Human Epidermal Growth Factor Receptor 2 Overexpression in Micropapillary and Other Variants of Urothelial Carcinoma.

Behzatoğlu K1, Yörükoğlu K2, Demir H3, Bal N4.

Author information

1: Department of Pathology, Istanbul Education and Research Hospital, Ministry of Health, Istanbul, Turkey. Electronic address: kbehzatoglu@hotmail.com.
2: Department of Pathology, Medical Faculty, Dokuz Eylül University, lzmir, Turkey.
3: Department of Pathology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
4: Department of Pathology, Medical Faculty, Başkent University, Adana, Turkey.

Abstract

BACKGROUND:

Human epidermal growth factor receptor 2 (HER2) protein overexpression or gene amplification has been shown in urothelial bladder cancer. This could be helpful when using targeted anti-HER2 therapy on these tumors.

OBJECTIVE:

To evaluate HER2 immunohistochemical expression in conventional urothelial carcinoma (UC), in situ UC, and UC variants primarily in micropapillary urothelial carcinoma (MPUC).

DESIGN, SETTING, AND PARTICIPANTS:

The study evaluated 60 MPUC cases; 25 invasive, 20 low-grade noninvasive, and 10 high-grade noninvasive UC cases; 8 in situ UC cases; and 69 UC variant cases. The immunohistochemistry staining was scored according to recommendations of the American Society of Clinical Oncology/College of American Pathologists 2013 HER2 test guideline established for breast cancer and only 3+ staining was considered HER2 overexpression.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

HER2 overexpression was determined by 3+ staining.

RESULTS AND LIMITATIONS:

34 of 60 MPUC cases (56%) showed HER2 overexpression (3+ staining). We observed 3+ staining HER2 overexpression in nine of 25 conventional invasive UC cases (36%), four of eight in situ UC cases (50%), and three of six lipid cell variant cases (50%). 3+ staining HER2 overexpression was not seen in eight glandular, six small cell, and five sarcomatoid variant cases. HER2 overexpression was negative in the 20 low-grade noninvasive UC cases but positive in two of the 10 high-grade noninvasive UC cases (20%). We observed HER2 overexpression most commonly in MPUC cases. We also found HER2 overexpression in conventional invasive and in situ UC cases.

CONCLUSIONS:

Pure in situ UC and conventional invasive UC, especially MPUC, could be candidate tumors for treatment with anti-HER2 antibody (trastuzumab therapy).

PATIENT SUMMARY:

Targeted therapy has a limited place in treatment of bladder cancer. In this study, human epidermal growth factor receptor 2 (HER2) overexpression in bladder carcinomas was evaluated in a large number of cases. Anti-HER2 therapy could be used in bladder cancers, as in breast and gastric cancers.