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Differing deregulation of HER2 in primary gastric cancer and synchronous related metastatic lymph nodes

Mitsugu Kochi1, Masashi Fujii1, Shinobu Masuda2, Noriaki Kanamori1, Yoshiaki Mihara1, Tomoya Funada1, Hidenori Tamegai1, Megumu Watanabe1, Hiroshi Suda1 and Tadatoshi Takayama1*

Author Affiliations

1 Department of Digestive Surgery, Nihon University School of Medicine, 30-1OHyaguchi Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan

2 Department of Pathology, Nihon University School of Medicine, Tokyo, Japan

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Diagnostic Pathology 2013, 8:191  doi:10.1186/1746-1596-8-191

Published: 21 November 2013

Abstract

Background

The aim of this study was to investigate how differences in expression of HER2 between primary gastric cancers (PGCs) and their corresponding metastatic lymph nodes (LMNs) might affect its potential as a prognostic indicator in treatments including anti-HER2 agents.

Methods

The analysis was conducted in 102 patients who underwent surgical resection for primary gastric cancers (PGCs; adenocarcinoma, intestinal type) with synchronous LNMs. HER2 gene status and protein expression were investigated by immunohistochemistry (IHC) in all patients; fluorescence in situ hybridization (FISH) was performed in 22 patients. The correlation between HER2 gene status in PGCs and their LNMs was evaluated.

Results

Positive HER2 expression as detected by IHC + FISH was observed in 27/102 PGC samples (26.5%) and 29/102 LNM samples (28.4%). HER2 amplification status in 102 paired PGC and LNM samples as evaluated by FISH + IHC was concordant in 92 patients (90.2%), 69 (67.6%) were unamplified and 23/102 (22.5%) were amplified at both sites, and discordant in 10 patients (9.8%), 4 (3.9%) were positive for PGC and negative for LNM, while 6 (5.9%) were positive for LNM and negative for PGC. The results of FISH + IHC showed very strong concordance in HER2 status between the PGC and LNM groups (k = 0.754).

Conclusion

The high concordance between HER2 results for PGCs and their LNMs indicates that assessment of HER2 status in the primary cancer alone is a reliable basis for deciding treatment with anti-HER2 agents in patients with LNMs from gastric adenocarcinoma.

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9365749431029643 webcite.

Keywords:
Gastric cancer; HER2; Lymph node metastasis; Primary tumor