BACKGROUND: Increased epidermal growth factor receptor (EGF receptor) expression has been noted in various cancers and has become a useful target for therapeutic interventions. Small studies from Asia and Australia have demonstrated EGFR over-expression in gallbladder cancer. We sought to evaluate the expression of EGFR in a series of 16 gallbladder cancer patients from North America. METHODS: Using tumor registry data, we identified 16 patients diagnosed with gall bladder carcinoma at our medical center between the years of 1998 and 2005. We performed a retrospective review of these patients' charts, obtained cell blocks from pathology archives and stained for EGFR and Her2/neu. RESULTS: Fifteen of sixteen patients were noted to over-express EGFR. Three were determined 1+, nine were 2+ and three were 3+. Eight patients had poorly differentiated adenocarcinoma, six had moderately differentiated and two had well-differentiated tumors. In this small series, there was a trend toward shorter survival and more poorly differentiated tumors in patients with greater intensity of EGFR expression. One patient was EGFR negative but 3+ for erb-2/Her 2-neu expression. No patient co-expressed EGFR and Her-2-neu. Median survival of patients in this series was 17 months. CONCLUSION: In view of our observations confirming the over-expression of EGFR in our patient population in North America, and the recent success of EGFR targeted therapies in other solid tumors that over-express EGFR, it may now be appropriate to evaluate agents targeting this pathway either as single agents or in combination with standard chemotherapy.Key words: gallbladder cancer, endothelial growth factor receptor (EGFR), differentiation, survival, her-2-neu IntroductionApproximately 5000 cases of gallbladder cancer are diagnosed in the United States per year. Higher rates are seen in Latin American countries such as Mexico, Chile and Bolivia, roughly correlating with the higher incidence of cholelithiasis. Various chemotherapy agents, including 5-FU and Gemcitabine, have been evaluated for the management advanced disease but thus far results have been disappointing [1][2][3][4].5 FU plus LV has been the backbone of randomized clinical trials done in the past, demonstrating a RR of 32% and OS of 6months.[5] Combination therapy with 5FU and cisplatin have shown RRs of 10%-40% and median OS better than those observed with 5-FU alone. [5][6][7][8][9][10][11][12] Single agent gemcitabine has been extensively evaluated in patients with metastatic biliary tract tumors with RRs in the range of 0%-30%, with median OS times in the range of 5-14 months.[13-18]Gemcitabine combinations with cisplatin, oxaliplatin or capecitabine have been tested in several clinical trials, which have demonstrated RRs 21%-53% and median OS times 5-15 months; these results are somewhat better than those from single-agent gemcitabine studies. [19][20][21][22][23] A pooled analysis of 112 trial using gemcitabine-based combination regimens confirmed superiority to single agent therapy. Howe...

No abstract

A biphasic tumor with features of benign ductal elements and a malignant stromal component that lacks the architecture of a phylloides tumor represents a diagnostic challenge. A 35-year-old woman presented with a painful mass located in the upper inner quadrant of the right breast. A biopsy revealed histologically that the tumor had a multinodular architecture with malignant spindle cells forming cuffs around multiple open benign ducts. No leaf-like architecture was present. In addition, liposarcomatous differentiation was seen in focal areas. Immunohistochemical staining showed positive for CD34, vimentin and CDK4, and negative for ER, PR, Her2/neu, CD10, CD117, p63, bcl-2, cytokeratin, and MDM2. A diagnosis of periductal stromal sarcoma with liposarcomatous differentiation was established. Following excision with mastectomy and adjuvant chemotherapy, the patient was disease-free for 10 years. To our knowledge, this is the first case report of periductal stromal sarcoma showing liposarcomatous differentiation.

Metastatic cardiac tumors are mainly diagnosed postmortem, while cardiac metastases of laryngeal cancer are exceedingly rare. We report a case of laryngeal carcinoma with subsequent metastatic disease to the heart diagnosed nine months after surgical resection of laryngeal cancer. Additionally, we attempted to summarize published case reports of laryngeal cancer with cardiac metastasis. Retrospective chart review and literature search via PubMed and Google Scholar were performed. Twenty cases of laryngeal squamous cell carcinoma (SCC) with cardiac metastatic tumors were identified. We described demographics, typical features seen on diagnostic studies, and analyzed current literature on incidence, diagnostic studies, treatment options, and prognosis of secondary cardiac tumors. More data are needed to decide on the optimal treatment strategy for metastatic cardiac disease.

No abstract