Recommendations for the Management of Uveitis Associated With Juvenile Idiopathic Arthritis: The Czech and Slovak adaptation of SHARE Initiative.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is its most important extra-articular manifestation. Evidence-based recommendations are available only to a limited extent and therefore JIA associated uveitis management is mostly based on physicians experience. Consequently, treatment practices differ widely, both nationally and internationally. Therefore, an effort to optimize and publish recommendations for the care of children and young adults with rheumatic diseases was launched in 2012 as part of the international project SHARE (Single Hub and Access Point for Pediatric Rheumatology in Europe) to facilitate clinical practice for paediatricians and (paediatric) rheumatologists. The aim of this work was to translate published international SHARE recommendations for the diagnosis and treatment of JIA associated uveitis and to adapt them for use in the Czech and Slovak Republics. International recommendations were developed according to the standard methodology of the European League against Rheumatism (EULAR) by a group of nine experienced paediatric rheumatologists and three experts in ophthalmology. It was based on a systematic literature review and evaluated in the form of an online survey and subsequently discussed using a nominal group technique. Recommendations were accepted if > 80% agreement was reached (including all three ophthalmologists). A total of 22 SHARE recommendations were accepted: 3 on diagnosis, 5 on disease activity assessment, 12 on treatment and 2 on future recommendations. Translation of the original text was updated and modified with data specific to the czech and slovak health care systems and supplemented with a proposal for a protocol of ophthalmological dispensarization of paediatric JIA patients and a treatment algorithm for JIA associated uveitis. Conclusion: The aim of the SHARE initiative is to improve and standardize care for paediatric patients with rheumatic diseases across Europe. Therefore, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated based on the evidence and agreement of leading European experts in this field.

Expression of E-cadherin and c-erbB-2/HER-2/neu oncoprotein in high-grade breast cancer.

E-cadherin (E-CD) is an epithelial-specific cell adhesion molecule, whose expression is lost in invasive lobular (ILC) but not in invasive ductal carcinoma (IDC) of the breast. This cell adhesion system can be disrupted by tyrosine kinase c-erbB-2/HER-2/neu. We examined 106 cases of high-grade invasive breast cancer, including 91 IDCs, 12 ILCs and 3 pleomorphic lobular carcinomas (PLCs). We determined Nottingham histological grade and performed immunohistochemistry for estrogen and progesterone receptors (ER/PR), Ki-67, E-CD and c-erbB-2/HER-2/neu with subsequent fluorescence in situ hybridization. Amplification of c-erbB-2/HER-2/neu gene was observed in 55/91 (60.4%) of IDCs, 3/12 (25%) of ILCs and 1/3 (33.3%) of PLCs, and associated with positive axillary lymph nodes. E-CD expression was lost in 14/91 (15.4%) of IDCs, 10/12 (83.3%) of ILCs and 2/3 (66.7%) of PLCs. The loss of E-CD immunoreactivity in IDCs appeared to be associated with c-erbB-2/HER-2/neu gene amplification, negative ER/PR status and positive lymph nodes, whereas E-CD-positive ILCs tended to be HER-2/neu-positive. The biological significance of E-CD expression seems to be different in high-grade IDC and ILC. Oncogenic pathway mediated by c-erbB-2/HER-2/neu may affect the E-CD expression in most invasive ductal breast carcinomas in vivo.

Analysis of ERBB2 and TOP2A gene status using fluorescence in situ hybridization versus immunohistochemistry in localized breast cancer.

The aim of our study was to assess the ERBB2 and TOP2A gene status in breast carcinoma tissue using fluorescence in situ hybridization (FISH) and to compare their amplification with immunohistochemistry assay (IHC) of the ERBB2, resp. topoisomerase IIalpha proteins. TOP2A status is important in tailored treatment as topoisomerase IIalpha is the molecular target for topoisomerase IIalpha inhibitors. This study was conducted to determine whether the methods are equivalent in their assessment of TOP2A status and to correlate the genetic findings with basic tumor and disease characteristics. Locus specific ERBB2, TOP2A genes and chromosome 17 centromeres (CEP17) probes were hybridized to 72 formalin-fixed paraffin-embedded (FFPE) tissue samples from patients with non-metastatic breast carcinoma (M0). The ERBB2, TOP2A and CEP17 signals were counted and gene numbers per nucleus or per CEP17 were calculated, respectively. Sections were also stained with commercial polyclonal antibody (HercepTestTM), anti-topoisomerase IIalpha monoclonal antibody (clone SWT3D1) and scored for the presence of membrane/nuclear staining. ERBB2 amplification was found in 20.3%, ERBB2 and TOP2A co-amplification was detected in 14.5% of cases. Deletion of the ERBB2/TOP2A gene was found in 1.4/2.8% of sections, respectively. Concordance of FISH and IHC techniques in the evaluation of ERBB2 and TOP2A status was found in 88.4% and 66.7%, respectively. The low concordance of FISH versus IHC in the evaluation of TOP2A status was mainly due to the presence of TOP2A amplified tumors in IHC negative or weakly positive specimens. Topoisomerase IIalpha expression was increased in bigger tumors, although direct correlation with tumor grading was not found. ERBB2 amplification was found in more aggressive breast cancers with grades 2 and 3, respectively. Interestingly, chromosome 17 polysomy was more frequently observed among older women (>55 years), suffering usually from less aggressive disease. Our results confirm the high concordance of the ERBB2 and TOP2A gene co-amplification in breast carcinoma. Differences between FISH and IHC in the case of ERBB2 gene status were found only in IHC 2+ sections as reported in the literature. However, our study points to the importance of FISH examination of TOP2A gene status in all tumors with ERBB2 amplification.