乳腺髓样癌HER．2基因扩增与临床病理因素相关性分析

目的：总结分析荧光原位杂交（fluorescenceinsituhybridization,FISH）技术检测乳腺髓样癌HER-2基因扩增的经验和临床病理学意义。方法：用FISH和免疫组化技术诊断32例乳腺髓样癌患者HER-2基因状态,并分析典型髓样癌和非典型髓样癌HER-2基因扩增的关系。结果：乳腺髓样癌HER-2基因扩增阳性率为37．5％（12／32）,其中典型髓样癌为7．7％（1／13）,非典型髓样癌为57．9％（1l／19）。HERu2基因扩增与髓样癌肿瘤类型（P=0．008）、肿瘤大小（P=0．040）、淋巴结转移（P=0．006）、临床分期（P=0．037）、HER-2蛋白表达（P=0．0001）和p53蛋白表达（P=0．015）有关,与患者年龄（．P=0．438）、ER（P=0．081）和PR（P=0．517）无关。乳腺髓样癌类型与HER-2蛋白表达有关（P=0．010）,与患者年龄（P=0．426）、肿瘤大小（P=0．786）、淋巴结转移（P=0．115）、临床分期（P=0．129）、ER（P=0．116）、PR（P=0．773）和p53（P=0．280）无关。结论：HER-2基因扩增可能参与乳腺髓样癌的演化与进展,乳腺典型髓样癌与非典型髓样癌的HER-2基因扩增有显著性差异,临床应用FISH技术诊断HER-2基因扩增靶标有助于指导乳腺非典型髓样癌-妁分子靶向治疗。     

CD44V6、E-cadherin和nm23-H1在肾细胞癌中的表达及意义

目的　探讨CD44V 6、E cadherinhe和nm 2 3 H 1蛋白表达与肾细胞癌 (RCC)的发生、发展及转移的关系。方法　采用免疫组化SP方法 ,检测 46例肾细胞癌组织和 10例正常肾组织中CD44V 6、E cadherin和nm 2 3 H 1蛋白的表达情况。结果　CD 44V 6蛋白在肾细胞癌组织中的阳性表达率为 2 6.1% ,CD 44V 6高表达与肾细胞癌脉管浸润转移呈正相关 (P <0 .0 5 )。nm 2 3 H 1和E cadherin蛋白在肾细胞癌组织中阳性表达率分别为 2 3 .9%和 5 8.7% ,显著低于正常肾组织 ( 10 0 .0 % ) (P <0 .0 1)。nm 2 3 H 1和E cadherin阳性表达与肾细胞癌的组织学分级相关 (P <0 .0 5 )。CD 44V 6、E cadherin、nm 2 3 H 1阳性表达与肾细胞癌组织学分型和肿瘤大小无关 (P >0 .0 5 )。结论　CD44V 6蛋白高表达和E cadherin、nm 2 3 H 1蛋白低表达是判断肾细胞癌的生物学行为的良好指标。     

CD44v6、E-cadherin蛋白表达与大肠癌浸润转移的关系

目的　探讨CD44v6和E cadherin(E cad)蛋白表达与大肠癌浸润转移的关系及相关性。方法　应用催化信号放大系统免疫组织化学技术 ,检测 90例大肠癌组织中CD44v6和E cadherin蛋白表达。结果　 90例大肠癌CD44v6和E cadherin蛋白阳性表达率分别为 75 .6%和 46.7%。CD44v6高表达及E cad低表达与大肠癌Dukes分期、浆膜浸润、淋巴结转移、肝脏转移均呈正相关 (P <0 .0 5 )。大肠癌中CD44v6表达与E cad表达呈负相关 (r =-0 .43 ,P <0 .0 0 5 )。结论　CD44v6和E cad表达具有负调节的协同作用。CD44v6和E cad表达与大肠癌浸润转移密切相关。检测CD44v6和E cad蛋白表达可作为判断大肠癌预后的客观指标。     

甲状腺肿瘤中CD44v6的表达及临床意义

目的 :研究甲状腺癌组织中CD44v6抗原的表达情况及其临床意义。方法 :应用微波—LSAB免疫组织化学法 ,检测 5 0例甲状腺癌、45例甲状腺腺瘤和 2 0例癌旁甲状腺组织中CD44v6的表达。结果 :在甲状腺癌中CD44v6表达阳性率为 6 4 0 % ,显著高于甲状腺腺瘤 (37 0 % )和癌旁甲状腺 (2 5 0 % ,P <0 0 5 )。CD44v6表达与甲状腺癌组织类型无关 ,在淋巴结转移病例和病理分期Ⅲ～Ⅳ期病例 ,CD44v6表达阳性率显著高于相应的无淋巴结转移病例和病理分期Ⅰ～Ⅱ期病例 (P <0 0 5 )。CD44v6阳性的甲状腺癌复发及死亡率显著高于CD44v6阴性的甲状腺癌复发和死亡率 (P <0 0 5 )。结论 :CD44v6表达对甲状腺癌恶性程度判断、生物学行为预测和预后评估是一种很有意义的客观指标。     

乳腺癌组织中CD44v6和MMP-2的表达及其与淋巴结转移的关系

目的:检测CD44v6、MMP-2在乳腺浸润性导管癌中的表达情况,探讨它们与淋巴结转移的关系。方法:采用免疫组化SP法检测100例乳腺浸润性导管癌中CD44v6、MMP-2的表达情况。结果:CD44v6蛋白在正常乳腺组织及乳腺浸润性导管癌中的阳性表达率分别为12.5%(5/40)、87%(87/100),CD44v6在淋巴结转移组中的阳性表达率(56/60)明显高于无淋巴结转移组(P<0.05)。MMP-2蛋白在正常乳腺组织及乳腺浸润性导管癌中的阳性表达率分别为0(0/40)、94%(94/100),MMP-2在淋巴结转移组中的阳性表达率(59/60)明显高于无淋巴结转移组(P<0.05)。结论:CD44v6、MMP-2蛋白在乳腺浸润性导管癌组织高表达,且均与淋巴结转移有关(P<0.05),联合检测CD44v6与MMP-2有助于综合判断乳腺浸润性导管癌的恶性程度和转移潜能。     

CD44v6和E-cadherin表达与乳腺癌生物学行为的关系

目的 :探讨CD4 4v6和E cadherin(E Cad)表达与乳腺癌临床病理生物学行为的关系 ,以及它们之间的相关性。方法 :应用催化信号放大系统免疫组化方法 ,对 94例乳腺癌组织进行CD4 4v6和E Cad蛋白检测。结果 :CD4 4v6阳性表达及E Cad阴性表达均与乳腺癌的组织学分级、临床分期、淋巴结转移、复发和预后呈正相关 (P <0 0 5 )。乳腺癌中CD4 4v6表达与E Cad表达呈负相关 (P <0 0 5 )。结论 :CD4 4v6表达与E Cad表达具有负调节的协同作用。CD4 4v6和E Cad表达对估计乳腺癌淋巴结转移及患者生存期有重要意义 ,可作为判断乳腺癌的转移和预后的参考指标     

甲状腺髓样癌临床病理分析

目的:探讨甲状腺髓样癌(MTC)的临床病理特点、免疫表型及电镜诊断特点。方法:回顾性分析10例甲状腺髓样癌的临床资料,采用免疫组化、组织化学方法研究其病理形态特点,结合文献分析甲状腺髓样癌的电镜诊断特点。结果:散发型甲状腺髓样癌8例,家族型甲状腺髓样癌2例,6例淋巴结转移;9例肿瘤间质刚果红染色( );免疫组化:癌组织中降钙素( )10例、铬粒素A( )10例、突触素( )7例,1例见甲状腺球蛋白阳性细胞,CD44V6在髓样癌中的阳性表达率为60%;电镜下见癌细胞胞质内有大小不一的神经内分泌颗粒。结论:MTC具有多分化肿瘤的特点,可产生多种神经内分泌物质;其诊断依赖于组织病理学、免疫组化和组织化学,电镜在MTC的诊断中有重要价值;降钙素(CT)是其特异性标记物;CD44V6的高表达与MTC的颈部淋巴结转移密切相关。     

食管鳞癌中CD44v4/5、CD44v6的表达与浸润转移的关系

目的　探讨食管鳞癌中CD44v4/5、CD44v6的表达与浸润转移的关系。方法　用免疫组化LSAB法检测了 42例食管鳞癌中CD44v4/5、CD44v6的表达。结果　CD44v4/5在淋巴结转移组的阳性表达率为 76 19% (16/2 1) ,而在非转移组的阳性表达率为42 86% (9/2 1) ,两组之间差异显著 (P <0 0 5 )。CD44v6在淋巴结转移组的阳性表达率为 71 43 % (15 /2 1) ,而在非转移组阳性表达率为 3 8 0 9% (8/2 1) ,两组之间亦具有显著差异 (P <0 0 5 )。从Ⅰ级癌到Ⅲ级癌 ,CD44v4/5的阳性率依次为 69 2 3 % (9/13 )、64 71%(11/17)和 41 67% (5 /12 ) ,彼此间无显著差异 (P >0 0 5 )。CD44v6的阳性率依次为 76 92 % (10 /13 )、5 2 94% (9/17)、3 3 3 3 % (4 /12 ) ,各组之间无显著差异 (P >0 0 5 )。CD44v4/5和CD44v6的阳性率之间差异无显著性 ,也无相关关系。癌巢周围向间质浸润的癌细胞、肌间浸润的癌细胞 ,有核分裂的癌细胞和癌栓中的癌细胞及浸润血管壁的癌细胞CD44v4/5和CD44v6均呈强阳性表达。结论　CD44v4/5和CD44v6的表达均与食管鳞癌浸润转移有关。     

CD44v6在乳腺癌中的表达及其临床意义

目的 :探讨 CD4 4v6 在乳腺癌中的表达及其临床意义。方法 :应用免疫组织化学 S- P法分别检测 CD4 4v6 在 5例正常乳腺组织和 6 4例乳腺癌组织中的表达 ,分析它的表达与乳腺癌临床病理因素的关系。结果 :CD4 4v6 在正常乳腺导管上皮细胞和腺泡上皮细胞呈阴性表达 ,而在肌上皮细胞呈强阳性表达 ;CD4 4v6 表达和淋巴结有无转移、ER、PR有关 (P<0 .0 0 1和 P<0 .0 5 ) ,CD4 4v6 表达阴性患者 5年生存率高于阳性者 ,差异有显著性意义 (P<0 .0 5 ) ,而与患者年龄、月经状态、肿瘤大小、TNM分期、组织学类型、组织学分级无关。结论 :CD4 4v6 在乳腺癌浸润和转移中可能起重要作用 ,可作为一个预后指标     

乳腺癌组织中CD44v6和MMP-2的表达及其与淋巴结转移的关系

目的：检测CD44v6、MMP-2在乳腺浸润性导管癌中的表达情况,探讨它们与淋巴结转移的关系。方法：采用免疫组化SP法检测100例乳腺浸润性导管癌中CD44v6、MMP-2的表达情况。结果：CD44v6蛋白在正常乳腺组织及乳腺浸润性导管癌中的阳性表达率分别为12．5％（5／40）、87％（87／100）,CD44v6在淋巴结转移组中的阳性表达率（56／60）明显高于无淋巴结转移组（P〈0．05）。MMP-2蛋白在正常乳腺组织及乳腺浸润性导管癌中的阳性表达率分别为0（0／40）、94％（94／100）,MMP-2在淋巴结转移组中的阳性表达率（59／60）明显高于无淋巴结转移组（P〈0．05）。结论：CD44v6、MMP-2蛋白在乳腺浸润性导管癌组织高表达,且均与淋巴结转移有关（P〈0．05）,联合检测CD44v6与MMP-2有助于综合判断乳腺浸润性导管癌的恶性程度和转移潜能。     

乳腺髓样癌的X线表现

目的 研究乳腺髓样癌的X线表现,并比较不同病理分型的X线特点,提高对该病的影像诊断水平.方法 回顾性分析经手术病理证实、有完整乳腺X线资料的乳腺髓样癌32例共33个病灶,其中典型髓样癌27个病灶,不典型髓样癌6个病灶;观察其X线特点.结果 33个病灶中表现为不伴钙化的肿块30个(90.9%),伴钙化肿块2个(6.1%)...     

Medullary breast carcinoma. A reevaluation of 95 cases of breast cancer with inflammatory stroma

The hallmarks of diagnosis of medullary breast cancer (MedBC) used by the authors since 1977 have been that the tumor is well circumscribed, has syncytial architecture in greater than 75% of its surface, contains diffuse inflammatory infiltrate, has atypical nuclei, and forms no glandular pattern. In order to assess the clinical utility of these criteria, we studied a series of 95 previously untreated, surgically operable patients with breast carcinoma at the Institut Gustave-Roussy (IGR) between 1960 and 1979. A diagnosis of MedBC was initially made for these patients or suspected based on abundant inflammatory stroma observed in a histologic evaluation. Using these criteria, 26 cases were identified as typical medullary carcinoma (TMC), 23 cases as atypical medullary carcinoma (AMC), and 46 cases as nonmedullary carcinoma (NMC). The 26 cases of TMC represent a very small fraction of the total infiltrating operable breast carcinomas diagnosed at IGR during the same time period. The prognosis for these 26 patients was much more favorable than for the other groups. They had a 10-year disease-free survival of 92% compared with 53% for the AMC group and 51% for the NMC group. Neither distant metastasis nor secondary primaries of the same histology were seen. Therefore, it is possible with the use of strict histologic criteria to distinguish a group of patients with a much more favorable prognosis. This histologic diagnosis alone renders a most favorable prognosis for the patient even if other factors such as large tumor size and lymph node involvement are present and, by inference, the only therapy needed is the removal of all tumor. In contrast, atypical forms have a prognosis no different from other atypical types of breast carcinomas without inflammatory stroma, and adjuvant therapy appears to be justified if other factors warrant it.     

A study of high-nuclear-grade breast cancer in Thailand: subclassification and correlation with prognostic factors and immunohistochemical study

Objectives  

To classify high-nuclear-grade breast cancer (BC) into typical medullary carcinoma (TMC), atypical medullary carcinoma (AMC), and non-medullary carcinoma (NMC), and luminal A, luminal B, and HER2, and to correlate these tumors with other prognostic factors.     

The prognostic significance of inflammation and medullary histological type in invasive carcinoma of the breast

The new gene expression molecular taxonomy of breast cancer places medullary carcinoma in the basal group. The basal group is considered to have a poor prognosis, but medullary carcinoma is considered to have a better prognosis than other grade 3 carcinomas. The prognostic significance of tumour associated inflammation, an important feature of medullary carcinomas, remains controversial. The aim of this study was to assess the prognostic importance of medullary histological type and inflammation in breast cancer. One thousand five hundred and ninety-seven patients who received no systemic adjuvant treatment and who had a median follow up of 9.5 years were studied. Results: Prominent inflammation was associated with high histological grade and with better survival [relative risk (RR) 0.57, 95% confidence intervals (CI) 0.44–0.74] on multivariate analysis. Typical and atypical medullary carcinomas (n = 132) did not have significantly different survival and were grouped together. Medullary carcinoma did not have significantly different prognosis than grade 3 ductal carcinoma with prominent inflammation, but both had a better prognosis than grade 3 ductal carcinoma without prominent inflammation (P < 0.0001 and P = 0.03). These differences were independent of other prognostic factors. These results question the current separation of typical and atypical medullary carcinoma. Prominent inflammation is associated with a better prognosis, and may explain the better prognosis in medullary carcinoma compared with grade 3 ductal carcinoma without prominent inflammation. The good prognosis of medullary carcinoma emphasises the heterogeneity of basal-like breast carcinomas. Further studies are needed to investigate the difference in survival between medullary carcinoma and other forms of basal carcinomas and the role of inflammation in any such differences in behaviour.     

P27kip1和cyclinE在子宫内膜癌中的表达及其意义

 目的　探讨P2 7kip1、cyclinE的表达与子宫内膜癌发生发展的关系。 方法　用免疫组化方法检测P2 7kip1和cyclinE在 4 0例子宫内膜癌、10例子宫内膜不典型增生、2 0例正常子宫内膜组织中的表达。结果　P2 7kip1在正常子宫内膜、内膜不典型增生、子宫内膜癌中的表达率分别为 90 %、70 %、6 2 .5 % ,其中子宫内膜癌与正常子宫内膜差异有显著性 (P <0 .0 5 )。cyclinE表达阳性率子宫内膜癌组显著高于内膜不典型增生组和正常子宫内膜组 (P <0 .0 5 )。P2 7kip1表达与子宫内膜癌的组织学分级、手术分期有关 (P <0 .0 5 )。P2 7kip1与cyclinE表达呈负相关。 结论　P2 7kip1、cyclinE在子宫内膜癌发生中可能起一定作用 ,P2 7kip1还与子宫内膜癌的进展有关 ,并可能成为判断预后的有用指标。     

PTEN和CyclinA蛋白在子宫内膜癌组织中的表达及临床意义

目的：探讨PTEN和CyclinA在子宫内膜癌中的表达及其在癌发生发展中的作用。方法：采用免疫组化SP法检测PTEN和CyclinA蛋白在30例正常子宫内膜、30例子宫内膜增生、20例子宫内膜不典型性增生、55例子宫内膜癌组织中的表达。结果：不典型增生组和子宫内膜癌组中PTEN阳性表达率分别为55．00％（11／20）、45．45％（25／55），与全部为阳性表达的正常内膜及阳性表达率为90．00％（27／30）的子宫内膜增生组比较，不典型增生组和癌组中PTEN阳性表达均显著低于正常子宫内膜和子宫内膜增生组（P〈0．05）。CyclinA在不典型增生组和癌组中阳性表达率分别为45．00％（9／20）、67．27％（37／55），显著高于全部阴性表达的正常子宫内膜组和子宫内膜增生组（10．00％，3／30）（P〈0．05）。两者在不典型增生和子宫内膜癌组中的表达均呈显著性负相关（r=-0．5330，r=-0．5556；P〈0．001）。癌组中PTEN阳性表达的缺失与组织学分级有关（P〈0．05），但与肿瘤的浸润转移、临床分期和复发无关（P〉0．05）；CyclinA的阳性表达率与组织学分级、肿瘤的浸润转移和临床分期、复发有关。结论：PTEN表达缺失和CyclinA的过度表达涉及子宫内膜癌的发生、发展过程，二者联合检测可作为子宫内膜癌早期诊断、判断肿瘤生物学行为的免疫学指标。     

Medullary carcinoma of the thyroid with atypical patterns.

A case of a highly invasive thyroid carcinoma, which occurred in a 68-year-old woman, was studied by light and electron microscopy, and histochemical and biochemical analysis. Light microscopical, histochemical, and biochemical features were consistent with a diagnosis of a calcitonin-producing, amyloid-rich medullary carcinoma; electron microscopical patterns, mainly the presence of lumina, microvilli, and extensively dilated cytoplasmic E.R., were reminiscent of the ultrastructural features of the follicular carcinoma. Electron-dense bodies interpreted as "secretory granules" were very scarce. This case appears very similar to the case recently presented by Valenta et al. and interpreted as a microfollicular carcinoma. The atypical features of our case of MCT seem to indicate that this tumor should be included in a group of atypical MCT; these should be kept separate from the typical (differentiated) ones on morphological, functional, and prognostic grounds.     

Immunohistochemical differentiation of atypical hyperplasia vs. carcinoma in situ of the breast.

The distinction between atypical hyperplasia and carcinoma in situ in breast lesions can be difficult. The identification of myoepithelial cell layers may be helpful in establishing a diagnosis of proliferative breast disease vs. intraepithelial neoplasia. We reviewed pathologic material on 20 cases of atypical hyperplasia and 29 cases of carcinoma in situ. Immunohistochemical stains were employed against muscle-specific actin, S-100 protein, and cytokeratin to identify myoepithelial cells and to recognize different staining patterns. In atypical hyperplasia, muscle-specific actin staining identified myoepithelial cells in fine branching fibrovascular layers or as scattered cells between other proliferating cells. This pattern was absent in carcinoma in situ. S-100 protein showed more positive staining in atypical hyperplasia than in carcinoma in situ with patterns distinct from muscle-specific actin. Immunostaining for cytokeratin demonstrated distinctly different patterns between the two lesions. This study suggests that muscle-specific actin, S-100 protein, and cytokeratin in combination may assist in distinguishing proliferative breast disease with atypia from carcinoma in situ.     

The distribution of carcinoembryonic antigen in breast carcinoma. Diagnostic and prognostic implications

Carcinoembryonic antigen (CEA) has been shown to be a useful tumor marker in patients with breast carcinoma. The unlabeled antibody immunoperoxidase technique was used to localize CEA in 93 cases of primary breast carcinoma, 15 cases of atypical duct papillomatosis, and 4 cases of duct papilloma. Normal breast epithelium and breast epithelium in fibrocystic disease did not stain positively for CEA. Twenty-four of 27 (88%) intraductal carcinomas, and 47 of 69 (68%) infiltrating duct carcinomas were CEA positive. In contrast, only 5 of 21 (23%) in situ lobular carcinomas and 8 of 24 (33%) infiltrating lobular carcinomas were positive for CEA. All 15 cases of atypical epithelial papillomatosis were negative, whereas 1 of the 4 cases of duct papilloma exhibited microscopic foci of weak CEA positivity. There was a trend for infiltrating duct carcinomas, 3 cm in diameter or smaller, staining strongly positive for CEA, to be associated with synchronous axillary lymph node metastases (P = 0.09). Tumor heterogeneity was a constant feature of CEA staining with positivity varying from region to region and even from cell to cell. Positive immunohistochemical staining for CEA may play an adjunctive role in discriminating intraductal carcinoma from atypical papillary ductal proliferations.