Jensen M L, Kiaer H, Melsen F
Institutes of Pathology, Aarhus University Hospital, Svendborg Hospital, Denmark.
Histopathology. 1996 Sep;29(3):241-5. doi: 10.1111/j.1365-2559.1996.tb01397.x.
Sixty breast carcinomas previously indexed as medullary carcinomas over a 24-year-period were reviewed and reclassified according to definitions suggested by Ridolfi et al. as typical medullary carcinoma, atypical medullary carcinoma, and non-medullary carcinoma. Paraffin sections of tumour tissue were examined by an avidin-biotin complex method using two keratin 19-specific monoclonal antibodies (BA17, DAKO and clone 170-2-14, Boehringer) and a monoclonal oestrogen receptor antibody (DAKO). For comparison 52 ductal carcinomas of grade II and grade III were immunostained as well. The results showed that all 60 tumours with medullary features and all 52 ductal carcinomas reacted moderately to strongly positive with anti-keratin 19 (Boehringer). The staining was diffuse in all cases, except one case of ductal carcinoma (grade III), which stained focally. Immunostaining with the second keratin 19 antibody (BA17) revealed similar results with positive staining in 59 (95%) cases of carcinomas with medullary features and 51 (98%) cases of ductal carcinomas. Only one case in each group did not express keratin 19 (BA17), one re-classified case of non-medullary carcinoma with neuroendocrine features and one case of ductal carcinoma of grade III. None of the 13 cases of typical medullary carcinoma were oestrogen receptor positive and only seven (12%) of the carcinomas with medullary features (2 atypical, 5 non-medullary) were oestrogen receptor positive with quantitative values from 20 to 100%. The 52 ductal carcinomas of grade II and III were oestrogen receptor positive in 56% and 47% of cases. It is concluded that keratin 19 staining is of no particular value in differentiating medullary from poorly differentiated ductal carcinoma. A carcinoma with positive oestrogen receptor staining is not likely to be a typical medullary carcinoma.
对24年间曾被归类为髓样癌的60例乳腺癌进行回顾，并根据里多尔菲等人提出的定义重新分类为典型髓样癌、非典型髓样癌和非髓样癌。采用抗生物素蛋白-生物素复合物法，使用两种角蛋白19特异性单克隆抗体（BA17，丹麦戴科公司；克隆号170-2-14，德国宝灵曼公司）和一种单克隆雌激素受体抗体（丹麦戴科公司）对肿瘤组织石蜡切片进行检查。为作比较，还对52例Ⅱ级和Ⅲ级导管癌进行了免疫染色。结果显示，所有60例具有髓样特征的肿瘤和所有52例导管癌对抗角蛋白19（德国宝灵曼公司）呈中度至强阳性反应。除1例导管癌（Ⅲ级）呈局灶性染色外，所有病例的染色均为弥漫性。用第二种角蛋白19抗体（BA17）进行免疫染色，结果相似，59例（95%）具有髓样特征的癌和51例（98%）导管癌呈阳性染色。每组仅1例未表达角蛋白19（BA17），1例重新分类的具有神经内分泌特征的非髓样癌和1例Ⅲ级导管癌。13例典型髓样癌均无雌激素受体阳性，仅7例（12%）具有髓样特征的癌（2例非典型、5例非髓样）雌激素受体阳性，定量值为20%至100%。52例Ⅱ级和Ⅲ级导管癌中，雌激素受体阳性率分别为56%和47%。结论是，角蛋白19染色在区分髓样癌和低分化导管癌方面无特殊价值。雌激素受体染色阳性的癌不太可能是典型髓样癌。
