IMMUNOLOCALIZATION AND EXPRESSION OF HER2, HER3, HER4, EGFR AND P53 IN A PATIENT WITH SYNCHRONOUS PRIMARY ENDOMETRIAL ADENOCARCINOMA AND CLEAR CELL RENAL CARCINOMA: A CASE REPORT

Endometrial adenocarcinoma accounts for 85% of the endometrial carcinomas and renal cancer accounts for around 3% of all adult malignancies. When patients present with more than one tumor in the same or different organs/tissues, multiple primary tumors may be present. A major challenge is to find an anticancer therapy for multiple cancer types without increasing toxicity, pharmacological interactions, and without negative impact of overall outcome. It is hypothesized that immunolocalization and gene expression may be used to help identify patients that may present with multiple site tumors. To illustrate this possibility, the case report of a 69 year-old, non-obese, post-menopausal woman diagnosed with synchronous endometrial adenocarcinoma and renal cell carcinoma is presented. The 2 primary cancers may indicate genetic susceptibility to develop multiple site tumors. Immunolocalization of the EGER, HER2, HER3, HER4 and p53 proteins by immunohistochemistry (IHC) was performed to investigate synchronous expression of these biomarkers. The endometrial adenocarcinoma was a welldifferentiated tumor, with discernable glandular structure with moderate mitotic index. IHC revealed weak HER2, HER3 and HER4 staining of cell membranes in welldifferentiated areas, and intense HER2 and p53 staining in tumor areas showing histological aggressiveness characteristic. EGFR was found only in the stromal area. The renal cell carcinoma showed clear cell type, solid tumor, Fuhrman nuclear grade 2, presence of necrosis and hemorrhage. IHC revealed intense HER2 and HER4 staining of tumor cell membranes, but no HER3, EGFR and p53 staining. In summary, overexpression of HER2 and HER4 proteins was found in both primary tumors, suggesting that these proteins should be investigated in family history. The results show the potential of using immunolocalization and gene expression to evaluate patients that may be prone to multiple primary tumor development.