Abstract:
:Gastric cancer and cancer of the oesophagogastric junction is diagnosed in the locally advanced or metastatic setting in 55 - 65 % of the cases and is generally treated with perioperative or palliative chemotherapy. For patients with metastatic disease, it is important to reliably determine the HER2 status for potential treatment with trastuzumab. Unfortunately this assessment is not trivial and afflicted with problems of pronounced tumor heterogeneity as well as with an unclear HER2 scoring algorithm. We report an 80 year old male patient diagnosed with an advanced adenocarcinoma of the oesophagogastric junction (uT3 uN + cM0; Siewert II). The initial external HER2 test was negative (HER2 value 1 +) but was repeated in-house. On the basis of more extensive biopsies focal but strong HER2 positivity (HER2 value 3 +, ~10 % of the tumor cells positive) was demonstrated. The patient subsequently received a combination of oxaliplatin, 5-fluorouracil/folinic acid and trastuzumab, resulting in an improvement of symptoms and a tumor regression. The discrepancy of the two HER2 tests performed was caused by heterogeneity of HER2 expression, not detectable during initial sampling due to a low number of tumor containing biopsies. In addition, uncertainties of the HER2 scoring algorithm of oesophagogastric cancer samples could have played a role. This case report illustrates that oesophagogastric carcinoma with an only minor HER2 positive clone may benefit from an anti-HER2 therapy in combination with chemotherapy. It also describes problems and challenges associated with HER2 testing of oesophagogastric carcinoma, especially when only a few tumor-bearing biopsies could be obtained. :Das Magenkarzinom und das Karzinom des ösophagogastralen Überganges werden in 55 – 65 % der Fälle im lokal fortgeschrittenen bzw. metastasierten Stadium diagnostiziert und in der Regel mit einer perioperativen bzw. palliativen Chemotherapie behandelt. Im metastasierten Stadium muss der HER2-Status als positiver prädiktiver Faktor für eine Therapie mit Trastuzumab vor Therapieeinleitung zuverlässig bestimmt werden. Leider ist diese Bestimmung aber nicht trivial und sowohl mit dem Problem der ausgesprochenen Tumorheterogenität für HER2 als auch mit Problemen des HER2-Auswertungsalgorithmus behaftet. Wir berichten über einen 80 Jahre alten Patienten, welcher bei neu aufgetretenen Schluckbeschwerden mit einem fortgeschrittenen Adenokarzinom des ösophagogastralen Überganges diagnostiziert wurde (uT3 uN+ cM0; Siewert II). Die initiale auswärtige HER2-Testung verlief negativ (HER2-Score 1 +) wurde aber in domo an umfangreicheren Biopsien wiederholt. Nach nachgewiesener fokaler, aber starker HER2-Positivität (HER2-Wert 3 +, ~10 % der Tumorzellen positiv) wurde eine Kombinationstherapie von Oxaliplatin, 5-Fluoruracil/Folinsäure und Trastuzumab eingeleitet, welche zur Besserung der Beschwerden und zu einer Remission führte. Die hier vorliegende Diskrepanz der zwei durchgeführten HER2-Testungen wurde verursacht durch eine Heterogenität der HER2-Expression, welche in den initialen, eher spärlichen Biopsien nicht erfasst wurde. Außerdem könnten Unterschiede zwischen dem bekannten, weitverbreiteten HER2-Auswertungsalgorithmus des Mammakarzinoms und dem mit Unschärfe behafteten, weniger oft verwendeten Magenkarzinom-Algorithmus eine Rolle gespielt haben. Dieser Fallbericht beschreibt einen Patienten mit gutem Ansprechen auf eine anti-HER2-Therapie in Kombination mit einer Chemotherapie bei einem offensichtlich nur in geringfügigen Anteilen HER2-positiven fortgeschrittenen Karzinom des ösophagogastralen Übergangs und illustriert, welche Probleme mit der HER2-Testung verbunden sind, gerade wenn nur wenig tumortragende Biopsien gewonnen werden konnten.
journal_name
Z Gastroenteroljournal_title
Zeitschrift fur Gastroenterologieauthors
Gaiser T,Hirsch D,Hofheinz RDdoi
10.1055/s-0043-116493subject
Has Abstractpub_date
2017-09-01 00:00:00pages
866-871issue
9eissn
0044-2771issn
1439-7803journal_volume
55pub_type
杂志文章abstract::Seventy-nine caustic burns of the upper gastrointestinal tract were divided into early and late effects. The radiological findings were analysed and discussed. The central role of radiology proved to be indisputable, particularly for demonstration of a perforation and for the control of treatment. Endoscopy is of part...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1978-11-01 00:00:00
abstract::The oesophagus, stomach and pancreas are primary target organs for ethanol-related diseases. In the oesophagus and stomach, ethanol induces motility disorders and mucosal lesions that are dose-dependent and reversible under acute conditions. Chronic consumption of alcohol causes a significant increase in the risk for ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2005-858257
更新日期:2005-08-01 00:00:00
abstract::1. In conscious rats provided with indwelling pancreatic and biliary catheters, the influence of anesthesia was investigated. 2. Ether was applied in concentrations of 4, 6 and 8 Vol % by an evaporator and Na-pentobarbital injected intravenously (30 mg/kg b. w.) 3. Flow rate, electrolytes (ion-selective electrodes and...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1982-02-01 00:00:00
abstract::Die COVID-19-Pandemie ist ein weltweiter Ausbruch von neu aufgetretenen Infektionen mit dem SARS-CoV-2-Virus, von denen weltweit derzeit mehr als 10.670.000 Menschen erkrankt sind bzw. waren. In Deutschland leiden ca. 450.000 Patienten an einer chronisch entzündlichen Darmerkrankung; diese Patienten benötigen in der R...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/a-1193-5475
更新日期:2020-07-01 00:00:00
abstract::Endoscopic retrieval of proximally migrated biliary stents is sometimes challenging. We report on the successful use of a three-prong colon polyp retrieval device in a two year old child. ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0034-1366050
更新日期:2014-04-01 00:00:00
abstract::Atrophy of the small intestinal mucosa is functionally characterized by a reduction in non-electrolyte transport in vivo. In order to elucidate the cellular defect being responsible for this malabsorption, we have studied the Na+-dependent D-glucose accumulation as well as the activities of aminopeptidase M and maltas...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1986-11-01 00:00:00
abstract::Liver fibrosis is the final common pathway in a variety of liver diseases. To model liver fibrosis in mice is important as mechanisms not only of fibrogenesis, but also of fibrolysis, need to be clearly defined. Also, small rodents present a possibility to test potential treatments in vivo. Today, there are several mo...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2006-927387
更新日期:2007-01-01 00:00:00
abstract::Severe chronic pancreatitis can be easily diagnosed by means of pancreatic function tests and/or imaging procedures, whereas the mild form of the disease or its early stages are more difficult to detect and are often only retrospectively diagnosed. The reliability of imaging procedures depends mainly on the experience...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:
更新日期:1990-05-01 00:00:00
abstract:BACKGROUND: More and more gastroenterologists are not satisfied with their working conditions and run the risk of developing burnout symptoms. Little is known about the job satisfaction and burnout risk among physicians working in endoscopy units in Germany. This study examines the risk of burnout and job satisfaction ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/a-1176-2344
更新日期:2020-10-01 00:00:00
abstract::In a nine-year period, 46 patients with early gastric cancer were diagnosed and operated at a county hospital. Fiberscopy of the stomach raised the percentage of early gastric cancer from 1% in a five year pre-endoscopic period to 11.9% with endoscopy. On an average, subjects with early gastric cancer were 8 years you...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1981-02-01 00:00:00
abstract::Various sorbents were tested in-vitro for their ability to support hepatic excretory and detoxification functions, and their in-vivo perfusion with plasma was studied in an animal experiment. Amino acids, particularly phenylalanine and tyrosine, were strongest bound by activated charcoal, while Amberlite XAD-7 removed...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1979-02-01 00:00:00
abstract::Biological therapies in inflammatory bowel disease reflect the exponential advancement in understanding the human intestinal immune system and particularly the biology of intestinal inflammation during the past decade. The better understanding of the mechanisms of inflammatory bowel disease has evolved from desriptive...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2003-42924
更新日期:2003-10-01 00:00:00
abstract::A patient with multiple hamartoma syndrome or Cowden's disease with multiple gastrointestinal polyps and malignant melanoma is presented. The syndrome is characterized by hamartomatous tumors of the skin, fibrocystic disease of the breasts, gastrointestinal polyps and disease of the thyroid gland such as goiter and ad...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1990-07-01 00:00:00
abstract::In 26 patients endoscopic-radiologic pancreography routinely performed caused severe pain with certain origin from pancreatic glan. Pain could be stopped immediately and with constant effect by lingual application of nitroglycerine. According to these informations we suppose that pancreatic pain is started by vascular...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1976-11-01 00:00:00
abstract::Endoscopic sclerotherapy to stop acute gastrointestinal haemorrhage is simple as well as inexpensive in comparison to laser or electrocoagulation. In this paper a report on our experiences during the last five years is given. 187 patients with different bleeding sites in the upper and lower digestive tract have been t...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1983-06-01 00:00:00
abstract:BACKGROUND:Following the introduction of the MELD score, the survival rates have worsened after liver transplantation (LTX) in Germany. Existing organ shortages, shorter survival rates after LTX, and failures in the liver allocation process provide true challenges. Facilitated by a structured questionnaire, the appropr...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0034-1366290
更新日期:2014-08-01 00:00:00
abstract::10 patients with right upper quadrant pain were treated with a choleretic agent (Febuprol; 3 X 200 mg t. i. d.) and placebo in a cross-over double dummy technique for 16 weeks. Lithogenic index, bile acid profile and serum lipids were determined every 4 weeks. During Febuprol application the clinical symptoms were rel...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 临床试验,杂志文章
doi:
更新日期:1987-11-01 00:00:00
abstract::The role of endogenous gastrin in the pathogenesis of "idiopathic" ulcer disease is difficult to determine; however, gastrin is probably only of limited importance besides various probable more important factors. In conditions associated with uncontrolled gastrin production by a gastrin secreting tumor or in cases in ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract::Surgery of anorectal incontinence includes two essential forms: the traumatic lesion of the sphincter and the spontaneous proceeding incontinence. Both forms of incontinence require a surgical therapy that is concerned to its cause. Fresh traumatic lesions of the sphincter can be reconstructed directly by primary sutu...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1993-06-01 00:00:00
abstract::Reference values for B-mode abdominal ultrasound are controversially discussed in the literature mainly due to the lack of data and non-standardized examination techniques. A cohort of 100 patients was prospectively examined. Patients with hepatobiliary diseases including gallstones, acute or chronic pancreatitis (n =...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0033-1335175
更新日期:2013-04-01 00:00:00
abstract::Hepatitis C is one of the world's leading infectious diseases. The interferon-ribavirin combination therapy is the new standard for the treatment of hepatitis C in naive and relapse patients. Virological sustained response rates can be more than doubled by the IFN-ribavirin combination therapy compared to IFN-monother...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2000-14867
更新日期:2000-03-01 00:00:00
abstract::Budesonide is a locally acting steroid with a high first-pass metabolism in the liver and low systemic effects. We performed the first pilot study comparing budesonide foam (1 mg/50 ml b.i.d.) with mesalazine enemas (4 g/60 ml o.d.). 33 patients from 3 centres were enrolled in this open randomized clinical trial. 16 p...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1055/s-2000-14869
更新日期:2000-04-01 00:00:00
abstract::In a 63-year-old cirrhotic patient, recanalisation of a partial portal vein thrombosis was achieved by a low dose of rivaroxaban (10 mg daily). After anticoagulant therapy was stopped, partial vein thrombosis recurred. Restarting rivaroxaban at a dose of 10 mg led to recanalisation. The patient did not suffer any comp...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-0034-1385171
更新日期:2014-10-01 00:00:00
abstract::Implantation of the ureters in the sigma is practicable as far as cystectomy or congential malformations are concerned. The problem of the development of sigma-rectum polyps following ureterosigmoidostomy (uss) is being discussed within the description of three own case reports. The polyp of our first case is classif...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:
更新日期:1980-03-01 00:00:00
abstract:BACKGROUND:Endoscopic stenting with self-expanding metal stents (SEMS) has proved to be an efficient palliative endoscopic therapy option in treating malignant dysphagia. Different types of SEMS have been examined previously in small randomized clinical trials. METHODS:A total of 150 consecutive patients (from 1/1995-...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2005-858532
更新日期:2005-10-01 00:00:00
abstract::Foreign bodies as a nucleus for precipitation of gall-stones are not frequently observed. The combination of primary immigrated foreign bodies into the bile ducts and following encasing by a gall-stone could be even more rarely found. A case report is presented concerning a patient, in whom a hemo-clip was fixed away ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1985-03-01 00:00:00
abstract::The liver is an organ with unique immune regulatory potential. This review highlights the experimental evidence for the involvement of hepatic cell populations in the induction of oral tolerance. Although immune tolerance towards oral antigens is mainly induced in the gastrointestinal tract within gut associated lymph...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-2005-858988
更新日期:2006-01-01 00:00:00
abstract::Infective esophagitis is a rare disease, affecting mostly immunocompromised patients. Very few cases of a multiple viral infection have been reported. We present a case of combined cytomegalovirus (CMV) and herpes simplex virus (HSV) esophagitis in an 81-year-old female with extracapillary sclerosing glomerulonephriti...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:10.1055/s-2000-14887
更新日期:2000-06-01 00:00:00
abstract::Purpose of this investigation was to characterize the effect of antibiotics as a possible limiting factor for the evaluation of hydrogen (H2) breath analysis tests which depend on bacterial carbohydrate fermentation. Breath H2-excretion following ingestion of the non-absorbable disaccharide lactulose was monitored in ...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章
doi:
更新日期:1980-03-01 00:00:00
abstract::For many years ultrasound-guided biopsy and drainage has represented a routine part of clinical practice. Percutaneous biopsy and drainage are minimally invasive procedures for sampling tissue or the removal of fluid collections within the body. Differing image guidance techniques for the positioning of the needles/ca...
journal_title:Zeitschrift fur Gastroenterologie
pub_type: 杂志文章,评审
doi:10.1055/s-0029-1245706
更新日期:2010-11-01 00:00:00