Interobserver Reproducibility of Immunohistochemical Her-2/Neu Assessment in Human Breast Cancer: An Update from INQAT round III

The clinical interest in HER-2/neu is related to trastuzumab, a drug used to treat patients with invasive breast carcinoma overexpressing the HER-2/neu protein. It is very important to correctly identify those patients who may benefit from trastuzumab by accurate assessment of the HER-2/neu status. Of the various methods available, the Dako Herceptest for immunohistochemical assay is considered the most reliable to reach this goal. The aim of this study was to investigate within a group of Italian laboratories the reproducibility of the results of HER-2/neu assessment by means of the Dako scoring system on slides stained with the Herceptest kit. This study was also conceived as the continuation of one of our previous studies, which was similar in its aims but different in the classification criteria adopted. Our results show that, whereas the intra-observer reproducibility was generally satisfactory, the interobserver reproducibility was not. Moreover, our findings confirm that the two extreme classes (0 and 3+) are more easy to identify than the other two and that the Herceptest does not allow to discriminate optimally between scoring classes 2+ and 3+. These findings are relevant in clinical practice where the treatment choice is based on categories defined by this assay, suggesting the need of adopting educational programs and/or new reference materials to improve the assay performance.

Crohn's disease: prevalence of intestinal and extraintestinal manifestations detected by computed tomography enterography with water enema

BACKGROUND

Computed tomography enterography (CTE) may detect the presence, severity, and extent of bowel inflammation in patients with Crohn's disease (CD). The aim of our study was to assess, among a cohort of 22 histologically proven CD patients, the prevalence of disease distribution, behavior, anastomotic recurrence and extraintestinal manifestations detected by an original CTE technique.

METHODS

Two radiologists reviewed 221 CTEs performed providing both small and large bowel distension by oral administration of neutral contrast material and trans-rectal introduction of a water enema (CTE-WE).

RESULTS

Ileal CD was detected in 116 CTE-WEs (52.4%), including 71/116 (61.2%) non-stricturing/non-penetrating, 17/116 (14.6%) stricturing, and 28/116 (24.1%) penetrating forms. Colonic CD was appreciable in 35 (15.8%) patients, including 18/35 (51.4%) non-stricturing/non-penetrating, 6/35 (17.1%) stricturing, and 11/35 (31.4%) penetrating forms. Ileocolic CD was present in 52 (23.5%) CTE-WEs, including 30/52 (57.7%) non-stricturing/ non-penetrating; 3/52 (5.7%) stricturing, and 19/52 (36.5%) penetrating forms. In 10/221 patients (4.5%), upper gastrointestinal involvement (UGI) was present. Perianal disease was observed in 17/221 patients (7.7%). Fistulas were present in 52 (23.5%) and abscesses in 24 (10.8%) CTE-WEs, respectively. Among 57/221 (25.8%) patients who had undergone a disease-related intestinal resection, in 30/57 cases (52.6%) CD recurrence at the anastomosis was present. 4/221 patients (1.8%) with a histologically confirmed intestinal neoplastic stenosis were observed. Sacroiliitis (24%) was found to be prevalent over hepatic steatosis (10.8%), cholelithiasis (8.6%), and nephrolithiasis (4%).

CONCLUSIONS

CTE-WE represents a comprehensive imaging technique which may demonstrate bowel inflammation and CD extraintestinal manifestations. A peculiar prevalence of UGI involvement and neoplastic strictures were observed. In our study the prevalence of sacroiliitis resulted higher than previously reported.

[Severe postmenopausal hyperandrogenism due to an ovarian lipoid cell tumor: a case report]

The case of a 62-year-old woman with severe post-menopausal hirsutism is described. Her clinical history revealed regular menstrual periods until menopause at the age of 50, hysterectomy for fibromatosis at 58 years, non-insulin dependent diabetes mellitus, hypertension, obesity, severe hirsutism, which had developed in the previous 3 years, with a deeping of the voice. Examination showed android obesity, hypertension and severe hirsutism involving the face and the trunk. Endocrine evaluation pointed out regular adrenal function, serum total and free-testosterone in the adult male range, with normal androstenedione, DHEAS and 17OHP levels. Estradiol was slightly increased and LH and FSH were inappropriately low for her post-menopausal age. Computed tomography of the abdomen showed regular adrenal glands, and a radio-labeled cholesterol scan was negative. A further pelvic transvaginal ultrasonography revealed a small cystic formation near the right ovary and a slight increase in the size of the left ovary. The patient underwent bilateral ovariectomy. Histological examination showed a lipoid cell tumor within the left ovary. Immunohistochemical studies were positive for inhibin and cytokeratin. After surgery, serum testosterone fell to normal levels, gonadotropins increased to menopausal levels, confirming that the tumor was able to produce both LH, and FSH-inhibiting factors, and hirsutism greatly improved. Periodic hormonal tests remained normal and CT of the abdomen and pelvic ultrasonography did not show alterations at a 3 years follow-up.

[Detection of Helicobacter pylori in 201 stomach biopsies using the polymerase chain reaction, histological staining (H&E/Giemsa) and immunohistochemistry]

Helicobacter Pylori is believed to be an essential etiologic agent of type B chronic gastritis and peptic ulcer disease in humans. Recent reports have also suggested a role for these organisms in the development of gastric carcinoma and MALT-Lymphoma. A variety of diagnostic procedures are used for the identification of Helicobacter Pylori in clinical samples. 201 gastric biopsy (164 antral and 37 body biopsy specimens) were obtained from 164 patients with endoscopic abnormalities. These samples were studied for the detection of the presence of Helicobacter Pylori by histological staining (EE/Giemsa), immunohistochemistry and PCR by using a primer pair derived from the nucleotide sequence of the Urease A gene of Helicobacter Pylori. Specific amplification of a 411 base pair DNA fragment from all strain of Helicobacter Pylori tested was achieved. Of the 201 gastric biopsy analyzed, 63 (31%) were infected with Helicobacter Pylori on the basis of both histological and immunohistochemical staining, and 81 (41%) were positive with PCR (P < 0.001). Our results support a role for PCR in the rapid and highly sensitive and specific identification of Helicobacter Pylori in gastric biopsy specimens.

Experimental analysis of internal rigid fixation osteosynthesis performed with titanium bone screw and plate systems

The authors report the results of an experimental analysis performed on titanium miniplates and screws in order to gain a better understanding of dynamic forces in internal rigid fixation. Ten segments of bovine scapula were prepared. Osteotomies were carried out along the minor axis, following which five were fixed with four hole straight miniplates and the other five with six hole double-Y miniplates. Each sample was fastened in a special clamp adapted to a tension test machine and shearing force was applied. Force versus time was recorded and the 50 bone fragments were examined by a pathologist. On the basis of the test results, two simple computer models were developed. No significant difference was evident between the mechanical and computed tests. The most critical sections were located near the hole proximal to the osteotomy and the microscopic findings confirmed this. On the basis of the experimental results, the authors propose a new plate design in which the area subject to most stress, proximal to the bone section, would be of miniplate thickness, the distal aspect being thinner as in a microplate. It is suggested that this design would provide sufficient stability and a high degree of anatomical adjustment of the system.

[Malignant melanoma of nasal cavities. Case contributions]

Primitive melanoma of nasal cavities is a rare clinical event. Its pathogenesis is due to the neoplastic development of melanocytes of neuroectodermal origin which are located in the nasal mucosa. Characteristics clinical symptoms are nasal obstruction and recurrent nose-bleeding. In spite of new therapeutic approaches the prognosis of this disease remains severe. No case of primitive malignant melanoma of the nasal cavities has been treated with radiotherapy, according to the authors experience. Sometimes it may be difficult to recognize a cutaneous malignant melanoma because of regression. It may be found after the evidentiation of its recurrences and/or metastasis in different sites. One of the cases here reported came to the authors' attention as ethmoido-frontal metastasis.

[Metastatic location in the temporal bone of a primary bladder carcinoma]

The authors on basis of literature point out, the relative shortage in human beings of metastatic locations to the temporal bone from primitive tumours to another seat. After an examination of the anatomopathological report they describe a case, occurred to their observation, of massive metastases to the temporal bone of bladder carcinoma painting out its exceptionality.