HER2 status in breast cancer: changes in guidelines and complicating factors for interpretation

Human epidermal growth factor receptor 2 (HER2) protein overexpression and/or HER2 gene amplification is found in about 20% of invasive breast cancers. It is a sole predictive marker for treatment benefits from HER2 targeted therapy and thus, HER2 testing is a routine practice for newly diagnosed breast cancer in pathology. Currently, HER2 immunohistochemistry (IHC) is used for a screening test, and in situ hybridization is used as a confirmation test for HER2 IHC equivocal cases. Since the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines on HER2 testing was first released in 2007, it has been updated to provide clear instructions for HER2 testing and accurate determination of HER2 status in breast cancer. During HER2 interpretation, some pitfalls such as intratumoral HER2 heterogeneity and increase in chromosome enumeration probe 17 signals may lead to inaccurate assessment of HER2 status. Moreover, HER2 status can be altered after neoadjuvant chemotherapy or during metastatic progression, due to biologic or methodologic issues. This review addresses recent updates of ASCO/CAP guidelines and factors complicating in the interpretation of HER2 status in breast cancers.

Changes in Biomarker Status in Metastatic Breast Cancer and Their Prognostic Value / 한국유방암학회지

PURPOSE: There is cumulative evidence that changes in biomarker status occur frequently during the metastatic progression of breast cancer and affect treatment response. The purpose of this study was to evaluate the frequency of biomarker changes in metastatic breast cancer (MBC) and its impact on prognosis. METHODS: A total of 152 patients diagnosed with MBC at the time of initial diagnosis or during post-surgical follow-up were included. Changes in biomarker status in MBCs, their frequency according to various metastatic sites, tumor characteristics, and their association with patient survival were analyzed. RESULTS: Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 status changed in 9 (6.0%), 40 (26.3%), 12 (7.9%), and 29 (19.1%) patients, respectively. ER, PR, and HER2 mainly showed positive to negative conversion, whereas Ki-67 changed mostly from a low to high index. There were no differences in the frequencies of biomarker changes according to the metastatic sites. As for ER and HER2, cases with negative conversion showed low expression levels in the primary tumor. Survival analyses indicated that a positive to negative conversion of ER was an independent poor prognostic factor in patients with primary ER-positive breast cancer. CONCLUSION: Changes in biomarker status are not rare, and usually occur in an unfavorable direction in breast cancer metastases. Negative conversion of ER status is a predictor of poor prognosis. Thus, it is beneficial to evaluate changes in biomarker status in MBC not only for the purpose of determining treatment options but also for prognostication of patients.

Treatment of the Medial Blow-out Fracture by Medial Transconjunctival Approach

Blow-out fractures usually occur at the weakest point of orbital wall such as medial wall or orbital floor. The operative treatment of blow-out fracture involve restoration of intra-orbital soft tissue and bony structural integrity. The surgical reduction of medial blow-out fracture are mainly transcutaneous, transnasal and transconjunctival approaches. The conventional methods has several disadvantages, such as external scar, narrow operative field and injury of neurovascular bundle. But medial transconjunctival approach has advantages such as minimal scar, short operative time and relative safety. We experinced 26 cases of medial blow-out fracture using medial transconjunctival approach from June 2001 to May 2003. Preoperatively 21 cases showed diplopia and 14 cases showed enophthalmos. In postoperative complications, diplopia were 2 cases, enophthalmos was 1 case, anterior displacement of implant were 2 cases, conjunctival scar were 2 cases and injury of caruncle was 1 case. We report the medial transconjunctival approach that was effective treatment for medial blow-out fracture without specific complications.

The Dynamic Lip Reconstruction with Variable Free Neuromuscular Transfers in Chronic Facial Palsy

The goals of ideal lip reconstruction in chronic facial palsy include recovery of sphincteric function of the lip and symmetry of mouth during facial expression and the resting state. The lip reconstruction in chronic facial palsy can be mainly divided into dynamic and static method. Recently, the dynamic lip reconstruction tend to be reported more frequently with the development of microsurgery. From December of 1994 to August of 2001, We had 6 dynamic lip reconstruction by one or two staged free neurovascular flap, and followed up from 1 to 4 years and 4 months (mean 36 months). One case was two-staged free rectus abdominis flap after cross-face nerve graft with sural nerve. Another case was one- staged free gracilis muscle flap anastmosised with one of the buccal branch of facial nerve in the affected side, which had relatively good function. The other 4 cases were one-staged free neurovascular latissimus dorsi flaps. We also combined other procedures such as gold implant for lagophthalmos, temporalis muscle transfer on ectropion of the lower eyelid, and the excisional eyebrow lift on the affected side. We got relatively satisfactory results except 1 case.

New Classification of Naso-Ethmoid-Orbital Fracture using Computerized Tomography

Naso-ethmoid-orbital fractures are the most challenging of all craniofacial fractures to treat because of the intricate anatomy of this region and the difficulty in fracture fixation. Inadequate initial treatment will often result in severe deformity that may be extremely difficult or impossible to correct adequately. Naso-ethmoid-orbital injuries have been described in detail by numerous authors, but to date, no adequate classification of these injuries exits. In this study, we reviewed and analyzed the medical records and facial bone CT scans of 66 patients from May 1990 to August 1998 by retrospective analysis method. The pattern of injury in these patients was carefully analyzed in order to formulate a working classification based on clinical features and fracture types. Injuries may be unilateral or bilateral, and three clinical types of fractures have been recognized, each of which may occasionally have a combination of features. The types of fracture were divided into Type I, Type II and Type III. Type I was isolated bony NEO injury (31 cases), Type II was bony NEO injury with maxilla (11 cases) and Type III was extended NEO injury (24 cases). Also, type II was subdivided into 1) Bony NEO injury with central maxillay crush only, 2) with central maxilla and one lateral maxillary crush, and 3) with central and bilateral maxillary crush, and type III was 1) with craniofacial injuries, 2) with Le Fort II and III fractures and 3) with orbital displacement. The recognition and diagnosis of each specific injury pattern by our new classification method will define the correct treatment choice in each case.

Two Cases of Tuberculous Cervicitis / 대한부인종양콜포스코피학회잡지

Genital tract tuberculosis is uncommon disease, and usually developed secondary to a primary focus elsewhere in the body. The incidence of cervical involvement in genital tract tuberculosis is extremely low. The disease remains prevalent in developing countries and with changing patterns its incidence in developed countries appears to be increasing. The gross appearance of cervical tuberculosis is most commonly confused with cervical carcinoma. We report two cases of tuberculosis of cervix of uterus with brief review of literature.

A Case Report of Arteriovenous Malformation of the Uterus complicated with Hydatidiform Mole / 대한산부인과학회잡지

Uterine arteriovenous malformation(AVM) is a rare cause of massive uterine bleeding. Although uterine AVM is a rare cause of menorrhagia or postmenopausal bleeding, it is important to consider in the assessment of a patient with abnormal uterine bleeding because accurate diagnosis can allow appropriate treatment to be planned and avoid hysterectomy in women who wish to retain their reproductive capacity. Curettage may precipitate life-threatening hemorrhage and is therefore contraindicated when uterine AVM is suspected. These lesinons may be congenital or acquired. Acquired lesions are believed to follow trauma or may arise after choriocarcinoma or other gynecologic malignancies. Until rescently, this condition was difficult to diagnose and management almost always required hysterectomy. Doppler flow ultrasound and pelvic angiography are important for diagnosis and assessment. Transcatheter embolization has replaced hysterectomy as the treatment of choice in woman who wish to retain their fertility. We have experienced one case of uterine AVM complicated by partial hydatidiform mole, which is presented with a brief review of the literature.

Two Cases of pregnancies Complicated with Liver Cirrhosis / 대한주산의학회잡지

No abstract available.

Epicanthoplasty Using Modified Park's Method

The creation of a supratarsal fold is the most frequently performed cosmetic surgical procedure in Asia. The presence of epicanthal folds in Asian eyelids is one of their unique features, in combination with the lack of supratasrsal folds. While this represents an element of Oriental beauty in a traditional way, many seek cosmetic improvement in the medial canthal area to eliminate the epicanthal fold. Epicanthoplasty enhances the aesthetic result of the double-lid procedure by lengthening the palpebral fissure, thus producing the image of a larger, open eye. In this paper, we present modified Park's epicanthoplasty based on our experience with 36 cases performed during the past 3 years. Double fold operation with modified Park's epicanthoplasty were performed in 25 cases and modified Park's epicanthoplasty without double fold operation were performed in remaining 11 cases. The follow-up period ranged from 6 months to 2 years. The results were satisfactory except 1 case of hypertrophic scar and 3 cases of undercorrection. The advantages of modified Park's epicanthoplasty are simplicity in design and minimal scarring produced in the medial canthal area as compared with complex W-plasty or Z-plasty, which requires multiple incisions and often creates unsightly scarring. Incorporating epicanthoplasty by modified Park's method with or without double-lid procedure gives oriental eyes a balanced and aesthetically pleasing look.