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目的免疫组化双染技术是一种先进的染色方法,该方法可在一张切片上同时检测两种抗原的表达情况。利用该技术探讨乳腺腺鳞癌的临床病理特征、免疫表型及其鉴别诊断。方法收集衡水市人民医院病理科2011-01-01-2015-12-31诊断的4例原发性乳腺腺鳞癌,应用免疫组化SP法和(CK5/p63)免疫组化双染法,检测乳腺腺鳞癌组织中的SM-MHC、p63、CK5、CK34βE12、EGFR、p53、ER、PR、C-erbB-2表达情况,并复习相关文献。结果共治疗979例乳腺恶性肿瘤患者,其中乳腺腺鳞癌患者4例(0.408%),中位发病年龄55岁。临床多表现为无痛性肿块,临床分期:Ⅰ期2例,ⅡA期1例,ⅡB期1例。患者经乳腺B超、外科查体、术中肿物活检冷冻病理诊断为乳腺癌,4例患者均行乳腺改良根治术。术后1例给予吡柔比星+多西他赛方案治疗;1例行环磷酰胺+吡柔比星方案治疗。1例患者术后9d猝死;另1例C-erbB-2强阳性患者,先给予吡柔比星+多西他赛方案治疗,然后转院进行靶向治疗。随访至2016-01-31,3例患者均无复发转移。免疫组化双染技术染色成功。结论乳腺腺鳞癌属于乳腺化生性癌,发病率低,肉眼观呈囊性是其特征之一,免疫组化SM-MHC、p63、CK5和CK34βE12组合有助于乳腺腺鳞癌的诊断。治疗多采用乳腺改良根治术,术后辅助化疗,对于淋巴结阳性患者应行术后放疗。
Objective The immunohistochemical double staining technique is an advanced staining method that can simultaneously detect the expression of two antigens on a single slice. The use of the technology to explore the clinicopathological features of breast adenosquamous carcinoma, immunophenotype and differential diagnosis. Methods Four cases of primary adenosquamous adenocarcinoma diagnosed by Department of Pathology, Hengshui People’s Hospital of Shandong Province from January 2011 to January 2015 were enrolled in this study. Immunohistochemical SP method and double staining (CK5 / p63) To detect the expression of SM-MHC, p63, CK5, CK34βE12, EGFR, p53, ER, PR and C-erbB-2 in breast adenocarcinoma and to review the literature. Results A total of 979 breast cancer patients were treated, including 4 patients with adenosquamous adenocarcinoma (0.408%), the median age at onset was 55 years. Clinical manifestations of painless mass, the clinical stage: Ⅰ in 2 cases, Ⅱ A in 1 case, Ⅱ B in 1 case. Patients with breast B ultrasound, surgical examination, intraoperative biopsy frozen pathological diagnosis of breast cancer, 4 patients underwent modified radical mastectomy. One patient was given pirarubicin + docetaxel after treatment and one was treated with cyclophosphamide plus pirarubicin. One patient died suddenly 9 days after operation. Another patient with strong positive C-erbB-2 was treated with pirarubicin + docetaxel and then transferred to the hospital for targeted therapy. Follow-up to 2016-01-31, 3 patients had no recurrence and metastasis. Immunohistochemical double staining technique was successfully stained. Conclusions Breast adenosquamous carcinoma belongs to mastocarcinoma with low incidence and cystic appearance in the macroscopic view. Immunohistochemistry of SM-MHC, p63, CK5 and CK34βE12 is helpful to diagnose breast adenosquamous carcinoma. More treatment of breast modified radical mastectomy, postoperative adjuvant chemotherapy, lymph node positive patients should be treated with postoperative radiotherapy.