Background: To assess the prognostic and predictive significance of HER-1/EGFR protein levels in high-risk patients with breast cancer treated with dose-dense sequential adjuvant chemotherapy. Methods: 595 high-risk breast cancer patients were treated with adjuvant anthracycline-based dose-dense sequential chemotherapy (E-CMF vs. E-T-CMF). Disease-free survival (DFS) was the primary end point. HER-1/EGFR was assessed by immunohistochemistry (IHC) in 312 patients. Results: HER-1/EGFR expression was detected in 54 of 312 patients (17%). Positive expression of HER-1/EGFR was significantly associated with negative receptor status (52 vs. 17%, p < 0.001), worse histological grade (70 vs. 45%, p = 0.001), HER-2 overexpression (46 vs. 27%, p = 0.01) and positive p53 expression (48 vs. 19%, p < 0.001). With a median follow-up of 7 years, the total number of relapses was 105 (34%), and the total number of deaths 69 (22%). The analysis for DFS provides significant evidence that the HER-1/EGFR effect on the risk of disease progression was different according to treatment (interaction p = 0.02). Regarding overall survival, a trend towards a significant difference for an interaction of HER-1/EGFR and treatment was found (p = 0.07). Conclusion: The present study demonstrated a differential effect of positive HER-1/EGFR expression in the two treatment groups, with HER-1/EGFR being a negative prognostic marker in the absence of paclitaxel.

Cryptogenic organizing pneumonia is a rare manifestation of Sweet's syndrome, which may be complicated by respiratory failure. Prompt treatment with corticosteroids usually leads to clinical and radiographic improvement.

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This 52-year-old woman complained of lower trunk and limb numbness 2 months before admission. She presented with deteriorating leg weakness and urinary incontinence. Spastic quadriparesis, with impaired pinprick sensation below the T-2 dermatome, was demonstrated.Magnetic resonance (MR) imaging of the cervical spine with slight Gd enhancement revealed a diffuse intramedullary tumor extending from C-5 to T-3. Brain and lumbosacral MR images were negative. The tumor was radically resected via a posterior cervicothoracic laminectomy and midline myelotomy by the senior surgeon (C.E.G.) (Fig. 1). The gross appearance of the lesion was that of an intramedullary astrocytoma. At surgery, the tumor was easily dissected from the normal spinal cord. There was no distinct tumor capsule. The postoperative clinical course was uneventful, and the patient's neurological condition remarkably improved. She underwent rehabilitation for 3 months and has been followed for 8 months. She remains in excellent neurological condition without evidence of tumor recurrence. Histopathological examination showed a vascularized neoplasm composed of nonatypical vacuolated cells with clear cytoplasm and displaced deep-colored nuclei. Immunohistochemical analysis for S100 protein, vimentine, keratin AE1, and epithelial membrane antigen (EMA) was positive, whereas it was negative for glial fibrillary acidic protein (Fig. 2). The conclusion was that the tumor was a chordoma.Chordomas are tumors arising from the embryological remnants of the notochord. The presence of chordomas as intradural extramedullary lesions of the spine without osseous involvement is extremely rare. To the best of our knowledge, our case represents the first report of a purely intramedullary spinal chordoma. 1-4