乳腺导管内癌全乳腺切片病理组织学及免疫组化研究

Whole Breast Section Pathohistological and Immunohistochemical Study on Ductal Carcinoma in Situ of the Breast

目的：探索导管内癌（ｄｕｃｔａｌ ｃａｒｃｉｎｏｍａ ｉｎ ｓｉｔｕ，ＤＣＩＳ）的生物学特性，以期能为导管内癌新的分型提供依据。方法：对导管内癌标本进行全乳腺次连续切片、ｃ－ｅｒｂＢ－２、ｐ５３和ＰＣＮＡ蛋白免疫组化检测并结合形态学观察，探讨导管内癌的生物学特性。结果：１）核分级与小叶内末梢导管受累相关（Ｐ＜０．０５），Ⅲ级病变较Ⅰ级病变易累及小叶内末梢导管。２）对 ３４例导管内癌全乳腺次连续切片观察发现：核分级 Ⅰ级的 ＤＣＩＳ ７０％（１４／２０）的病变范围小于 ５ｃｍ，而３例Ⅲ级的病变范围均大于５ｃｍ：２例（６％）ＤＣＩＳ呈多中心性。３）免疫组化检测发现：ｃ—ｅｒｂＢ—２、ＰＣＮＡ的阳性表达率粉刺型ＤＣＩＳ比非粉利型高（Ｐ＜０．０５）；ｃ—ｅｒｂＢ—２、ＰＣＮＡ、ｐ５３的阳性表达率与核分级呈正相关（Ｐ＜０．０５），与小叶内末梢导管受累和坏死程度则无关（Ｐ＞０．０５）。核分级高者ｃ－ｅｒｂＢ－２、ｐ５３，ＰＣＮＡ的表达率均较核分级低者高（Ｐ＜０．０５～Ｐ＜０．０１）。４）导管内癌腋淋巴结转移率较低为１．７％，转移是由于隐匿性浸润所致。结论：导管内癌无论在病理形态还是生物学行为方面都是异质性的群体，除传统的组织学?

Objective: To explore the biologic characteristics of the ductal carcinoma in situ (DCIS) so that it could provide the scientific basis for a new method of histologic classification in DCIS. Methods: Whole breast subserial sectioning technique and immunohistochemical method (IHC) as well as morphology were used to observe DCIS. Results: Whether the terminal lobular ducts were involved or not was related to the grade of tumor (P<0.05). Grade Ⅲ DCIS was prone to involve the terminal lobular ducts than grade I lesions. Whole breast subserial section of 34 cases showed that the diameter in 70% (l4/20) of Grade I lesions was less than 5cm and the diameter in 3 cases of Grade Ⅲ lesions was more than 5cm. The IHC results showed: the expressions of c-erbB-2 and PCNA in comedo type were higher than that in noncomedo type (P<0.05). Expressions of c-erbB-2, PCNA and p53 had no correlation with the terminal lobular ductal involvement and necrosis (P>0.05), but had positive correlation with the nuclear grade (P<0.05~P<0.01). The axillary lymph node metastatic rate in DCIS was very low (l.7%) which was resulted from occult invasion. Conclusion: DCIS is a heterogenity group no matter from pathologic morphology or biologic behavior. In addition to the histologic subtype, clear grade and expression of c-erbB-2, p53 and PCNA can be regarded as the indexes to indicate the malignant degree in which nuclear grade can exactly reflect the biologic characteristics of DCIS and become an important marker of histologic classification. Therefore, we divided DCIS into three different biologic characteristic subtypes according to the nuclear grade.