Testing for her2 in breast cancer: current pathology challenges faced in Canada.

This review is designed to highlight several key challenges in the diagnosis of human epidermal growth factor receptor 2 (her2)-positive breast cancer currently faced by pathologists in Canada: Pre-analysis issues affecting the accuracy of her2 testing in non-excision sample types: core-needle biopsies, effusion samples, fine-needle aspirates, and bone metastasesher2 testing of core-needle biopsies compared with surgical specimensCriteria for retesting her2 status upon disease recurrenceLiterature searches for each topic were carried out using the medline, Embase, International Pharmaceutical Abstracts, and biosis databases. In addition, the congress databases of the American Society of Clinical Oncology (2005-2011) and the San Antonio Breast Cancer Symposium (2007-2011) were searched for relevant abstracts.All authors are expert breast pathologists with extensive experience of her2 testing, and several participated in the development of Canadian her2 testing guidelines. For each topic, the authors present an evaluation of the current data available for the guidance of pathology practice, with recommendations for the optimization or improvement of her2 testing practice.

Updated recommendations from the Canadian National Consensus Meeting on HER2/neu testing in breast cancer.

Testing for HER2/neu in breast cancer at the time of primary diagnosis is now the standard of care. Accurate and standardized testing methods are of prime importance to ensure the proper classification of the patient's HER2/neu status. A meeting of pathologists from across Canada was convened to update the Canadian HER2/neu testing guidelines. This National HER2/neu Testing Committee reviewed the recently published American Society of Clinical Oncology/ College of American Pathologists (ASCO/CAP) guidelines for HER2/neu testing in breast cancer. The updated Canadian HER2/neu testing guidelines are based primarily on the ASCO/CAP guidelines, with some modifications. It is anticipated that widespread adoption of these guidelines will further improve the accuracy of HER2/neu testing in Canada.

Bupropion Hydrochloride.

Bupropion hydrochloride is a norepinephrine-dopamine disinhibitor (NDDI) approved for the treatment of depression and smoking cessation. Bupropion is a trimethylated monocyclic phenylaminoketone second-generation antidepressant, which differs structurally from most antidepressants, and resides in a novel mechanistic class that has no direct action on the serotonin system. Comprehensive chemical, physical, and spectroscopic profiles are presented. This analytical profile provides an extensive spectroscopic investigation utilizing mass spectrometry, one- and two-dimensional NMR, solid-state NMR, IR, NIR, Raman, UV, and X-ray diffraction. The profile also includes significant wet chemistry studies for pH, solubility, solution, and plasma stability. Both HPLC and UPLC methodology are presented for bupropion and its related impurities or major metabolites. The profile concludes with an overview of biological properties that includes toxicity, drug metabolism, and pharmacokinetics.

Aerosol therapy of influenza infections of mice and primates with rimantadine, ribavirin, and related compounds.

Ribavirin administered as small-article aerosols had significant therapeutic effect in the treatment of viral respiratory infections induced by influenza virus. The preliminary experiment using ribavirin to treat influenza infection in the squirrel monkey is encouraging. We expect to extend these experiments by initiating therapy at a later time to investigate the potential value of ribavirin in a clinical situation. Several derivatives of ribavirin are effective antiviral compounds. The tri-O-acetyl derivative appears to offer a potential advantage over ribavirin, although this cannot be stated with certainty since the data were obtained from separate experiments. Radiolabeling has been used as a means of measuring tissue concentration and clearance rates of various drugs. It is hoped that the use of labeled ribavirin and the tri-O-acetyl derivative will assist us in determining whether a depot of antiviral drug is created in pulmonary tissues after administration as a small-particle aerosol. These experiments are now in progress.

Multicentric gastric carcinoids complicating pernicious anemia. Origin from the metaplastic endocrine cell population.

We report three cases of multicentric carcinoid tumors of the stomach in patients with long-standing pernicious anemia and severe atrophic gastritis (type A). The tumor nodules arose in nonantral gastric mucosa showing marked intestinal metaplasia. Diffuse endocrine cell hyperplasia was present in both fundus and antrum. Antral G-cell hyperplasia was observed. A widely accepted pathogenesis of this syndrome suggests that the proliferating cell type is the argyrophilic, enterochromaffinlike cell native to the gastric body and fundus. Our findings conflict with this view, in that focal argentaffin staining was also present within tumor cells, as well as immunoreactivity for serotonin and substance P (more characteristic of small-intestinal enterochromaffin or Kulchitsky's cells and small-intestinal carcinoids). Findings in these cases at least suggest an alternative possibility: the tumors may derive from small-intestinal-type metaplastic endocrine cells within the atrophic mucosa, rather than the hypertrophic native endocrine cell population.

The osteoclast-type giant cell tumor of the pancreas.

We present a case report of osteoclast-type giant cell tumor of the pancreas and review the literature concerning this rare neoplasm, the histogenesis of which is uncertain. Electron microscopic features have suggested stromal, histiocytic, and epithelial origins to different investigators. Analysis of the present case supports and epithelial origin, with positive immunocytochemical staining for carcinoembryonic antigen and for low molecular weight keratin in the mononuclear and in some osteoclastlike giant cells. These tumor cells did not stain for mesenchymal markers (lysozyme, alpha 1-antitrypsin, alpha 1-antichymotrypsin, S100 protein). Zymogen granules, desmosomes, and zonulae occludentes were identified ultrastructurally and further support an epithelial derivation.

Aspiration biopsy cytology of metastatic endometrial stromal sarcoma and extragenital mixed mesodermal tumor.

Aspiration biopsy from metastatic tumors in two cases of endometrial stromal sarcoma and one case of endometrial adenosarcoma revealed malignant endometrial stromal cells with ill-defined cytoplasm and round or oval hyperchromatic nuclei showing irregular chromatin clumping and conspicuous nucleoli. They were seen mainly in clusters. Aspirate from a metastatic tumor of a mixed mesodermal tumor arising from the omentum showed similar malignant endometrial stroma cells, irregular tight clusters of malignant glandular cells having scanty but well-defined cytoplasm and vesicular nuclei with conspicuous nucleoli, and fragments of atypical smooth muscle tissue. The diagnostic malignant endometrial stromal cells in those reported cases did not display any distinctive cellular features permitting their cytologic identification. They were difficult to differentiate from those of other types of sarcoma. In a clinical setting, with a known primary endometrial stromal sarcoma or mixed mesodermal tumor, however, a cytodiagnosis of its metastases may be suggested when malignant endometrial stromal-cell-like cells are seen in aspirated material, oviating an open-tissue biopsy.

Treatment of Klebsiella pneumoniae respiratory tract infection of squirrel monkeys with aerosol administration of kanamycin.

The therapeutic efficacy of IM-administered kanamycin was compared with the efficacy of aerosol-administered kanamycin in Klebsiella pneumoniae-infected squirrel monkeys. Differences in mortality or morbidity were not seen with equivalent dosages of antibiotic ranging from 15 to 6.9 mg/kg of body weight/day. Seemingly, the IM route of kanamycin administration was as effective as the aerosol route for therapy.

Protection against Klebsiella pneumoniae respiratory tract infection of mice and squirrel monkeys given kanamycin by aerosol and injection.

The methods of aerosol administration of kanamycin and IM injection of the antibiotic were compared for their protection of mice and squirrel monkeys against Klebsiella pneumoniae respiratory tract infection. Mice exposed to LD90 of K pneumoniae at 0.5, 4, 24, 48 and 72 hours after they were treated with aerosol of kanamycin (27 mg/kg of body weight) were significantly better protected at all exposure times than were mice given the antibiotic (450 mg/kg) by IM injection. Squirrel monkeys given the aerosol at dose level of 11.25 mg/kg were completely protected against K pneumoniae exposure at 6 and 24 hours, whereas only one of eight monkeys treated with the same dose given IM survived the exposure at 6 hours and none survived at 24 hours. Antibiotic clearance curves indicated that kanamycin remained in the lungs at higher concentrations and for longer periods after aerosol treatment than after IM treatment.

Simian model for the evaluation of immunity to influenza.

Rhesus monkeys (Macaca mulatta) exposed to small-particle aerosols of the Aichi strain of type A2 influenza virus responded by shedding virus from the nasopharynx for 7 to 9 days and by seroconversion (hemagglutination inhibition) 8 or 9 days after exposure. After rechallenge with the homologous virus, no replication of the organism was observed, and a serological anamnestic reaction occurred. The data indicate that the rhesus monkey is a useful primate model for evaluating induced immunity to influenza virus infection.

Relationship of method of administration to respiratory virulence of Klebsiella pneumoniae for mice and squirrel monkeys.

Klebsiella pneumoniae given by aerosol was significantly less virulent in mice and monkeys than when given by intranasal (mice) or intratracheal (monkeys) instillation.

Influence of blue-green algae (cyanobacteria) on survival of Legionella pneumophila in aerosols.

The fluid in which blue-green algae (cyanobacteria) (Fischerella sp.) had been grown (algal extract) was investigated for its effect on aerosols of Legionella pneumophila. The bacteria were significantly more stable when suspended in algal extract than in the tryptose-saline solution employed in previously reported experiments. The stabilizing property of the extract disappeared after dialysis, suggesting that a relatively small molecule was involved. The relationship of this observation to the epidemiology of Legionnaires disease is discussed.

Effect of prior influenza virus infections on susceptibility of AKR/J mice to respiratory challenge with Legionella pneumophila.

Influenza virus administered intranasally to AKR/J mice, followed 3 days later by Legionella pneumophila inoculated intranasally, caused significantly greater mortality than did either of the two agents administered alone. Viable concentrations of both bacteria and viruses dropped in sequentially infected animals, despite the ultimate fatal outcome. Viral concentrations, however, did not decrease as rapidly in sequentially infected as in singly infected mice. Histopathologic lesions were consistent with viral replication aided by elaboration of a bacterial toxin. This observation contrasts with the more commonly observed sequence in which the bacterium proliferates after the virus interferes with host defense. Cell-free preparations were found to have toxic activity.

Evaluation of commercially prepared vaccines for experimentally induced type A/New Jersey/8/76 influenza virus infections in mice and squirrel monkeys.

Mice and squirrel monkeys were vaccinated and subsequently challenged at selected times to evaluate the immunoprophylactic value of vaccines against influenza virus type A/New Jersey/76. Mice were challenged with virulent, homologous virus either 17 or 60 days after vaccination with 80 chick cell-agglutinating (CCA) units of whole-virus vaccine. Vaccinated mice showed minimal lesions and virus in lung tissue and had lower lung weights than unvaccinated controls. These mice had titers of hemagglutination-inhibiting (HAI) antibody in serum of greater than 1:400, but only traces of antibody were found in lung washes. Vaccinated squirrel monkeys had significantly less illness than unvaccinated controls when challenged with virulent virus 30 days after intramuscular immunization with 200 CCA units of whole virus or 400 CCA units of split virus given either once or twice (at 30-day intervals). Equal protection was observed in all monkeys despite the absence of serum HAI antibody in some monkeys after vaccination. Anamnestic reactions were observed only in monkeys vaccinated with whole virus. The possible roles of various immune factors and antibody to neuraminidase are discussed.

Reaction of squirrel monkeys to intratracheal inoculation with influenza/A/New Jersey/76 (swine) virus.

To determine whether a model could be established for laboratory investigations, nine squirrel monkeys were inoculated intratracheally with 10(7) median egg-infectious doses of influenza virus type A/New Jersey/8/76 (HSW1N1) (swine influenza virus). They responded with clinically detectable illness including fever, leukopenia, decreased food consumption, increased respiratory rate, occasional coughing, labored breathing, nasal discharge, and lethargy. Convalescence was well advanced by the day 10. All monkeys excreted virus for 7 to 8 days. A scoring procedure (illness score) has been developed for use in studies of vaccine and chemotherapeutic efficacy.

Effect of simulated solar radiation and sodium fluorescein on the recovery of Venezuelan equine encephalomyelitis virus from aerosols.

Almost 90% of the Trinidad strain of Venezuelan equine encephalomyelitis (VEE) virus survived for 1 hr after aerosolization into a dark environment at 30% relative humidity (RH), and 78% survived for 1 hr at 60% RH. After exposure to simulated solar radiation (584 mcal per cm(2) per min) 0.02% of the aerosolized virus survived for 1 hr at 30% RH and 0.006% survived for 1 hr at 60% RH. When 1.0 mg of sodium fluorescein per ml was added to suspensions prior to aerosol dissemination (to determine physical loss of aerosol), no virus was detected after 30 min at either RH upon irradiation. Sodium fluorescein also exhibited some toxicity (31% survival at 60 min) for nonirradiated aerosols of VEE virus at 60% RH; no effect was noted at 30%.

Experimental tularemia in Macaca mulatta: relationship of aerosol particle size to the infectivity of airborne Pasteurella tularensis.

Ninety-six Macaca mulatta were exposed to aerosol particles containing Pasteurella tularensis. Four different aerosols were employed that contained particle size distributions with median diameters of 2.1, 7.5, 12.5, or 24.0 mum. Size distributions were calculated only for those particles observed by phase microscope to contain organisms. Animals exposed to particles whose median diameters were either 2.1 or 7.5 mum were all infected and showed extensive infection of the lower respiratory tract, evidenced by large patches of consolidation with many necrotic foci on the surface. Death occurred in these animals 4 to 8 days after exposure. Monkeys exposed to 12.5- or 24.0-mum median diameter particles presented involvement of the cervical and mandibular lymph nodes, evidenced by swelling and abscess formation. Thirty-eight of the 45 animals in this group were infected. Those animals succumbing to the disease died from 8 to 21 days after exposure. The respiratory LD(50) values increased from 14 to 4,447 cells as the median diameter was raised from 2.1 to 24.0 mum.

Influenza alone and in sequence with pneumonia due to Streptococcus pneumoniae in the squirrel monkey.

Squirrel monkeys (Saimiri sciureus) inoculated intratracheally with 10(4.2)-10(8.2) egg median infectious doses (EID50) of type A influenza virus (H3N2) responded with clinical illness including such signs as fever, sneezing or coughing, coryza, and increased respiratory rates. Necropsy studies performed six days after inoculation revealed bronchopneumonia in addition to a mild tracheitis. Squirrel monkeys given 10(5)-6 x 10(8) colony-forming units (cfu) of Streptococcus pneumoniae intratracheally died four to six days later after developing severe illness characterized by fever, bacteremia, lethargy, anorexia, coughing, labored breathing, and bronchopneumonia. Monkeys given 770 cfu of S. pneumoniae responded with less severe symptoms and survived. Four squirrel monkeys inoculated with 10(8.2) EID50 of virus and then 102 hr later with 770 cfu of S. pneumoniae developed severe disease; three of the four animals died within 40 hr. At necropsy these monkeys had more extensive and severe bronchopneumonia than was seen in monkeys infected with either organism alone.

Treatment of respiratory Klebsiella pneumoniae infection in mice with aerosols of kanamycin.

Aerosols of kanamycin resulted in greater survival of mice challenged with respiratory Klebsiella pneumoniae than the same dosage given intramuscularly. Determinations of viable bacteria in the blood and lungs revealed that aerosolized kanamycin was most effective when infection was confined to the lungs. After the organisms had spread to other areas, however, aerosol therapy was still more effective than intramuscular therapy, but only one-half the infected mice survived.

Surgical treatment of colonic ganglioneuromatosis in neurofibromatosis.

Gastrointestinal involvement in neurofibromatosis occurs in three forms: neurofibromatous tumours, visceral vasculopathy and ganglioneuromatosis. A case of colonic ganglioneuromatosis is reported and six similar cases from the literature are reviewed. The clinical and pathological features of this condition are summarized and guidelines for surgical therapy formulated. Subtotal colectomy is recommended for pseudo-obstructive symptoms refractory to medical management.