HLA-DR and ß₂ microglobulin expression in medullary and atypical medullary carcinoma of the breast: histopathologically similar but biologically distinct entities

Meora Feinmesser¹, Aaron Sulkes², Sara Morgenstern¹, Jaqueline Sulkes³, Sidi Stern¹ and Elimelech Okon¹

¹ Department of Pathology, Rabin Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Beilinson Campus, Petah Tiqva 49100, Israel
² Department of Oncology, Rabin Medical Centre
³ Epidemiology Unit, Rabin Medical Centre

Correspondence to:
Dr Feinmesser

Aims—To examine the expression of HLA-DR and ß₂ microglobulin in medullary carcinoma and atypical medullary carcinoma of the breast to determine if the effective presentation of tumour antigens to the immune system can differentiate between these two histopathologically similar entities.

Methods—Expression of HLA-DR and ß₂ microglobulin was examined by immunohistochemical methods in five samples of medullary carcinoma of the breast, which has a relatively favourable prognosis, six samples of atypical medullary carcinoma of the breast, which has a prognosis closer to that of regular invasive duct carcinoma, and 20 samples of invasive duct carcinomas, 10 with an accompanying lymphocytic infiltrate.

Results—A positive and significant correlation was found between tumour type and both HLA-DR and ß₂ microglobulin expression. Expression was most prominent in medullary carcinoma, followed by atypical medullary carcinoma and invasive duct carcinoma with and without lymphocytic infiltrates. The mean intensity and percentage of HLA-DR tumour immunostaining were significantly higher in medullary carcinoma than in the other three tumour groups, as was the mean intensity of ß₂ microglobulin immunostaining. Mean percentage of ß₂ microglobulin immunostaining was significantly higher in medullary carcinoma than in invasive duct carcinoma without lymphocytic infiltrates, and showed a trend to increase from invasive duct carcinoma with lymphocytic infiltrates to atypical medullary carcinoma and medullary carcinoma.

Conclusions—Medullary carcinoma and atypical medullary carcinoma of the breast differ in their expression of HLA-DR and ß₂ microglobulin. The relatively favourable prognosis of medullary carcinoma of the breast may be related to effective tumour antigen presentation to the immune system through MHC-I and MHC-II expression. Immunotherapy aimed at MHC-I and MHC-II induction might have a beneficial effect in breast cancer.

Key Words: medullary carcinoma of the breast • HLA-DR expression • ß₂ microglobulin expression

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