Trastuzumab-based treatment of HER2-positive breast cancer: an antibody-dependent cellular cytotoxicity mechanism?

This study evaluated by immunohistochemistry (IHC) immune cell response during neoadjuvant primary systemic therapy (PST) with trastuzumab in patients with HER2-positive primary breast cancer. In all, 23 patients with IHC 3+ primary breast cancer were treated with trastuzumab plus docetaxel. Pathological complete and partial responses were documented for nine (39%) and 14 (61%) patients, respectively. Case-matched controls comprised patients treated with docetaxel-based PST without trastuzumab (D; n=23) or PST without docetaxel or trastuzumab (non-taxane, non-trastuzumab, NT-NT; n=23). All surgical specimens were blind-analysed by two independent pathologists, with immunohistochemical evaluation of B and T lymphocytes, macrophages, dendritic cells and natural killer (NK) cells. Potential cytolytic cells were stained for Granzyme B and TiA1. HER2 expression was also evaluated in residual tumour cells. Trastuzumab treatment was associated with significantly increased numbers of tumour-associated NK cells and increased lymphocyte expression of Granzyme B and TiA1 compared with controls. This study supports an in vivo role for immune (particularly NK cell) responses in the mechanism of trastuzumab action in breast cancer. These results suggest that trastuzumab plus taxanes lead to enhanced NK cell activity, which may partially account for the synergistic activity of trastuzumab and docetaxel in breast cancer.

[HER2 gene amplification assay: is CISH an alternative to FISH?]

The HER2 proto-oncogene encodes a transmembrane protein, which is considered to function as a growth factor receptor. Overexpression of this protein found by immunohistochemistry in about 20% of infiltrating breast carcinomas, has a predictive value of response to treatment by trastuzumab, an anti-HER2 humanized monoclonal antibody. Search for HER2 gene amplification is necessary to adapt the immunohistochemical technique quality and also in the cases of delicate analysis or weak overexpression. It is usually carried out by Fluorescence In Situ Hybridization (FISH). A more recent hybridization technique, named CISH because of its chromogenic revelation is an alternative method, which gives highly correlated results with FISH. We present details of this technique, which may be more familiar for the pathologists than FISH, because reading analysis is similar to that of immunohistochemical staining.

Human haptocorrin in hepatocellular carcinoma

This study aimed to determine whether haptocorrin (HC), a vitamin B12 binder, is stored in hepatic cells and whether this storage is modified by hepatic carcinogenesis. It was carried out using immunohistochemistry on different liver tissues (normal liver and steatosis, N = 22; cirrhosis, N = 13; and hepatocellular carcinoma, N = 31). No significant immunostaining of HC was detected in noncancerous biopsies with the exception of in one case of cirrhosis. Hepatocellular carcinoma (HCC) sections showed a weak to moderate cytoplasmic staining of cancerous cells (93% of cases) and of noncancerous hepatocytes surrounding the tumor (95%) of cases. Sections with pseudoglandular structures showed a moderate to strong staining of their secretion products. These results and previous studies would seem to confirm the hypothesis that the raised HC serum level observed in HCC is due both to the increased hepatic synthesis of HC and to a decreased uptake by the liver of the particular isoform of this glycoprotein present in the serum of HCC patients.

COL1A1-PDGFB fusion in a ring chromosome 4 found in a dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DP), an infiltrative skin tumor of intermediate malignancy, presents specific cytogenetic features such as reciprocal translocations t(17;22)(q22;q13.1) or, more often, supernumerary ring chromosomes derived from t(17;22). Different translocations, including t(2;17) and t(X;7), have also been described. We have shown previously that both r(17;22) and t(17;22) present the same molecular rearrangement fusing the COL1A1 gene on chromosome 17 and the PDGFB gene on chromosome 22. Out of our series of 16 DPs, we detected an extra ring chromosome in tumor T96-1175, which juxtaposed sequences from chromosomes 4 and 17. As shown by fluorescence in situ hybridization (FISH) using chromosome painting and alpha-satellite probes, T96-1175 apparently lacked chromosome 22 material in the ring. However, involvement of chromosome 22 through a rearrangement of PDGFB was shown by Southern blotting, reverse transcriptase-polymerase chain reaction (RT-PCR), and FISH. This study demonstrates that a cryptic molecular rearrangement between chromosomes 17 and 22 occurred in addition to the recombination of chromosomes 4 and 17 initially identified by FISH. Assessment for cryptic molecular events should be performed in other variant DP rearrangements.

[A comparative study of hormone receptors in breast cancer with quantitative immunocytochemistry and biochemistry]

As the biochemical assay, the measurement of hormone receptors by immunocytochemistry in invasive breast cancers may predict the ability of patients to respond to hormone therapy. The objective of this work is to determine the reliability of hormone receptors analysis on cytologic spreadings. Estrogen and progesterone receptors analysis was carried out in 109 invasive breast carcinomas: (1) with a SAMBA 2005 image analysis system on frozen cytologic spreadings (ER/PR-ICA, Abbott); (2) by visual evaluation on paraffin sections (ER-1D5, Dako; PR-ICA, Abbott); (3) by biochemistry (EIA, Abbott). There is a significant correlation between the three methods of hormone receptors analysis (0.716 to 0.842). The sensitivity of immunocytochemical methods ranges from 88.0 to 94.3%, and the specificity from 70.0 to 94.7%. The minimum concordance is 87.2%. This study demonstrates that immunocytochemistry of hormone receptors is a good alternative to biochemical measurement, especially when applied to cytologic spreadings. Therefore, immunocytochemistry can be used, when conventional biochemical assay cannot be performed for hormone receptors evaluation, particularly on cytoponctions.

[Expression of the c-erbB-2 oncoprotein in mammary Paget's disease. Immunohistochemical study by using 3 antibodies]

An overexpression of the c-erbB-2 oncoprotein has been demonstrated in the breast cancer and has been associated with a poor prognosis. Our study involved 23 cases of mammary Paget's disease which was found to be associated with the intraductal carcinomas in 13 cases, the intraductal carcinomas supposed micro-invasive in 2 cases, the infiltrating ductal carcinomas with predominant intraductal component in 6 cases and the infiltrating ductal carcinomas in 2 cases. The presence of c-erbB-2 oncoprotein has been determined immunohistochemically with 3 different antibodies: rabbit anti-human c-erbB-2 oncoprotein A485 (Dako), c-erbB-2 oncoprotein (internal domain) mouse monoclonal antibody NCL-CB11 (Novocastra), and c-erbB-2 oncoprotein (external domain) mouse monoclonal antibody NCL-CBE1 (Novocastra). An overexpression of the c-erbB-2 oncoprotein has been observed in 21 of the 23 studied cases. We noted an intense membrane staining in the intraepidermal or intraglandular tumour cells of mammary Paget's disease. Any staining has been observed in 2 cases with glandular component of pure intraductal type. These results are identical whatever the antibody used. In a previous study concerning mammary Paget's disease, it has been noted a correlation between this overexpression and presence of large malignant cells. We also have found this notion in mammary Paget's disease where the c-erbB-2 positive neoplastic cells in the different tumour components were large with prominent cytoplasm. The obtained results argue strongly for adenocarcinomatous origin for mammary Paget's disease and exhibit that the overexpression of c-erbB-2 oncoprotein was not constantly in correlation with a poor prognosis.

Vaginal reconstruction after initial construction of the external genitalia in girls with salt-wasting adrenal hyperplasia

A total of 28 patients with salt-wasting adrenal hyperplasia who underwent revision of the external genitalia at an early age (mean age 21.4 months) has been followed for 12 to 20 years (mean 16.3 years). The age at initial surgery ranged from 3 weeks to 5 years. Twenty-five patients had a low and 3 had a high takeoff of the vagina from the urogenital sinus. Of these children 22 (78.5%) required further vaginal reconstructive procedures to achieve a normal vaginal outlet. Of the 22 patients requiring further repair 18 have undergone vaginal reconstructive procedures with an initial success rate of 72.2%. These long-term data suggest that if vaginal reconstructive surgery is performed in infancy details, such as placement of the perineal flap well into the vagina and careful followup of the vaginal outlet, are mandatory for success. If there is evidence of outlet narrowing, periodic dilation will be needed to prevent vaginal stenosis and further vaginal surgery.

Hormone and hormonal agents in the treatment of aggression

Evidence for the role of androgens in the male aggressive and sexual behavior is reviewed. Medroxyprogesterone acetate (MPA; Provera, Upjohn) has a marked antiandrogen property; it is effective in lowering the testosterone level and controlling certain otherwise intractable sex deviations. The finding in 6 patients treated for sex deviation are summarized. The effects of MPA in the treatment of 11 temporal lobe epileptics and 5 other patients with severe angry-aggressive behavior disorder are reported. Most temporal lobe epileptics responded well to MPA. Weight gain and earlier sleep were consistent side effects. The values of plasma testosterone, serum luteinizing hormone, and urinary 17-ketosteroids were decreased by the treatment. Four patients were XYY individuals with lack of control over their sexual-aggressive or angry-aggressive impulses.