Ponnuswamy Karkuzhali* and Aja Chandramohan


Purpose: To analyse the clinical and histological features of the precursor lesions, to correlate with radiological findings and to determine the role of immunohistochemistry in the diagnosis of these lesions. Methods: Patients with suspicious breast lesions in radio imaging (BI-RADS III&IV) & radiologically ambiguous cases were directed towards core/excision biopsy. The panel of immunomarkers used were p63, SMMHC, CK 5/6, E-Cadherin, ER, PR and HER2/neu. Results: In the Institute of pathology, 1464 surgical specimens of breast (6.9%) were received during November 2011 to October 2013. Precursor lesions constituted 14.03% of benign lesions. Sclerosing adenosis and usual epithelial hyperplasia was common comprising 60.82% (59 cases). Precursor lesions had a peak incidence in the age group of 31-40 years. Commonest symptom of presentation was lump in the breast (63.92%). Most of the cases belonged to BI-RADS III score (30.86%). IHC done with myoepithelial markers such as p63 and SMMHC showed nuclear and cytoplasmic positivity of myoepithelial cells in all cases of sclerosing adenosis, ductal papilloma and DCIS. CK 5/6 was helpful in confirming cases of usual epithelial hyperplasia. Conclusion: We found that there is no significant difference in the incidence and age group of precursor lesions, as compared to literature. Myoepithelial markers were found to be useful in assessing the benignity of lesions in cases of diagnostic dilemma. ER, PR and HER2/neu expression were higher in pure precursor lesions than precursors associated with malignancy. Patients having lesions with ER expression will be benefited by Tamoxifen therapy and further progression to invasion can be arrested.

Keywords: Cytokeratin 5/6, HER2/neu, Breast Precursor lesions, p63, SMMHC, ER/PR.

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