PMC6041303_01
Clinical course and molecular profiling of the primary tumor. a Computed tomography scan obtained at the time of diagnosis. The 8.2 x 8.8 cm lobulated metastatic mass in the liver (arrow) and the 8.0 cm centrally necrotic primary tumor mass in the left mesentery (asterisk) are shown. b Representative image of an H&E stained section of the primary tumor. c Copy number count estimates from both exonic (blue) and intragenic or intronic (cyan) reads in Chromosome 17 are shown. d Representative FISH image of the primary tumor using ERBB2/CEP17 dual-color probes. The average ERBB2 signal copy number was 5.1 and the ERBB2/CEP17 ratio was 2.0. e Representative ErbB2 IHC image of the primary tumor. f Sagittal and coronal images of the PET/CT scans before and after treatment with three cycles of paclitaxel and neratinib (second-line treatment). The SUV maximum value for each lesion before and after treatment was, respectively: right lateral abdominal wall musculature, 11.7 and 6.6; posterior 11th rib, 11.2 and 4.1; and the soft tissue abutting the hepatic surgical site, 14.8 and 7.9.
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Fig1
A computed tomography (CT) scan demonstrated a large mass in the posterior segment of the right hepatic lobe and a centrally necrotic mass in the left mesentery (Fig. 1a). The histologic section demonstrated an epithelial neoplasm with papillary architecture, composed of pleomorphic and hyperchromatic tumor cells with cleared to pink cytoplasm (Fig. 1b). ERBB2 amplification (Fig. 1c), which was confirmed by FISH (Fig. 1d). ErbB2 IHC demonstrated homogenous, dark circumferential staining in greater than 10% of tumor cells, consistent with a score of 3+ (Fig. 1e). CT after 4 cycles of therapy revealed no evidence of new disease and a partial metabolic response in the areas of known disease (Fig. 1f). Consolidative radiotherapy and cryoablation were delivered to areas of minimal residual disease in the chest wall.