Journal of Nippon Medical School: Vol.71 No.3 page.203

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ArticleTitle Breast Cancer with Neuroendocrine Differentiation Detected by Unique Staining Pattern of Neoplastic Cells in Hercep Test

AuthorList Junko Mieda¹, Yoshiharu Ohaki¹, Tatsuo Oguro¹, Hideki Shimizu¹, Kumi Akasaka¹, Akinori Kyomoto¹, Mie Kurokawa¹, Satoru Arai¹, Osamu Mori, Susumu Okada², Syoji Kyono³ and Noritake Tanaka³

Affiliation ¹Department of Pathology, Nippon Medical School Chiba Hokusoh Hospital
²Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital
³Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital

Language JA

Volume 71

Issue 3

Year 2004

Page 203-208

Received August 1, 2003

Accepted September 4, 2003

Keywords HERCEP TEST, breast cancer, neuroendocrine differentiation, HER2, neurosecretory granule

Abstract
Hercep Test (DAKO) is an immunohistological screening kit to select cases of advanced breast cancer with indication for treatment with a humanized mouse monoclonal antibody to human epidermal growth factor receptor-2, trasthzumab (Herceptin). We report a case of an 84-year-old female with invasive ductal carcinoma of the right breast, whose neoplastic cells showed a unique staining pattern in Hercep Test. The cells showed an intracytoplasmic fine granular staining pattern, instead of the membranous pattern of typical breast cancer cells. This unique staining pattern suggested some special features of the neoplastic cells. This case was finally diagnosed as invasive ductal carcinoma with focal neuroendocrine differentiation by subsequent imunohistochemical and electron microscopic examinations. The neoplastic cells showed positive reactivity for grimelius stain, chromogranin A, synaptophysin, and neuronspecific enolase, as well as electron-dense neurosecretory granules (up to 150 nm in diameter). This unique staining pattern of the neoplastic cells with Hercep Test is a useful clue to detect breast cancer with neuroendocrine differentiation, which is likely to be missed in routine examination. Clinical and pathologic findings including immunohistochemical and ultrastructural findings of this case are reported, together with a brief review of the literature.

Correspondence to Junko Mieda, Department of Pathology, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inba-mura, Inba, Chiba 270-1694, Japan
j-mieda@nms.ac.jp

ArticleTitle	Breast Cancer with Neuroendocrine Differentiation Detected by Unique Staining Pattern of Neoplastic Cells in Hercep Test
AuthorList	Junko Mieda¹, Yoshiharu Ohaki¹, Tatsuo Oguro¹, Hideki Shimizu¹, Kumi Akasaka¹, Akinori Kyomoto¹, Mie Kurokawa¹, Satoru Arai¹, Osamu Mori, Susumu Okada², Syoji Kyono³ and Noritake Tanaka³
Affiliation	¹Department of Pathology, Nippon Medical School Chiba Hokusoh Hospital ²Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital ³Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
Language	JA
Volume	71
Issue	3
Year	2004
Page	203-208
Received	August 1, 2003
Accepted	September 4, 2003
Keywords	HERCEP TEST, breast cancer, neuroendocrine differentiation, HER2, neurosecretory granule
Abstract	Hercep Test (DAKO) is an immunohistological screening kit to select cases of advanced breast cancer with indication for treatment with a humanized mouse monoclonal antibody to human epidermal growth factor receptor-2, trasthzumab (Herceptin). We report a case of an 84-year-old female with invasive ductal carcinoma of the right breast, whose neoplastic cells showed a unique staining pattern in Hercep Test. The cells showed an intracytoplasmic fine granular staining pattern, instead of the membranous pattern of typical breast cancer cells. This unique staining pattern suggested some special features of the neoplastic cells. This case was finally diagnosed as invasive ductal carcinoma with focal neuroendocrine differentiation by subsequent imunohistochemical and electron microscopic examinations. The neoplastic cells showed positive reactivity for grimelius stain, chromogranin A, synaptophysin, and neuronspecific enolase, as well as electron-dense neurosecretory granules (up to 150 nm in diameter). This unique staining pattern of the neoplastic cells with Hercep Test is a useful clue to detect breast cancer with neuroendocrine differentiation, which is likely to be missed in routine examination. Clinical and pathologic findings including immunohistochemical and ultrastructural findings of this case are reported, together with a brief review of the literature.
Correspondence to	Junko Mieda, Department of Pathology, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inba-mura, Inba, Chiba 270-1694, Japan j-mieda@nms.ac.jp