乳腺导管原位癌病理形态及c-erbB-2、p53和PCNA表达

目的：对乳腺导管原位癌进行病理形态分析，并行ｃ－ｅｒｂＢ－２、ｐ５３癌基因蛋白、增殖细胞核抗原（ＰＣＮＡ）表达以及相关性的研究，以期为临床判断潜在恶性程度及预后提供参考指标。方法：运用病理形态分析以及枸橼酸－微波－ＡＢＣ免疫组化法对２５例常规福尔马林固定、石蜡包埋乳腺导管原位癌组织进行回顾性研究。结果：（１）２５例乳腺原位导管癌ｃ－ｅｒｂＢ－２、ｐ５３、ＰＣＮＡ表达的阳性率分别为３６．０％，４０．０％和４０．０％；（２）粉刺型ｃ－ｅｒｂＢ－２、ｐ５３、ＰＣＮＡ表达的阳性率均高于非粉刺型，而且ｃ－ｅｒｂＢ－２阳性率相差有显著性（Ｐ＜０．０５）；（３）坏死、核异型性、核分裂数与ｃ－ｅｒｂＢ－２、ｐ５３、ＰＣＮＡ的表达有关，其中，坏死与ＰＣＮＡ阳性表达显著相关（Ｐ＜０．０５），核异型性与ｃ－ｅｒｂＢ－２蛋白表达显著相关（Ｐ＜０．０５）。结论：乳腺导管原位癌无论病理形态还是生物学行为都是异质性的，除了组织学亚型，某些形态指标以及ｃ－ｅｒｂＢ－２癌基因蛋白的表达也可作为恶性度指标。

Histologic features and c erbB 2, p53, PCNA expression of breast ductal carcinoma in situ

Purpose The purpose of current study in breast ductal carcinoma in situ (DCIS) is to provide reliable parameters of prognosis and potential malignancy for the treatment of these patients. Methods Twenty five cases of breast ductal carcinoma in situ were studied using histologic features analysis and Citric Acid Microwave ABC immunohistochemical methods with the antibodies c erbB 2, p53 and PCNA. Results The immunoreactivity for c erbB 2, p53 and PCNA in this group was 36 0% , 40 0% and 40 0%, respectively. The expression of c erbB 2, p53 and PCNA in comedo type was higher than in non comedo type. There was a significant difference in the expression of c erbB 2 ( P <0 05). Necrosis, nuclear pleomorphism and mitotic rate were positively related with the expression of c erbB 2, p53 and PCNA. The present of necrosis has a significant relationship with the positivity of PCNA ( P <0 05), and marked pleomorphism was significantly related with the expression of c erbB 2 ( P <0 05). Conclusions Breast ductal carcinoma in situ is morphologic and biologic heterogeneity. Besides histologic classification, nuclear pleomorphism and c erbB 2 expression may constitute additional criteria of high grade of malignancy.