Search

The case of a patient with severe pulmonary hypertension whose etiology has remained unknown until an autopsy was performed is discussed in a symposium of pathological anatomy. This case helped to address the diagnostic and therapeutic management of pulmonary hypertension. The broad differential diagnosis of this disease requires a diagnostic strategy to be developped. Clinical reasoning leading to a probable diagnosis based on clinical biological and radiological information is not only a difficult task for the speaker but also a rich source of learning opportunities for our medical community.

Her2/neu is a tyrosine kinase receptor which stimulates cell growth. The receptor is overexpressed in about 20% of breast cancers. Her2/neu expression is an indicator of poor prognosis but also the target of the treatment of breast cancer using humanised anti-Her2/ neu antibodies. Only cancers overexpressing the protein will respond to this therapy, but which has significant (cardiac) side effects and is expensive. It is therefore important to test for the overexpression of the protein on breast cancer cells. This paper discusses how this can be done and ongoing research into new therapeutic options targeting the involved signaling pathways.

Today, breast cancer prognosis and (neo-) adjuvant treatment selection are based on clinical as well as on histological and immunohistochemical data. Will genetic expression profiles have a better predictive value? Ongoing studies will provide the answer.

Tailoring adjuvant therapy in breast cancer patients relies on prognostic and predictive factors, most of which are currently established by histopathological analysis of tumors. The quality of the assessment of the former (i.e.: tumor size, lymph node status, tumor grade, HER2 status, and lymphovascular invasion) and the latter (estrogen and progesteron receptors expression, HER2 overexpression or amplification) is an essential prerequisite for an optimal therapeutic decision. If the prognostic and predictive values of multigenes signatures are confirmed by on-going clinical studies, this approach could enter the clinical practice in the coming years and result in improved accuracy of adjuvant therapies in breast cancer patients. This approach might especially allow avoiding overtreatment in patients at low risk of recurrence.

Premalignant breast lesions are defined by their characteristic histologic features. Based on these criteria, an increased risk is assigned of eventually progressing towards a malignant lesion, but the most majority of these lesions will never progress to cancer. Hence, the clinical management depends on correct sampling and thorough histologic examination.

Medical progress depends on the availability of human tissue for teaching, quality control, and research. These tissue samples typically originate from resection specimen obtained during therapeutic and diagnostic interventions and it is hence the pathologist in charge of selecting and conserving tissue samples and eventually making them avaliable for the diverse academic purposes. These activities happen in a vaguely defined framework of medical, ethical, and legal constrictions, with important and partly conflicting interests of patient autonomy and data protection. This article introduces the reader to this complex subject, focusing on questions of informed individual versus general consent, and proposes practical solutions for dealing with these conflicting interest in the daily routine work.