الفهرس 
Title pageOnly 14 pages are availabe for public view
 |  | from | 114 |  |  |
| | | from | 114 | | |
Abstract
Breast cancer is the most common malignancy among females throughout the world accounting for 25% of all cancer cases. Triple –negative breast cancer cases (TNBC), characterized by tumors that do not express Estrogen receptor (ER), Progesterone receptor (PR) and HER-2 genes, displays an poor pathological and clinical features compared to other subtypes of breast cancer due to lack of targeted therapy.
The present work aimed to evaluate the role of PELP1 immunohistochemical expression as a prognostic and diagnostic marker of TNBC patients.
The current study was undertaken on a total of 50 retrospective samples and diagnosed as triple negative breast cancer cases which divided into two grades II&III. Clinicopathological parameters data (age, tumor size, lymph nodes metastasis and vascular invasive) were collected from the barcode of patients sample and data sheet at the Department of Pathology, Medical Research institute, Alexandria University, Egypt. The paraffin blocks for each sample were cut into 5 𝞵m thickness sections on slides at Histochemistry and cell biology Department, the slides were stained with Haematoxylin and Eosin stain for histopathological demonstration, Periodic acid-Schiff for glycogen demonstration, and immunohistochemical staining for PELP1 as an immunomarker. Analysis of the recorded images was quantitatively assessed using digital image analyzer software and the results were statistically verified using statistical software package SPSS 20 for all the tests P ≤ 0.05 as a statistically significant.
The fifty samples of TNBC cases were demonstrated for histopathology and figures were taken under the light microscopy and diagnosed into grade II (20 cases) and grade III (30 cases). The correlation and differentiation of the fifty sample with the clinical parameters was revealed that the age of the TNBC patients ranged from 30->60 years and reported that 40% of grade II and grade III cases at age range >50- 60 years, In contrast to the young age from 30-40 years the grade II cases were 20% in comparing to 13% of grade III cases. According to TNM (Tumor, Node, Metastasis) staging were assessed. The present work reported that 55% (11/20) of the grade II was T2 <2 versus 6% (2/30) of grade III, in contrast to 80% (24/30) of grade III cases were T2 (> 2-5 cm) versus 45% (9/20) grade II cases. For the lymph node metastasis, there was the majority 100% (20/20) of grade II and 70% (21/30) grade III in TNBC was free of lymph node metastasis, while a minority 30% (9/30) of grade III was positive LNM with significant difference P=0.007. Whereas the vascular invasion (VI) study revealed that the majority 100% (20/20) of grade II TNBC was positive vascular invasion in verses of 43.3% (13/30) were positive vascular invasion of grade III cases and 56% (17/30) negative of vascular invasion (VI).
The histopatholoical study revealed IDC of the TNBC cases are progressive tumor that the malignant ductal cells have pleomorphic and hyperchromatic nuclei other with fragmented nuclei, condensed nuclear chromatin, and many necrotic gland was seen. The nests form and thick fibrotic stroma with focal hyalinization among the nests revealed marked desmoplastic stroma.
The main concept of the present study is the immunohistochemical detection of PELP1 in both diagnosed grades of TNBC cases; the PELP1 expressed in diffuse brown color immunostaining of the PELP1 expression in the nuclei of the ductal epithelial cells and differentiated malignant cells in stroma. The negative blue color was shown in the stroma and infiltrating lymphocytes. The intense activity of the PELP1 protein immunoexpression was present in the proliferating and invasive ductal epithelial cell in the grade III compared to the grade II. The percentage of immunostaining expression of PELP1 in IDC of TNBC cases were 55% (11/20) moderate positive expression (ve2+) in grade II versus to 33.4% (10/30) in grade III. Whereas 66.6% (20/30) were strong positive expression (ve3+) in of grade III versus to 35% (7/20) in grade II.
In addition, the present results of the image analysis of the integrated optical density (IOD) of PAS stain and PELP1 protein immunostain revealed that:
- The stroma thickness was measured through the PAS stain in IDC TNBC cases. The means±SD thickness was 266.50 ± 48.07 in grade II and 173.86 ± 13.18 in grade III revealed a high significant difference decrease (P=0.001) of stroma thickness between the ducts for grade III compare to grade II.
- The means±SD intensity of PAS staining (IOD) was 150.2 ±5.24 in grade II and 161.0 ±6.33 in grade III represented a high significant difference increase (P= 0.001) of PAS IOD for grade III compare to grade II.
- The correlation between the PAS density (IOD) and clinicopathological parameters in the present work revealed a high significant difference correlated to tumor grade, LNM, vascular invasion, and negative correlation was noticed in age and tumor size.
- The means±SD of PLEP1 immunostaining density (IOD) of the grade II was 106.9 ±3.89 and grade III was 138.0 ±5.39, revealed high statistical significant increase (P= 0.001) of PLEP density for grade III compare to grade II.
- The correlation of the IOD of PELP1-protein distributed in TNBC cases and the clinicopathological parameters. There was no statistical significant difference between PELP1 IOD and patients’ age (r=0.086, p=0.553). While, the high significant difference was recorded between PELP1 IOD and tumor size (r=0.435, p=0.002*) as well as, positive LNM (r=0.374, p=0.007) correlation was noticed. But, the IOD of PELP1was inversely correlated with vascular invasion (r=-0.552, P=<0.001).
- In other hand a high significant difference was recorded in grade III (r=0.955, P=<0.001) and IOD of PAS (r=0.697, P=<0.001), and inversely correlated with stroma thickness/mm (r= -0.763, P=<0.001).