Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA 02114, USA.
Mod Pathol. 2010 May;23(5):713-9. doi: 10.1038/modpathol.2010.46. Epub 2010 Feb 26.
Often the distinction of primary adnexal carcinoma from metastatic adenocarcinoma to skin from breast, lung, and other sites can be a diagnostic dilemma. Current markers purportedly of utility as diagnostic adjuncts include p63 and D2-40; however, their expression has been demonstrated in 11-22% and 5% of metastatic cutaneous metastases, respectively. Both cytokeratin (CK) 15 and nestin have been reported as follicular stem cell markers. We performed CK15 and nestin, as well as previously reported stains (such as p63, D2-40, and calretinin) on 113 cases (59 primary adnexal carcinomas and 54 cutaneous metastases). Expressions of p63, CK15, nestin, D2-40, and calretinin were observed in 91, 40, 37, 44, and 14% of primary adnexal carcinoma, respectively, and in 8, 2, 8, 4, and 10% of cutaneous metastases, respectively. p63 appeared to be the most sensitive marker (with a sensitivity of 91%) in detecting primary adnexal carcinomas. CK15 appeared to be the most specific marker with a specificity of 98%. Using chi(2) analysis, statistically significant P-values (<0.05) were observed for p63, CK15, nestin, and D2-40 in the distinction of primary adnexal carcinoma versus cutaneous metastases. In logistic regression and stepwise selection for predicting a primary adnexal carcinoma, statistical significance was observed for p63, CK15, and D2-40 (P-values: <0.001, 0.0275, and 0.0298, respectively) but not for nestin (P-value=0.4573). Our study indicates that diagnostic sensitivity and specificity are significantly improved using a selected panel of immunohistochemical markers, including p63, CK15, and D2-40. Positive staining with all three markers argues in favor of a primary cutaneous adnexal neoplasm.
通常，原发性附件腺癌与转移性乳腺癌、肺癌和其他部位腺癌转移至皮肤的鉴别诊断可能是一个难题。目前，据称一些标志物可作为辅助诊断手段，包括 p63 和 D2-40；然而，它们的表达分别在 11-22%和 5%的转移性皮肤转移中得到证实。细胞角蛋白（CK）15 和巢蛋白均被报道为滤泡干细胞标志物。我们对 113 例病例（59 例原发性附件腺癌和 54 例皮肤转移）进行了 CK15 和巢蛋白以及之前报道的染色（如 p63、D2-40 和钙视网膜蛋白）检测。p63、CK15、巢蛋白、D2-40 和钙视网膜蛋白在原发性附件腺癌中的表达分别为 91%、40%、37%、44%和 14%，在皮肤转移中的表达分别为 8%、2%、8%、4%和 10%。p63 在检测原发性附件腺癌方面似乎是最敏感的标志物（敏感性为 91%）。CK15 似乎是最特异的标志物，特异性为 98%。通过卡方分析，在原发性附件腺癌与皮肤转移的鉴别诊断中，p63、CK15、巢蛋白和 D2-40 的 P 值（<0.05）具有统计学意义。在逻辑回归和逐步选择预测原发性附件腺癌时，p63、CK15 和 D2-40 的 P 值具有统计学意义（P 值分别为：<0.001、0.0275 和 0.0298），而巢蛋白的 P 值（P 值=0.4573）无统计学意义。我们的研究表明，使用包括 p63、CK15 和 D2-40 在内的一组选定的免疫组化标志物可显著提高诊断的敏感性和特异性。三种标志物均阳性提示为原发性皮肤附件肿瘤。
