A two-phase study model for the standardization of HER2 immunohistochemical assay on invasive ductal carcinoma of the breast.

OBJECTIVES: To develop and verify a standardized protocol for HER2 immunohistochemical assays on invasive ductal carcinoma of the breast in Thailand. MATERIAL AND METHOD: A two-phase study approach was employed. In the Phase One, after verifying the proposed protocol that adopted the HercepTest procedure using readily available primary antibodies, CB11 and A0485, Lab 1 performed the HER2 immunohistochemical staining for 137 cases of invasive ductal carcinoma twice with two types of the antibody. Nine pathologists from 8 centers independently examined and scored all the 2 x 137 stained slides that were blinded for antibody type. Interobserver reliability was calculated using pair-wise kappa. Following discussion of the results, the Phase Two study was planned. Lab 2 and Lab 3 independently performed the HER2 staining according to the protocol for 60 invasive breast carcinoma cases. The same group of pathologists scored 2 x 60 stained slides that were masked for laboratories. Interobserver reliability and interlaboratory agreement from each pathologist were calculated using kappa statistics. Three interpreted categories--namely negative, equivocal and positive tests were used in the analyses. RESULTS: Phase One study showed interobserver agreement between pairs varied from kappa 0.75 (95%CI, 0.68-0.82) to 0.06 (95%CI, 0-0.14) while Phase Two study obtained pair-wise kappa scores ranged from 0.84 (95%CI, 0. 80-0.89) to 0. 65 (95%CI, 0.59-0.71). Interlaboratory kappa for each pathologist was 0.67 (95%CI, 0.61-0.73). CONCLUSION: The standardization of HER2 immunohistochemical assay was achieved through this two-phase study model. It had added benefits of improving pathologists' expertise and verifying the HER2 testing protocol to be used in Thailand.

Correlation of HBV and HCV with CH, LC, HCC in liver biopsied tissue at Rajavithi Hospital.

Retrospective study in Clinicopathology of 66 surgical liver tissue from adult Thai patients admitted at Rajavithi Hospital, in Bangkok, during December 2002-September 2003 (10 month periods). The main purposes are: 1) To find the correlation of HBV, HCV with CH, LC, HCC. 2) To compare the correlation of Hepatocyte, AFP, CEA (IHC) in malignant cells, which one is the best usage to confirm the diagnosis of HCC in both primary and metastasis. 3) To review the clinicopathology of all these 66 liver samples. The results were significant correlation of HBsAg (serology) with HCC (p = 0.010), and also significant correlation of HBsAg (IHC in liver tissue) with CH, LC (p = 0.038, 0.021 respectively). Although no significant correlation (p > 0.05) of HCV (positive anti HCV) with CH, LC, HCC; the causes due to the small sample sizes and short period study are possibly bias factors. The authors concluded that Hepatocyte or Hep-Par I is the best immunocellular marker for malignant liver cells both in primary and metastasis (p < 0.001). The AFP, CEA show no correlation (p = 0.999, 0.670). The authors found other interesting non-viral related liver disease, common, uncommon, tumor and tumor-like (pseudotumor) lesions in the liver from the present study. The results of significant correlation of HBV (HBsAg) with CH, LC, HCC is one good evidence to further support The National HBV Vaccine Program for the uninfected population, which has been sponsored by the Thai Government, The Ministry of Public Health since 1992 and be one of the best and successful Thai Public-Health Policy.

Leiomyosarcoma in peripheral nerve: the first case report.

A neoplasm of the peripheral nerves can be obscured, especially during the early phase. The authors report a patient with sciatic nerve leiomyosarcoma. The patient's presentation and initial management are unique. A 51-year-old man with clinical manifestations of von Recklinghausen's disease reported numbness and weakness of the left leg for one and a half years. The symptoms gradually progressed. The symptoms were consistent with peripheral neuritis. The patient developed foot drop one month before coming to our service. Two episodes of biopsy confirmed leiomyosarcoma. A long, large sciatic nerve leiomyosarcoma was found intra-operatively, positioned from the upper thigh to the point where the tibial nerve passes beneath the upper margin of the soleus muscle. Surgical resection was done and confirmed the diagnosis. Decreased sensation was still intact after resection.