Memenin sınır duktal neoplastik lezyonlarında ayırıcı tanı
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Dosyalar
Tarih
2010
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Memenin sınırda duktal neoplastik lezyonları olarak bilinen atipik duktal hiperplaziler ve duktal karsinoma insitu memenin intraduktal proliferatif lezyonları içinde yer almaktadır. Memenin intraduktal proliferasyonları terminal duktal lobuler üniteden kaynaklanır ve benign lezyonlarla başlayıp malignite ile sona eren geniş bir spektrumu yansıtır. Trakya Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı'na 2000-2010 tarihleri arasında gönderilen, 27 atipik duktal hiperpazi, 24 duktal karsinoma insitu, 20 invaziv duktal karsinom ve 20 benign meme dokusu tanılı olgu çalışmaya dahil edildi. Her bir olguya ait doku örneğinin immunohistokimyasal belirteçlerle boyanma özellikleri ve KS-300 software yazılımı için görüntü analizi yöntemiyle atipik duktal hiperplazi ve duktal karsinoma insitu' lu olgularda lezyonun en geniş tutulum gösterdiği duktusun transvers çapı morfometrik olarak ölçüldü. Glut-5, Cyclin D1, Ki- 67 ve p-53 ile boyanmanın atipik duktal hiperplazi' de benign meme dokusundan anlamlı olarak daha yaygın olduğu bulunmuştur (p<0.05). Boyanma yaygınlığına göre, Glut-5, Cyclin D1, Ki-67 ve p-53' ün duktal karsinoma insitu ve atipik duktal hiperplazi' ayırıcı tanısında kullanımının anlamlı olduğu bulunmuştur (p<0.05). Glut-1 ile boyanma yaygınlığı benign meme, atipik duktal hiperplazi ve duktal karsinoma insitu ayırıcı tanısında anlamlı bulunmamıştır. Bcl-2 ile benign meme dokusunda diğer gruplara göre daha yüksek oranda boyanma yaygınlığı olduğu gözlenmiştir (p<0.05). Ancak Bcl-2 ile boyanma benign meme grubunda atipik duktal hiperplaziye göre daha yaygın olmakla beraber, istatiksel anlamlılığa ulaşmamıştır. Bcl-2'nin ADH'yı DCIS'dan ayırmada kullanımının anlamlı olmadığı bulunmuştur. Glut-5, Bcl-2, Ki-67, p-53 ile boyanma yoğunluklarının hasta grupları arasında anlamlı fark gösterdiği izlenmiştir (p<0,01). Glut-1 ve Cyclin D1 ile kimi gözlerde sayı çok küçük olduğu değerlendirme yapılamamıştır. Duktal karsinoma insitu'lu olgularda ölçülen maksimum lezyon çapı atipik duktal hiperplazi'li olgulardan anlamlı olarak daha yüksek bulunmuştur. (1,05±0,92, 0,45±0,37, p<0.01) Sonuç olarak, atipik duktal hiperplazi ile duktal karsinoma insitu' lu olguların ayırıcı tanısında morfometrik analizin immunohistokimyasal incelemeden daha ayırdettirici olduğu görülmüştür. Bununla birlikte ayırıcı tanı sorunları olan intraduktal proliferatif lezyonların değerlendirilmesinde, morfometrik incelemeye ek olarak Glut-5, Cyclin D1, Ki-67 ve p-53 ile immunohistokimyasal incelemenin kombine kullanımının yarar sağlayacağı düşünülmüştür. Anahtar kelimeler: Atipik duktal hiperplazi, insitu duktal karsinom, ayırıcı tanı, immunohistokimya, morfometri.
Abstract
Atypical ductal hyperplasia and ductal carcinoma incitu as borderline ductal neoplasias of breast have been classified as intraductal proliferative lesions of breast arise from terminale ductal lobular unit and reflects a wide pathological spectrum from benign to malign lesions. The study grup was composed of 27 atypical ductal hyperplasia, 24 ductal carcinoma incitu and 20 invasive ductal carcinoma specimens and 20 benign breast tissues from University of Trakya, Faculty of Medicine, Department of Pathology , between 2000-2010. Immunohistochemical staining characteristics by using spesific markers and morphometric features by using KS-300 software image analyser were investigated for each tissue specimen. Transvers diameter of ductus having the maximum infiltration in terminale ductal lobular unit was compared by KS-300 software image analyser for each patients with atypical ductal hyperplasia and ductal carcinoma incitu. Glut- 5, Cyclin D1, Ki- 67 and p-53 staining were significantly diffuse in atypical ductal hyperplasia patients in comparison to benign breast tissues. (p<0.05) Staining reaction of Glut-5, Cyclin D1, Ki-67 and p-53 were significantly diffuse in ductal carcinoma insitu patients in comparison atypical ductal hyperplasia. (p<0.05) Staining pattern of Glut-1 was found to be insignificant to differentiate ADH, ductal carcinoma insitu and benign breast tissues. Bcl-2 staining was significantly higher in benign breast in comparison to other patient groups (p<0,05). Staining pattern of Bcl-2 was found to be more diffuse in benign breast tissues comparing to atypical ductal hyperplasia, but not statistically significant We demonstrated significant difference in Glut-5, Bcl-2, Ki-67,p-53 staining intensity between all patient groups (p<0,01). Glut-1 and Cyclin D1 staining intensity could not be evaluated statistically because of the small number of patients The maximum diameter of lesion was significantly higher in patients with ductal carcinoma insitu in comparison to atypical ductal hyperplasia, patients (1,05±0,92, 0,45±0,37, p<0.01). In conclusion, morphometric analyses was found to be able to differentiate the patients with atypical ductal hyperplasia and ductal carcinoma insitu more than immunohistochemical analysis. However, combined evaluation with immunostaining antibodies such as Glut-5, Cyclin D1, Ki-67 and p-53 was thought to be helpful in the evaluation of intraductal proliferative lesions that have differential diagnostic difficulties. There is need to the further reports from large patient cohorts and multicentric studies that could minimize the interobserver variabilities and statistical problems. Keywords: Atypical ductal hyperplasia, ductal carcinoma insitu, differential diagnosis, morphometry .
Abstract
Atypical ductal hyperplasia and ductal carcinoma incitu as borderline ductal neoplasias of breast have been classified as intraductal proliferative lesions of breast arise from terminale ductal lobular unit and reflects a wide pathological spectrum from benign to malign lesions. The study grup was composed of 27 atypical ductal hyperplasia, 24 ductal carcinoma incitu and 20 invasive ductal carcinoma specimens and 20 benign breast tissues from University of Trakya, Faculty of Medicine, Department of Pathology , between 2000-2010. Immunohistochemical staining characteristics by using spesific markers and morphometric features by using KS-300 software image analyser were investigated for each tissue specimen. Transvers diameter of ductus having the maximum infiltration in terminale ductal lobular unit was compared by KS-300 software image analyser for each patients with atypical ductal hyperplasia and ductal carcinoma incitu. Glut- 5, Cyclin D1, Ki- 67 and p-53 staining were significantly diffuse in atypical ductal hyperplasia patients in comparison to benign breast tissues. (p<0.05) Staining reaction of Glut-5, Cyclin D1, Ki-67 and p-53 were significantly diffuse in ductal carcinoma insitu patients in comparison atypical ductal hyperplasia. (p<0.05) Staining pattern of Glut-1 was found to be insignificant to differentiate ADH, ductal carcinoma insitu and benign breast tissues. Bcl-2 staining was significantly higher in benign breast in comparison to other patient groups (p<0,05). Staining pattern of Bcl-2 was found to be more diffuse in benign breast tissues comparing to atypical ductal hyperplasia, but not statistically significant We demonstrated significant difference in Glut-5, Bcl-2, Ki-67,p-53 staining intensity between all patient groups (p<0,01). Glut-1 and Cyclin D1 staining intensity could not be evaluated statistically because of the small number of patients The maximum diameter of lesion was significantly higher in patients with ductal carcinoma insitu in comparison to atypical ductal hyperplasia, patients (1,05±0,92, 0,45±0,37, p<0.01). In conclusion, morphometric analyses was found to be able to differentiate the patients with atypical ductal hyperplasia and ductal carcinoma insitu more than immunohistochemical analysis. However, combined evaluation with immunostaining antibodies such as Glut-5, Cyclin D1, Ki-67 and p-53 was thought to be helpful in the evaluation of intraductal proliferative lesions that have differential diagnostic difficulties. There is need to the further reports from large patient cohorts and multicentric studies that could minimize the interobserver variabilities and statistical problems. Keywords: Atypical ductal hyperplasia, ductal carcinoma insitu, differential diagnosis, morphometry .
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Patoloji, Pathology, Atipik Duktal Hiperplazi, İnsitu Duktal Karsinom, Ayırıcı Tanı, İmmunohistokimya, Morfometri, Atypical Ductal Hyperplasia, Ductal Carcinoma Insitu, Morphometry
