Skip to main content

Advertisement

SpringerLink
Log in

Usefulness of immunohistochemistry for differential diagnosis between benign and malignant breast lesions

  • Special Feature
  • Current issues and perspectives on breast cancer diagnosis
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Immunohistochemistry (IHC) is routinely performed during pathology practice for various breast lesions. Hormone receptor and HER2 analysis for primary breast carcinoma and cytokeratin staining for sentinel lymph nodes analysis are widely conducted. In addition to those markers, there are several situations in which certain IHC staining is valuable as an ancillary tool. This manuscript will present three useful examples of IHC for making differential diagnosis between benign and malignant lesions. Case 1 is an intraductal papilloma with solid epithelial proliferation, for which diagnosis was resolved by myoepithelial markers and high-molecular-weight cytokeratins (HMWCKs). Case 2 is a noninvasive ductal carcinoma with solid and papillary morphology. Many cases with such morphology mimic benign papillomas, but expression of neuroendocrine markers may lead to the correct diagnosis. Case 3 is a benign complex sclerosing lesion, with recognition of a pseudoinvasive process by myoepithelial markers. Although IHC results were excellent in these cases, they are effective only for limited situations. It is important to use IHC with caution, and re-evaluation of histological findings on hematoxylin and eosin stain and clinicopathological correlation of each case is essential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CK:

Cytokeratin

IHC:

Immunohistochemistry

HE:

Hematoxylin and eosin

FNAC:

Fine-needle aspiration biopsy cytology

SMA:

Smooth muscle actin

DCIS:

Ductal carcinoma in situ

HMWCK:

High-molecular-weight cytokeratin

References

  1. Moriya T, Kozuka Y, Kanomata N, Tse GM, Tan PH. The role of immunohistochemistry in the differential diagnosis of breast lesions. Pathology. 2009;41:68–76.

    Article  PubMed  CAS  Google Scholar 

  2. Moriya T, Kasajima A, Ishida K, Kariya Y, Akahira J, Endoh M, et al. New trends of immunohistochemistry for making differential diagnosis of breast lesions. Med Mol Morphol. 2006;39:8–13.

    Article  PubMed  CAS  Google Scholar 

  3. The Japanese Breast Cancer Society. Histological classification. Breast Cancer. 2005;12:S12–4.

    Article  Google Scholar 

  4. Oyama T, Koener FC. Noninvasive papillary proliferations. Sem Diagn Pathol. 2004;21:32–41.

    Article  Google Scholar 

  5. Mulligan A, O’Malley FP. Papillary lesions of the breast. A review. Adv Anat Pathol. 2007;14:108–19.

    Article  PubMed  Google Scholar 

  6. Collins LC, Schnitt SJ. Papillary lesions of the breast. Selected diagnostic and management issues. Histopathology. 2008;52:20–9.

    PubMed  CAS  Google Scholar 

  7. Bhargava R, Dabbs DJ. Use of immunohistochemistry in diagnosis of breast epithelial lesions. Adv Anat Pathol. 2007;14:93–107.

    Article  PubMed  Google Scholar 

  8. Wang X, Mori I, Tang W, Nakamura M, Nakamura Y, Sato M, et al. P63 expression in normal, hyperplastic and malignant breast tissues. Breast Cancer. 2002;9:216–9.

    Article  PubMed  Google Scholar 

  9. Tse GM, Tan PH, Lui PC, Gilks CB, Poon CS, Ma TK, et al. The role of immunohistochemistry for smooth muscle actin, p63, CD10 and cytokeratin 14 in the differential diagnosis of the breast. J Clin Pathol. 2007;60:315–20.

    Article  PubMed  CAS  Google Scholar 

  10. Ichihara S, Fijimoto T, Hashimoto K, Moritani S, Hasegawa M, Yokoi T, et al. Double immunostaining with p63 and high-molecular-weight cytokeratins distinguishes borderline papillary lesion of the breast. Pathol Int. 2007;57:126–32.

    Article  PubMed  Google Scholar 

  11. Bocker W, Burger H, Buchwalow IB, Decker T. CK5-positive cells are precursor cells of glandular and myoepithelial cell lineages in the human breast epithelium. A new cell concept as a basis for a better understanding of proliferative breast disease? Verh Dtsch Ges Pathol. 2005;89:45–7.

    PubMed  CAS  Google Scholar 

  12. Tan PH, Aw MY, Yip G, Bay BH, Sil LH, Murugaya S, et al. Cytokeratins in papillary lesions of the breast. Is there a role in distinguishing intraductal papilloma from papillary ductal carcinoma in situ? Am J Surg Pathol. 2005;29:625–32.

    Article  PubMed  Google Scholar 

  13. Lerwill MF. Current practical applications of diagnostic immunohistochemistry in breast pathology. Am J Surg Pathol. 2004;28:1076–91.

    Article  PubMed  Google Scholar 

  14. Nassar H, Qureshi H, Volkanadsay N, Visscher D. Clinicopathologic analysis of solid papillary carcinoma of the breast and associated invasive carcinomas. Am J Surg Pathol. 2006;30:501–7.

    Article  PubMed  Google Scholar 

  15. Kawasaki T, Nakamura S, Sakamoto G, Murata S, Tsunoda-Shimizu H, Suzuki K, et al. Neuroendocrine ductal carcinoma in situ (NE-DCIS) of the breast. Comparative clinicopathological study of 20 NE-DCIS cases and 274 non-NE-DCIS cases. Histopathology. 2008;41:288–98.

    Article  Google Scholar 

  16. Moritani S, Ichihara S, Kushima R, Okabe H, Bamba M, Kobayashi TK, et al. Myoepithelial cells in solid variant of intraductal papillary carcinoma of the breast. A potential diagnostic pitfall and a proposal of an immunohistochemical panel in the diagnosis with intraductal papilloma with usual ductal hyperplasia. Virchows Arch. 2007;450:539–47.

    Article  PubMed  Google Scholar 

  17. Rabban J, Koerner FC, Lerwill MF. Solid papillary ductal carcinoma in situ versus usual ductal hyperplasia in the breast: a potentially difficult distinction resolved by cytokeratin 5/6. Hum Pathol. 2006;37:787–93.

    Article  PubMed  CAS  Google Scholar 

  18. Otsuki Y, Yamada M, Shimizu S, Suwa K, Yoshida M, Tanioka F, et al. Solid-papillary carcinoma of the breast. Clinicopathological study of 20 cases. Pathol Int. 2007;57:421–9.

    Article  PubMed  Google Scholar 

  19. Tse GM, Tan PH, Chaiwun B, Putti TC, Lui PC, Tsang AK, et al. P63 is useful in the diagnosis of mammary metaplastic carcinomas. Pathology. 2006;38:16–20.

    Article  PubMed  CAS  Google Scholar 

  20. Hill CB, Yeh IT. Myoepithelial cell staining patterns of papillary breast lesions. From intraductal papillomas to invasive papillary carcinomas. Am J Clin Pathol. 2005;123:36–44.

    Article  PubMed  Google Scholar 

  21. Nicolas MM, Wu Y, Middleton LP, Gilcrease MZ. Loss of myoepithelium is variable in solid papillary carcinoma of the breast. Histopathology. 2007;51:657–65.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Part of this study was supported by a Kawasaki Medical School Project Grant (Project No. 20-208S).

Author information

Authors and Affiliations

  1. Department of Pathology, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, 701-0192, Japan

    Takuya Moriya, Naoki Kanomata, Yuji Kozuka, Motoi Fukumoto, Nobuhisa Iwachido & Sakae Hata

  2. Department of Pathology, Tohoku University Hospital, Sendai, Japan

    Yayoi Takahashi, Hiroshu Miura, Kazuyuki Ishida & Mika Watanabe

Authors
  1. Takuya Moriya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoki Kanomata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuji Kozuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Motoi Fukumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuhisa Iwachido
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sakae Hata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yayoi Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroshu Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kazuyuki Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mika Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takuya Moriya.

About this article

Cite this article

Moriya, T., Kanomata, N., Kozuka, Y. et al. Usefulness of immunohistochemistry for differential diagnosis between benign and malignant breast lesions. Breast Cancer 16, 173–178 (2009). https://doi.org/10.1007/s12282-009-0127-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-009-0127-7

Keywords

Search

Navigation