乳腺黏液癌神经内分泌分化和肾母细胞瘤蛋白1表达特征及其意义

摘要

Objective: To investigate neuroendocrine differentiation and Wilms ’ tumor protein-1 ( WT-1 ) expression in breast mucinous carcinoma and their clinicopathological significance.Methods: The clinicopathological data of 65 patients with breast mucinous carcinoma, including 31 cases of mixed mucinous carcinoma, 23 cases of hypocellular pure mucinous carcinoma and 11 cases of hypercellular pure mucinous carcinoma, admitted in Taizhou Hospital from January 2010 to June 2015 were retrospectively reviewed.The expression of neuroendocrine markers and WT-1 was detected by immunohistochemistry staining in all cases. Re sults: The mixed mucinous carcinomas and hypercelluar pure mucinous carcinomas had higher incidence of axillary lymph node metastasis and human epidermal recepter 2 ( HER-2 ) positive than hypocellular pure mucinous carcinoma (all P<0.01).However, the difference was not significant between mixed mucinous carcinomas and hypercellular pure mucinous carcinomas (all P>0.05).The expression of neuroendocrine marker was stronger in hypercellular mucinous carcinoma than that in mixed mucinous carcinoma and hypocellular mucinous carcinoma(all P<0.05), but the difference was not statistically significant between mixed mucinous carcinoma and hypocellular pure mucinous carcinoma ( P >0.05 ) .The expression of WT-1 was weaker in mixed mucinous carcinoma than that in hypercellular and hypocellular pure mucinous carcinoma( all P<0.05 ) , but the difference was not statistically significant between hypercellular and hypocellular pure mucinous carcinoma (P >0.05).The mucinous carcinomas with lymph node metastasis had lower expression of neuroendocrine markers than those without lymph node metastasis ( P<0 .01 ) .The expression of WT-1 in breast mucinous carcinoma with lymph node metastasis trended lower than that in those without lymph node metastasis, but the difference was not statistically significant ( P >0.05 ) . Conclus ion:Hypercellular pure mucinous breast carcinoma has higher rates of lymph node metastasis and HER-2 amplification than hypocellular pure mucinous carcinoma, the sub-classification of breast pure mucinous carcinoma should be considered . Neuroendocrine differentiation and WT-1 expression may be helpful in distinguishing the subtypes of breast mucinous carcinoma.Breast mucinous carcinoma with neuroendocrine differentiation trends to have less lymph node metastasis.%目的：分析乳腺黏液癌的临床病理特征并探讨其神经内分泌分化及肾母细胞瘤蛋白1（ WT-1）表达的意义。方法：收集并分析浙江省台州医院2010年1月至2015年6月连续诊断的65例乳腺黏液癌（混合型黏液癌31例、纯黏液癌细胞稀少型23例、纯黏液癌细胞丰富型11例）的临床病理特征，采用免疫组织化学染色法检测神经内分泌标志物及WT-1的表达。比较各型乳腺黏液癌神经内分泌标志物、WT-1的表达差异及其与淋巴结转移的关系。结果：混合型黏液癌和纯黏液癌细胞丰富型的淋巴结转移率、人表皮生长因子2（ HER-2）阳性率高于纯黏液癌细胞稀少型（均P＜0.01）。而混合型黏液癌的淋巴结转移率、HER-2阳性率与纯黏液癌细胞丰富型间差异无统计学意义（均P＞0.05）。各型黏液癌均有不同程度的神经内分泌分化和WT-1表达，三组间差异均有统计学意义（均P＜0.01）。进一步分析发现，纯黏液癌细胞丰富型的神经内分泌表达高于混合型黏液癌和纯黏液癌细胞稀少型（均P＜0.05），但混合型黏液癌与纯黏液癌细胞稀少型间差异无统计学意义（ P＞0.05）。混合型黏液癌的WT-1表达低于纯黏液癌细胞稀少型和纯黏液癌细胞丰富型（均P＜0．05），但纯黏液癌细胞丰富型与纯黏液癌细胞稀少型间差异无统计学意义（ P＞0.05）。乳腺黏液癌淋巴结转移组的神经内分泌标志物表达低于淋巴结无转移组（P＜0.01）， WT-1虽然在淋巴结转移组表达较低，但与淋巴结无转移组差异无统计学意义（ P＞0.05）。结论：纯黏液癌细胞丰富型比纯黏液癌细胞稀少型HER-2扩增率和淋巴结转移率高，因此纯黏液癌有必要进一步分类。检测乳腺黏液癌神经内分泌标志物及WT-1的表达对亚型分类有所帮助。有神经内分泌分化的乳腺黏液癌淋巴结转移率较低。