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Arai S, Tomioka R, Ueda Y, Shimizu A, Okamoto I, Tsukahara K. Maxillary Sinus NUT Carcinoma: A Case Report. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:370-378. [PMID: 38707725 PMCID: PMC11062161 DOI: 10.21873/cdp.10334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/19/2024] [Indexed: 05/07/2024]
Abstract
Background/Aim Nuclear protein in testis (NUT) carcinoma is extremely rare, occurs in the midline of the body, progresses rapidly and is refractory to treatment; most patients die within a year. Here, we describe a case of maxillary sinus NUT carcinoma presenting with epistaxis and nasal obstruction that was treated as a standard head and neck carcinoma. Case Report The patient was a 41-year-old male with a left buccal swelling; the diagnosis was made of primary NUT carcinoma of the left maxillary sinus and bone metastasis in the cervical spine. After induction chemotherapy with docetaxel plus cisplatin and 5-fluorouracil, the tumor decreased in size, and the patient was further treated with cisplatin and radiation therapy. One month after that, the tumor remained small, however, lung metastasis was observed. Therefore, nivolumab was administered. Cetuximab and paclitaxel were administered after the lung metastasis worsened, but the patient developed progressive disease and died 11 months after diagnosis. Conclusion Effective treatments for NUT carcinoma have not yet been established. However, early testing to establish the diagnosis may provide useful insights to guide clinical decisions to improve patient outcomes.
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Affiliation(s)
- Sayaka Arai
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryota Tomioka
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuri Ueda
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Akira Shimizu
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Isaku Okamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
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Skálová A, Agaimy A, Bradova M, Poorten VV, Hanna E, Guntinas-Lichius O, Franchi A, Hellquist H, Simpson RHW, Lopéz F, Nuyts S, Chiesa-Estomba C, Ng SP, Homma A, Teng Y, Leivo I, Ferlito A. Molecularly defined sinonasal malignancies: an overview with focus on the current WHO classification and recently described provisional entities. Virchows Arch 2024:10.1007/s00428-024-03775-y. [PMID: 38491228 DOI: 10.1007/s00428-024-03775-y] [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: 01/06/2024] [Revised: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
Classification of tumors of the head and neck has evolved in recent decades including a widespread application of molecular testing in tumors of the sinonasal tract, salivary glands, and soft tissues with a predilection for the head and neck. The availability of new molecular techniques has allowed for the definition of multiple novel tumor types unique to head and neck sites. Moreover, an expanding spectrum of immunohistochemical markers specific to genetic alterations facilitates rapid identification of diagnostic molecular abnormalities. As such, it is currently possible for head and neck pathologists to benefit from a molecularly defined tumor classification while making diagnoses that are still based largely on histopathology and immunohistochemistry. This review covers the principal molecular alterations in sinonasal malignancies, such as alterations in DEK, AFF2, NUTM1, IDH1-2, and SWI/SNF genes in particular, that are important from a practical standpoint for diagnosis, prognosis, and prediction of response to treatment.
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Affiliation(s)
- Alena Skálová
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic.
- Bioptic Laboratory, Ltd., Pilsen, Czech Republic.
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Martina Bradova
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic
- Bioptic Laboratory, Ltd., Pilsen, Czech Republic
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, 3000, Louvain, Belgium
- Department of Oncology, Section Head and Neck Oncology, Leuven Cancer Institute, KU Leuven, Louvain, Belgium
| | - Ehab Hanna
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alessandro Franchi
- Department of Translational Research, School of Medicine, University of Pisa, Pisa, Italy
| | - Henrik Hellquist
- Faculty of Medicine and Biomedical Sciences (FMCB), Biomedical Center Research Institute (ABC-RI), University of Algarve, Faro, Portugal
| | | | - Fernando Lopéz
- Department of Otolaryngology, ISPA, IUOPA, CIBERONC, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000, Louvain, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000, Louvain, Belgium
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, Donostia-San Sebastian, Guipuzkoa-Basque Country, Spain
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Yong Teng
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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3
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Chen J, Li M, Lu H. Nuclear protein in testis carcinoma of the lung. Transl Oncol 2023; 30:101640. [PMID: 36780749 PMCID: PMC9947104 DOI: 10.1016/j.tranon.2023.101640] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/21/2023] [Accepted: 02/06/2023] [Indexed: 02/13/2023] Open
Abstract
Nuclear protein in testis (NUT) carcinoma is a kind of highly aggressive and fatal solid tumor characterized by a rearrangement of the NUT carcinoma family member 1 (NUTM1) gene located on chromosome 15 q l4, where the most common form of fusion is BRD4-NUT. NUT carcinoma occurred in different organs and was most commonly found in the midline organs and the lungs. NUT carcinoma can occur in patients of almost all ages, having a roughly consistent incidence in both sexes. Most of the patients were diagnosed in advanced stages with an extremely poor prognosis due to the lack of effective treatment. After years of research, the mechanism of NUT carcinoma is still not fully clear, and its therapeutic approaches need to be further studied and explored. In order to gain a more comprehensive understanding of NUT carcinoma and explore the effective treatments, this review aimed to summarize the clinical features, pathological characteristics, differential diagnosis, and treatment strategies for this disease.
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Affiliation(s)
- Jing Chen
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine (IBCM), 310022, P.R. China,Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine (IBCM), 310022, P.R. China,Wenzhou Medical University, Wenzhou, 325035, P.R. China
| | - Meihui Li
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine (IBCM), 310022, P.R. China,Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine (IBCM), 310022, P.R. China,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, 325035, P.R. China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine (IBCM), 310022, P.R. China; Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Institute of Basic and Cancer Medicine (IBCM), 310022, P.R. China.
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Higashino M, Kinoshita I, Kurisu Y, Kawata R. Supraglottic NUT Carcinoma: A Case Report and Literature Review. Case Rep Oncol 2022; 15:980-987. [PMID: 36636674 PMCID: PMC9830291 DOI: 10.1159/000526815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022] Open
Abstract
Nuclear protein of the testis (NUT) carcinoma is a very rare cancer that occurs in relatively young patients. In this study, we experienced a case of laryngeal NUT carcinoma that followed a rapid course. A 22-year-old woman was diagnosed with supraglottic squamous cell carcinoma, cT3N2bM0. She underwent chemoradiotherapy (CRT) (total dose, 70 Gy; 2 Gy × 35 Fr; 80 mg/m2 every 3 weeks with CDDP) as a curative treatment and achieved a complete response. However, 3 weeks after the completion of CRT, she presented to the outpatient clinic complaining of abdominal pain. Magnetic resonance imaging revealed a huge neoplastic lesion in the right ovary. Abdominal right adnexal resection plus partial retreatment was performed. The pathology of ovarian tumor was poorly differentiated squamous cell carcinoma, and NUT protein was positive. The laryngeal carcinoma was also positive for NUT protein; therefore, we diagnosed ovarian tumor is metastasis from supraglottic carcinoma. Peritoneal dissemination was observed in the early postoperative period. She was refractory to subsequent chemotherapy and had a rapid progression. Subsequently, CT showed further thickening of the peritoneum, increased ascites, and increased metastases. She died 32 weeks after initial diagnosis and 14 weeks after abdominal surgery. NUT carcinoma is difficult to diagnose without suspicion. Therefore, the possibility of NUT carcinoma should be considered in young patients with laryngeal carcinoma.
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Affiliation(s)
- Masaaki Higashino
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medial and Pharmaceutical University, Takatsuki City, Osaka, Japan,*Masaaki Higashino,
| | - Ichita Kinoshita
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medial and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Yoshitaka Kurisu
- Department of Pathology, Osaka Medial and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medial and Pharmaceutical University, Takatsuki City, Osaka, Japan
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NUT Midline Carcinoma: A Rare Solid Tumour Characterized by Chromosome Rearrangement. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3369895. [PMID: 35832518 PMCID: PMC9273375 DOI: 10.1155/2022/3369895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/25/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023]
Abstract
Objective Rare and poorly differentiated NUT midline carcinoma (NMC) is a highly malignant tumour. However, due to the rarity of NMC, reports on its clinical, imaging, and pathologic features are still scarce. Methods In this study, three patients diagnosed with NMC located in the parotid gland, lung, and trachea were used as examples to summarize the clinicopathological features of NMC. All the cases were diagnosed by measuring positive nuclear reactivity to NUT antibody after dual-colour FISH tests were conducted, and all of the results were positive, indicating chromosomal rearrangements on 15q14 of the NUT gene. Results These three patients were treated with conventional treatments, including surgical therapy and chemoradiotherapy. Given the poor efficacy of intensive conventional treatment, two novel therapies, histone deacetylase inhibitors (HDACi) and bromodomain inhibitors (BETi) are recommended, as both can arrest the growth of tumour cells, and these targeted therapies may extend patient survival time in the future. Conclusions NMC is an easily misdiagnosed cancer with a poor prognosis; therefore, improving the awareness of clinicians is critical for increasing the diagnostic accuracy, and selecting effective treatment is the main method to improve prognosis.
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Tosic L, Voglis S, Reuss AM, Rushing EJ, Regli L, Serra C. Intra-, para-, and suprasellar nuclear protein of testis carcinoma with infiltration of cavernous sinus and clivus-a case report. Acta Neurochir (Wien) 2022; 164:1105-1110. [PMID: 34800152 DOI: 10.1007/s00701-021-05065-x] [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: 01/15/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
A nuclear protein of testis (NUT) carcinoma, also known as NUT midline carcinoma, is a rare subtype of squamous carcinoma known for its aggressive growth behaviour. It can form anywhere in the body. Although, it usually occurs along midline structures (head, neck, lungs). The authors present the first report of intrasellar NUT carcinoma with cavernous sinus infiltration in a 47-year-old patient. MRI showed an inhomogeneous, gadolinium-enhancing lesion with intra- and suprasellar growth, invasion of the cavernous sinus without clear differentiation from normal pituitary tissue. Given the lymphoma diagnosis in the frozen section and invasion of the cavernous sinus, the patient underwent endoscopic, transnasal, and transsphenoidal subtotal resection only. Local tumour and spinal metastases showed a good response to radio-chemotherapy. Despite combined radio-chemotherapy, the patient died of pulmonary insufficiency due to rapid progression of pulmonary metastasis 6 months after the initial diagnosis.
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7
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Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Hypopharynx, Larynx, Trachea and Parapharyngeal Space. Head Neck Pathol 2022; 16:31-39. [PMID: 35312977 PMCID: PMC9018940 DOI: 10.1007/s12105-021-01405-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
In this article, we review the chapter on tumors of the larynx, hypopharynx, trachea and parapharyngeal space in the new edition of the WHO book, focusing on the new developments in comparison to the previous edition. Squamous cell carcinoma (SCC) and its variants are by far the most common malignancies at these locations, with very limited new insights. The most important is the introduction of new targeted treatment-checkpoint inhibitors, with a new task for pathologists, who may help to predict the response to treatment by analyzing the expression of targeted proteins in biopsy samples. Precancerous lesions remain a controversial topic and, similarly to other organs, it is acceptable to use the terms "dysplasia" or "squamous intraepithelial lesion" (SIL), but there is a slight difference between low-grade dysplasia and low-grade SIL: in the former, mild atypia must be present, while the latter also includes hyperplastic epithelium without atypia. Two approaches have been proposed: a two-tiered system with low- and high-grade dysplasia/SIL and a three-tiered system with an additional category, carcinoma in situ. We are still searching for reliable diagnostic markers to surpass the subjectivity in biopsy diagnosis, with a few potential candidate markers on the horizon, e.g., stem cell markers. Other tumors are rare at these locations, e.g., hematolymphoid, neuroendocrine and salivary gland neoplasms, and are no longer included in Chapter 3. They must be diagnosed according to criteria described in specific chapters. The same holds true for soft tissue tumors, with the exception of cartilaginous neoplasms, which are still included in Chapter 3.
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Zhou J, Duan M, Jiao Q, Chen C, Xing A, Su P, Tang J, Zhang H, Liu Z. Primary Thyroid NUT Carcinoma With High PD-L1 Expression and Novel Massive IGKV Gene Fusions: A Case Report With Treatment Implications and Literature Review. Front Oncol 2022; 11:778296. [PMID: 35127482 PMCID: PMC8807656 DOI: 10.3389/fonc.2021.778296] [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: 09/16/2021] [Accepted: 12/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background Nuclear protein in testis (NUT) carcinoma (NC) is a rare and aggressive undifferentiated carcinoma that typically arises from midline supradiaphragmatic structures. It is uniquely driven by a NUT gene rearrangement on chromosome 15q14. Few thyroid NCs have been reported and there are no established treatment guidelines for NUT carcinoma. Method Ultrasound-guided fine needle aspiration smear was performed for the preoperative diagnosis of thyroid lesions. Cytopathology, histology, and immunochemical staining all indicated NC. Fluorescence in situ hybridization (FISH), qRT-PCR, and next-generation sequencing (NGS) were used to analyze the genetic characteristics of NC. Results We describe a rare case of thyrogenic NC in a 38-year-old male with cytological, histological, immunohistochemical, and genetic features. Cytological smears and histopathological specimens showed typical features of NC. Immunohistochemistry confirmed strong immunoreactivity with NUT, EMA, P63, TTF-1, and c-myc. CK19 was positive exclusively in sudden keratosis. No immunoreactivity was found for neuroendocrine markers. FISH was applied to isolate the NUT gene on chromosome 15q14. The NGS results revealed a BRD4-NUT gene fusion, which was further confirmed by RT-qPCR. Structural variation (SV) of NUTM1 occurred in the exon region, and the mutation site was 15q14. Moreover, BRD4 single-nucleotide variation (SNV) occurs in the 3′ UTR at mutation site 19p13.12. The PD-L1 combined predictive score was over 30%. The patient received chemotherapy, followed by programmed cell death 1 (PD-1) inhibition with camrelizumab, and died 10 months after surgery. Conclusion Thyroid NC is an extremely rare and fatal malignant tumor. It is necessary to consider NC when squamous differentiation is observed cytologically or histologically. NGS is an effective tool for obtaining the final diagnosis and obtaining a better understanding of tumor pathogenesis. A large number of IGKV gene fusions in addition to the BRD4-NUT fusion may play a role in the pathogenesis and immunotherapy response of NC. Immunotherapy for NC remains to be explored due to the rarity of this aggressive malignancy.
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Affiliation(s)
- Juan Zhou
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Miao Duan
- Department of Pathology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Chunyan Chen
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Aiyan Xing
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, China
| | - Peng Su
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, China
| | - Juan Tang
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Hui Zhang
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Hui Zhang, ; Zhiyan Liu,
| | - Zhiyan Liu
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Hui Zhang, ; Zhiyan Liu,
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Jiang J, Ren Y, Xu C, Lin X. NUT midline carcinoma as a primary lung tumor treated with anlotinib combined with palliative radiotherapy: a case report. Diagn Pathol 2022; 17:4. [PMID: 34996489 PMCID: PMC8742416 DOI: 10.1186/s13000-021-01188-y] [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: 02/01/2021] [Accepted: 12/03/2021] [Indexed: 01/12/2023] Open
Abstract
Background NUT (nuclear protein in testis) midline carcinoma (NMC) is a rapidly progressive tumor arising from midline structures. Recent cases have reported that the poor prognosis with a median survival of 6.7 months and a 2 years overall survival of 19% due to limited treatment. Based on the effect of arotinib on inhibiting tumor growth and angiogenesis. We present one patient case treated with anlotinib and radiotherapy. Case presentation Here, we describe a 33-year old patient who complained of cough and chest pain and was diagnosed as a pulmonary NMC through CT scan, FISH and immunohistochemistry. In addition, we initially demonstrated that anlotinib combined with palliative radiotherapy could significantly prevent the tumor growth in a pulmonary NMC. Conclusion The report indicated that anlotinib combined with palliative radiotherapy could inhibit the tumor progression in a pulmonary NMC, which may provide a combined therapy to pulmonary NMC in the future.
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Affiliation(s)
- Jin Jiang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yikun Ren
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chengping Xu
- Department of Pathology, The Southwest Hospital, the Southwest Hospital of Army Medical University, Chongqing, 400038, China
| | - Xing Lin
- Department of Biological Immunotherapy, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Shapingba District, Chongqing, 400030, China.
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Zhang Y, Han K, Dong X, Hou Q, Li T, Li L, Zhou G, Liu X, Zhao G, Li W. Case Report and Literature Review: Primary Pulmonary NUT-Midline Carcinoma. Front Oncol 2021; 11:700781. [PMID: 34527578 PMCID: PMC8435908 DOI: 10.3389/fonc.2021.700781] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022] Open
Abstract
Nuclear protein of the testis (NUT) carcinoma is a very rare and aggressive carcinoma characterized by chromosomal rearrangement. NUT-midline carcinoma (NMC) can occur anywhere in the body, but most of the tumors are found in the midline anatomic structure or mediastinum. Pulmonary-originated NMC is extremely rare and often difficult to be distinguished from other poorly differentiated tumors, making the diagnosis awfully challenged in clinical practice. There are less than 100 cases of NUT carcinoma reported so far. In this study, the diagnosis and molecular mechanisms of reported NUT carcinoma cases were reviewed. Furthermore, a case of primary pulmonary NUT-midline carcinoma and its pathological features was reported. The process of pathological identification and genomic analysis for establishing the diagnosis was discussed. We found that NUT carcinoma could be identified by combining CT, H&E staining, immunohistochemistry (IHC), and molecular tests. The development of NUT carcinoma might be associated with mutation of MYC, p63, and MED24 genes and the Wnt, MAPK, and PI3K signaling pathways. Our study provided a detailed molecular mechanistic review on NMC and established a procedure to identify pulmonary NMC.
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Affiliation(s)
- Yunxiang Zhang
- Pathology Department, Weifang People’s Hospital, Weifang, China
| | - Kai Han
- Pathology Department, Weifang People’s Hospital, Weifang, China
| | - Xiaotong Dong
- Pathology Department, Weifang People’s Hospital, Weifang, China
| | - Qian Hou
- Pathology Department, Weifang People’s Hospital, Weifang, China
| | - Tianbao Li
- Scientific Research Department, Qingdao Geneis Institute of Big Data Mining and Precision Medicine, Qingdao, China
| | - Li Li
- Pathology Department, Qilu Hospital of Shandong University, Jinan, China
| | - Gengyin Zhou
- Pathology Department, Qilu Hospital of Shandong University, Jinan, China
| | - Xia Liu
- Ophthalmology Department, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Guifeng Zhao
- Prenatal Diagnosis Department, Weifang People’s Hospital, Weifang, China
| | - Wei Li
- Thoracic Surgery Department, Weifang People’s Hospital, Weifang, China
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11
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Holtmann EM, van Ackeren K, Tischoff I, Volkenstein S, Dazert S. [NUT-Midline-Carcinoma in patients of advanced age - a rare differential diagnosis]. Laryngorhinootologie 2021; 100:905-906. [PMID: 34450670 DOI: 10.1055/a-1555-3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eva Maria Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-Universität Bochum, Bochum, Germany
| | - Konstantin van Ackeren
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-Universität Bochum, Bochum, Germany
| | - Iris Tischoff
- Institute of Pathology, Ruhr University Bochum, Bochum, Germany
| | - Stefan Volkenstein
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Ruhr-Universität Bochum, HNO-Klinik, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-Universität Bochum, Bochum, Germany
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12
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Bal M, Sharma A, Rane SU, Mittal N, Chaukar D, Prabhash K, Patil A. Neuroendocrine Neoplasms of the Larynx: A Clinicopathologic Analysis of 27 Neuroendocrine Tumors and Neuroendocrine Carcinomas. Head Neck Pathol 2021; 16:375-387. [PMID: 34401980 PMCID: PMC9187832 DOI: 10.1007/s12105-021-01367-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
Laryngeal neuroendocrine neoplasms (NENs) are rare and heterogeneous, encompassing well-differentiated neuroendocrine tumors (NETs; grade 1, 2, and 3), neuroendocrine carcinomas (NECs, small cell and large cell types), and mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN). We aimed to study the clinicopathologic spectrum of these neoplasms. A retrospective review of all primary laryngeal NENs diagnosed from 2005 to 2017 was undertaken. Mitotic index was divided into < 2, ≥ 2-10, and > 10 mitoses/2 mm2, with a Ki-67 labelling index of < 2%, ≥ 2-20%, and > 20% for the NET grade 1, 2 and 3 categories, respectively. A total of 27 patients were included. The median age at presentation was 60 years; the male-to-female ratio was 8:1. Supraglottis (n = 22) was the most frequently affected subsite. There were 9 NETs grade 2 (G2), and 18 NECs cases. There were no NET grade 1 or 3 cases in our cohort. Among the NETs G2, the morphology was epithelioid (2), plasmacytoid (3), clear (2), oncocytic (1), and rhabdoid (1). Unique 'glomeruloid structures' (n = 5), calcification (n = 3), lymphoid aggregates (n = 5), intranuclear inclusions (n = 2), hyaline globules (n = 3), and Leisegang rings (n = 2) were identified. NECs comprised 16 small cell neuroendocrine carcinoma and 2 large cell neuroendocrine carcinoma. On immunohistochemistry, tumor cells expressed AE1/AE3 (86%), synaptophysin (100%), chromogranin (100%), INSM1 (100%), calcitonin (33.3%). In the NEC group, p53 aberrant expression (87.5%), Retinoblastoma (Rb) loss (88.2%), and diffuse p16 immunoreactivity (66.7%) were additionally observed. Lymph-node metastasis was detected in 62.5% and 85.7%, while distant metastasis in 55.6% and 76.9%, respectively in NET G2 and NEC. Laryngeal NENs are aggressive neoplasms with a high rate of nodal and distant metastasis. Awareness of the wide pathologic spectrum of laryngeal NENs and appropriate use of IHC is needed to render an accurate diagnosis. Ki67 assessment is strongly recommended for laryngeal NEN prognostication.
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Affiliation(s)
- Munita Bal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Aishwarya Sharma
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Swapnil Ulhas Rane
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Devendra Chaukar
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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13
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Malignant Sinonasal Tumors: Update on Histological and Clinical Management. ACTA ACUST UNITED AC 2021; 28:2420-2438. [PMID: 34287240 PMCID: PMC8293118 DOI: 10.3390/curroncol28040222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 02/03/2023]
Abstract
Tumors of nasal cavity and paranasal sinuses (TuNSs) are rare and heterogeneous malignancies, presenting different histological features and clinical behavior. We reviewed the literature about etiology, biology, and clinical features of TuNSs to define pathologic features and possible treatment strategies. From a diagnostic point of view, it is mandatory to have high expertise and perform an immunohistochemical assessment to distinguish between different histotypes. Due to the extreme rarity of these neoplasms, there are no standard and evidence-based therapeutic strategies, lacking prospective and large clinical trials. In fact, most studies are retrospective analyses. Surgery represents the mainstay of treatment of TuNSs for small and localized tumors allowing complete tumor removal. Locally advanced lesions require more demolitive surgery that should be always followed by adjuvant radio- or chemo-radiotherapy. Recurrent/metastatic disease requires palliative chemo- and/or radiotherapy. Many studies emphasize the role of specific genes mutations in the development of TuNSs like mutations in the exons 4-9 of the TP53 gene, in the exon 9 of the PIK3CA gene and in the promoter of the TERT gene. In the near future, this genetic assessment will have new therapeutic implications. Future improvements in the understanding of the etiology, biology, and clinical features of TuNSs are warranted to improve their management.
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14
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Agaimy A, Tögel L, Haller F, Zenk J, Hornung J, Märkl B. YAP1-NUTM1 Gene Fusion in Porocarcinoma of the External Auditory Canal. Head Neck Pathol 2020; 14:982-990. [PMID: 32436169 PMCID: PMC7669971 DOI: 10.1007/s12105-020-01173-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/29/2022]
Abstract
Gene fusions involving the NUTM1 gene (NUT) represent defining genetic markers of a highly aggressive carcinoma type with predilection for the midline structures of children and young adults, hence the original description as NUT midline carcinoma. Recent studies have increasingly documented involvement of the NUTM1 gene in the pathogenesis of other entities as well. We herein describe two cases of auditory canal carcinomas with features of porocarcinoma, both harboring a newly described YAP1-NUTM1 gene fusion. Patients were males aged 28 and 82 years who presented with slowly growing lesions in the external auditory canal. Histologic examination showed monomorphic basaloid and squamoid cells arranged into organoid solid aggregates, nests, ducts, small cysts, and focal pseudocribriform pattern with variable mitotic activity, infiltrative growth, and focal squamous differentiation, particularly in the most superficial part of the tumor. Immunohistochemistry revealed consistent reactivity for CK5, p63 and SOX10 and diffuse aberrant expression of TP53. CK7 expression was limited to a few luminal ductal cells. The androgen receptor and S100 were negative. Next generation sequencing (TruSight RNA fusion panel, Illumina) revealed the same YAP1-NUTM1 gene fusion in both tumors, which was subsequently confirmed by NUT-FISH and the monoclonal anti-NUT antibody. These cases represent a novel contribution to the spectrum of NUT-rearranged head and neck malignancies. This adnexal carcinoma variant should not be confused with the highly lethal NUT carcinoma based on NUT immunoreactivity alone.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen, Germany
| | - Lars Tögel
- Institute of Pathology, University Hospital, Erlangen, Germany
| | - Florian Haller
- Institute of Pathology, University Hospital, Erlangen, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Augsburg, Germany
| | - Joachim Hornung
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Erlangen, Germany
| | - Bruno Märkl
- Institute of Pathology and Molecular Diagnostics, University Hospital, Augsburg, Germany
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15
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Clinicopathological Analysis of Five Cases of NUT Midline Carcinoma, including One with the Gingiva. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9791208. [PMID: 32149149 PMCID: PMC7042505 DOI: 10.1155/2020/9791208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/27/2020] [Indexed: 01/04/2023]
Abstract
Aims NUT midline carcinoma (NMC) is a rare, poorly differentiated carcinoma defined by the presence of NUT gene rearrangement. In order to better understand the diagnostic and clinicopathologic features of this disease as they pertain to clinical practice, we have herein compiled findings pertaining to 5 cases of NMC at our institution. Methods Clinicopathological findings from 5 NMC cases were retrospectively reviewed, with histologic findings being reassessed and summarized accordingly. Tumor samples in the present study had been stained for markers including NUT, P63, P40, TTF-1, keratin, CK7, Syn, CD56, CgA, CD34, CD117, EGFR, and Ki-67. All cases were subjected to both fluorescence in situ hybridization (FISH) and followed up. Results Of these 5 NMC cases, 2 were males and 3 were females, with ages ranging from 26 to 69 years. A total of 2 cases localized to the lung, 1 to the larynx, 1 to the maxillary gingiva, and 1 to the orbital cavity. Upon microscopic assessment, these tumors appeared as clusters of small rounded cells with interstitial neutrophil infiltration. Squamous epithelial differentiation varied between samples. NUT staining revealed strong diffuse nuclear staining in tumor cells, and FISH confirmed the presence of NUT gene translocation in these samples. Conclusions NMC is a form of highly invasive cancer that can manifest in a number of tissues including the gingiva. NMC tumors have a fairly well-defined pathological morphology, and both immunohistochemistry and FISH are valuable for NMC diagnosis.
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16
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Lee T, Cho J, Baek CH, Son YI, Jeong HS, Chung MK, Hong SD, Ahn YC, Oh DR, Noh JM, Park K, Ahn MJ, Kim HJ, Kim YK, Ko YH. Prevalence of NUT carcinoma in head and neck: Analysis of 362 cases with literature review. Head Neck 2020; 42:924-938. [PMID: 31903701 DOI: 10.1002/hed.26067] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/14/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nuclear protein in testis (NUT) carcinoma is a poorly differentiated carcinoma defined by the presence of NUT gene rearrangement. In the head and neck, the true prevalence of NUT carcinoma is unknown. METHODS We retrospectively investigated NUT expression with clinicopathologic features in 362 patients of poorly differentiated or undifferentiated carcinomas in the head and neck, and reviewed the literature reports. RESULTS Four (4/362, 1.1%) cases showed strong nuclear expression for NUT-specific monoclonal antibody, and all these tumors were in the sinonasal tract (4/40, 10%). The clinical outcome and histology were diverse unlike previously described. Although previous studies reported different frequency results according to study subjects, frequencies in sinonasal tract are relatively constant (10/80, 12.5%). CONCLUSIONS This is the largest study on the prevalence of NUT carcinoma in head and neck areas. It is important to include in the differential diagnosis of poorly differentiated carcinoma, particularly in the sinonasal tract.
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Affiliation(s)
- Taebum Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Junhun Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Ryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yi Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Hyeh Ko
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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17
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Zhang H, Liu M, Zhang J, Luo S, Wang C, Zhao Z, Ge Y, Zhang J, Geng F. Successful treatment of a case with NUT midline carcinoma in the larynx and review of the literature. Clin Case Rep 2020; 8:176-181. [PMID: 31998511 PMCID: PMC6982469 DOI: 10.1002/ccr3.2568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/28/2019] [Accepted: 11/08/2019] [Indexed: 11/20/2022] Open
Abstract
In this report, we gave the first case of successful treatment for laryngeal NMC, which is exceedingly rare with dismal prognosis. intensity-modulated radiation therapy accompanied by traditional Chinese medicine was administrated for the young woman, instead of radical resection, and she got continuous remission for more than 2 years, with no recurrence detected.
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Affiliation(s)
- Hai Zhang
- Department of OncologyThe Hospital of 81st Group Army PLAZhang Jia KouChina
| | - Ming‐Hua Liu
- Department of PharmacyThe Hospital of 81st Group Army PLAZhang Jia KouChina
| | - Jie Zhang
- Department of Radiation MedicineFaculty of Preventive MedicineAir Force Medical UniversityXi'anChina
| | - Shu‐Peng Luo
- Department of OncologyThe Hospital of 81st Group Army PLAZhang Jia KouChina
| | - Chao‐Bo Wang
- Department of OncologyThe Hospital of 81st Group Army PLAZhang Jia KouChina
- Outpatient Department of Dongcheng Fourth Cadres'SanatoriumBeijingChina
| | - Zeng‐Hu Zhao
- Department of OncologyThe Hospital of 81st Group Army PLAZhang Jia KouChina
| | - Yan‐Li Ge
- Department of OncologyThe Hospital of 81st Group Army PLAZhang Jia KouChina
| | - Jian‐Yu Zhang
- Department of OncologyThe Hospital of 81st Group Army PLAZhang Jia KouChina
| | - Feng‐Hao Geng
- Department of OncologyThe Hospital of 81st Group Army PLAZhang Jia KouChina
- Department of Radiation MedicineFaculty of Preventive MedicineAir Force Medical UniversityXi'anChina
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18
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Neves‐Silva R, Almeida LY, Silveira HA, Colturato CBN, Duarte A, Ferrisse TM, Silva EV, Vanzolin BF, Bufalino A, Ribeiro‐Silva A, León JE. SMARCB1 (INI‐1) and NUT immunoexpression in a large series of head and neck carcinomas in a Brazilian reference center. Head Neck 2019; 42:374-384. [DOI: 10.1002/hed.26008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/17/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Rodrigo Neves‐Silva
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Luciana Y. Almeida
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Heitor A. Silveira
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Carla B. N. Colturato
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Andressa Duarte
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Tulio M. Ferrisse
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Evânio V. Silva
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Bárbara F. Vanzolin
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Andreia Bufalino
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Alfredo Ribeiro‐Silva
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Jorge E. León
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
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19
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Cho RJ, Alexandrov LB, den Breems NY, Atanasova VS, Farshchian M, Purdom E, Nguyen TN, Coarfa C, Rajapakshe K, Prisco M, Sahu J, Tassone P, Greenawalt EJ, Collisson EA, Wu W, Yao H, Su X, Guttmann-Gruber C, Hofbauer JP, Hashmi R, Fuentes I, Benz SC, Golovato J, Ehli EA, Davis CM, Davies GE, Covington KR, Murrell DF, Salas-Alanis JC, Palisson F, Bruckner AL, Robinson W, Has C, Bruckner-Tuderman L, Titeux M, Jonkman MF, Rashidghamat E, Lwin SM, Mellerio JE, McGrath JA, Bauer JW, Hovnanian A, Tsai KY, South AP. APOBEC mutation drives early-onset squamous cell carcinomas in recessive dystrophic epidermolysis bullosa. Sci Transl Med 2019; 10:10/455/eaas9668. [PMID: 30135250 DOI: 10.1126/scitranslmed.aas9668] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/09/2018] [Accepted: 08/01/2018] [Indexed: 01/05/2023]
Abstract
Recessive dystrophic epidermolysis bullosa (RDEB) is a rare inherited skin and mucous membrane fragility disorder complicated by early-onset, highly malignant cutaneous squamous cell carcinomas (SCCs). The molecular etiology of RDEB SCC, which arises at sites of sustained tissue damage, is unknown. We performed detailed molecular analysis using whole-exome, whole-genome, and RNA sequencing of 27 RDEB SCC tumors, including multiple tumors from the same patient and multiple regions from five individual tumors. We report that driver mutations were shared with spontaneous, ultraviolet (UV) light-induced cutaneous SCC (UV SCC) and head and neck SCC (HNSCC) and did not explain the early presentation or aggressive nature of RDEB SCC. Instead, endogenous mutation processes associated with apolipoprotein B mRNA-editing enzyme catalytic polypeptide-like (APOBEC) deaminases dominated RDEB SCC. APOBEC mutation signatures were enhanced throughout RDEB SCC tumor evolution, relative to spontaneous UV SCC and HNSCC mutation profiles. Sixty-seven percent of RDEB SCC driver mutations was found to emerge as a result of APOBEC and other endogenous mutational processes previously associated with age, potentially explaining a >1000-fold increased incidence and the early onset of these SCCs. Human papillomavirus-negative basal and mesenchymal subtypes of HNSCC harbored enhanced APOBEC mutational signatures and transcriptomes similar to those of RDEB SCC, suggesting that APOBEC deaminases drive other subtypes of SCC. Collectively, these data establish specific mutagenic mechanisms associated with chronic tissue damage. Our findings reveal a cause for cancers arising at sites of persistent inflammation and identify potential therapeutic avenues to treat RDEB SCC.
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Affiliation(s)
- Raymond J Cho
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
| | - Ludmil B Alexandrov
- Department of Cellular and Molecular Medicine and Department of Bioengineering and Moores Cancer Center, University of California, San Diego, La Jolla, CA 92093, USA
| | | | - Velina S Atanasova
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Mehdi Farshchian
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Elizabeth Purdom
- Department of Statistics, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Tran N Nguyen
- Departments of Anatomic Pathology and Tumor Biology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Cristian Coarfa
- Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Kimal Rajapakshe
- Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Marco Prisco
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Joya Sahu
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Patrick Tassone
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Evan J Greenawalt
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Eric A Collisson
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94115, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Wei Wu
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94115, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA.,Translational Medical Center, Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Hui Yao
- Bioinformatics and Computational Biology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xiaoping Su
- Bioinformatics and Computational Biology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christina Guttmann-Gruber
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Josefina Piñón Hofbauer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Raabia Hashmi
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ignacia Fuentes
- Fundación DEBRA Chile, Santiago 7760099, Chile.,Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | | | | | - Erik A Ehli
- Avera Institute for Human Genetics, Sioux Falls, SD 57108, USA
| | | | - Gareth E Davies
- Avera Institute for Human Genetics, Sioux Falls, SD 57108, USA
| | | | - Dedee F Murrell
- St. George Hospital, University of New South Wales, Sydney, New South Wales 2217, Australia
| | - Julio C Salas-Alanis
- Escuela de Medicina y Ciencias de la Salud TecSalud del Tecnologico de Monterrey, Morones Prieto 3000, Los doctores, Monterrey, Nuevo León 64710, Mexico
| | - Francis Palisson
- Fundación DEBRA Chile, Santiago 7760099, Chile.,Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Anna L Bruckner
- Departments of Dermatology and Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - William Robinson
- Cutaneous Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Cristina Has
- Department of Dermatology, Medical Center-University of Freiburg, 79104 Freiburg, Germany
| | | | - Matthias Titeux
- INSERM UMR 1163, Paris, France.,Imagine Institute, 75015 Paris, France
| | - Marcel F Jonkman
- Center for Blistering Diseases, Department of Dermatology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Elham Rashidghamat
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 9RT, UK
| | - Su M Lwin
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 9RT, UK
| | - Jemima E Mellerio
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 9RT, UK
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 9RT, UK
| | - Johann W Bauer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Alain Hovnanian
- INSERM UMR 1163, Paris, France.,Imagine Institute, 75015 Paris, France
| | - Kenneth Y Tsai
- Departments of Anatomic Pathology and Tumor Biology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Andrew P South
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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20
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NUT Midline Carcinoma. Clin Oncol (R Coll Radiol) 2019; 31:732. [DOI: 10.1016/j.clon.2019.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/23/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022]
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21
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Prasad M, Baheti A, Ramadwar M, Chinnaswamy G, Vora T, Qureshi S. Pediatric NUT Carcinoma Is a Rare and Challenging Tumor: Single Center Experience of Five Children. Oncologist 2019; 24:e1232-e1235. [PMID: 31488618 DOI: 10.1634/theoncologist.2019-0358] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/06/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Nuclear protein of the testis (NUT) carcinoma is a rare and aggressive malignancy associated with rearrangements of the nuclear protein of the testis (NUT) gene on chromosome 15q14. Because of its rarity, this tumor is often underdiagnosed and underreported, and there is limited literature regarding its biology and optimal management. METHODS AND RESULTS We report our experience of five patients with pediatric NUT carcinoma, all of whom presented with midline head and neck mass. In spite of aggressive multimodality treatment, only one patient survives. CONCLUSION NUT carcinoma has a dismal prognosis in spite of aggressive multimodality management (surgery and adjuvant chemotherapy and/or radiation). Novel strategies are required to improve outcomes of patients with this tumor.
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Affiliation(s)
- Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Akshay Baheti
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Sajid Qureshi
- Pediatric Surgery, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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22
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23
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Reddy R, Woods TR, Allan RW, Malhotra P, Mehta HJ, Sarkar PK, Boyce BJ, Asirvatham JR. NUT (Nuclear Protein in Testis) Carcinoma: A Report of Two Cases With Different Histopathologic Features. Int J Surg Pathol 2018; 27:225-229. [DOI: 10.1177/1066896918796606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
NUT (nuclear protein in testis) carcinoma (NC) is an aggressive carcinoma characterized by rearrangements of the NUT gene on chromosome 15q14. Histologically, it is a poorly differentiated carcinoma composed of monotonous, medium-sized, round cells with scant amphophilic or eosinophilic cytoplasm. Foci of abrupt keratinization are often seen. In this report, we compare the morphology of 2 cases of NC. The first case shows characteristic features of uniform, round epithelioid cells admixed with foci of abrupt keratinization. The second case demonstrates nests of epithelioid-polygonal cells that appear to be loosely cribriform within a mucoid stroma. Although considered rare, the actual incidence of NC may be underestimated, as it is likely that many go undiagnosed because the morphology deviates from what is typical. Our report demonstrates that NC should always be considered in any case of an undifferentiated carcinoma and should not be excluded if typical histologic and immunohistochemical features of squamous differentiation are lacking.
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Affiliation(s)
| | - Tina R. Woods
- University of Mississippi Medical Center, Jackson, MS, USA
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24
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Tan E, Mody MD, Saba NF. Systemic therapy in non-conventional cancers of the larynx. Oral Oncol 2018; 82:61-68. [DOI: 10.1016/j.oraloncology.2018.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/05/2018] [Accepted: 05/10/2018] [Indexed: 12/11/2022]
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Vorstenbosch LJMJ, Mavinkurve-Groothuis AMC, van den Broek G, Flucke U, Janssens GO. Long-term survival after relapsed NUT carcinoma of the larynx. Pediatr Blood Cancer 2018; 65:e26946. [PMID: 29319213 DOI: 10.1002/pbc.26946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Uta Flucke
- Department of Pathology, RadboudUMC, Nijmegen, The Netherlands
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Centre Utrecht and Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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26
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Ma Y, Feng J, Xiao X, Chen L. NUT Midline Carcinoma in the Mediastinum in a Ten-Year-Old Boy. Arch Bronconeumol 2018; 54:539-541. [PMID: 29650254 DOI: 10.1016/j.arbres.2017.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Yangyang Ma
- Department of Pathology, Children's Hospital Fudan University, Shanghai, China
| | - Jiayan Feng
- Department of Pathology, Children's Hospital Fudan University, Shanghai, China
| | - Xianmin Xiao
- Department of Surgery, Children's Hospital Fudan University, Shanghai, China
| | - Lian Chen
- Department of Pathology, Children's Hospital Fudan University, Shanghai, China.
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27
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Hellquist H, Hunt JL, Cardesa A, Skalova A, Slootweg PJ, Rinaldo A, Ferlito A. Role of ancillary techniques in profiling unclassified laryngeal malignancies. Virchows Arch 2018; 472:705-715. [PMID: 29623469 DOI: 10.1007/s00428-018-2348-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/09/2018] [Accepted: 03/26/2018] [Indexed: 12/31/2022]
Abstract
Laryngeal biopsies, contrary to biopsies from many other sites of the body, very often contain minute amounts of tumour tissue that may consist of morphologically undifferentiated tumour only. In haematoxylin- and eosin-stained sections, there may be no indicative features of what specific tumour entity that is present. In the larynx, particularly small round cell neoplasms, primary or metastatic, often cause a diagnostic dilemma and where an incorrect diagnosis can induce substantial clinical consequences for the patient (e.g., primary neuroendocrine carcinomas vs metastatic variants, certain sarcomas). If sufficient/representative material has been obtained, the application of immunohistochemistry and/or molecular techniques should in virtually every case reveal the true nature of the malignancy. In cases with sparse amount of material, and therefore a limited number of sections to be cut, a careful and thoughtful stepwise approach is necessary to ascertain a reliable diagnosis, or at least guide the clinician to the most likely diagnoses. With today's advanced and widely available technology with an abundance of markers to discriminate different tumours, the use of the term "undifferentiated" should be largely unnecessary. In the exceptional, and indeed exceedingly rare cases, when a classification is not possible, even after repeat biopsy, we suggest that the laryngeal neoplasm is better termed "unclassified malignant neoplasm" rather than "undifferentiated malignant neoplasm".
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Affiliation(s)
- H Hellquist
- CBMR, Centre for Biomedical Research, University of Algarve, Edificio 2, Ala Norte, University of Algarve, 8005-139, Faro, Portugal. .,Epigenetics and Human Disease Laboratory, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal. .,Algarve Biomedical Centre, Campus Gambelas, University of Algarve, Faro, Portugal.
| | - J L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Cardesa
- Department of Anatomic Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Skalova
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - P J Slootweg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rinaldo
- University of Udine School of Medicine, Udine, Italy
| | - A Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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28
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Lemelle L, Pierron G, Fréneaux P, Huybrechts S, Spiegel A, Plantaz D, Julieron M, Dumoucel S, Italiano A, Millot F, Le Tourneau C, Leverger G, Chastagner P, Carton M, Orbach D. NUT carcinoma in children and adults: A multicenter retrospective study. Pediatr Blood Cancer 2017. [PMID: 28643357 DOI: 10.1002/pbc.26693] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Nuclear protein of the testis (NUT) carcinoma (formerly NUT midline carcinoma) is an aggressive tumor defined by the presence of NUT rearrangement with a poor prognosis. This rare cancer is underdiagnosed and poorly treated. OBJECTIVE The primary objective of this study was to describe the clinical, radiologic, and biological features of NUT carcinoma. The secondary objective was to describe the various treatments and assess their efficacy. METHODS This retrospective multicenter study was based on review of the medical records of children and adults with NUT carcinoma with specific rearrangement or positive anti-NUT nuclear staining (>50%). RESULTS This series of 12 patients had a median age of 18.1 years (ranges: 12.3-49.7 years). The primary tumor was located in the chest in eight patients, the head and neck in three patients, and one patient had a multifocal tumor. Nine patients presented regional lymph node involvement and eight distant metastases. One-half of patients were initially misdiagnosed. Specific NUT antibody was positive in all cases tested. A transient response to chemotherapy was observed in four of 11 patients. Only two patients were treated by surgery and five received radiotherapy with curative intent. At the end of follow-up, only one patient was still in remission more than 12 years after the diagnosis. Median overall survival was 4.7 months (95% confidence interval [CI]: 2.1-17.7). CONCLUSION NUT carcinoma is an aggressive disease refractory to conventional therapy. Early diagnosis by NUT-specific antibody immunostaining in cases of undifferentiated or poorly differentiated carcinoma to identify the specific rearrangement of NUT gene is useful to propose the optimal therapeutic strategy.
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Affiliation(s)
- Lauriane Lemelle
- Department of Pediatric, Adolescent, Young Adults, Institut Curie, Paris, France
| | - Gaëlle Pierron
- Unité de Génétique somatique, Institut Curie, Paris, France
| | - Paul Fréneaux
- Département de pathologie, Institut Curie, Paris, France
| | - Sophie Huybrechts
- Hematology-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, ULB Université libre de Bruxelles, Brussels, Belgium
| | - Alexandra Spiegel
- Department of Pediatric Hematology-Oncology, CHU Hautepierre, Strasbourg, France
| | - Dominique Plantaz
- Department of Pediatric Hematology-Oncology, Hôpital de Grenoble, Grenoble, France
| | - Morbize Julieron
- Head and Neck Surgery Department, Centre Oscar Lambret, Lille, France
| | - Sophie Dumoucel
- CHU Sainte Justine, University of Montreal, Montreal, Canada
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Fréderic Millot
- Pediatric Oncology Department, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Christophe Le Tourneau
- Medical Oncology Department, Institut Curie, Paris, France.,INSERM U900 Research unit, Saint-Cloud, France
| | - Guy Leverger
- Department of Pediatric Hematology and Oncology, Assistance Publique - Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France
| | - Pascal Chastagner
- Department of Pediatric Hematology-Oncology, Hôpital d'Enfants de Brabois, Vandoeuvre Les Nancy, France
| | - Matthieu Carton
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric, Adolescent, Young Adults, Institut Curie, Paris, France.,French Pediatric Rare Tumor Group (groupe Fracture)
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29
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Ba M, Long H, Yan Z, Wang S, Wu Y, Tu Y, Gong Y, Cui S. BRD4 promotes gastric cancer progression through the transcriptional and epigenetic regulation of c-MYC. J Cell Biochem 2017; 119:973-982. [PMID: 28681984 DOI: 10.1002/jcb.26264] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/05/2017] [Indexed: 12/27/2022]
Abstract
Although the significance of BRD4 in the epigenetic memory and cancer genesis has been intensively investigated, little is known about its function and potential roles during the generation and progression of gastric cancer. We report here that BRD4 increases the proliferation and represses the apoptosis of gastric cancer cells through activating c-MYC via transcriptional and epigenetic regulation mechanisms. Expression analyses in both small and large cohort of sample show that BRD4 is highly expressed in gastric cancer tissues/cells when compared with the adjacent non-tumor tissues/normal cells. We also find a positive correlation between the expression of BRD4 and c-MYC in patient samples. The repression of BRD4 by siRNAs leads to the down-regulation of c-MYC in gastric cancer cells. Chromatin immunoprecipitation-qPCR and luciferase assays show that BRD4 binds to and coordinately activates c-MYC promoter, indicating that c-MYC is transcriptional target of BRD4 and BRD4 regulates its basal expression. Further evidence show that the histone acetylation inhibitor reduces the binding of BRD4 as well as the histone activation level on c-MYC promoter, and leads to the down-regulation of c-MYC, suggesting that BRD4 regulates the expression of c-MYC through epigenetic mechanism. Functionally, the suppression of BRD4 leads to growth inhibition and apoptosis in gastric cancer cells. Force expression of c-MYC alongside with BRD4 repression rescue the anti-cancer effects caused by BRD4 repression. Collectively, our data not only uncovered the mechanism of BRD4 in regulating the proliferation of gastric cancer cells but also provides a new therapeutic strategy for this type of cancer.
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Affiliation(s)
- Mingchen Ba
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Hui Long
- Department of Pharmacy, Guangzhou Dermatology Institute, Guangzhou, P. R. China
| | - Zhaofei Yan
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Shuai Wang
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Yinbing Wu
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Yinuo Tu
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Yuanfeng Gong
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Shuzhong Cui
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital of Guangzhou Medical University, Guangzhou, P. R. China
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