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      Subclonal analysis in a lobular breast cancer with classical and solid growth pattern mimicking a solid‐papillary carcinoma

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          Abstract

          Recently, a new variant of invasive lobular breast cancer (ILBC) with solid‐papillary‐like growth pattern has been described. We present a case of ILBC with solid‐papillary‐like growth pattern in the main tumour mass and classical invasive lobular growth pattern in adjacent satellite foci. The two tumour components were subjected to comprehensive molecular analyses. Both components were ER/PR‐positive, HER2‐negative, and showed a complete loss of E‐cadherin and beta‐catenin protein expression, as determined by immunohistochemistry. Gene expression profiling classified the main tumour and a satellite focus as luminal‐B and luminal‐A subtypes, respectively. Whole‐genome copy number profiles were highly similar in both tumour components. Shared copy number alterations (CNAs) included gains of chromosome 1q21.1–q43 and losses of chromosome 16q11.2–q24.3, the locus of the CDH1/E‐cadherin tumour suppressor gene. CNAs detected only in the main tumour included a gain of chromosome 20q12–q13.33 and a loss of chromosome 1p36.33–p34.3, which has recently been associated with the solid variant of ILBC. Next generation sequencing revealed an identical, truncating CDH1 mutation (p.G169fs*5) in both tumour components confirming a common clonal ancestry. In conclusion, we confirm the recently described variant of ILBC with solid‐papillary‐like growth pattern and provide evidence that it evolves from classical ILBC by subclonal evolution.

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          Comparison of PAM50 risk of recurrence score with oncotype DX and IHC4 for predicting risk of distant recurrence after endocrine therapy.

          Risk of distant recurrence (DR) among women with estrogen receptor (ER) -positive early breast cancer is the major determinant of recommendations for or against chemotherapy. It is frequently estimated using the Oncotype DX recurrence score (RS). The PAM50 risk of recurrence (ROR) score provides an alternative approach, which also identifies intrinsic subtypes. mRNA from 1,017 patients with ER-positive primary breast cancer treated with anastrozole or tamoxifen in the ATAC trial was assessed for ROR using the NanoString nCounter. Likelihood ratio (LR) tests and concordance indices (c indices) were used to assess the prognostic information provided beyond that of a clinical treatment score (CTS) by RS, ROR, or IHC4, an index of DR risk derived from immunohistochemical assessment of ER, progesterone receptor, human epidermal growth factor receptor 2 (HER2), and Ki67. ROR added significant prognostic information beyond CTS in all patients (Δ LR-χ(2) = 33.9; P < .001) and in all four subgroups: node negative, node positive, HER2 negative, and HER2 negative/node negative; more information was added by ROR than by RS. C indices in the HER2-negative/node-negative subgroup were 0.73, 0.76, and 0.78 for CTS, CTS plus RS, and CTS plus ROR, respectively. More patients were scored as high risk and fewer as intermediate risk by ROR than by RS. Relatively similar prognostic information was added by ROR and IHC4 in all patients but more by ROR in the HER2-negative/node-negative group. ROR provides more prognostic information in endocrine-treated patients with ER-positive, node-negative disease than RS, with better differentiation of intermediate- and higher-risk groups.
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            FGFR1 emerges as a potential therapeutic target for lobular breast carcinomas.

            Classic lobular carcinomas (CLC) account for 10% to 15% of all breast cancers. At the genetic level, CLCs show recurrent physical loss of chromosome16q coupled with the lack of E-cadherin (CDH1 gene) expression. However, little is known about the putative therapeutic targets for these tumors. The aim of this study was to characterize CLCs at the molecular genetic level and identify putative therapeutic targets. We subjected 13 cases of CLC to a comprehensive molecular analysis including immunohistochemistry for E-cadherin, estrogen and progesterone receptors, HER2/neu and p53; high-resolution comparative genomic hybridization (HR-CGH); microarray-based CGH (aCGH); and fluorescent and chromogenic in situ hybridization for CCND1 and FGFR1. All cases lacked the expression of E-cadherin, p53, and HER2, and all but one case was positive for estrogen receptors. HR-CGH revealed recurrent gains on 1q and losses on 16q (both, 85%). aCGH showed a good agreement with but higher resolution and sensitivity than HR-CGH. Recurrent, high level gains at 11q13 (CCND1) and 8p12-p11.2 were identified in seven and six cases, respectively, and were validated with in situ hybridization. Examination of aCGH and the gene expression profile data of the cell lines, MDA-MB-134 and ZR-75-1, which harbor distinct gains of 8p12-p11.2, identified FGFR1 as a putative amplicon driver of 8p12-p11.2 amplification in MDA-MB-134. Inhibition of FGFR1 expression using small interfering RNA or a small-molecule chemical inhibitor showed that FGFR1 signaling contributes to the survival of MDA-MB-134 cells. Our findings suggest that receptor FGFR1 inhibitors may be useful as therapeutics in a subset of CLCs.
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              Simultaneous loss of E-cadherin and catenins in invasive lobular breast cancer and lobular carcinoma in situ.

              Loss of expression of the intercellular adhesion molecule E-cadherin frequently occurs in invasive lobular breast carcinomas as a result of mutational inactivation. Expression patterns of E-cadherin and the molecules comprising the cytoplasmic complex of adherens junctions, alpha-, beta- and gamma-catenin, were studied in a series of 38 lobular breast carcinomas with known E-cadherin mutation status. The effect of loss of E-cadherin by mutational inactivation (or other mechanisms) on the expression of catenins was investigated. Complete loss of plasma membrane-associated E-cadherin expression was observed in 32 out of 38 invasive lobular carcinomas, for which in 21 cases a mutation was found in the extracellular domain of E-cadherin. In total, 15 frameshift mutations of small deletions or insertions, ranging from 1 to 41 bp, three non-sense mutations, and three splice mutations were identified. Mutations were scattered over the whole coding region and no hot spots could be detected. In all cases, simultaneous loss of E-cadherin and alpha- and beta-catenin expression was found; in 50 per cent of these cases, additional loss of gamma-catenin was observed. In six invasive lobular carcinomas, expression of both E-cadherin and catenins was retained. In none of these carcinomas was an E-cadherin mutation detected. Lobular carcinoma in situ adjacent to invasive lobular carcinoma showed simultaneous loss of E-cadherin and catenins in all the cases studied--remarkably, also, in four cases positive for E-cadherin and catenin expression in the invasive component. These results indicate that simultaneous loss of E-cadherin and alpha-, beta- and gamma-catenin may be an important step in the formation of lobular carcinoma in situ, as a precursor of invasive lobular breast cancer. Events additional to E-cadherin inactivation must be involved in the transition of lobular carcinoma in situ to invasive lobular carcinoma.
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                Author and article information

                Contributors
                Christgen.Matthias@MH-Hannover.de
                Journal
                J Pathol Clin Res
                J Pathol Clin Res
                10.1002/(ISSN)2056-4538
                CJP2
                The Journal of Pathology: Clinical Research
                John Wiley and Sons Inc. (Hoboken )
                2056-4538
                19 July 2017
                July 2017
                : 3
                : 3 ( doiID: 10.1002/cjp2.v3.3 )
                : 191-202
                Affiliations
                [ 1 ] Institute of Pathology, Hannover Medical School Hannover Germany
                [ 2 ] Department of Human Genetics Hannover Medical School Hannover Germany
                [ 3 ] Department of Diagnostic Radiology Hannover Medical School Hannover Germany
                [ 4 ] Department of Obstetrics and Gynecology Hannover Medical School Hannover Germany
                [ 5 ] Institute of Pathology Viersen Viersen Germany
                Author notes
                [*] [* ]Correspondence to: Matthias Christgen, Institute of Pathology, Hannover Medical School, Carl‐Neuberg‐Str. 1, 30625 Hannover, Germany. E‐mail: Christgen.Matthias@ 123456MH-Hannover.de
                Author information
                http://orcid.org/0000-0001-5878-0546
                Article
                CJP276
                10.1002/cjp2.76
                5527319
                28770103
                1fffc98d-7062-43d6-9cd3-195c83c41d03
                © 2017 The Authors The Journal of Pathology: Clinical Research published by The Pathological Society of Great Britain and Ireland and John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 04 March 2017
                : 10 June 2017
                Page count
                Figures: 5, Tables: 1, Pages: 12, Words: 6489
                Funding
                Funded by: Hannover Biomedical Research School (HBRS)
                Funded by: Claudia von Schilling breast cancer research junior award
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                cjp276
                July 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.4 mode:remove_FC converted:26.07.2017

                lobular breast cancer,papillary breast cancer,clonal evolution,e‐cadherin,copy number profiling

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