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Papalexis P, Georgakopoulou VE, Keramydas D, Vogiatzis R, Taskou C, Anagnostopoulou FA, Nonni A, Lazaris AC, Zografos GC, Kavantzas N, Thomopoulou GE. Clinical, Histopathological, and Immunohistochemical Characteristics of Predictive Biomarkers of Breast Cancer: A Retrospective Study. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:340-351. [PMID: 38707726 PMCID: PMC11062156 DOI: 10.21873/cdp.10330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 05/07/2024]
Abstract
Background/Aim Breast cancer is a complex disease with variability in clinical manifestation, response to current therapy, and biochemical and histological features among various subgroups. Histologic grading and immuno-histochemical evaluation of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 proliferation index play a crucial role in increasing the differential diagnostic value among various types of breast carcinoma. The aim of this study was to determine the histopathological and immuno-histochemical characteristics of breast tumors from a University Laboratory of Pathology in Greece. Patients and Methods The study included female patients over 18 years of age, whose histopathological and immunohistochemical reports were stored in the archives of the First Department of Pathology of National and Kapodistrian University of Athens. The study involved 197 female patients with a median age of 70 years and median tumor size of 2.6 cm. Results Most tumors were located at the left breast and ductal carcinoma was the most common histologic type (35.5%). Most tumors had histologic grade 2 (106, 53.8%), and were classified as TNM stage IIA (65, 33%). Most grade 1 and 2 tumors exhibited high expression of PR, whereas most grade 3 tumors had no PR expression. Moreover, patients with triple-negative cancer presented with grades 2 and 3 at a lower percentage compared to patients without a triple-negative phenotype (p=0.001). Conclusion The study provided valuable insights into the histopathological and immuno-histochemical characteristics involved in the development and progression of breast cancer.
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Affiliation(s)
- Petros Papalexis
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | | | - Dimitrios Keramydas
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Master's Program "Environment and Health, Management of Environmental Health Effects", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Aphrodite Nonni
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas C Lazaris
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George C Zografos
- Department of Propedeutic Surgery, Hippokration Hospital, University of Athens, Medical School, Athens, Greece
| | - Nikolaos Kavantzas
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Master's Program "Environment and Health, Management of Environmental Health Effects", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Eleni Thomopoulou
- Cytopathology Department, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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The Therapeutic Potential of the Restoration of the p53 Protein Family Members in the EGFR-Mutated Lung Cancer. Int J Mol Sci 2022; 23:ijms23137213. [PMID: 35806218 PMCID: PMC9267050 DOI: 10.3390/ijms23137213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Despite the recent development of precision medicine and targeted therapies, lung cancer remains the top cause of cancer-related mortality worldwide. The patients diagnosed with metastatic disease have a five-year survival rate lower than 6%. In metastatic disease, EGFR is the most common driver of mutation, with the most common co-driver hitting TP53. EGFR-positive patients are offered the frontline treatment with tyrosine kinase inhibitors, yet the development of resistance and the lack of alternative therapies make this group of patients only fit for clinical trial participation. Since mutant p53 is the most common co-driver in the metastatic setting, therapies reactivating the p53 pathway might serve as a promising alternative therapeutic approach in patients who have developed a resistance to tyrosine kinase inhibitors. This review focuses on the molecular background of EGFR-mutated lung cancer and discusses novel therapeutic options converging on the reactivation of p53 tumor suppressor pathways.
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ΔNp63 regulates a common landscape of enhancer associated genes in non-small cell lung cancer. Nat Commun 2022; 13:614. [PMID: 35105868 PMCID: PMC8807845 DOI: 10.1038/s41467-022-28202-1] [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: 03/11/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
Distinct lung stem cells give rise to lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC). ΔNp63, the p53 family member and p63 isoform, guides the maturation of these stem cells through the regulation of their self-renewal and terminal differentiation; however, the underlying mechanistic role regulated by ∆Np63 in lung cancer development has remained elusive. By utilizing a ΔNp63-specific conditional knockout mouse model and xenograft models of LUAD and LUSC, we found that ∆Np63 promotes non-small cell lung cancer by maintaining the lung stem cells necessary for lung cancer cell initiation and progression in quiescence. ChIP-seq analysis of lung basal cells, alveolar type 2 (AT2) cells, and LUAD reveals robust ∆Np63 regulation of a common landscape of enhancers of cell identity genes. Importantly, one of these genes, BCL9L, is among the enhancer associated genes regulated by ∆Np63 in Kras-driven LUAD and mediates the oncogenic effects of ∆Np63 in both LUAD and LUSC. Accordingly, high BCL9L levels correlate with poor prognosis in LUAD patients. Taken together, our findings provide a unifying oncogenic role for ∆Np63 in both LUAD and LUSC through the regulation of a common landscape of enhancer associated genes. The mechanistic role regulated by the oncogene ∆Np63 in lung cancer development is currently unclear. Here, the authors show that ΔNp63 is pro-tumorigenic in lung adenocarcinoma as well as squamous cell carcinoma, and maintains lung cancer progenitor cells via regulation of super-enhancer-associated genes, including BCL9L
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Gürgen D, Conrad T, Becker M, Sebens S, Röcken C, Hoffmann J, Langhammer S. Breaking the crosstalk of the Cellular Tumorigenic Network by low-dose combination therapy in lung cancer patient-derived xenografts. Commun Biol 2022; 5:59. [PMID: 35039644 PMCID: PMC8763947 DOI: 10.1038/s42003-022-03016-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/27/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is commonly diagnosed at advanced stages limiting treatment options. Although, targeted therapy has become integral part of NSCLC treatment therapies often fail to improve patient's prognosis. Based on previously published criteria for selecting drug combinations for overcoming resistances, NSCLC patient-derived xenograft (PDX) tumors were treated with a low dose combination of cabozantinib, afatinib, plerixafor and etoricoxib. All PDX tumors treated, including highly therapy-resistant adeno- and squamous cell carcinomas without targetable oncogenic mutations, were completely suppressed by this drug regimen, leading to an ORR of 81% and a CBR of 100%. The application and safety profile of this low dose therapy regimen was well manageable in the pre-clinical settings. Overall, this study provides evidence of a relationship between active paracrine signaling pathways of the Cellular Tumorigenic Network, which can be effectively targeted by a low-dose multimodal therapy to overcome therapy resistance and improve prognosis of NSCLC.
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Affiliation(s)
- Dennis Gürgen
- EPO Experimental Pharmacology & Oncology, Berlin, Germany
| | | | - Michael Becker
- EPO Experimental Pharmacology & Oncology, Berlin, Germany
| | - Susanne Sebens
- Institute for Tumorbiology, University of Kiel, Kiel, Germany
| | | | - Jens Hoffmann
- EPO Experimental Pharmacology & Oncology, Berlin, Germany
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Umakanthan S, Chalapathi Rao AV, Mohammed W. Role of immunohistochemistry markers in neoplastic lung lesions. J Cancer Res Ther 2021; 17:1382-1388. [PMID: 34916368 DOI: 10.4103/jcrt.jcrt_187_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives The objective of the evaluate was to study and determine the usefulness of immunohistochemistry (IHC) staining in neoplastic lung lesions. Materials and Methods We evaluated seven IHC stains in fifty lung cancers that included adenocarcinoma (AC), squamous cell carcinoma (SCC), small cell carcinoma, and carcinoid tumors. Results P63 was expressed in all the cases of SCCs and thyroid transcription factor-1 (TTF-1) was expressed in all cases of ACs. CK 5/6 was expressed in 77.77% of SCCs and CK 7 was expressed in 92.59% of ACs. Synaptophysin and chromogranin-A were expressed in 100% of neuroendocrine (NE) carcinomas. Conclusion P63 and TTF-1 are sensitive markers for SCCs and ACs. Synaptophysin and Chromogranin-A are sensitive markers for NE carcinomas.
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Affiliation(s)
- Srikanth Umakanthan
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of The West Indies, Trinidad and Tobago
| | - A V Chalapathi Rao
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of The West Indies, Trinidad and Tobago
| | - Wayne Mohammed
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of The West Indies, Trinidad and Tobago
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Veena VS, Saritha VN, George PS, Rajan K, Jayasree K, Sujathan K. Immunoexpression of TTF1 and p63 Differentiates Lung Adenocarcinomas in Sputum Samples. J Cytol 2021; 38:151-157. [PMID: 34703092 PMCID: PMC8489695 DOI: 10.4103/joc.joc_252_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/04/2017] [Accepted: 04/12/2021] [Indexed: 11/04/2022] Open
Abstract
Context Differentiating NSCLC as either adeno or squamous type and identification of Epidermal Growth Factor Receptor (EGFR) mutations is clinically relevant for lung cancer patients for selecting treatment. Thyroid transcription factor-1 (TTF-1) and p63 were demonstrated as useful markers for histologic typing of lung cancer. Mutation and overexpression of EGFR has been reported in a subset of non-small cell lung cancers. If these markers can be validated for the differential diagnosis of adenocarcinoma in a sputum sample itself, it will be highly beneficial for lung cancer patients. Aims To evaluate whether immunocytochemical expression of TTF-1, p63, and EGFR proteins in sputum samples can be used for differential diagnosis of lung adenocarcinoma by comparing with that of the corresponding tissue samples. Settings and Design Ninety sputum samples and matched tissue samples were used for the study. Subjects and Methods Monolayered smears and cell blocks of sputum and the corresponding tissue samples were immunostained with the standard ABC method. The expression patterns of these markers were analyzed statistically and compared with clinic-pathological parameters. Statistical Analysis Used Chi-square test and paired t-test. Results The p63 protein had a positive expression in 73.9% of SCC whereas TTF1 had positive expression in 75.8% of ADC. The EGFR expression was positive in 27 cases of adenocarcinoma, 21 cases of SCC and 19 cases of NSCLC. Conclusions Immunocytochemistry of the aforementioned antibodies in sputum samples can be used as supplementary evidence for the subtyping of NSCLC.
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Affiliation(s)
- V S Veena
- Divisions of Pathology, Regional Cancer Centre, Medical College, Trivandrum, Kerala, India
| | - V N Saritha
- Cancer Research, Regional Cancer Centre, Medical College, Trivandrum, Kerala, India
| | - Preethi Sara George
- Epidemiology, Regional Cancer Centre, Medical College, Trivandrum, Kerala, India
| | - K Rajan
- Respiratory Medicine, Medical College, Trivandrum, Kerala, India
| | - K Jayasree
- Divisions of Pathology, Regional Cancer Centre, Medical College, Trivandrum, Kerala, India
| | - K Sujathan
- Cancer Research, Regional Cancer Centre, Medical College, Trivandrum, Kerala, India
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MicroRNA31 and MMP-1 contribute to the differentiated pathway of invasion -with enhanced epithelial-to-mesenchymal transition- in squamous cell carcinoma of the skin. Arch Dermatol Res 2021; 314:767-775. [PMID: 34647185 DOI: 10.1007/s00403-021-02288-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 12/11/2022]
Abstract
Epithelial to mesenchymal transition (EMT) is an important mechanism of invasion in cutaneous squamous cell carcinomas (cSCCs) and has been found to be enhanced in tumors originated from actinic keratosis with transformation limited to the basal epithelial layer -differentiated pathway-, compared to cases with invasion subsequent to complete epidermal transformation -classical pathway-. Several microRNAs and proteins can contribute to EMT modulation in cSCCs. MicroRNA21 and microRNA31 are involved in posttranscriptional regulation of protein expression and could play a relevant role in EMT and cSCC progression. Throughout the EMT process upregulation of matrix metalloproteinases (MMPs) enhances invasiveness and MMP-1 and MMP-3 contribute to local invasion, angiogenesis and metastasis in cSCCs. Additionally, cSCC development is associated with PTEN loss and NF-κB, NOTCH-1 and p63 activation. The aim of this work is to identify differences in the expression of those molecules between both pathways of cSCCs development. Eight tissue microarrays from 80 consecutive cSCCs were analyzed using LNA-based miRNA in situ hybridization for miRNA21 and miRNA31 evaluation, and immunohistochemistry for MMP-1, MMP-3, PTEN, NOTCH-1, NF-κB, p63 and CD31. Significantly higher expression of miRNA31 (p < 0.0001) and MMP-1 (p = 0.0072) and angiogenesis (p = 0.0199) were found in the differentiated pathway, whereas PTEN loss (p = 0.0430) was more marked in the classical pathway. No significant differences were found for the other markers. Our findings support a contribution of miRNA31 and MMP-1 in the differentiated pathway, associated to EMT and increased microvascularization. The greater PTEN loss in the classical pathway indicate that its relevance in cSCC is not EMT-related.
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Prieto-Garcia C, Tomašković I, Shah VJ, Dikic I, Diefenbacher M. USP28: Oncogene or Tumor Suppressor? A Unifying Paradigm for Squamous Cell Carcinoma. Cells 2021; 10:2652. [PMID: 34685632 PMCID: PMC8534253 DOI: 10.3390/cells10102652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 01/03/2023] Open
Abstract
Squamous cell carcinomas are therapeutically challenging tumor entities. Low response rates to radiotherapy and chemotherapy are commonly observed in squamous patients and, accordingly, the mortality rate is relatively high compared to other tumor entities. Recently, targeting USP28 has been emerged as a potential alternative to improve the therapeutic response and clinical outcomes of squamous patients. USP28 is a catalytically active deubiquitinase that governs a plethora of biological processes, including cellular proliferation, DNA damage repair, apoptosis and oncogenesis. In squamous cell carcinoma, USP28 is strongly expressed and stabilizes the essential squamous transcription factor ΔNp63, together with important oncogenic factors, such as NOTCH1, c-MYC and c-JUN. It is presumed that USP28 is an oncoprotein; however, recent data suggest that the deubiquitinase also has an antineoplastic effect regulating important tumor suppressor proteins, such as p53 and CHK2. In this review, we discuss: (1) The emerging role of USP28 in cancer. (2) The complexity and mutational landscape of squamous tumors. (3) The genetic alterations and cellular pathways that determine the function of USP28 in squamous cancer. (4) The development and current state of novel USP28 inhibitors.
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Affiliation(s)
- Cristian Prieto-Garcia
- Protein Stability and Cancer Group, Department of Biochemistry and Molecular Biology, University of Würzburg, 97074 Würzburg, Germany
- Comprehensive Cancer Centre Mainfranken, 97074 Würzburg, Germany
- Molecular Signaling Group, Institute of Biochemistry II, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (I.T.); (V.J.S.); (I.D.)
| | - Ines Tomašković
- Molecular Signaling Group, Institute of Biochemistry II, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (I.T.); (V.J.S.); (I.D.)
| | - Varun Jayeshkumar Shah
- Molecular Signaling Group, Institute of Biochemistry II, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (I.T.); (V.J.S.); (I.D.)
| | - Ivan Dikic
- Molecular Signaling Group, Institute of Biochemistry II, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (I.T.); (V.J.S.); (I.D.)
- Buchmann Institute for Molecular Life Sciences, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Markus Diefenbacher
- Protein Stability and Cancer Group, Department of Biochemistry and Molecular Biology, University of Würzburg, 97074 Würzburg, Germany
- Comprehensive Cancer Centre Mainfranken, 97074 Würzburg, Germany
- Mildred Scheel Early Career Center, 97074 Würzburg, Germany
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Yu J, Lang Q, Zhong C, Wang S, Tian Y. Genome-Wide Identification of Autophagy Prognostic Signature in Pancreatic Cancer. Dose Response 2021; 19:15593258211023260. [PMID: 34262410 PMCID: PMC8252352 DOI: 10.1177/15593258211023260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Autophagy plays a vital role in cancer development. However, there is currently no comprehensive study regarding the effects of autophagy-related genes (ARGs) on pancreatic cancer prognosis. Thus, this study aimed to establish an autophagy-related signature for predicting the prognosis of patients with pancreatic cancer. Methods: We identified and validated differentially-expressed ARGs using data from The Cancer Genome Atlas (TCGA) database, Genotype-Tissue Expression project (GTEx) and Expression Omnibus (GEO) database. We performed Cox proportional hazards regression analysis on the differentially-expressed ARGs to develop an autophagy-related signature. We tested the expression of these genes through western blotting and verified their prognostic values through gene expression profiling and interactive analyses (GEPIA). Results: We identified a total of 21 differentially-expressed ARGs and screened 4 OS-related ARGs (TP63, RAB24, APOL1, and PTK6). Both the training and validation sets showed that the autophagy-related signature was more accurate than the Tumor Node Metastasis (TNM) staging system. Moreover, the western blotting result showed that the expression of TP63, APOL1, and PTK6 was high, whereas that of RAB24 was low in cancer tissues. Conclusion: This 4-ARG signature might potentially help in providing personalized therapy to patients with cancer.
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Affiliation(s)
- Jianfa Yu
- Department of General Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, China
| | - Qi Lang
- Department of General Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, China
| | - Chongli Zhong
- Department of General Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, China
| | - Shuang Wang
- Key Laboratory of Higher Education of Liaoning Province, Shenyang, Liaoning, China
| | - Yu Tian
- Department of General Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, China
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Xu J, Li F, Gao Y, Guo R, Ding L, Fu M, Yi Y, Chen H, Xiao ZXJ, Niu M. E47 upregulates ΔNp63α to promote growth of squamous cell carcinoma. Cell Death Dis 2021; 12:381. [PMID: 33833226 PMCID: PMC8032790 DOI: 10.1038/s41419-021-03662-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 12/28/2022]
Abstract
Targeted therapy has greatly improved both survival and prognosis of cancer patients. However, while therapeutic treatment of adenocarcinoma has been advanced greatly, progress in treatment of squamous cell carcinoma (SCC) has been slow and ineffective. Therefore, it is of great importance to decipher mechanisms and identify new drug targets involved in squamous cell carcinoma development. In this study, we demonstrate that E47 plays the distinctive and opposite roles on cell proliferation in adenocarcinoma and squamous cell carcinoma. While E47 suppresses cell proliferation in adenocarcinoma cells, it functions as a oncoprotein to promote cell proliferation and tumor growth of squamous cell carcinoma. Mechanistically, we show that E47 can directly bind to the promoter and transactivate ΔNp63 gene expression in squamous cell carcinoma cells, resulting in upregulation of cyclins D1/E1 and downregulation of p21, and thereby promoting cell proliferation and tumor growth. We further show that expression of E2A (E12/E47) is positively correlated with p63 and that high expression of E2A is associated with poor outcomes in clinical samples of squamous cell carcinoma. These results highlight that the E47-ΔNp63α axis may be potential therapeutic targets for treatment of squamous cell carcinoma.
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Affiliation(s)
- Jing Xu
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Fengtian Li
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Ya Gao
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Rongtian Guo
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Liangping Ding
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Mengyuan Fu
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Yong Yi
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Hu Chen
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Zhi-Xiong Jim Xiao
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Mengmeng Niu
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China.
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p63 expression in human tumors and normal tissues: a tissue microarray study on 10,200 tumors. Biomark Res 2021; 9:7. [PMID: 33494829 PMCID: PMC7830855 DOI: 10.1186/s40364-021-00260-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background Tumor protein 63 (p63) is a transcription factor of the p53 gene family involved in differentiation of several tissues including squamous epithelium. p63 immunohistochemistry is broadly used for tumor classification but published data on its expression in cancer is conflicting. Methods To comprehensively catalogue p63 expression, tissue microarrays (TMAs) containing 12,620 tissue samples from 115 tumor entities and 76 normal tissue types were analyzed. Results p63 expression was seen in various normal tissues including squamous epithelium and urothelium. At least occasional weak p63 positivity could be detected in 61 (53%) of 115 different tumor types. The frequencies of p63 positivity was highest in squamous cell carcinomas irrespective of their origin (96–100%), thymic tumors (100%), urothelial carcinomas (81–100%), basal type tumors such as basal cell carcinomas (100%), and various salivary gland neoplasias (81–100%). As a rule, p63 was mostly expressed in cancers derived from p63 positive normal tissues and mostly not detectable in tumors derived from p63 negative cancers. However, exceptions from this rule occurred. A positive p63 immunostaining in cancers derived from p63 negative tissues was unrelated to aggressive phenotype in 422 pancreatic cancers, 160 endometrium cancers and 374 ovarian cancers and might be caused by aberrant squamous differentiation or represent stem cell properties. In 355 gastric cancers, aberrant p63 expression occurred in 4% and was linked to lymph node metastasis (p = 0.0208). Loss of p63 in urothelial carcinomas - derived from p63 positive urothelium - was significantly linked to advanced stage, high grade (p < 0.0001 each) and poor survival (p < 0.0001) and might reflect clinically relevant tumor dedifferentiation. Conclusion The high prevalence of p63 expression in specific tumor types makes p63 immunohistochemistry a suitable diagnostic tool. Loss of p63 expression might constitute a feature of aggressive cancers. Supplementary Information The online version contains supplementary material available at 10.1186/s40364-021-00260-5.
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Chen W, Zhang W, Zhou T, Cai J, Yu Z, Wu Z. A Newly Defined Pyroptosis-Related Gene Signature for the Prognosis of Bladder Cancer. Int J Gen Med 2021; 14:8109-8120. [PMID: 34803395 PMCID: PMC8594790 DOI: 10.2147/ijgm.s337735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Bladder cancer (BC), as the most common urinary system tumor type and the main cause of tumor-related death, has an unsatisfactory prognosis. In recent years, related literature has proposed that cell pyroptosis is an inflammatory form of programmed cell death. However, in BC, the relationship between the expression of pyroptosis-related genes and the prognosis has not been elucidated. METHODS We got the RNA sequencing data from TCGA and GEO datasets. Fifty-two pyroptosis-related genes were extracted for further explore. Then, we compared the gene expression levels between the normal bladder and BC tissues. After that, we develop and validate a pyroptosis-related gene prognostic model and made following functional enrichment analysis and single-sample gene set enrichment analysis of the differentially expressed genes between the high- and low-risk groups. RESULTS Twenty-nine differentially expressed genes (DEGs) were found between normal and tumor tissues. Based on the median score calculated by the risk score formula from 8 pyroptosis-related genes, 414 patients were equally divided into low- and high-risk subgroups. The survival probability of BC patients in the high-risk group was significantly lower than that in the low-risk group (P < 0.001). Through multivariate analysis, our risk score is an independent factor predicting OS in BC patients. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis show that high-risk populations are rich in immune-related genes and have a decreased immune status. All the above results have been externally verified from GEO cohort. CONCLUSION Pyroptosis-related genes are closely related to tumor immunity and are a potential prognostic tool for predicting BCs.
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Affiliation(s)
- Weikang Chen
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People’s Republic of China
| | - Wenhao Zhang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 325000, People’s Republic of China
- Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 325000, People’s Republic of China
| | - Tao Zhou
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People’s Republic of China
| | - Jian Cai
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People’s Republic of China
| | - Zhixian Yu
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People’s Republic of China
- Correspondence: Zhixian Yu; Zhigang Wu Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Road Lucheng District, Wenzhou, Zhejiang, 325000, People’s Republic of China Email ;
| | - Zhigang Wu
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, People’s Republic of China
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Park S, Lee S, Kim J, Kim G, Park KH, Kim TU, Chung D, Lee H. ΔNp63 to TAp63 expression ratio as a potential molecular marker for cervical cancer prognosis. PLoS One 2019; 14:e0214867. [PMID: 30973901 PMCID: PMC6459502 DOI: 10.1371/journal.pone.0214867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/21/2019] [Indexed: 12/23/2022] Open
Abstract
p63 is a transcription factor p53 family. Two major isoforms of p63, TAp63 with transactivation (TA) domain and ΔNp63 with truncated TA domain, have been reported to play opposing roles either in tumor suppression or oncogenic function. Little is known about the association of these two isoforms of p63 in the carcinogenesis of cervical cancer. In this study, the mRNA expression levels of TAp63 and ΔNp63 in 40 normal, 30 low-grade squamous intraepithelial lesions (LSIL), 38 high-grade squamous intraepithelial lesions (HSIL), and 52 cervical cancer formalin-fixed paraffin-embedded tissues were examined using quantitative reverse transcription polymerase chain reaction (RT-qPCR). We analyzed the association between the ΔNp63 and ΔN/TAp63 mRNA expression ratio and clinicopathological parameters and compared disease-specific survival of each ΔNp63 mRNA expression and ΔN/TAp63 mRNA expression ratio. The ΔN/TAp63 mRNA expression ratio in cervical cancer showed higher sensitivity than the mRNA expression levels of ΔNp63 (52.0% vs 44.2%). The level of ΔN/TAp63 mRNA expression ratio in precancerous LSIL and HSIL was higher than in normal tissues (P = 0.01 and P = 0.003) and lower than in cervical cancer tissues (P = 0.03 and P = 0.02). Besides, the positive ΔN/TAp63 mRNA expression ratio was associated with bulky tumor size and high expression of Ki-67, the proliferation marker, in cervical cancer (P = 0.04 and P = 0.02). The cervical cancer patients with the positive ΔN/TAp63 mRNA expression ratio showed worse survival compared to those who with the negative expression ratio of ΔN/TAp63 (HR = 5.7, 95% CI: 1.6–19.9). In conclusion, the balance of TAp63 and ΔNp63 is closely related to the carcinogenesis of cervical cancer. The ΔN/TAp63 mRNA expression ratio could be useful as a diagnostic and prognostic marker of cervical cancer.
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Affiliation(s)
- Sunyoung Park
- Department of Biomedical Laboratory Science, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Suji Lee
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju-si, Gangwon-do, Republic of Korea
| | - Jungho Kim
- Department of Biomedical Laboratory Science, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Geehyuk Kim
- Department of Biomedical Laboratory Science, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Kwang Hwa Park
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju-si, Gangwon-do, Republic of Korea
| | - Tae Ue Kim
- Department of Biomedical Laboratory Science, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Dawn Chung
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail: (DC); (HL)
| | - Hyeyoung Lee
- Department of Biomedical Laboratory Science, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
- * E-mail: (DC); (HL)
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14
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Khosravi P, Kazemi E, Imielinski M, Elemento O, Hajirasouliha I. Deep Convolutional Neural Networks Enable Discrimination of Heterogeneous Digital Pathology Images. EBioMedicine 2018; 27:317-328. [PMID: 29292031 PMCID: PMC5828543 DOI: 10.1016/j.ebiom.2017.12.026] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022] Open
Abstract
Pathological evaluation of tumor tissue is pivotal for diagnosis in cancer patients and automated image analysis approaches have great potential to increase precision of diagnosis and help reduce human error. In this study, we utilize several computational methods based on convolutional neural networks (CNN) and build a stand-alone pipeline to effectively classify different histopathology images across different types of cancer. In particular, we demonstrate the utility of our pipeline to discriminate between two subtypes of lung cancer, four biomarkers of bladder cancer, and five biomarkers of breast cancer. In addition, we apply our pipeline to discriminate among four immunohistochemistry (IHC) staining scores of bladder and breast cancers. Our classification pipeline includes a basic CNN architecture, Google's Inceptions with three training strategies, and an ensemble of two state-of-the-art algorithms, Inception and ResNet. Training strategies include training the last layer of Google's Inceptions, training the network from scratch, and fine-tunning the parameters for our data using two pre-trained version of Google's Inception architectures, Inception-V1 and Inception-V3. We demonstrate the power of deep learning approaches for identifying cancer subtypes, and the robustness of Google's Inceptions even in presence of extensive tumor heterogeneity. On average, our pipeline achieved accuracies of 100%, 92%, 95%, and 69% for discrimination of various cancer tissues, subtypes, biomarkers, and scores, respectively. Our pipeline and related documentation is freely available at https://github.com/ih-_lab/CNN_Smoothie.
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Affiliation(s)
- Pegah Khosravi
- Institute for Computational Biomedicine, Weill Cornell Medical College, NY, USA; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Ehsan Kazemi
- Yale Institute for Network Science, Yale University, New Haven, CT, USA
| | - Marcin Imielinski
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medical College, NY, USA; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, NY, USA; The New York Genome Center, NY, USA; The Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Institute for Computational Biomedicine, Weill Cornell Medical College, NY, USA; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medical College, NY, USA; The Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Iman Hajirasouliha
- Institute for Computational Biomedicine, Weill Cornell Medical College, NY, USA; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medical College, NY, USA; The Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
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15
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Conde E, Caminoa A, Dominguez C, Calles A, Walter S, Angulo B, Sánchez E, Alonso M, Jimenez L, Madrigal L, Hernando F, Sanz-Ortega J, Jimenez B, Garrido P, Paz-Ares L, de Castro J, Hernandez S, Lopez-Rios F. Aligning digital CD8+scoring and targeted next-generation sequencing with programmed death ligand 1 expression: a pragmatic approach in early-stage squamous cell lung carcinoma. Histopathology 2017; 72:270-284. [DOI: 10.1111/his.13346] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Esther Conde
- Pathology-Laboratorio de Dianas Terapeuticas; Hospital Universitario HM Sanchinarro; Universidad CEU San Pablo; Madrid Spain
- Centro de Investigación Biomedica en Red de Cancer (CIBERONC); Madrid Spain
| | - Alejandra Caminoa
- Pathology-Laboratorio de Dianas Terapeuticas; Hospital Universitario HM Sanchinarro; Universidad CEU San Pablo; Madrid Spain
| | - Carolina Dominguez
- Pathology-Laboratorio de Dianas Terapeuticas; Hospital Universitario HM Sanchinarro; Universidad CEU San Pablo; Madrid Spain
| | - Antonio Calles
- Medical Oncology; Hospital Universitario Gregorio Marañón; Madrid Spain
| | - Stefan Walter
- Fundación de Investigación Sanitaria de Getafe; Madrid Spain
- University of California San Francisco; San Francisco CA USA
| | - Barbara Angulo
- Pathology-Laboratorio de Dianas Terapeuticas; Hospital Universitario HM Sanchinarro; Universidad CEU San Pablo; Madrid Spain
- Centro de Investigación Biomedica en Red de Cancer (CIBERONC); Madrid Spain
| | - Elena Sánchez
- Pathology-Laboratorio de Dianas Terapeuticas; Hospital Universitario HM Sanchinarro; Universidad CEU San Pablo; Madrid Spain
| | - Marta Alonso
- Pathology-Laboratorio de Dianas Terapeuticas; Hospital Universitario HM Sanchinarro; Universidad CEU San Pablo; Madrid Spain
| | - Luis Jimenez
- Thoracic Surgery; Hospital Universitario HM Sanchinarro; Madrid Spain
| | - Luis Madrigal
- Thoracic Surgery; Hospital Universitario HM Sanchinarro; Madrid Spain
| | - Florentino Hernando
- Thoracic Surgery; Hospital Clínico San Carlos; Universidad Complutense; Madrid Spain
| | - Julian Sanz-Ortega
- Centro de Investigación Biomedica en Red de Cancer (CIBERONC); Madrid Spain
- Pathology; Hospital Clínico San Carlos; Universidad Complutense; Madrid Spain
| | - Beatriz Jimenez
- Medical Oncology; Hospital Universitario HM Sanchinarro; Madrid Spain
| | - Pilar Garrido
- Centro de Investigación Biomedica en Red de Cancer (CIBERONC); Madrid Spain
- Medical Oncology, IRYCIS; Hospital Universitario Ramón y Cajal; Universidad de Alcalá; Madrid Spain
| | - Luis Paz-Ares
- Centro de Investigación Biomedica en Red de Cancer (CIBERONC); Madrid Spain
- Medical Oncology; Hospital Universitario 12 de Octubre; CNIO and Universidad Complutense; Madrid Spain
| | - Javier de Castro
- Centro de Investigación Biomedica en Red de Cancer (CIBERONC); Madrid Spain
- Medical Oncology; Hospital Universitario HM Sanchinarro; Madrid Spain
| | - Susana Hernandez
- Pathology-Laboratorio de Dianas Terapeuticas; Hospital Universitario HM Sanchinarro; Universidad CEU San Pablo; Madrid Spain
| | - Fernando Lopez-Rios
- Pathology-Laboratorio de Dianas Terapeuticas; Hospital Universitario HM Sanchinarro; Universidad CEU San Pablo; Madrid Spain
- Centro de Investigación Biomedica en Red de Cancer (CIBERONC); Madrid Spain
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16
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Alexander M, Chiaffarano J, Zhou F, Cangiarella J, Yee-Chang M, Simsir A. Can p40 (Polyclonal) Replace p63 (Clone 4A4) in the Cytologic Diagnosis of Pulmonary Non-Small Cell Carcinoma? Am J Clin Pathol 2017; 147:580-588. [PMID: 28498881 DOI: 10.1093/ajcp/aqx031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Differentiating squamous cell carcinoma from adenocarcinoma (ACA) in cytology specimens can be challenging. Recent literature showed p40 had higher specificity than p63 for this purpose. METHODS We identified 190 cytology cases with p40 (polyclonal) and p63 (monoclonal clone 4A4) immunohistochemistry, including specimens from fine-needle aspirations (FNAs) and effusions. RESULTS ACAs of lung origin stained for p40 and p63 in 21% and 20% of cases, respectively, regardless of specimen site. Among lung FNAs of primary pulmonary ACAs (n = 42), 14% were positive for p40 and 24% were positive for p63. Of the 20 pulmonary ACAs in effusions, more cases showed p40 positivity (40%) compared with FNAs, whereas p63 were positive in 15%. Among metastatic ACAs from other sites (n = 14), more cases were positive for p40 than p63. CONCLUSIONS Polyclonal p40 yields a level of false positivity in ACAs similar to p63, which is highest in effusions and is not limited to lung origin.
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Affiliation(s)
| | | | - Fang Zhou
- From New York University Langone Medical Center, New York, NY
| | | | | | - Aylin Simsir
- From New York University Langone Medical Center, New York, NY
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17
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Li H, Jiang Z, Leng Q, Bai F, Wang J, Ding X, Li Y, Zhang X, Fang H, Yfantis HG, Xing L, Jiang F. A prediction model for distinguishing lung squamous cell carcinoma from adenocarcinoma. Oncotarget 2017; 8:50704-50714. [PMID: 28881596 PMCID: PMC5584193 DOI: 10.18632/oncotarget.17038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/04/2017] [Indexed: 12/19/2022] Open
Abstract
Accurate classification of squamous cell carcinoma (SCC) from adenocarcinoma (AC) of non–small cell lung cancer (NSCLC) can lead to personalized treatments of lung cancer. We aimed to develop a miRNA-based prediction model for differentiating SCC from AC in surgical resected tissues and bronchoalveolar lavage (BAL) samples. Expression levels of seven histological subtype-associated miRNAs were determined in 128 snap-frozen surgical lung tumor specimens by using reverse transcription-polymerase chain reaction (RT-PCR) to develop an optimal panel of miRNAs for acutely distinguishing SCC from AC. The biomarkers were validated in an independent cohort of 112 FFPE lung tumor tissues, and a cohort of 127 BAL specimens by using droplet digital PCR for differentiating SCC from AC. A prediction model with two miRNAs (miRs-205-5p and 944) was developed that had 0.988 area under the curve (AUC) with 96.55% sensitivity and 96.43% specificity for differentiating SCC from AC in frozen tissues, and 0.997 AUC with 96.43% sensitivity and 96.43% specificity in FFPE specimens. The diagnostic performance of the prediction model was reproducibly validated in BAL specimens for distinguishing SCC from AC with a higher accuracy compared with cytology (95.69 vs. 68.10%; P < 0.05). The prediction model might have a clinical value for accurately discriminating SCC from AC in both surgical lung tumor tissues and liquid cytological specimens.
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Affiliation(s)
- Hui Li
- Department of Pathology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhengran Jiang
- Department of Pathology, the University of Maryland School of Medicine, Baltimore, Maryland, USA.,The F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Qixin Leng
- Department of Pathology, the University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Fan Bai
- Department of Pathology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Juan Wang
- Department of Pathology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaosong Ding
- Department of Pathology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuehong Li
- Department of Pathology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xianghong Zhang
- Department of Pathology, Hebei Medical University, Shijiazhuang, Hebei, China.,Department of Pathology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - HongBin Fang
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, D.C., USA
| | - Harris G Yfantis
- Pathology and Laboratory Medicine, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Lingxiao Xing
- Department of Pathology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Feng Jiang
- Department of Pathology, the University of Maryland School of Medicine, Baltimore, Maryland, USA
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18
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Kerr K, López-Ríos F. Precision medicine in NSCLC and pathology: how does ALK fit in the pathway? Ann Oncol 2016; 27 Suppl 3:iii16-iii24. [DOI: 10.1093/annonc/mdw302] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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19
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Wang W, Li X, Song W, Zhang Y, Yue C, Shang L, Li J, Wen F, Liu J, Zha P. An Atypically Large, Free-Floating Thrombus Extending From the Lung to the Left Atrium via a Pulmonary Vein: A Case Report. Medicine (Baltimore) 2015; 94:e1853. [PMID: 26579798 PMCID: PMC4652807 DOI: 10.1097/md.0000000000001853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
An atypically large, free-floating thrombus extending from primary pulmonary malignancy into the left atrium (LA) is a rare phenomenon. Here, we report a 61-year-old man presenting with a large mass in the lower lobe of the left lung, extending to LA via the left inferior pulmonary vein.The thrombus remained clinically silent and was detected by computed tomography (CT) and transthoracic echocardiography. To prevent life-threatening complications including systemic embolism and sudden death, the patient underwent surgical excision of the mass under cardiopulmonary bypass. Pathology of the tumor and the embolus was confirmed as moderately differentiated squamous cell carcinoma. Furthermore, immunohistochemical studies demonstrated consistency of the tumor cells in this pathological category.The patient tolerated the surgery well and his condition began to improve gradually after the operation.
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Affiliation(s)
- Wei Wang
- From the Department of Thoracic Surgery (WW, XL, WS, CY, LS, JL, FW, JL, PZ) and Department of Ultrasound (YZ), PLA Navy General Hospital, Beijing, China
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20
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Okabe N, Ezaki J, Yamaura T, Muto S, Osugi J, Tamura H, Imai JI, Ito E, Yanagisawa Y, Honma R, Gotoh M, Watanabe S, Waguri S, Suzuki H. FAM83B is a novel biomarker for diagnosis and prognosis of lung squamous cell carcinoma. Int J Oncol 2015; 46:999-1006. [PMID: 25586059 PMCID: PMC4324586 DOI: 10.3892/ijo.2015.2817] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/10/2014] [Indexed: 01/28/2023] Open
Abstract
Personalized therapy for non-small cell lung cancer (NSCLC), particularly lung adenocarcinoma, has recently been significantly improved by the discovery of various molecular targets. However, this has not been the case for lung squamous cell carcinoma (SCC). In the present study, we identified the family with sequence similarity 83, member B (FAM83B) as a candidate marker for SCC through a comprehensive gene expression analysis and examined its correlations with various clinicopathological factors. The subjects of this study consisted of 215 patients with NSCLC who underwent complete resection from 2005 to 2011 at the Fukushima Medical University Hospital (Fukushima, Japan). They included 102 patients with adenocarcinoma and 113 with SCC. FAM83B expression was first examined in some of the samples by gene expression analysis and western blotting, and then all clinical specimens were evaluated by immunohistochemistry (IHC). The relationship between the quantitative values for IHC and clinicopathological factors was statistically analyzed. The results showed that FAM83B mRNA expression was significantly higher in SCC than in normal lung or adenocarcinoma (P<0.0001). Immunoblot analysis also confirmed this trend. Specimens containing >10% positive area for FAM83B were judged as ‘positive’; 94.3% (107/113) of SCC and 14.7% (15/102) of adenocarcinoma were positive. Patients were divided into two subgroups according to expression (54 high-expression and 53 low-expression patients); the high-expression group was associated with a better disease-free survival (DFS) rate (P=0.042, log-rank test). In conclusion, FAM83B may be a reliable diagnostic and prognostic biomarker for SCC. Detailed analyses of FAM83B function in lung cancer are required to understand how its expression is associated with better prognosis in SCC.
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Affiliation(s)
- Naoyuki Okabe
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Junji Ezaki
- Medical‑Industrial Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Takumi Yamaura
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Satoshi Muto
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Jun Osugi
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Hirosumi Tamura
- Medical‑Industrial Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Jun-Ichi Imai
- Medical‑Industrial Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Emi Ito
- Medical‑Industrial Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | | | - Reiko Honma
- Nippon Gene Co., Ltd., Chiyoda, Tokyo 101‑0054, Japan
| | - Mitsukazu Gotoh
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Shinya Watanabe
- Medical‑Industrial Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Satoshi Waguri
- Medical‑Industrial Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
| | - Hiroyuki Suzuki
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960‑1295, Japan
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21
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ΔNp63 expression in four carcinoma cell lines and the effect on radioresistance—a siRNA knockdown model. Clin Oral Investig 2013; 18:1259-1268. [DOI: 10.1007/s00784-013-1078-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/24/2013] [Indexed: 12/17/2022]
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22
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Kanaji N, Bandoh S, Hayashi T, Haba R, Watanabe N, Ishii T, Kunitomo A, Takahama T, Tadokoro A, Imataki O, Dobashi H, Matsunaga T. EGFR mutation identifies distant squamous cell carcinoma as metastasis from lung adenocarcinoma. World J Respirol 2013; 3:38-43. [DOI: 10.5320/wjr.v3.i2.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/07/2013] [Accepted: 06/04/2013] [Indexed: 02/06/2023] Open
Abstract
Lung cancer metastasis is typically determined by histologic similarity between distant and primary lesions. Herein, we present a 70-year-old Japanese woman with an adenocarcinoma in her lung and a squamous cell carcinoma in her femur; both tumors had an identical epidermal growth factor receptor mutation, G719S. This indicated that both tumors had a common origin, despite their histologic dissimilarity. The tumor in the femur was thus identified genetically as a lung cancer metastasis. This case suggests that genetic analysis can determine whether a distant lesion is a lung cancer metastasis, particularly when the histology differs from that of the primary lesion.
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23
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Conde E, Angulo B, Izquierdo E, Paz-Ares L, Belda-Iniesta C, Hidalgo M, López-Ríos F. Lung adenocarcinoma in the era of targeted therapies: histological classification, sample prioritization, and predictive biomarkers. Clin Transl Oncol 2013; 15:503-8. [PMID: 23359174 PMCID: PMC3695315 DOI: 10.1007/s12094-012-0983-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 11/27/2012] [Indexed: 01/10/2023]
Abstract
The arrival of targeted therapies has presented both a conceptual and a practical challenge in the treatment of patients with advanced non-small cell lung carcinomas (NSCLCs). The relationship of these treatments with specific histologies and predictive biomarkers has made the handling of biopsies the key factor for success. In this study, we highlight the balance between precise histological diagnosis and the practice of conducting multiple predictive assays simultaneously. This can only be achieved where there is a commitment to multidisciplinary working by the tumor board to ensure that a sensible protocol is applied. This proposal for prioritizing samples includes both recent technological advances and the some of the latest discoveries in the molecular classification of NSCLCs.
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Affiliation(s)
- E. Conde
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - B. Angulo
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - E. Izquierdo
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - L. Paz-Ares
- Department of Oncology, Instituto de Biomedicina de Sevilla (IBIS) and Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - C. Belda-Iniesta
- Department of Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - M. Hidalgo
- Department of Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
| | - F. López-Ríos
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Faculty of Medicine, Universidad San Pablo-CEU, Madrid, Spain
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24
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Rossi G, Pelosi G, Barbareschi M, Graziano P, Cavazza A, Papotti M. Subtyping non-small cell lung cancer: relevant issues and operative recommendations for the best pathology practice. Int J Surg Pathol 2013; 21:326-36. [PMID: 23740564 DOI: 10.1177/1066896913489346] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Morphology still remains the cornerstone in lung cancer classification and cytology and small biopsy samples should be interpreted by morphology, whenever feasible, according to shared and widely agreed-upon diagnostic schemes. However, as novel therapy strategies are being offered on the basis of the diverse tumor characteristics, pathologists are now challenged by the need to offer clinicians more detailed typing of non-small cell lung cancer, not otherwise specified (NSCLC-NOS), especially when dealing with limited diagnostic material or poorly differentiated tumors. Close integration of morphology, immunohistochemistry, and clinical data is highly warranted according to a multidisciplinary approach to limit the category of NSCLC-NOS as much as possible or exclude unsuspected metastases, so rendering more definite and clinically useful diagnoses. Among the many proposed immunohistochemical markers, which as a whole are more practical and diagnostically useful than cumbersome and expensive molecular assays, a 2-hit model including thyroid transcription factor-1 (TTF-1) and p40 (the latter more specific for squamous differentiation than p63) seems to be the most effective to basically highlight adenocarcinoma (positivity for TTF-1 regardless of p63) and squamous (always strongly and diffusely positive for p40 or p63 and negative for TTF-1) differentiation. This minimalist 2-hit diagnostic approach paves the way to novel perspectives in clinical trials on lung cancer, and it is also in keeping with the need of strategically preserving diagnostic material for molecular assays that are essential for personalizing therapies.
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Affiliation(s)
- Giulio Rossi
- Azienda Arcispedale S Maria Nuova/IRCCS, Reggio Emilia, Italy
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25
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Hwang DH, Szeto DP, Perry AS, Bruce JL, Sholl LM. Pulmonary large cell carcinoma lacking squamous differentiation is clinicopathologically indistinguishable from solid-subtype adenocarcinoma. Arch Pathol Lab Med 2013; 138:626-35. [PMID: 23738762 DOI: 10.5858/arpa.2013-0179-oa] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Pulmonary large cell carcinoma (LCC) includes tumors not readily diagnosed as adenocarcinoma (ADC) or squamous cell carcinoma on morphologic grounds, without regard to immunophenotype, according to the World Health Organization (WHO). This ambiguous designation may cause confusion over selection of mutation testing and directed therapies. Several groups have proposed the use of immunohistochemistry (IHC) to recategorize LCC as ADC or squamous cell carcinoma; however, it remains unclear if strictly defined LCCs are a clinicopathologically distinct lung tumor subset. OBJECTIVE To compare the pathologic, molecular, and clinical features of 2 morphologically similar tumors: solid-subtype ADC and LCC. DESIGN Tumors were included on the basis of solid growth pattern; tumors with squamous or neuroendocrine differentiation were excluded. Solid ADC (n = 42) and LCC (n = 57) were diagnosed by using WHO criteria (5 intracellular mucin droplets in ≥2 high-power fields for solid ADC) and tested for KRAS, EGFR, and ALK alterations. RESULTS Both solid ADC and LCC groups were dominated by tumors with "undifferentiated"-type morphology and both had a high frequency of thyroid transcription factor 1 expression. KRAS was mutated in 38% of solid ADCs versus 43% of LCCs (P = .62). One ALK-rearranged and 1 EGFR-mutated tumor were detected in the solid ADC and LCC groups, respectively. There were no significant differences in clinical features or outcomes; the prevalence of smoking in both groups was greater than 95%. CONCLUSIONS Other than a paucity of intracellular mucin, LCC lacking squamous or neuroendocrine differentiation is indistinguishable from solid-subtype ADC. We propose the reclassification of these tumors as mucin-poor solid adenocarcinomas.
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Affiliation(s)
- David H Hwang
- Published as an Early Online Release June 5, 2013. From the Department of Pathology (Drs Hwang, Bruce, and Sholl, and Mr Szeto) and Center for Advanced Molecular Diagnostics (Mr Szeto and Drs Bruce and Sholl), Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts (Drs Hwang and Sholl); and the Department of Pathology, Banner MD Anderson Cancer Center, Gilbert, Arizona (Dr Perry)
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Rekhtman N, Tafe LJ, Chaft JE, Wang L, Arcila ME, Colanta A, Moreira AL, Zakowski MF, Travis WD, Sima CS, Kris MG, Ladanyi M. Distinct profile of driver mutations and clinical features in immunomarker-defined subsets of pulmonary large-cell carcinoma. Mod Pathol 2013; 26:511-22. [PMID: 23196793 PMCID: PMC3594043 DOI: 10.1038/modpathol.2012.195] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pulmonary large-cell carcinoma-a diagnostically and clinically controversial entity-is defined as a non-small-cell carcinoma lacking morphologic differentiation of either adenocarcinoma or squamous cell carcinoma, but suspected to represent an end stage of poor differentiation of these tumor types. Given the recent advances in immunohistochemistry to distinguish adenocarcinoma and squamous cell carcinoma, and the recent insights that several therapeutically relevant genetic alterations are distributed differentially in these tumors, we hypothesized that immunophenotyping may stratify large-cell carcinomas into subsets with distinct profiles of targetable driver mutations. We therefore analyzed 102 large-cell carcinomas by immunohistochemistry for TTF-1 and ΔNp63/p40 as classifiers for adenocarcinoma and squamous cell carcinoma, respectively, and correlated the resulting subtypes with nine therapeutically relevant genetic alterations characteristic of adenocarcinoma (EGFR, KRAS, BRAF, MAP2K1/MEK1, NRAS, ERBB2/HER2 mutations and ALK rearrangements) or more common in squamous cell carcinoma (PIK3CA and AKT1 mutations). The immunomarkers classified large-cell carcinomas as variants of adenocarcinoma (n=62; 60%), squamous cell carcinoma (n=20; 20%) or marker-null (n=20; 20%). Genetic alterations were found in 38 cases (37%), including EGFR (n=1), KRAS (n=30), BRAF (n=2), MAP2K1 (n=1), ALK (n=3) and PIK3CA (n=1). All molecular alterations characteristic of adenocarcinoma occurred in tumors with immunoprofiles of adenocarcinoma or marker-null, but not in tumors with squamous immunoprofiles (combined mutation rate 50% vs 30% vs 0%, respectively; P<0.001), whereas the sole PIK3CA mutation occurred in a tumor with squamous profile (5%). Furthermore, marker-null large-cell carcinomas were associated with significantly inferior disease-free (P<0.001) and overall (P=0.001) survival. In conclusion, the majority (80%) of large-cell carcinomas can be classified by immunomarkers as variants of adenocarcinoma or squamous cell carcinoma, which stratifies these tumors into subsets with a distinct distribution of driver mutations and distinct prognoses. These findings have practical implications for diagnosis, predictive molecular testing and therapy selection.
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Affiliation(s)
- Natasha Rekhtman
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Lopez-Rios F, Angulo B, Gomez B, Mair D, Martinez R, Conde E, Shieh F, Tsai J, Vaks J, Current R, Lawrence HJ, Gonzalez de Castro D. Comparison of molecular testing methods for the detection of EGFR mutations in formalin-fixed paraffin-embedded tissue specimens of non-small cell lung cancer. J Clin Pathol 2013; 66:381-5. [PMID: 23386666 PMCID: PMC3632986 DOI: 10.1136/jclinpath-2012-201240] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aim To conduct a methods correlation study of three different assays for the detection of mutations at EGFR gene in human formalin-fixed paraffin-embedded tumour (FFPET) specimens of non-small cell lung carcinomas (NSCLC). Methods We conducted a 2-site method comparison study of two european conformity (CE) in vitro diagnostic (IVD)-marked assays, the cobas EGFR Mutation Test and the Therascreen EGFR29 Mutation Kit, and 2× bidirectional Sanger sequencing. We blind-tested 124 NSCLC FFPET specimens with all three methods; the cobas test was performed at both sites. Positive (PPA) and negative percent agreements (NPA) were determined for the cobas test versus each of the other two methods. Specimens yielding discordant test results between methods were further tested using quantitative massively parallel pyrosequencing (MPP). Results PPA between cobas and Sanger was 98.8%; NPA was 79.3%. Overall there were seven discordant results. MPP confirmed an exon 19 deletion in two cases and L858R mutation in four cases. PPA between cobas and Therascreen was 98.9% and NPA was 100%. There was one discordant result. Reproducibility of the cobas test between the two sites was 99.2%. Conclusions The invalid rates for the cobas test and Therascreen were lower than Sanger sequencing. The cobas and Therascreen assays showed a high degree of concordance, and both were more sensitive for the detection of exon 19 deletion and L858R mutations than Sanger. The cobas test was highly reproducible between the two testing sites, used the least amount of DNA input and was the only test with automated results reporting.
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Affiliation(s)
- Fernando Lopez-Rios
- Laboratorio de Dianas Terapeuticas, Centro Integral Oncologico Clara Campal, Hospital Universitario Madrid Sanchinarro, Madrid, Spain.
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Conde E, Angulo B, Izquierdo E, Muñoz L, Suárez‐Gauthier A, Plaza C, Dominguez N, Torres M, Madrigal L, Rubio‐Viqueira B, Belda‐Iniesta C, Hidalgo M, López‐Ríos F. The
ALK
translocation in advanced non‐small‐cell lung carcinomas: preapproval testing experience at a single cancer centre. Histopathology 2013; 62:609-16. [DOI: 10.1111/his.12037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 09/28/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Esther Conde
- Laboratorio de Dianas Terapéuticas Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU MadridSpain
| | - Bárbara Angulo
- Laboratorio de Dianas Terapéuticas Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU MadridSpain
| | - Elisa Izquierdo
- Laboratorio de Dianas Terapéuticas Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU MadridSpain
| | - Luna Muñoz
- Laboratorio de Dianas Terapéuticas Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU MadridSpain
| | - Ana Suárez‐Gauthier
- Laboratorio de Dianas Terapéuticas Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU MadridSpain
| | - Carlos Plaza
- Laboratorio de Dianas Terapéuticas Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU MadridSpain
| | - Nuria Dominguez
- Laboratorio de Dianas Terapéuticas Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU MadridSpain
| | - Maribel Torres
- Radiology Department Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU Madrid Spain
| | - Luis Madrigal
- Thoracic Surgery Department Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU Madrid Spain
| | - Belén Rubio‐Viqueira
- Oncology Department Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU Madrid Spain
| | - Cristobal Belda‐Iniesta
- Oncology Department Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU Madrid Spain
| | - Manuel Hidalgo
- Oncology Department Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU Madrid Spain
| | - Fernando López‐Ríos
- Laboratorio de Dianas Terapéuticas Centro Integral Oncológico ‘Clara Campal’, Hospital Universitario Madrid Sanchinarro Universidad San Pablo‐CEU MadridSpain
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Kim MJ, Shin HC, Shin KC, Ro JY. Best immunohistochemical panel in distinguishing adenocarcinoma from squamous cell carcinoma of lung: tissue microarray assay in resected lung cancer specimens. Ann Diagn Pathol 2012; 17:85-90. [PMID: 23040737 DOI: 10.1016/j.anndiagpath.2012.07.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 07/17/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
Abstract
The emergence of the targeted therapies for non-small cell lung carcinoma (NSCLC) has generated a need for accurate histologic subtyping of NSCLC. In this study, we assessed the utility of immunohistochemical markers that could be helpful in distinction between adenocarcinoma (ADC) and squamous cell carcinoma (SCC). We performed a battery of immunohistochemistry using tissue microarray for napsin-A, Thyroid transcription factor 1 (TTF-1), p63, cytokeratin (CK) 5/6, thrombomodulin (CD141), Epithelial-related antigen (MOC-31), carcinoembryonic antigen (CEA), Cyclooxygenase 2 (COX-2), high-molecular-weight CK (HMWCK), p27kip1 (p27), and Rb protein in 129 resected primary NSCLC with 81 ADCs and 48 SCCs and 10 metastatic ADC to the lung (primary in colon, 7 cases; stomach, 2 cases; vagina, 1 case). Cases of ADC and SCC were morphologically unequivocal and solid tumors with no definite squamous or glandular differentiation were excluded for this analysis. Napsin-A and TTF-1 were positive in 81% and 70% of ADC and in 0% and 2% of SCC, respectively, whereas P63 and CK5/6 were positive in 91% and 90% of SCC and in 9% and 4% of ADC, respectively (P < .001). CD141 stained significantly higher in SCC over ADC (positive in 2% of ADC and 46% of SCC. MOC-31, CEA, COX-2, HMWCK, p27, and Rb appeared to be not useful markers in distinction between ADC and SCC because of their low specificity. None of metastatic ADC to the lung showed positive for napsin-A and TTF-1. It was evident that combination of napsin-A, TTF-1, CK5/6, and p63 was the best immunohistochemical panel in differentiating ADC from SCC of the lung in this study. CD141 appeared to be a potential new marker for SCC with high specificity. Cyclooxygenase 2, MOC-31, CEA, HMWCK, p27, and Rb showed less specificity for differentiation ADC from SCC.
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Affiliation(s)
- Mi Jin Kim
- Department of Pathology, Yeungnam University College of Medicine, Nam-gu, Daegu, South Korea.
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Bone marrow-derived cells contribute to NDEA-induced lung squamous cell carcinoma. Tumour Biol 2012; 34:145-54. [PMID: 23055190 DOI: 10.1007/s13277-012-0522-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/09/2012] [Indexed: 01/09/2023] Open
Abstract
Bone marrow-derived stem cells (BMDCs) have the ability to differentiate into lung epithelial cells in response to damage; however, their role in squamous cell carcinoma (SCC) formation is unknown. This study aimed to determine whether BMDC-derived lung epithelial cells could contribute to SCC formation. A model of lung SCC induced with N-nitrosodiethylamine (NDEA) in recipient female mice transplanted with green fluorescent protein (GFP)-positive BMDCs from male donors was established. Incorporation of BMDCs in lung tissue was determined using immunohistochemistry and immunofluorescence to detect GFP expression and fluorescence in situ hybridization to Y chromosomes. BMDC appeared at three stages of lung SCC progression: metaplasia, dysplasia, and carcinoma. There was a significantly higher proportion of GFP-positive (GFP(+)) cells within SCC than was found in metaplasia and dysplasia 16 weeks post-transplantation (both P < 0.017); GFP(+) BMDCs were also observed in clusters within several SCC nests. Furthermore, most GFP(+) cells in SCC were pancytokeratin-positive (PCK(+)) epithelial cells, and some exhibited proliferative activity as determined by Ki67 staining (9.7 ± 3.92 %). The presence of GFP(+)Ki67(+)PCK(+) cells within SCC nests suggested that some donor BMDCs differentiated into proliferating epithelial cells. Finally, analysis of p63 expression, a marker of SCC cells, indicated that the presence of GFP(+)p63(+) cells (green) in inner parts of the SCC. These findings strongly suggest that BMDC-derived lung epithelial cells could participate in lung SCC formation and partially contribute to tumor growth, which might have significant potential implications for both clinical cancer therapy using BMDCs.
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Angulo B, Conde E, Suárez-Gauthier A, Plaza C, Martínez R, Redondo P, Izquierdo E, Rubio-Viqueira B, Paz-Ares L, Hidalgo M, López-Ríos F. A comparison of EGFR mutation testing methods in lung carcinoma: direct sequencing, real-time PCR and immunohistochemistry. PLoS One 2012; 7:e43842. [PMID: 22952784 PMCID: PMC3428292 DOI: 10.1371/journal.pone.0043842] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 07/30/2012] [Indexed: 01/06/2023] Open
Abstract
The objective of this study is to compare two EGFR testing methodologies (a commercial real-time PCR kit and a specific EGFR mutant immunohistochemistry), with direct sequencing and to investigate the limit of detection (LOD) of both PCR-based methods. We identified EGFR mutations in 21 (16%) of the 136 tumours analyzed by direct sequencing. Interestingly, the Therascreen EGFR Mutation Test kit was able to characterize as wild-type one tumour that could not be analyzed by direct sequencing of the PCR product. We then compared the LOD of the kit and that of direct sequencing using the available mutant tumours. The kit was able to detect the presence of a mutation in a 1% dilution of the total DNA in nine of the 18 tumours (50%), which tested positive with the real-time quantitative PCR method. In all cases, EGFR mutation was identified at a dilution of 5%. Where the mutant DNA represented 30% of the total DNA, sequencing was able to detect mutations in 12 out of 19 cases (63%). Additional experiments with genetically defined standards (EGFR ΔE746-A750/+ and EGFR L858R/+) yielded similar results. Immunohistochemistry (IHC) staining with exon 19-specific antibody was seen in eight out of nine cases with E746-A750del detected by direct sequencing. Neither of the two tumours with complex deletions were positive. Of the five L858R-mutated tumours detected by the PCR methods, only two were positive for the exon 21-specific antibody. The specificity was 100% for both antibodies. The LOD of the real-time PCR method was lower than that of direct sequencing. The mutation specific IHC produced excellent specificity.
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Affiliation(s)
- Bárbara Angulo
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Esther Conde
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Ana Suárez-Gauthier
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Carlos Plaza
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Rebeca Martínez
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Pilar Redondo
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Elisa Izquierdo
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
| | - Belén Rubio-Viqueira
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
- Gastrointestinal Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Luis Paz-Ares
- Department of Oncology, Instituto de Biomedicina de Sevilla (IBIS) & Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Hidalgo
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
- Gastrointestinal Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Fernando López-Ríos
- Laboratorio de Dianas Terapéuticas, Faculty of Medicine, Centro Integral Oncológico “Clara Campal”, Hospital HM Universitario Sanchinarro, Universidad San Pablo-CEU, Madrid, Spain
- * E-mail:
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Prognosis of Metastatic Carcinoma of the Lung in the Bevacizumab Era: Comparison Between the Major Histologic Types of Lung Cancer. J Surg Res 2012; 174:20-3. [DOI: 10.1016/j.jss.2011.06.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 06/06/2011] [Accepted: 06/21/2011] [Indexed: 12/21/2022]
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Mittal S, Jain D, Roy S, Mehta VS. Correlation of p63 Protein Expression With Histological Grade of Meningiomas. Int J Surg Pathol 2012; 20:349-54. [DOI: 10.1177/1066896911434549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prediction of tumor behavior in meningiomas based on morphological features alone remains difficult. Several immunohistochemical biomarkers have been proposed to assist conventional methods. However, no single immunohistochemical marker can unequivocally discriminate between benign and aggressive meningiomas. There is only 1 study available in the literature that correlates p63 expression with overall histological grade of the meningioma. The present study is undertaken to assess the correlation between p63 expression and histological grade of meningiomas. For this purpose, the authors studied and analyzed the immunohistochemical expression of p63 in 85 cases of meningioma, including WHO grade I (63), grade II (11), and grade III (11) cases. Correlation between histological grade and nuclear immunoreactivity to p63 antibody was performed. Furthermore, expression of p63 protein was correlated with short clinical follow-up and Ki-67 proliferation index. Among 85 patients analyzed, there were 61 women (71.7 %) and 24 men (28.2%) between 7 and 75 years old. Expression of p63 protein was found in 34.9% of grade I cases, but in grade II and III, 63.6% of cases each were immunoreactive. Correlation between histological grade and p63 immunoreactivity was significant ( P = .02). p63-positive grade I meningiomas did not show elevated Ki-67 index. The present study contradicts earlier reports because there are a considerable number of grade I meningiomas that express p63. Although p63 expression is significantly associated with higher histological grade of meningiomas, it may not be considered as a sole biomarker to assess aggressive behavior of the tumor.
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Utility of 10 immunohistochemical markers including novel markers (desmocollin-3, glypican 3, S100A2, S100A7, and Sox-2) for differential diagnosis of squamous cell carcinoma from adenocarcinoma of the Lung. J Thorac Oncol 2011; 6:1190-9. [PMID: 21623236 DOI: 10.1097/jto.0b013e318219ac78] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Recent clinical trials revealed that accurate histologic typing of non-small cell lung cancer, especially squamous cell carcinoma (SCC), is essential. PATIENTS AND METHODS We analyzed 10 antibodies expression in 150 SCC cases (53 well-, 51 moderately, and 46 poorly differentiated cases) and 159 adenocarcinoma (AC) cases (49 well-, 52 moderately, and 58 poorly differentiated cases). RESULTS In all SCC and AC cases, p63 was the most sensitive marker for SCC (98.7%), followed by high-molecular-weight (HM) cytokeratin (CK) (97.3%), CK5/6 (93.3%), Sox2 (80%), thrombomodulin (79.3%), desmocollin-3 (72.7%), S100A7 (70.7%), S100A2 (63.3%), and glypican-3 (46.7%). Desmocollin-3 was the most specific marker for SCC (100%), followed by CK5/6 (98%), Sox2 (95.5%), glypican-3 (92.4%), S100A7 (86.8%), thrombomodulin (79.9%), S100A2 (64.6%), p63 (51.6%), and HMCK (33.3%). Thyroid transcription factor-1 (TTF-1) expression was observed in 87.4% of AC cases and 2.0% of SCC cases. When analyzing only poorly differentiated tumors, HMCK was the most sensitive marker for SCC (100%), followed by p63 (97.8%), CK5/6 (87.0%), Sox2 (71.7%), thrombomodulin (58.7%), desmocollin-3 (52.2%), S100A2 (50%), glypican-3 (45.7%), and S100A7 (45.7%). Desmocollin-3 was the most specific marker for poorly differentiated SCC (100%), followed by CK5/6 (98.3%), glypican-3 (94.8%), Sox2 (94.8%), S100A2 (81%), S100A7 (75.9%), thrombomodulin (72.4%), p63 (48.3%), and HMCK (36.8%). The 10-fold crossvalidated classification and regression tree analysis revealed that the combination of CK5/6 and TTF-1 was the best immunohistochemical marker panel for the differentiation between SCC and AC. CONCLUSION CK5/6 is the best marker for differentiating SCC and AC, irrespective of the histological grade of the tumor. Thus, the combination of CK5/6 and TTF-1 is the most recommended combination of immunohistochemical markers.
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Thunnissen E, Kerr KM, Herth FJF, Lantuejoul S, Papotti M, Rintoul RC, Rossi G, Skov BG, Weynand B, Bubendorf L, Katrien G, Johansson L, López-Ríos F, Ninane V, Olszewski W, Popper H, Jaume S, Schnabel P, Thiberville L, Laenger F. The challenge of NSCLC diagnosis and predictive analysis on small samples. Practical approach of a working group. Lung Cancer 2011; 76:1-18. [PMID: 22138001 DOI: 10.1016/j.lungcan.2011.10.017] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 10/20/2011] [Accepted: 10/22/2011] [Indexed: 12/17/2022]
Abstract
Until recently, the division of pulmonary carcinomas into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) was adequate for therapy selection. Due to the emergence of new treatment options subtyping of NSCLC and predictive testing have become mandatory. A practical approach to the new requirements involving interaction between pulmonologist, oncologist and molecular pathology to optimize patient care is described. The diagnosis of lung cancer involves (i) the identification and complete classification of malignancy, (ii) immunohistochemistry is used to predict the likely NSCLC subtype (squamous cell vs. adenocarcinoma), as in small diagnostic samples specific subtyping is frequently on morphological grounds alone not feasible (NSCLC-NOS), (iii) molecular testing. To allow the extended diagnostic and predictive examination (i) tissue sampling should be maximized whenever feasible and deemed clinically safe, reducing the need for re-biopsy for additional studies and (ii) tissue handling, processing and sectioning should be optimized. Complex diagnostic algorithms are emerging, which will require close dialogue and understanding between pulmonologists and others who are closely involved in tissue acquisition, pathologists and oncologists who will ultimately, with the patient, make treatment decisions. Personalized medicine not only means the choice of treatment tailored to the individual patient, but also reflects the need to consider how investigative and diagnostic strategies must also be planned according to individual tumour characteristics.
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Affiliation(s)
- Erik Thunnissen
- Department of Pathology, VU Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Barbareschi M, Cantaloni C, Del Vescovo V, Cavazza A, Monica V, Carella R, Rossi G, Morelli L, Cucino A, Silvestri M, Tirone G, Pelosi G, Graziano P, Papotti M, Palma PD, Doglioni C, Denti MA. Heterogeneity of large cell carcinoma of the lung: an immunophenotypic and miRNA-based analysis. Am J Clin Pathol 2011; 136:773-82. [PMID: 22031317 DOI: 10.1309/ajcpyy79xagraycj] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Large cell carcinomas (LCCs) of the lung are heterogeneous and may be of different cell lineages. We analyzed 56 surgically resected lung tumors classified as LCC on the basis of pure morphologic grounds, using a panel of immunophenotypic markers (adenocarcinoma [ADC]-specific, thyroid transcription factor-1, cytokeratin 7, and napsin A; squamous cell carcinoma [SQCC]-specific, p63, cytokeratin 5, desmocollin 3, and Δnp63) and the quantitative analysis of microRNA-205 (microRNA sample score [mRSS]). Based on immunoprofiles 19 (34%) of the cases were reclassified as ADC and 14 (25%) as SQCC; 23 (41%) of the cases were unclassifiable. Of these 23 cases, 18 were classified as ADC and 5 as SQCC according to the mRSS. Our data show that an extended panel of immunohistochemical markers can reclassify around 60% of LCCs as ADC or SQCC. However, a relevant percentage of LCCs may escape convincing immunohistochemical classification, and mRSS could be used for further typing, but its clinical relevance needs further confirmation.
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Affiliation(s)
- Mattia Barbareschi
- Unit of Surgical Pathology, Trento, Italy
- Laboratory of Molecular Pathology, Trento, Italy
- Trentino Biobank, Unit of Surgical Pathology, Trento, Italy
| | - Chiara Cantaloni
- Unit of Surgical Pathology, Trento, Italy
- Trentino Biobank, Unit of Surgical Pathology, Trento, Italy
| | | | - Alberto Cavazza
- Unit of Pathologic Anatomy, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Valentina Monica
- Unit of Pathologic Anatomy, San Luigi Hospital and University of Turin, Orbassano, Italy
| | - Rodolfo Carella
- Unit of Surgical Pathology, S. Maurizio Hospital, Bolzano, Italy
| | - Giulio Rossi
- Section of Pathologic Anatomy, Azienda Ospedaliera-Universitaria Policlinico, Modena, Italy
| | | | | | | | | | - Giuseppe Pelosi
- Unit of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Graziano
- Unit of Pathologic Anatomy, Forlanini Hospital, Rome, Italy
| | - Mauro Papotti
- Unit of Pathologic Anatomy, San Luigi Hospital and University of Turin, Orbassano, Italy
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Shimoji M, Nakajima T, Yamatani C, Yamamoto M, Saishou S, Isaka M, Maniwa T, Ode Y, Nakagawa K, Okumura T, Watanabe R, Ito I, Kameya T, Endo M, Kondo H. A clinicopathological and immunohistological re-evaluation of adenosquamous carcinoma of the lung. Pathol Int 2011; 61:717-22. [PMID: 22126378 DOI: 10.1111/j.1440-1827.2011.02730.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Since the World Health Organization histological criteria were published in 1999, several studies have focused on adenosquamous carcinoma of the lung. Therefore, we aimed to clinicopathologically re-evaluate this tumor using immunohistochemical methods. In our hospital, there have been 21 surgically resected adenosquamous carcinomas. The frequency of adenosquamous carcinoma was 1.9% and the clinical data including the patient prognosis data obtained in this study were similar to those reported previously. A fluorodeoxyglucose positron emission tomography study first revealed that the median maximum standardized uptake value of adenosquamous carcinoma was 9.3 and ranged from 2.0 to 24.5. According to the results of immunohistochemical staining for thyroid transcription factor-1 (TTF-1) and p63, adenosquamous carcinomas were divided into four subgroups: group 1, TTF-1+ and p63+ (10 cases); group 2, TTF-1- and p63+ (six cases); group 3, TTF-1+ and p63- (three cases); and group 4, TTF-1- and p63- (two cases). Of the six group 2 tumors, three were composed of unique solid nests with mucin-filled cysts and showed characteristic p63 expression, which might suggest a special type of adenosquamous carcinoma. Immunohistochemical analysis of TTF-1 and p63 expression shows that adenosquamous carcinoma is composed of diverse tumor groups, for which the biological and histogenetic nature further needs to be clarified.
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Affiliation(s)
- Masaki Shimoji
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo, Nagaizumi, Shizuoka, Japan
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39
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Rekhtman N, Ang DC, Sima CS, Travis WD, Moreira AL. Immunohistochemical algorithm for differentiation of lung adenocarcinoma and squamous cell carcinoma based on large series of whole-tissue sections with validation in small specimens. Mod Pathol 2011; 24:1348-59. [PMID: 21623384 DOI: 10.1038/modpathol.2011.92] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immunohistochemistry is increasingly utilized to differentiate lung adenocarcinoma and squamous cell carcinoma. However, detailed analysis of coexpression profiles of commonly used markers in large series of whole-tissue sections is lacking. Furthermore, the optimal diagnostic algorithm, particularly the minimal-marker combination, is not firmly established. We therefore studied whole-tissue sections of resected adenocarcinoma and squamous cell carcinoma (n=315) with markers commonly used to identify adenocarcinoma (TTF-1) and squamous cell carcinoma (p63, CK5/6, 34βE12), and prospectively validated the devised algorithm in morphologically unclassifiable small biopsy/cytology specimens (n=38). Analysis of whole-tissue sections showed that squamous cell carcinoma had a highly consistent immunoprofile (TTF-1-negative and p63/CK5/6/34βE12-diffuse) with only rare variation. In contrast, adenocarcinoma showed significant immunoheterogenetity for all 'squamous markers' (p63 (32%), CK5/6 (18%), 34βE12 (82%)) and TTF-1 (89%). As a single marker, only diffuse TTF-1 was specific for adenocarcinoma whereas none of the 'squamous markers,' even if diffuse, were entirely specific for squamous cell carcinoma. In contrast, coexpression profiles of TTF-1/p63 had only minimal overlap between adenocarcinoma and squamous cell carcinoma, and there was no overlap if CK5/6 was added as a third marker. An algorithm was devised in which TTF-1/p63 were used as the first-line panel, and CK5/6 was added for rare indeterminate cases. Prospective validation of this algorithm in small specimens showed 100% accuracy of adenocarcinoma vs squamous cell carcinoma prediction as determined by subsequent resection. In conclusion, although reactivity for 'squamous markers' is common in lung adenocarcinoma, a two-marker panel of TTF-1/p63 is sufficient for subtyping of the majority of tumors as adenocarcinomas vs squamous cell carcinoma, and addition of CK5/6 is needed in only a small subset of cases. This simple algorithm achieves excellent accuracy in small specimens while conserving the tissue for potential predictive marker testing, which is now an essential consideration in advanced lung cancer specimens.
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Affiliation(s)
- Natasha Rekhtman
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Abstract
Recent advances in non-small-cell lung cancer (NSCLC) therapy mean the relatively simple discrimination between small-cell and 'non-small-cell' carcinoma is insufficient to determine the best treatment for individual patients. Safety, efficacy and prescribing requirements mandate more specific subtyping of NSCLC for several new drugs: practice made difficult by the tumour heterogeneity combined with the paucity of tissue in most diagnostic samples. Immunohistochemical approaches have emerged as accurate predictors of probable tumour histotype. P63 and/or cytokeratins 5 and 6 and thyroid transcription factor 1 (TTF1) are among the best predictors, respectively, of squamous and adenocarcinoma histology. Molecular characteristics may predict response to both newer molecular targeted agents and traditional cytotoxic agents. Specific mutations in the epidermal growth factor receptor (EGFR) gene as predictors of response to EGFR tyrosine kinase inhibitors (erlotinib, gefitinib) is the first example of markers which predict response to targeted agents. Actual drug targets [e.g. thymidilate synthase (TS) - pemetrexed] or markers of the tumour's ability to repair cytotoxic drug-induced damage [e.g. excision repair cross-complementation group 1 (ERCC1) - cisplatin] may well also complement NSCLC diagnosis. This extended diagnostic requirement from increasingly limited material provided by minimally invasive biopsy techniques poses major challenges for pathology.
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Affiliation(s)
- Keith M Kerr
- Aberdeen University Medical School, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
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