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Lomeli Martinez SM, Carrillo Contreras NG, Gómez Sandoval JR, Zepeda Nuño JS, Gomez Mireles JC, Varela Hernández JJ, Mercado-González AE, Bayardo González RA, Gutiérrez-Maldonado AF. Oral Pyogenic Granuloma: A Narrative Review. Int J Mol Sci 2023; 24:16885. [PMID: 38069207 PMCID: PMC10706684 DOI: 10.3390/ijms242316885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Pyogenic granuloma (PG) is a benign vascular lesion found predominantly in the oral cavity. Characterized by rapid growth and propensity to bleed, PG presents diagnostic challenges due to its similarity and alarming proliferation. This narrative review synthesizes current knowledge on the epidemiology, etiopathogenesis, clinical manifestations, and management of oral PG, with emphasis on recent advances in diagnostic and therapeutic approaches. The epidemiology of the injury is meticulously analyzed, revealing a higher incidence in women and a wide range of ages of onset. It delves into the etiopathogenesis, highlighting the uncertainty surrounding the exact causal factors, although historical attributions suggest an infectious origin. It exhaustively analyzes the clinical and histopathological aspects of oral PG, offering information on its various presentations and the importance of an accurate diagnosis to guide effective treatment. It details treatment strategies, emphasizing the personalized approach based on individual patient characteristics. This comprehensive review consolidates current knowledge on oral PG, highlighting the need for further research to clarify its pathogenesis and optimize treatment protocols.
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Affiliation(s)
- Sarah Monserrat Lomeli Martinez
- Department of Medical and Life Sciences, University of Guadalajara (CUCiénega-UdeG), 1115 Ave. Universidad, Ocotlán 47810, Jalisco, Mexico; (S.M.L.M.); (J.J.V.H.)
- Master of Public Health, Department of Wellbeing and Sustainable Development, University of Guadalajara (CUNorte-UdeG), 23 Federal Highway, Km. 191, Colotlán 46200, Jalisco, Mexico
- Periodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico; (N.G.C.C.); (J.R.G.S.); (J.C.G.M.)
- Prostodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico
| | - Nadia Guadalupe Carrillo Contreras
- Periodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico; (N.G.C.C.); (J.R.G.S.); (J.C.G.M.)
| | - Juan Ramón Gómez Sandoval
- Periodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico; (N.G.C.C.); (J.R.G.S.); (J.C.G.M.)
- Research Institute of Dentistry, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico
| | - José Sergio Zepeda Nuño
- Microbiology and Pathology Department, Pathology Laboratory, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico;
| | - Juan Carlos Gomez Mireles
- Periodontics Program, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico; (N.G.C.C.); (J.R.G.S.); (J.C.G.M.)
| | - Juan José Varela Hernández
- Department of Medical and Life Sciences, University of Guadalajara (CUCiénega-UdeG), 1115 Ave. Universidad, Ocotlán 47810, Jalisco, Mexico; (S.M.L.M.); (J.J.V.H.)
| | - Ana Esther Mercado-González
- Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, 777 Coronel Calderón, Guadalajara 44200, Jalisco, Mexico;
| | - Rubén Alberto Bayardo González
- Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico;
| | - Adrián Fernando Gutiérrez-Maldonado
- Department of Medical and Life Sciences, University of Guadalajara (CUCiénega-UdeG), 1115 Ave. Universidad, Ocotlán 47810, Jalisco, Mexico; (S.M.L.M.); (J.J.V.H.)
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McDaniel CG, Adams DM, Steele KE, Hammill AM, Merrow AC, Crane JL, Smith CL, Kozakewich HPW, Le Cras TD. Kaposiform lymphangiomatosis: Diagnosis, pathogenesis, and treatment. Pediatr Blood Cancer 2023; 70:e30219. [PMID: 36683202 PMCID: PMC10018800 DOI: 10.1002/pbc.30219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023]
Abstract
Kaposiform lymphangiomatosis (KLA) is a life-threatening rare disease that can cause substantial morbidity, mortality, and social burdens for patients and their families. Diagnosis often occurs long after initial symptoms, and there are few centers in the world with the expertise to diagnose and care for patients with the disease. KLA is a lymphatic anomaly and significant advancements have been made in understanding its pathogenesis and etiology since its first description in 2014. This review provides multidisciplinary, comprehensive, and state-of-the-art information on KLA patient presentation, diagnostic imaging, pathology, organ involvement, genetics, and pathogenesis. Finally, we describe current therapeutic approaches, important areas for research, and challenges faced by patients and their families. Further insights into the pathogenesis of KLA may advance our understanding of other vascular anomalies given that similar signaling pathways may be involved.
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Affiliation(s)
| | - Denise M. Adams
- Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Kimberley E. Steele
- Collaborative Research Advocacy for Vascular Anomalies
Network (CaRAVAN), a 501(C)(3)
| | - Adrienne M. Hammill
- University of Cincinnati College of Medicine, Cincinnati,
Ohio
- Cincinnati Children’s Hospital and Medical Center,
Cincinnati, Ohio
| | - A. Carl Merrow
- University of Cincinnati College of Medicine, Cincinnati,
Ohio
- Cincinnati Children’s Hospital and Medical Center,
Cincinnati, Ohio
| | - Janet L. Crane
- Johns Hopkins University School of Medicine, Baltimore,
Maryland
| | | | | | - Timothy D. Le Cras
- University of Cincinnati College of Medicine, Cincinnati,
Ohio
- Cincinnati Children’s Hospital and Medical Center,
Cincinnati, Ohio
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3
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Claire Hou YC, Evenson MJ, Corliss MM, Mahapatra L, Aldawood A, Carpentieri DF, Chamlin SL, Kulungowski AM, Madan-Khetarpal S, Sebastian J, Pet MA, Coughlin CC, Willing MC, Pearson GD, Setty BA, El-Haffaf Z, Cottrell CE, Parikh BA, Krysiak K, Schroeder MC, Heusel JW, Neidich JA, Cao Y. A comparative analysis of RAS variants in patients with disorders of somatic mosaicism. Genet Med 2023; 25:100348. [PMID: 36571464 DOI: 10.1016/j.gim.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE RAS genes (HRAS, KRAS, and NRAS) are commonly found to be mutated in cancers, and activating RAS variants are also found in disorders of somatic mosaicism (DoSM). A survey of the mutational spectrum of RAS variants in DoSM has not been performed. METHODS A total of 938 individuals with suspected DoSM underwent high-sensitivity clinical next-generation sequencing-based testing. We investigated the mutational spectrum and genotype-phenotype associations of mosaic RAS variants. RESULTS In this article, we present a series of individuals with DoSM with RAS variants. Classic hotspots, including Gly12, Gly13, and Gln61 constituted the majority of RAS variants observed in DoSM. Furthermore, we present 12 individuals with HRAS and KRAS in-frame duplication/insertion (dup/ins) variants in the switch II domain. Among the 18.3% individuals with RAS in-frame dup/ins variants, clinical findings were mainly associated with vascular malformations. Hotspots were associated with a broad phenotypic spectrum, including vascular tumors, vascular malformations, nevoid proliferations, segmental overgrowth, digital anomalies, and combinations of these. The median age at testing was higher and the variant allelic fraction was lower in individuals with in-frame dup/ins variants than those in individuals with mosaic RAS hotspots. CONCLUSION Our work provides insight into the allelic and clinical heterogeneity of mosaic RAS variants in nonmalignant conditions.
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Affiliation(s)
- Ying-Chen Claire Hou
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael J Evenson
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Meagan M Corliss
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Lily Mahapatra
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ali Aldawood
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Sarah L Chamlin
- Departments of Pediatrics and Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | | | - Jessica Sebastian
- Division of Medical Genetics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Marcia C Willing
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Gregory D Pearson
- Department of Pediatric Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Bhuvana A Setty
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Zaki El-Haffaf
- Genetic Medicine Service, Montreal University Hospital (CHUM-CRCHUM), Montréal, Quebec, Canada
| | - Catherine E Cottrell
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pathology, The Ohio State University College of Medicine, Columbus, OH
| | - Bijal A Parikh
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kilannin Krysiak
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Molly C Schroeder
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jonathan W Heusel
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Genetics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Julie A Neidich
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Yang Cao
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO.
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Fasano G, Muto V, Radio FC, Venditti M, Mosaddeghzadeh N, Coppola S, Paradisi G, Zara E, Bazgir F, Ziegler A, Chillemi G, Bertuccini L, Tinari A, Vetro A, Pantaleoni F, Pizzi S, Conti LA, Petrini S, Bruselles A, Prandi IG, Mancini C, Chandramouli B, Barth M, Bris C, Milani D, Selicorni A, Macchiaiolo M, Gonfiantini MV, Bartuli A, Mariani R, Curry CJ, Guerrini R, Slavotinek A, Iascone M, Dallapiccola B, Ahmadian MR, Lauri A, Tartaglia M. Dominant ARF3 variants disrupt Golgi integrity and cause a neurodevelopmental disorder recapitulated in zebrafish. Nat Commun 2022; 13:6841. [PMID: 36369169 PMCID: PMC9652361 DOI: 10.1038/s41467-022-34354-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/24/2022] [Indexed: 11/13/2022] Open
Abstract
Vesicle biogenesis, trafficking and signaling via Endoplasmic reticulum-Golgi network support essential developmental processes and their disruption lead to neurodevelopmental disorders and neurodegeneration. We report that de novo missense variants in ARF3, encoding a small GTPase regulating Golgi dynamics, cause a developmental disease in humans impairing nervous system and skeletal formation. Microcephaly-associated ARF3 variants affect residues within the guanine nucleotide binding pocket and variably perturb protein stability and GTP/GDP binding. Functional analysis demonstrates variably disruptive consequences of ARF3 variants on Golgi morphology, vesicles assembly and trafficking. Disease modeling in zebrafish validates further the dominant behavior of the mutants and their differential impact on brain and body plan formation, recapitulating the variable disease expression. In-depth in vivo analyses traces back impaired neural precursors' proliferation and planar cell polarity-dependent cell movements as the earliest detectable effects. Our findings document a key role of ARF3 in Golgi function and demonstrate its pleiotropic impact on development.
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Affiliation(s)
- Giulia Fasano
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Valentina Muto
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Francesca Clementina Radio
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Martina Venditti
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Niloufar Mosaddeghzadeh
- grid.411327.20000 0001 2176 9917Institute of Biochemistry and Molecular Biology II, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Simona Coppola
- grid.416651.10000 0000 9120 6856National Center for Rare Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Graziamaria Paradisi
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy ,grid.12597.380000 0001 2298 9743Department for Innovation in Biological Agro-food and Forest systems (DIBAF), University of Tuscia, 01100 Viterbo, Italy
| | - Erika Zara
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy ,grid.7841.aDepartment of Biology and Biotechnology “Charles Darwin”, Università “Sapienza”, Rome, 00185 Italy
| | - Farhad Bazgir
- grid.411327.20000 0001 2176 9917Institute of Biochemistry and Molecular Biology II, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alban Ziegler
- grid.7252.20000 0001 2248 3363UFR Santé de l’Université d’Angers, INSERM U1083, CNRS UMR6015, MITOVASC, SFR ICAT, F-49000 Angers, France ,grid.411147.60000 0004 0472 0283Département de Génétique, CHU d’Angers, 49000 Angers, France
| | - Giovanni Chillemi
- grid.12597.380000 0001 2298 9743Department for Innovation in Biological Agro-food and Forest systems (DIBAF), University of Tuscia, 01100 Viterbo, Italy ,grid.5326.20000 0001 1940 4177Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies, Centro Nazionale delle Ricerche, 70126 Bari, Italy
| | - Lucia Bertuccini
- grid.416651.10000 0000 9120 6856Servizio grandi strumentazioni e core facilities, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Antonella Tinari
- grid.416651.10000 0000 9120 6856Centro di riferimento per la medicina di genere, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Annalisa Vetro
- grid.8404.80000 0004 1757 2304Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children’s Hospital, University of Florence, 50139 Florence, Italy
| | - Francesca Pantaleoni
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Simone Pizzi
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Libenzio Adrian Conti
- grid.414603.4Confocal Microscopy Core Facility, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Stefania Petrini
- grid.414603.4Confocal Microscopy Core Facility, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Alessandro Bruselles
- grid.416651.10000 0000 9120 6856Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Ingrid Guarnetti Prandi
- grid.12597.380000 0001 2298 9743Department for Innovation in Biological Agro-food and Forest systems (DIBAF), University of Tuscia, 01100 Viterbo, Italy
| | - Cecilia Mancini
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Balasubramanian Chandramouli
- grid.431603.30000 0004 1757 1950Super Computing Applications and Innovation, CINECA, 40033 Casalecchio di Reno, Italy
| | - Magalie Barth
- grid.411147.60000 0004 0472 0283Département de Génétique, CHU d’Angers, 49000 Angers, France
| | - Céline Bris
- grid.7252.20000 0001 2248 3363UFR Santé de l’Université d’Angers, INSERM U1083, CNRS UMR6015, MITOVASC, SFR ICAT, F-49000 Angers, France ,grid.411147.60000 0004 0472 0283Département de Génétique, CHU d’Angers, 49000 Angers, France
| | - Donatella Milani
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Angelo Selicorni
- grid.512106.1Mariani Center for Fragile Children Pediatric Unit, Azienda Socio Sanitaria Territoriale Lariana, 22100 Como, Italy
| | - Marina Macchiaiolo
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Michaela V. Gonfiantini
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Andrea Bartuli
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Riccardo Mariani
- grid.414603.4Department of Laboratories Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Cynthia J. Curry
- grid.266102.10000 0001 2297 6811Genetic Medicine, Dept of Pediatrics, University of California San Francisco, Ca, Fresno, Ca, San Francisco, CA 94143 USA
| | - Renzo Guerrini
- grid.8404.80000 0004 1757 2304Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children’s Hospital, University of Florence, 50139 Florence, Italy
| | - Anne Slavotinek
- grid.266102.10000 0001 2297 6811Genetic Medicine, Dept of Pediatrics, University of California San Francisco, Ca, Fresno, Ca, San Francisco, CA 94143 USA
| | - Maria Iascone
- grid.460094.f0000 0004 1757 8431Medical Genetics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Bruno Dallapiccola
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Mohammad Reza Ahmadian
- grid.411327.20000 0001 2176 9917Institute of Biochemistry and Molecular Biology II, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Antonella Lauri
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Marco Tartaglia
- grid.414603.4Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
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The Genetic Architecture of Vascular Anomalies: Current Data and Future Therapeutic Perspectives Correlated with Molecular Mechanisms. Int J Mol Sci 2022; 23:ijms232012199. [PMID: 36293054 PMCID: PMC9603778 DOI: 10.3390/ijms232012199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Vascular anomalies (VAs) are morphogenesis defects of the vascular system (arteries, capillaries, veins, lymphatic vessels) singularly or in complex combinations, sometimes with a severe impact on the quality of life. The progress made in recent years with the identification of the key molecular pathways (PI3K/AKT/mTOR and RAS/BRAF/MAPK/ERK) and the gene mutations that lead to the appearance of VAs has allowed the deciphering of their complex genetic architecture. Understanding these mechanisms is critical both for the correct definition of the phenotype and classification of VAs, as well as for the initiation of an optimal therapy and the development of new targeted therapies. The purpose of this review is to present in synthesis the current data related to the genetic factors involved in the etiology of VAs, as well as the possible directions for future research. We analyzed the data from the literature related to VAs, using databases (Google Scholar, PubMed, MEDLINE, OMIM, MedGen, Orphanet) and ClinicalTrials.gov. The obtained results revealed that the phenotypic variability of VAs is correlated with genetic heterogeneity. The identification of new genetic factors and the molecular mechanisms in which they intervene, will allow the development of modern therapies that act targeted as a personalized therapy. We emphasize the importance of the geneticist in the diagnosis and treatment of VAs, as part of a multidisciplinary team involved in the management of VAs.
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6
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Atherton K, Hinen H. Vascular Anomalies. Dermatol Clin 2022; 40:401-423. [DOI: 10.1016/j.det.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Strobel K, Maurus K, Hamm H, Roth S, Goebeler M, Rosenwald A, Wobser M. Recurrent Alterations in the MAPK pathway in Sporadic Pyogenic Granuloma of Childhood. Acta Derm Venereol 2022; 102:adv00715. [DOI: 10.2340/actadv.v102.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pyogenic granuloma is one of the most common vascular tumours. The cause of pyogenic granuloma was previously thought to be an inflammatory reaction with consecutive stimulation of endothelial cell proliferation. However, recent studies suggest that pyogenic granuloma may be driven by constitutive activation of the mitogen-activated protein kinase pathway. The aim of this study was to investigate the molecular profile of sporadic pyogenic granuloma of childhood, using a systematic approach scrutinizing potential aberrations within different oncogenic pathways. Within a retrospective setting pyogenic granuloma of 15 patients was analysed by targeted next generation sequencing using the Oncomine Focus Assay, which includes genes of key tumorigenic signalling pathways. Activating mutations were found in 4 out of 15 cases (27%). Two HRAS hotspot mutations (p.Gly13Arg, p.Ala59Thr), 1 BRAF (p.Val600Glu) mutation and a novel, previously not reported, MAP2K1 hotspot mutation (p.Glu203Lys) were identified. It is notable that all of these genes are involved in constitutive mitogen- activated protein kinase signalling. This study increases the range of underlying genetic alterations in pyogenic granuloma by identifying novel oncogenic mutations in crucial mitogen-activated protein kinase pathway genes. The results provide supporting evidence that activated mitogen-activated protein kinase signalling is a key driver in the pathogenesis of pyogenic granuloma, which might be exploited by targeted treatment approaches for selected cases.
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8
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Boscolo E, Pastura P, Schrenk S, Goines J, Kang R, Pillis D, Malik P, Le Cras TD. NRAS Q61R mutation in human endothelial cells causes vascular malformations. Angiogenesis 2022; 25:331-342. [PMID: 35391614 DOI: 10.1007/s10456-022-09836-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
Somatic mutations in NRAS drive the pathogenesis of melanoma and other cancers but their role in vascular anomalies and specifically human endothelial cells is unclear. The goals of this study were to determine whether the somatic-activating NRASQ61R mutation in human endothelial cells induces abnormal angiogenesis and to develop in vitro and in vivo models to identify disease-causing pathways and test inhibitors. Here, we used mutant NRASQ61R and wild-type NRAS (NRASWT) expressing human endothelial cells in in vitro and in vivo angiogenesis models. These studies demonstrated that expression of NRASQ61R in human endothelial cells caused a shift to an abnormal spindle-shaped morphology, increased proliferation, and migration. NRASQ61R endothelial cells had increased phosphorylation of ERK compared to NRASWT cells indicating hyperactivation of MAPK/ERK pathways. NRASQ61R mutant endothelial cells generated abnormal enlarged vascular channels in a 3D fibrin gel model and in vivo, in xenografts in nude mice. These studies demonstrate that NRASQ61R can drive abnormal angiogenesis in human endothelial cells. Treatment with MAP kinase inhibitor U0126 prevented the change to a spindle-shaped morphology in NRASQ61R endothelial cells, whereas mTOR inhibitor rapamycin did not.
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Affiliation(s)
- Elisa Boscolo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA.
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital, Cincinnati, OH, USA.
| | - Patricia Pastura
- Division of Pulmonary Biology, Cincinnati Children's Hospital, Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Sandra Schrenk
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jillian Goines
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Rachael Kang
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Devin Pillis
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Punam Malik
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Timothy D Le Cras
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Division of Pulmonary Biology, Cincinnati Children's Hospital, Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.
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9
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Maurus K, Kosnopfel C, Kneitz H, Appenzeller S, Schrama D, Glutsch V, Roth S, Gerhard-Hartmann E, Rosenfeldt M, Möhrmann L, Fröhlich M, Hübschmann D, Stenzinger A, Glimm H, Fröhling S, Goebeler M, Rosenwald A, Kutzner H, Schilling B. Cutaneous epithelioid hemangiomas show somatic mutations in the MAPK pathway. Br J Dermatol 2021; 186:553-563. [PMID: 34726260 DOI: 10.1111/bjd.20869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epithelioid hemangioma (EH) arising from the skin is a benign vascular tumor with marked inflammatory cell infiltration, which exhibits a high tendency to persist and frequently recurs after resection. So far, the underlying pathogenesis is largely elusive. OBJECTIVES To identify genetic alterations by next-generation-sequencing and/or droplet digital PCR (ddPCR) in cutaneous EH. METHODS DNA and RNA from an EH lesion of an index patient were subjected to whole genome and RNA sequencing. Multiplex PCR-based panel sequencing of genomic DNA isolated from archival formalin-fixed paraffin-embedded (FFPE) tissue of 18 cutaneous EH patients was performed. ddPCR was used to confirm mutations. RESULTS We identified somatic mutations in genes of the MAPK pathway (MAP2K1 and KRAS) in cutaneous EH biopsies. By ddPCR we could confirm the recurrent presence of activating, low-frequency mutations affecting MAP2K1. In total, 9 out of 18 analyzed patients showed activating MAPK pathway mutations, which were mutually exclusive. Comparative analysis of tissue areas enriched for lymphatic infiltrate or aberrant endothelial cells, respectively, revealed an association of these mutations with the presence of endothelial cells. CONCLUSIONS Taken together, our data suggest that EH shows somatic mutations in genes of the MAPK pathway which might contribute to the formation of this benign tumor.
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Affiliation(s)
- K Maurus
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - C Kosnopfel
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - H Kneitz
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - S Appenzeller
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - D Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - V Glutsch
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - S Roth
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | | | - M Rosenfeldt
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - L Möhrmann
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), Dresden, Germany
- Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
- Center for Personalized Oncology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - M Fröhlich
- Computational Oncology Group, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D Hübschmann
- Computational Oncology Group, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Dresden, Germany
| | - A Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - H Glimm
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), Dresden, Germany
- Center for Personalized Oncology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Functional Cancer Genomics, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Fröhling
- German Cancer Consortium (DKTK), Dresden, Germany
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - A Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - H Kutzner
- Dermatopathology, Friedrichshafen, Germany
| | - B Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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10
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Abstract
Vascular and lymphatic malformations represent a challenge for clinicians. The identification of inherited and somatic mutations in important signaling pathways, including the PI3K (phosphoinositide 3-kinase)/AKT (protein kinase B)/mTOR (mammalian target of rapamycin), RAS (rat sarcoma)/RAF (rapidly accelerated fibrosarcoma)/MEK (mitogen-activated protein kinase kinase)/ERK (extracellular signal-regulated kinases), HGF (hepatocyte growth factor)/c-Met (hepatocyte growth factor receptor), and VEGF (vascular endothelial growth factor) A/VEGFR (vascular endothelial growth factor receptor) 2 cascades has led to the evaluation of tailored strategies with preexisting cancer drugs that interfere with these signaling pathways. The era of theranostics has started for the treatment of vascular anomalies. Registration: URL: https://www.clinicaltrialsregister.eu; Unique identifier: 2015-001703-32.
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Affiliation(s)
- Angela Queisser
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium (A.Q., L.M.B., M.V.), University of Louvain, Brussels, Belgium (M.V.)
| | - Emmanuel Seront
- Centre for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc Brussels, Belgium (E.S., L.M.B., M.V.).,Institut Roi Albert II, Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium (E.S.).,VASCERN VASCA European Reference Centre Cliniques Universitaires Saint-Luc, Brussels, Belgium (E.S., L.M.B., M.V.)
| | - Laurence M Boon
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium (A.Q., L.M.B., M.V.), University of Louvain, Brussels, Belgium (M.V.).,Centre for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc Brussels, Belgium (E.S., L.M.B., M.V.).,VASCERN VASCA European Reference Centre Cliniques Universitaires Saint-Luc, Brussels, Belgium (E.S., L.M.B., M.V.)
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium (A.Q., L.M.B., M.V.), University of Louvain, Brussels, Belgium (M.V.).,Centre for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc Brussels, Belgium (E.S., L.M.B., M.V.).,University of Louvain, Brussels, Belgium (M.V.).,University of Louvain, Brussels, Belgium (M.V.).,Walloon Excellence in Life Sciences and Biotechnology (WELBIO), University of Louvain, Brussels, Belgium (M.V.).,VASCERN VASCA European Reference Centre Cliniques Universitaires Saint-Luc, Brussels, Belgium (E.S., L.M.B., M.V.)
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11
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Jansen P, Müller H, Lodde GC, Zaremba A, Möller I, Sucker A, Paschen A, Esser S, Schaller J, Gunzer M, Standl F, Bauer S, Schadendorf D, Mentzel T, Hadaschik E, Griewank KG. GNA14, GNA11, and GNAQ Mutations Are Frequent in Benign but Not Malignant Cutaneous Vascular Tumors. Front Genet 2021; 12:663272. [PMID: 34040639 PMCID: PMC8141909 DOI: 10.3389/fgene.2021.663272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
Cutaneous vascular tumors consist of a heterogeneous group of benign proliferations, including a range of hemangiomas and vascular malformations, as well as heterogeneous groups of both borderline and malignant neoplasms such as Kaposi’s sarcoma and angiosarcomas. The genetics of these tumors have been assessed independently in smaller individual cohorts making comparisons difficult. In our study, we analyzed a representative cohort of benign vascular proliferations observed in a clinical routine setting as well as a selection of malignant vascular proliferations. Our cohort of 104 vascular proliferations including hemangiomas, malformations, angiosarcomas and Kaposi’s sarcoma were screened by targeted next-generation sequencing for activating genetic mutations known or assumed to be potentially relevant in vascular proliferations. An association analysis was performed for mutation status and clinico-pathological parameters. Frequent activating hotspot mutations in GNA genes, including GNA14 Q205, GNA11 and GNAQ Q209 were identified in 16 of 64 benign vascular tumors (25%). GNA gene mutations were particularly frequent (52%) in cherry (senile) hemangiomas (13 of 25). In angiosarcomas, activating RAS mutations (HRAS and NRAS) were identified in three samples (16%). No activating GNA or RAS gene mutations were identified in Kaposi’s sarcomas. Our study identifies GNA14 Q205, GNA11 and GNAQ Q209 mutations as being the most common and mutually exclusive mutations in benign hemangiomas. These mutations were not identified in malignant vascular tumors, which could be of potential diagnostic value in distinguishing these entities.
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Affiliation(s)
- Philipp Jansen
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | | | - Georg C Lodde
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Anne Zaremba
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Inga Möller
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Annette Paschen
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Stefan Esser
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | | | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, University Duisburg-Essen, Essen, Germany
| | - Fabian Standl
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- Department of Medical Oncology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Thomas Mentzel
- Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Klaus G Griewank
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany.,Dermatopathologie bei Mainz, Nieder-Olm, Germany
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12
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Greenberger S, Stein R, Ollech A, Hartstein ME, Benyamini O, Yalon M, Levi A, Lapidoth M, Barzilai A. Agminated benign vascular tumour successfully treated with trametinib. Br J Dermatol 2021; 184:1195-1197. [PMID: 33452815 DOI: 10.1111/bjd.19814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- S Greenberger
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - R Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.,Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Yitzhak Shamir Medical Center, Tel Aviv University, Tzrifin, Israel
| | - A Ollech
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - M E Hartstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.,Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Yitzhak Shamir Medical Center, Tel Aviv University, Tzrifin, Israel
| | - O Benyamini
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Yitzhak Shamir Medical Center, Tel Aviv University, Tzrifin, Israel
| | - M Yalon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.,Pediatric Neuro-Oncology Service, Pediatric Hemato-Oncology Department, Chaim Sheba Medical Center, Tel HaShomer, 52621, Israel
| | - A Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.,Department of Dermatology, Laser Unit, Rabin Medical Center, Petach Tikva, Israel
| | - M Lapidoth
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.,Department of Dermatology, Laser Unit, Rabin Medical Center, Petach Tikva, Israel
| | - A Barzilai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.,Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel
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13
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Ugwu N, Atzmony L, Ellis KT, Panse G, Jain D, Ko CJ, Nassiri N, Choate KA. Cutaneous and hepatic vascular lesions due to a recurrent somatic GJA4 mutation reveal a pathway for vascular malformation. HGG ADVANCES 2021; 2. [PMID: 33912852 PMCID: PMC8078848 DOI: 10.1016/j.xhgg.2021.100028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The term “cavernous hemangioma” has been used to describe vascular anomalies with histology featuring dilated vascular spaces, vessel walls consisting mainly of fibrous stromal bands lined by a layer of flattened endothelial cells, and an irregular outer rim of interrupted smooth muscle cells. Hepatic hemangiomas (HHs) and cutaneous venous malformations (VMs) share this histologic pattern, and we examined lesions in both tissues to identify genetic drivers. Paired whole-exome sequencing (WES) of lesional tissue and normal liver in HH subjects revealed a recurrent GJA4 c.121G>T (p.Gly41Cys) somatic mutation in four of five unrelated individuals, and targeted sequencing in paired tissue from 9 additional HH individuals identified the same mutation in 8. In cutaneous lesions, paired targeted sequencing in 5 VMs and normal epidermis found the same GJA4 c.121G>T (p.Gly41Cys) somatic mutation in three. GJA4 encodes gap junction protein alpha 4, also called connexin 37 (Cx37), and the p.Gly41Cys mutation falls within the first transmembrane domain at a residue highly conserved among vertebrates. We interrogated the impact of the Cx37 mutant via lentiviral transduction of primary human endothelial cells. We found that the mutant induced changes in cell morphology and activated serum/glucocorticoid-regulated kinase 1 (SGK1), a serine/threonine kinase known to regulate cell proliferation and apoptosis, via non-canonical activation. Treatment with spironolactone, an inhibitor of angiogenesis, suppressed mutant SGK1 activation and reversed changes in cell morphology. These findings identify a recurrent somatic GJA4 c.121G>T mutation as a driver of hepatic and cutaneous VMs, revealing a new pathway for vascular anomalies, with spironolactone a potential pathogenesis-based therapy.
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Affiliation(s)
- Nelson Ugwu
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA.,Vascular Malformations Program (VaMP), Yale New Haven Hospital, New Haven, CT, USA
| | - Lihi Atzmony
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA.,Department of Genetics, Yale University School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.,Vascular Malformations Program (VaMP), Yale New Haven Hospital, New Haven, CT, USA
| | - Katharine T Ellis
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Gauri Panse
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.,Vascular Malformations Program (VaMP), Yale New Haven Hospital, New Haven, CT, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Christine J Ko
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.,Vascular Malformations Program (VaMP), Yale New Haven Hospital, New Haven, CT, USA
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA.,Vascular Malformations Program (VaMP), Yale New Haven Hospital, New Haven, CT, USA.,Senior author
| | - Keith A Choate
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA.,Department of Genetics, Yale University School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.,Vascular Malformations Program (VaMP), Yale New Haven Hospital, New Haven, CT, USA.,Senior author
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14
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Ribeiro JL, Moraes RM, Carvalho BFC, Nascimento AO, Milhan NVM, Anbinder AL. Oral pyogenic granuloma: An 18-year retrospective clinicopathological and immunohistochemical study. J Cutan Pathol 2021; 48:863-869. [PMID: 33486806 DOI: 10.1111/cup.13970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/24/2020] [Accepted: 01/13/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pyogenic granuloma (PG) is a lesion characterized by the proliferation of blood vessels, commonly affecting the skin and the mouth. We aimed to compare clinical, microscopic, and immunohistochemical features of the two types of oral PG: lobular capillary hemangioma (LCH) and non-LCH (NLCH). METHODS Epidemiological and clinical data from 2000 to 2018 were collected from the archives of our institution, and histopathological sections of PG were reviewed. Immunohistochemical analyses (CD34, D2-40, SMA, mast cell, and Ki-67) were performed in 34 cases. RESULTS Sixty-two LCH and 107 non-LCH samples were included. The mean (±SD) age of the patients was 38.59 ± 16.96 years; 55.62% were female; 39.64% of cases occurred in the gingiva, 44% of the nodules were pedunculated, and 13.02% of patients reported a history of trauma. NLCH was more prevalent among older patients than LCH. The most prevalent site of LCH was the lips, while NLCH occurred more in the gingiva (P < 0.05). Epithelial atrophy, microvessels, SMA-positive areas, and Ki-67-positive nuclei were more prevalent in LCH (P < 0.05). CONCLUSIONS PG accounted for 2.25% of lesions archived in the pathology service and most cases were NLCH. LCH and NLCH exhibited clinicopathological differences in terms of age, site, epithelial atrophy, vascularization, and proliferation rate.
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Affiliation(s)
- Jaqueline L Ribeiro
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Renata M Moraes
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Bruna F C Carvalho
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Anderson O Nascimento
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Noala V M Milhan
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Ana Lia Anbinder
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
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15
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Kilmister EJ, Hansen L, Davis PF, Hall SRR, Tan ST. Cell Populations Expressing Stemness-Associated Markers in Vascular Anomalies. Front Surg 2021; 7:610758. [PMID: 33634164 PMCID: PMC7900499 DOI: 10.3389/fsurg.2020.610758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022] Open
Abstract
Treatment of vascular anomalies (VAs) is mostly empirical and, in many instances unsatisfactory, as the pathogeneses of these heterogeneous conditions remain largely unknown. There is emerging evidence of the presence of cell populations expressing stemness-associated markers within many types of vascular tumors and vascular malformations. The presence of these populations in VAs is supported, in part, by the observed clinical effect of the mTOR inhibitor, sirolimus, that regulates differentiation of embryonic stem cells (ESCs). The discovery of the central role of the renin-angiotensin system (RAS) in regulating stem cells in infantile hemangioma (IH) provides a plausible explanation for its spontaneous and accelerated involution induced by β-blockers and ACE inhibitors. Recent work on targeting IH stem cells by inhibiting the transcription factor SOX18 using the stereoisomer R(+) propranolol, independent of β-adrenergic blockade, opens up exciting opportunities for novel treatment of IH without the β-adrenergic blockade-related side effects. Gene mutations have been identified in several VAs, involving mainly the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways. Existing cancer therapies that target these pathways engenders the exciting possibility of repurposing these agents for challenging VAs, with early results demonstrating clinical efficacy. However, there are several shortcomings with this approach, including the treatment cost, side effects, emergence of treatment resistance and unknown long-term effects in young patients. The presence of populations expressing stemness-associated markers, including transcription factors involved in the generation of induced pluripotent stem cells (iPSCs), in different types of VAs, suggests the possible role of stem cell pathways in their pathogenesis. Components of the RAS are expressed by cell populations expressing stemness-associated markers in different types of VAs. The gene mutations affecting the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways interact with different components of the RAS, which may influence cell populations expressing stemness-associated markers within VAs. The potential of targeting these populations by manipulating the RAS using repurposed, low-cost and commonly available oral medications, warrants further investigation. This review presents the accumulating evidence demonstrating the presence of stemness-associated markers in VAs, their expression of the RAS, and their interaction with gene mutations affecting the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways, in the pathogenesis of VAs.
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Affiliation(s)
| | - Lauren Hansen
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Paul F. Davis
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | | | - Swee T. Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
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16
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Hu W, Liu Z, Salato V, North PE, Bischoff J, Kumar SN, Fang Z, Rajan S, Hussain MM, Miao QR. NOGOB receptor-mediated RAS signaling pathway is a target for suppressing proliferating hemangioma. JCI Insight 2021; 6:142299. [PMID: 33400686 PMCID: PMC7934876 DOI: 10.1172/jci.insight.142299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/23/2020] [Indexed: 12/30/2022] Open
Abstract
Infantile hemangioma is a vascular tumor characterized by the rapid growth of disorganized blood vessels followed by slow spontaneous involution. The underlying molecular mechanisms that regulate hemangioma proliferation and involution still are not well elucidated. Our previous studies reported that NOGOB receptor (NGBR), a transmembrane protein, is required for the translocation of prenylated RAS from the cytosol to the plasma membrane and promotes RAS activation. Here, we show that NGBR was highly expressed in the proliferating phase of infantile hemangioma, but its expression decreased in the involuting phase, suggesting that NGBR may have been involved in regulating the growth of proliferating hemangioma. Moreover, we demonstrate that NGBR knockdown in hemangioma stem cells (HemSCs) attenuated growth factor-stimulated RAS activation and diminished the migration and proliferation of HemSCs, which is consistent with the effects of RAS knockdown in HemSCs. In vivo differentiation assay further shows that NGBR knockdown inhibited blood vessel formation and adipocyte differentiation of HemSCs in immunodeficient mice. Our data suggest that NGBR served as a RAS modulator in controlling the growth and differentiation of HemSCs.
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Affiliation(s)
- Wenquan Hu
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York, USA.,Division of Pediatric Surgery, Department of Surgery, and.,Division of Pediatric Pathology, Department of Pathology, Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zhong Liu
- Division of Pediatric Surgery, Department of Surgery, and.,Division of Pediatric Pathology, Department of Pathology, Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Valerie Salato
- Division of Pediatric Pathology, Department of Pathology, Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paula E North
- Division of Pediatric Pathology, Department of Pathology, Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joyce Bischoff
- Vascular Biology Program and Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Suresh N Kumar
- Division of Pediatric Pathology, Department of Pathology, Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zhi Fang
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York, USA.,Division of Pediatric Surgery, Department of Surgery, and.,Division of Pediatric Pathology, Department of Pathology, Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sujith Rajan
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York, USA
| | - M Mahmood Hussain
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York, USA
| | - Qing R Miao
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York, USA.,Division of Pediatric Surgery, Department of Surgery, and.,Division of Pediatric Pathology, Department of Pathology, Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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17
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Abstract
Vascular malformations are inborn errors of vascular morphogenesis and consist of localized networks of abnormal blood and/or lymphatic vessels with weak endothelial cell proliferation. They have historically been managed by surgery and sclerotherapy. Extensive insight into the genetic origin and molecular mechanism of development has been accumulated over the last 20 years. Since the discovery of the first somatic mutations in a vascular anomaly 10 years ago, it is now recognized that they are perhaps all caused by inherited or somatic mutations in genes that hyperactivate two major intracellular signaling pathways: the RAS/MAPK/ERK and/or the phosphatidylinositol 3 kinase (PIK3)/protein kinase B/mammalian target of rapamycin (mTOR) pathway. Several targeted molecular inhibitors of these pathways have been developed, mostly for the treatment of cancers that harbor mutations in the same pathways. The mTOR inhibitor sirolimus is the most studied compound for the treatment of venous, lymphatic, and complex malformations. Disease responses of vascular malformations to sirolimus have now been reported in several studies in terms of clinical changes, quality of life, functional and radiological outcomes, and safety. Other targeted treatment strategies, such as the PIK3CA inhibitor alpelisib for PIK3CA-mutated vascular malformations, are also emerging. Repurposing of cancer drugs has become a major focus in this rapidly evolving field.
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18
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Qiao C, Richter GT, Pan W, Jin Y, Lin X. Extracranial arteriovenous malformations: from bedside to bench. Mutagenesis 2020; 34:299-306. [PMID: 31613971 DOI: 10.1093/mutage/gez028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 09/14/2019] [Indexed: 01/08/2023] Open
Abstract
Arteriovenous malformation (AVM) is defined as a fast-flow vascular anomaly that shunts blood from arteries directly to veins. This short circuit of blood flow contributes to progressive expansion of draining veins, resulting in ischaemia, tissue deformation and in some severe cases, congestive heart failure. Various medical interventions have been employed to treat AVM, however, management of which remains a huge challenge because of its high recurrence rate and lethal complications. Thus, understanding the underlying mechanisms of AVM development and progression will help direct discovery and a potential cure. Here, we summarize current findings in the field of extracranial AVMs with the aim to provide insight into their aetiology and molecular influences, in the hope to pave the way for future treatment.
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Affiliation(s)
- Congzhen Qiao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gresham T Richter
- Center for Investigation of Congenital Anomalies of Vascular Development, Arkansas Vascular Biology Program, Arkansas Children's Hospital, Little Rock, AR, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Weijun Pan
- Key Laboratory of Stem Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yunbo Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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19
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Theranostic Advances in Vascular Malformations. J Invest Dermatol 2020; 140:756-763. [DOI: 10.1016/j.jid.2019.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/22/2022]
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20
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Abstract
Genodermatoses are inherited disorders presenting with cutaneous manifestations with or without the involvement of other systems. The majority of these disorders, particularly in cases that present with a cutaneous patterning, may be explained in the context of genetic mosaicism. Despite the barriers to the genetic analysis of mosaic disorders, next-generation sequencing has led to a substantial progress in understanding their pathogenesis, which has significant implications for the clinical management and genetic counseling. Advances in paired and deep sequencing technologies in particular have made the study of mosaic disorders more feasible. In this review, we provide an overview of genetic mosaicism as well as mosaic cutaneous disorders and the techniques required to study them.
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Affiliation(s)
- Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Young Lim
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Keith A Choate
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA.
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21
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Abstract
A 16-year-old female developed a satellite-like recurrence of a pyogenic granuloma on her thorax 2 weeks after complete excision. Treatment with a pulsed dye laser led to a complete resolution. BRAF and RAS mutations detected in the pyogenic granuloma are considered major driver mutations. Whether these findings are also of importance for the etiopathogenesis of satellitosis is unknown. In our patient, no BRAF or NRAS mutation could be detected.
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Affiliation(s)
- G Wagner
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland.
| | - R Abbenseth
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland
| | - M Heine
- Pathologisches Institut Bremerhaven, Bremerhaven, Deutschland
| | - C Rose
- Dermatopathologie Lübeck, Lübeck, Deutschland
| | - M M Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland
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22
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Pereira TDSF, de Amorim LSD, Pereira NB, Vitório JG, Duarte-Andrade FF, Guimarães LM, Diniz MG, Gomes CC, Gomez RS. Oral pyogenic granulomas show MAPK/ERK signaling pathway activation, which occurs independently of BRAF, KRAS, HRAS, NRAS, GNA11, and GNA14 mutations. J Oral Pathol Med 2019; 48:906-910. [PMID: 31310691 DOI: 10.1111/jop.12922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pyogenic granuloma (PG) is a benign nodular lesion with a prominent vascular component which may affect different sites. Recently, BRAF, KRAS, HRAS, NRAS, GNA11, and GNA14 mutations were reported on PGs of the skin. The present study assessed the role of the MAPK/ERK pathway in oral PG pathogenesis. METHODS Mutations in hotspot regions of genes involved in the MAPK/ERK pathway activation were investigated by Sanger sequencing. The expression of phospho-ERK1/2 was evaluated by immunohistochemistry. RESULTS Oral PGs did not show mutations in the sequenced regions of the genes BRAF, KRAS, HRAS, NRAS, GNA11, or GNA14. Our results also showed activation of the MAPK/ERK pathway demonstrated by phospho-ERK1/2 immunohistochemical positivity. CONCLUSIONS Although oral PG shows MAPK/ERK pathway activation, the driver molecular event remains to be elucidated.
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Affiliation(s)
| | | | - Núbia Braga Pereira
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jéssica Gardone Vitório
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Filipe Fideles Duarte-Andrade
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Letícia Martins Guimarães
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marina Gonçalves Diniz
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carolina Cavaliéri Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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23
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Schneider MH, Garcia CFV, Aleixo PB, Kiszewski AE. Congenital cutaneous pyogenic granuloma: Report of two cases and review of the literature. J Cutan Pathol 2019; 46:691-697. [PMID: 31095756 DOI: 10.1111/cup.13496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/27/2019] [Accepted: 05/06/2019] [Indexed: 01/06/2023]
Abstract
Congenital cutaneous pyogenic granuloma is a rare benign vascular tumor with clinical and histopathological features similar to infantile hemangioma. It usually presents as a red, pedunculated and highly friable papule. On histopathological analysis, one can see a capillary vessel proliferation with lobular pattern and endothelial proliferation. The differential diagnosis is based on negativity of glucose transporter 1 (GLUT1) immunochemistry studies. We report two infants with congenital pyogenic granuloma, one with a unique cutaneous lesion and the other with multiple lesions affecting both skin and mucosal surfaces. These two cases highlight the importance of the differential diagnosis based on the GLUT1 immunochemistry analysis considering the distinct treatments required to these infant vascular tumors.
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Affiliation(s)
| | | | - Pedro Bandeira Aleixo
- Pathology and Forensic Medicine Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Ana Elisa Kiszewski
- Dermatology Service, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.,Internal Medicine Department, Section of Pediatric Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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24
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Cheraghlou S, Lim Y, Choate K. Genetic investigation of childhood vascular tumor biology reveals pathways for therapeutic intervention. F1000Res 2019; 8. [PMID: 31069062 PMCID: PMC6492225 DOI: 10.12688/f1000research.16160.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 12/19/2022] Open
Abstract
Vascular tumors are neoplasms of endothelial cells, a significant number of which present in childhood. Recent studies have examined the mutational landscape of many subtypes of vascular tumors, identifying mutations primarily within the Ras–mitogen-activated protein kinase (MAPK) pathway and providing a unique opportunity to consider targeted therapeutics. This review will summarize the current understanding of childhood vascular tumor pathobiology.
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Affiliation(s)
- Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale School of Medicine, New Haven, CT, USA.,Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Young Lim
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale School of Medicine, New Haven, CT, USA.,Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Keith Choate
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale School of Medicine, New Haven, CT, USA.,Department of Genetics, Yale School of Medicine, New Haven, CT, USA
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25
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Barclay SF, Inman KW, Luks VL, McIntyre JB, Al-Ibraheemi A, Church AJ, Perez-Atayde AR, Mangray S, Jeng M, Kreimer SR, Walker L, Fishman SJ, Alomari AI, Chaudry G, Trenor Iii CC, Adams D, Kozakewich HPW, Kurek KC. A somatic activating NRAS variant associated with kaposiform lymphangiomatosis. Genet Med 2018; 21:1517-1524. [PMID: 30542204 PMCID: PMC6565516 DOI: 10.1038/s41436-018-0390-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/19/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose: Kaposiform lymphangiomatosis (KLA) is a rare, frequently aggressive, systemic disorder of the lymphatic vasculature, occurring primarily in children. Even with multimodal treatments, KLA has a poor prognosis and high mortality rate secondary to coagulopathy, effusions and systemic involvement. We hypothesized that, as has recently been found for other vascular anomalies, KLA may be caused by somatic mosaic variants affecting vascular development. Methods: We performed exome sequencing of tumor samples from five individuals with KLA, along with samples from uninvolved control tissue in three of the five. We used digital PCR (dPCR) to validate the exome findings and to screen KLA samples from six other individuals. Results: We identified a somatic activating NRAS variant (c.182A>G, p.Q61R) in lesional tissue from 10/11 individuals, at levels ranging from 1–28%, that was absent from the tested control tissues. Conclusion: The activating NRAS p.Q61R variant is a known ‘hotspot’ variant, frequently identified in several types of human cancer, especially melanoma. KLA, therefore, joins a growing group of vascular malformations and tumors caused by somatic activating variants in the RAS/PI3K/mTOR signalling pathways. This discovery will expand treatment options for these high risk patients as there is potential for use of targeted RAS pathway inhibitors.
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Affiliation(s)
- Sarah F Barclay
- Departments of Pathology & Laboratory Medicine and Medical Genetics, Alberta Children's Hospital Research Institute and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Kyle W Inman
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Valerie L Luks
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - John B McIntyre
- Translational Laboratory, Tom Baker Cancer Centre, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA.,Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | | | - Shamlal Mangray
- Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael Jeng
- Division of Pediatric Hematology-Oncology, Lucile Salter Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Sara R Kreimer
- Division of Pediatric Hematology-Oncology, Lucile Salter Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Lori Walker
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Steven J Fishman
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Ahmad I Alomari
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, USA.,Division of Interventional Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Gulraiz Chaudry
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, USA.,Division of Interventional Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Cameron C Trenor Iii
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, USA.,Department of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Denise Adams
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, USA.,Department of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Harry P W Kozakewich
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA.,Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, USA
| | - Kyle C Kurek
- Departments of Pathology & Laboratory Medicine and Medical Genetics, Alberta Children's Hospital Research Institute and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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26
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Castel P, Bagué S, Granell E, Guerrero Vara R, Baselga J, Baselga E. A novel vascular tumour characterized by coexisting HRAS and GNAQ activating mutations. Br J Dermatol 2018; 180:927-928. [PMID: 30387498 DOI: 10.1111/bjd.17393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- P Castel
- Human Oncology & Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, U.S.A
| | - S Bagué
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, 167 Sant Antoni M. Claret, Barcelona, Spain, 08025
| | - E Granell
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, 167 Sant Antoni M. Claret, Barcelona, Spain, 08025
| | - R Guerrero Vara
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, 167 Sant Antoni M. Claret, Barcelona, Spain, 08025
| | - J Baselga
- Human Oncology & Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, U.S.A.,Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, U.S.A
| | - E Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, 167 Sant Antoni M. Claret, Barcelona, Spain, 08025
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27
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Laakkonen JP, Lähteenvuo J, Jauhiainen S, Heikura T, Ylä-Herttuala S. Beyond endothelial cells: Vascular endothelial growth factors in heart, vascular anomalies and placenta. Vascul Pharmacol 2018; 112:91-101. [PMID: 30342234 DOI: 10.1016/j.vph.2018.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 12/19/2022]
Abstract
Vascular endothelial growth factors regulate vascular and lymphatic growth. Dysregulation of VEGF signaling is connected to many pathological states, including hemangiomas, arteriovenous malformations and placental abnormalities. In heart, VEGF gene transfer induces myocardial angiogenesis. Besides vascular and lymphatic endothelial cells, VEGFs affect multiple other cell types. Understanding VEGF biology and its paracrine signaling properties will offer new targets for novel treatments of several diseases.
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Affiliation(s)
- Johanna P Laakkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Johanna Lähteenvuo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Suvi Jauhiainen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tommi Heikura
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland; Science Service Center, Kuopio University Hospital, Kuopio, Finland; Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
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28
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Abstract
BACKGROUND Vascular anomalies currently are classified according to their clinical and histological characteristics. Recent advances in molecular genetics have enabled the identification of somatic mutations in most types of vascular anomalies. The purpose of this study was to collate information regarding the genetic basis of vascular anomalies. METHODS The PubMed literature was reviewed for all citations that identified a mutation in a vascular anomaly between 1994 and 2017. Search terms included "vascular anomaly," "mutation," "gene," "hemangioma," "pyogenic granuloma," "kaposiform hemangioendothelioma," "capillary malformation," "venous malformation," lymphatic malformation," "arteriovenous malformation," and "syndrome." Articles that identified both germline and somatic mutations in vascular anomalies were analyzed. Mutations were categorized by type (germline or somatic), gene, signaling pathway, and cell(s) enriched for the mutation. RESULTS The majority of vascular anomalies had associated mutations that commonly affected tyrosine kinase receptor signaling through the RAS or PIK3CA pathways. Mutations in PIK3CA and G-protein-coupled receptors were most frequently identified. Specific types of vascular anomalies usually were associated with a single gene. However, mutations in the same gene occasionally were found in different vascular lesions, and some anomalies had a mutation in more than one gene. Mutations were most commonly enriched in endothelial cells. CONCLUSIONS Identification of somatic mutations in vascular anomalies is changing the paradigm by which lesions are diagnosed and understood. Mutations and their pathways are providing potential targets for the development of novel pharmacotherapy. In the future, vascular anomalies will be managed based on clinical characteristics and molecular pathophysiology.
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29
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McGinness A, Gillam A, Yeh I, Mathes EF. Topical timolol: An effective treatment option for agminated pyogenic granuloma. Pediatr Dermatol 2018; 35:e300-e303. [PMID: 29961974 DOI: 10.1111/pde.13575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We present three patients with agminated pyogenic granulomas who experienced significant decrease in size and bleeding with treatment with topical timolol solution with minimal side effects. One patient had complete clinical resolution. For patients with agminated pyogenic granuloma who may otherwise have limited treatment options, timolol is an effective potential solution.
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Affiliation(s)
- Anelah McGinness
- School of Medicine, University of California, San Francisco, CA, USA
| | - Amy Gillam
- Department of Dermatology, Palo Alto Medical Foundation, Palo Alto, San Francisco, CA, USA.,Department of Dermatology, University of California, San Francisco, CA, USA
| | - Iwei Yeh
- Department of Dermatology, University of California, San Francisco, CA, USA.,Department of Pathology, University of California, San Francisco, CA, USA
| | - Erin F Mathes
- Department of Dermatology, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
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30
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Dong J, Peng SG, Zhang XY, Tong CG, Liu F, Cao M, Li YH, He YL. Efficacy of Nd-YAG laser for treatment of pyogenic granuloma on the fingers and toes. Lasers Med Sci 2018; 34:41-45. [PMID: 29998355 DOI: 10.1007/s10103-018-2577-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
Abstract
Pyogenic granuloma (PG) is a common benign vascular proliferation which often occurs on the head, neck, hands, and feet. Among the various treatment options for PG, surgical excision is the most effective treatment which offers the lowest overall recurrence rates and also provides the exact diagnosis. However, it could have difficulties to do the surgery when lesions are located on the fingers and toes, especially very near to the nails, so laser may be a very good alternative choice. In this article, we evaluated the clinical efficacy and safety of neodymium-yttrium aluminum garnet (Nd:YAG) laser for treatment of PG located on the fingers and toes. Twenty-one patients with 21 PGs located on the fingers and toes were treated by multispot Nd-YAG laser. We chose monopulse (pulse width 10.5-13.5 ms; energy 100-125 J/cm2); treatment interval was 3-4 weeks. All lesions disappeared after one or two treatments. There was no apparent scar formation, no impact on the function of the fingers and toes, no damage to nail growth, and no recurrence in more than 12-month follow-up. Nd-YAG is an effective and safety treatment option for treatment of PG located on the fingers and toes.
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Affiliation(s)
- J Dong
- Dermatology Department, Beijing Chaoyang Hospital, Capital Medical University, 8# South Road, Worker's Stadium, Chaoyang District, Beijing, China
| | - S G Peng
- Dermatology Department, Beijing Chaoyang Hospital, Capital Medical University, 8# South Road, Worker's Stadium, Chaoyang District, Beijing, China
| | - X Y Zhang
- Dermatology Department, Beijing Chaoyang Hospital, Capital Medical University, 8# South Road, Worker's Stadium, Chaoyang District, Beijing, China
| | - C G Tong
- Dermatology Department, Beijing Chaoyang Hospital, Capital Medical University, 8# South Road, Worker's Stadium, Chaoyang District, Beijing, China
| | - F Liu
- Dermatology Department, Beijing Chaoyang Hospital, Capital Medical University, 8# South Road, Worker's Stadium, Chaoyang District, Beijing, China
| | - M Cao
- Dermatology Department, Beijing Chaoyang Hospital, Capital Medical University, 8# South Road, Worker's Stadium, Chaoyang District, Beijing, China
| | - Y H Li
- Dermatology Department, Beijing Chaoyang Hospital, Capital Medical University, 8# South Road, Worker's Stadium, Chaoyang District, Beijing, China
| | - Y L He
- Dermatology Department, Beijing Chaoyang Hospital, Capital Medical University, 8# South Road, Worker's Stadium, Chaoyang District, Beijing, China.
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31
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Abstract
Genetic mosaicism arises when a zygote harbors two or more distinct genotypes, typically due to de novo, somatic mutation during embryogenesis. The clinical manifestations largely depend on the differentiation status of the mutated cell; earlier mutations target pluripotent cells and generate more widespread disease affecting multiple organ systems. If gonadal tissue is spared-as in somatic genomic mosaicism-the mutation and its effects are limited to the proband, whereas mosaicism also affecting the gametes, such as germline or gonosomal mosaicism, is transmissible. Mosaicism is easily appreciated in cutaneous disorders, as phenotypically distinct mutant cells often give rise to lesions in patterns determined by the affected cell type. Genetic investigation of cutaneous mosaic disorders has identified pathways central to disease pathogenesis, revealing novel therapeutic targets. In this review, we discuss examples of cutaneous mosaicism, approaches to gene discovery in these disorders, and insights into molecular pathobiology that have potential for clinical translation.
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Affiliation(s)
- Young H Lim
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA; .,Departments of Pathology and Genetics, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | - Zoe Moscato
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA;
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA; .,Departments of Pathology and Genetics, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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32
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Mabeta P. Oncosuppressors and Oncogenes: Role in Haemangioma Genesis and Potential for Therapeutic Targeting. Int J Mol Sci 2018; 19:E1192. [PMID: 29652858 PMCID: PMC5979526 DOI: 10.3390/ijms19041192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/26/2018] [Accepted: 04/04/2018] [Indexed: 01/08/2023] Open
Abstract
Genetic lesions in proto-oncogenes result in the perturbation of angiogenesis, the formation of neovessels from a pre-existing microvasculature. Similarly, the subversion of tumor suppressor genes promotes tumor vascularization. Excessive neovessel formation is associated with various neoplasms such as infantile hemangiomas (IH). Hemangiomas are the most common tumors in pediatric patients and at present have no definitive treatment. The pathogenesis of IH is not well understood; however, both vasculogenesis and angiogenesis are associated with hemangioma genesis. A number of factors that modulate angiogenesis and vasculogenesis have been shown to be dysregulated in IH. Several of the oncogenes and tumor suppressors linked to the promotion of angiogenesis are also altered in infantile hemangioma. In this review, the roles of oncogenes and tumor suppressor genes during neovascularization and hemangioma genesis are explored. In addition, the potential for targeting these genes in IH therapy is discussed.
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Affiliation(s)
- Peace Mabeta
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, 9 Botshelo Road, Pretoria 0007, South Africa.
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33
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Analyzing the Genetic Spectrum of Vascular Anomalies with Overgrowth via Cancer Genomics. J Invest Dermatol 2018; 138:957-967. [DOI: 10.1016/j.jid.2017.10.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/02/2017] [Accepted: 10/30/2017] [Indexed: 01/19/2023]
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34
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Abstract
This overview of mesenchymal tumors presenting in the skin and/or subcutis in children brings together the range of neoplasms and hamartomas which are seen in this age-group. It is not surprising from the perspective of the pediatric or general surgical pathologist that vascular anomalies, including true neoplasms and vascular malformations, are the common phenotypic category. Since there is considerable morphologic overlap among these lesions, clinicopathologic correlation may be more important than for many of the other mesenchymal tumors. The skin and subcutis are the most common sites of clinical presentation for the infantile myofibroma which is the most common of fibrous mesenchymal tumors in children. Several of the other mesenchymal tumors are more common adults-like dermatofibrosarcoma protuberans, but nonetheless have an important presence in children, even as a congenital neoplasm. A lipomatous tumor in a young child should be considered as a possible manifestation of an overgrowth syndrome.
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Affiliation(s)
- Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri.,2 Dermatopathology Center and Division of Dermatology, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 3 Department of Pathology, University of Virginia, Charlottesville, Virginia.,4 Department of Dermatology, University of Virginia, Charlottesville, Virginia
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Queisser A, Boon LM, Vikkula M. Etiology and Genetics of Congenital Vascular Lesions. Otolaryngol Clin North Am 2018; 51:41-53. [DOI: 10.1016/j.otc.2017.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Nguyen HL, Boon LM, Vikkula M. Vascular Anomalies Caused by Abnormal Signaling within Endothelial Cells: Targets for Novel Therapies. Semin Intervent Radiol 2017; 34:233-238. [PMID: 28955112 DOI: 10.1055/s-0037-1604296] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Vascular anomalies arise as a consequence of improper development and maintenance of the vasculature. Our knowledge on the pathophysiological bases of vascular anomalies has skyrocketed during the past 5 years. It is becoming clear that common intracellular signaling pathways are often activated by mutations, causing endothelial cell dysfunction. These mutations cause hyperactivation of two major intracellular signaling pathways that may be controlled by inhibitors developed for cancer treatment. Although we do not know yet all the downstream effects, it has become evident that normalization of the abnormal signaling is an interesting target for therapy. This is a major paradigm change, as developmental malformations were considered to be inert to any molecular treatment.
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Affiliation(s)
- Ha-Long Nguyen
- Laboratory of Human Molecular Genetics, de Duve Institute, University of Louvain (UCL), Brussels, Belgium
| | - Laurence M Boon
- Laboratory of Human Molecular Genetics, de Duve Institute, University of Louvain (UCL), Brussels, Belgium.,Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, University of Louvain (UCL), Brussels, Belgium
| | - Miikka Vikkula
- Laboratory of Human Molecular Genetics, de Duve Institute, University of Louvain (UCL), Brussels, Belgium.,Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, University of Louvain (UCL), Brussels, Belgium
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Sfecci A, Dupuy A, Dinulescu M, Droitcourt C, Adamski H, Hadj-Rabia S, Odent S, Galibert MD, Boussemart L. Do the Side Effects of BRAF Inhibitors Mimic RASopathies? J Invest Dermatol 2017; 137:805-809. [DOI: 10.1016/j.jid.2016.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/17/2016] [Accepted: 12/01/2016] [Indexed: 11/26/2022]
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Couto JA, Huang AY, Konczyk DJ, Goss JA, Fishman SJ, Mulliken JB, Warman ML, Greene AK. Somatic MAP2K1 Mutations Are Associated with Extracranial Arteriovenous Malformation. Am J Hum Genet 2017; 100:546-554. [PMID: 28190454 DOI: 10.1016/j.ajhg.2017.01.018] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/06/2017] [Indexed: 01/09/2023] Open
Abstract
Arteriovenous malformation (AVM) is a fast-flow, congenital vascular anomaly that may arise anywhere in the body. AVMs typically progress, causing destruction of surrounding tissue and, sometimes, cardiac overload. AVMs are difficult to control; they often re-expand after embolization or resection, and pharmacologic therapy is unavailable. We studied extracranial AVMs in order to identify their biological basis. We performed whole-exome sequencing (WES) and whole-genome sequencing (WGS) on AVM tissue from affected individuals. Endothelial cells were separated from non-endothelial cells by immune-affinity purification. We used droplet digital PCR (ddPCR) to confirm mutations found by WES and WGS, to determine whether mutant alleles were enriched in endothelial or non-endothelial cells, and to screen additional AVM specimens. In seven of ten specimens, WES and WGS detected and ddPCR confirmed somatic mutations in mitogen activated protein kinase kinase 1 (MAP2K1), the gene that encodes MAP-extracellular signal-regulated kinase 1 (MEK1). Mutant alleles were enriched in endothelial cells and were not present in blood or saliva. 9 of 15 additional AVM specimens contained mutant MAP2K1 alleles. Mutations were missense or small in-frame deletions that affect amino acid residues within or adjacent to the protein's negative regulatory domain. Several of these mutations have been found in cancers and shown to increase MEK1 activity. In summary, somatic mutations in MAP2K1 are a common cause of extracranial AVM. The likely mechanism is endothelial cell dysfunction due to increased MEK1 activity. MEK1 inhibitors, which are approved to treat several forms of cancer, are potential therapeutic agents for individuals with extracranial AVM.
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Lim YH, Bacchiocchi A, Qiu J, Straub R, Bruckner A, Bercovitch L, Narayan D, McNiff J, Ko C, Robinson-Bostom L, Antaya R, Halaban R, Choate KA. GNA14 Somatic Mutation Causes Congenital and Sporadic Vascular Tumors by MAPK Activation. Am J Hum Genet 2016; 99:443-50. [PMID: 27476652 PMCID: PMC4974082 DOI: 10.1016/j.ajhg.2016.06.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/13/2016] [Indexed: 12/20/2022] Open
Abstract
Vascular tumors are among the most common neoplasms in infants and children; 5%-10% of newborns present with or develop lesions within the first 3 months of life. Most are benign infantile hemangiomas that typically regress by 5 years of age; other vascular tumors include congenital tufted angiomas (TAs), kaposiform hemangioendotheliomas (KHEs), and childhood lobular capillary hemangiomas (LCHs). Some of these lesions can become locally invasive and unresponsive to pharmacologic intervention, leading to significant complications. Recent investigation has revealed that activating mutations in HRAS, KRAS, NRAS, GNAQ, and GNA11 can cause certain types of rare childhood vascular tumors, and we have now identified causal recurrent somatic activating mutations in GNA14 by whole-exome and targeted sequencing. We found somatic activating GNA14 c.614A>T (p.Gln205Leu) mutations in one KHE, one TA, and one LCH and a GNA11 c.547C>T (p.Arg183Cys) mutation in two LCH lesions. We examined mutation pathobiology via expression of mutant GNA14 or GNA11 in primary human endothelial cells and melanocytes. GNA14 and GNA11 mutations induced changes in cellular morphology and rendered cells growth-factor independent by upregulating the MAPK pathway. Our findings identify GNA14 mutations as a cause of childhood vascular tumors, offer insight into mechanisms of oncogenic transformation by mutations affecting Gaq family members, and identify potential targets for therapeutic intervention.
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Affiliation(s)
- Young H Lim
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pathology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Genetics, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Antonella Bacchiocchi
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Jingyao Qiu
- Department of Genetics, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Robert Straub
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Anna Bruckner
- Departments of Dermatology and Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Deepak Narayan
- Section of Plastic Surgery, Department of Surgery, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Jennifer McNiff
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pathology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Christine Ko
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pathology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Leslie Robinson-Bostom
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Richard Antaya
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pediatrics, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Ruth Halaban
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Keith A Choate
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Pathology, School of Medicine, Yale University, New Haven, CT 06510, USA; Department of Genetics, School of Medicine, Yale University, New Haven, CT 06510, USA.
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Groesser L, Peterhof E, Evert M, Landthaler M, Berneburg M, Hafner C. BRAF and RAS Mutations in Sporadic and Secondary Pyogenic Granuloma. J Invest Dermatol 2016; 136:481-6. [PMID: 26802240 DOI: 10.1038/jid.2015.376] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/07/2015] [Accepted: 09/11/2015] [Indexed: 01/13/2023]
Abstract
Pyogenic granuloma (PG) is a common benign vascular skin lesion presenting as a rapidly growing angiomatous papule. The pathogenesis of most sporadic PGs and PGs associated with port wine stains (PWSs) remains elusive. We report that of 10 PGs secondarily arisen on a PWS, 8 showed a BRAF c.1799T>A (p.(Val600Glu)) and 1 a NRAS c.182A>G (p.(Gln61Arg)) mutation. The GNAQ c.548G>A mutation was identified in the PG and in the respective underlying PWS, indicating that PGs originate from cells of the PWS. In contrast to PG, 12 papulonodular lesions, which had developed in the PWSs of seven patients, showed a RAS and BRAF wild-type status. In sporadic PG we identified the BRAF c.1799T>A mutation in 3 of 25, a BRAF c.1391G>A mutation in 1 of 25, and a KRAS c.37G>C mutation in 1 of 25. Mutation-specific immunohistochemical detection of BRAF p.(Val600Glu) confirmed endothelial cells as carriers of the mutation in secondary and sporadic PG. Our study identifies the BRAF c.1799T>A mutation as a major driver mutation in the pathogenesis of, particularly, secondary PG. These data shed light on the hitherto undetermined genetic basis of PG and classify PG as a benign neoplasm.
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Affiliation(s)
- Leopold Groesser
- Department of Dermatology, University of Regensburg, Regensburg, Germany.
| | - Eva Peterhof
- Department of Dermatology, University of Regensburg, Regensburg, Germany
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Michael Landthaler
- Department of Dermatology, University of Regensburg, Regensburg, Germany
| | - Mark Berneburg
- Department of Dermatology, University of Regensburg, Regensburg, Germany
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Ayturk UM, Couto JA, Hann S, Mulliken JB, Williams KL, Huang AY, Fishman SJ, Boyd TK, Kozakewich HPW, Bischoff J, Greene AK, Warman ML. Somatic Activating Mutations in GNAQ and GNA11 Are Associated with Congenital Hemangioma. Am J Hum Genet 2016; 98:789-95. [PMID: 27058448 DOI: 10.1016/j.ajhg.2016.03.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/14/2016] [Indexed: 11/16/2022] Open
Abstract
Congenital hemangioma is a rare vascular tumor that forms in utero. Postnatally, the tumor either involutes quickly (i.e., rapidly involuting congenital hemangioma [RICH]) or partially regresses and stabilizes (i.e., non-involuting congenital hemangioma [NICH]). We hypothesized that congenital hemangiomas arise due to somatic mutation and performed massively parallel mRNA sequencing on affected tissue from eight participants. We identified mutually exclusive, mosaic missense mutations that alter glutamine at amino acid 209 (Glu209) in GNAQ or GNA11 in all tested samples, at variant allele frequencies (VAF) ranging from 3% to 33%. We verified the presence of the mutations in genomic DNA using a combination of molecular inversion probe sequencing (MIP-seq) and digital droplet PCR (ddPCR). The Glu209 GNAQ and GNA11 missense variants we identified are common in uveal melanoma and have been shown to constitutively activate MAPK and/or YAP signaling. When we screened additional archival formalin-fixed paraffin-embedded (FFPE) congenital cutaneous and hepatic hemangiomas, 4/8 had GNAQ or GNA11 Glu209 variants. The same GNAQ or GNA11 mutation is found in both NICH and RICH, so other factors must account for these tumors' different postnatal behaviors.
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Affiliation(s)
- Ugur M Ayturk
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Javier A Couto
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - Steven Hann
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - John B Mulliken
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Kaitlin L Williams
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - August Yue Huang
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Steven J Fishman
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - Theonia K Boyd
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Harry P W Kozakewich
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Joyce Bischoff
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Matthew L Warman
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Boston, MA 02115, USA; Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA 02115, USA.
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Mlacker S, Shah VV, Aldahan AS, Alsaidan M, Samarkandy S, Nouri K. Cells to Surgery Quiz: February 2016. J Invest Dermatol 2016; 136:e21. [PMID: 30477696 DOI: 10.1016/j.jid.2015.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Stephanie Mlacker
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vidhi V Shah
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adam S Aldahan
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mohammed Alsaidan
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sahal Samarkandy
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Hsu CK, Saito R, Nanda A, Rashidghamat E, Al-Ajmi H, Lee JYY, Hide M, McGrath JA. Systematised naevus sebaceus resulting from post-zygotic mutation in HRAS. Australas J Dermatol 2015; 58:58-60. [DOI: 10.1111/ajd.12399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/26/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Chao-Kai Hsu
- St John's Institute of Dermatology; King's College London, Guy's Hospital; London UK
- Department of Dermatology, National Cheng Kung University Hospital, ; National Cheng Kung University; Tainan Taiwan
- Institute of Clinical Medicine, College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - Ryo Saito
- St John's Institute of Dermatology; King's College London, Guy's Hospital; London UK
- Department of Dermatology; Hiroshima University; Hiroshima Japan
| | - Arti Nanda
- As' ad Al-Hamad Dermatology Center; Al-Sabah Hospital; Kuwait Kuwait
| | - Ellie Rashidghamat
- St John's Institute of Dermatology; King's College London, Guy's Hospital; London UK
| | - Hejab Al-Ajmi
- As' ad Al-Hamad Dermatology Center; Al-Sabah Hospital; Kuwait Kuwait
| | - Julia Yu-Yun Lee
- Department of Dermatology, National Cheng Kung University Hospital, ; National Cheng Kung University; Tainan Taiwan
| | - Michihiro Hide
- Department of Dermatology; Hiroshima University; Hiroshima Japan
| | - John A McGrath
- St John's Institute of Dermatology; King's College London, Guy's Hospital; London UK
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Richey JD, North JP. Extramedullary Hematopoiesis in a Pyogenic Granuloma. J Cutan Pathol 2015; 42:375-8. [DOI: 10.1111/cup.12533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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