title: Status of Her2 over expression in muscle invasive urothelial bladder carcinoma: Report of 21 cases.
abstract: BACKGROUND
  Invasive urothelial bladder carcinomas have a poor prognosis even with cystectomy and chemotherapy. A high number of these patients have Her2 overexpression. The goal of this study is to assess the Her2 status in muscle invasive urothelial bladder carcinoma, to evaluation heterogeneity and discordance with metastases.
  
  
  METHODS
  We retrospectively analyzed 21 specimens of transurethral resection or cystectomy in patients with invasive urothelial bladder carcinoma. We selected one representative section from primary tumors and metastases for immunohistochemistry analysis. Staining was evaluated according to the same criteria of breast cancer. A chromogenic in situ hybridization (CISH) was performed in case of 2+ score or in heterogeneous samples.
  
  
  RESULTS
  Median age of our patients was 62 years. Intratumoral heterogeneity was observed in 2 cases (less than 1%). One case showed a Her2 3+ score (high grade, pT2 stage) and 3 cases showed a 2+ score (all low grades, stage T2, T4, M1, respectively). Two metastatic lymph nodes scored 1+ for the first (primary 1+) and 2+ for the second (primary 1+). Two cases showed CISH gene amplification. The first one scored 2+ and had area of 3+ score. The second one scored 1+ and had area with 2+ score. Four patients died from disease, one of them had Her2 3+ score.
  
  
  CONCLUSIONS
  Her2 overexpression can be observed in muscle invasive urothelial bladder carcinoma in an important number of patients. Evaluation criteria must be standardized, especially with heterogeneous cases. Metastases tests can also readdress the expression of Her2, which gives the patient a supplementary therapeutic tool.
authors.affiliation: Department of Medical Oncology, Salah Azaiez Institute, Tunisia.
authors.forename: Nesrine
authors.initials: N
authors.lastname: Mejri
authors.affiliation: Department of Pathology, Salah Azaiez Institute, Tunisia.
authors.forename: Rym
authors.initials: R
authors.lastname: Sellami
authors.affiliation: Department of Pathology, Salah Azaiez Institute, Tunisia.
authors.forename: Charfi
authors.initials: C
authors.lastname: Lamia
authors.affiliation: Department of Pathology, Salah Azaiez Institute, Tunisia.
authors.forename: Doghri
authors.initials: D
authors.lastname: Raoudha
authors.affiliation: Department of Pathology, Salah Azaiez Institute, Tunisia.
authors.forename: Naziha B
authors.initials: NB
authors.lastname: Hmida
authors.affiliation: Department of Pathology, Faraht Hached Sousse, Tunisia.
authors.forename: Badreddine
authors.initials: B
authors.lastname: Sriha
authors.affiliation: Department of Pathology, Faraht Hached Sousse, Tunisia.
authors.forename: Hmissa
authors.initials: H
authors.lastname: Sihem
authors.affiliation: Department of Pathology, Salah Azaiez Institute, Tunisia.
authors.forename: Mrad
authors.initials: M
authors.lastname: Karima
authors.affiliation: Department of Pathology, Salah Azaiez Institute, Tunisia.
authors.forename: Khaled B
authors.initials: KB
authors.lastname: Romdhane
keywords: Her2; immunohistochemistry; prognosis; targeted therapy; urothelial invasive bladder carcinoma