Department of Pathology, New York University School of Medicine, New York, NY 10016, USA.
Mod Pathol. 2010 May;23(5):654-61. doi: 10.1038/modpathol.2010.38. Epub 2010 Feb 19.
The risk of developing a second primary cancer is increased in patients with breast cancer, and the lung is one of the major sites involved. Moreover, the lung is the major metastatic site for breast cancers. A distinction between metastatic breast cancer and primary lung cancer can be histologically difficult, and both show an overlapping CK7+/CK20- immunoprofile in a majority of cases. The degree of difficulty increases with poorly differentiated tumors. We investigated differential expressions of TTF-1, Napsin A, surfactant apoprotein A, estrogen receptor, GATA-3, mammaglobin, and GCDFP-15 immunostains in 197 pulmonary carcinomas (158 adenocarcinomas, 39 squamous) and 115 invasive mammary carcinomas (91 ductal, 24 lobular type). In mammary carcinomas, estrogen receptor, GATA-3, mammaglobin, and GCDFP-15 were expressed in 74, 72, 64, and 62%, respectively, whereas TTF-1, Napsin A, and surfactant apoprotein A were all negative. The expressions were diffuse in estrogen receptor and GATA-3, and variable in mammaglobin and GCDFP-15. For a combination of estrogen receptor/mammaglobin or GATA-3/mammaglobin, 83% of mammary carcinomas were positive, and the detection rate was not improved by using all three markers. All lung squamous cell carcinomas were negative for all markers studied. TTF-1, Napsin A, and surfactant apoprotein A were positive in 80, 77, and 45% of pulmonary adenocarcinomas. None of the TTF-1-negative tumors expressed surfactant apoprotein A. GCDFP-15 was focally expressed in 2.5% of pulmonary adenocarcinomas, and estrogen receptor was focally expressed in one case (1.2%) of pulmonary adenocarcinoma. When metastasis from breast cancer is suspected in the lung, a combination of either estrogen receptor/mammaglobin or GATA-3/mammaglobin as breast markers, and a combination of TTF-1 and Napsin A as lung markers may be helpful for differentiating between the two. Caution should be taken in the interpretation of GCDFP-15 due to its occasional expression in pulmonary adenocarcinomas.
乳腺癌患者发生第二原发癌的风险增加，肺部是主要受累部位之一。此外，肺部是乳腺癌的主要转移部位。转移性乳腺癌和原发性肺癌之间的鉴别在组织学上可能具有一定难度，大多数情况下两者的 CK7+/CK20-免疫组化表现重叠。这种难度随着肿瘤分化程度的降低而增加。我们研究了 TTF-1、Napsin A、表面活性剂 A 蛋白、雌激素受体、GATA-3、乳球蛋白和 GCDFP-15 免疫组化在 197 例肺癌（158 例腺癌，39 例鳞癌）和 115 例浸润性乳腺癌（91 例导管癌，24 例小叶癌）中的差异表达。在乳腺癌中，雌激素受体、GATA-3、乳球蛋白和 GCDFP-15 的表达率分别为 74%、72%、64%和 62%，而 TTF-1、Napsin A 和表面活性剂 A 蛋白均为阴性。雌激素受体和 GATA-3 的表达呈弥漫性，乳球蛋白和 GCDFP-15 的表达呈多变性。对于雌激素受体/乳球蛋白或 GATA-3/乳球蛋白的组合，83%的乳腺癌呈阳性，而使用所有三种标志物并不能提高检测率。所有肺鳞癌均为所有研究标志物的阴性。TTF-1、Napsin A 和表面活性剂 A 蛋白在 80%、77%和 45%的肺腺癌中呈阳性。没有 TTF-1 阴性的肿瘤表达表面活性剂 A 蛋白。GCDFP-15 在 2.5%的肺腺癌中呈局灶性表达，雌激素受体在 1.2%的肺腺癌中呈局灶性表达。当怀疑肺部有乳腺癌转移时，使用雌激素受体/乳球蛋白或 GATA-3/乳球蛋白作为乳腺标志物的组合，以及 TTF-1 和 Napsin A 作为肺标志物的组合，可能有助于区分两者。由于 GCDFP-15 在肺腺癌中偶尔表达，因此在解释时应谨慎。
