CAJ | 학술논문

目的探讨乳腺导管内乳头状肿瘤(IDPN)的诊断方法和标准.方法收集187例IDPN患者的临床和病理资料,结合目前认可的2003年WHO乳腺和女性生殖系统肿瘤病理学和遗传学分类标准、Page等和Tavassoli的诊断标准,对其形态学特点进行分析,并对其中53例行CD10、p63、CK14、CK5/6、CK7、乳珠蛋白-1(MGB1)及p53免疫组织化学EnVision法染色分析.结果 187例IDPN患者中导管内乳头状瘤(IDPMa) 128例,不典型导管内乳头状瘤(A-IDPMa) 16例,导管内乳头状癌(IDPCa) 43例.IDPN在形态学上表现为不同程度的上皮细胞和间质增生,以及继发病变等,这些使病灶呈现异常复杂的多样性.免疫组织化学肌上皮标记(CD10和p63)染色在IDPMa、A-IDPMa及IDPCa的表达依次减少,组间比较差异均有统计学意义(均P＜0.001).基底型角蛋白(CK5/6和CK14)染色显示良性病变的表达呈镶嵌状阳性表达,在A-IDPMa的不典型区和IDPCa中表达明显减少或缺如,两者相比差异有统计学意义(P＜0.001).腺腔上皮标志物CK7染色各组间比较差异无统计学意义(P=0.06).MGB1在IDPCa组染色明显减少(P值分别为0.002和0.007),p53染色各组均呈阴性.结论 IDPN是一组组织学改变复杂的疾病,应注意其诊断标准的掌握.肌上皮、基底型角蛋白和腺腔上皮标志物联合应用在该组复杂病变中有很好的诊断和鉴别诊断价值.
목적 탐토유선도관내유두상종류(IDPN)적진단방법화표준.방법 수집187례IDPN환자적림상화병리자료,결합목전인가적2003년WHO유선화녀성생식계통종류병이학화유전학분류표준、Page등화Tavassoli적진단표준,대기형태학특점진행분석,병대기중53례행CD10、p63、CK14、CK5/6、CK7、유주단백-1(MGB1)급p53면역조직화학EnVision법염색분석.결과 187례IDPN환자중도관내유두상류(IDPMa) 128례,불전형도관내유두상류(A-IDPMa) 16례,도관내유두상암(IDPCa) 43례.IDPN재형태학상표현위불동정도적상피세포화간질증생,이급계발병변등,저사사병조정현이상복잡적다양성.면역조직화학기상피표기(CD10화p63)염색재IDPMa、A-IDPMa급IDPCa적표체의차감소,조간비교차이균유통계학의의(균P＜0.001).기저형각단백(CK5/6화CK14)염색현시량성병변적표체정양감상양성표체,재A-IDPMa적불전형구화IDPCa중표체명현감소혹결여,량자상비차이유통계학의의(P＜0.001).선강상피표지물CK7염색각조간비교차이무통계학의의(P=0.06).MGB1재IDPCa조염색명현감소(P치분별위0.002화0.007),p53염색각조균정음성.결론 IDPN시일조조직학개변복잡적질병,응주의기진단표준적장악.기상피、기저형각단백화선강상피표지물연합응용재해조복잡병변중유흔호적진단화감별진단개치.
Objective To evaluate the diagnostic approach and criteria for intraductal papillary neoplasms of breast.Methods 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.Results 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.Conclusions Intraductal papillary neoplasms of breast represent a heterogeneous group of lesions with various morphologic appearances.Correlation with immunostaining results for myoepithelial narkers,basal-type cytokeratins and luminal epithelial markers are helpful in arriving at a definitive diagnosis.