Changes in ER, PR and HER2 Expression in Primary Breast Cancer, Lymph Nodes and Distant Metastases

Global Journal of Cancer Research and Treatment
Volume 1, Issue 1, August 2020, Pages: 1-6
Received: August 20, 2020; Accepted: August 28, 2020; Published: December 09, 2020

Authors: Dr. Marwa Krifa, Dr. Ahlem Bdioui

Faculty of medicine of Sousse-Tunisia

Introduction: Breast cancer is a heterogeneous disease, the treatment of which depends on the  molecular class. A possible change in molecular status during disease progression  is likely to lead to a change in the molecular profile of the tumor and consequently the therapeutic management.

Patients and methods: We included in our study only the patients whose molecular status was evaluated and this because of the defects of means in our country. We identified 7 patients with invasive primary breast carcinoma and who presented after an average period of 15 months lymph nodes or distant metastases. The expression of ER, PR and HER2 has been evaluated by using immunochemistry (IHC). The aim of this study was to compare molecular features (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor type 2, [HER2]) between primary breast carcinoma, lymph nodes and distant metastases.

Figure (1) Lymph node metastasis of breast carcinoma type NOS

Results: Hormonal receptor modification status was observed only in 1 patient with adrenal gland metastasis for PR (14.2%). The  ER expression was unchanged for all the cases. However, a modification of HER2 was observed in lymph node(figure1) and brain metastases in 2/7 (28.5%). Molecular subtype modification was shown in 2 cases.

Figure (2) Positivity of ER and PR      Figure (3) HER-2 loss of expression (score 0)

Discussion and Conclusion: The review of the literature showed a significant number of patients with discordant expression of molecular markers between primary with nodal or distant metastases (1,2). Appropriately measured, the molecular status could be a more accurate measurement for guiding adjuvant therapy, which requires testing in a clinical trial (3).

Figure (4) Ki67 70%

Keywords: Breast Cancer, ER, PR,HER2, Molecular Phenotype, Nodal Metastases, Distant Metastases


  1. Broom RJ, Tang PA, Simmons C, Bordeleau L, Mulligan AM, O’Malley FP, et al. Changes in estrogen receptor, progesterone receptor and Her-2/neu status with time: discordance rates between primary and metastatic breast cancer. Anticancer Res. mai 2009;29(5):1557‑62.
  2. Joubert C, Boissonneau S, Fina F, Figarella-Branger D, Ouafik L, Fuentes S, et al. [Immunohistochemical hormonal mismatch and human epidermal growth factor type 2 [HER2] phenotype of brain metastases in breast cancer carcinoma compared to primary tumors]. Neurochirurgie. juin 2016;62(3):151‑6.
  3. Quantitative analysis of changes in ER, PR and HER2 expression in primary breast cancer and paired nodal metastases – Ann Oncol.2010 Jun;21(6):1254-1261.

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To citation of this article: Dr. Marwa Krifa, Dr. Ahlem Bdioui, Changes in ER, PR and HER2 Expression in Primary Breast Cancer, Lymph Nodes and Distant Metastases, Global Journal of Cancer Research and Treatment

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