Kesesuaian Ekspresi E-Cadherin pada Karsinoma Duktal dan Lobular Payudara - . Mona Oktarina ZD, Heni Maulani, M.Rasjid HS, M.Zulkarnain (Perhimpunan Dokter Spesialis Patologi Anatomik Indonesia (PDSPA), 2012)
ABSTRAK Latar belakang Karsinoma duktal (40-70%) dan lobular (5-15%) merupakan jenis karsinoma payudara yang banyak dijumpai. Kedua jenis karsinoma ini memiliki gambaran histopatologik berbeda, namun terkadang gambaran ini dapat tumpang tindih sehingga cukup menyulitkan ahli patologi. Penelitian sebelumnya melaporkan ekspresi E-cadherin umumnya menghilang pada karsinoma lobular karena Loss Of Heterozygocity (LOH) gen CDH1 atau mutasi gen disertai hilangnya wild-type allele, sedangkan pada karsinoma duktal akan menetap karena tidak dijumpai mutasi ini.Penelitian ini bermaksud melihat kesesuaian antara gambaran histopatologik dengan ekspresiE-cadherin tersebut. Bahan dan cara kerja Sampelsejumlah 72 kasuskarsinoma payudara jenis duktal, lobular, serta kasus karsinoma invasif dengan gambaran histopatologik meragukan antara kedua jenis karsinoma tersebut (Januari 2008-Juli 2011) dari arsippreparat HE dan blok parafin ditinjau ulang, dilakukan pulasan imunohistokimia E-cadherin, diinterpretasikan oleh 2 orang ahli patologi secara independen; dilakukan uji statistik Kappa. Hasil Nilai Kappa untuk kesesuaian diagnosis antara ahli patologi = 0,380. Dari 27 kasus duktal: ekspresi E-cadherin positif 25 kasus,negatif 1 kasus, 1 kasus menunjukkan ekspresi positif dan negatif. Kasus lobular hanya 2 kasus:semua menunjukkan ekspresi negatif.Kasus meragukan: ekspresi E-cadherin positif 21 kasus, negatif 14 kasus, dan 1 kasus dijumpai ekspresi positif dan negatif dalam satu tumor (nilai kappa = 0,809). Kesimpulan Ada kesesuaian yang sangat kuat antaraekspresi E-cadherin dengan gambaran histopatologik (positif untuk karsinoma duktal; negatif untuk karsinoma lobular), dapat digunakan untuk membantu membedakan kedua jenis karsinoma tersebut terutama pada kasus yang memiliki gambaran histopatologik meragukan. Kata kunci: Karsinoma duktal, karsinoma lobular, ekspresi E-cadherin ABSTRACT Background The most common breast carcinomas are ductal (40-70%) and lobular (5-15%) types. They have distinct histopathologycal features, but the challenge for the pathologists are sometimes both features can appears on the same tumor in confusing pattern. Many research reported that lobular carcinomas commonly have lost expression of E-cadherin due to Loss of heterozygocity (LOH) or mutation of CDH1 gene with loss of wild-type allele, meanwhile ductal carcinomas have positive expression because no mutation was detected. This study want to see the conformity between the histopathologycal features with the E-cadherin expression. Methods Seventy two samples of H&E-stained slides and paraffin blocks consists of 18 ductal carcinomas, 18 lobular carcinomas and 36 invasive carcinomas showing confusing histopathologycal features of both types (Januari 2008-Juli 2011) from the pathologycal archieves being reviewed, E-cadherin immunohistochemical stains were performed, evaluated independently by two pathologists; Kappa statistical test were conducted. Results Kappa value between the 2 pathologists are 0,380. From 27 cases of ductal carcinomas, the E-cadherin expression were positive in 25 cases, negative in 1 case, and both expression was seen in 1 case. Lobular carcinoma only 2 cases; both showed negative E-cadherin expressions. In the confusing cases: positive E-cadherin expression were observed in 21 cases, negative in 14 cases, and 1 case was found with both positive and negative expression (Kappa value = 0,809). Conclusion E-cadherin expression is strongly conform with the histopathologycal features (ductal carcinomas are positive; lobular carcinomas are negative), can be used as a useful diagnostic tool to differentiate both types of carcinomas; especially for the cases with confusing histopathologycal features. Keywords: Ductal carcinomas, lobular carcinomas, E-cadherin expression