Study On The Clinicopathology And Expression Of Myoepithelial Markers In Solid Papillary Carcinoma Of The Breast

Purpose:To investigate the clinical features,microscopical characteristics,immuno-histochemical status and the expression of myoepithelial biomarkers in solid papillary carcinomas(SPCs).Method:1.To cllect and review the SPC cases diagnosed in the pathology department of PUMCH and summarize the clinical,microscopical and inmmunohistochemical features through HE slides and IHC staining.2.To score the IHC results of CK14,CD10,P63,SMA,CK34βE and CK5/6 and to analyze the expression of these markers in the fibrovascular core and the periphery respectively.Result:1.Clinicopathological Features(1)These 38 cases are all female,aging from 30 to 88 years old,of which 37 patients are unilateral lesions and only one is bilateral.In the unilateral group,the tumors are of single nodule in 30 patients and multiple in 7 patients.There is one nodule in the each breast for the patient with bilateral lesions.Only one case with invasive carcinoma of no specific type showed axillary lymphnode metastasis at the operation time.The tumor ranges from 4mm to 19mm in the greatest dimension.The relationship between age and the greatest diameter is statistically signifigant.29 cases were followed up for 6 to 63 months with distant metastasis in one case of SPC with invasive carcinoma of no specific type while others without local recurrence or distant metastasis.(2)The morphology of SPC is presented with solid expansive lesions or scattered tumor nodules under low magnification,in which various structures may be observed.The neoplastic cells can be classified into eosinophilic type,plasmacytoid type,spindle type and signet ring type along with low to moderate grade nuclei and mitosis lower than 5/10HPF.SPCs may be associated with invasion or invasive carcinoma such as mucinous carcinoma,invasive carcinoma of no specific type and neuroendocrine carcinoma.(3)A11 cases are positive for both ER and PR.However,HER2 is graded 0 or 1+.Ki-67 index remains a low level in 36 cases.SPCs are positive for CgA and Syn both or Syn only while a minority of cases are both negative.2.The expression features of myoepithelial markers(1)35 cases are positive in whole or in part for at least 1 MEC marker in the papillae or periphery while 3 cases are absolutely negative.In the 10 cases with one peripheral MEC markers negative,7 cases are absent for CD 10 while 2 cases for CK34βE and 1 case for CK5/6.However,in the 7 cases with one papillary MEC markers negative,3 cases are absent for CD 10 while 3 cases for CK34βE and 1 case for CK5/6.The combination of two MEC markers absent in periphery and papillae both includes CD10+CK5/6,CD10+SMA,CD10+CK34βE and CK5/6+CK34βE.(2)In periphery,the MEC biomarkers with the largest number of staining decrease are SMA and CK5/6.The number of cases with markedly reduced or completely absent staining is 26 and 31 respectively.The MEC biomarker with the smallest number of staining decrease is CK14,in which 17 cases are staining markedly reduced or completely absent.In papillae,the MEC biomarker with the largest number for staining decrease is CK5/6,in which 26 cases are staining markedly reduced and completely absent.The MEC biomarker with the smallest number for staining decrease is SMA.The number of cases with markedly reduced or completely absent staining is 15.Only SMA shows significant expression difference between periphery and papillae.There are differences between papillae and periphery as for the expression tendency of MEC biomarkers.In periphery,firstly,the change of CK34βE and CK5/6 is almost identical.Secondly,CK14 and P63 are of nearly the same expression tendency.And SMA is between the former two groups.What’s more,CD 10 shows the general step-down trend.In papillae,CK14,CK34βE and CK5/6 are similar in expression.P63 firstly ascended and then descended.And SMA shows the general step-up trend while CD 10 step-down.(3)CK14,CD10,P63 and CK5/6 are significantly different among SPC in situ,invasive SPC and SPC with invasive carcinoma.However,except CK14,there are no significant statistics difference in multiple comparison.And CK14 shows significant statistics difference only between SPC in situ and SPC with invasive carcinoma.Conclusion:1.SPC is a clinicallyspecial entity and the age and the greatest diameter are correlated.2.There are varieties in morphology and somewhat consistency in IHC among SPCs.3.Heterogeneity of MEC markers expression exsits among different SPC cases.4.The expression intensity sequence of MEC markers in SPC is CK14≈P63>SMA>CK34βE≈CK5/6>CD105.No correlations of myoepithelial protein expression are found among SPC in situ,invasive SPC and SPC with invasive carcinoma.