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Sorbye H, Knappskog S, Grob T, Venizelos A, Amstutz U, Hjortland G, Lothe I, Kersten C, Hofsli E, Sundlov A, Elvebakken H, Garresori H, Couvelard A, Svensson J, Perren A. 890MO Mutation spectrum in liquid versus solid biopsies from advanced digestive neuroendocrine carcinoma patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Evrard D, Hourseau M, Couvelard A, Paradis V, Gauthier H, Raymond E, Halimi C, Barry B, Faivre S. PD-L1 expression in the microenvironment and the response to checkpoint inhibitors in head and neck squamous cell carcinoma. Oncoimmunology 2020; 9:1844403. [PMID: 33299655 PMCID: PMC7714503 DOI: 10.1080/2162402x.2020.1844403] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In head and neck squamous cell carcinoma (HNSCC), data from studies using checkpoint-inhibiting antibodies that target programmed death 1 (PD-1) or its ligand the programmed death ligand 1 (PD-L1) demonstrated outstanding clinical activity. Translational investigations also suggested some correlations between therapeutic response and PD-L1 expression in tumor tissue. We comprehensively summarize results that have evaluated PD-L1 expression in HNSCC. We discuss flaws and strength of current PD-1/PD-L1 detection, quantification methods and the evaluation of PD-L1 as a prognostic and theragnostic biomarker. Understanding tumor microenvironment may help understanding resistance to checkpoint inhibitors, designing clinical trials that can exploit drug combinations.
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Affiliation(s)
- D Evrard
- Department of Otorhinolaryngology, Bichat Hospital, Paris, France
| | - M Hourseau
- Pathology Department, Bichat Hospital, Paris 7 University, Paris, France
| | - A Couvelard
- Pathology Department, Bichat Hospital, Paris 7 University, Paris, France
| | - V Paradis
- Pathology Department, Beaujon Hospital, Paris 7 University, Paris, France
| | - H Gauthier
- Medical Oncology Department, Saint-Louis Hospital, Paris 7 University, Paris, France
| | - E Raymond
- Medical Oncology Department, Paris-St Joseph Hospital, Paris, France
| | - C Halimi
- Department of Otorhinolaryngology, Bichat Hospital, Paris, France
| | - B Barry
- Department of Otorhinolaryngology, Bichat Hospital, Paris, France
| | - S Faivre
- Medical Oncology Department, Saint-Louis Hospital, Paris 7 University, Paris, France
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Azoulay A, Cros J, Vullierme MP, de Mestier L, Couvelard A, Hentic O, Ruszniewski P, Sauvanet A, Vilgrain V, Ronot M. Morphological imaging and CT histogram analysis to differentiate pancreatic neuroendocrine tumor grade 3 from neuroendocrine carcinoma. Diagn Interv Imaging 2020; 101:821-830. [PMID: 32709455 DOI: 10.1016/j.diii.2020.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare morphological imaging features and CT texture histogram parameters between grade 3 pancreatic neuroendocrine tumors (G3-NET) and neuroendocrine carcinomas (NEC). MATERIALS AND METHODS Patients with pathologically proven G3-NET and NEC, according to the 2017 World Health Organization classification who had CT and MRI examinations between 2006-2017 were retrospectively included. CT and MRI examinations were reviewed by two radiologists in consensus and analyzed with respect to tumor size, enhancement patterns, hemorrhagic content, liver metastases and lymphadenopathies. Texture histogram analysis of tumors was performed on arterial and portal phase CT images. images. Morphological imaging features and CT texture histogram parameters of G3-NETs and NECs were compared. RESULTS Thirty-seven patients (21 men, 16 women; mean age, 56±13 [SD] years [range: 28-82 years]) with 37 tumors (mean diameter, 60±46 [SD] mm) were included (CT available for all, MRI for 16/37, 43%). Twenty-three patients (23/37; 62%) had NEC and 14 patients (14/37; 38%) had G3-NET. NECs were larger than G3-NETs (mean, 70±51 [SD] mm [range: 18 - 196mm] vs. 42±24 [SD] mm [range: 8 - 94mm], respectively; P=0.039), with more tumor necrosis (75% vs. 33%, respectively; P=0.030) and lower attenuation on precontrast (30±4 [SD] HU [range: 25-39 HU] vs. 37±6 [SD] [range: 25-45 HU], respectively; P=0.002) and on portal venous phase CT images (75±18 [SD] HU [range: 43 - 108 HU] vs. 92±19 [SD] HU [range: 46 - 117 HU], respectively; P=0.014). Hemorrhagic content on MRI was only observed in NEC (P=0.007). The mean ADC value was lower in NEC ([1.1±0.1 (SD)]×10-3 mm2/s [range: (0.91 - 1.3)×10-3 mm2/s] vs. [1.4±0.2 (SD)]×10-3 mm2/s [range: (1.1 - 1.6)×10-3 mm2/s]; P=0.005). CT histogram analysis showed that NEC were more heterogeneous on portal venous phase images (Entropy-0: 4.7±0.2 [SD] [range: 4.2-5.1] vs. 4.5±0.4 [SD] [range: 3.7-4.9]; P=0.023). CONCLUSION Pancreatic NECs are larger, more frequently hypoattenuating and more heterogeneous with hemorrhagic content than G3-NET on CT and MRI.
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Affiliation(s)
- A Azoulay
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France
| | - J Cros
- Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; Université de Paris, Diderot Paris 7, 75010 Paris, France; INSERM U1149, CRI, Paris, France
| | - M-P Vullierme
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France
| | - L de Mestier
- Université de Paris, Diderot Paris 7, 75010 Paris, France; Department of Pancreatology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; INSERM U1149, CRI, Paris, France
| | - A Couvelard
- Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; Université de Paris, Diderot Paris 7, 75010 Paris, France; INSERM U1149, CRI, Paris, France
| | - O Hentic
- Department of Pancreatology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France
| | - P Ruszniewski
- Université de Paris, Diderot Paris 7, 75010 Paris, France; Department of Pancreatology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; INSERM U1149, CRI, Paris, France
| | - A Sauvanet
- Department of HPB Surgery, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France
| | - V Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; Université de Paris, Diderot Paris 7, 75010 Paris, France; INSERM U1149, CRI, Paris, France
| | - M Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; Université de Paris, Diderot Paris 7, 75010 Paris, France; INSERM U1149, CRI, Paris, France.
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Esnault H, Lahaye C, Girard L, Desoutter MA, Couvelard A, Alexandra JF, Faucher N, Raynaud-Simon A, Lilamand M, Sanchez M. [Bilateral adrenal tumors]. Rev Med Interne 2019; 41:62-64. [PMID: 31133331 DOI: 10.1016/j.revmed.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/23/2019] [Indexed: 11/25/2022]
Affiliation(s)
- H Esnault
- Département de gériatrie, hôpital universitaire Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Lahaye
- Département de gériatrie, hôpital universitaire Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Diderot-Paris VII, Paris, France
| | - L Girard
- Département de gériatrie, hôpital universitaire Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - M-A Desoutter
- Département de gériatrie, hôpital universitaire Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Couvelard
- Département d'anatomo-pathologie, hôpital universitaire Bichat, Paris, France
| | - J-F Alexandra
- Département de médecine interne, hôpital universitaire Bichat, Paris, France
| | - N Faucher
- Département de gériatrie, hôpital universitaire Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Raynaud-Simon
- Département de gériatrie, hôpital universitaire Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Diderot-Paris VII, Paris, France
| | - M Lilamand
- Département de gériatrie, hôpital universitaire Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Diderot-Paris VII, Paris, France
| | - M Sanchez
- Département de gériatrie, hôpital universitaire Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Diderot-Paris VII, Paris, France.
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Messal N, Fernandez N, Dayot S, Gratio V, Nicole P, Prochasson C, Chantret I, LeGuilloux G, Jarry A, Couvelard A, Tréton X, Voisin T, Ogier-Denis E, Couvineau A. Ectopic expression of OX1R in ulcerative colitis mediates anti-inflammatory effect of orexin-A. Biochim Biophys Acta Mol Basis Dis 2018; 1864:3618-3628. [PMID: 30251681 DOI: 10.1016/j.bbadis.2018.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 02/08/2023]
Abstract
Orexins (orexin-A and orexin-B) are hypothalamic peptides that are produced by the same precursor and are involved in sleep/wake control, which is mediated by two G protein-coupled receptor subtypes, OX1R and OX2R. Ulcerative colitis (UC) is an inflammatory bowel disease, (IBD) which is characterized by long-lasting inflammation and ulcers that affect the colon and rectum mucosa and is known to be a significant risk factor for colon cancer development. Based on our recent studies showing that OX1R is aberrantly expressed in colon cancer, we wondered whether orexin-A could play a role in UC. Immunohistochemistry studies revealed that OX1R is highly expressed in the affected colonic epithelium of most UC patients, but not in the non-affected colonic mucosa. Injection of exogenous orexin-A specifically improved the inflammatory symptoms in the two colitis murine models. Conversely, injection of inactive orexin-A analog, OxB7-28 or OX1R specific antagonist SB-408124 did not have anti-inflammatory effect. Moreover, treatment with orexin-A in DSS-colitis induced OX1R-/- knockout mice did not have any protective effect. The orexin-A anti-inflammatory effect was due to the decreased expression of pro-inflammatory cytokines in immune cells and specifically in T-cells isolated from colonic mucosa. Moreover, orexin-A inhibited canonical NFκB activation in an immune cell line and in intestinal epithelial cell line. These results suggest that orexin-A might represent a promising alternative to current UC therapies.
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Affiliation(s)
- N Messal
- INSERM UMR1149/Inflammation Research Center (CRI), Team "From inflammation to cancer in digestive diseases" labeled by "la Ligue Nationale contre le Cancer", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - N Fernandez
- INSERM UMR1149/Inflammation Research Center (CRI), Team "Intestinal inflammation", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - S Dayot
- INSERM UMR1149/Inflammation Research Center (CRI), Team "From inflammation to cancer in digestive diseases" labeled by "la Ligue Nationale contre le Cancer", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - V Gratio
- INSERM UMR1149/Inflammation Research Center (CRI), Team "From inflammation to cancer in digestive diseases" labeled by "la Ligue Nationale contre le Cancer", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - P Nicole
- INSERM UMR1149/Inflammation Research Center (CRI), Team "From inflammation to cancer in digestive diseases" labeled by "la Ligue Nationale contre le Cancer", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - C Prochasson
- INSERM UMR1149/Inflammation Research Center (CRI), Team "From inflammation to cancer in digestive diseases" labeled by "la Ligue Nationale contre le Cancer", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - I Chantret
- INSERM UMR1149/Inflammation Research Center (CRI), Team "Inflammatory and stress responses in chronic liver diseases", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - G LeGuilloux
- INSERM UMR1149/Inflammation Research Center (CRI), Team "From inflammation to cancer in digestive diseases" labeled by "la Ligue Nationale contre le Cancer", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - A Jarry
- EA4273 Biometadys, Faculté de Médecine, Université de Nantes, 1 Rue Gaston Veil, 44035 Nantes, France
| | - A Couvelard
- INSERM UMR1149/Inflammation Research Center (CRI), Team "From inflammation to cancer in digestive diseases" labeled by "la Ligue Nationale contre le Cancer", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - X Tréton
- INSERM UMR1149/Inflammation Research Center (CRI), Team "Intestinal inflammation", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - T Voisin
- INSERM UMR1149/Inflammation Research Center (CRI), Team "From inflammation to cancer in digestive diseases" labeled by "la Ligue Nationale contre le Cancer", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - E Ogier-Denis
- INSERM UMR1149/Inflammation Research Center (CRI), Team "Intestinal inflammation", Paris-Diderot University, DHU UNITY, 75018 Paris, France
| | - A Couvineau
- INSERM UMR1149/Inflammation Research Center (CRI), Team "From inflammation to cancer in digestive diseases" labeled by "la Ligue Nationale contre le Cancer", Paris-Diderot University, DHU UNITY, 75018 Paris, France.
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Sannier A, Stroumza N, Caligiuri G, Le Borgne-Moynier M, Andreata F, Senemaud J, Louedec L, Even G, Gaston AT, Deschildre C, Couvelard A, Ou P, Cheynier R, Nataf P, Dorent R, Nicoletti A. Thymic function is a major determinant of onset of antibody-mediated rejection in heart transplantation. Am J Transplant 2018; 18:964-971. [PMID: 29160947 DOI: 10.1111/ajt.14595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/20/2017] [Accepted: 11/05/2017] [Indexed: 01/25/2023]
Abstract
Thymic function decreases progressively with age but may be boosted in certain circumstances. We questioned whether heart transplantation was such a situation and whether thymic function was related to the onset of rejection. Twenty-eight antithymocyte globulin-treated heart transplant recipients were included. Patients diagnosed for an antibody-mediated rejection on endomyocardial biopsy had a higher proportion of circulating recent thymic emigrant CD4+ T cells and T cell receptor excision circle levels than other transplanted subjects. Thymus volume and density, assessed by computed tomography in a subset of patients, was also higher in patients experiencing antibody-mediated rejection. We demonstrate that thymic function is a major determinant of onset of antibody-mediated rejection and question whether thymectomy could be a prophylactic strategy to prevent alloimmune humoral responses.
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Affiliation(s)
- A Sannier
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Pathology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | | | - G Even
- INSERM U1148, Paris, France
| | | | | | - A Couvelard
- Denis Diderot University, Paris, France.,Department of Pathology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - P Ou
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Cheynier
- INSERM U1016, Cochin Institute, Paris, France
| | - P Nataf
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Dorent
- INSERM U1148, Paris, France.,Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A Nicoletti
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France
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Suárez-Calvet X, Toquet S, Danel C, Couvelard A, Roland P, Uzunhan Y, Balada E, Selva-O'Callaghan A, Allenbach Y, Benveniste O. The pathogenesis of dermatomyositis associated to MDA5 autoantibodies: An in vitro and in vivo study. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cros J, Hentic O, Rebours V, Zappa M, Gille N, Theou-Anton N, Vernerey D, Maire F, Lévy P, Bedossa P, Paradis V, Hammel P, Ruszniewski P, Couvelard A. MGMT expression predicts response to temozolomide in pancreatic neuroendocrine tumors. Endocr Relat Cancer 2016; 23:625-33. [PMID: 27353036 DOI: 10.1530/erc-16-0117] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/28/2016] [Indexed: 01/31/2023]
Abstract
Temozolomide (TEM) showed encouraging results in well-differentiated pancreatic neuroendocrine tumors (WDPNETs). Low O(6)-methylguanine-DNA methyltransferase (MGMT) expression and MGMT promoter methylation within tumors correlate with a better outcome under TEM-based chemotherapy in glioblastoma. We aimed to assess whether MGMT expression and MGMT promoter methylation could help predict the efficacy of TEM-based chemotherapy in patients with WDPNET. Consecutive patients with progressive WDPNET and/or liver involvement over 50% who received TEM between 2006 and 2012 were retrospectively studied. Tumor response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guidelines. Nuclear expression of MGMT was assessed by immunochemistry (H-score, 0-300) and MGMT promoter methylation by pyrosequencing. Forty-three patients (21 men, 58years (27-84)) with grade 1 WDPNET (n=6) or 2 (n=36) were analyzed. Objective response, stable disease, and progression rates were seen in 17 patients (39.5%), 18 patients (41.9%), and 8 patients (18.6%), respectively. Low MGMT expression (≤50) was associated with radiological objective response (P=0.04) and better progression-free survival (PFS) (HR=0.35 (0.15-0.81), P=0.01). Disease control rate at 18months of treatment remained satisfying with an MGMT score up to 100 (74%) but dropped with a higher expression. High MGMT promoter methylation was associated with a low MGMT expression and longer PFS (HR=0.37 (0.29-1.08), P=0.05). Low MGMT score (≤50) appears to predict an objective tumor response, whereas an intermediate MGMT score (50-100) seems to be associated with prolonged stable disease.
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Affiliation(s)
- J Cros
- Department of PathologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France U1149 - University Paris DiderotParis, France
| | - O Hentic
- Department of Gastroenterology and PancreatologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France
| | - V Rebours
- U1149 - University Paris DiderotParis, France Department of Gastroenterology and PancreatologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France
| | - M Zappa
- Department of RadiologyAP-HP, DHU UNITY, Beaujon Hospital, Clichy, France
| | - N Gille
- Department of PathologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France
| | - N Theou-Anton
- Department of Somatic GeneticAP-HP, DHU UNITY, Bichat University Hospital, Paris, France
| | - D Vernerey
- Methodology and Quality of Life in Oncology Unit (EA 3181)University Hospital of Besançon, Besançon, France
| | - F Maire
- Department of Gastroenterology and PancreatologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France
| | - P Lévy
- U1149 - University Paris DiderotParis, France Department of Gastroenterology and PancreatologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France
| | - P Bedossa
- Department of PathologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France U1149 - University Paris DiderotParis, France
| | - V Paradis
- Department of PathologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France U1149 - University Paris DiderotParis, France
| | - P Hammel
- U1149 - University Paris DiderotParis, France Department of Digestive OncologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France
| | - P Ruszniewski
- U1149 - University Paris DiderotParis, France Department of Gastroenterology and PancreatologyAP-HP, DHU UNITY, Beaujon University Hospital, Clichy, France
| | - A Couvelard
- U1149 - University Paris DiderotParis, France Department of PathologyAP-HP, DHU UNITY, Bichat University Hospital, Paris, France
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Cavin JB, Arapis K, Ducroc R, Ribeiro-Parenti L, Couvelard A, Marmuse JP, Bado A, Le Gall M. P160: Importance du jéjunum dans la régulation de la glycémie après la chirurgie bariatrique. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Buc E, Couvelard A, Kwiatkowski F, Dokmak S, Ruszniewski P, Hammel P, Belghiti J, Sauvanet A. Adenocarcinoma of the pancreas: Does prognosis depend on mode of lymph node invasion? Eur J Surg Oncol 2014; 40:1578-85. [DOI: 10.1016/j.ejso.2014.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/08/2014] [Accepted: 04/27/2014] [Indexed: 12/13/2022] Open
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Hu HH, Dumaz N, Lesage S, Descamps V, Mourah S, Lebbé C, Basset-Seguin N, Bagot M, Bensussan A, Deschamps L, Leccia MT, Tsalamlal A, Klebe S, Kannengiesser C, Couvelard A, Grandchamp B, Thomas L, Brice A, Soufir N. Maladie de Parkinson et mélanome : une piste génétique commune liée à l’inactivation du gène PARK2. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hentic O, Hammel P, Couvelard A, Rebours V, Zappa M, Palazzo M, Maire F, Goujon G, Gillet A, Lévy P, Ruszniewski P. FOLFIRI regimen: an effective second-line chemotherapy after failure of etoposide-platinum combination in patients with neuroendocrine carcinomas grade 3. Endocr Relat Cancer 2012; 19:751-7. [PMID: 22940375 DOI: 10.1530/erc-12-0002] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Patients with neuroendocrine carcinomas (NECs) grade 3 have a poor prognosis. Etoposide-platinum combination is the standard chemotherapy but the role of a second-line therapy remains unknown. Irinotecan alone or in combination has shown some efficacy in patients treated for small cell lung cancer which had pathological similarities with neuroendocine tumors. The aim of this study is to determine safety and efficacy of the FOLFIRI regimen in patients with NECs grade 3 after failure of etoposide-platinum combination. This study was retrospective, including patients with NECs grade 3 and treated with the FOLFIRI regimen after progression or toxicity of etoposide-platinum combination in first-line. Patients with Eastern Cooperative Oncology Group (ECOG) performance status ≥3 and/or serum alkaline phosphatase ≥5×upper limit of normal value (ULN) and/or bilirubin ≥1.5×ULN were excluded. Among 39 patients who failed etoposide-platinum combination, 19 (49%; 12 women, median age 53 (29-78) years) received the FOLFIRI regimen with a median number of 6 (1-16) courses. Six patients (31%) had at least one episode of grades 3-4 toxicity (neutropenia, n=3; diarrhea, n=3) without toxic death. Six patients (31%) had objective response, 6 (31%) stable disease, and 7 (38%) tumor progression. Median progression-free survival under FOLFIRI was 4 months. Overall survival was 18 vs 6.8 months in noneligible patients. FOLFIRI regimen is a safe and potentially efficient chemotherapy given as second-line in patients with NECs grade 3 who remain in good condition and with correct liver tests after failure of etoposide-platinum combination. These results should be confirmed in a future prospective study.
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Affiliation(s)
- O Hentic
- Pôle des Maladies de L'appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, Clichy, France.
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Bachet JB, Maréchal R, Demetter P, Bonnetain F, Couvelard A, Svrcek M, Bardier-Dupas A, Hammel P, Sauvanet A, Louvet C, Paye F, Rougier P, Penna C, Vaillant JC, André T, Closset J, Salmon I, Emile JF, Van Laethem JL. Contribution of CXCR4 and SMAD4 in predicting disease progression pattern and benefit from adjuvant chemotherapy in resected pancreatic adenocarcinoma. Ann Oncol 2012; 23:2327-2335. [PMID: 22377565 DOI: 10.1093/annonc/mdr617] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Prognosis of patients with pancreatic adenocarcinoma is poor. Many prognostic biomarkers have been tested, but most studies included heterogeneous patients. We aimed to investigate the prognostic and/or predictive values of four relevant biomarkers in a multicentric cohort of patients. PATIENTS AND METHODS A total of 471 patients who had resected pancreatic adenocarcinoma were included. Using tissue microarray, we assessed the relationship of biomarker expressions with the overall survival: Smad4, type II TGF-β receptor, CXCR4, and LKB1. RESULTS High CXCR4 expression was found to be the only independent negative prognostic biomarker [hazard ratio (HR) = 1.74; P < 0.0001]. In addition, it was significantly associated with a distant relapse pattern (HR = 2.19; P < 0.0001) and was the strongest prognostic factor compared with clinicopathological factors. In patients who did not received adjuvant treatment, there was a trend toward decrease in the overall survival for negative Smad4 expression. Loss of Smad4 expression was not correlated with recurrence pattern but was shown to be predictive for adjuvant chemotherapy (CT) benefit (HR = 0.59; P = 0.002). CONCLUSIONS CXCR4 is a strong independent prognostic biomarker associated with distant metastatic recurrence and appears as an attractive target to be evaluated in pancreatic adenocarcinoma. Negative SMAD4 expression should be considered as a potential predictor of adjuvant CT benefit.
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Affiliation(s)
- J B Bachet
- Medical University Pierre et Marie Curie, UFR Paris VI, Paris; EA4340 "Epidémiologie et oncogènes des tumeurs digestives", Versailles Saint-Quentin-en-Yvelines University, Versailles; Department of Hepato-Gastroenterology, Pitié-Salpêtrière Hospital, APHP, Paris, France; Department of Gastroenterology, Gastrointestinal cancer Unit, Erasme Hospital, Université Libre de Bruxelles, Brussels.
| | - R Maréchal
- Department of Gastroenterology, Gastrointestinal cancer Unit, Erasme Hospital, Université Libre de Bruxelles, Brussels
| | - P Demetter
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, and DiaPath, Brussels, Belgium
| | - F Bonnetain
- Department of Biostatistic and Epidemiology (EA 4184), Georges François Leclerc Center, Dijon
| | - A Couvelard
- Department of Pathology, Beaujon Hospital, APHP, Clichy
| | - M Svrcek
- Medical University Pierre et Marie Curie, UFR Paris VI, Paris; Department of Pathology, Saint Antoine Hospital, APHP, Paris
| | - A Bardier-Dupas
- Medical University Pierre et Marie Curie, UFR Paris VI, Paris; Department of Pathology, Pitié-Salpêtrière Hospital, APHP, Paris
| | - P Hammel
- Department of Gastroenterology, Beaujon Hospital, APHP, Clichy
| | - A Sauvanet
- Department of Surgery, Beaujon Hospital, APHP, Clichy
| | - C Louvet
- Medical University Pierre et Marie Curie, UFR Paris VI, Paris; Department of Oncology, Saint Antoine Hospital, APHP, Paris; Department of Oncology, Institut Mutualiste Montsouris, Paris
| | - F Paye
- Medical University Pierre et Marie Curie, UFR Paris VI, Paris; Department of Surgery, Saint Antoine Hospital, APHP, Paris
| | - P Rougier
- EA4340 "Epidémiologie et oncogènes des tumeurs digestives", Versailles Saint-Quentin-en-Yvelines University, Versailles; Department of Digestive Oncology, European Georges Pompidou Hospital, APHP, Paris
| | - C Penna
- EA4340 "Epidémiologie et oncogènes des tumeurs digestives", Versailles Saint-Quentin-en-Yvelines University, Versailles; Department of Surgery, Ambroise Paré Hospital, APHP, Boulogne-Billancourt
| | - J C Vaillant
- Medical University Pierre et Marie Curie, UFR Paris VI, Paris; Department of Surgery, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - T André
- Medical University Pierre et Marie Curie, UFR Paris VI, Paris; Department of Hepato-Gastroenterology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - J Closset
- Department of Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - I Salmon
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, and DiaPath, Brussels, Belgium
| | - J F Emile
- EA4340 "Epidémiologie et oncogènes des tumeurs digestives", Versailles Saint-Quentin-en-Yvelines University, Versailles; Department of Pathology, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France
| | - J L Van Laethem
- Department of Gastroenterology, Gastrointestinal cancer Unit, Erasme Hospital, Université Libre de Bruxelles, Brussels
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Rindi G, Falconi M, Klersy C, Albarello L, Boninsegna L, Buchler MW, Capella C, Caplin M, Couvelard A, Doglioni C, Delle Fave G, Fischer L, Fusai G, de Herder WW, Jann H, Komminoth P, de Krijger RR, La Rosa S, Luong TV, Pape U, Perren A, Ruszniewski P, Scarpa A, Schmitt A, Solcia E, Wiedenmann B. TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study. J Natl Cancer Inst 2012; 104:764-77. [PMID: 22525418 DOI: 10.1093/jnci/djs208] [Citation(s) in RCA: 316] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Both the European Neuroendocrine Tumor Society (ENETS) and the International Union for Cancer Control/American Joint Cancer Committee/World Health Organization (UICC/AJCC/WHO) have proposed TNM staging systems for pancreatic neuroendocrine neoplasms. This study aims to identify the most accurate and useful TNM system for pancreatic neuroendocrine neoplasms. METHODS The study included 1072 patients who had undergone previous surgery for their cancer and for which at least 2 years of follow-up from 1990 to 2007 was available. Data on 28 variables were collected, and the performance of the two TNM staging systems was compared by Cox regression analysis and multivariable analyses. All statistical tests were two-sided. RESULTS Differences in distribution of sex and age were observed for the ENETS TNM staging system. At Cox regression analysis, only the ENETS TNM staging system perfectly allocated patients into four statistically significantly different and equally populated risk groups (with stage I as the reference; stage II hazard ratio [HR] of death = 16.23, 95% confidence interval [CI] = 2.14 to 123, P = .007; stage III HR of death = 51.81, 95% CI = 7.11 to 377, P < .001; and stage IV HR of death = 160, 95% CI = 22.30 to 1143, P < .001). However, the UICC/AJCC/WHO 2010 TNM staging system compressed the disease into three differently populated classes, with most patients in stage I, and with the patients being equally distributed into stages II-III (statistically similar) and IV (with stage I as the reference; stage II HR of death = 9.57, 95% CI = 4.62 to 19.88, P < .001; stage III HR of death = 9.32, 95% CI = 3.69 to 23.53, P = .94; and stage IV HR of death = 30.84, 95% CI = 15.62 to 60.87, P < .001). Multivariable modeling indicated curative surgery, TNM staging, and grading were effective predictors of death, and grading was the second most effective independent predictor of survival in the absence of staging information. Though both TNM staging systems were independent predictors of survival, the UICC/AJCC/WHO 2010 TNM stages showed very large 95% confidence intervals for each stage, indicating an inaccurate predictive ability. CONCLUSION Our data suggest the ENETS TNM staging system is superior to the UICC/AJCC/WHO 2010 TNM staging system and supports its use in clinical practice.
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Affiliation(s)
- G Rindi
- Institute of Anatomic Pathology, Università Cattolica del Sacro Cuore, Histopathology and Cytodiagnosis Unit, Policlinico Gemelli, Largo A. Gemelli, 8, Roma I-00168, Italy.
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15
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Moreau S, Cazals-Hatem D, Guedj N, Couvelard A, Bouhnik Y, Bretagnol F, Panis Y, Bedossa P. Maladies inflammatoires chroniques de l’intestin compliquées de néoplasie digestive : étude monocentrique de 20 patients avec analyse clinique, morphologique et immunohistochimique. Ann Pathol 2011. [DOI: 10.1016/j.annpat.2011.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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16
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Maréchal R, Bachet J, Mackey JR, Demetter P, Graham K, Couvelard A, Svrcek M, Bardier A, Hammel P, Sauvanet A, Louvet C, Paye F, Rougier P, Hannoun L, Andre T, Dumontet CM, Cass CE, Salmon I, Emile J, Van Laethem J. Prediction of gemcitabine benefit after curative-intent resection of pancreatic adenocarcinoma using HENT1 and dCK protein expression. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Hentic O, Couvelard A, Rebours V, Zappa M, Dokmak S, Hammel P, Maire F, O'Toole D, Lévy P, Sauvanet A, Ruszniewski P. Ki-67 index, tumor differentiation, and extent of liver involvement are independent prognostic factors in patients with liver metastases of digestive endocrine carcinomas. Endocr Relat Cancer 2011; 18:51-9. [PMID: 20959440 DOI: 10.1677/erc-09-0319] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The prognosis remains ill-defined in patients with liver metastases of well-differentiated (WD) digestive endocrine carcinomas (DEC) with high Ki-67 index. The objectives of this study were to determine whether Ki-67 index, tumor differentiation, and extent of liver involvement are independent prognostic factors in patients with DEC, and whether chemotherapy commonly used in patients with poorly differentiated (PD) carcinomas might be applied to those with high Ki-67 index but well-differentiated DEC. Sixty-three patients with DEC metastatic to the liver were retrospectively studied and divided into three prognostic groups. Group 1 comprised patients with well-differentiated carcinomas and Ki-67 index<15% (n=28), group 2 comprised those with well-differentiated carcinomas and Ki-67 index≥15% (n=17), and group 3 comprised those with poorly differentiated carcinomas (n=18). Therapeutic strategy was decided in accordance to guidelines, and tumoral response rate was assessed by computed tomography scan (RECIST). Prognostic factors were determined by uni/multivariate analysis. The 5-year survival rates were 89, 36, and 6% in groups 1, 2, and 3 respectively (P<0.001). Multivariate analysis showed that Ki-67 index≥15%, poor tumor differentiation, and large liver tumor burden were independent predictors of poorer survival. Disease control rates after etoposide-cisplatin were 50 and 53% in groups 2 and 3 respectively (NS). In conclusion, Ki-67 index, tumor differentiation, and extent of liver involvement are independent prognostic factors in patients with liver metastases of DEC. Patients with well-differentiated carcinomas with high Ki-67 index (≥15%) have intermediate prognosis and a similar response rate to the etoposide-cisplatin combination as those with poorly differentiated carcinomas.
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Affiliation(s)
- O Hentic
- Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France.
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18
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Mordant P, Mercier O, Calderaro J, Couvelard A, Fabre D, Mussot S, Soria J, Deutsch E, Dartevelle P, Fadel E. 641 Level of c-kit expression on pre therapeutic mediastinal lymph node biopsy does not predict its level of expression on post chemotherapy lung tumor. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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Scigliano S, Lebtahi R, Maire F, Stievenart JL, Kianmanesh R, Sauvanet A, Vullierme MP, Couvelard A, Belghiti J, Ruszniewski P, Le Guludec D. Clinical and imaging follow-up after exhaustive liver resection of endocrine metastases: a 15-year monocentric experience. Endocr Relat Cancer 2009; 16:977-90. [PMID: 19470616 DOI: 10.1677/erc-08-0247] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver metastases are common in gastroenteropancreatic neuroendocrine tumors and significantly impair survival. Hepatic resection is the only potential curative treatment. The records of 41 consecutive patients undergoing exhaustive resection of liver-only endocrine metastases and followed between 1992 and 2006 were reviewed. Patient's outcome and diagnostic accuracy of somatostatin receptor scintigraphy (SRS) and morphological imaging (MI) for detection of recurrences during post-operative follow-up were assessed. All identified primary had been resected. MI studies including abdominal computed tomography (CT) and/or liver magnetic resonance imaging and thoracic CT if indicated were performed every 6 months; SRS timing was decided by referring clinician. Tumor recurrences were confirmed by pathology or subsequent imaging studies. The results of 136 MI and SRS examinations performed within a 30-day interval from each other were retrospectively compared. Median post-operative follow-up was 51 months (7-165). Recurrences developed in 32 patients (78%), mainly in the liver (n=24) after a median of 19 months (2-79). Five-year overall and disease-free survival rates were 79 and 3% respectively. For recurrence detection, sensitivity, specificity, and accuracy were 89, 94, and 91% for SRS, 68, 91, and 74% for MI respectively. In 11 out of 32 patients (34%), abdominal or extra-abdominal metastases were detected 15.5 months earlier by SRS than MI. In conclusion, despite exhaustive liver surgery for endocrine metastases, hepatic or extra-hepatic recurrences are frequent and develop early. SRS is highly accurate for the detection of recurrences during post-operative follow-up and permitted early diagnosis in one third of patients; therapeutic implications of this early diagnosis remain to be determined.
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Affiliation(s)
- S Scigliano
- Department of Nuclear Medicine, Beaujon University Hospital, 100 Boulevard du Général Leclerc, Clichy 92110, France.
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Abstract
We report a case of infratentorial primary paraganglioma for which we have a 10-year incomplete pretreatment clinical and radiological follow-up. Partial surgical removal followed by external radiotherapy resulted in stable disease at 6 years follow-up. We compare our patient's case with similar cases reported in the literature.
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Affiliation(s)
- A Xhumari
- Department of Neurosurgery, Hôpital Beaujon, Université Paris 7, Clichy, France
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21
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Blanc B, Sauvanet A, Couvelard A, Pessaux P, Dokmak S, Vullierme MP, Lévy P, Ruszniewski P, Belghiti J. [Limited pancreatic resections for intraductal papillary mucinous neoplasm]. ACTA ACUST UNITED AC 2009; 145:568-78. [PMID: 19106888 DOI: 10.1016/s0021-7697(08)74688-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION For non-invasive intraductal papillary and mucinous neoplasm (IPMN) with limited extent, pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) seem excessive due to the risk of pancreatic insufficiency. Enucleation (EN) or medial pancreatectomy (MP) are not commonly performed for IPMN. The aim of this study was to evaluate the feasibility and results of EN and MP for non-invasive IPMN. PATIENTS AND METHODS Of 249 patients with IPMN, we attempted a limited resection in 50 (20%) EN (n=31) or MP (n=20) with routine intra-operative frozen section pathology. One attempted EN was converted to MP. Indications for surgery were pain/pancreatitis (44%), suspicion of main duct involvement (28%), mural nodules in branch duct (14%), branch duct>30 mm (8%) or suspicion of mucinous cystadenoma (6%). Follow-up clinical assessment and MRI were performed on a yearly basis. RESULTS Of the 31 attempted enucleations, 5 (13%) were immediately converted (4 PD, 1 MP) due to technical reasons (n=3) or due to findings on frozen section (n=2). At definitive pathological examination (accuracy of frozen sectioning=98%), branch ducts were involved by mild (n=21), moderate (n=7) or high grade dysplasia (n=2). One patient underwent a double EN. Of 20 attempted medial pancreatectomies, 8 (40%) required additional segmental resection due to significant IPMN lesions at pancreatic margins; 3 of the additional resection margins were tumor-free, and 5 were involved by IPMN (4 conversions to PD or DP, one contra-indication to PD). Overall, 49 pancreatic margins were analyzed by frozen sectioning with 98% accuracy. Resected specimens of 16 MP showed involvement by mild (n=7), moderate (n=7) or high grade dysplasia (n=2). There was no postoperative mortality. Median length of stay was 21 and 30 days respectively after EN and MP. Pancreatic fistula rate was 54% and 81% respectively after EN and MP. Three patients underwent early re-operation for hemorrhage. Overall median follow-up was 24 months (3-121). All patients are alive, 2 patients (5%) have presented with recurrent pain and 4 have developed tumor recurrence on imaging follow-up (4/33=12%). Two patients (5%) developed de novo diabetes (one after EN combined with DP) and a third patient developed worsening of pre-existing diabetes plus exocrine insufficiency. No patient had surgery for recurrence. CONCLUSIONS EN and MP are feasible for non-invasive IPMN. Their significant early morbidity is counterbalanced by low rates of both long-term functional disorders and tumor recurrence.
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Affiliation(s)
- B Blanc
- Service de chirurgie hépatique et pancréatique, pôle des maladies de l'appareil digestif (PMAD), AP-HP, hôpital Beaujon, université Paris-7, Denis Diderot - Clichy
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22
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Neuzillet C, Hammel P, Couvelard A, Msika S, Felce-Dachez M, Laé M, Lévy P, Ruszniewski P. [Desmoplastic small round cell tumour of the pancreas with breast metastasis]. ACTA ACUST UNITED AC 2009; 33:217-24. [PMID: 19268512 DOI: 10.1016/j.gcb.2008.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 10/22/2008] [Accepted: 10/23/2008] [Indexed: 11/25/2022]
Abstract
Desmoplastic small round cell tumour (DSRCT) is a very rare, highly aggressive neoplasm. Most cases have been reported in adolescent and young male patients. These tumours occur mainly in the peritoneal cavity, with peritoneal and lymphatic dissemination. Their histologic features are unspecific and immunohistochemistry and cytogenetic or biomolecular techniques are required for their diagnosis. Involvement of the pancreas is exceptional and is difficult to differentiate from other pancreatic primary tumours. We report here the case of a 49-year-old woman who had a DSRCT of the pancreas with metastasis to the breast. She died within one year after the diagnosis despite an aggressive surgical strategy.
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Affiliation(s)
- C Neuzillet
- Pôle des maladies de l'appareil digestif, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Hentic O, Hammel P, Rebours V, Dreyer C, Maire F, Vullierme M, Couvelard A, Faivre S, Raymond E, Lévy P, Ruszniewski P. P.245 La chimiothérapie par Folfiri en 2e ligne après échec du VP16-cisplatine dans les carcinomes endocrines digestifs peu différenciés (CEDPD) : un traitement potentiellement efficace. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s0399-8320(09)72936-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Deschamps L, Bretagnol F, Couvelard A, Corcos O, Bedossa P, Panis Y. Inflammatory fibroid polyp in Crohn's disease revealed by ileoileal intussusception: case report and review of the literature. Inflamm Bowel Dis 2008; 14:1317-20. [PMID: 18357578 DOI: 10.1002/ibd.20446] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Stefanescu C, Vullierme MP, Couvelard A, Bretagnol F, Amouyal P, Maire F, Rebours V, Hammel P, Ruszniewski P, Lévy P. Cystic dystrophy in gastric heterotopic pancreas complicated by intracystic hemorrhage and fistulisation in the stomach - a pediatric case. ACTA ACUST UNITED AC 2008; 32:645-8. [PMID: 18547764 DOI: 10.1016/j.gcb.2008.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 02/23/2008] [Accepted: 02/26/2008] [Indexed: 12/15/2022]
Abstract
CONTEXT Cystic dystrophy of the digestive wall, a rare but well-known complication of heterotopic pancreas when it is located in the duodenum, has been mainly described in adult series. Cystic dystrophy of the heterotopic pancreas within the gastric wall has been reported in only six adult cases. To our knowledge, no pediatric case has been described. CASE REPORT We report a 15-year-old boy surgically treated for cystic dystrophy located in the antrum, complicated by an intracystic hemorrhage and fistulisation into the stomach. CONCLUSION The diagnosis of heterotopic pancreas must be considered in case of submucosal cystic-gastric lesions, even in pediatric cases. Although the surgical approach is not systematic, it is recommended when cystic dystrophy is symptomatic (e.g., occlusion or hemorrhage).
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Affiliation(s)
- C Stefanescu
- Service de gastroentérologie-pancréatologie, pôle des maladies de l'appareil digestif, hôpital Beaujon, AP-HP, 92118 Clichy cedex, France
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Van den Eynden GG, Colpaert CG, Couvelard A, Pezzella F, Dirix LY, Vermeulen PB, Van Marck EA, Hasebe T. A fibrotic focus is a prognostic factor and a surrogate marker for hypoxia and (lymph)angiogenesis in breast cancer: review of the literature and proposal on the criteria of evaluation. Histopathology 2007; 51:440-51. [PMID: 17593207 DOI: 10.1111/j.1365-2559.2007.02761.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A fibrotic focus is a scar-like area in the centre of a carcinoma and can be regarded as a focus of exaggerated reactive tumour stroma formation. Although modern surgical pathology uses different histopathological and molecular markers to assess the aggressiveness and predict the behaviour of malignant tumours, markers reflecting stromal cell behaviour and interactions between epithelial cells and stromal cells are scarce. In this review we summarize all studies investigating the value of a fibrotic focus as a prognostic factor and as a surrogate marker for hypoxia and (lymph)angiogenesis in patients with breast cancer. These data show that a fibrotic focus can be used as a practical, easily assessable and reproducible integrative histological prognostic parameter in breast cancer. We propose a consensus methodology to assess the fibrotic focus in breast cancer.
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Affiliation(s)
- G G Van den Eynden
- Translational Cancer Research Group (Laboratory Pathology University of Antwerp/University Hospital Antwerp and Oncology Centre, General Hospital St.-Augustinus, Wilrijk), Antwerp, Belgium.
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Kotelevets L, Foudi N, Louedec L, Couvelard A, Chastre E, Norel X. A new mRNA splice variant coding for the human EP3-I receptor isoform. Prostaglandins Leukot Essent Fatty Acids 2007; 77:195-201. [PMID: 18023986 DOI: 10.1016/j.plefa.2007.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 09/09/2007] [Accepted: 09/15/2007] [Indexed: 01/22/2023]
Abstract
The cellular localization of prostaglandin E2 receptors (EP) and their corresponding transcripts were investigated in human gastric and vascular tissues. A strong staining of the EP3 receptor on the gastric glands, mucous cells, media of the mammary and pulmonary arteries was observed by immunohistochemistry. We identified a new mRNA splice variant of the EP3 gene in human gastric fundic mucosa, mammary artery and pulmonary vessels. This EP3-Ic transcript contains exons 1, 2, 3, 5 and 6 of the EP3 gene and should be translated in the EP3-I isoform. In addition, the EP3-Ib, EP3-II, EP3-III, EP3-IV and EP3-e mRNAs were detected in these tissues.
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Cuilliere-Dartigues P, Fabiani B, Dumont S, Copie-Bergman C, Couvelard A, Molina T, Duval A, Flejou JF. Absence of mismatch repair deficiency in gastric lymphoma: an immunohistochemical study of mlh1 and msh2 protein expression. Virchows Arch 2007; 451:983-4. [PMID: 17849149 DOI: 10.1007/s00428-007-0500-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 08/03/2007] [Accepted: 08/13/2007] [Indexed: 11/25/2022]
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Rindi G, Klöppel G, Couvelard A, Komminoth P, Körner M, Lopes JM, McNicol AM, Nilsson O, Perren A, Scarpa A, Scoazec JY, Wiedenmann B. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2007; 451:757-62. [PMID: 17674042 DOI: 10.1007/s00428-007-0452-1] [Citation(s) in RCA: 617] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 06/14/2007] [Accepted: 06/14/2007] [Indexed: 12/11/2022]
Abstract
Criteria for the staging and grading of neuroendocrine tumors (NETs) of midgut and hindgut origin were established at the second Consensus Conference in Frascati (Rome) organized by the European Neuroendocrine Tumor Society (ENETS). The proposed tumor-node-metastasis (TNM) classifications are based on the recently published ENETS Guidelines for the Diagnosis and Treatment of gastroenteropancreatic NETs and follow our previous proposal for foregut tumors. The new TNM classifications for NETs of the ileum, appendix, colon, and rectum, and the grading system were designed, discussed, and consensually approved by all conference participants. These proposals need to be validated and are meant to help clinicians in the stratification, treatment and follow-up of patients.
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Affiliation(s)
- G Rindi
- Department of Pathology, University of Parma, Parma, Italy.
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Mourra N, Couvelard A, Tiret E, Olschwang S, Flejou JF. Clusterin is highly expressed in pancreatic endocrine tumours but not in solid pseudopapillary tumours. Histopathology 2007; 50:331-7. [PMID: 17257128 DOI: 10.1111/j.1365-2559.2007.02608.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Clusterin is a sulphated glycoprotein, implicated in many processes, including tumorigenesis. Several studies have reported its overexpression in many human neoplasms, including prostatic and pancreatic adenocarcinoma, but its expression has not been described previously in other pancreatic tumours. Our aim was to investigate the expression of clusterin by immunohistochemistry in 30 endocrine pancreatic tumours (ENTs) and 22 solid pseudopapillary tumours (SPPTs) to document its potential in differential diagnosis, and the possible correlation between this expression and clinicopathological parameters. METHODS AND RESULTS Cytoplasmic positivity was scored qualitatively (weak, moderate or strong immunoreactivity) and quantitatively on a four-tiered scale. The pattern of immunoreactivity (cytoplasmic, secretory or Golgi pattern) was also assessed. Except for scattered tumour cells in five cases, all SPPTs were negative, while all ENTs showed strong immunoreactivity in a variable proportion of tumour cells. Neither the reactivity score nor the pattern of immunoreactivity was correlated with tumour size, vascular permeation, perineural invasion or lymph node metastasis. DISCUSSION The expression of clusterin in all ENTs is of interest and could be an additional useful marker in the differential diagnosis with SPPTs. However, the lack of correlation between clusterin expression and clinicopathological parameters rules out a role as a predictive marker for endocrine tumour aggressiveness.
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Affiliation(s)
- N Mourra
- Department of Pathology, St Antoine Hospital, Paris, France.
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Marrache F, Vullierme MP, Roy C, Assoued YE, Couvelard A, O'Toole D, Mitry E, Hentic O, Hammel P, Lévy P, Ravaud P, Rougier P, Ruszniewski P. Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours. Br J Cancer 2006; 96:49-55. [PMID: 17164755 PMCID: PMC2360220 DOI: 10.1038/sj.bjc.6603526] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Transcatheter arterial chemoembolisation (TACE) has been reported to be an efficient treatment of liver metastases of endocrine tumours in short series of patients. However, several factors seem to affect its results. The aim of this work is to identify predictors of response to TACE for liver metastases of endocrine tumours. A total of 163 TACE procedures were performed in 67 patients between 1994 and 2004. Forty-four patients were treated with streptozotocin and 23 with doxorubicin. Primary tumour was located in the pancreas for 19 patients, and had been removed in 43. Thirty-eight tumours were functioning. Response rate was 37% (confidence interval [CI] 95%: 28–49%). Median time to progression (TTP) was 14.5 months (CI 95%: 9–41). In multivariate analysis (n=43), predictors of tumour response were body mass index (BMI) (odds ratio [OR]: 1.3; CI 95%: 1.04–1.63; P=0.022), functioning type of tumour (OR: 7.31; CI 95%: 1.26–42.5; P=0.027), arterial phase enhancement on abdominal computed tomography (CT) (OR: 8.11; CI 95%:1.06–62; P=0.044) and use of streptozotocin for cytotoxic agent (OR: 21.3; CI 95%: 1.48–306; P=0.025). Analysis of TTP predictors showed that BMI (hazard ratio [HR]: 0.85; CI 95%: 0.76–0.86; P=0.01) and arterial phase enhancement (HR: 0.3; CI 95%: 0.12–0.73; P=0.008) were associated with delayed progression. This large study confirms the previously reported results of TACE regarding its efficacy for the treatment of liver metastases of endocrine tumours. Arterial phase enhancement on abdominal CT and BMI are predictors of treatment's efficacy. Streptozotocin should be the preferred cytotoxic agent in order to save anthracycline for systemic chemotherapy.
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Affiliation(s)
- F Marrache
- Service de Gastroentérologie, hôpital Beaujon, AP-HP, Université Paris 7, Clichy, France
| | - M P Vullierme
- Service de Radiologie, hôpital Beaujon AP-HP, Clichy, France
| | - C Roy
- Département d’Epidémiologie, Biostatistique et Recherche Clinique, Groupe Hospitalier Bichat-Claude Bernard, AP-HP – Université Paris 7, Clichy, France
| | - Y El Assoued
- Service d’Hépato-Gastroentérologie, hôpital Ambroise Paré, AP-HP, Clichy, France
| | - A Couvelard
- Service d’Anatomie et Cytologie Pathologiques, hôpital Beaujon, AP-HP, Clichy, France
| | - D O'Toole
- Service de Gastroentérologie, hôpital Beaujon, AP-HP, Université Paris 7, Clichy, France
| | - E Mitry
- Département d’Epidémiologie, Biostatistique et Recherche Clinique, Groupe Hospitalier Bichat-Claude Bernard, AP-HP – Université Paris 7, Clichy, France
| | - O Hentic
- Service de Gastroentérologie, hôpital Beaujon, AP-HP, Université Paris 7, Clichy, France
| | - P Hammel
- Service de Gastroentérologie, hôpital Beaujon, AP-HP, Université Paris 7, Clichy, France
| | - P Lévy
- Service de Gastroentérologie, hôpital Beaujon, AP-HP, Université Paris 7, Clichy, France
| | - P Ravaud
- Département d’Epidémiologie, Biostatistique et Recherche Clinique, Groupe Hospitalier Bichat-Claude Bernard, AP-HP – Université Paris 7, Clichy, France
| | - P Rougier
- Service d’Hépato-Gastroentérologie, hôpital Ambroise Paré, AP-HP, Clichy, France
| | - P Ruszniewski
- Service de Gastroentérologie, hôpital Beaujon, AP-HP, Université Paris 7, Clichy, France
- E-mail:
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Mourra N, Couvelard A, Olschwang S, Flejou JF. La clusterine : un nouveau marqueur pour le diagnostic différentiel entre les tumeurs endocrines et les tumeurs solides et pseudopapillaires du pancréas. Ann Pathol 2006. [DOI: 10.1016/s0242-6498(06)78434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Couvelard A. Tumeurs endocrines digestives : principales caractéristiques pathologiques. Ann Pathol 2006. [DOI: 10.1016/s0242-6498(06)78376-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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O'Toole D, Calender A, Couvelard A, Scoazec JY. [Endocrine digestive tumors: pathogenesis, diagnosis and classification]. Ann Pathol 2006; 26 Spec No 1:1S55-61. [PMID: 17149179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- D O'Toole
- Service de Gastroentérologie, CHU d'Angers
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Cuilliere-dartigues P, Dumont S, Copie-bergman C, Couvelard A, Molina T, Duval A, Fléjou JF, Fabiani B. Le phénomène d’instabilité de microsatellites n’intervient pas dans le développement des lymphomes gastriques. Ann Pathol 2006. [DOI: 10.1016/s0242-6498(06)78488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scoazec J, Coindre J, Cervera P, Delattre C, Ramos J, Monges G, Couvelard A, Balaton A, Terris B, Lazure T, Diebold M, Walter P, Mosnier J, Ranchère-Vince D. Diagnostic des tumeurs stromales gastro-intestinales (GIST) : intérêt de la reclassification des tumeurs conjonctives digestives (étude ERMIT). Ann Pathol 2006. [DOI: 10.1016/s0242-6498(06)70784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rindi G, Klöppel G, Alhman H, Caplin M, Couvelard A, de Herder WW, Erikssson B, Falchetti A, Falconi M, Komminoth P, Körner M, Lopes JM, McNicol AM, Nilsson O, Perren A, Scarpa A, Scoazec JY, Wiedenmann B. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2006; 449:395-401. [PMID: 16967267 PMCID: PMC1888719 DOI: 10.1007/s00428-006-0250-1] [Citation(s) in RCA: 1038] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 06/06/2006] [Indexed: 02/06/2023]
Abstract
The need for standards in the management of patients with endocrine tumors of the digestive system prompted the European Neuroendocrine Tumor Society (ENETS) to organize a first Consensus Conference, which was held in Frascati (Rome) and was based on the recently published ENETS guidelines on the diagnosis and treatment of digestive neuroendocrine tumors (NET). Here, we report the tumor–node–metastasis proposal for foregut NETs of the stomach, duodenum, and pancreas that was designed, discussed, and consensually approved at this conference. In addition, we report the proposal for a working formulation for the grading of digestive NETs based on mitotic count and Ki-67 index. This proposal, which needs to be validated, is meant to help clinicians in the stratification, treatment, and follow-up of patients.
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Affiliation(s)
- G Rindi
- Dipartimento di Patologia e, Medicina di Laboratorio, Sezione di Anatomia Patologica, Università di Parma, Via Gramsci, 14, 43100, Parma, Italy, and Department of Internal Medicine, Royal Free Hospital, London, UK.
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Handra-Luca A, Fléjou JF, Rufat P, Corcos O, Belghiti J, Ruszniewski P, Degott C, Bedossa P, Couvelard A. Human pancreatic mucinous cystadenoma is characterized by distinct mucin, cytokeratin and CD10 expression compared with intraductal papillary-mucinous adenoma. Histopathology 2006; 48:813-21. [PMID: 16722930 DOI: 10.1111/j.1365-2559.2006.02444.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS To examine cytokeratin, epithelial glycoprotein (mucin) and glycoprotein CD10 expression in benign mucinous cystdenomas (MCAs) in comparison with intraductal papillary mucinous adenomas (IPMAs). METHODS AND RESULTS Thirty MCAs of the pancreas were analysed for immunohistochemical expression of cytokeratin (CK) 7, CK20, MUC1, MUC2, MUC5AC and CD10 and were compared with 16 IPMAs. CK7 was expressed in all neoplasms. CK20 was significantly more frequent in MCAs compared with IPMAs (56.66% versus 18.75%, P = 0.027). MUC1 was more frequent in MCAs (40% versus 12.5%, P = 0.0915), whereas MUC5AC was significantly less frequent in MCAs (33.33% versus 100%). MUC2 was expressed in goblet cells of seven MCAs. In MCAs, CD10 was observed both in epithelial cells and in the ovarian-type stromal cells (24/30). Epithelial expression of CD10 was significantly lower in IPMAs (66.66% versus 6.25%, p = 0.0001). CONCLUSIONS MCA is characterized by a significantly greater frequency of expression of CK20 and CD10 when compared with IPMA, which preferentially expresses MUC5AC.
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Affiliation(s)
- A Handra-Luca
- Service d'Anatomie Pathologique, Hôpital Beaujon, Clichy, France.
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Fournier M, Couvelard A, Mal H, Groussard O. [Non transplant-related constrictive bronchiolitis in adults]. Rev Mal Respir 2006; 23:6S57-6S66. [PMID: 16820749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The term bronchiolitis refers to inflammatory disorders of the bronchioles. Constrictive bronchiolitis is the type most frequently encountered. STATE OF THE ART/PERSPECTIVES The main clinical manifestations include the development of exertional dyspnoea and fixed airflow obstruction. Chest x-ray findings are usually unhelpful, but CT scanning may reveal a mosaic pattern on expiration. Peripheral micronodules are less frequently seen. The causes of constrictive bronchiolitis are numerous. The diagnosis may be clear from the clinical context when a causative event or predisposing condition can be identified (lung or bone marrow transplantation, toxic fume or gas inhalation, rheumatoid arthritis); in other conditions, a stepwise approach to the diagnosis is usually recommended in order to exclude other causes of subacute or chronic obstructive disease. Formal diagnosis requires histological examination of surgical lung biopsies. Despite corticosteroid administration, respiratory failure usually develops. Specific inhibitors of pro-inflammatory cytokines may offer a new and promising therapeutic approach. CONCLUSIONS If the clinical context or the radiology and clinical findings are not highly suggestive of a constrictive bronchiolitis, a surgical lung biopsy should be considered.
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Affiliation(s)
- M Fournier
- Service de Pneumologie B--Hôpital Bichat, Paris, France.
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41
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Rodallec M, Vilgrain V, Couvelard A, Rufat P, O'Toole D, Barrau V, Sauvanet A, Ruszniewski P, Menu Y. Endocrine pancreatic tumours and helical CT: contrast enhancement is correlated with microvascular density, histoprognostic factors and survival. Pancreatology 2005; 6:77-85. [PMID: 16327283 DOI: 10.1159/000090026] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 04/14/2005] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the role of contrast-enhanced helical CT in the evaluation of tumour vascularity in endocrine pancreatic tumours (EPTs), and to determine the predictive factors of malignancy of EPTs at helical CT with CT-histopathological correlation. MATERIALS AND METHODS Thirty-seven consecutive patients with histopathologically proven EPTs underwent dual-phase helical CT. For each tumour detected, its density relative to the surrounding parenchyma was scored on the pancreatic phase using a 5-point scale. Radiological findings were correlated with histopathological (vessel density count) and clinical follow-up findings. RESULTS Thirty of 37 patients had non-functioning EPTs and overall 44 tumours were detected by helical CT (mean size 38, range 5-100 mm). CT showed calcifications in 10 tumours. Calcifications were associated with well-differentiated carcinomas (90%, p = 0.02). Vascular density assessed by light microscopy was significantly correlated with tumour enhancement at the pancreatic phase (p = 0.0001). Poorly differentiated carcinomas were less vascularised than well-differentiated tumours and carcinomas (34 vs. 264 vessels/mm2, p = 0.0073). Tumour differentiation also correlated with tumour enhancement at the pancreatic phase (p = 0.0044, trend test): poorly differentiated carcinomas were hypoattenuating (71%) and isoattenuating or weakly hyperattenuating (29%), compared with well-differentiated carcinomas and tumours that were mainly moderately or strongly hyperattenuating (53%). In univariate analysis, poor tumoral differentiation, hepatic metastasis, high mitotic index, poor tumoral enhancement at the pancreatic phase and less vascularised tumours were correlated with decreased survival rate. CONCLUSION Enhancement of EPT at CT is correlated with tumour vascularity assessed by light microscopy. Low-enhancing EPT at CT are correlated with poorly differentiated EPT and with a decrease in overall survival.
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Affiliation(s)
- M Rodallec
- Department of Radiology, Hôpital Beaujon, Clichy, France.
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Abstract
BACKGROUND In patients with hepatic endocrine tumours, a primary neoplasm is not always found elsewhere despite extensive investigations, raising the possibility that the hepatic lesion is the primary tumour. The aim of this study was to assess the incidence, characteristics and prognosis of patients with primary hepatic endocrine tumours. METHODS Patients with histologically confirmed hepatic endocrine tumours identified since 1993 were reviewed. All those with no primary tumour identified by computed tomography of the thorax, abdomen and pelvis, upper and lower digestive endoscopy, duodenopancreatic endoscopic ultrasonography or somatostatin receptor scintigraphy (SRS) were included. Clinical and tumour characteristics were assessed retrospectively. RESULTS Of 393 patients with digestive endocrine tumours, 17 (seven men; median age 55 (range 26-69) years) had hepatic endocrine tumours without evidence of an extrahepatic primary lesion either at diagnosis or during a median follow-up of 43 (range 12-108) months. Ten patients had multiple and seven had single tumours. The tumours were non-functional in 13 patients and well differentiated in 14 patients. SRS was positive in the liver in 11 patients. Curative resection was performed in seven. Overall actuarial survival rates were 100, 69 and 51 per cent at 1, 3 and 5 years respectively. Only poor differentiation was associated with an unfavourable outcome (relative risk 20.8; P < 0.001). CONCLUSION Primary hepatic endocrine tumours were identified in almost 5 per cent of patients with digestive endocrine tumours. Poor differentiation was the only factor associated with unfavourable outcome.
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Affiliation(s)
- F Maire
- Federation of Hepato-Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy Cedex, France.
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Morin AS, Bellier C, Couvelard A, Zarrouk V, Belmatoug N, Fantin B, de Korwin JD. [Where are you, wolf?]. Rev Med Interne 2005; 26 Suppl 2:S208-12. [PMID: 16129148 DOI: 10.1016/s0248-8663(05)80028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- A-S Morin
- Service de médecine interne, CHU Beaujon, Clichy, France
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Couvelard A, O'Toole D, Leek R, Turley H, Sauvanet A, Degott C, Ruszniewski P, Belghiti J, Harris AL, Gatter K, Pezzella F. Expression of hypoxia-inducible factors is correlated with the presence of a fibrotic focus and angiogenesis in pancreatic ductal adenocarcinomas. Histopathology 2005; 46:668-76. [PMID: 15910598 DOI: 10.1111/j.1365-2559.2005.02160.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS To study the expression of hypoxia-regulated markers in pancreatic ductal adenocarcinomas (PA) in relationship to the presence of a fibrotic focus, angiogenesis quantification and clinical outcome. METHODS AND RESULTS The expression of hypoxia-inducible factor (HIF)-1alpha, HIF-2alpha, carbonic anhydrase 9 (CA9) and vascular endothelial growth factor (VEGF) was immunohistochemically detected in 50 PA and correlated with tumour characteristics, microvascular density (MVD) and survival. HIF-1alpha was expressed within tumour cells in 68%, HIF-2alpha in 46%, CA9 in 78% and VEGF in 52% of the cases. Stromal expression was also noted for HIF-2alpha and CA9 in, respectively, 42% and 48% of the cases. Tumour CA9 expression was associated with that of VEGF (P=0.004) and that of stromal HIF-2alpha (P=0.013), with the presence of a fibrotic focus (P=0.046) and with an increased MVD (P=0.034). Tumour VEGF expression correlated with the presence of a fibrotic focus (P=0.039) and a greater MVD (P=0.047). Both the presence of a fibrotic focus (P=0.0002) and high tumour CA9 expression (P=0.029) were associated with reduced overall survival. CONCLUSION The strong association of the presence of a fibrotic focus with CA9 expression and lower survival demonstrates that hypoxia-driven angiogenesis plays an important role in the progression of PA.
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Affiliation(s)
- A Couvelard
- Department of Pathology, Hopital Beaujon, Assistance Publique - Hopitaux de Paris, Clichy, France.
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Vullierme MP, Giraud M, Hammel P, Couvelard A, Sauvanet A, Belghiti J, Ruszniewski P, Vilgrain V. Aspect radiologique des tumeurs intracanalaires pancréatiques mucineuses et papillaires. ACTA ACUST UNITED AC 2005; 86:781-94; quiz 795-6. [PMID: 16142072 DOI: 10.1016/s0221-0363(05)81445-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IPMTP is a pancreatic duct disease that can better be diagnosed due to advances in imaging techniques. This probably explains the recent increased frequency of this disease. Enlargement of the main pancreatic duct and/or branch ducts is a typical feature. CT and MRI with MRCP are useful for diagnosis. Features of malignant degeneration are better known. Preoperative staging is performed at CT. Differential diagnosis includes main pancreatic duct dilatation and pancreatic cysts. Recent papers indicate that isolated side branch IPMTP is less frequently malignant. Surgery is indicated in the presence of acute pancreatitis or suspicion of malignant degeneration. Imaging is useful for the follow up of patients with isolated side branch IPMTP. In this paper, the diagnostic, staging and malignant features of IPMTP will be reviewed.
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Affiliation(s)
- M P Vullierme
- Service de Radiologie, Hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy
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Couvelard A, O'Toole D, Turley H, Leek R, Sauvanet A, Degott C, Ruszniewski P, Belghiti J, Harris AL, Gatter K, Pezzella F. Microvascular density and hypoxia-inducible factor pathway in pancreatic endocrine tumours: negative correlation of microvascular density and VEGF expression with tumour progression. Br J Cancer 2005; 92:94-101. [PMID: 15558070 PMCID: PMC2361752 DOI: 10.1038/sj.bjc.6602245] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Tumour-associated angiogenesis is partly regulated by the hypoxia-inducible factor (HIF) pathway. Endocrine tumours are highly vascularised and the molecular mechanisms of their angiogenesis are not fully delineated. The aim of this study is to evaluate angiogenesis and expression of HIF-related molecules in a series of patients with pancreatic endocrine tumours (PETs). The expression of vascular endothelial growth factor (VEGF), HIF-1alpha, HIF-2alpha and carbonic anhydrase 9 (CA9) was examined by immunohistochemistry in 45 patients with PETs and compared to microvascular density (MVD), endothelial proliferation, tumour stage and survival. Microvascular density was very high in PETs and associated with a low endothelial index of proliferation. Microvascular density was significantly higher in benign PETs than in PETs of uncertain prognosis, well-differentiated and poorly differentiated carcinomas (mean values: 535, 436, 252 and 45 vessels mm(-2), respectively, P < 0.0001). Well-differentiated tumours had high cytoplasmic VEGF and HIF-1alpha expression. Poorly differentiated carcinomas were associated with nuclear HIF-1alpha and membranous CA9 expression. Low MVD (P = 0.0001) and membranous CA9 expression (P = 0.0004) were associated with a poorer survival. Contrary to other types of cancer, PETs are highly vascularised, but poorly angiogenic tumours. As they progress, VEGF expression is lost and MVD significantly decreases. The regulation of HIF signalling appears to be specific in pancreatic endocrine tumours.
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Affiliation(s)
- A Couvelard
- Department of Pathology, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France.
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Deschamps L, Couvelard A, Handra-Luca A, Colnot N, Ruzniewski P, Degott C. Expression du CD10 dans les tumeurs endocrines pancréatiques : corrélation avec des facteurs histopronostiques. Ann Pathol 2004. [DOI: 10.1016/s0242-6498(04)94194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Guedj N, Couvelard A, Arcangeli G, Dubois S, Thabut G, Lesèche G, Fournier M, Degott C, Groussard O. Angiogenesis and extracellular matrix remodelling in bronchioloalveolar carcinomas: distinctive patterns in mucinous and non-mucinous tumours. Histopathology 2004; 44:251-6. [PMID: 14987229 DOI: 10.1111/j.1365-2559.2004.01803.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Bronchioloalveolar carcinomas (BACs) are rare primitive lung adenocarcinomas growing along the alveolar septum without stromal, vascular or pleural invasion. We report an immunohistochemical study of their vascular microenvironment. METHODS AND RESULTS In three mucinous BACs (M-BAC) and three non-mucinous BACs (NM-BAC) we examined the following parameters in comparison with the normal lung: (i) constituents of the alveolar extracellular matrix; (ii) qualitative and quantitative changes of alveolar capillaries; and (iii) expression of vascular endothelial growth factor (VEGF) by tumour cells. In M-BAC, the alveolar matrix was unchanged compared with the normal parenchyma. Capillaries expressed normal alveolar endothelial markers and their average surface was calculated, as in normal lung, as 8%. VEGF was negative in tumour cells. In NM-BAC, the alveolar wall was thickened by deposits of fibronectin and type III collagen containing myofibroblasts and the basement membrane was disrupted. Capillaries did not retain alveolar endothelial markers and their surface was calculated as 19%. Tumour cells expressed high levels of VEGF. CONCLUSIONS In contrast to NM-BAC, M-BAC do not modify the alveolar structure and seem to exploit the normal alveolar vascular bed to grow, without inducing neoangiogenesis. A better understanding of the mechanisms of growth of lung cancers may have implications for future anti-angiogenic therapeutic strategies.
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Affiliation(s)
- N Guedj
- Service d'Anatomie Pathologique, Hôpital Beaujon, Clichy, France
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Giraud M, Vullierme MP, Hammel P, Maire F, Otoole D, Lévy P, Couvelard A, Sauvanet A, Belghiti J, Degot C, Ruszniewski P, Vilgrain V. Resecabilite des TIPMP degenerees : correlation TDM, chirurgicale et anatomo-pathologique a propos de 60 patients. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s0221-0363(04)77387-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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