Immunohistochemical Study of Estrogen Receptor, Progesteron

Receptor and Human Epidermal Receptor2 Expression in Breast

Ductal Carcinoma among Bataknese Woman under Age 40

Esther Reny Deswani Sitorus

, Fitriani Lumongga

, Feby Yanti Harahap

and Meggiy Saputra

Faculty of Medicine, Universitas Sumatera Utara, Jl. Dr. Mansur no 5, Medan, Indonesia

Department of Anatomic, Universitas Sumatera Utara, Medan, Indonesia

Department of Histology, Universitas Sumatera Utara, Medan, Indonesia

Student, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Immunohistochemical, Expression, Breast Cancer, Bataknese, Under 40.

Abstract: Breast cancer often occurs in women aged over 45 years according to data in the United States in 2003. But

according to research in 2006 found data of cancer patients under 40 years to 250,000 people, indicating there

has been a shift in the risk of breast cancer at a younger age .According to the Central Bureau of Statistics of

North Sumatra Province 2014 population based on ethnic or tribal in Medan City, most of which is Java and

followed by Batak and Tionghoa. Throughout the year 2014, most breast cancer patients in North Sumatra

are Batak women.This research shows that during the period of January 1, 2017-June 2018 there were 22

cases of breast cancer in Batak women aged under 40 years, and increasing in the age group 37-40 years. In

this study both ER and PR Receptor Hormonal showed the same expression that is Positive in 63.6%, while

Her-2 / neu expression is Positive in 50% of cases.

1 INTRODUCTION

Breast cancer is a type of malignant neoplasm that

most often occurs in women, especially women aged

over 45 years. Breast cancer is rare in women under

45, but breast cancer that appears in women ages is

usually more aggressive, found in advanced stages

and a worse prognosis (IGCP and IBTW, 2017).

In Indonesia, breast cancer is also the most

common cancer cases in women. Based on data from

the International Agency on Research in Cancer

(IARC), ARC incidence of breast cancer in Indonesia

is 36.2 per 100,000 population and the mortality rate

due to breast cancer is 18.6 per 100,000

population.(Siregar, 2013) According to the Central

Bureau of Statistics of North Sumatra Province 2014

population based on ethnic or tribal in Medan City,

most of which is Java and followed by Batak and

Tionghoa. Throughout the year 2014, most breast

cancer patients in North Sumatra are Batak women

(Siregar, 2015).

The exact cause of breast cancer is unknown, but

more than most neoplasms in humans, breast cancer is

known to show more family involvement than any

other type of cancer.(Siregar, 2013)(Tavassolli F.A.,

2002)

In routine clinical management patients with

invasive breast cancer who play a role are three

molecular biomarkers or hormonal receptor images

namely: ER (Estrogen Receptor), PR (Progesterone

Receptor), and HER-2 (Human Epidermal Receptor-

2). Factors that influence the prognosis in addition to

the age of the sufferer are large tumors, histology

type, histology degree and involvement of the lymph

nodes (Calderón-Garcidueñas etal., 2012)

(Gadelkarim Ahmed, 2011).

The urgency of this study is to refer to the

literature that the prognosis of breast carcinoma in

young women is worse than women over 45 years of

age. In accordance with the above problems, and from

the various studies the authors are interested to know

the ImmunohistochemistryExpression of ER, PR and

Her-2 / neu breast cancer patients in Batak women

aged under 40 years.

718

Sitorus, E., Lumongga, F., Harahap, F. and Saputra, M.

Immunohistochemical Study of Estrogen Receptor, Progesteron Receptor and Human Epidermal Receptor2 Expression in Breast Ductal Carcinoma among Bataknese Woman under Age

40.

DOI: 10.5220/0010085407180720

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

718-720

ISBN: 978-989-758-449-7

2 OBJECTIVE

The aim of this study is to analyze the expression of

immunohistochemical marker of breast cancer which

are ER, PR and Her-2/neu among Bataknese woman

under age 40.

3 METHOD

This study is a retrospective study with cross

sectional approach and has been approved by the

Ethics Committee. The study was conducted at the

Anatomic Pathology Laboratory of MurniTeguh

Memorial Hospital by collecting parrafin blocks of

breast cancer patients under 40 years in the period of

January 2017 to June 2018. Paraffin blocks of breast

cancer patients from Batak women aged under 40

years are all taken into this research sample, ie there

are 42 women with breast cancer under the age of 40

years, while 22 people are Batak women.

In each case, the data were recorded for patient

characteristics, clinicopathology profiles and ER, PR

and Her-2 / neu immunohistochemical

expressions.Thetumors were typed according to the

WHO classification system and graded according to

the Nottingham modification of Bloom-Richardson

grading scheme.The size of the tumor mass was

defined by gross pathological measurements as

maximum diameter (Tavassolli F.A., 2002)(Taib

W.M., 2015).

Slides for immunohistochemistry were stained for

ER, PR, and HER2/neu using antibodiesPositive and

negative control slides were involved in each run of

staining. A Positive control slides for ER and PR were

prepared from breast carcinoma known to be positive

for the hormone receptors studied.The hormone

receptor status (ER,PR) immunohistochemical stain

was scored positive cells ≥ 10.0% is positive and <

10% is negative. Her2 according to

immunohistochemical staining of cells can be divided

into 0,1+. 2+ and 3+. Score 0 (negative, no rectivity),

1+ (negative, faint weak reactivity in > 10 % of tumor

cells but only a portion of the membrane is positive),

2+ (equivocal, circumferential intense membran

staining in < 30% of cells . Score 0 and 1 were

considered negative, score 2 was considered weakly

positive and score 3 was considered strongly positive.

Only score 3 cases were considered as Her-2

overexpressing cases.

4 RESULT

The general profile of breast cancer patients in

women aged under 40 years in Murni Teguh

Memorial Hospital in the period January 2017-June

2018

Table 1. Characteristic profile of patiens with breast

carcinoma among Bataknese woman under age 40 (N=22)

Variables

N (%)

Mean

Range

Age

33-40

33-36

(22.7)

37-40

(77.3)

Surgical Methode

Core Biopsy

(54.5)

(9)

(36.3)

(59)

(41)

(36.4)

(63.6)

(36.4)

(9.1)

(54.5)

(36.4)

(63.6)

Table 1 shows that during the period of January 1,

2017-June 2018 there were 22 cases of breast cancer

in Batak women aged under 40 years, and increasing

in the age group 37-40 years. This is in accordance

with the literature that as age increases, the risk for

breast cancer will increase (Tavassolli F.A., 2002).

From the side aspect of the breasts involved it

can be seen that in this study breast involving side

the most is the Left Breast (13%) (Tavassolli F.A.,

2002).

Based on Grade Histology, it was found that in

this research most Grade III were 63.6%. In the table

above there is data that is Not Available on

Lymphnode involvement as much as 54.5%, this may

Immunohistochemical Study of Estrogen Receptor, Progesteron Receptor and Human Epidermal Receptor2 Expression in Breast Ductal

Carcinoma among Bataknese Woman under Age 40

719

be caused by small tumor size and Lymphnode whose

size is also small so that lymphnode not identified.

The interesting thing is also shown by table 1, that is

High Tumor Infiltrating Lymphocyte found the most

in this research, it can be an evidence that young age

have a self defense agains malignancy.

Table 2. Immunohistochemistry Expression of Breast

Carcinoma in Bataknese woman under 40 age.

IHC Expression

(%)

Estrogen Receptor

Positive 14 63.6

Negative 8 36.4

Progesteron Receptor

Positive 14 63.6

Negative 8 36.4

Her-2/Neu

Negative 4 18.18

1(+), Negative 5 22.73

2(+), Equivocal 2 9.09

3(+), Positive 11 50

Triple Negative 2 9.09

Triple Positive 4 18.18

Based on table 2 it can be seen that in this study

both ER and PR Receptor Hormonal showed the

same expression that is Positive in 63.6%, while Her-

2 / neu expression is Positive in 50% of cases. In this

study there is a Triple Negative as an

immunohistochemical expression of Batak women

with breast cancer, while for Triple positive is

shown by the immunohistochemical expression of

breast cancer patients in this study so.

5 CONCLUSION

Breast cancer often occurs in women aged over 45

years according to data in the United States in 2003.

But according to research in 2006 found data of

cancer patients under 40 years to 250,000 people,

indicating there has been a shift in the risk of breast

cancer at a younger age (Xing et al., 2010). In this

study, most Batak women who suffer from breast

cancer is in the age group 34-40, with Triple Negative

Immunohistochemical expression of 9.09% and

Triple Positive of 18.18%.

Further research should be made out for different

clinical outcomes with improved survival.

Breast cancer in young women should be a

challenge to be conquered through various means of

early detection. Research on breast cancer in Batak

women still requires more research with more sample

quantities and also requires proof with various

statistical tests, so it can show the correlation between

variables for the benefit of prognosis and therapy.

ACKNOWLEDGEMENTS

This study was suported by TALENTA Program of

Universitas Sumatera Utara.

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