12例化生性乳腺癌临床病理分析

Clinicopathological analysis of 12 patients with metaplastic breast carcinoma

目的分析化生性乳腺癌的临床病理特征及其与基底样乳腺癌的关系。方法应用免疫组化法检测12例化生性乳腺癌中ER、PR、HER2、CK5/6、CK14、P63和EGFR的蛋白表达,应用荧光原位杂交检测化生性乳腺癌中的HER2基因扩增,用电镜观测化生性乳腺癌的超微结构,对CK5/6在化生性乳腺癌诊断中的敏感性及化生性乳腺癌预后因素进行分析。结果 12例化生性乳腺癌的ER、PR及HER2免疫染色均为阴性,而CK5/6则为100%(12/12)的阳性表达,CK14、EGFR及P63的阳性表达率分别为75.0%(9/12)、83.3%(10/12)和66.7%(8/12)。FISH实验结果显示化生性乳腺癌中无HER2基因扩增(Ratio<1.8)。超微结构观察见癌细胞胞浆内有张力原纤维丝、细肌丝和密体。CK5/6、CK14、P63和EGFR免疫染色阳性反应之间有显著统计学意义(P=0.000)。年龄和淋巴结转移与化生性乳腺癌的预后具有显著统计学意义(P=0.004)。结论化生性乳腺癌为基底样乳腺癌表型。CK5/6、CK14、P63和EGFR可作为化生性乳腺癌的诊断标记物,其中CK5/6比CK14和P63更为敏感。化生性乳腺癌的预后与年龄和淋巴结转移有关。

Objective Metaplastic breast carcinoma （MBC） encompasses a heterogeneous group of tumors. Based upon the microarray of MBCs, these tumours showed features of basal-like carcinoma and myoepithelial differentiation. However, MBCs entity still remained unclear, so we performed a systematic research to explicit MBCs for further. Methods A panel of ER, PR, HER2, CK5/6, CK14, P63 and EGFR were prepared for detection of MBCs, and fluorescence in situ hybridization for HER2 gene amplification and ultrastructure observation were also performed. Sensitive between CK5/6 and others antibody in diagnosis and survival analysis were also carry out. Results ER, PR and HER2 were negative. CK5/6 （12/12） , CK14 （9/12） , EGFR （10/12） and P63 （8/12） were positive. FISH for HER2 displayed no amplification （ Ratio 〈 1.8）. Ultrastructure showed tonofibrils, thin filament and dense body in the cytoplasm. Significant statistically differences were showed between groups（P = 0.000） of score of CK.5/6, CK14, P63 and EGFR. Significant statistically differences were also detected between age and lymph node involvement and survival （ P = 0. 004）. Conclusions MBCs may be actually basal-like carcinomas. In the diagnosis of MBCs, CK5/6, CK14, P63 and EGFR may be effective and CK5/6 may be more sensitive than CK14 and P63. Survival of MBCs may be associated with age and lymph node involvement.