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Smuk G, Pajor G, Szuhai K, Morreau H, Kocsmár I, Kocsmár É, Pajor L, Kajtár B, Sárosi V, Lotz G, Tornóczky T. Attenuated isolated 3' signal: A highly challenging therapy relevant ALK FISH pattern in NSCLC. Lung Cancer 2020; 143:80-85. [PMID: 32272316 DOI: 10.1016/j.lungcan.2020.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/14/2020] [Accepted: 03/08/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Targeted therapies in the management of patients with lung cancer provide significantly better outcome compared to chemotherapy. Detection of the anaplastic lymphoma kinase (ALK) gene rearrangement has great predictive value for treatment with small molecule tyrosine kinase inhibitor (crizotinib and alectinib commonly). Fluorescent in situ hybridisation (FISH) assay is a basic diagnostic test designed for detecting ALK gene rearrangements. Although being considered as gold standard method by IASLC's guideline, it is often regarded as difficult and error prone. Our aim was to examine a unique atypical ALK FISH pattern, revealed during a systematic large-scale monitoring, which carries the great risk of misinterpretation, hence may result in loss of patients eligible for targeted therapy. MATERIALS AND METHODS Tissue and cytology samples from nearly one thousand patients with advanced stage non-small cell lung cancer (NSCLC, n = 996) were routinely examined by ALK FISH and immunohistochemistry (Ventana ALK-D5F3-CDx assay). Anchored Multiplex PCR based Next Generation Sequencing (AMP-NGS) was used to detect fusion gene transcripts in ambiguous cases. RESULTS Fifty-nine (5,9%) of the cases were positive with ALK FISH test. Three cases showed atypical pattern with a significantly reduced sized red (3') signal and complete loss of green signals. Digital signal measurement confirmed this finding, showing consistent attenuation of 3' signals throughout the tumours. In all three cases AMP-NGS and ALK IHC verified the presence of a fusion gene and expressed oncoprotein, respectively. CONCLUSION Approximately 5% of the 59 ALK positive cases exhibited atypical attenuated isolated 3' signal pattern. The immunohistochemistry and AMP-NGS examinations helped to clarify the presence of oncoprotein and the fusion gene, respectively. Our results emphasize the importance of extensive exploration of the genetic background of any unexpected FISH finding to avoid false diagnosis. This enables clinicians to indicate the adequate therapy with higher efficiency for patients suffering from NSCLC.
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Affiliation(s)
- Gábor Smuk
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary
| | - Gábor Pajor
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary
| | - Károly Szuhai
- Department of Cell and Chemical Biology, Leiden University Medical Center, Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Netherlands
| | - Ildikó Kocsmár
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Hungary
| | - Éva Kocsmár
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Hungary
| | - László Pajor
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary
| | - Béla Kajtár
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary
| | - Veronika Sárosi
- 1st Department of Internal Medicine, Medical School and Clinical Center, University of Pécs, Hungary
| | - Gábor Lotz
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Hungary
| | - Tamás Tornóczky
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary.
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3
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Bridge JA, Sumegi J, Druta M, Bui MM, Henderson-Jackson E, Linos K, Baker M, Walko CM, Millis S, Brohl AS. Clinical, pathological, and genomic features of EWSR1-PATZ1 fusion sarcoma. Mod Pathol 2019; 32:1593-1604. [PMID: 31189996 DOI: 10.1038/s41379-019-0301-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 01/12/2023]
Abstract
Molecular diagnostics of sarcoma subtypes commonly involve the identification of characteristic oncogenic fusions. EWSR1-PATZ1 is a rare fusion partnering in sarcoma, with few cases reported in the literature. In the current study, a series of 11 cases of EWSR1-PATZ1 fusion positive malignancies are described. EWSR1-PATZ1-related sarcomas occur across a wide age range and have a strong predilection for chest wall primary site. Secondary driver mutations in cell-cycle genes, and in particular CDKN2A (71%), are common in EWSR1-PATZ1 sarcomas in this series. In a subset of cases, an extended clinical and histopathological review was performed, as was confirmation and characterization of the fusion breakpoint revealing a novel intronic pseudoexon sequence insertion. Unified by a shared gene fusion, EWSR1-PATZ1 sarcomas otherwise appear to exhibit divergent morphology, a polyphenotypic immunoprofile, and variable clinical behavior posing challenges for precise classification.
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Affiliation(s)
- Julia A Bridge
- Division of Molecular Pathology, The Translational Genomics Research Institute/Ashion, Phoenix, AZ, USA. .,Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Janos Sumegi
- Division of Molecular Pathology, The Translational Genomics Research Institute/Ashion, Phoenix, AZ, USA.,Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mihaela Druta
- Sarcoma Department, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Marilyn M Bui
- Sarcoma Department, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Evita Henderson-Jackson
- Sarcoma Department, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, NH, USA
| | - Michael Baker
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, NH, USA
| | - Christine M Walko
- Personalized Medicine Institute, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Andrew S Brohl
- Sarcoma Department, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Chemical Biology and Molecular Medicine Program, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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4
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Minderman H. Simultaneous Analysis of Phenotype and Cytogenetics Using Imaging Flow Cytometry: Time to Teach Old Dogs New Tricks. Cytometry A 2019; 95:943-945. [PMID: 31006975 DOI: 10.1002/cyto.a.23776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Hans Minderman
- Flow and Image Cytometry, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263
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5
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Uguen A. Random Colocalization and Split of ALK Break Apart Probe Signals: Potential Concerns in the Real-Life Diagnosis of Non-Small-Cell Lung Cancer. Cytometry A 2018; 93:980-981. [PMID: 30157315 DOI: 10.1002/cyto.a.23590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Arnaud Uguen
- Department of Pathology, CHRU Brest, Brest, 29220, France.,Inserm U1053 BaRITOn, Bordeaux, 33076, France
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