INTRODUCTION:The detection of estrogen, progesterone and HER-2 neu receptors on the surface of the tumour cell is a significant prognostic factor, alone or in combination. The presence or absence of receptors on the surface of the tumour cell is associated with the conditional gene expression in the tumour cell itself. Based on these genetically determined expressions of the tumour cell, five molecular subtypes of breast cancer have been classified on the St. Gallen International Expert Consensus in 2011 that can be immunohistochemically detected, with each subtype manifesting certain prognosis and aggression.AIM:Analyzing the presentation of molecular subtypes of breast cancer that are immunohistochemically detected in surgically treated patients at the Clinic for Thoracic and Vascular Surgery.MATERIAL AND METHODS:We used the international classification on molecular subtypes of breast cancer which divides them into: Luminal A (ER+ and/or PR+, HER-2 negative, Ki-67 < 14%), Luminal B with HER-2 negative (ER+ and/or PR+, HER-2 negative, Ki-67 ≥ 14%), Luminal B with HER-2 positive (ER+ and/or PR+, HER-2+, any Ki-67), HER-2 enriched (ER-, PR-, HER-2+), and basal-like (triple negative) (ER-, PR-, HER-2 negative, CK5/6+ and/or EGFR+). A total of 290 patients, surgically treated for breast cancer, were analysed during 2014.RESULTS:In our analysis, we found that Luminal A was present in 77 (26.55%) patients, Luminal B HER-2 negative was present in 91 (31.38%) patients, Luminal B HER-2 positive was present in 70 (24.14%) patients, HER-2 enriched was present in 25 (8.62%) patients and basal-like (or triple negative) was present in 27 (9.31%) patients.CONCLUSION:Detecting the subtype of breast cancer is important for evaluating the prognosis of the disease, but also for determining and providing an adequate therapy. Therefore, determining the subtype of breast cancer is necessary for the routine histopathological assay.

Class II major histocompatibility complex (MHC) antigen-presenting cells are associated with the early phase of the immune response. We have studied the distribution of class II-expressing cells in developing, healthy and carious human teeth to clarify, when human pulp acquires an immunologic defense potential and how this reacts to dental caries. Antigen-expressing cells were identified immunohistochemically with the following monoclonal antibodies: HLA-DR - for dendritic cells and CD68 - for macrophages. In the pulp of unerupted developing teeth, HLA-DR-positive cells were distributed mainly in and around the odontoblast layer. A few CD68 positive cells were located more coronary around the blood vessels. In erupted teeth, HLA-DR-positive cells were located, for the most part, just beneath the odontoblast layer. CD68 positive cells were also located coronary, mainly around the blood vessels. Superficial caries lesions caused an aggregation of HLA-DR-positive cells and macrophages in the dental pulp corresponding to the lesion. These findings showed that: (1) human teeth are already equipped with an immunological defense potential prior to eruption; (2) in the initial stage of caries infection, an immuno-response mediated by class-II-expressing cells is initiated in human dental pulp (Fig. 8, Ref. 33).

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Antigen-presenting cells are capable of participating in the stimulation of T cells by antigen presentation. Antigen-presenting cells are considered essential for the induction and expansion of the immune reaction because their interaction with antigen is the first step in immune induction.We have studied the distribution of class II expressing cells in developing, healthy and carious human teeth to clarify when human pulp acquires an immunologic defense potential. Antigen-expressing cells were identified immunohistochemically with HLA-DR monoclonal antibodies (for dendritic cells) and CD68 monoclonal antibodies (for macrophages).In the pulp of unerupted developing teeth, HLA-DR-positive cells were distributed mainly in and around the odontoblast layer. A few CD68 positive cells were located more coronary around the blood vessels. In erupted teeth, HLA-DR-positive cells were located, for the most part just beneath the odontoblast layer. CD68 positive cells were also located coronary mainly around the blood vessels. Superficial caries lesions caused aggregation of HLA-DR-positive cells and macrophages in the dental pulp corresponding to the lesion.Our results showed that human teeth are already equipped with an immunological defense potential before the eruption. In the initial stage of caries infection, an immune response mediated by class II expressing cells is initiated in human dental pulp.

Lymphocyte-predominant Hodgkin disease (LPHD) presents as early-stage disease with slow disease progression and excellent initial response to conventional chemotherapy. Although 96% of LPHD patients experience a complete remission (CR) upon first line treatment, many relapses occur. Residual tumor cells in Hodgkin’s patients can survive standard therapy and cause relapse. Thus, the elimination of minimal residual disease after first line treatment might improve the outcome in Hodgkin disease. CD20+ is strongly expressed by malignant cells in LPHD, but so far there is limited information regarding the efficacy of Rituximab in this patient population. A 66 year-old woman presented with bilateral inguinal lymphadenopathy in 2004 and complained on malaise and weight loss. Lymph node biopsy confirmed a diagnosis of LPHD and immunohistochemistry confirmed that CD20 antigen was expressed on more than 30% of malignant cells. Staging revealed II B disease. There were lymph node enlargements in the pelvis on CT. Her blood count, erythrocyte sedimentation rate, and albumin were normal with elevation of and lactate dehydrogenase and alkaline phoshatase. She was treated with ABVD regiment 8 cycles and CR was achieved. After standard chemotherapy patient with CD20+ LPHD received four weekly doses of Rituximab at 375 mg/m2 and maintenance therapy with additional four doses of Rituximab every three months for the next year. Treatment was well tolerated without any complications. Evaluation of disease assessment included physical examination and computed tomography, bone marrow biopsy and routine analyses, after the end of treatment and every 3 months after for the first two years, and on six months for the following year. There were no abnormalities on CT after the end of the treatment. Patient was in complete remission. CT after 36 months showed no detectible tumor mass. Patient remains still in complete remission three years after chemotherapy without detectible tumor mass. Our case report suggests that Rituximab is both safe and effective in patients with CD20+ LPHD. The optimal treatment for patients with LPHD remains uncertain. Current research aims to identify alternative treatment approaches that possess significant activity but less toxicity. Radiotherapy for early-stage patients and chemotherapy or combined modality treatment for advanced-stage patients remains to be standard of care. Initial observed benefit of Rituximab treatment in this group of patients suggests that there is a role for monoclonal antibodies in optimal treatment approach, especially in improving the outcome. Further studies with Rituximab are warranted in this patient population.