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HER-2/NEU overexpression in vulvar Paget disease: the Yale experience
  1. Christine E Richter1,
  2. Pei Hui2,
  3. Natalia Buza2,
  4. Dan-Arin Silasi1,
  5. Masoud Azodi1,
  6. Alessandro D Santin1,
  7. Peter E Schwartz1,
  8. Thomas J Rutherford1
  1. 1Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Christine E Richter, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; christine.richter{at}yale.edu

Abstract

Aims To determine the level of HER-2/neu overexpression in vulvar Paget disease (PD) in order to assess the possibility of using HER-2/neu as a target for the treatment of Paget disease.

Methods A medical record search identified 39 patients with a histologically confirmed diagnosis of vulvar PD between 1986 and 2009. A tissue microarray containing all 39 tumour samples was created, and corresponding sections were stained immunohistochemically with an anti-HER-2/neu-antibody (HercepTest). Staining results were reported on a scale from 0 to 3+. 2+ and 3+ were considered as HER-2/neu overexpression. The HER-2/neu expression was correlated with clinical, pathological and outcome data.

Results Negative staining for HER-2/neu was noticed in four patients (12%), 1+ in 10 patients (30%), 2+ in 11 patients (33%) and 3+ in eight patients (25%), resulting in 19 patients with HER-2/neu overexpression (2+ and 3+, 58%) and 14 patients without HER-2/neu overexpression (0 and 1+, 42%). The proportion of HER-2/neu overexpression was higher in the patients with invasive than with non-invasive PD (71%, n=5/7 invasive PD vs 54%, n=14/26 non-invasive PD). There was no significant correlation between HER-2/neu staining results and clinical, pathological or outcome data.

Conclusions Surgical treatment of vulvar Paget disease is associated with a high recurrence rate and extensive reconstructive procedures. In this study, over 50% of the patients with vulvar Paget disease overexpress HER-2/neu. Anti-HER-2/neu-antibodies like trastuzumab may therefore be an interesting treatment option for HER-2/neu-positive vulvar Paget disease. Clinical trials are needed to evaluate the efficacy of trastuzumab in this disease.

  • Gynaecologic pathology
  • Paget's disease
  • immunohistochemistry
  • antibodies
  • oncology

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Yale University School of Medicine, Human Investigation Committee, New Haven, CT, USA (HIC# 0909005672).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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