Sabato 27 ottobre 2012 - Pacini Editore

PoStER
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the Stomach Resembling Early Gastric Cancer. Case Rep Oncol
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the stomach may mimic primary gastric cancer: report of two cases
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in separation of metastatic lobular carcinoma of the breast and
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in distinguishing primary adenocarcinomas from metastatic
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1992;22:421-5.
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HEr2 status in advanced/metastatic gastric
carcinomas: a sicilian retrospective multicentric
analysis
A. Ieni1,8 , G. Giuffrè1 , S. Lanzafame2 , L. Villari3 , E. Salomone3 ,
E. Roz4 , D. Cabibi5 , V. Franco5 , G. Certo6 , A. Labate6 , C. Nagar7 ,
E. Magliolo8 , B. Brogi9 , C. Fazzari10 , F. Italia10 , G. Tuccari1,11 1 2 Dipartimento di Patologia Umana, Università di Messina; Dipartimento
Anatomia, Patologia diagnostica, Medicina legale, Igiene e Sanità Pubblica,
Università di Catania, “Policlinico G. Rodolico”, Catania; 3 A.O.U.
Vittorio Emanuele II, Catania; 4 Casa di Cura “La Maddalena”, Palermo;
5 Dipartimento di Patologia Umana, Università di Palermo, A.O.U. “Policlinico
Giaccone”, Palermo; 6 Casa di Cura “IOMI-Cappellani”, Messina;
7 U.O.C. Anatomia Patologica, ASP 6 Palermo; 8 U.O.C. Anatomia
Patologica, ASP 5 Messina; 9 U.O.C. Anatomia Patologica, ASP 8 Siracusa;
10 Laboratorio Oncopath, Floridia (SR); 11 Programma Interdipartimentale
di Citodiagnostica e Patologia Molecolare, A.O.U. “Policlinico
G.Martino”, Messina
Background. HER2 gene amplification and protein overexpression
have been suggested as targets for a therapy with anti-HER2
humanized monoclonal antibody (Trastuzumab) in various cancers.
Recently, the phase 3 randomized ToGA study showed a
reduction of 26% in risk of death when Trastuzumab is added
to chemiotherapy (HR = 0.74) in advanced gastric carcinomas
(AGC). Moreover, it has been reported that gastric carcinomas
classified as intestinal type are more likely to be HER2 positive
(16-34%) than diffuse (2-7%) or mixed (5-20%) types. In
the present study, we have analyzed HER2 status in a cohort of
304 surgical cases of advanced/metastatic gastric carcinomas,
obtained from archives of ten Sicilian anatomopathological units,
to verify the positive rate of HER2 positive cases, taking into
consideration also the characteristics of histotype, grade, stage
and Ki67 expression.
Methods. From three-hundred four formalin-fixed paraffin-embedded
tissue blocks of AGC, 4 µm thick parallel sections were
cut, mounted on silane-coated glasses and subjected to a retrieval
373
procedure performed by three changes in 0.01 M citrate buffer
pH6.0 in a microwave oven at 750W; then each section was
immunostained for Ki-67 antigen (MIB-1, DAKO Cytomation,
1:200) and HER2 status (HercepTest AO485 DAKO). The Ki-67
labelling index (LI) value was calculated as a mean percentage by
counting the stained nuclei of 1000 tumors cells, utilizing the median
of 30% as the cut-off point. HER2 expression was evaluated
by the following score: 0 (no staining), 1+ (faint and discontinous
staining in < 10% of neoplastic elements), 2+ (light to moderate
lateral, basolateral or complete staining in > 10% of neoplastic elements),
3+ (strong, intense lateral, basolateral or complete staining
in > 10% of neoplastic elements). Cases considered equivocal
(2+) have been successively assessed by FISH test (pharmDx
DAKO) or SISH (Ventana, Inform HER2 Dual assay). Statistical
analysis was performed by Chi-square test.
Results. Taking into consideration the HER2 positive rate, a
range of variability was found in different anatomopathological
units from 7.69% to 21.7%, with a mean value of 17.21%. This
value is really similar to the mean HER2 positivity rate reported
in literature (19.2%). Moreover, HER2 overexpression was encountered
in 51 cases of AGC as a whole; a progressive increase
in the oncoprotein immunoreactivity was appreciated moving
from the poorly cohesive histotype (3.5%) to mitochondrion-rich
(11.1%), tubular/papillary (31.3%) and hepatoid (42.9%) adenocarcinomas.
Finally, HER2 overexpression was significantly associated
with high grade (p = 0.011), advanced stage (p = 0.002)
and high Ki67 LI value (p = 0.015).
Conclusions. The association of Trastuzumab with chemotherapy
has been shown to determine an improvement of survival
in patients with advanced gastric cancers, mostly as the result of
the survival advantage conferred to patients with amplification
or overexpression of HER2 protein. On the basis of our findings,
Trastuzumab should be confirmed as an additional useful
therapeutic standard option for patients with HER2-positive
advanced gastric cancers and furtherly in aggressive variants of
adenocarcinomas.
Pancreatic solid pseudopapillary neoplasm
with liver metastasis: a report of three cases
K. Hirabayashia c , G. Zambonia b , L. Bortesia , P. Castellia ,
M.R. Ballottad , R. Mencarellid a Department of Pathology, Ospedale Sacro Cuore Don Calabria, Verona,
Italy; b Department of Pathology, University of Verona, Verona, Italy ;
c Department of Pathology, Tokai University School of Medicine, 143
Shimokasuya, Isehara, Kanagawa, Japan; d Department of Pathology,
Ospedale Santa Maria della Misericordia, Rovigo
Background. Solid pseudopapillary neoplasm (SPN) is a rare
pancreatic neoplasm composed of poorly cohesive, monomorphic
cells forming solid and pseudopapillary structures with frequent
hemorrhagic-cystic degeneration, that predominantly occurs in
young women. SPN is categorized as a low-grade malignant
neoplasm 1 . However, SPN rarely metastasizes to the liver or
peritoneum (5-15% of cases) 1 . The histological differences between
SPN with metastasis and SPN without metastasis are still
controversial. Immunohistochemically, SPN usually expresses
vimentin, α-1-antitrypsin, CD56, progesterone receptor, CD10,
and nuclear/cytoplasmic β-catenin 2-4 We report of three cases of
SPN with liver metastasis.
Clinical presentations. Case 1: a 37-year-old woman from Ospedale
Sacro Cuore Don Calabria, Verona had a tumor in the pancreatic
tail and multiple synchronous hepatic masses. Distal pancreatectomy
and partial resection of the liver were performed.
Case 2: a-14-year-old woman from Tokai University Hospital,
Kanagawa, Japan had a tumor in the pancreatic head. Enucleation
of the pancreatic tumor was performed. About 30 months after
the first operation, a hepatic tumor was found. Partial resection
of the hepatic tumor was performed.