HER2 blockade in metastatic collecting duct carcinoma (CDC) of the kidney: a case report.

BACKGROUND: Collecting duct carcinoma of the kidney (CDC) is a rare cancer associated with bad prognosis and, at present, with no specific effective therapies. CASE REPORT: We report a clinical case with disseminated highgrade CDC presenting with widespread metastasis to both lungs, pelvic bones, axial skeleton, and the central nervous system (posterior fossa, both hemispheres and pituitary-hypothalamic). The primary tumor in the kidney was demonstrated (by fluorescence in situ hybridization and immunohistochemistry with Herceptest (3+ score)) to significantly overexpress HER2. Critically ill at presentation, the patient received oral capecitabine together with double HER2 blockade with both intravenous trastuzumab and oral lapatinib. His clinical response was a dramatic improvement and a progressive decline in the radiological size of all of his multiple cancer lesions. CONCLUSION: Double HER2 blockade is an effective therapy in disseminated CDC even in the presence of brain metastases.

Carcinoma microinvasivo de mama: estudio clinicopatológico de 18 casos / Microinvasive breast carcinoma: a clinicopathological profile of 18 cases

Introducción: La definición exacta del carcinoma microinvasivo de mama sigue siendo problemática, y su comportamiento clínico incierto. Hemos estudiado de forma retrospectiva 38 casos con el diagnostico de carcinoma microinvasivo realizado en diversas instituciones, según los criterios de Silver y Tavassoli. Material y métodos: Describimos las características clinicopatológicas y la reproducibilidad del diagnostico de microinvasion, siguiendo los criterios predeterminados. También estudiamos el valor de la p63 y de la calponina, para establecer la integridad de la capa mioepitelial. Resultados: Los casos fueron revisados por dos de los autores (FG, VM) y reclasificados como carcinoma microinvasivo en 18 casos (47%), microinvasión dudosa, 1 caso, carcinoma ductal in situ (DCIS) con el pseudoinvasión, 11 casos (28,9%), y carcinoma ductal invasor pT1a y pT1b en 8 casos (21,6%). El tamaño del DCIS asociado varió entre 7 y 80 mm. En once casos solo había un foco de microinvasión, los otros casos demostraron dos o tres focos de microinvasión. Dos casos mostraron invasión vascular como la única evidencia del microinvasión. El estudio immunohistoquímico con la calponina y la p63 fue útil en la diagnosis en el 50% de los casos. La axila se extirpó en 15 casos, con un solo ganglio positivo (6,6%). El seguimiento ha oscilado entre 3-120 meses (promedio de 42 meses) con sólo una recidiva local sobre la cicatriz por CDIS a los 9 meses. Conclusiones: El sobrediagnóstico histológico es uno de los problemas de esta entidad. Unos criterios morfológicos estrictos y el uso de la inmunohistoquímica es útil en el diagnóstico diferencial con el CDIS y el carcinoma ductal infiltrante. La incidencia de las recurrencias locales y la metástasis ganglionar son bajas y usualmente se asocian a CDIS de alto grado con necrosis. La extirpación del ganglio centinela puede estar indicada en casos de CDIS con microinvasión

Introduction: The exact definition of microinvasive breast carcinoma remains problematic, and its clinical behavior is uncertain. We have studied retrospectively 38 cases with the diagnosis of microinvasive carcinoma made in different institutions, according to the criteria of Silver and Tavassoli. Material and Methods: We describe the clinico-pathologic characteristics and the reproducibility of the diagnosis of microinvasion, following predetermined criteria. We also study the value of immunohistochemical stains with p63 and calponin, to establish the integrity of the myoepithelial layer. Results: The cases were reviewed by two of the authors (FG, VM) and reclassified as microinvasive carcinoma, 18 cases (47%), doubtful microinvasion, 1 case, ductal carcinoma in situ (DCIS) with pseudoinvasion, 11 cases (28.9%), and invasive ductal carcinoma pT1a and pT1b, 8 cases (21.6%).The size of the associated DCIS varied between 7 and 80 mms. In eleven cases one single focus of microinvasion was found, the other cases showed two or three foci of microinvasion. Two cases showed angiolymphatic invasion, as the only evidence of microinvasion. Immunohistochemistry with calponin and p63 was helpful in the diagnosis of microinvasion in 50% of the cases. Axillary lymph nodes were obtained in 15 cases, and a single positive lymph node was found. One patient recurred as DCIS in the surgical scar nine months after surgery. The other patients were disease free after a variable follow-up, between 3 and 120 months (average 42 months). Conclusions: Microinvasive breast carcinoma is often overdiagnosed histologically. The implementation of strict morphological criteria and the use of immunohistochemistry may be helpful in the differential diagnosis with DCIS and invasive ductal carcinoma. The incidence of local recurrence and lymph node metastases is low, and it is usually associated with the presence of high grade DCIS with necrosis. Sentinel lymph node biopsy may be indicated in cases of DCIS with microinvasion (AU)