Pathology and Clinical Laboratory Division, National Cancer Center Hospital, 104-0045 Tokyo, Japan.
Hum Pathol. 2011 Nov;42(11):1777-84. doi: 10.1016/j.humpath.2011.04.002.
Breast carcinomas sometimes metastasize to the stomach, and the histopathologic distinction of such metastases from primary gastric adenocarcinomas is often difficult. We characterized the clinicopathologic features of 21 breast carcinomas that had metastasized to the stomach and examined the use of a panel of antibodies, including hepatocyte nuclear factor 4A, for distinguishing the metastases from primary gastric diffuse-type adenocarcinomas. Histologically, all the metastatic breast carcinomas showed a poorly differentiated and/or signet ring cell morphology. Although most metastatic breast and primary gastric carcinomas contained signet ring cell components, the cases that were predominantly or exclusively composed of univacuolated-type signet ring cells were limited to metastatic breast carcinomas. Immunohistochemically, hepatocyte nuclear factor 4A was expressed in all 33 primary gastric carcinomas that were examined but was never expressed in metastatic breast carcinomas. Previously reported markers for breast and gastric carcinomas also showed a high specificity, but their sensitivities were quite variable. Estrogen receptor α, progesterone receptor, mammaglobin, and gross cystic disease fluid protein 15 were expressed in 76%, 33%, 52%, and 62%, respectively, of the metastatic breast carcinomas, whereas none of the primary gastric carcinomas expressed these antigens. CDX2, MUC5AC, MUC6, and CK20 were expressed in 36%, 85%, 27%, and 55%, respectively, of the primary gastric carcinomas. All the metastatic breast carcinomas were negative for these antibodies except for 1 case that expressed MUC5AC. Overall, the use of immunohistochemistry efficiently discriminated metastatic breast carcinomas from primary gastric carcinomas. In particular, the present study identified hepatocyte nuclear factor 4A as an excellent marker for differentiating the 2 lesions.
乳腺癌有时会转移到胃部，因此鉴别这些转移灶与原发性胃腺癌的组织病理学特征常常具有挑战性。我们对 21 例转移至胃部的乳腺癌的临床病理特征进行了研究，并检测了一组抗体（包括肝细胞核因子 4A）在鉴别转移性乳腺癌与原发性弥漫型胃腺癌中的应用。组织学上，所有转移性乳腺癌均表现为低分化和/或印戒细胞形态。尽管大多数转移性乳腺癌和原发性胃癌均包含印戒细胞成分，但主要或仅由单泡型印戒细胞组成的病例仅限于转移性乳腺癌。免疫组织化学染色显示，在所有 33 例接受检查的原发性胃癌中均表达肝细胞核因子 4A，但在转移性乳腺癌中从未表达过。先前报道的用于乳腺癌和胃癌的标志物也具有很高的特异性，但它们的敏感性差异很大。雌激素受体α、孕激素受体、乳球蛋白和巨大囊性疾病液体蛋白 15 在 76%、33%、52%和 62%的转移性乳腺癌中表达，而原发性胃癌均不表达这些抗原。CDX2、MUC5AC、MUC6 和 CK20 在 36%、85%、27%和 55%的原发性胃癌中表达。除 1 例表达 MUC5AC 外，所有转移性乳腺癌均对这些抗体呈阴性。总的来说，免疫组织化学检测能够有效地鉴别转移性乳腺癌与原发性胃癌。特别是，本研究发现肝细胞核因子 4A 是鉴别这两种病变的一个极好的标志物。
