Mentrikoski Mark J, Wick Mark R
From the Division of Surgical Pathology and Cytopathology, University of Virginia Medical Center, Charlottesville.
Am J Clin Pathol. 2015 Mar;143(3):430-6. doi: 10.1309/AJCP2N1AFXEFOVYE.
Even with adequate history, the distinction of cutaneous metastatic breast carcinoma from primary sweat gland carcinoma can be difficult. Although previous studies have attempted to separate these tumors with various immunohistochemical panels, those series have been limited by small numbers of patients as well as the inclusion of benign sweat gland tumors.
In this analysis, stains for p63, CK5/6, and D2-40 were included, as well as GATA3 and mammaglobin, in an evaluation of 21 primary sweat gland carcinomas and 33 examples of cutaneous metastatic breast carcinoma.
Immunoreactivity for p63, CK5/6, D2-40, GATA3, and mammaglobin was respectively observed in 81%, 71%, 52%, 71%, and 5% of sweat gland carcinomas compared with 6%, 6%, 6%, 91%, and 45% of metastatic breast carcinomas. These differences were statistically significant for p63, CK5/6, and D2-40. For the diagnosis of metastatic breast carcinoma, GATA3 was the most sensitive marker (91%), but its sensitivity was substantially lower. Mammaglobin was 95% specific for breast carcinoma but again suffered from limited sensitivity (45%) in this context.
These data suggest that p63 and CK5/6 are specific determinants for sweat gland carcinoma in the stated setting. In the absence of those analytes, metastatic breast carcinoma cannot always be identified to the exclusion of a primary tumor. This diagnostic scenario continues to require the procurement of a detailed clinical history regarding the number and duration of skin lesions in any given case.
即便有充分的病史，鉴别皮肤转移性乳腺癌与原发性汗腺癌仍可能存在困难。尽管既往研究尝试通过各种免疫组化指标来区分这些肿瘤，但这些研究系列受限于患者数量少以及纳入了良性汗腺肿瘤。
在本分析中，纳入了p63、CK5/6、D2-40以及GATA3和乳腺珠蛋白的染色，对21例原发性汗腺癌和33例皮肤转移性乳腺癌进行评估。
p63、CK5/6、D2-40、GATA3和乳腺珠蛋白的免疫反应性在汗腺癌中的阳性率分别为81%、71%、52%、71%和5%，而在转移性乳腺癌中的阳性率分别为6%、6%、6%、91%和45%。p63、CK5/6和D2-40的这些差异具有统计学意义。对于转移性乳腺癌的诊断，GATA3是最敏感的标志物（91%），但其敏感性大幅降低。乳腺珠蛋白对乳腺癌的特异性为95%，但在此情况下其敏感性同样有限（45%）。
这些数据表明，在所述情况下，p63和CK5/6是汗腺癌的特异性决定因素。在缺乏这些分析物的情况下，不能总是排除原发性肿瘤而确诊转移性乳腺癌。在任何特定病例中，这种诊断情况仍然需要获取关于皮肤病变数量和持续时间的详细临床病史。
