Hormonal and Her-2 Receptor Status in DCIS and Concurrent Invasive Carcinoma
Dimple M Pandya, Chiraag D Patel, Sui Zee, Jingxuan Liu, Carmen Tornos. Stony Brook University Medical Center, Stony Brook, NY
Background: Information on hormone status is useful in determining prognosis and therapy of invasive breast carcinomas. There are instances in which the amount of invasive tumor is inadequate to render accurate results. The aim of this study was to compare the ER, PR, and Her2/neu immunohistochemistry of invasive carcinomas and its concurrent DCIS present at the immediate periphery, to determine whether the immunoprofile is similar enough to extrapolate and apply the DCIS immunohistochemical profile towards therapy of the invasive tumor.
Design: We reviewed the H&E slides and ER, PR and Her-2 immunostains from 50 cases of invasive ductal carcinomas and concurrent DCIS in the same paraffin block. The histological characteristics, and the percentage and intensity of the immunostaining of both the in situ and invasive component were reviewed and compared by the same pathologist.
Results: The ER was concordant in 47 cases (94%), positive in 40, and negative in 7 cases. The PR was concordant in 42 cases (84%), positive in 35 and negative in 7 cases. The Her-2 was concordant in 48 cases (96%), negative in 42 and positive in 6 cases. The three markers were concordant in 40 cases (80%). ER was negative in one invasive tumor (grade 2) with 30% positivity in the DCIS (high nuclear grade without necrosis). Two cases had ER positive in invasive carcinoma but negative in DCIS. The invasive carcinoma in both cases was moderately differentiated with DCIS being either intermediate or high grade with necrosis. Two cases of moderately differentiated invasive carcinoma where PR was negative, while the DCIS was positive in both cases, with 60-80% positivity, low to intermediate nuclear grade with necrosis. Six cases were positive for PR in the invasive component (grade 2) but negative in the DCIS (low to intermediate grade). Two of the fifty cases showed discordance in Her2/neu staining. The invasive tumor was negative for Her-2 in both cases (one grade 1 and one grade 2) while the DCIS was high grade with necrosis and positive for Her-2.
Conclusions: 80% of the tumors were concordant for all three markers. However, 20% of cases had at list one marker discordant. There were no cases of DCIS negative/invasive tumor positive, therefore one may assume that when the DCIS is Her-2 negative the invasive component is also negative. Other assumptions regarding ER and PR cannot be justified since we found ER or PR positive DC IS with ER or PR negative invasive cancer, and vice versa ER or PR negative DCIS with ER or PR positive invasive cancer.
Monday, March 4, 2013 1:00 PM
Poster Session II # 57, Monday Afternoon