Department of Pathology, The First People's Hospital of Jingmen, Hubei, China.
Department of Gastroenterology, The First People's Hospital of Jingmen, Hubei, China.
World J Surg Oncol. 2023 Jun 19;21(1):181. doi: 10.1186/s12957-023-03074-x.
This study investigated the clinicopathological features, immunophenotypic characteristics and differential diagnosis of primary breast carcinomas with signet ring cell differentiation, as well as differences in the traits of signet ring-like cell mucin.
A total of five cases of primary breast cancer diagnosed with signet ring cell differentiation and treated at The First People's Hospital of Jingmen from January 2016 to December 2021 were collected. HE, immunohistochemical staining, and AB-PAS staining were used for the analysis.
Although we strictly selected all the primary breast cancer cases with signet ring cell differentiation, there were differences in the arrangement of the cells and the grading of nuclei. Our immunohistochemical results showed that the ER was consistently strongly positive, and the PR expression was not consistent, while all the cases of HER2 were negative. CK7 was negative in one case, and CK20 and CK5/6 were not expressed in all the cases. The mucin MUC1 was positive and showed two patterns. MUC2 was strongly positive in all the cases. All the cases were negative for CDX2, SATB2, PAX8, TTF-1, and Napsin A, while the positive expression of COX2, Villin, and WT-1 was not constant. One case expressed neuroendocrine markers. The expression level of Ki67 was between 10 and 30%. AB (pH 2.5)-PAS staining revealed that the intracellular mucus contained more cells with neutral mucus, while the extracellular mucus was mainly acidic.
We found that histological morphology, cell morphology, and nuclear grading differentiate among different cases. The immunohistochemical characteristics of primary breast cancers diagnosed with signet ring cell differentiation are helpful for identification. The differences in the expression patterns of mucins may be related to unfavorable clinicopathological factors, but their usefulness as a prognostic marker remains to be further understood. The heterogeneity of cell mucus, the differentiation of tumor cells, and the phenotypic changes of tumors also need further study.
本研究旨在探讨原发性乳腺癌伴印戒细胞分化的临床病理特征、免疫表型特征及鉴别诊断，以及印戒样细胞黏液的特征差异。
收集 2016 年 1 月至 2021 年 12 月期间在荆门市第一人民医院诊断为原发性乳腺癌伴印戒细胞分化并接受治疗的 5 例患者的临床资料，采用 HE、免疫组化染色和 AB-PAS 染色进行分析。
尽管我们严格选择了所有原发性乳腺癌伴印戒细胞分化的病例，但细胞排列和核分级仍存在差异。我们的免疫组化结果显示 ER 始终呈强阳性，PR 表达不一致，而所有 HER2 病例均为阴性。CK7 在 1 例中呈阴性，CK20 和 CK5/6 在所有病例中均不表达。MUC1 黏液呈阳性，表现为两种模式。MUC2 在所有病例中均呈强阳性。所有病例均为 CDX2、SATB2、PAX8、TTF-1 和 Napsin A 阴性，而 COX2、Villin 和 WT-1 的阳性表达并不恒定。1 例表达神经内分泌标志物。Ki67 的表达水平在 10%至 30%之间。AB(pH 2.5)-PAS 染色显示细胞内黏液含有更多中性黏液的细胞，而细胞外黏液主要为酸性。
我们发现不同病例的组织学形态、细胞形态和核分级存在差异。原发性乳腺癌伴印戒细胞分化的免疫组织化学特征有助于鉴别诊断。黏液表达模式的差异可能与不良的临床病理因素有关，但它们作为预后标志物的用途仍需进一步研究。细胞黏液的异质性、肿瘤细胞的分化以及肿瘤的表型变化也需要进一步研究。
