应用免疫组化双染技术探讨乳腺原发性腺鳞癌临床病理特征

Clinicopathologic study of breast primary adenosquamous carcinoma by using immunohistochemic double stain technique

目的免疫组化双染技术是一种先进的染色方法,该方法可在一张切片上同时检测两种抗原的表达情况。利用该技术探讨乳腺腺鳞癌的临床病理特征、免疫表型及其鉴别诊断。方法收集衡水市人民医院病理科2011-01-01-2015-12-31诊断的4例原发性乳腺腺鳞癌,应用免疫组化SP法和(CK5/p63)免疫组化双染法,检测乳腺腺鳞癌组织中的SM-MHC、p63、CK5、CK34βE12、EGFR、p53、ER、PR、C-erbB-2表达情况,并复习相关文献。结果共治疗979例乳腺恶性肿瘤患者,其中乳腺腺鳞癌患者4例(0.408%),中位发病年龄55岁。临床多表现为无痛性肿块,临床分期:Ⅰ期2例,ⅡA期1例,ⅡB期1例。患者经乳腺B超、外科查体、术中肿物活检冷冻病理诊断为乳腺癌,4例患者均行乳腺改良根治术。术后1例给予吡柔比星+多西他赛方案治疗;1例行环磷酰胺+吡柔比星方案治疗。1例患者术后9d猝死;另1例C-erbB-2强阳性患者,先给予吡柔比星+多西他赛方案治疗,然后转院进行靶向治疗。随访至2016-01-31,3例患者均无复发转移。免疫组化双染技术染色成功。结论乳腺腺鳞癌属于乳腺化生性癌,发病率低,肉眼观呈囊性是其特征之一,免疫组化SM-MHC、p63、CK5和CK34βE12组合有助于乳腺腺鳞癌的诊断。治疗多采用乳腺改良根治术,术后辅助化疗,对于淋巴结阳性患者应行术后放疗。

OBJECTIVE Immunohistochemical double-staining is a advanced staining method,which can detect two different antigens＇ expression in one tissue section.Using this stain method to study the clinicopathologic significance,immunohistochemical phenotypes and differential diagnoses of primary adenosquamous carcinoma of the breast.METHODS Using immunohistochemical method（SP）and（CK5/p63）immunohistochemical double stain to detect the expression of SM-MHC,p63,CK5,CK34βE12,EGFR,p53,ER,PR and C-erbB-2in 4cases who were diagnosed as primary adenosquamous carcinoma of the breast in the People＇s Hospital of Hengshui from January 1,2011 to December 31,2015,and the relevant literatures were also reviewed.RESULTS Adenosquamous carcinoma of the breast accounted for0.408%（4/979）of all breast cancer,with a median age of 55 years old.Four patients were all manifesting as painless mass.Two patients were in stageⅠ,one in stageⅡA and the other in stageⅡB.Four patients were diagnosed breast cancer by B ultrasound,surgical procedure and intra-operative frozen section diagnosis,then underwent the modified radical mastectomy.After operation,one patient received pirarubicin plus docetaxel therapy,another patient received cyclophosphamide plus pirarubicin therapy.One patient was death after operation for only living nine days.The patient with strongly positive C-erbB-2first received pirarubicin plus docetaxel therapy,and then targeted therapy.The follow-up ended in January 31,2016,all of 3cases had no metastasis and recurrence.Immunohistochemical double stain was successful.CONCLUSIONS The incidence of primary adenosquamous carcinoma of the breast is rare,which is one subtype of metaplastic breast carcinoma.Cystic solid mass is its remarkable feature.The group of SM-MHC,p63,CK5 and CK34βE12in immunohistochemical staining can help the diagnosis.Combination of mastectomy and adjuvant therapy are needed for patients.