HER2 oncogene amplification in extramammary Paget's disease

AIMS: To study HER2 oncogene amplification and over-expression in skin samples of 23 patients with extramammary Paget's disease (EMP). EMP is a rare intra-epidermal adenocarcinoma, which has been reported to over-express the HER2 oncoprotein. METHODS AND RESULTS: HER2 gene amplification, detected by chromogenic in-situ hybridization, was found in 43% (10/23) of the lesions. HER2 protein over-expression (3+ immunostaining intensity) was found in 12 tumours (52%), including all 10 tumours with gene amplification. Two tumours showed low-level (2+) HER2 immunostaining. Mammary Paget's lesions, which were used as controls, showed HER2 amplification and over-expression in all 10 cases studied. CONCLUSIONS: These results indicate that HER-2 protein over-expression in EMP is common and due exclusively to gene amplification. They open up the possibility of HER2-targetted immunotherapy for patients with HER2+ disease.     

乳腺癌HER2与TOP2A的表达及其相关性

目的 探讨乳腺癌患者HER2与TOP2A基因及蛋白的表达情况及其表达的相关性。 方法 采用免疫组织化学方法与荧光原位杂交（FISH）方法,检测58例乳腺癌中HER2及TOP2A的基因及蛋白表达情况,并分析其相关性。 结果 58例乳腺癌患者,HER2评分：0分11例（11/58,19.0%）,1⁺19例（19/58,32.8%）,2⁺13例（13/58,22.4%）,3⁺15例（15/58,25.8%）;TopoⅡα评分：0分28例（28/58,48.3%）,1⁺22例（22/58,37.9%）,2⁺8例（8/58,13.8%）。HER2基因扩增19例（19/58,32.8%）,HER2基因无扩增39例（39/58,67.2%）;TOP2A基因扩增11例（11/58,19.0%）,TOP2A基因无扩增47例（47/58,81.0%）。免疫组织化学方法检测HER2与FISH检测HER2的结果明显相关,其相关系数r_s=0.80（P<0.05）;免疫组织化学方法检测TopoⅡα与FISH检测TOP2A结果相关,其相关系数r_s=0.50（P<0.05）;FISH检测HER2与TOP2A的结果明显相关,相关系数r_s=0.69(P<0.05)。 结论 HER2和TOP2A在乳腺癌中的扩增具有高度一致性,TOP2A的扩增及表达可能依赖于HER2的扩增及表达。     

p185HER2 overexpression and HER2 oncogene amplification in recurrent vulvar Paget's disease.

We evaluated p186Her2 overexpression and HER2 oncogene amplification in recurrent vulvar Paget's disease. We identified six patients with recurrent vulvar Paget's disease in our archives. The number of recurrences ranged from 1 to 11 over a time period of 1-168 months. Recurrences were evaluated immunohistochemically for p185Her2 overexpression with the HercepTest and for HER2 oncogene amplification with fluorescence in situ hybridization. p185Her2 overexpression was scored as 3 in two patients, as 2 in two patients, and as 1 in two patients. All patients with scores 2 and 3 showed HER2 oncogene amplification. Overexpression of p185Her2 and HER2 oncogene amplification appears to be common in recurrent vulvar Paget's disease.     

Evaluating HER2 amplification and overexpression in breast cancer.

The development of Herceptin (Trazumatab) makes testing for HER2 status important for choosing optimal therapy in breast cancer. This study addresses the precision, accuracy, and reproducibility of HER2 assays. HER2 was assessed retrospectively by immunohistochemistry (IHC) with Dako 'Herceptest', by IHC with the monoclonal antibody CB11, and by fluorescence in situ hybridization (FISH, PathVysion), in a series of 216 formalin-fixed breast carcinomas including 191 for which quantitative HER2 data from radioimmunohistochemistry (Q-IHC) were available. All tests were scored independently by two observers. Positivity rates varied between Herceptest (12.6%), FISH (19.4%), and CB11 IHC (28.5%). Kappa values showed that IHC-based tests were more susceptible to inter-observer variation (kappa=0.67 and 0.74 for Herceptest and CB11, respectively) than FISH (kappa=0.973). Overall test accuracy (see the Materials and methods section) for CB11 IHC (83.8%) was lower than Herceptest (87.4%) or FISH (93.2%). FISH predicted p185 HER2 overexpression (determined by Q-IHC) better (concordance index C.Ind. 0.90) than CB11 IHC (C.Ind.=0.85) or Herceptest (C.Ind.=0.81). Of 42 cases with gene amplification by FISH, 67% were positive in the Herceptest (2+ or 3+) vs. 83% with CB11. Of 174 cases negative by FISH, 96% were negative in the Herceptest and 68% with CB11. In conclusion, FISH is the most accurate, reproducible, and precise predictor of HER2 overexpression in routine diagnostic laboratories.     

Genomic analysis of the HER2/TOP2A amplicon in breast cancer and breast cancer cell lines

HER2 and TOP2A are targets for the therapeutic agents trastuzumab and anthracyclines and are frequently amplified in breast cancers. The aims of this study were to provide a detailed molecular genetic analysis of the 17q12-q21 amplicon in breast cancers harbouring HER2/TOP2A co-amplification and to investigate additional recurrent co-amplifications in HER2/TOP2A-co-amplified cancers. In total, 15 breast cancers with HER2 amplification, 10 of which also harboured TOP2A amplification, as defined by chromogenic in situ hybridisation, and 6 breast cancer cell lines known to be amplified for HER2 were subjected to high-resolution microarray-based comparative genomic hybridisation analysis. This revealed that the genomes of 12 cases were characterised by at least one localised region of clustered, relatively narrow peaks of amplification, with each cluster confined to a single chromosome arm (ie 'firestorm' pattern) and 3 cases displayed many narrow segments of duplication and deletion affecting the vast majority of chromosomes (ie 'sawtooth' pattern). The smallest region of amplification (SRA) on 17q12 in the whole series extended from 34.73 to 35.48 Mb, and encompassed HER2 but not TOP2A. In HER2/TOP2A-co-amplified samples, the SRA extended from 34.73 to 36.54 Mb, spanning a region of approximately 1.8 Mb. Apart from HER2 and TOP2A, this region encompassed four additional genes whose expression levels as defined by quantitative real-time PCR are significantly higher in HER2/TOP2A-co-amplified vs HER2-amplified breast cancers: CASC3, CDC6, RARA and SMARCE1. Of the cell lines studied, SKBR3 and UACC812 showed HER2/TOP2A co-amplification. In conclusion, this is the first detailed genome-wide characterisation of HER2/TOP2A-amplified breast cancers; cell lines were identified that can be used to model these cancers in vitro. The 17q12 amplicon is complex and harbours multiple genes that may be associated with breast cancer development and progression, and potentially exploitable as therapeutic targets.     

结直肠癌EGFR和HER2蛋白表达及其基因拷贝数分析

目的探索结直肠癌EGFR和HER2蛋白表达和基因拷贝数增加的频率,以及蛋白表达与基因拷贝数增加之间的相关性。方法以石蜡包埋组织芯片为材料,分别采用免疫组织化学（EGFR pharmDx^TM和HercepTest^TM试剂盒）和荧光原位杂交（FISH,LSI EGFR SpectrumOrange／CEP7 SpectrumGreen探针组合和Path V ysion^TM试剂盒）方法,检测42例中国人结直肠癌EGFR和HER2蛋白表达和基因状态。结果EGFR免疫组织化学0者18例、1＋者10例、2＋者5例、3＋者9例;HER2免疫组织化学0者39例、1＋者1例、2＋者1例、3＋者1例。通过FISH分析,EGFR基因拷贝数无明显增高18例（42．9％）,其中包括二体性14例（33．3％）、低三体性4例（9．5％）;EGFR基因拷贝数相对增高者24例（57．1％）,包括高三体性3例（7．1％）、低多体性9例（21．4％）、高多体性12例（28．6％）;本组患者中无EGFR基因扩增者。HER2基因拷贝数增加者共4例（9．5％）,其中包括基因扩增1例（2．4％）。EGFR的蛋白表达与基因拷贝数增加无相关性,两指标与肿瘤分化之间也无相关性。HER2免疫组织化学3＋和基因扩增结果一致,与乳腺癌相似。结论这组患者中,具有较高的EGFR蛋白表达和基因拷贝数增加的比率,但蛋白表达与基因状态之间以及二者与肿瘤分化程度之间都没有相关性;HER2表达和基因拷贝数增加的频率较低。     

HER2 protein expression and gene amplification in androgen-independent prostate cancer

The role of the HER2 receptor remains uncertain in the pathogenesis and progression of human prostate cancer. Previous studies have reported widely divergent rates for HER2 expression in primary prostate tumors, probably owing to significant methodologic differences in the studies. Few data exist about the frequency of HER2 protein overexpression and gene amplification in androgen-independent prostate cancer (AIPC), although recent xenograft models suggest HER2 expression may be up-regulated in the transition from androgen-dependent to androgen-independent disease. We studied the role of HER2 protein in AIPC by immunohistochemical and fluorescence in situ hybridization (FISH) analyses on AIPC specimens using well-characterized and validated reagents. Fourteen (36%) of 39 specimens expressed HER2; however, only 2 (5%) had moderate (2+) expression, and 2 (5%) had high-level (3+) expression. Two (6%) of 36 specimens had gene amplification by FISH. These data suggest that HER2 protein overexpression and gene amplification are relatively uncommon in AIPC.     

HER2 overexpression and amplification as a potential therapeutic target in colorectal cancer: analysis of 3256 patients enrolled in the QUASAR,FOCUS and PICCOLO colorectal cancer trials

HER2 overexpression/amplification is linked to trastuzumab response in breast/gastric cancers. One suggested anti‐EGFR resistance mechanism in colorectal cancer (CRC) is aberrant MEK–AKT pathway activation through HER2 up‐regulation. We assessed HER2‐amplification/overexpression in stage II–III and IV CRC patients, assessing relationships to KRAS/BRAF and outcome. Pathological material was obtained from 1914 patients in the QUASAR stage II–III trial and 1342 patients in stage IV trials (FOCUS and PICCOLO). Tissue microarrays were created for HER2 immunohistochemistry. HER2‐amplification was assessed using FISH and copy number variation. KRAS/BRAF mutation status was assessed by pyrosequencing. Progression‐free survival (PFS) and overall survival (OS) data were obtained for FOCUS/PICCOLO and recurrence and mortality for QUASAR; 29/1342 (2.2%) stage IV and 25/1914 (1.3%) stage II–III tumours showed HER2 protein overexpression. Of the HER2‐overexpressing cases, 27/28 (96.4%) stage IV tumours and 20/24 (83.3%) stage II–III tumours demonstrated HER2 amplification by FISH; 41/47 (87.2%) also showed copy number gains. HER2‐overexpression was associated with KRAS/BRAF wild‐type (WT) status at all stages: in 5.2% WT versus 1.0% mutated tumours (p < 0.0001) in stage IV and 2.1% versus 0.2% in stage II–III tumours (p = 0.01), respectively. HER2 was not associated with OS or PFS. At stage II–III, there was no significant correlation between HER2 overexpression and 5FU/FA response. A higher proportion of HER2‐overexpressing cases experienced recurrence, but the difference was not significant. HER2‐amplification/overexpression is identifiable by immunohistochemistry, occurring infrequently in stage II–III CRC, rising in stage IV and further in KRAS/BRAF WT tumours. The value of HER2‐targeted therapy in patients with HER2‐amplified CRC must be tested in a clinical trial. © 2015 The Authors. Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.     

Her-2/neu oncogene amplification in clinically localised prostate cancer

AIM: To examine the incidence of Her-2/neu oncogene amplification in clinically localised prostate cancer using in situ hybridisation. METHODS: One hundred and seventeen patients, who had undergone radical prostatectomy, were identified and in situ hybridisation was performed on formalin fixed, paraffin wax embedded tissue using the Quantum Appligene probe for Her-2/neu. The enzyme peroxidase was used to detect the probe because this enabled a permanent record to be kept. Tumours in which there were five or more signals in each nucleus in > 20% of the tumour cells were considered to have a significantly increased copy number. A serial section from these tumours was then hybridised with the chromosome 17 alpha satellite probe. The ratio of the percentage of cells showing an increase in Her-2/neu copy number to the number showing polysomy for chromosome 17 was calculated. A ratio above 2 was considered amplified. RESULTS: Biochemical recurrence occurred in 50 (43%) patients and 24 (21%) had clinical recurrence. In situ hybridisation for Her-2/neu was accessible in 114 (97%) patients. A significant increase in copy number was present in two patients (1.75 %), but chromosome 17 hybridisation showed that the increase was the result of polysomy rather than true amplification. Both these patients had a Gleason score of 7 and stage T3; they also had recurrent clinical disease with distal metastasis within two and 19 months. CONCLUSIONS: Increased Her-2/neu oncogene copy number appears to be rare in clinically localised prostatic adenocarcinoma and is related to chromosome 17 polysomy rather than true amplification. As a result, it would not be a useful biomarker for identifying those patients who will have recurrences after radical prostatectomy.     

Status of HER1 and HER2 in peritoneal,ovarian and colorectal endometriosis and ovarian endometrioid adenocarcinoma

A role for the EGF system, in particular HER1 and 2, in growth of the endometrium has been suggested but HER1 and 2 have not been studied in all locations of endometriosis and in ovarian endometrioid adenocarcinoma (OEC) which is a rare form of malignant transformation of endometriosis. Immunohistochemistry (IHC) was used for studying HER1 and HER2 in ovarian (n = 10), peritoneal (n = 10), colorectal endometriosis (n = 20) and OEC (n = 10). Fluorescent in situ hybridisation (FISH) was used for analysing the status of HER2 gene in colorectal endometriosis and OEC. All samples were negative for HER2 in both glandular and stromal cells and in glandular cells for HER1 by IHC. In 15 out of 20 colorectal endometriosis, there was a weak expression in stromal cells. Following FISH, two colorectal samples had a partial 17 aneusomy and three OEC, a 17 polysomy. The other samples were 17 disomic without HER2 amplification; HER1 and 2 do not seem to have a role in endometriosis physiopathology.     

乳腺癌组织HER2基因扩增的检测方法

目的:评价高分辨率熔体聚合酶链反应(high-resolution melt polymerase chain reaction,HRM-PCR)检测HER2基因扩增的有效性及其与荧光原位杂交(fluorescence in situ hybridization,FISH)和免疫组织化学(immunohistochemistry,IHC)检测法的一致性.方法:采用HRM-PCR法检测HER2阴性及阳性细胞株,评估检测方法的有效性;检测98例已行FISH和/或IHC的临床样本,并与FISH和IHC结果进行比较.结果:HRM-PCR检测可以有效区分HER2阴性及阳性细胞株(P<0.05),具有较好的可重复性;检测98例临床样本显示,阴性和阳性样本检测结果差异有统计学意义(0.18±0.14 vs 1.42±0.88,P<0.01),与IHC的一致性为80.33%(kappa=0.6,P<0.01),与FISH的一致性为87.88%(kappa=0.7,P<0.01),结论:HRM-PCR是一种可靠有效的检测HER2基因扩增的方法,与FISH和IHC均有较好的一致性.     

Expression and amplification of Her2, EGFR and cyclin D1 in breast cancer: immunohistochemistry and chromogenic in situ hybridization

Determination of Her2, epidermal growth factor receptor (EGFR) and cyclin D1 status is now of major clinical importance due to the development of molecule-targeting drugs in anticancer therapy. Immunohistochemistry (IHC) and chromogenic in situ hybridization (CISH) are the most simple and convenient methods for evaluating gene alterations and their protein consequences. The purpose of the present study was to investigate the status of Her2, EGFR and cyclin D1 on both IHC and CISH in 95 primary breast carcinomas. There was substantial consistency between the IHC and CISH results of Her2 and EGFR, showing fair agreement between protein overexpression and gene amplification. However, cyclin D amplification was not related to protein overexpression. Moreover, there was no correlation between Her2, EGFR and cyclin D1. Her2 protein overexpression and amplification were positively associated with histological grade, nuclear grade and inversely correlated with the expression of estrogen receptor (ER) and progesterone receptor (PR). In ER-negative and postmenopausal patients, EGFR gene amplification was strongly associated with worse recurrence-free survival (P = 0.0087, P = 0.0149, respectively). Overall, the present findings suggest that EGFR gene amplification is important in predicting prognosis and this should be evaluated in breast carcinoma in addition to Her2 status in routine pathological practice.     

非小细胞肺癌EGFR和HER2基因状态及相关性

目的探讨EGFR和HER2基因变化在非小细胞肺癌发生发展中的作用及其二者相关性。方法采用PathVysion^TM探针试剂盒和LSI EGFR SpectrumOrange／CEP7 SpectrumGreen探针组合,对31例中国人非小细胞肺癌石蜡切片标本,其中腺癌20例、鳞癌2例、大细胞癌2例、细支气管肺泡癌4例、腺鳞癌3例,分别进行EGFR和HER2基因状态的检测,并统计分析二者之间的相关性。结果EGFR基因扩增者6例;EGFR基因无扩增的25例中4例为四体,5例为多体,EGFR基因拷贝数增加和基因扩增者共15例（15／31）。HER2基因扩增者2例;HER2基因无扩增的29例中4例为三体,1例为四体,9例为多体,HER2基因拷贝数增加和基因扩增者共16例（16／31）。同时为EGFR和HER2基因异常（包括基因扩增和拷贝数增高）者12例（12／31）,而且几乎都是临床Ⅲ期至Ⅳ期的患者。EGFR和HER2基因异常之间的相关性X^2Adj=7．3045,P确切=0．0069。结论EGFR或HER2基因扩增在非小细胞肺癌中的发生率较低,但基因拷贝数增加是较常发生的事件。EGFR和HER2异常有相关性,EGFR和HER2基因都参与了非小细胞肺癌的发生发展,EGFR和HER2二聚体是肺癌常见的异源二聚体形式,而且它们的相互作用可能与疾病进展有关。     

HER2 protein expression and HER2 gene amplification are infrequent in small intestinal carcinomas

Human epidermal growth factor receptor 2 (HER2/neu) gene amplification and HER2 protein overexpression have been associated with clinicopathological parameters and clinical outcome in many carcinomas. The aim of this study was to evaluate the frequency and prognostic impact of HER2 protein overexpression and gene amplification in small intestinal carcinoma (SIC). We performed immunohistochemistry (IHC) for HER2 protein and silver in situ hybridization for the HER2 gene in a total of 194 SICs. A total of 184 cases (94.8 %) were IHC 0 and 6 cases (3.1 %) were IHC 1+ with no gene amplification. HER2 protein overexpression (IHC 3+) with concordant gene amplification was detected in four cases (2.1 %), using the American Society of Clinical Oncology–College of American Pathologists guidelines for breast cancer. HER2 gene amplification was observed in an equivocal (IHC 2+) metastatic tumor in lymph node. No significant correlation was observed between HER2 status and clinicopathological parameters. Although HER2 protein overexpression and amplification were rare and did not correlate with clinicopathological parameters, further studies will be necessary to answer the question as to whether adjuvant therapy targeting the HER2 receptor might improve outcome in patients with a SIC with HER2 gene amplification and protein overexpression.     

Expression of HER2 in colorectal cancer does not correlate with prognosis

Estimation of HER2 membranous expression is routinely used in breast and gastric cancers, as both a prognostic and a predictive factor. To date there is no evidence for similar application of HER2 expression in colorectal cancer (CRC) cells. In CRC, HER2 is sometimes overexpressed in the cell membrane and very often in the cytoplasm. This study was conducted to determine possible correlations between both membranous and cytoplasmatic expression of HER2 in CRC cells and the outcome of the disease. The prognostic significance of combined staining intensity in the cell membrane and cytoplasm in the entire CRC cell was also investigated. HER2 expression in resectable colorectal adenocarcinoma cells was evaluated by immunohistochemistry in specimens taken from 202 patients. The percentage of cancer cells with membranous or cytoplasmatic reactions and the staining intensity of the reaction in the whole cell were recorded. A membranous reaction was present in 27% of cases, and cytoplasmatic reaction in 66% of cases. The total staining intensity in the entire cell was evaluated as moderate (2+) in 32% of cases and strong (3+) staining in 15%. There was no correlation found between either membranous or cytoplasmatic HER2 expression and survival. Furthermore combined staining intensity did not provide any prognostic information. We conclude that HER2 expression in CRC does not correlate with prognosis.