p16和cyclinD1在乳腺导管非典型增生癌变过程中的表达

目的 探讨乳腺导管非典型增生癌变过程中p16和cyclinD1的变化及其相互关系。方法 应用免疫组织化学方法检溯p16、cyclin成在乳腺各组病变中的蛋白表达情况。结果 乳腺导管单纯性增生、非典型增生组织中p16蛋白表达率明显高于乳腺癌组织,差异有显性。cyclinD1在中,重度非典型增生组表达最为明显,且与乳腺导管单纯性增生组及轻度非典型增生组比较,差异均有显性。p16、cyclinD1蛋白在乳腺各组病变中表达呈负相关关系。结论 p16、cyclinDl在乳腺增生性病变中呈现不同程度表达,其表达强度在一定程度上与细胞的恶性倾向有关,检测其表达水平可作为乳腺导管非典型增生组织恶性转化的一个客观检测指标。其中,cyclinD1蛋白可能是乳腺癌发生过程中的早期分子事件,可作为临床早期发现乳腺癌的免疫学指标。     

乳腺浸润性导管癌组织中CAS蛋白表达的临床病理意义

目的研究乳腺浸润性导管癌组织中细胞凋亡易感蛋白（CAS）表达的临床病理意义。方法选取乳腺浸润性导管癌53例、普通导管增生20例、异型导管增生20例、导管原位癌10例、正常乳腺组织14例,应用免疫组化方法观察CAS蛋白的表达,并探讨CAS与乳腺癌临床病理因素的关系,分析CAS和HER2、ER、PR以及ki-67指数的关系。结果 CAS在正常乳腺、普通导管增生、异型导管增生、导管原位癌、浸润性导管癌中的阳性率逐渐升高,分别为14.3%、25.0%、40.0%、60%、75.5%（P=0.000）,CAS、HER2均与乳腺癌组织学分级、核分裂像、淋巴结转移有关;CAS评分与ki-67指数（r=0.439,P=0.003）和HER2评分（r=0.598,P=0.000）正相关。结论 CAS与乳腺癌的发生、发展、增殖、淋巴结转移有关,可能作为反映乳腺癌生物学行为的肿瘤标记物,CAS蛋白的表达和HER2有一定的相关性。     

磷脂酰肌醇3-激酶在乳腺导管不典型增生癌变过程中的表达和意义

目的探讨乳腺导管不典型增生癌变过程中PI3-K p85调节亚单位的变化.方法应用免疫组织化学S-P方法检测PI3-K p85调节亚单位在乳腺正常组织及各组病变中的蛋白表达情况.结果 PI3-K p85催化亚单位在乳腺癌组表达最为明显,其阳性表达率明显高于乳腺导管单纯性增生、不典型增生组织,差异有显著性.结论 PI3-K的表达强度在一定程度上与细胞的恶性倾向有关,可能是乳腺癌发生过程中的晚期分子事件;以PI3-K信号成分作为直接切入点设计药物将为乳腺癌的治疗提供新的靶点.     

乳腺癌及良性乳腺组织p185和p16蛋白表达的免疫组织化学研究

应用免疫组化S P法检测了 37例良性乳腺组织 (非上皮增生组 17例、上皮增生组 2 0例 )和 5 9例乳腺癌组织中癌基因蛋白 p185和抑癌基因 p16蛋白的表达状况。结果显示非上皮增生组、上皮增生组和癌的p185阳性率分别为 0 %、15 %和 47%(p <0 0 1) ;p16阳性率分别为 41%、30 %和 34%。p185和p16的表达无明显相关性。乳腺癌早期的 p185过表达和p16失表达率高于浸润性导管癌。两者的阳性率均随组织学级别的增高和瘤体的增大而呈上升趋势 ,但 p >0 0 5。淋巴结转移组的p185阳性率 ( 6 4%)明显高于无淋巴结转移者 ( 32 %) ,p <0 0 5。表明 p185过表达和p16失表达在乳腺癌的发生发展中各自发挥独立的作用。p185是乳腺癌重要的肿瘤标志物。     

乳腺癌组织中VEGF—C和p38MAPK的表达及与伴淋巴结转移的关系

目的探讨乳腺浸润性导管癌组织中血管内皮生长因子C（VEGF—C）和丝裂原激活蛋白激酶p38（p38MAPK）的表达关系,以及与乳腺浸润性导管癌淋巴结转移等生物学行为的关系。方法采用免疫组织化学sP法检测70例乳腺浸润性导管癌组织及15例癌旁正常组织中VEGF-C和p38MAPK蛋白的表达,并采用Westernblot法检测13例伴有淋巴结转移的乳腺癌及12例无淋巴结转移的乳腺癌的新鲜组织中VEGF—C和p38MAPK蛋白表达。结果VEGF—C和p38MAPK在乳腺浸润性导管癌组织中的表达（阳性率分别为67．0％和61．4％）明显高于癌旁正常组织;VEGF-C和p38MAPK蛋白在伴有淋巴结转移组的乳腺癌组织中的表达均高于无淋巴结转移组（P=0．005,P=0．005）;在乳腺浸润性导管癌组织中VEGF-C和p38MAPK表达存在显著正相关（r=0．383,P=0．001）,并与乳腺浸润性导管癌的TNM分期（P=0．019,P=0．010）有关;VEGF-C和p38MAPK蛋白表达与乳腺浸润性导管癌肿块的大小（P=0．203,P=0．086）和患者的年龄（P=0．0．266,P=0．087）无明显关系。Western blot也证实,VEGF-C和p38MAPK蛋白在有淋巴结转移组中表达高于无淋巴结转移组。结论VEGF-C和p38MAPK的蛋白表达与乳腺浸润性导管癌的淋巴结转移密切相关,其有望成为乳腺癌治疗的新靶点。     

Snail mRNA及其蛋白在乳腺癌中的表达研究

目的观察Snail蛋白及mRNA在人乳腺癌组织中的表达及其与临床病理特征的关系,并探讨它在乳腺癌发生、发展及转移中的作用。方法应用SP免疫组织化学和原位分子杂交方法检测Snail蛋白和Snail mRNA在70例乳腺浸润性导管癌、30例乳腺导管内癌、30例乳腺单纯性增生组织中的表达。结果①70例乳腺癌中,Snail蛋白和Snail mRNA阳性率分别为87.2%(61/70)、81.4%(57/70),分别高于乳腺导管内癌组织53.3%(16/30)、46.7%(14/30)和乳腺单纯性增生组织26.7%(8/30)、23.3%(7/30),三者相比有统计学意义(χ2=36.4,P<0.01;χ2=32.4,P<0.01)。②Snail蛋白和SnailmRNA在有淋巴结转移组中的阳性率为97.6%(40/41)、95.1%(39/41),无转移组阳性率为72.4%(21/29)、62.1%(18/29),两者相比有统计学意义(χ2=8.29,P<0.01);组织学分级Ⅲ级组明显高于Ⅰ、Ⅱ级组表达,但无统计学意义(χ2=0.72,P>0.05;χ2=0.98,P>0.05)。③Snail蛋白与Snail mRNA的表达与年龄、肿瘤大小均无关(P>0.05)。结论 Snail蛋白与Snail mRNA的表达呈正相关,与乳腺癌的发生发展、淋巴结转移密切相关,可作为判断乳腺癌预后、转移的生物学标志。     

乳腺癌及癌前病变血管生成相关分子的表达及意义

目的探讨血管生成异常与乳腺癌发生发展的关系。方法采用免疫组化方法检测30例正常乳腺,30例普通性增生,30例非典型增生（AH）,20例导管内癌,50例浸润性导管癌组织中微血管密度（MVD）、VEGF及受体Flk-1/KDR的表达变化。结果各组CD34、VEGF及Flk-1/KDR的表达程度不同,浸润性导管癌组最高。随病程演进,MVD增加（P〈0.05）,VEGF及其受体Flk-1/KDR在血管内皮细胞表达渐进增高（P〈0.05）,但在病程初期各主要指标改变不明显,显著变化始于AH阶段。MVD在AH与导管内癌组间差异不显著（P〉0.05）,VEGF及Flk-1/KDR的表达在AH与导管内癌组间有显著差异（P〈0.05）。结论血管生成在乳腺癌发生发展过程中起着重要作用,血管生成异常可能是乳腺癌发生过程中的早期事件。VEGF及其受体Flk-1/KDR的表达异常可能是乳腺普通性增生-AH-乳腺癌这一癌性转化过程中血管生成异常的主要始动因素,VEGF及其受体Flk-1/KDR可能成为乳腺癌早期诊断及治疗的分子靶标。     

B 超引导下乳腺肿块粗针穿刺诊断的分析(附120 例报道）

目的：探讨B 超引导下粗针穿刺在乳腺肿块诊断中的应用意义。方法：使用B 超引导下粗针吸取穿刺对120 例乳腺肿块进 行穿刺活检,然后进行固定,脱水,染色,镜检,结合临床作出病理学诊断。结果：粗针穿刺诊断包括良性病变48 例,非典型性导管 上皮增生（ADH)32 例,导管内癌12 例,浸润性癌28 例。与后续手术标本病理诊断比较得出确诊率,其中良性病变的诊断率为 95.83%（46/48）,ADH 的确诊率为75%（24/32）,导管内癌的确诊率为58.33%（7/12）,浸润性癌诊断率为92.86%（26/28）,其中导管 内癌与浸润性导管癌和乳腺良性病变的确诊率有显著性差异,而ADH 与浸润性导管癌和乳腺良性病变间的确诊率有差异,但本 组数据没有统计学意义。结论：超声引导下粗针穿刺对乳腺浸润性癌和良性病变的诊断率较高,但对ADH和原位癌的确诊率较 低,有待进一步改进。     

MUC1粘蛋白在乳腺肿瘤中的表达及其生物学意义

目的　探讨MIC1粘蛋白在乳腺肿瘤组织中的表达特征及其生物学和临床意义。方法　应用免疫组织化学ABC法对 15例乳腺非典型增生 ,15例乳腺良性肿瘤 ,44例乳腺癌 (2 1例含癌旁组织 )染色 ,观察MUC1在不同类型乳腺组织中的表达特征及其与雌激素受体和孕激素受体表达的关系。结果　MUC1在所检测的乳腺组织中均表达 ,但在不同病变乳腺组织中其表达的方式和强度不同。在癌旁和非典型增生组织中只表达在近管腔或腺腔侧的胞膜上 ,胞浆未见表达。在乳腺癌组织中整个胞膜和胞浆均表达 ,且表达强度与细胞的恶性化程度成正相关 (P <0 0 1)。浸润性癌中MUC1表达明显强于原位癌 (P <0 0 0 5 ) ;乳腺癌组织中MUC1的表达强度与雌激素受体的表达成正相关 (P <0 0 5 ) ,与孕激素受体表达无关 (P >0 0 5 )。乳腺癌组织中MUC1有旁分泌现象。结论　MUC1表达水平可反映乳腺肿瘤恶性化程度 ,并可能作为乳腺癌治疗效果判断和预后评价的参考指标。     

血管内皮生长因子-C与乳腺癌淋巴管生成和淋巴结转移的关系

目的探讨血管内皮生长因子-C与乳腺癌淋巴管生成和淋巴结转移的关系。方法免疫组化法检测21例乳腺增生组和68例乳腺浸润性导管癌组病灶组织内VEGF-C蛋白的表达,并用淋巴管内皮细胞特异性标志物D2-40标记肿瘤新生淋巴管,计数肿瘤淋巴管的密度（LVD）。结果乳腺浸润性导管癌组VEGF-C的表达和淋巴管的密度（LVD）都明显高于乳腺增生组（P〈0．01）;乳腺浸润性导管癌中VEGF-C阳性组中淋巴管的密度（11．32±5．78）与VEGF-C阴性组中的淋巴管密度（8．75±3．53）,差别有统计学意义（P〈0．01）;乳腺浸润性导管癌中VEGF-C蛋白的表达和淋巴管密度（LVD）都与有无腋窝淋巴结转移及淋巴结转移个数有关（P〈0．05）。结论VEGF-C在乳腺浸润性导管癌淋巴管的生成中起着重要的作用;VEGF-C的高表达和淋巴管密度（LVD）的升高是促进乳腺导管癌淋巴结转移的重要的影响因素。     

Genetic alterations in presumptive precursor lesions of breast carcinomas.

The hypothetical multistep model of breast carcinogenesis suggests a transition from normal epithelium to invasive carcinoma via intraductal hyperplasia (without and with atypia) and in situ carcinoma. These presumptive precursor lesions are currently defined by their histological features, and their prognosis is imprecisely estimated from indirect epidemiological evidence. Cytogenetic and molecular-genetic analysis of these lesions give evidence for an accumulation of various genetic alterations during breast tumorigenesis. Using immuno-histochemistry overexpression of the c-erbB-2 oncogene was found in ductal carcinoma in situ (DCIS), but not in atypical intraductal hyperplasia (AIDH) and intraductal hyperplasia (IDH). An expression of mutant p53 tumor suppressor gene as well as expression of cyclin D1 was identified in DCIS. In IDH lesions loss of heterozygosity (LOH) at various loci could be identified, and comparative genomic hybridization (CGH) and fluorescence in situ hybridization (FISH) studies delivered evidence for DNA amplification on chromosomal region 20q13 in the early stage of IDH.However, little is currently known about genetic alterations in those premalignant lesions, and the chronology of genetic alterations and histopathological changes during carcinogenesis is mainly undiscovered.     

Aromatase and in situ estrogen production in DCIS (ductal carcinoma in situ) of human breast

Ductal carcinoma in situ or DCIS belongs to intraductal proliferative lesions, which are a group of cytologically and architecturally diverse ductal proliferations, typically originating from the terminal duct–lobular units. In these intraductal proliferative diseases, estrogens are considered to be involved in the progression of the disease especially from ductal non-neoplastic hyperplasia to DCIS and possibly development of invasive carcinoma from DCIS. Estrogen receptor (ER) alpha is abundantly expressed in atypical ductal hyperplasia and low grade DCIS. Suppression of estrogenic actions using tamoxifen resulted in inhibition of recurrence of DCIS and/or of progression into invasive carcinoma. Intratumoral estrogen concentration in DCIS determined by liquid chromatography/electrospray tandem mass spectrometry is significantly higher than that in non-neoplastic breast tissues with statistically not lower than that in invasive carcinoma. Aromatase mRNA expression in both stromal and parenchymal cells of DCIS determined by quantitative RT-PCR following laser capture microdissection was also much higher than that in non-neoplastic breast, although lower than that in invasive carcinoma. Immunohistochemistry of aromatase also revealed the similar patterns of immunolocalization as in invasive carcinoma. Aromatase is overexpressed in noninvasive breast malignancies including DCIS and results in elevated concentrations of intratumoral estradiol. These findings could provide the scientific rationale as to employing aromatase inhibitors in the management of ER positive DCIS patients.     

乳腺内不可触及病灶的定位活检应用价值

目的:探讨乳腺内不可触及病灶(NPBL)的定位活检技术及其在乳腺癌早期诊断中的临床应用价值。方法:对彩超发现的4459个和钼靶发现的25个NPBL分别行麦默通旋切和钩丝定位活检,确定病灶的病理类型。结果:4459个NPBL中3196个病灶为乳腺腺病或伴纤维腺瘤样结节(71.7%),1198个为纤维腺瘤(26.9%),11个为分叶状肿瘤(0.2%),17个为导管内乳头状瘤(0.4%),9个为乳腺导管原位癌,5个为导管原位癌伴微浸润,23个为浸润性癌(恶性占0.8%)。25个钼靶发现的NPBL中乳腺腺病13例(52%),导管原位癌7例,导管原位癌伴微浸润2例,浸润性癌3例(恶性占48%)。结论:超声引导下麦默通和钼靶引导下钩丝定位切除可以对NPBL做出定性诊断,具备创伤小、手术时间短和定位精准等特点,对提高乳腺癌的早期诊断率、降低死亡率具有一定的临床应用价值。     

Changed expression of 9-O-acetyl GD3 (CDw60) in benign and atypical proliferative lesions and carcinomas of the human breast

 Expression of gangliosides is affected in various ways by malignant cell transformation. In the present study, we investigated the expression of CDw60, a constituent of O-acetylated disialogangliosides, in benign and atypical proliferative breast diseases, and preinvasive and invasive carcinomas by immunohistochemistry and thin-layer chromatography (TLC). In normal ducts, antibodies to CDw60 (mAb M-T21) reacted to membranes of the Golgi apparatus in the juxtaluminal cell compartment. A similar polarized distribution of Golgi cisterns in epithelial cells was observed in several benign lesions, i.e., fibroadenomas, intraductal papillomas, and gynecomastia. In contrast, blunt duct adenosis and duct hyperplasia exhibited an abnormal cytosolic and cell surface staining, whereas atypical duct hyperplasia showed randomly dispersed immunoreactive Golgi cisterns, indicating loss of epithelial polarity. In mammary carcinomas and in two breast carcinoma cell lines (MCF-7 and EFM-19) the neoplastic cells contained CDw60-immunolabelled Golgi complexes, which were distributed in a disorderly fashion throughout the cytoplasm, thus reflecting a loss of epithelial polarity. Additionally, only well differentiated ductal carcinomas in situ or invasive ductal carcinomas disclosed a strong cell surface labelling, which was absent in lower differentiated carcinomas of the same types. In all carcinomas, the intensity of CDw60 immunostaining decreased with progressing loss of differentiation (grade of dedifferentiation), as demonstrated by staining intensity in paraffin sections and by evaluation of the relative amounts of extracted 9-O-acetyl GD3 by TLC. Our results indicate that abnormal CDw60 expression is already detectable in benign proliferative breast lesions with different risk rates to develop into malignant lesions. Downregulation of CDw60 expression in poorly differentiated invasive carcinomas may be the consequence of loss of cell functions usually associated with poor prognosis. Received: 19 February 1998     

Stereotaxic fine needle aspiration cytology of clinically occult malignant and premalignant breast lesions

Stereotaxic fine needle aspiration (FNA) cytology was used to study clinically occult (nonpalpable) breast lesions in 114 consecutive patients with mammographically suspicious findings prior to excisional biopsy. The aspirate contained insufficient material for cytologic evaluation in 15 cases (13.2%), which were histologically diagnosed as benign (7 cases), atypical hyperplasia (7 cases) or carcinoma in situ (1 case). The cytologic findings indicated a benign lesion in 77 cases (67.5%), which were histologically diagnosed as benign (71 cases) or atypical ductal hyperplasia (6 cases). The cytologic sample showed atypia in eight cases (7.0%), which were histologically diagnosed as severe atypical ductal hyperplasia (three cases), carcinoma in situ (one case) or proliferative fibrocystic disease (four cases). In the eight cases (7.0%) cytologically interpreted as probably malignant, histology confirmed six invasive carcinomas, one carcinoma in situ and one fibrocystic disease. Of six cases (4.4%) cytologically reported as malignant, five were histologically diagnosed as invasive carcinoma and one as carcinoma in situ. Overall, stereotaxic FNA cytology reported as malignant or probably malignant 14 of the 15 cases with a histologic confirmation of malignancy, for a sensitivity of 93.3%. Cytology correctly identified 78 of the 83 histologically negative cases, for a specificity of 94.0%. The 16 cases histologically diagnosed as ductal hyperplasia, which carries a high risk for subsequent malignancy, were studied in detail in an effort to define histologic and cytologic criteria for this entity. Using selected histologic criteria, 11 of these cases were graded as showing mild-to-moderate atypical hyperplasia and 5 as showing severe atypical hyperplasia. Three of the latter cases were similarly identified by an analogous cytologic grading; the other two cases had insufficient cytologic samples. The total results in this series of 114 cases support the use of stereotaxic FNA cytology in the diagnosis of these nonpalpable breast lesions, examples of which are illustrated. In particular, it may help to raise the low specificity yielded by mammography alone, which would represent a significant advance for the patient in terms of the accuracy, expediency and reduced cost of diagnosing these lesions.