Discordant expression of hormone receptors and HER2 in breast cancer. A retrospective comparison of primary tumors with paired metachronous recurrences or metastases

PURPOSE

Expression of biomarkers in breast cancer, such as the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2), can impact therapeutic decisions; however, it has been reported that their expression may change with disease progression. The aim of this retrospective study was to investigate the expression of these biomarkers in primary breast cancer and in its metachronous recurrences or metastases, and to estimate the percentage of cases with discordant expression.

METHODS

Paired primary and metastatic tumor samples were collected from patients with primary breast cancer and subsequent metachronous distant metastases, diagnosed at the Metaxa Cancer Hospital, Piraeus, Greece, from 1988 to 2008. Two cases of local recurrence were also included. ER, PR and HER2 expression were assessed by immunohistochemistry (IHC) according to ASCO-CAP 2007 guidelines. Statistical comparisons were made using McNemar's exact test and Bowker's test for symmetry.

RESULTS

Tumor samples from 110 patients were analysed. In the primary tumor, ER, PR and HER2 were positively expressed in 64.5%, 58.2% and 32.7% of cases, respectively, and expression of these biomarkers was lost in 18.2%, 21.8% and 10.9% of the corresponding metastases, respectively. Overall, a change of ER, PR and HER2 expression from positive to negative and vice versa occurred in 27.3% (p = 0.0987), 25.5% (p < 0.001) and 18.2% (p = 0.5034) of the cases, respectively.

CONCLUSION

The expression of ER, PR and HER2 in metachronous recurrences or metastases can be discordant from that observed in the primary tumor. As such changes can occur during disease progression, the evaluation of biomarkers in metastatic sites should be mandatory, whenever possible, to ensure that patients are receiving the most effective treatment at all times.

Evaluation of the prognostic and predictive value of p53 and Bcl-2 in breast cancer patients participating in a randomized study with dose-dense sequential adjuvant chemotherapy

PURPOSE

To assess the prognostic and predictive significance of p53 and Bcl-2 protein expression in high risk patients with breast cancer treated with dose-dense sequential chemotherapy.

PATIENTS AND METHODS

From June 1997 until November 2000, 595 patients were randomized to three cycles of epirubicin (E) 110 mg/m2 followed by three cycles of paclitaxel (P) 250 mg/m2 followed by three cycles of 'intensified' CMF (cyclophosphamide 840 mg/m2, methotrexate 47 mg/m2 and fluorouracil 840 mg/m2) or to four cycles of E, followed by four cycles of CMF. p53 and Bcl-2 expression was investigated by immunohistochemistry in 392 and 397 patients respectively.

RESULTS

Positive expression of p53 was detected in 104 (26.5%) patients and was significantly associated with negative hormonal status, worse histologic grade, higher incidence of disease relapse and higher rate of death. p53 positive expression was a significant negative predictor of overall survival (OS) (P = 0.002) and disease-free survival (DFS) (P = 0.001). Negative expression of Bcl-2 was detected in 203 (51%) patients and was significantly associated with negative hormonal status. Multivariate analysis revealed that, positive p53 expression, higher number of positive nodes and worse tumor grade were related to significantly poorer OS and DFS.

CONCLUSIONS

For both treatments, p53 positive expression was a significant negative prognostic factor for OS and DFS while Bcl-2 was not. No predictive ability of p53 status or Bcl-2 status for paclitaxel treatment was evident.

Gastrointestinal tract metastasis as first presentation of breast cancer

Gastrointestinal metastases of breast cancer are a rare occurrence. It is even rarer to be the first manifestation of an unknown breast cancer. We present 2 cases of metastatic breast cancer of the lobular type to the stomach and large bowel in 2 women, initially considered as primary disease. The establishment of diagnosis required experienced histopathologic and immunohistochemical examination. The management follows the principles of the primary disease. Surgery is spared for complications. Mean survival is one year. Prognosis is better for patients with positive hormonal receptors.

Multiple dermoid cysts within the same ovary: our experience of a rare case with review of the literature

OBJECTIVE

Ovarian dermoid cysts are relatively frequent ovarian lesions that can be easily diagnosed by transvaginal ultrasonography. However, the recognition of multiple dermoid cysts, separated by normal ovarian tissue, within a single ovary is rare.

CASE

We present a case with bilateral dermoid cysts, four dermoid cysts within the right ovary and one in the contralateral ovary. Transvaginal ultrasonography showed hyperechogenic areas in the right ovary with a hypoechogenic area in front of them; the hyperechogenic areas were separated by areas with the echogenicity of normal ovarian tissue and indentation, suggesting the presence of multiple dermoid cysts within the same ovary.

CONCLUSION

Preoperative ultrasonographic suspicion of multiple dermoid cysts within the same ovary might contribute to a better decision about the surgical approach.