Combined E-cadherin and high molecular weight cytokeratin immunoprofile differentiates lobular, ductal, and hybrid mammary intraepithelial neoplasias
Combined E-cadherin and high molecular weight cytokeratin immunoprofile differentiates lobular, ductal, and hybrid mammary intraepithelial neoplasias
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DOI：
10.1053/hupa.2002.124789
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发表时间：
2002-06-01
期刊：
影响因子：
3.3
通讯作者：
Tavassoli, FA
中科院分区：
文献类型：
--
作者：
Bratthauer, GL;Moinfar, F;Tavassoli, FA
终末导管-小叶单位是上皮内瘤变的两种不同变体的起源，传统上根据细胞学和结构特征的组合分为导管型和小叶型。一般来说，完全发展的或典型的小叶上皮内瘤变（LIN）与各种级别的导管上皮内瘤变的区别。(DIN)不是问题越来越多的病变，似乎有中间，重叠的导管和小叶的特点被送到我们的咨询，因为这两种诊断的临床意义明显不同。我们将其分离并命名为MIN（乳腺上皮内瘤变，未另行说明），而其他人将其分类为明确的导管或小叶亚型。最近的研究结果表明，LIN缺乏E-钙粘蛋白的免疫反应，加上显着减少到缺乏表达的高分子量（HMW）细胞角蛋白在超过90%的1b级或更高的DIN提示我们评估上皮内瘤变可能更精确的免疫组化分类。110例上皮内瘤形成，包括40例经典LIN，20例明确DIN I c至DIN 3（导管原位癌）和50例MIN，均来自武装部队病理研究所的文件。用E-钙粘蛋白抗体和HMW细胞角蛋白1、5、10和14反应性抗体34 β E12检测这些标本。LIN的所有样品显示完全没有与抗E-钙粘蛋白的反应，而DIN的所有情况下显示阳性免疫反应。相反，DIN病变显示很少或没有反应与34 β E12，而小叶病变显示细胞质反应，往往在一个独特的核周模式。23例形态学不确定的病例可根据免疫特征分为导管型或小叶型，27例表现出不同于典型DIN或经典LIN的免疫特征。在27个MIN中，11个对两种标记物均为阴性（阴性杂交体），而16个对两种标记物均为阳性（阳性杂交体）。这两种抗体联合使用在区分小叶和导管病变以及澄清某些形态学中间病例的性质方面非常有用。此外，他们还证实了一组上皮内病变（MIN）的存在，不仅具有重叠的形态学特征，而且免疫特征明显不同于DIN或LIN。这些MIN病变可能反映了DIN和LIN发展的短暂阶段（即干细胞后阶段）或从一种类型向另一种类型过渡的可塑性组。这组需要进一步评估，以更好地了解其意义，进展模式和行为。这是美国政府的工作。它的使用没有限制。
The terminal duct-lobular unit is the origin of 2 distinct variants of intraepithelial neoplasia traditionally separated into ductal and lobular types based on a combination of cytologic and architectural features. In general, distinction of the fully developed or classic lobular intraepithelial neoplasia (LIN) from various grades of ductal intraepithelial neoplasia. (DIN) is not a problem. An increasing number of lesions that appear to have intermediate, overlapping ductal and lobular features are being sent to us for consultation because of the distinctly different clinical implication of the 2 diagnoses. We have separated and designated these as MIN (mammary intraepithelial neoplasia, not otherwise specified), whereas others have categorized them into either a definitive ductal or lobular subtype. The recent findings that LIN lacks immunoreaction for E-cadherin coupled with significantly diminished to absent expression of the high molecular weight (HMW) cytokeratins in more than 90% of grade 1b or higher DIN prompted us to evaluate intraepithelial neoplasias for a possibly more precise immunohistochemical categorization. One hundred and ten examples of intraepithelial neoplasias, consisting of 40 classic LIN, 20 unequivocal DIN I c to DIN 3 (ductal carcinoma in situ), and 50 MIN, were acquired from the files of the Armed Forces Institute of Pathology. These specimens were tested with an antibody to E-cadherin and with antibody 34betaE12 reactive against HMW cytokeratins 1, 5, 10 and 14. All samples of LIN showed complete absence of reactivity with anti-E-cadherin, whereas all cases of DIN displayed a positive immunoreaction. In contrast, the DIN lesions displayed little or no reactivity with 34betaE12, whereas the lobular lesions showed cytoplasmic reactivity, often in a distinct perinuclear pattern. Twenty-three of the morphologically indeterminate cases could be classified as either ductal or lobular based on the immunoprofile, and 27 demonstrated an immunoprofile that differed from either typical DIN or classic LIN. Among the 27 MIN, I I were negative for both markers (negative hybrids), whereas 16 were positive for both markers (positive hybrids). These 2 antibodies in combination are extremely useful in distinguishing lobular and ductal lesions and clarifying the nature of some of the morphologically intermediate cases. Also, they have confirmed the presence of a group of intraepithelial lesions (MIN) with not only overlapping morphologic features, but also immunoprofiles distinctly different from either DIN or LIN. These MIN lesions may reflect either a transient stage in the development of DIN and LIN (the immediate post-stem cell stage) or a plastic group in transition from one type to the other. This group needs further evaluation for better understanding of its significance, pattern of progression, and behavior. This is a US government work. There are no restrictions on its use.