P=0.2448). The specificity for invasive micropapillary carcinoma vs invasive urothelial carcinoma with retraction artifact using antibodies MUC1, CA125, and Her2Neu was 37, 87, and 92%, respectively. Invasive micropapillary carcinoma more commonly showed immunoreactivity for MUC1, CA125, and Her2Neu compared to invasive urothelial carcinoma with retraction artifact, but only MUC1 reached statistical significance. The lack of specificity of these evaluated markers for invasive micropapillary carcinoma limits their utility in the distinction from invasive urothelial carcinoma with retraction artifact, especially given the potentially significant therapeutic implications.
基于近期的临床研究，一些泌尿外科肿瘤学家并不为诊断为膀胱微乳头癌的患者提供保膀胱治疗，即使是浅表浸润性疾病的情况下。不幸的是，在某些病例中，区分浸润性微乳头癌与具有明显退缩假象的典型浸润性尿路上皮癌可能会很困难。在本研究中，我们使用先前报道的对微乳头癌具有特异性的抗体，比较了浸润性微乳头癌与具有退缩假象的浸润性尿路上皮癌的免疫表型。使用单克隆抗体MUC1、CA125和Her2Neu对24例尿路浸润性微乳头癌和24例具有退缩假象的浸润性尿路上皮癌病例对照进行免疫组织化学染色。对每个病例的一个代表性切片上的MUC1和CA125的染色范围和强度进行评分。根据2007年CAP/ASCO乳腺癌指南对Her2Neu进行免疫染色评分。24例浸润性微乳头癌中有23例（96%）和24例具有退缩假象的浸润性尿路上皮癌中有15例（63%）发现基底（“反向顶端”）MUC1染色（P = 0.0102）。24例浸润性微乳头癌中有8例（33%）和24例具有退缩假象的浸润性尿路上皮癌中有3例（13%）出现与CA125的膜反应性（P = 0.1681）。24例浸润性微乳头癌中有6例（25%）和24例具有退缩假象的浸润性尿路上皮癌中有2例（8%）出现阳性（3+）膜Her2Neu染色（P = 0.2448）。使用抗体MUC1、CA125和Her2Neu区分浸润性微乳头癌与具有退缩假象的浸润性尿路上皮癌的特异性分别为37%、87%和92%。与具有退缩假象的浸润性尿路上皮癌相比，浸润性微乳头癌更常显示对MUC1、CA125和Her2Neu的免疫反应性，但只有MUC1达到统计学意义。这些评估的标志物对浸润性微乳头癌缺乏特异性，限制了它们在与具有退缩假象的浸润性尿路上皮癌区分中的效用，特别是考虑到潜在的重大治疗意义。
