Zhang Hong, Xiong Yan, Zhang Shuang, Zhang Ying, Wang Yun-hong, Li Ting
Department of Pathology, Peking University First Hospital, Beijing 100034, China.
Zhonghua Bing Li Xue Za Zhi. 2011 Nov;40(11):726-31.
To evaluate the diagnostic approach and criteria for intraductal papillary neoplasms of breast.
According to the criteria of 2003 WHO classification, 187 cases of intraductal papillary neoplasm of breast were identified and enrolled into the study. The clinical and histologic features were reviewed and immunohistochemical study for CD10, p63, CK14, CK5/6, CK7, MGB1 and p53 were carried out on 53 cases.
Amongst the 187 cases studied, there were 128 cases of intraductal papilloma, 16 cases of atypical intraductal papilloma and 43 cases of intraductal papillary carcinoma. They showed a spectrum of morphologic features including epithelial and stromal hyperplasia and secondary changes. The expression of myoepithelial markers, including CD10 and p63, significantly decreased in ascending order from intraductal papillomas, atypical intraductal papillomas and intraductal papillary carcinomas (P < 0.001). The expression of basal cell markers, including CK5/6 and CK14, showed a mosaic pattern in benign lesions and significantly decreased or was absent in atypical and carcinomatous lesions (P < 0.001). In contrast, the luminal cell marker CK7 expressed in the three groups with no statistically significant difference (P = 0.06). On the other hand, the expression of MGB1 in intraductal papillary carcinomas was much lower than that in the other two groups (P = 0.002 and P = 0.007). The staining for p53 was negative in all of the three groups.
Intraductal papillary neoplasms of breast represent a heterogeneous group of lesions with various morphologic appearances. Correlation with immunostaining results for myoepithelial markers, basal-type cytokeratins and luminal epithelial markers are helpful in arriving at a definitive diagnosis.
评估乳腺导管内乳头状肿瘤的诊断方法及标准。
根据2003年世界卫生组织分类标准，确定187例乳腺导管内乳头状肿瘤病例并纳入研究。回顾其临床和组织学特征，并对53例病例进行CD10、p63、CK14、CK5/6、CK7、MGB1和p53的免疫组化研究。
在187例研究病例中，有128例导管内乳头状瘤，16例非典型导管内乳头状瘤和43例导管内乳头状癌。它们呈现出一系列形态学特征，包括上皮和间质增生以及继发性改变。肌上皮标志物（包括CD10和p63）的表达从导管内乳头状瘤、非典型导管内乳头状瘤到导管内乳头状癌呈逐渐显著下降趋势（P < 0.001）。基底细胞标志物（包括CK5/6和CK14）在良性病变中呈镶嵌样表达，在非典型和癌性病变中显著降低或缺失（P < 0.001）。相比之下，腔面细胞标志物CK7在三组中的表达无统计学显著差异（P = 0.06）。另一方面，MGB1在导管内乳头状癌中的表达远低于其他两组（P = 0.002和P = 0.007）。三组中p53染色均为阴性。
乳腺导管内乳头状肿瘤是一组具有多种形态学表现的异质性病变。与肌上皮标志物、基底型细胞角蛋白和腔面上皮标志物的免疫染色结果相关联有助于做出明确诊断。
