51
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Dong F, Costigan DC, Howitt BE. Targeted next-generation sequencing in the detection of mismatch repair deficiency in endometrial cancers. Mod Pathol 2019; 32:252-257. [PMID: 30206407 DOI: 10.1038/s41379-018-0125-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 02/08/2023]
Abstract
Mismatch repair deficiency represents a biomarker of immunotherapy response and a phenotypic feature of Lynch syndrome-associated endometrial cancers. Using a targeted next-generation sequencing assay, we identified molecular features of mismatch repair deficiency, specifically insertion and deletion mutations in mononucleotide repeats, and established thresholds for the number of such mutations to classify endometrial cancers as mismatch repair deficient, proficient, or indeterminate. Sequencing classification was compared to the loss of MLH1, MSH2, MSH6, or PMS2 expression by immunohistochemistry. A total of 259 endometrial cancers were classified by sequencing as mismatch repair deficient (n = 48, 19%), proficient (n = 199, 77%), or indeterminate (n = 12, 5%). Sequencing findings were concordant with loss of expression of at least one mismatch repair protein in 47 of 48 (98%) cases classified as deficient and retained expression of all four proteins in 190 of 199 (95%) cases classified as proficient. Of the 12 cases classified as indeterminate, 7 (58%) demonstrated mismatch repair protein loss. Overall, targeted next-generation sequencing exhibited a high rate of concordance with immunohistochemistry for mismatch repair deficiency; however, sequencing was indeterminate in a few cases and demonstrated a false negative rate of 5%. Although we recommend implementation of a mismatch repair deficiency algorithm for laboratories performing next-generation sequencing cancer panels, immunohistochemistry remains a cost-effective screening method for mismatch repair deficiency in endometrial cancer.
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Affiliation(s)
- Fei Dong
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Brooke E Howitt
- Department of Pathology, Stanford University Medical Center, Stanford, CA, USA.
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52
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Hodgson A, Olkhov-Mitsel E, Howitt BE, Nucci MR, Parra-Herran C. International Endocervical Adenocarcinoma Criteria and Classification (IECC): correlation with adverse clinicopathological features and patient outcome. J Clin Pathol 2019; 72:347-353. [PMID: 30679193 DOI: 10.1136/jclinpath-2018-205632] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/03/2022]
Abstract
AIMS The International Endocervical Adenocarcinoma Criteria and Classification (IECC) was recently proposed as an improved method for categorising endocervical adenocarcinoma (EA) into human papillomavirus (HPV)-associated adenocarcinomas (HPVAs) and non-HPV-associated adenocarcinomas (NHPVAs). Such categorisation correlates with patient age and tumour size; however, its association with patient outcome remains to be established. METHODS Institutional cases of EA with histological material available were selected. Three gynaecological pathologists independently classified all tumours according to the IECC with consensus review used when necessary. Clinicopathologic variables were recorded for each case. RESULTS Of a total of 87 EAs, 71 (82%) were classified as HPVA and 16 (18%) as NHPVA. Among HPVA, most were usual type (51/71, 72%) followed by mucinous not otherwise specified (10/71, 14%) and invasive stratified mucin-producing carcinoma (ISMC, 8/71, 11%). Most NHPVAs were of gastric type (12/16, 71%) followed by clear cell and mesonephric (two each, 12%). Compared with HPVAs, NHPVAs were significantly associated with older age (p<0.001), larger horizontal extent (p=0.013), greater depth of invasion (p=0.003), lymphovascular space invasion (p<0.001), advanced stage (p<0.001) and invasive pattern C (p<0.001). On univariate analysis, worse disease-free survival (DFS) and disease-specific survival (DSS) correlated with NHPVA group. Among the HPVA subtypes, ISMC showed worse DFS and DSS compared with other HPVA types. CONCLUSIONS The simple morphological approach of the IECC appears to be prognostically valuable. NHPVA (in particular gastric type) and ISMC (a recently recognised subset of HPVA) have an adverse outcome and their recognition following the IECC is important. We provide further evidence to replace the current WHO classification with the IECC.
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Affiliation(s)
- Anjelica Hodgson
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina Olkhov-Mitsel
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brooke E Howitt
- Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Marisa R Nucci
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Parra-Herran
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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53
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Ding L, Kim HJ, Wang Q, Kearns M, Jiang T, Ohlson CE, Li BB, Xie S, Liu JF, Stover EH, Howitt BE, Bronson RT, Lazo S, Roberts TM, Freeman GJ, Konstantinopoulos PA, Matulonis UA, Zhao JJ. PARP Inhibition Elicits STING-Dependent Antitumor Immunity in Brca1-Deficient Ovarian Cancer. Cell Rep 2018; 25:2972-2980.e5. [PMID: 30540933 PMCID: PMC6366450 DOI: 10.1016/j.celrep.2018.11.054] [Citation(s) in RCA: 349] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/02/2018] [Accepted: 11/13/2018] [Indexed: 12/19/2022] Open
Abstract
PARP inhibitors have shown promising clinical activities for patients with BRCA mutations and are changing the landscape of ovarian cancer treatment. However, the therapeutic mechanisms of action for PARP inhibition in the interaction of tumors with the tumor microenvironment and the host immune system remain unclear. We find that PARP inhibition by olaparib triggers robust local and systemic antitumor immunity involving both adaptive and innate immune responses through a STING-dependent antitumor immune response in mice bearing Brca1-deficient ovarian tumors. This effect is further augmented when olaparib is combined with PD-1 blockade. Our findings thus provide a molecular mechanism underlying antitumor activity by PARP inhibition and lay a foundation to improve therapeutic outcome for cancer patients.
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Affiliation(s)
- Liya Ding
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Hye-Jung Kim
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Qiwei Wang
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Michael Kearns
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Tao Jiang
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Carolynn E Ohlson
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ben B Li
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Shaozhen Xie
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Joyce F Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Elizabeth H Stover
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Roderick T Bronson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Suzan Lazo
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Thomas M Roberts
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | | | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
| | - Jean J Zhao
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA.
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54
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Soong TR, Howitt BE, Horowitz N, Nucci MR, Crum CP. The fallopian tube, "precursor escape" and narrowing the knowledge gap to the origins of high-grade serous carcinoma. Gynecol Oncol 2018; 152:426-433. [PMID: 30503267 DOI: 10.1016/j.ygyno.2018.11.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 12/28/2022]
Abstract
Most ovarian carcinomas are high-grade serous carcinomas (HGSC) that contain TP53 mutations, present at advanced stage, and eventually become resistant to chemotherapy. The rapid evolution of this disease has been attributed to an origin in the distal fallopian tube, in the form of serous tubal intraepithelial carcinomas (STICs). This has led to a disease model where malignancy develops first in the tube and spreads to the peritoneum or regional lymph nodes. However, although most early or incidentally discovered HGSCs manifest in the tube with STICs, many advanced HGSCs are not accompanied by a malignancy in the fimbria. To resolve this paradox, the focus has shifted to earlier, premalignant serous proliferations (ESPs) in the tubes, which lack the cytomorphologic features of malignancy but contain TP53 mutations. These have been termed p53 signatures or serous tubal intraepithelial lesions (STILs). Although they have not been presumed to have cancer-causing potential by themselves, some ESPs have recently been shown to share identical TP53 mutations with concurrent HGSCs, indicating a shared lineage between these early mucosal changes and metastatic malignancy. This discovery supports a paradigm by which HGSCs can emerge not only from STICs but also from exfoliated precursor cells (precursor escape) that eventually undergo malignant transformation within the peritoneal cavity. This paradigm unifies both localized and widespread HGSCs to a visible pre-existing cellular alteration in the tubal epithelium, and highlights a consistent and necessary biologic event (TP53 mutation) rarely encountered in the ovary or secondary Mullerian system. This dual pathway to HGSCs underscores the subtle nature of many serous cancer origins in the tube, explains contrasting clinico-pathologic presentations, and explains why, until recently, the fallopian tube was unappreciated as the principal origin of HGSCs. Moreover, it highlights additional challenges faced in preventing or intercepting HGSCs at a curable stage.
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Affiliation(s)
- Thing Rinda Soong
- Department of Pathology, University of Washington Medical Center, Seattle, WA 98195, United States of America
| | - Brooke E Howitt
- Department of Pathology, Stanford University Medical Center, Palo Alto, CA 94305, United States of America
| | - Neil Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Marisa R Nucci
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Christopher P Crum
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA 02115, United States of America.
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55
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Soong TR, Howitt BE, Miron A, Horowitz NS, Campbell F, Feltmate CM, Muto MG, Berkowitz RS, Nucci MR, Xian W, Crum CP. Evidence for lineage continuity between early serous proliferations (ESPs) in the Fallopian tube and disseminated high-grade serous carcinomas. J Pathol 2018; 246:344-351. [PMID: 30043522 DOI: 10.1002/path.5145] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/02/2018] [Accepted: 07/17/2018] [Indexed: 01/18/2023]
Abstract
The distal Fallopian tube is a site of origin for many 'ovarian' high-grade serous carcinomas (HGSCs) with intraepithelial carcinomas (STICs) that share identical TP53 mutations with metastatic tumors. TP53 mutation-positive early serous proliferations (ESPs) comprise a spectrum including p53 signatures and serous tubal intraepithelial lesions (STILs) and are not considered malignant; however, ESPs are often the only abnormality found in Fallopian tubes of women with metastatic HGSC. The purpose of this study was to determine if a relationship exists between isolated ESPs and concurrent metastatic HGSCs in the absence of STIC. Fallopian tubes from 32 HGSCs without a co-existing STIC/HGSC in the endosalpinx were exhaustively sectioned. The presence of either STIC/HGSC or ESP in the endosalpinx was documented and DNA from tissues containing ESPs, concurrent HGSC, and control epithelia were interrogated for TP53 mutations by targeted amplicon-based sequencing with average coverage reads >4000 across DNA replicate samples. Serial sectioning revealed a previously unrecognized STIC/HGSC in 3 of 32 (9.3%) and ESPs in 13 (40.6%). Twelve contained TP53 mutations. Nine (75%) shared identical TP53 mutations with concurrent HGSCs, four at high (≥ 5%) and five at low (< 5%) allele frequency. All control epithelia were TP53 mutation-negative. This study, for the first time, indicates lineage identity between ESPs in the distal tube and some metastatic HGSCs via a shared site-specific TP53 mutation. It supports a novel serous carcinogenic sequence in which an ESP could eventually culminate in a metastatic serous cancer via 'precursor escape' and would explain the apparent sudden onset of cancers without co-existing STICs. This paradigm for serous cancer development underscores the likelihood that multiple precursor types in the Fallopian tube contribute to serous cancer development with implications for the evolution, pathologic classification, and prevention of this lethal malignancy. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Thing Rinda Soong
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brooke E Howitt
- Department of Pathology, Stanford University Medical Center, Palo Alto, California, USA
| | | | - Neil S Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Colleen M Feltmate
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael G Muto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ross S Berkowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wa Xian
- Institute of Molecular Medicine, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Christopher P Crum
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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56
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Kolin DL, Dong F, Baltay M, Lindeman N, MacConaill L, Nucci MR, Crum CP, Howitt BE. SMARCA4-deficient undifferentiated uterine sarcoma (malignant rhabdoid tumor of the uterus): a clinicopathologic entity distinct from undifferentiated carcinoma. Mod Pathol 2018; 31:1442-1456. [PMID: 29700418 DOI: 10.1038/s41379-018-0049-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/25/2018] [Accepted: 02/04/2018] [Indexed: 12/22/2022]
Abstract
Small cell carcinoma of the ovary, hypercalcemic type is a rare, aggressive malignancy which usually occurs in young women and is characterized by mutations in SMARCA4, with few other alterations. We recently encountered uterine tumors with morphologic, immunohistochemical, and genetic similarities to small cell carcinoma of the ovary, hypercalcemic type. Herein we report the clinicopathologic and molecular features (using a targeted massively parallel sequencing [MPS] assay) of these tumors. The cases were diagnosed on cervical and endometrial biopsies (n = 2, 34, and 29 years) or hysterectomy and bilateral salpingo-oophorectomy (n = 3, 25, 33, and 58 years). The tumors were composed of sheets of large atypical epithelioid cells with prominent rhabdoid morphology, indistinguishable from the "large cell" variant of small cell carcinoma of the ovary, hypercalcemic type. In three cases, the ovaries were pathologically examined to exclude a primary ovarian malignancy. Immunohistochemically, four of four cases showed SMARCA4 loss, and were negative or only focally positive for keratins, EMA, and claudin-4. One of three cases was positive for WT-1. Targeted MPS was successfully performed on 4 of 5 tumors, and showed recurrent mutations in SMARCA4, with few other alterations. Of the cases diagnosed on hysterectomy, all had extensive lymphovascular invasion, extra-uterine spread, and marked infiltrative growth. These tumors were uniformly aggressive; all patients died of disease (median survival 7 months, range 1-43 months). We propose this entity be called "SMARCA4-deficient undifferentiated uterine sarcoma (malignant rhabdoid tumor of the uterus)", a term which describes both the tumor's underlying molecular abnormality and its morphology. Its unique clinicopathologic and molecular features differentiate it from other related malignancies, including undifferentiated endometrial carcinoma, small cell carcinoma of the ovary (hypercalcemic type), and epithelioid sarcoma. We review and discuss previously reported "rhabdoid tumors of the uterus;" while they are a heterogenous group of tumors, some of them are likely examples of this entity. Correctly identifying cases of SMARCA4-deficient uterine sarcoma from histologic mimics is important as it may have prognostic, predictive, and germline implications.
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Affiliation(s)
- David L Kolin
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Fei Dong
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Michele Baltay
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Neal Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Laura MacConaill
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Christopher P Crum
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Brooke E Howitt
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA. .,Department of Pathology, Stanford University Medical Center, Stanford, CA, 94305, USA.
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57
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Farkkila A, Chopra SS, Lin JR, Maliga Z, Koruchupakkal B, Strickland KC, Howitt BE, Santagata S, Matulonis UA, Elias K, Swisher EM, Konstantinopoulos PA, Sorger P, D'Andrea AD. Abstract 139: DNA damage and immunoprofiling with highly multiplexed tissue immunofluorescence (t-CycIF) in high-grade serous ovarian cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Immune checkpoint blockade (ICB) has emerged as a new promising therapeutic approach in multiple cancers, however, the responses to single-agent ICBs have been modest in high-grade serous ovarian cancer (HGSOC). Preclinical- and early clinical data show promising efficacy of combining DNA damaging agents with immunotherapy. An improved understanding of the interplay between DNA damage in cancer cells and anti-tumor immune responses may therefore accelerate the development of rational drug combinations and identify predictive biomarkers. The majority of HGSOC are deficient in homologous recombination (HR) DNA repair, and use alternative, error-prone DNA repair pathways, that have been shown to be associated with increased immune recognition (Strickland et al, 2016). Compelling evidence has shown that DNA damaging agents increase the expression of immune-regulatory genes, such as MCH class I antigens, and interferons in HR deficient tumors. Further, HR deficient tumor exhibit an increased response to ICBs, and DNA damage-driven activation of interferon signalling has been shown to overcome resistance to ICBs (Wang et al, 2016). To reveal the relationship between intrinsic and treatment-induced DNA damage and the HGSOC immune microenvironment we are employing a novel, high-multiplex tissue cyclic immunofluorescence (t-CycIF) platform (Lin et al, 2016& 2017) allowing for the simultaneous detection of up to 60 different antigens at single cell resolution. Utilizing t-CycIF we are in the process of profiling the DNA damage and immune responses in three unique HGSOC clinical cohorts including i) tumors with inherent DNA repair deficiencies ii) pre- and post DNA damaging therapy iii) tumors collected in an innovative clinical trial combining Poly- ADP Ribose Polymerase inhibitor (PARPi) Niraparib and ICB Pembrolizumab. Using this high-dimensional, quantitative data we are mapping the abundance, spatial arrangement and functional state of cancer cells, immune cells, and stroma in the HGSOC microenvironment. The highly multiplexed t-CycIF data are processed with established computational algorithms and correlated with clinical outcomes. Our preliminary data shows that t-CycIF sensitively captures immune cell subpopulations, tumor heterogeneity and DNA damage in HGSOC. We anticipate that t-CycIF could accelerate the development of rational strategies for combining DNA damaging agents with immunotherapy to ultimately improve the treatment and outcomes of patients with ovarian cancer.
Citation Format: Anniina Farkkila, Sameer S. Chopra, Jia-Ren Lin, Zoltan Maliga, Bose Koruchupakkal, Kyle C. Strickland, Brooke E. Howitt, Sandro Santagata, Ursula A. Matulonis, Kevin Elias, Elizabeth M. Swisher, Panagiotis A. Konstantinopoulos, Peter Sorger, Alan D. D'Andrea. DNA damage and immunoprofiling with highly multiplexed tissue immunofluorescence (t-CycIF) in high-grade serous ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 139.
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Affiliation(s)
- Anniina Farkkila
- 1Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Bose Koruchupakkal
- 1Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kyle C. Strickland
- 1Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brooke E. Howitt
- 1Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sandro Santagata
- 3Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Ursula A. Matulonis
- 1Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kevin Elias
- 4Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Alan D. D'Andrea
- 1Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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58
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Angell TE, Vyas CM, Barletta JA, Cibas ES, Cho NL, Doherty GM, Gawande AA, Howitt BE, Krane JF, Marqusee E, Strickland KC, Alexander EK, Moore FD, Nehs MA. Reasons Associated with Total Thyroidectomy as Initial Surgical Management of an Indeterminate Thyroid Nodule. Ann Surg Oncol 2018. [DOI: 10.1245/s10434-018-6421-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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59
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Markt SC, Tang T, Cronin AM, Katz IT, Howitt BE, Horowitz NS, Lee LJ, Wright AA. Insurance status and cancer treatment mediate the association between race/ethnicity and cervical cancer survival. PLoS One 2018; 13:e0193047. [PMID: 29447263 PMCID: PMC5814056 DOI: 10.1371/journal.pone.0193047] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 02/02/2018] [Indexed: 11/18/2022] Open
Abstract
Cervical cancer outcomes remain poor among disadvantaged populations, including ethnic minorities, low-income, and underinsured women. The aim of this study was to evaluate the mechanisms that underlie the observed association between race/ethnicity and cervical cancer survival. We identified 13,698 women, ages 21 to 64 years, diagnosed with stages I-III primary cervical cancer between 2007-2013 in Surveillance, Epidemiology, and End Results (SEER). Multivariable Cox proportional hazards regression models evaluated associations between race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, Other) and cervical cancer-specific mortality. We conducted mediation analysis to calculate the mediation proportion and its 95% confidence interval. Non-Hispanic black women had an increased risk of cervical cancer-specific mortality (HR: 1.23, 95% CI: 1.08-1.39), and Hispanic women a decreased risk of dying from their disease (HR: 0.82, 95% CI: 0.72-0.93), compared with non-Hispanic white. The estimated proportion of excess cervical cancer mortality for non-Hispanic black women relative to non-Hispanic white women that was mediated by insurance was 18.6% and by treatment was 47.2%. Furthermore, non-Hispanic black women were more likely to receive radiation and less likely to receive surgery for early-stage disease. In this population-based study we found that some of the excess cervical cancer-specific mortality for non-Hispanic black women is mediated by factors such as insurance status and treatment. These findings suggest that enhancing existing insurance coverage and ensuring equal and adequate treatment in all women may be a key strategy for improving cervical cancer outcomes.
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Affiliation(s)
- Sarah C. Markt
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Tianyu Tang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Angel M. Cronin
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ingrid T. Katz
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Brooke E. Howitt
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Neil S. Horowitz
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics and Gynecology, Division Gynecologic Oncology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Larissa J. Lee
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Alexi A. Wright
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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60
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Talia KL, Stewart CJ, Howitt BE, Nucci MR, McCluggage WG. HPV-negative gastric type adenocarcinoma in situ of the cervix. Pathology 2018. [DOI: 10.1016/j.pathol.2017.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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61
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Yang EJ, Howitt BE, Fletcher CDM, Nucci MR. Solitary fibrous tumour of the female genital tract: a clinicopathological analysis of 25 cases. Histopathology 2018; 72:749-759. [DOI: 10.1111/his.13430] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/31/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Eric J Yang
- Department of Pathology; Stanford University Medical Center; Stanford CA USA
| | - Brooke E Howitt
- Division of Women's & Perinatal Pathology; Department of Pathology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
| | | | - Marisa R Nucci
- Division of Women's & Perinatal Pathology; Department of Pathology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
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Abstract
The mesonephric (Wolffian) duct regresses in females during embryological development. Remnants of this duct may persist typically along the lateral walls of the cervix, vagina, adnexa, and uterine corpus. These mesonephric epithelia may expand into hyperplastic proliferations and rarely form neoplasms. The spectrum of morphology, immunophenotype, clinical presentation, and molecular characteristics of mesonephric lesions is reviewed, with attention to distinction from entities in the differential diagnosis.
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Affiliation(s)
- Brooke E Howitt
- Brigham and Women's Hospital, Department of Pathology, Division of Women's and Perinatal Pathology, Boston, MA, USA; Department of Pathology, Stanford School of Medicine, Stanford, CA, United States.
| | - Marisa R Nucci
- Brigham and Women's Hospital, Department of Pathology, Division of Women's and Perinatal Pathology, Boston, MA, USA.
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63
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Tashakori M, Pimentel J, Howitt BE, Sanchez J, Michalowski S, Chitale D, Ormsby AH, Williamson SR. Pleomorphic fibroma of the skin with MDM2 immunoreactivity: A potential diagnostic pitfall. J Cutan Pathol 2017; 45:59-62. [PMID: 28981153 DOI: 10.1111/cup.13052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/06/2017] [Accepted: 09/29/2017] [Indexed: 01/01/2023]
Abstract
Pleomorphic fibroma is a rare benign cutaneous neoplasm characterized by spindle-shaped cells and multinucleated giant cells scattered throughout collagenous stroma. These morphologic features can lead to diagnostic confusion, including atypical lipomatous tumor as one consideration. In contrast to atypical lipomatous tumor, previous studies have found pleomorphic fibroma to be negative for MDM2 immunohistochemical staining and MDM2 gene amplification. Here, we present a case of pleomorphic fibroma of skin with nuclear MDM2 immunoreactivity in the absence of MDM2 gene amplification, underscoring the superiority of fluorescence in situ hybridization as a diagnostic test in this differential diagnosis. The RB1 locus is also explored for differential diagnosis with pleomorphic/spindle cell lipoma and related entities.
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Affiliation(s)
- Mehrnoosh Tashakori
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Jason Pimentel
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jessica Sanchez
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Susan Michalowski
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Dhananjay Chitale
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan.,Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan
| | - Adrian H Ormsby
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Sean R Williamson
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan.,Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan
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64
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Mirkovic J, Schoolmeester JK, Campbell F, Miron A, Nucci MR, Howitt BE. Cervical mesonephric hyperplasia lacks KRAS/NRAS
mutations. Histopathology 2017; 71:1003-1005. [DOI: 10.1111/his.13307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jelena Mirkovic
- Department of Pathology; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
| | | | | | - Alexander Miron
- AgriPlex Genomics; Cleveland OH USA
- Department of Genetics and Genome Sciences; Case Western Reserve University Medical School; Cleveland OH USA
| | - Marisa R Nucci
- Department of Pathology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Brooke E Howitt
- Department of Pathology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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65
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Strickland KC, Howitt BE, Barletta JA, Cibas ES, Krane JF. Suggesting the cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): A retrospective analysis of atypical and suspicious nodules. Cancer Cytopathol 2017; 126:86-93. [DOI: 10.1002/cncy.21922] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/11/2017] [Accepted: 08/29/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Kyle C. Strickland
- Department of Pathology, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Brooke E. Howitt
- Department of Pathology, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Justine A. Barletta
- Department of Pathology, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Edmund S. Cibas
- Department of Pathology, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Jeffrey F. Krane
- Department of Pathology, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
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66
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Talia KL, Stewart CJR, Howitt BE, Nucci MR, McCluggage WG. HPV-negative Gastric Type Adenocarcinoma In Situ of the Cervix: A Spectrum of Rare Lesions Exhibiting Gastric and Intestinal Differentiation. Am J Surg Pathol 2017; 41:1023-1033. [PMID: 28394803 DOI: 10.1097/pas.0000000000000855] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In recent years, a number of benign and malignant cervical glandular lesions exhibiting gastric differentiation have been described but premalignant gastric-type lesions have not been well characterized. We report a series of 9 cases of a rare form of cervical adenocarcinoma in situ (AIS) distinguished by gastric and sometimes intestinal differentiation and lack of association with human papillomavirus (HPV) infection. The lesions occurred in women aged 25 to 73 years (mean age 51 y). All cases were located at (or just proximal to) the cervical transformation zone and there was extension to the lower uterine segment in 3 cases, 2 of which also involved the endometrium. In all cases, the normal cervical glandular architecture was largely preserved but in 5 cases there was a mild degree of increased intraglandular architectural complexity. The glandular epithelium ranged from almost purely gastric in type (4 cases) to mixed gastric and intestinal (5 cases), with varying proportions of intermixed goblet cells. In contrast to the basophilic cytoplasm of normal endocervical glands, the gastric-type epithelium was typically predominantly composed of cells with eosinophilic or pale pink cytoplasm, but conspicuous foamy or clear cell cytoplasm was present in some cases. Nuclear atypia was present in all cases but was considered low-grade in 8. High-grade features such as marked nuclear pleomorphism and hyperchromasia were evident in only 1 case. Mitotic activity and apoptotic bodies were present but both were noted to be less frequent than in usual type (HPV-related) AIS. Immunohistochemically, there was usually positive staining with CK 7 (7/7 cases) and MUC 6 (7/8 cases) and some cases were positive with CK 20 (3/7), CDX2 (5/9), PAX 8 (5/9) and CEA (2/6). Estrogen receptor and progesterone receptor were usually negative, although Estrogen receptor was positive in 3 of 9 cases. p16 was negative or exhibited mosaic-type staining (nonblock staining) in all cases and there was mutation-type p53 staining in 2 of 9 cases. HPV molecular testing was negative in all 4 cases tested. We believe this unusual subtype of AIS, which we term "gastric-type AIS (gAIS)," represents a precursor to gastric-type adenocarcinoma of the cervix and suggest that gAIS and so-called "atypical lobular endocervical glandular hyperplasia" are related entities within a spectrum of premalignant gastric-type lesions for which we propose the umbrella term gAIS. The malignant potential and optimal management of gAIS are currently unknown but in one of our cases a gastric-type adenocarcinoma developed 6 years after removal of a cervical polyp which contained gAIS. The introduction of HPV vaccination will result in a relative increase in incidence of premalignant and malignant cervical glandular lesions exhibiting gastric differentiation and these will not be detected by HPV-based screening programs.
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Affiliation(s)
- Karen L Talia
- *Department of Pathology, Box Hill Hospital, Melbourne, Vic. †Department of Histopathology, King Edward Memorial Hospital, Perth, WA, Australia ‡Department of Pathology, Brigham and Women's Hospital, Boston, MA §Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
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67
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Abstract
This article focuses on the diagnostic, prognostic, and predictive molecular biomarkers in uterine malignancies, in the context of morphologic diagnoses. The histologic classification of endometrial carcinomas is reviewed first, followed by the description and molecular classification of endometrial epithelial malignancies in the context of histologic classification. Taken together, the molecular and histologic classifications help clinicians to approach troublesome areas encountered in clinical practice and evaluate the utility of molecular alterations in the diagnosis and subclassification of endometrial carcinomas. Putative prognostic markers are reviewed. The use of molecular alterations and surrogate immunohistochemistry as prognostic and predictive markers is also discussed.
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Affiliation(s)
- Lauren L Ritterhouse
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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68
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Wong KS, Strickland KC, Angell TE, Nehs MA, Alexander EK, Cibas ES, Krane JF, Howitt BE, Barletta JA. The Flip Side of NIFTP: an Increase in Rates of Unfavorable Histologic Parameters in the Remainder of Papillary Thyroid Carcinomas. Endocr Pathol 2017; 28:171-176. [PMID: 28271380 DOI: 10.1007/s12022-017-9476-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was recently proposed to replace noninvasive follicular variant of papillary thyroid carcinoma (FVPTC) both to promote more conservative management of these tumors and spare patients the psychological burden of a cancer diagnosis. This reclassification will lower the incidence of papillary thyroid carcinoma (PTC). In addition, it could result in an increase in the rates of unfavorable histologic prognosticators for PTC overall because NIFTPs had previously accounted for many of the PTCs without these features. Our aim was to evaluate the potential impact of the reclassification of NIFTP on the rates of extrathyroidal extension, lymphovascular invasion, and lymph node metastases in PTC. We identified all PTCs clinically over 1 cm diagnosed on surgical resection between August 2010 and August 2012. The histopathologic characteristics, including PTC subtype, tumor size, presence of extrathyroidal extension and lymphovascular invasion, and surgical margin and lymph node status were all recorded. Based on these parameters, cases were classified according to the American Thyroid Association (ATA) risk stratification system for structural disease recurrence. Tumor slides for cases initially diagnosed as FVPTC were reviewed to identify tumors that would now be classified as NIFTPs. Our cohort included 348 cases of PTC, of which 94 (27%) would now be classified as NIFTPs. After excluding NIFTPs from the PTC category, there were increased rates of extrathyroidal extension (26% up from 19%, p = 0.046), lymphovascular invasion (37% up from 27%, p = 0.0099), and lymph node metastases (26% up from 19%, p = 0.045) among the remaining PTCs. Based on these changes in histologic features, 10% fewer cases were defined as ATA low risk (62% down from 72%, p = 0.0081). Our results indicate that the downgrading of some carcinomas to NIFTP will increase the rates of higher risk histologic parameters in the remaining PTCs by statistically significant margins. Although the overall survival for PTC is very high and would likely not be changed significantly by the introduction of NIFTP, additional studies evaluating the impact of the NIFTP shift are warranted.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kyle C Strickland
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Trevor E Angell
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Erik K Alexander
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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69
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Choi P, Howitt BE, Crum CP, Berkowitz RS, Ng S. Abstract MIP-052: THE ROLES OF CD24 IN OVARIAN CANCER DEVELOPMENT. Clin Cancer Res 2017. [DOI: 10.1158/1557-3265.ovcasymp16-mip-052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
OBJECTIVES: CD24 is recently reported as ovarian cancer stem cell markers, and the expression of CD24 is increased from borderline tumors to invasive ovarian carcinomas. However, the underlying pathways controlled by CD24 in ovarian pathogenesis were poorly understood. We investigated the potential roles of CD24 in normal fallopian tube epithelial (FTE) cells and ovarian cancer development.
METHODS: Lentiviral particles harboring CD24 shRNAs targeting CD24 expression were used to establish FTE cell lines and ovarian cancer cell lines with CD24 knockdown. The resulting cell lines were compared with the correspondent cells with non target shRNA control in colony formation assay, BrdU incorporation, cell growth and drug resistance. Western blot was used for analyzing downstream pathways affected by the knockdown of CD24. Expression of CD24 and its downstream effectors identified from western blot, including Pax 2 and Gli1 were studied in normal FTE, non–serous and serous tumor tissues by immunohistochemistry (IHC) to confirm whether the in vitro study is clinically relevant.
RESULTS: Western blot analysis showed that CD24 expression was absent in normal ovarian surface epithelial (OSE) cells but was relatively high in normal FTE cells. In addition, serous cancer cell lines have a lower CD24 expression when compared to non–serous cancer cell lines. Knockdown of CD24 in FTE cells caused slower growth, lower ability in colony formation, reduced percentage of cells in S phase and decrease in expression of p–stat3 in JAK pathway and the JAK downstream targets Nanog and OCT3/4; and Pax2, which is normally expressed in FTE but lost in FTE secretory cell outgrowth (SCOUT). The loss of Pax2 in SCOUT is associated with serous carcinoma. IHC showed cytoplasmic co–localized expression of CD24 and Pax2 in the normal FTE tissue, suggesting the possibility of interaction between these two proteins in vivo. In contrast, knockdown of CD24 in ovarian cancer cells caused faster growth, higher ability in colony formation, increased percentage of cells in S phase, more resistant to carboplatin and higher expression of Shh and Gli1 in Sonic hedgehog (SHH) pathway. The above effects were more obvious in the non–serous cancer cell line. Activation of SHH pathway requires translocation of Gli1 into the nucleus. Concurrent with the in vitro results, IHC showed that the expression of Gli1 was found inside the nucleus in the non–serous tumor tissues but in the cytoplasm in serous–tissue, suggesting that the effect brought by SHH pathway is more prominent in the non–serous cancer cells.
CONCLUSION: Our study is the first study revealing the linkage between CD24 and PAX2, and suggesting normal FTE cells depends on CD24/JAK pathway for growth and the loss of CD24 expression and hence, the loss of PAX2 may be associated with serous type tumor development, basing on other studies that SCOUTs were significantly associated with serous carcinoma. Moreover, the study also suggests CD24 pathway affects Type I and Type II (HGSOC) tumors differently. The CD24/SHH pathways may be responsible in controlling cell growth and drug resistance in ovarian cancer cells, hence, warrant further studies.
Citation Format: Pui–Wah Choi, Brooke E. Howitt, Christopher P. Crum, Ross S. Berkowitz, and Shu–Wing Ng. THE ROLES OF CD24 IN OVARIAN CANCER DEVELOPMENT [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr MIP-052.
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Affiliation(s)
- Pui–Wah Choi
- 1Department of Obstetrics/Gynecology and Reproductive Biology,
| | - Brooke E. Howitt
- 2Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Christopher P. Crum
- 2Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | | | - Shu–Wing Ng
- 1Department of Obstetrics/Gynecology and Reproductive Biology,
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Howitt BE, Herfs M, Tomoka T, Kamiza S, Gheit T, Tommasino M, Delvenne P, Crum CP, Milner D. Comprehensive Human Papillomavirus Genotyping in Cervical Squamous Cell Carcinomas and Its Relevance to Cervical Cancer Prevention in Malawian Women. J Glob Oncol 2017; 3:227-234. [PMID: 28717764 PMCID: PMC5493214 DOI: 10.1200/jgo.2015.001909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Cervical squamous cell carcinoma (SCC) continues to be a significant cause of cancer morbidity and is the third leading cause of cancer-related death in women worldwide. In sub-Saharan Africa, cervical cancer is not only the most common female cancer but also the leading cause of cancer-related deaths in women. Malawi, in particular, has the highest burden of cervical cancer. With the increasing use of human papillomavirus (HPV) vaccination, documenting the prevalent HPV types in those high-risk populations is necessary to both manage expectations of HPV vaccination and guide future vaccine development. MATERIALS AND METHODS In this study, we performed HPV typing on 474 cervical SCC samples and analyzed the potential impact of HPV vaccination in this population. RESULTS Ninety-seven percent of tumors were positive for at least one HPV type, and 54% harbored more than one HPV type. HPV 16 was the most common type (82%), followed by HPV 18 (34%), HPV 35 (24%), and HPV 31 (12%). A vaccine against HPV 16 and 18 would ideally prevent 53% of cervical SCC, and the nonavalent HPV vaccine (covering HPV 16, 18, 31, 33, 45, 52, and 58) would prevent 71% of cervical SCC in Malawi (assuming 100% vaccine efficacy). The main reason for a lack of coverage was high prevalence of HPV 35, which was also present as a single infection in a small subset of patients. CONCLUSION Although any HPV vaccination in this population would likely prevent a significant proportion of cervical cancer, the nonavalent vaccine would provide better coverage. Furthermore, investigation of the role of HPV 35 in this population, including possible cross-protection with other HPV types, should be pursued.
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Affiliation(s)
- Brooke E. Howitt
- Brooke E. Howitt, Christopher P. Crum, and Danny Milner, Brigham and Women’s Hospital, Boston, MA; Michael Herfs and Philippe Delvenne, University of Liege, Liege, Belgium; Tamiwe Tomoka, Steve Kamiza, and Danny Milner, Malawi College of Medicine, Blantyre, Malawi; and Tarik Gheit and Massimo Tommasino, International Agency for Research on Cancer, Lyon, France
| | - Michael Herfs
- Brooke E. Howitt, Christopher P. Crum, and Danny Milner, Brigham and Women’s Hospital, Boston, MA; Michael Herfs and Philippe Delvenne, University of Liege, Liege, Belgium; Tamiwe Tomoka, Steve Kamiza, and Danny Milner, Malawi College of Medicine, Blantyre, Malawi; and Tarik Gheit and Massimo Tommasino, International Agency for Research on Cancer, Lyon, France
| | - Tamiwe Tomoka
- Brooke E. Howitt, Christopher P. Crum, and Danny Milner, Brigham and Women’s Hospital, Boston, MA; Michael Herfs and Philippe Delvenne, University of Liege, Liege, Belgium; Tamiwe Tomoka, Steve Kamiza, and Danny Milner, Malawi College of Medicine, Blantyre, Malawi; and Tarik Gheit and Massimo Tommasino, International Agency for Research on Cancer, Lyon, France
| | - Steve Kamiza
- Brooke E. Howitt, Christopher P. Crum, and Danny Milner, Brigham and Women’s Hospital, Boston, MA; Michael Herfs and Philippe Delvenne, University of Liege, Liege, Belgium; Tamiwe Tomoka, Steve Kamiza, and Danny Milner, Malawi College of Medicine, Blantyre, Malawi; and Tarik Gheit and Massimo Tommasino, International Agency for Research on Cancer, Lyon, France
| | - Tarik Gheit
- Brooke E. Howitt, Christopher P. Crum, and Danny Milner, Brigham and Women’s Hospital, Boston, MA; Michael Herfs and Philippe Delvenne, University of Liege, Liege, Belgium; Tamiwe Tomoka, Steve Kamiza, and Danny Milner, Malawi College of Medicine, Blantyre, Malawi; and Tarik Gheit and Massimo Tommasino, International Agency for Research on Cancer, Lyon, France
| | - Massimo Tommasino
- Brooke E. Howitt, Christopher P. Crum, and Danny Milner, Brigham and Women’s Hospital, Boston, MA; Michael Herfs and Philippe Delvenne, University of Liege, Liege, Belgium; Tamiwe Tomoka, Steve Kamiza, and Danny Milner, Malawi College of Medicine, Blantyre, Malawi; and Tarik Gheit and Massimo Tommasino, International Agency for Research on Cancer, Lyon, France
| | - Philippe Delvenne
- Brooke E. Howitt, Christopher P. Crum, and Danny Milner, Brigham and Women’s Hospital, Boston, MA; Michael Herfs and Philippe Delvenne, University of Liege, Liege, Belgium; Tamiwe Tomoka, Steve Kamiza, and Danny Milner, Malawi College of Medicine, Blantyre, Malawi; and Tarik Gheit and Massimo Tommasino, International Agency for Research on Cancer, Lyon, France
| | - Christopher P. Crum
- Brooke E. Howitt, Christopher P. Crum, and Danny Milner, Brigham and Women’s Hospital, Boston, MA; Michael Herfs and Philippe Delvenne, University of Liege, Liege, Belgium; Tamiwe Tomoka, Steve Kamiza, and Danny Milner, Malawi College of Medicine, Blantyre, Malawi; and Tarik Gheit and Massimo Tommasino, International Agency for Research on Cancer, Lyon, France
| | - Danny Milner
- Brooke E. Howitt, Christopher P. Crum, and Danny Milner, Brigham and Women’s Hospital, Boston, MA; Michael Herfs and Philippe Delvenne, University of Liege, Liege, Belgium; Tamiwe Tomoka, Steve Kamiza, and Danny Milner, Malawi College of Medicine, Blantyre, Malawi; and Tarik Gheit and Massimo Tommasino, International Agency for Research on Cancer, Lyon, France
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71
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Lee LJ, Howitt BE, Fendler W, Stawiski K, Bu P, Cho L, Chowdhury D, Matulonis UA, Konstantinopoulos PA. miRNA profiling in a case: Control study of African American women with uterine serous carcinoma (USC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e17116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17116 Background: USC is an aggressive subtype of endometrial cancer associated with worse outcomes in African American patients. We evaluated differences in tumor miRNA expression by race, clinical and tumor characteristics, and survival outcomes. Methods: FFPE tumor tissue from hysterectomy specimens was identified for 29 African American cases. Case matching was performed by computer-based random assignment in a 1:1 ratio with Caucasian controls based on age ( < 70 vs. ≥70 years), stage (FIGO I/II vs. III/IV) and histologic subtype (pure vs. mixed). RNA was extracted from 77 specimens with sufficient tumor cellularity (54 tumors and 23 matched normal endometrium). miRNA array profiling was performed by microRNA Hi-Power Labeling (Hy3/Hy5) and hybridization to miRCURY LNA microRNA Array 7th Gen (Exiqon, Denmark). Analysis was performed with R/Bioconductor using a moderated t-statistic with multiple testing correction. Validation was done using the TCGA dataset. Results: Clinical and treatment characteristics were similar for cases and controls, although use of adjuvant radiation was less common in African Americans (p = 0.03). With a median follow-up of 43 months, 17 patients had recurrent or progressive disease. DFS and OS rates were similar by race (both logrank p > 0.5). Of 968 miRNAs analyzed, 649 were differentially expressed in normal endometrium vs. tumor. When compared by race, histologic subtype, stage or presence of LVI, no differentially expressed miRNAs were identified. In patients with disease recurrence at 3 years, miR-223 was significantly upregulated (fold change 1.5; p = 0.002). In validation using a TCGA dataset of 131 patients with mixed (n = 22) or pure serous (n = 109) histology, increased miR-223 expression ( > median) was associated with worse overall survival (HR 2.47; 95%CI 0.9-6.6). After adjustment for patient age and BMI, upregulation of miR-223 was a significant risk factor for death (adjusted HR 2.94; 95%CI 1.01-8.52). Conclusions: Upregulation of miR-223 was associated with disease recurrence in a cohort of women with uterine serous carcinoma and validated by TCGA data. miRNA profiling did not identify biological differences between African American and Caucasian patients.
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Affiliation(s)
| | | | | | | | - Paula Bu
- Brigham and Women's Hospital, Boston, MA
| | - Linda Cho
- Brigham and Women's Hospital, Boston, MA
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Lee LJ, Howitt BE, Oliva E, Zhang H, Catalano PJ, Crum C, Bu P, Cimbak N, Demaria R, Murphy R, Horowitz NS, Matulonis UA, Russo AL. Prognostic importance of p16 status for women with vulvar squamous cell carcinoma (SCC) treated with radiotherapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5599 Background: To evaluate the association between p16 status and in-field recurrence (IFR), progression-free (PFS) and overall (OS) survival in patients with vulvar SCC treated with radiation (RT) with or without surgical resection. Methods: In a multi-institutional retrospective cohort study, we identified 105 women with vulvar SCC who received RT between 1985-2011. Immunostaining for p16 was performed on archival tumor tissue using the Leica Bond III staining platform. Histopathology and p16 stains were reviewed by pathologists with expertise in gynecologic cancer; the intensity and extent of p16 staining in tumor cells were classified as negative (focal, weak, patchy) or positive (moderate or strong diffuse linear positive). Actuarial estimates of PFS, OS and IFR were calculated using the Kaplan-Meier method and compared by the logrank test. Multivariable analysis (MVA) was performed using the Cox proportional hazards model. Results: Patients with p16-positive disease were significantly younger at diagnosis (median 67 vs. 77 years) and were more likely to be current smokers (51% vs. 0%) and to have received concurrent chemotherapy (68% vs. 47%, all p<0.05). FIGO stage distribution, RT intent and median RT doses were similar by p16 status. With a median follow-up of 61 months, 5-year PFS and OS rates were 35% and 40%, respectively. Women with p16-positive tumors had significantly better 5-year PFS and OS rates than those with p16-negative tumors (61% and 23%, p<0.01 and 64% and 29%, p=0.01, respectively). The 5-year IFR rate was also lower for those with p16-positive disease (17% vs. 65%, p<0.01). On univariate analysis, use of concurrent chemotherapy was not associated with PFS (p=0.5), OS (p=0.3) or IFR (p=0.8). On MVA adjusted for age and stage, p16 positivity was significantly associated with better PFS (HR 0.57, 95% CI 0.33-0.97) and lower IFR (HR 0.24, 95% CI 0.09-0.6). Conclusions: In a multi-institutional setting, women with p16-positive vulvar SCC treated with RT had a lower IFR rate and longer survival than those with p16-negative disease. The magnitude of prognostic importance of p16 status is similar to that seen in oropharyngeal, anal and cervical cancers treated with RT.
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Affiliation(s)
| | | | | | | | | | | | - Paula Bu
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Neil S. Horowitz
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
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Douglas G, Howitt BE, Schoolmeester JK, Schwartz L, Kos Z, Islam S, Djordjevic B, Parra-Herran C. Architectural overlap between benign endocervix and pattern-A endocervical adenocarcinoma: Are all pattern-A tumors invasive? Pathol Res Pract 2017; 213:799-803. [PMID: 28554747 DOI: 10.1016/j.prp.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
Studies on the pattern-based classification for invasive endocervical adenocarcinoma showed that tumors with nondestructive invasion (pattern-A) have a 0% rate of nodal metastases. Our understanding of pattern-A tumors and their distinction from in-situ adenocarcinoma requires further study. Thirteen sections diagnosed independently as pattern-A adenocarcinoma by three gynecologic pathologists, and 14 sections of benign endocervix were selected. Three additional pathologists (reviewers) evaluated a digital image from each section and classified it as pattern-A or benign based on architecture only. To blind the interpretation to cytologic features, nuclei and cytoplasm were obscured using morphometric software (Zen 2011, Carl Zeiss Microscopy, Germany). 13/27 cases (48%; 8 pattern-A, 5 benign) were correctly classified by all reviewers; 19/27 (70%; 10 pattern-A, 9 benign) were correctly classified by ≥2 reviewers. 3/13 pattern-A cases (23%) were interpreted as benign by ≥2 reviewers. Conversely, 5/14 benign cervices (36%) were misinterpreted as pattern-A by ≥2 reviewers. The number of glands per 20× field was higher in pattern-A cases with high reviewer agreement (p=0.004). An abnormal architecture is seen in many pattern-A adenocarcinomas in support of their invasive nature; some, however, have architecture that overlaps with that of benign endocervix thus may actually represent in-situ lesions. Likewise, normal cervix can be architecturally complex and mirror patterns that pathologists would classify as pattern-A if malignant cytologic features were present. Based on this overlap and the nil risk of nodal spread, an emphasis on the non-destructive, rather than the invasive, nature of pattern-A adenocarcinoma is recommended.
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Affiliation(s)
- Gregory Douglas
- The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Brooke E Howitt
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Lauren Schwartz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Zuzana Kos
- The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Shahidul Islam
- The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Bojana Djordjevic
- Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
| | - Carlos Parra-Herran
- Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada.
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Howitt BE, Strickland KC, Sholl LM, Rodig S, Ritterhouse LL, Chowdhury D, D'Andrea AD, Matulonis UA, Konstantinopoulos PA. Clear cell ovarian cancers with microsatellite instability: A unique subset of ovarian cancers with increased tumor-infiltrating lymphocytes and PD-1/PD-L1 expression. Oncoimmunology 2017; 6:e1277308. [PMID: 28344892 DOI: 10.1080/2162402x.2016.1277308] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022] Open
Abstract
Clear cell ovarian carcinoma (CCOC) represents a distinct histologic subtype of ovarian cancer associated with significantly worse prognosis across all stages and no effective therapeutic options. Here, we report a rare but clinically important cohort of CCOCs with microsatellite instability (MSI) (MSI-CCOCs), which are highly immunogenic and may thus be very responsive to immune checkpoint blockade. CCOCs with MSI exhibit a significantly higher number of CD8+ TILs, higher CD8+/CD4+ ratio, and higher PD-1+ TILs compared with microsatellite stable (MSS) CCOCs and compared with high grade serous ovarian cancers, which are the most common histologic subtype of ovarian cancer. Of note, PD-L1 expression in tumor cells or immune cells was noted in all cases of CCOCs with MSI. These observations open an alternative therapeutic avenue for a fraction of patients with CCOC and argue for the routine testing of CCOCs for MSI, a test that is not currently routinely performed.
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Affiliation(s)
- Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, USA
| | - Kyle C Strickland
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, USA
| | - Scott Rodig
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, USA
| | - Lauren L Ritterhouse
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, USA
| | - Dipanjan Chowdhury
- Division of Genomic Stability and DNA Repair, Dana Farber Cancer Institute, Harvard Medical School , Boston, MA, USA
| | - Alan D D'Andrea
- Division of Genomic Stability and DNA Repair, Dana Farber Cancer Institute, Harvard Medical School , Boston, MA, USA
| | - Ursula A Matulonis
- Medical Gynecologic Oncology Program, Dana Farber Cancer Institute, Harvard Medical School , Boston, MA, USA
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75
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Sullivan MC, Graham PH, Alexander EK, Ruan DT, Nehs MA, Gawande AA, Moore FD, Howitt BE, Strickland KC, Krane JF, Barletta JA, Cho NL. Prevalence of Contralateral Tumors in Patients with Follicular Variant of Papillary Thyroid Cancer. J Am Coll Surg 2016; 224:1021-1027. [PMID: 28017809 DOI: 10.1016/j.jamcollsurg.2016.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Thyroid lobectomy alone is being performed increasingly for patients with encapsulated follicular variant of papillary thyroid carcinoma (fvPTC). However, the prevalence of contralateral disease in these patients is unknown. We investigated the presence of synchronous disease in fvPTC to improve decision making about the extent of surgical resection and need for surveillance. STUDY DESIGN We performed a retrospective review of patients who underwent thyroid surgery from October 2009 to February 2013 with a diagnosis of fvPTC as their primary lesion. We collected information on patient demographics, nodule size, multifocality, fine-needle aspiration results, lymphovascular invasion, extrathyroidal extension, and lymph node metastasis. Tumors were divided into noninvasive and invasive/infiltrative fvPTC categories. Characteristics of solitary and bilateral fvPTC were compared. RESULTS We identified 124 patients with final pathology demonstrating fvPTC. The most common fine-needle aspiration diagnosis was "suspicious for malignancy" (n = 53). Sixty-five contralateral tumors were identified in 44 of 124 patients (35.5%) and included fvPTC (n = 40), classical PTC (n = 22), tall cell PTC (n = 2), and follicular carcinoma (n = 1). Fifty contralateral tumors were 1 to 5 mm, 10 measured 6 to 9 mm, and 5 were ≥10 mm. Contralateral disease correlated significantly with lymphovascular invasion (p = 0.037) and larger primary lesions (p = 0.020). There was no significant difference noted in extrathyroidal extension or lymph node metastasis. Both noninvasive and invasive/infiltrative fvPTC demonstrated similar rates of contralateral disease. CONCLUSIONS Bilateral disease is common in fvPTC, primarily in the form of papillary microcarcinomas. Future monitoring of the contralateral lobe should be discussed with fvPTC patients who do not undergo completion thyroidectomy.
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Affiliation(s)
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erik K Alexander
- Department of Medicine, Thyroid Unit, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA
| | - Daniel T Ruan
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Atul A Gawande
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | | | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | | | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, MA.
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76
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Howitt BE, Sun HH, Roemer MGM, Kelley A, Chapuy B, Aviki E, Pak C, Connelly C, Gjini E, Shi Y, Lee L, Viswanathan A, Horowitz N, Neuberg D, Crum CP, Lindeman NL, Kuo F, Ligon AH, Freeman GJ, Hodi FS, Shipp MA, Rodig SJ. Genetic Basis for PD-L1 Expression in Squamous Cell Carcinomas of the Cervix and Vulva. JAMA Oncol 2016; 2:518-22. [PMID: 26913631 DOI: 10.1001/jamaoncol.2015.6326] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patients with squamous cell carcinoma (SCC) of the cervix or vulva have limited therapeutic options, and the potential for immunotherapy for this population has not been evaluated. Recent trials suggest that tumors with a genetic basis for PD-1 (programmed cell death protein 1) ligand expression are highly sensitive to therapeutic antibodies targeting PD-1. OBJECTIVE To determine the genetic status of CD274 (encoding PD-L1 [programmed cell death 1 ligand 1]) and PDCD1LG2 (encoding PD-L2 [programmed cell death 1 ligand 2]) in SCCs of the cervix and vulva and to correlate the findings with PD-L1 protein expression. DESIGN, SETTING, AND PARTICIPANTS We performed fluorescence in situ hybridization (FISH) using probes targeting CD274, PDCD1LG2, and the centromeric portion of chromosome 9, and immunohistochemistry (IHC) using an antibody recognizing PD-L1 on formalin-fixed, paraffin-embedded (FFPE) biopsy specimens from 48 cervical SCCs and 23 vulvar SCCs. MAIN OUTCOMES AND MEASURES Tumors were categorized according to the genetic abnormality in CD274 and PDCD1LG2 (coamplification > cogain > polysomy > disomy) as detected by FISH, and evaluated on a semiquantitative scale (modified H score, the product of the percentage of tumor cells with positive staining and the maximum intensity of positive staining) for PD-L1 protein expression as detected by IHC. RESULTS Overall, 71 samples of FFPE tissue from cases of cervical SCCs (n = 48) and vulvar SCCs (n = 23) were retrieved from the archives of Brigham and Women's Hospital and included in this study. We observed cogain or coamplification of CD274 and PDCD1LG2 in 32 of 48 cervical SCCs (67%) and 10 of 23 vulvar SCCs (43%). Median PD-L1 protein expression was highest among tumors with CD274 and PDCD1LG2 coamplification and lowest among tumors with disomy. CONCLUSIONS AND RELEVANCE Recurrent copy number gain of the genes encoding the PD-1 ligands provides a genetic basis for PD-L1 expression in a subset of cervical and vulvar SCCs and identifies a class of patients that are rational candidates for therapies targeting PD-1.
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Affiliation(s)
- Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Heather H Sun
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Alyssa Kelley
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bjoern Chapuy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts
| | - Emeline Aviki
- Departments of Obstetrics and Gynecology, Radiation Oncology, and Gynecological Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Pak
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Courtney Connelly
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Evisa Gjini
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts2Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts4The Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yunling Shi
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Larissa Lee
- Departments of Obstetrics and Gynecology, Radiation Oncology, and Gynecological Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Akila Viswanathan
- Departments of Obstetrics and Gynecology, Radiation Oncology, and Gynecological Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neil Horowitz
- Departments of Obstetrics and Gynecology, Radiation Oncology, and Gynecological Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christopher P Crum
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neal L Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Frank Kuo
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Azra H Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts4The Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts4The Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Margaret A Shipp
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts4The Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts4The Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Abstract
Ovarian cancer is not a single disease and can be subdivided into at least five different histological subtypes that have different identifiable risk factors, cells of origin, molecular compositions, clinical features and treatments. Ovarian cancer is a global problem, is typically diagnosed at a late stage and has no effective screening strategy. Standard treatments for newly diagnosed cancer consist of cytoreductive surgery and platinum-based chemotherapy. In recurrent cancer, chemotherapy, anti-angiogenic agents and poly(ADP-ribose) polymerase inhibitors are used, and immunological therapies are currently being tested. High-grade serous carcinoma (HGSC) is the most commonly diagnosed form of ovarian cancer and at diagnosis is typically very responsive to platinum-based chemotherapy. However, in addition to the other histologies, HGSCs frequently relapse and become increasingly resistant to chemotherapy. Consequently, understanding the mechanisms underlying platinum resistance and finding ways to overcome them are active areas of study in ovarian cancer. Substantial progress has been made in identifying genes that are associated with a high risk of ovarian cancer (such as BRCA1 and BRCA2), as well as a precursor lesion of HGSC called serous tubal intraepithelial carcinoma, which holds promise for identifying individuals at high risk of developing the disease and for developing prevention strategies.
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Affiliation(s)
- Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, and Center for RNA Interference and Non-Coding RNA, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, UK
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jalid Sehouli
- Charité Universitaetsmedizin Berlin Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Beth Y Karlan
- Women's Cancer Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
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78
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Abstract
Ovarian cancer is not a single disease and can be subdivided into at least five different histological subtypes that have different identifiable risk factors, cells of origin, molecular compositions, clinical features and treatments. Ovarian cancer is a global problem, is typically diagnosed at a late stage and has no effective screening strategy. Standard treatments for newly diagnosed cancer consist of cytoreductive surgery and platinum-based chemotherapy. In recurrent cancer, chemotherapy, anti-angiogenic agents and poly(ADP-ribose) polymerase inhibitors are used, and immunological therapies are currently being tested. High-grade serous carcinoma (HGSC) is the most commonly diagnosed form of ovarian cancer and at diagnosis is typically very responsive to platinum-based chemotherapy. However, in addition to the other histologies, HGSCs frequently relapse and become increasingly resistant to chemotherapy. Consequently, understanding the mechanisms underlying platinum resistance and finding ways to overcome them are active areas of study in ovarian cancer. Substantial progress has been made in identifying genes that are associated with a high risk of ovarian cancer (such as BRCA1 and BRCA2), as well as a precursor lesion of HGSC called serous tubal intraepithelial carcinoma, which holds promise for identifying individuals at high risk of developing the disease and for developing prevention strategies.
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Affiliation(s)
- Ursula A. Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, and Center for RNA Interference and Non-Coding RNA, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, UK
| | - Brooke E. Howitt
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jalid Sehouli
- Charité Universitaetsmedizin Berlin Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Beth Y. Karlan
- Women’s Cancer Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
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79
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Dong F, Davineni PK, Howitt BE, Beck AH. A BRCA1/2 Mutational Signature and Survival in Ovarian High-Grade Serous Carcinoma. Cancer Epidemiol Biomarkers Prev 2016; 25:1511-1516. [PMID: 27496093 DOI: 10.1158/1055-9965.epi-16-0286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/28/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mutational signatures have been identified by the broad sequencing of cancer genomes and reflect underlying processes of mutagenesis. The clinical application of mutational signatures is not well defined. Here we aim to assess the prognostic utility of mutational signatures in ovarian high-grade serous carcinoma. METHODS Open access data of 15,439 somatic mutations of 310 ovarian high-grade serous carcinomas from The Cancer Genome Atlas (TCGA) are used to construct a Bayesian model to classify each cancer as either having or lacking a BRCA1/2 mutational signature. We evaluate the association of the BRCA1/2 signature with overall survival on the TCGA dataset and on an independent cohort of 92 ovarian high-grade serous carcinomas from the Australian Ovarian Cancer Study (AOCS). RESULTS Patients from TCGA with tumors harboring the BRCA1/2 mutational signature have improved survival (55.2 months vs. 38.0 months), which is independent of BRCA1/2 gene mutation status, age, stage, and grade (HR = 0.64; P = 0.02). In the AOCS dataset, the BRCA1/2 mutational signature is also associated with improved overall survival (46.3 months vs. 23.6 months) independent of age and stage (HR = 0.52; P = 0.007). CONCLUSIONS A BRCA1/2 mutational signature is a prognostic marker in ovarian high-grade serous carcinoma. Mutational signature analysis of ovarian cancer genomes may be useful in addition to testing for BRCA1/2 mutations. IMPACT This study identifies the use of mutational signatures as a biomarker for survival outcome in ovarian high-grade serous carcinoma. Cancer Epidemiol Biomarkers Prev; 25(11); 1511-6. ©2016 AACR.
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Affiliation(s)
- Fei Dong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Phani K Davineni
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew H Beck
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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80
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Parra-Herran C, Taljaard M, Djordjevic B, Reyes MC, Schwartz L, Schoolmeester JK, Lastra RR, Quick CM, Laury A, Rasty G, Nucci MR, Howitt BE. Pattern-based classification of invasive endocervical adenocarcinoma, depth of invasion measurement and distinction from adenocarcinoma in situ: interobserver variation among gynecologic pathologists. Mod Pathol 2016; 29:879-92. [PMID: 27174588 DOI: 10.1038/modpathol.2016.86] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/09/2022]
Abstract
A pattern-based classification for invasive endocervical adenocarcinoma has been proposed as predictive of the risk of nodal metastases. We aimed to determine the reproducibility of such classification in the context of common diagnostic challenges: distinction between in situ and invasive adenocarcinoma and depth of invasion measurement. Nine gynecologic pathologists independently reviewed 96 cases of endocervical adenocarcinoma (two slides per case). They diagnosed each case as in situ or invasive carcinoma classifying the latter following the pattern-based classification as pattern A (non-destructive), B (focally destructive) or C (diffusely destructive). Depth of invasion, when applicable, was measured (mm). Overall, diagnostic reproducibility of pattern diagnosis was good (κ=0.65). Perfect agreement (9/9 reviewers) was seen in only 11 cases (11%), all destructively invasive (10 pattern C and 1 pattern B). In all, ≥5/9 reviewer concordance was achieved in 82/96 cases (85%). Distinction between in situ and invasive carcinoma, regardless of the pattern, showed only slight agreement (κ=0.37). Likewise, distinction restricted to in situ versus pattern A was poor (κ=0.23). Distinction between non-destructive (in situ+pattern A) and destructive (patterns B+C) carcinoma showed significantly higher agreement (κ=0.62). Estimation of depth of invasion showed excellent reproducibility (ICC=0.82). However, different measurements resulting in differing FIGO stages were common (from at least 1 reviewer in 79% cases). On the basis of interobserver agreement, the pattern-based classification is best at diagnosing destructive invasion, which carries a risk for nodal metastases. Agreement in diagnosing in situ versus invasive carcinoma, including pattern A, was poor. Given the nil risk of nodal spread in in situ and pattern A lesions, the term 'endocervical adenocarcinoma with non-destructive growth' can be considered when the distinction is difficult, after excluding destructive invasion. Depth of invasion measurement was highly reproducible among pathologists; thus, the pattern-based approach can complement, but should not replace, the depth of invasion metric.
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Affiliation(s)
- Carlos Parra-Herran
- Department of Laboratory Medicine and Pathobiology, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bojana Djordjevic
- Department of Pathology and Laboratory Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - M Carolina Reyes
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Schwartz
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John K Schoolmeester
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Charles M Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Anna Laury
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Golnar Rasty
- Department of Pathology, Toronto East General Hospital, University of Toronto, Toronto, ON, Canada
| | - Marisa R Nucci
- Department of Pathology, Women's and Perinatal Pathology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brooke E Howitt
- Department of Pathology, Women's and Perinatal Pathology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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81
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Ritterhouse LL, Nowak JA, Strickland KC, Garcia EP, Jia Y, Lindeman NI, Macconaill LE, Konstantinopoulos PA, Matulonis UA, Liu J, Berkowitz RS, Nucci MR, Crum CP, Sholl LM, Howitt BE. Morphologic correlates of molecular alterations in extrauterine Müllerian carcinomas. Mod Pathol 2016; 29:893-903. [PMID: 27150160 DOI: 10.1038/modpathol.2016.82] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/01/2016] [Accepted: 03/12/2016] [Indexed: 11/09/2022]
Abstract
Extrauterine high-grade serous carcinomas can exhibit various histologic patterns including (1) classic architecture that is papillary, micropapillary and infiltrative and (2) solid, endometrioid, and transitional (ie, SET) patterns. Although the SET pattern has been associated with germline BRCA mutations, potential molecular underpinnings have not been fully investigated. DNA was isolated from 174 carcinomas of the fallopian tube, ovary, or peritoneum. Targeted next-generation sequencing was performed and single-nucleotide and copy number variants were correlated with morphologic subtype. Overall, 79% of tumors were classified as high-grade serous carcinoma (n=138), and the most common mutations in high-grade serous carcinomas were TP53 (94%), BRCA1 (25%), BRCA2 (11%), and ATM (7%). Among chemotherapy-naive high-grade serous carcinomas, 40 cases exhibited classic morphology and 40 cases had non-classic morphology (SET or ambiguous features). Mutations in homologous recombination pathways were seen across all tumor histotypes. High-grade serous carcinomas with homologous recombination mutations were six times more likely to be associated with non-classic histology (P=0.002) and were significantly more likely to be platinum sensitive and have improved progression-free survival (PFS) (P=0.007 and P=0.004, respectively). In a multivariate analysis adjusted for age, homologous recombination mutation status and increased copy number variants were independently associated with improved PFS (P=0.008 and P=0.005, respectively). These findings underscore the potential significance of variant morphologic patterns and comprehensive genomic analysis in high-grade serous carcinomas with potential implications for pathogenesis, as well as response to targeted therapies.
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Affiliation(s)
- Lauren L Ritterhouse
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jonathan A Nowak
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Kyle C Strickland
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Elizabeth P Garcia
- Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Yonghui Jia
- Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.,Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Laura E Macconaill
- Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | | | | | - Joyce Liu
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ross S Berkowitz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Marisa R Nucci
- Women's and Perinatal Pathology Division, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Christopher P Crum
- Women's and Perinatal Pathology Division, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.,Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.,Women's and Perinatal Pathology Division, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
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82
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Strickland K, Howitt BE, Rodig SJ, Matulonis UA, Konstantinopoulos P. Immunogenicity of clear cell ovarian cancer: Association with ARID1A loss, microsatellite instability and endometriosis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Scott J. Rodig
- Department of Pathology, Division of Hematopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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83
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Howitt BE, Shukla SA, Sholl LM, Ritterhouse LL, Watkins JC, Rodig S, Stover E, Strickland KC, D'Andrea AD, Wu CJ, Matulonis UA, Konstantinopoulos PA. Association of Polymerase e-Mutated and Microsatellite-Instable Endometrial Cancers With Neoantigen Load, Number of Tumor-Infiltrating Lymphocytes, and Expression of PD-1 and PD-L1. JAMA Oncol 2016; 1:1319-23. [PMID: 26181000 DOI: 10.1001/jamaoncol.2015.2151] [Citation(s) in RCA: 449] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Immune checkpoint inhibitor therapy has shown benefit in various cancers, but their potential in endometrial cancer (EC) is unknown. OBSERVATIONS Prediction of neoantigen load was performed using sequencing data from the Cancer Genome Atlas data set. Evaluation of tumor-infiltrating lymphocytes (TILs) and PD-1 and PD-L1 expression was performed in 63 patients with EC referred to our institution. The predicted median (range) neoantigen load (predicted neoepitopes per sample) was proportional to the mutational load: highest in ultramutated polymerase e (POLE) tumors (8342 [628-20 440]), less in hypermutated MSI (541 [146-8063]; P < .001), and lowest in microsatellite-stable tumors (70.5 [7-1877]; P < .001). The POLE and MSI ECs exhibited higher numbers of CD3+ (44.5 vs 21.8; P = .001) and CD8+ (32.8 vs 13.5; P < .001) TILs compared with microsatellite-stable tumors. PD-1 was overexpressed in TILs (81% vs 28%; P < .001) and peritumoral lymphocytes (90% vs 28%; P < .001) of POLE and MSI tumors. PD-L1 expression was infrequently noted in tumor cells but was common in intraepithelial immune cells and more frequent in POLE and MSI tumors (39% vs 13%; P = .02). CONCLUSIONS AND RELEVANCE Polymerase e-mutated and MSI ECs are associated with high neoantigen loads and number of TILs, which is counterbalanced by overexpression of PD-1 and PD-L1. Polymerase e-mutated and MSI EC tumors may be excellent candidates for PD-1-targeted immunotherapies.
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Affiliation(s)
- Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sachet A Shukla
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts3Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lauren L Ritterhouse
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jaclyn C Watkins
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott Rodig
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Stover
- Medical Gynecologic Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Kyle C Strickland
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alan D D'Andrea
- Division of Genomic Stability and DNA Repair, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Catherine J Wu
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts3Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ursula A Matulonis
- Medical Gynecologic Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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84
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Strickland KC, Howitt BE, Shukla SA, Rodig S, Ritterhouse LL, Liu JF, Garber JE, Chowdhury D, Wu CJ, D'Andrea AD, Matulonis UA, Konstantinopoulos PA. Association and prognostic significance of BRCA1/2-mutation status with neoantigen load, number of tumor-infiltrating lymphocytes and expression of PD-1/PD-L1 in high grade serous ovarian cancer. Oncotarget 2016. [PMID: 26871470 DOI: 10.18632/oncotarget.7277] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Immune checkpoint inhibitors (e.g., anti-PD-1 and anti-PD-L1 antibodies) have demonstrated remarkable efficacy against hypermutated cancers such as melanomas and lung carcinomas. One explanation for this effect is that hypermutated lesions harbor more tumor-specific neoantigens that stimulate recruitment of an increased number of tumor-infiltrating lymphocytes (TILs), which is counterbalanced by overexpression of immune checkpoints such as PD-1 or PD-L1. Given that BRCA1/2-mutated high grade serous ovarian cancers (HGSOCs) exhibit a higher mutational load and a unique mutational signature with an elevated number of larger indels up to 50 bp, we hypothesized that they may also harbor more tumor-specific neoantigens, and, therefore, exhibit increased TILs and PD-1/PD-L1 expression. Here, we report significantly higher predicted neoantigens in BRCA1/2-mutated tumors compared to tumors without alterations in homologous recombination (HR) genes (HR-proficient tumors). Tumors with higher neoantigen load were associated with improved overall survival and higher expression of immune genes associated with tumor cytotoxicity such as genes of the TCR, the IFN-gamma and the TNFR pathways. Furthermore, immunohistochemistry studies demonstrated that BRCA1/2-mutated tumors exhibited significantly increased CD3+ and CD8+ TILs, as well as elevated expression of PD-1 and PD-L1 in tumor-associated immune cells compared to HR-proficient tumors. Survival analysis showed that both BRCA1/2-mutation status and number of TILs were independently associated with outcome. Of note, two distinct groups of HGSOCs, one with very poor prognosis (HR proficient with low number of TILs) and one with very good prognosis (BRCA1/2-mutated tumors with high number of TILs) were defined. These findings support a link between BRCA1/2-mutation status, immunogenicity and survival, and suggesting that BRCA1/2-mutated HGSOCs may be more sensitive to PD-1/PD-L1 inhibitors compared to HR-proficient HGSOCs.
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Affiliation(s)
- Kyle C Strickland
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sachet A Shukla
- The Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Scott Rodig
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren L Ritterhouse
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joyce F Liu
- Medical Gynecologic Oncology Program, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Judy E Garber
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Dipanjan Chowdhury
- Division of Genomic Stability and DNA Repair, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Catherine J Wu
- The Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alan D D'Andrea
- Division of Genomic Stability and DNA Repair, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ursula A Matulonis
- Medical Gynecologic Oncology Program, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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85
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Strickland KC, Howitt BE, Shukla SA, Rodig S, Ritterhouse LL, Liu JF, Garber JE, Chowdhury D, Wu CJ, D'Andrea AD, Matulonis UA, Konstantinopoulos PA. Association and prognostic significance of BRCA1/2-mutation status with neoantigen load, number of tumor-infiltrating lymphocytes and expression of PD-1/PD-L1 in high grade serous ovarian cancer. Oncotarget 2016. [PMID: 26871470 DOI: 10.18632/oncotarget.7277]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Immune checkpoint inhibitors (e.g., anti-PD-1 and anti-PD-L1 antibodies) have demonstrated remarkable efficacy against hypermutated cancers such as melanomas and lung carcinomas. One explanation for this effect is that hypermutated lesions harbor more tumor-specific neoantigens that stimulate recruitment of an increased number of tumor-infiltrating lymphocytes (TILs), which is counterbalanced by overexpression of immune checkpoints such as PD-1 or PD-L1. Given that BRCA1/2-mutated high grade serous ovarian cancers (HGSOCs) exhibit a higher mutational load and a unique mutational signature with an elevated number of larger indels up to 50 bp, we hypothesized that they may also harbor more tumor-specific neoantigens, and, therefore, exhibit increased TILs and PD-1/PD-L1 expression. Here, we report significantly higher predicted neoantigens in BRCA1/2-mutated tumors compared to tumors without alterations in homologous recombination (HR) genes (HR-proficient tumors). Tumors with higher neoantigen load were associated with improved overall survival and higher expression of immune genes associated with tumor cytotoxicity such as genes of the TCR, the IFN-gamma and the TNFR pathways. Furthermore, immunohistochemistry studies demonstrated that BRCA1/2-mutated tumors exhibited significantly increased CD3+ and CD8+ TILs, as well as elevated expression of PD-1 and PD-L1 in tumor-associated immune cells compared to HR-proficient tumors. Survival analysis showed that both BRCA1/2-mutation status and number of TILs were independently associated with outcome. Of note, two distinct groups of HGSOCs, one with very poor prognosis (HR proficient with low number of TILs) and one with very good prognosis (BRCA1/2-mutated tumors with high number of TILs) were defined. These findings support a link between BRCA1/2-mutation status, immunogenicity and survival, and suggesting that BRCA1/2-mutated HGSOCs may be more sensitive to PD-1/PD-L1 inhibitors compared to HR-proficient HGSOCs.
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Affiliation(s)
- Kyle C Strickland
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sachet A Shukla
- The Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Scott Rodig
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren L Ritterhouse
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joyce F Liu
- Medical Gynecologic Oncology Program, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Judy E Garber
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Dipanjan Chowdhury
- Division of Genomic Stability and DNA Repair, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Catherine J Wu
- The Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alan D D'Andrea
- Division of Genomic Stability and DNA Repair, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ursula A Matulonis
- Medical Gynecologic Oncology Program, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Howitt BE, Shukla SA, Konstantinopoulos PA. Neoepitopes and CD3-Positive and CD8-Positive Cells in Polymerase e-Mutated and Microsatellite-Instable Endometrial Cancers--Reply. JAMA Oncol 2016; 2:141-2. [PMID: 26767553 DOI: 10.1001/jamaoncol.2015.3903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sachet A Shukla
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
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87
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Yamamoto Y, Ning G, Howitt BE, Mehra K, Wu L, Wang X, Hong Y, Kern F, Wei TS, Zhang T, Nagarajan N, Basuli D, Torti S, Brewer M, Choolani M, McKeon F, Crum CP, Xian W. In vitro and in vivo correlates of physiological and neoplastic human Fallopian tube stem cells. J Pathol 2016; 238:519-530. [PMID: 26415052 DOI: 10.1002/path.4649] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/04/2015] [Accepted: 09/23/2015] [Indexed: 12/11/2022]
Abstract
High-grade serous cancer (HGSC) progresses to advanced stages without symptoms and the 5-year survival rate is a dismal 30%. Recent studies of ovaries and Fallopian tubes in patients with BRCA1 or BRCA2 mutations have documented a pre-metastatic intramucosal neoplasm that is found almost exclusively in the Fallopian tube, termed 'serous tubal intraepithelial carcinoma' or STIC. Moreover, other proliferations, termed p53 signatures, secretory cell outgrowths (SCOUTs), and lower-grade serous tubal intraepithelial neoplasms (STINs) fall short of STIC but share similar alterations in expression, in keeping with an underpinning of genomic disturbances involved in, or occurring in parallel with, serous carcinogenesis. To gain insight into the cellular origins of this unique tubal pathway to high-grade serous cancer, we cloned and both immortalized and transformed Fallopian tube stem cells (FTSCs). We demonstrated that pedigrees of FTSCs were capable of multipotent differentiation and that the tumours derived from transformed FTSCs shared the histological and molecular features of HGSC. We also demonstrated that altered expression of some biomarkers seen in transformed FTSCs and HGSCs (stathmin, EZH2, CXCR4, CXCL12, and FOXM1) could be seen as well in immortalized cells and their in vivo counterparts SCOUTs and STINs. Thus, a whole-genome transcriptome analysis comparing FTSCs, immortalized FTSCs, and transformed FTSCs showed a clear molecular progression sequence that is recapitulated by the spectrum of accumulated perturbations characterizing the range of proliferations seen in vivo. Biomarkers unique to STIC relative to normal tubal epithelium provide a basis for novel detection approaches to early HGSC, but must be viewed critically given their potential expression in lesser proliferations. Perturbations shared by both immortalized and transformed FTSCs may provide unique early targets for prevention strategies. Central to these efforts has been the ability to clone and perpetuate multipotent FTSCs.
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Affiliation(s)
- Yusuke Yamamoto
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Gang Ning
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Karishma Mehra
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Lingyan Wu
- Genome Institute of Singapore, A-STAR, Singapore
| | - Xia Wang
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Yue Hong
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Florian Kern
- Genome Institute of Singapore, A-STAR, Singapore
| | - Tay Seok Wei
- Genome Institute of Singapore, A-STAR, Singapore
| | - Ting Zhang
- Genome Institute of Singapore, A-STAR, Singapore
| | | | - Debargha Basuli
- Departments of Molecular, Microbial and Structural Biology, University of Connecticut Health Center, Farmington, CT, USA
| | - Suzy Torti
- Departments of Molecular, Microbial and Structural Biology, University of Connecticut Health Center, Farmington, CT, USA
| | - Molly Brewer
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, CT, USA
| | - Mahesh Choolani
- Division of Obstetrics and Gynecology, National University of Singapore, Singapore
| | - Frank McKeon
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.,Genome Institute of Singapore, A-STAR, Singapore.,MultiClonal Therapeutics, Inc, Farmington, CT, USA.,Department of Microbiology, National University of Singapore, Singapore.,Department of Biology and Biochemistry, University of Houston, TX, USA
| | | | - Wa Xian
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,MultiClonal Therapeutics, Inc, Farmington, CT, USA.,Department of Genetics and Developmental Biology, University of Connecticut Health Center, Farmington, CT, USA.,Center for Stem Cell & Regenerative Medicine, The University of Texas Health Science Center at Houston, TX, USA
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88
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Howitt BE, Chang S, Eszlinger M, Paschke R, Drage MG, Krane JF, Barletta JA. Fine-needle aspiration diagnoses of noninvasive follicular variant of papillary thyroid carcinoma. Am J Clin Pathol 2015; 144:850-7. [PMID: 26572991 DOI: 10.1309/ajcpeie12poiculi] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Endocrine pathologists are reconsidering whether tumors characterized as noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) warrant a diagnosis of carcinoma. A change in terminology would affect cytology diagnoses; thus, our aim was to study the preceding fine-needle aspiration (FNA) diagnoses of this group of tumors. METHODS We evaluated the FNA diagnoses of a primary cohort of 72 consecutively resected NFVPTCs and the cytologic and molecular features of an additional cohort of 39 tumors that included both NFVPTCs and classical papillary thyroid carcinomas (cPTCs). RESULTS For our primary cohort, the preceding FNA diagnosis associated with the highest risk of malignancy was suspicious for PTC in nearly half (48.6%) of cases. In contrast to the majority of cPTCs, no NFVPTCs in our second cohort had papillae or pseudoinclusions on cytologic evaluation of the FNA specimens, and none harbored a BRAF V600E mutation. CONCLUSIONS If NFVPTCs were no longer termed carcinomas, this would affect the rate of malignancy of FNA diagnostic categories. Cytologic and molecular features could aid in identifying NFVPTCs at the time of FNA diagnosis.
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89
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Strickland KC, Howitt BE, Marqusee E, Alexander EK, Cibas ES, Krane JF, Barletta JA. The Impact of Noninvasive Follicular Variant of Papillary Thyroid Carcinoma on Rates of Malignancy for Fine-Needle Aspiration Diagnostic Categories. Thyroid 2015; 25:987-92. [PMID: 26114752 DOI: 10.1089/thy.2014.0612] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Increased recognition of the indolent nature of noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) along with greater insight into the molecular alterations of these tumors has prompted endocrine pathologists to question whether these tumors warrant a diagnosis of carcinoma. However, a change in terminology would affect the rates of malignancy of fine-needle aspiration (FNA) diagnostic categories. Therefore, the aim of this study was to determine the percentage decrease in associated risk of malignancy for each FNA diagnostic category if NFVPTCs were no longer termed carcinomas. METHODS We evaluated a cohort of 655 FNAs with subsequent resection specimens over a 22-month time period. The diagnoses of the preceding FNAs were recorded according to the Bethesda System for Reporting Thyroid Cytopathology. For cases with more than one preceding FNA, the FNA diagnosis associated with the highest risk of malignancy was identified. Slides for all resection specimens with a diagnosis of FVPTC were reviewed to identify noninvasive tumors. By definition, all of these tumors were encapsulated, partially encapsulated, or well circumscribed and lacked any indication of infiltrative growth, capsular penetration, or lymphovascular invasion. RESULTS Our cohort of 655 FNAs with subsequent resection specimens included 53 (8.1%) nondiagnostic (ND), 167 (25.5%) benign, 97 (14.8%) atypia/follicular lesion of undetermined significance (AUS/FLUS), 88 (13.4%) suspicious for follicular neoplasm (SFN), 94 (14.4%) suspicious for malignancy (SUS), and 156 (23.8%) malignant cases (POS). Surgical resections demonstrated benign findings in 309 (47.2%) and malignant tumors in 346 (52.8%), including 85 NFVPTCs accounting for 24.6% of malignancies. Our rates of malignancy for ND, benign, AUS/FLUS, SFN, SUS, and POS were 18.9%, 13.2%, 39.2%, 45.5%, 87.2%, and 98.7%, respectively. If NFVPTC were no longer termed carcinoma, these rates would drop to 17.0% (10% decrease), 5.4% (59% decrease), 21.6% (45% decrease), 37.5% (18% decrease), 45.7% (48% decrease), and 93.6% (5% decrease), respectively. CONCLUSION Our findings demonstrate that if terminology were changed and NFVPTCs were not considered carcinomas, the rates of malignancy for FNA diagnostic categories would be substantially decreased, with the most clinically significant decrease seen in the SUS category, which demonstrated a relative decrease of nearly 50%.
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Affiliation(s)
- Kyle C Strickland
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Brooke E Howitt
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Ellen Marqusee
- 2 Division of Endocrinology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- 2 Division of Endocrinology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Jeffrey F Krane
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
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90
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Howitt BE, Hanamornroongruang S, Lin D, Conner JE, Schulte S, Garber J, Crum CP, Meserve EE. Abstract POSTER-CTRL-1208: A dualistic model for the origin of high-grade serous carcinoma: BRCA mutation status, histology and tubal intraepithelial carcinoma. Clin Cancer Res 2015. [DOI: 10.1158/1557-3265.ovcasymp14-poster-ctrl-1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Extra-uterine high-grade serous carcinoma (HGSC) is linked to the fimbria via serous tubal intraepithelial carcinoma or STIC. Women with deleterious BRCA1/2 germ-line mutations (BRCA+) are at high risk for HGSC and ~5% of risk reducing salpingo-oophorectomies harbor a STIC. However, STIC is found in only~40% of the HGSC population and less frequently in endometrioid variants of HGSC (Roh 2009). Consecutively tested women with untreated HGSC, with detailed fallopian tube examination (SEE-FIM protocol), who had germ-line BRCA testing were studied. STIC status was determined by histologic exam, and tumors were classified as predominately SET (> 50% solid, endometrioid-like, or transitional, Soslow 2012) or classic histology. SET features trended towards a higher frequency in BRCA+ vs BRCA- women (50 vs 28%, p = .11). BRCA- subjects with SET morphology were significantly younger than those with classic HGSC (mean 56.2 vs 64.8 years; p=0.04), with a generally better clinical outcome. STIC was significantly more frequent in BRCA- tumors (66 vs 31%, p = 0.017) and more frequent in classic HGSCs in BRCA- (83 vs 22%, p = 0.003) women. Overall, several co-variables – histology, BRCA status, age, coexisting STIC, response to therapy - suggest two categories of HGSC with differences in speed of development, progression, outcome, histology, and possibly, precursor type. We introduce a dualistic HGSC model with a faster evolving tumor type that is not linked to a long-standing STIC. Resolving the nature of this second pathway is germane to both resolving the precursors and expectations from both screening and prevention of HGSC.
Citation Format: Brooke E Howitt MD, Suchanan Hanamornroongruang MD, Douglas Lin MD PhD, James E Conner MD PhD, Stephanie Schulte MD, Judy Garber MD, Christopher P Crum MD, Emily E Meserve MD MPH. A dualistic model for the origin of high-grade serous carcinoma: BRCA mutation status, histology and tubal intraepithelial carcinoma [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr POSTER-CTRL-1208.
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Affiliation(s)
- Brooke E Howitt
- 1Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital,
| | | | - Douglas Lin
- 1Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital,
| | - James E Conner
- 1Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital,
| | - Stephanie Schulte
- 1Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital,
| | - Judy Garber
- 3Division of Cancer Epidemiology, Dana-Farber Cancer Institute
| | - Christopher P Crum
- 1Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital,
| | - Emily E Meserve
- 1Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital,
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Wang X, Yamamoto Y, Wilson LH, Zhang T, Howitt BE, Farrow MA, Kern F, Ning G, Hong Y, Khor CC, Chevalier B, Bertrand D, Wu L, Nagarajan N, Sylvester FA, Hyams JS, Devers T, Bronson R, Lacy DB, Ho KY, Crum CP, McKeon F, Xian W. Cloning and variation of ground state intestinal stem cells. Nature 2015; 522:173-8. [PMID: 26040716 PMCID: PMC4853906 DOI: 10.1038/nature14484] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 04/14/2015] [Indexed: 12/18/2022]
Abstract
Stem cells of the gastrointestinal tract, pancreas, liver, and other columnar epithelia collectively resist cloning in their elemental states. Here we demonstrate the cloning and propagation of highly clonogenic, “ground state” stem cells of the human intestine and colon. We show that derived stem cell pedigrees sustain limited copy number and sequence variation despite extensive serial passaging and display exquisitely precise, cell-autonomous commitment to epithelial differentiation consistent with their origins along the intestinal tract. This developmentally patterned and epigenetically maintained commitment of stem cells likely enforces the functional specificity of the adult intestinal tract. Using clonally-derived colonic epithelia, we show that toxins A or B of the enteric pathogen C. difficile recapitulate the salient features of pseudomembranous colitis. The stability of the epigenetic commitment programs of these stem cells, coupled with their unlimited replicative expansion and maintained clonogenicity, suggests certain advantages for their use in disease modeling and regenerative medicine.
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Affiliation(s)
- Xia Wang
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA
| | - Yusuke Yamamoto
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA
| | - Lane H Wilson
- 1] The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA [2] Department of Genetics and Developmental Biology, University of Connecticut Health Center, Farmington, Connecticut 06032, USA
| | - Ting Zhang
- Genome Institute of Singapore, Agency for Science, Technology and Research, 138672 Singapore
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02118, USA
| | - Melissa A Farrow
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
| | - Florian Kern
- Genome Institute of Singapore, Agency for Science, Technology and Research, 138672 Singapore
| | - Gang Ning
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA
| | - Yue Hong
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA
| | - Chiea Chuen Khor
- 1] Genome Institute of Singapore, Agency for Science, Technology and Research, 138672 Singapore [2] Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore
| | - Benoit Chevalier
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA
| | - Denis Bertrand
- Genome Institute of Singapore, Agency for Science, Technology and Research, 138672 Singapore
| | - Lingyan Wu
- Genome Institute of Singapore, Agency for Science, Technology and Research, 138672 Singapore
| | - Niranjan Nagarajan
- Genome Institute of Singapore, Agency for Science, Technology and Research, 138672 Singapore
| | - Francisco A Sylvester
- Department of Pediatrics, Division of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Jeffrey S Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA
| | - Thomas Devers
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut 06032, USA
| | - Roderick Bronson
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - D Borden Lacy
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, 119228 Singapore
| | - Christopher P Crum
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02118, USA
| | - Frank McKeon
- 1] The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA [2] Genome Institute of Singapore, Agency for Science, Technology and Research, 138672 Singapore [3] Department of Medicine, National University of Singapore, 119228 Singapore [4] Multiclonal Therapeutics, Inc., Farmington, Connecticut 06032, USA
| | - Wa Xian
- 1] The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06032, USA [2] Department of Genetics and Developmental Biology, University of Connecticut Health Center, Farmington, Connecticut 06032, USA [3] Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02118, USA [4] Department of Medicine, National University of Singapore, 119228 Singapore [5] Multiclonal Therapeutics, Inc., Farmington, Connecticut 06032, USA
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92
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Howitt BE, Sholl LM, Ritterhouse L, Watkins JC, Rodig SJ, Strickland K, D'Andrea AD, Matulonis U, Konstantinopoulos P. Association of POLE-mutated and MSI endometrial cancers with an elevated number of tumor-infiltrating and peritumoral lymphocytes and higher expression of PD-L1. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Scott J. Rodig
- Department of Pathology, Division of Hematopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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93
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Strickland K, Howitt BE, Rodig SJ, Ritterhouse L, D'Andrea AD, Matulonis U, Konstantinopoulos P. Tumor infiltrating and peritumoral T cells and expression of PD-L1 in BRCA1/2-mutated high grade serous ovarian cancers. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Scott J. Rodig
- Department of Pathology, Division of Hematopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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94
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Mirkovic J, Howitt BE, Roncarati P, Demoulin S, Suarez-Carmona M, Hubert P, McKeon FD, Xian W, Li A, Delvenne P, Crum CP, Herfs M. Carcinogenic HPV infection in the cervical squamo-columnar junction. J Pathol 2015; 236:265-71. [PMID: 25782708 DOI: 10.1002/path.4533] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/04/2015] [Accepted: 03/14/2015] [Indexed: 01/26/2023]
Abstract
Recent studies have suggested the involvement of a unique population of cells at the cervical squamo-columnar junction (SCJ) in the pathogenesis of early (squamous intraepithelial lesion or SIL) and advanced (squamous cell and adeno-carcinomas) cervical neoplasia. However, there is little evidence to date showing that SCJ cells harbour carcinogenic HPV or are instrumental in the initial phases of neoplasia. This study was designed to (1) determine if normal-appearing SCJ cells contained evidence of carcinogenic HPV infection and (2) trace their transition to early SIL. Sections of cervix from high-risk reproductive age women were selected and SCJ cells were analysed by using several techniques which increasingly implicated HPV infection: HPV DNA (genotyping and in situ hybridization)/RNA (PCR), immunostaining for HPV16 E2 (an early marker of HPV infection), p16(ink4), Ki67, and HPV L1 protein. In 22 cases with a history of SIL and no evidence of preneoplastic lesion in the excision specimen, HPV DNA was isolated from eight of ten with visible SCJ cells, six of which were HPV16/18 DNA-positive. In five of these latter cases, the SCJ cells were positive for p16(ink4) and/or HPV E2. Transcriptionally active HPV infection (E6/E7 mRNAs) was also detected in microdissected SCJ cells. Early squamous atypia associated with the SCJ cells demonstrated in addition diffuse p16(ink4) immunoreactivity, elevated proliferative index, and rare L1 antigen positivity. We present for the first time direct evidence that normal-appearing SCJ cells can be infected by carcinogenic HPV. They initially express HPV E2 and their progression to SIL is heralded by an expanding metaplastic progeny with increased proliferation and p16(ink4) expression. Whether certain SCJs are more vulnerable than others to carcinogenic HPV genotypes and what variables determine transition to high-grade SIL remain unresolved, but the common event appears to be a vulnerable cell at the SCJ.
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Affiliation(s)
- Jelena Mirkovic
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brooke E Howitt
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Patrick Roncarati
- Laboratory of Experimental Pathology, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Stephanie Demoulin
- Laboratory of Experimental Pathology, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Meggy Suarez-Carmona
- Laboratory of Experimental Pathology, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Pascale Hubert
- Laboratory of Experimental Pathology, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Frank D McKeon
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Wa Xian
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Anita Li
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Philippe Delvenne
- Laboratory of Experimental Pathology, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Christopher P Crum
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Herfs
- Laboratory of Experimental Pathology, GIGA-Cancer, University of Liège, Liège, Belgium
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95
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Howitt BE, Paulson VA, Barletta JA. Absence of BRAF V600E in non-infiltrative, non-invasive follicular variant of papillary thyroid carcinoma. Histopathology 2015; 67:579-82. [PMID: 25736029 DOI: 10.1111/his.12680] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vera A Paulson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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96
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Howitt BE, Magers MJ, Rice KR, Cole CD, Ulbright TM. Many Postchemotherapy Sarcomatous Tumors in Patients With Testicular Germ Cell Tumors Are Sarcomatoid Yolk Sac Tumors. Am J Surg Pathol 2015; 39:251-9. [DOI: 10.1097/pas.0000000000000322] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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97
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Howitt BE, Sholl LM, Dal Cin P, Jia Y, Yuan L, MacConaill L, Lindeman N, Kuo F, Garcia E, Nucci MR, Quade BJ. Targeted genomic analysis of Müllerian adenosarcoma. J Pathol 2014; 235:37-49. [PMID: 25231023 DOI: 10.1002/path.4442] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/04/2014] [Accepted: 09/09/2014] [Indexed: 12/30/2022]
Abstract
Müllerian adenosarcoma (MA) is a rare mixed mesenchymal tumour of the female genital tract, composed of malignant stroma and benign-appearing epithelium. Sarcomatous overgrowth (SO) is the only established histological variable associated with higher stage and shorter survival. Specific molecular or immunohistochemistry (IHC) tools for the diagnosis of MA are lacking. Our goal was to study genomic mutations and copy number variations (CNVs) in MA to understand better its pathobiology, and develop specific diagnostic and prognostic tools. DNA was extracted from 20 samples of MA from 18 subjects (12 without SO and 6 with SO), including two in which areas of both typical MA histology and SO were independently tested. Samples were analysed using a targeted next-generation sequencing assay interrogating exonic sequences of 275 cancer genes for mutations and CNVs as well as 91 introns across 30 genes for cancer-associated rearrangements. The mean number of mutations in MA with SO (mean 9.7; range 3-14) did not differ significantly from that in MA without SO (mean 9.6; range 5-16). MA with SO had significantly higher mean numbers of gene-level CNVs (24.6) compared to MA without SO (5; p = 0.0002). The most frequent amplification involved MDM2 and CDK4 (5/18; 28%), accompanied by focal CDK4 and MDM2 and diffuse HMGA2 expression using immunohistochemistry. MYBL1 amplification was seen in 4/18 (22%), predominantly in SO. Alterations in PIK3CA/AKT/PTEN pathway members were seen in 13/18 (72%). Notably, TP53 mutations were uncommon, present in only two cases with SO. Three out of 18 (17%) had mutations in ATRX, all associated with SO. No chromosomal rearrangements were identified. We have identified a number of recurrent genomic alterations in MA, including some associated with SO. Although further investigation of these findings is needed, confirmation of one or more may lead to new mechanistic insights and novel markers for this often difficult-to-diagnose tumour.
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Affiliation(s)
- Brooke E Howitt
- Women's and Perinatal Pathology Division, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
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98
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Groszmann Y, Howitt BE, Bromley B, Feltmate CM, Benacerraf BR. Decidualized endometrioma masquerading as ovarian cancer in pregnancy. J Ultrasound Med 2014; 33:1909-1915. [PMID: 25336477 DOI: 10.7863/ultra.33.11.1909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To identify the sonographic features of decidualized endometriomas in patients treated at a single institution and to determine whether sonographic findings can distinguish these lesions from malignant ovarian tumors during pregnancy. METHODS We conducted a retrospective cohort study that included pregnant women with a histologic diagnosis of decidualized endometrioma between January 1, 2005, and December 1, 2012, and had an ovarian cyst or mass seen preoperatively on obstetrical sonography. Sonographic characteristics of these masses were retrospectively evaluated using the International Ovarian Tumor Analysis Group definitions for adnexal masses. RESULTS Seventeen patients with 22 adnexal masses were included in our study. Nine of 22 lesions (41%) were classified as unilocular solid, and 14 of 22 (64%) had solid components, of which 12 of 14 (86%) had substantial blood flow. Septations were present in 8 of 22 masses (36%). Cyst sizes varied from 30 to 120 and 32 to 270 mm at the initial and follow-up scans, respectively. Eight patients had no follow-up scans and underwent surgery within 3 weeks of diagnosis. The other 9 patients (14 masses), had follow-up scans and underwent surgery from 3 to 34 weeks after their initial scans. Eight of these masses showed no notable change in size or appearance, and 1 became smaller. CONCLUSIONS There were no characteristic sonographic features identified to distinguish decidualized endometrioma from ovarian malignancy. However, lesions showing no change in size over 4 weeks or lacking solid components and vascularity are more likely to be benign rather than malignant and may justify delaying surgery until delivery or postpartum.
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Affiliation(s)
- Yvette Groszmann
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.).
| | - Brooke E Howitt
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
| | - Bryann Bromley
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
| | - Colleen M Feltmate
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
| | - Beryl R Benacerraf
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
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99
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Ning G, Bijron JG, Yamamoto Y, Wang X, Howitt BE, Herfs M, Yang E, Hong Y, Cornille M, Wu L, Hanamornroongruang S, McKeon FD, Crum CP, Xian W. The PAX2-null immunophenotype defines multiple lineages with common expression signatures in benign and neoplastic oviductal epithelium. J Pathol 2014; 234:478-87. [PMID: 25130537 DOI: 10.1002/path.4417] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 01/05/2023]
Abstract
The oviducts contain high-grade serous cancer (HGSC) precursors (serous tubal intraepithelial neoplasia or STINs), which are γ-H2AX(p) - and TP53 mutation-positive. Although they express wild-type p53, secretory cell outgrowths (SCOUTs) are associated with older age and serous cancer; moreover, both STINs and SCOUTs share a loss of PAX2 expression (PAX2(n) ). We evaluated PAX2 expression in proliferating adult and embryonic oviductal cells, normal mucosa, SCOUTs, Walthard cell nests (WCNs), STINs, and HGSCs, and the expression of genes chosen empirically or from SCOUT expression arrays. Clones generated in vitro from embryonic gynaecological tract and adult Fallopian tube were Krt7(p) /PAX2(n) /EZH2(p) and underwent ciliated (PAX2(n) /EZH2(n) /FOXJ1(p) ) and basal (Krt7(n) /EZH2(n) /Krt5(p) ) differentiation. Similarly, non-ciliated cells in normal mucosa were PAX2(p) but became PAX2(n) in multi-layered epithelium undergoing ciliated or basal (WCN) cell differentiation. PAX2(n) SCOUTs fell into two groups: type 1 were secretory or secretory/ciliated with a 'tubal' phenotype and were ALDH1(n) and β-catenin(mem) (membraneous only). Type 2 displayed a columnar to pseudostratified (endometrioid) phenotype, with an EZH2(p) , ALDH1(p) , β-catenin(nc) (nuclear and cytoplasmic), stathmin(p) , LEF1(p) , RCN1(p) , and RUNX2(p) expression signature. STINs and HGSCs shared the type 1 immunophenotype of PAX2(n) , ALDH1(n) , β-catenin(mem) , but highly expressed EZH2(p) , LEF1(p) , RCN1(p) , and stathmin(p) . This study, for the first time, links PAX2(n) with proliferating fetal and adult oviductal cells undergoing basal and ciliated differentiation and shows that this expression state is maintained in SCOUTs, STINs, and HGSCs. All three entities can demonstrate a consistent perturbation of genes involved in potential tumour suppressor gene silencing (EZH2), transcriptional regulation (LEF1), regulation of differentiation (RUNX2), calcium binding (RCN1), and oncogenesis (stathmin). This shared expression signature between benign and neoplastic entities links normal progenitor cell expansion to abnormal and neoplastic outgrowth in the oviduct and exposes a common pathway that could be a target for early prevention.
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Affiliation(s)
- Gang Ning
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
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100
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Herfs M, Somja J, Howitt BE, Suarez-Carmona M, Kustermans G, Hubert P, Doyen J, Goffin F, Kridelka F, Crum CP, Delvenne P. Unique recurrence patterns of cervical intraepithelial neoplasia after excision of the squamocolumnar junction. Int J Cancer 2014; 136:1043-52. [DOI: 10.1002/ijc.28978] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/09/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Michael Herfs
- Department of Pathology, Laboratory of Experimental Pathology; GIGA-Cancer; University of Liege; Liege Belgium
| | - Joan Somja
- Department of Pathology, Laboratory of Experimental Pathology; GIGA-Cancer; University of Liege; Liege Belgium
| | - Brooke E. Howitt
- Department of Pathology; Brigham and Women's Hospital Boston MA
- Division of Women's and Perinatal Pathology; Brigham and Women's Hospital Boston MA
| | - Meggy Suarez-Carmona
- Department of Pathology, Laboratory of Experimental Pathology; GIGA-Cancer; University of Liege; Liege Belgium
| | - Gaelle Kustermans
- Department of Pathology, Laboratory of Experimental Pathology; GIGA-Cancer; University of Liege; Liege Belgium
| | - Pascale Hubert
- Department of Pathology, Laboratory of Experimental Pathology; GIGA-Cancer; University of Liege; Liege Belgium
| | - Jean Doyen
- Department of Gynecology; University of Liege; Liege Belgium
| | - Frederic Goffin
- Department of Gynecology; University of Liege; Liege Belgium
| | | | - Christopher P. Crum
- Department of Pathology; Brigham and Women's Hospital Boston MA
- Division of Women's and Perinatal Pathology; Brigham and Women's Hospital Boston MA
| | - Philippe Delvenne
- Department of Pathology, Laboratory of Experimental Pathology; GIGA-Cancer; University of Liege; Liege Belgium
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