Quddus M Ruhul, Hansen Katrine, Tantravahi Umadevi, Sung C James
Department of Pathology, Women Infants Hospital/Alpert Medical School of Brown University, Providence, RI 02905, USA.
Gynecol Oncol Rep. 2020 Mar 16;32:100561. doi: 10.1016/j.gore.2020.100561. eCollection 2020 May.
The human epidermal growth factor receptor 2 (Her2) is tested in many human cancers, including breast, bladder, pancreatic, ovarian and stomach. The American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) have issued Clinical Practice Guidelines for reporting Her2 results for breast carcinomas (Wolf et al., 2018). For the last 1-2 years Her2/neu is tested in endometrial serous carcinoma, especially in recurrent tumors or non-responsive tumors as an option for additional treatment. College of American Pathologists (CAP) offers a template for prognostic marker reporting results for specimens with endometrial carcinomas (Fitzgibbons et al., 2019). Her2/neu testing by immunohistochemistry (IHC) mandates rigorous fixation time control, e.g., fixation time should fall within 6-72 h (Recommendations for Her2 Testing in Breast Cancer, 2013). For that reason, in breast cancers, Her2/neu testing is done on initial core biopsy specimens. The test is however, repeated on excision specimen in high grade tumors where Her2/neu expression was initially negative on core biopsies. For endometrial serous carcinoma no guidelines have been set or proposed as of yet. The Gynecologic Oncologists request this test because of proven benefit of adding Trastuzumab (Fader et al., 2018) and that is why it is important to documenting the findings in this report in the literature so that an informed request can be made by the treating oncologist when multiple tissue samples from the same patient are available for testing. Similarly pathologists also can decide which would be the best sample to test when no instruction is received. We report here three separate scenarios of uterine serous carcinomas in which the Her2/neu expressions were unique enough to justify documentation and therefore have implications for determining which specimen is ideal for the Her2 overexpression testing and likely to have highest possibility in identifying the Her2/neu overexpressed clone in the tumor which would expand the therapeutic options for the patients.
人表皮生长因子受体2（Her2）在许多人类癌症中都需要检测，包括乳腺癌、膀胱癌、胰腺癌、卵巢癌和胃癌。美国临床肿瘤学会（ASCO）/美国病理学家学会（CAP）已发布关于报告乳腺癌Her2检测结果的临床实践指南（Wolf等人，2018年）。在过去1 - 2年中，Her2/neu在子宫内膜浆液性癌中进行检测，特别是在复发肿瘤或无反应性肿瘤中作为额外治疗的一种选择。美国病理学家学会（CAP）提供了一份用于报告子宫内膜癌标本预后标志物检测结果的模板（Fitzgibbons等人，2019年）。通过免疫组织化学（IHC）检测Her2/neu要求严格控制固定时间，例如，固定时间应在6 - 72小时内（2013年乳腺癌Her2检测建议）。因此，在乳腺癌中，Her2/neu检测在初始粗针活检标本上进行。然而，对于高级别肿瘤，如果Her2/neu在粗针活检中最初表达为阴性，则在切除标本上重复检测。截至目前，对于子宫内膜浆液性癌尚未制定或提出相关指南。妇科肿瘤学家要求进行此项检测是因为已证实添加曲妥珠单抗有获益（Fader等人，2018年），这就是为什么在文献中记录本报告中的发现很重要，以便当同一患者有多个组织样本可供检测时，主治肿瘤学家能够做出明智的请求。同样，当没有收到指示时，病理学家也可以决定检测哪个样本是最佳选择。我们在此报告三例子宫浆液性癌的不同情况，其中Her2/neu的表达独特到足以证明记录的合理性，因此对于确定哪个标本是Her2过表达检测的理想标本以及在肿瘤中识别Her2/neu过表达克隆的可能性最高具有重要意义，这将为患者扩展治疗选择。
