Espinosa Inigo, Gallardo Alberto, D'Angelo Emanuela, Mozos Ana, Lerma Enrique, Prat Jaime
Department of Pathology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (IIB Sant Pau), Autonomous University of Barcelona, Barcelona, Spain.
Int J Gynecol Pathol. 2015 May;34(3):257-65. doi: 10.1097/PGP.0000000000000155.
Breast carcinomas rarely metastasize to the ovary and are even more rarely present clinically as primary ovarian tumors. However, patients with breast cancer not infrequently develop independent primary ovarian carcinomas. In these cases, distinction between independent primaries and metastatic tumors is crucial. Several comparative immunohistochemical studies have been reported, but few included significant clinicopathologic data and none investigated cases of ovarian and breast carcinomas from the same patients. In this study, we compared 18 cases of patients with bona fide independent breast and ovarian carcinomas (15 high-grade serous and 3 clear cell carcinomas), with 9 cases of patients with known mammary carcinomas (7 lobular and 2 ductal carcinomas) metastatic to the ovary. Immunohistochemical stains for Pax-8, WT-1, and GATA3 were carried out on tissue microarrays (TMA). Most primary ovarian carcinomas were larger than the metastatic tumors (P=0.001) and were diagnosed at an advanced stage. All primary ovarian tumors showed marked nuclear pleomorphism, whereas only 2 metastatic breast carcinomas had Grade 3 nuclei (P=0.000). The vast majority of ovarian metastases (7/9) showed the typical pattern of lobular breast carcinoma. Pax-8 and WT-1 expression were found in 16 of 18 (88%) and 13 of 18 (72%) primary ovarian carcinomas, respectively. In contrast, all primary ovarian carcinomas were negative for GATA3. The 2 Pax-8-negative ovarian carcinomas were also negative for WT-1. With the exception of 3 triple-negative carcinomas, all primary breast carcinomas were positive for GATA3. All metastatic breast carcinomas were positive for GATA3 and negative for Pax-8. WT-1 expression was seen in only 1 of 9 metastatic breast carcinomas (11%). Patients with ovarian metastases had worse prognosis than patients with independent breast and ovarian carcinomas (P=0.000). Pax-8, WT-1, and GATA3 immunoreactions are useful in the distinction between independent primaries and metastatic mammary carcinomas to the ovary in the light of clinicopathologic findings.
乳腺癌很少转移至卵巢，临床上更罕见以原发性卵巢肿瘤形式出现。然而，乳腺癌患者并非罕见地会发生独立的原发性卵巢癌。在这些病例中，区分独立的原发性肿瘤和转移性肿瘤至关重要。已有多项比较性免疫组化研究报道，但很少有研究纳入重要的临床病理数据，且无一研究同一患者的卵巢癌和乳腺癌病例。在本研究中，我们将18例确诊为独立的乳腺癌和卵巢癌患者（15例高级别浆液性癌和3例透明细胞癌）与9例已知有卵巢转移的乳腺癌患者（7例小叶癌和2例导管癌）进行了比较。在组织微阵列（TMA）上进行了Pax-8、WT-1和GATA3的免疫组化染色。大多数原发性卵巢癌比转移性肿瘤大（P = 0.001），且诊断时处于晚期。所有原发性卵巢肿瘤均显示明显的核多形性，而只有2例转移性乳腺癌有3级核（P = 0.000）。绝大多数卵巢转移瘤（7/9）表现为小叶型乳腺癌的典型模式。Pax-８和WT-1表达分别见于18例原发性卵巢癌中的16例（88%）和13例（72%）。相比之下，所有原发性卵巢癌GATA3均为阴性。2例Pax-8阴性的卵巢癌WT-1也为阴性。除3例三阴性癌外，所有原发性乳腺癌GATA3均为阳性。所有转移性乳腺癌GATA3均为阳性，Pax-8为阴性。WT-1表达仅见于9例转移性乳腺癌中的1例（11%）。有卵巢转移的患者预后比有独立的乳腺癌和卵巢癌的患者差（P = 0.000）。根据临床病理结果，Pax-8、WT-1和GATA3免疫反应有助于区分独立的原发性肿瘤和卵巢转移性乳腺癌。
