Clinicopathological spectrum of BCR-ABL-Negative myeloproliferative neoplasms with correlation with janus-associated kinase 2 mutation

Background: Non chronic myelogenous leukemia (non-CML)/BCR-ABL-negative myeloproliferative neoplasms (MPNs) include essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF) (apart from chronic neutrophilic leukemia and chronic eosinophilic leukemia, which are rare). They are uncommon clonal disorders of adults, with an incidence ranging from 0.5 to 3/100,000 persons, BCR-ABL negative, and characterized by the activation of Janus-associated kinase 2 (JAK2). Very few studies have been reported from India. Aims and Objectives: The aims and objectives of this study were to analyze the clinicopathological spectrum and to determine the frequency of JAK2 mutation in patients of non-CML/BCR-ABL negative MPNs. Materials and Methods: Clinical and morphological features and frequency of JAK2 mutation in patients with PV, ET, and PMF were studied at a tertiary care hospital. The material was retrieved from the hematopathology records and reviewed. Results: JAK2V617F mutation was found in 10 of 14 cases (71%) of MPNs, 100% in PV, 50% in ET, and 71% of idiopathic myelofibrosis. The presence of JAK2V617F mutation was associated with a higher hemoglobin level (P < 0.05), a higher TLC (P < 0.05), and higher age (P < 0.05). Results showed that there are morphologic differences, and megakaryocytic morphology represents a useful clue for the differential diagnosis of these three BCR-ABL-negative MPN subtypes. Conclusion: The JAK2 V617F mutation was detected in 71% of patients with MPN disorders. Peripheral blood mutation screening for JAK2 V617F should be incorporated into the initial evaluation of patients suspected to have MPNs. Differences in megakaryocytic morphology provide the histomorphological hallmark of BCR-ABL-negative MPN subtypes.

Docking protein-1 promotes inflammatory macrophage signaling in gastric cancer

Docking protein-1 (DOK1) is a tumor suppressor frequently lost in malignant cells, however, it retains the ability to control activities of immune receptors in adjacent stroma cells of the tumor microenvironment. We therefore hypothesized that addressing DOK1 may be useful for cancer immunotherapy. DOK1 mRNA and DOK1 protein expression were downregulated in tumor cells of gastric cancer patients (n = 249). Conversely, its expression was up-regulated in cases positive for Epstein Barr Virus (EBV+) together with genes related to macrophage biology and targets of clinical immunotherapy such as programmed-cell-death-ligand-1 (PD-L1). Notably, high DOK1 positivity in stroma cells conferred poor prognosis in patients and correlated with high levels of inducible nitric oxide synthase in CD68+ tumor-associated macrophages. In macrophages derived from human monocytic leukemia cell lines, DOK1 (i) was inducible by agonists of the anti-diabetic transcription factor peroxisome proliferator-activated receptor-gamma (PPARγ), (ii) increased polarization towards an inflammatory phenotype, (iii) augmented nuclear factor-κB-dependent transcription of pro-inflammatory cytokines and (iv) reduced PD-L1 expression. These properties empowered DOK1+ macrophages to decrease the viability of human gastric cancer cells in contact-dependent co-cultures. DOK1 also reduced PD-L1 expression in human primary blood monocytes. Our data propose that the drugability of DOK1 may be exploited to reprogram myeloid cells and enforce the innate immune response against EBV+ human gastric cancer.

Quality and quantity of volume replacement in trauma patients

An epidemiologic evaluation of trauma-related deaths in trauma centers reveals that the majority of patients die within 6 hours from exsanguination, whereas secondary brain injuries predominate between 6 and 24 hours. Late deaths remain attributable to sepsis and pulmonary embolism,1-3 while early deaths are due in part to multiple bleeding injuries or to a set of complex and untreatable injuries, mainly of the liver and pelvis. Before trauma systems existed, these patients died at the scene of the trauma, whereas since the establishment of the trauma system, they die in emergency or operating rooms. Another subset of early deaths result from severe bleeding injuries, which could be prevented if recognized early. For instance, if a 70 kg adult had a blood volume of 70 mL/kg (5 L), hypotension (systolic blood pressure [SBP]<90 mmHg) would usually occur after a one third-loss of blood volume, and death would follow with a 50% loss. A patient bleeding at a rate of 25 mL/min will become hypotensive within one hour and die within two hours, while a patient bleeding at a rate of 100 mL/min will be hypotensive within 15 minutes and die within 30 minutes. These considerations indicate a narrow window of opportunity for targeting fluid resuscitation. Moreover, increases in blood pressure before surgical hemostasis have been shown to disrupt clotting and increase bleeding, a fact that has been confirmed by a number of animal and human studies on uncontrolled hemorrhage. Furthermore, oxygen must be delivered to vital organs (brain, heart) to prevent death during hemorrhage. In summary, several constraints account for the differences in fluid use, timing of infusions, and determinations of whether to administer fluids at all.

Ultrastructure of ependymoma

Twenty-six ependymomas were studied by light and electron microscopy. By electron microscopy, the acellular zones around small vessels in light microscopic sections were seen to be composed of large numbers of closely packed, filament-rich, cytoplasmic processes ringing small vessels. Lumina were consistently present but many of them were too small to be seen by light microscopy. The lumina contained slender, curving microvilli and variable numbers of cilia. Their bordering cells were connected by unusually long tight junctions. Electron microscopy can be useful to establish or confirm a diagnosis of ependymoma when the light microscopic appearance is atypical, or when the tumor arises in an unusual location. The clinical data on the 26 cases has been reviewed; follow-up information was available on 23 patients.

Intratumoral DNA content variability. A study of non-small cell lung cancer

Twenty-eight resected primary non-small cell lung carcinomas were studied for intratumoral DNA variability by flow cytometry (FCM). Three separate tissue specimens from each resected tumor were divided equally for FCM analysis and histologic evaluation. FCM analysis also was performed on fine-needle aspirates (FNAs) from the center of the resected tumor. Histologically, there were 8 squamous carcinomas, 19 adenocarcinomas, and 1 large cell carcinoma. Twenty-three tumors (82%) were aneuploid, and 5 (18%) were diploid. The DNA index in aneuploid neoplasms ranged from 0.91 to 3.30 (mean, 1.64). All 5 diploid and 19 (83%) of the (23) aneuploid neoplasms manifested intratumoral DNA stability. Four (17%) of the aneuploid tumors showed regional DNA heterogeneity expressed as additional stemlines in at least one sample. The FNA yield was sufficient in 21 cases and inadequate for complete analysis in 7 cases. In general, good correlation between FNA and tissue analysis was obtained. However, in three of the aneuploid neoplasms, FNA materials did not reveal an additional nondominant stemline, as noted in the tissue specimens. The authors attribute this finding to a dilutional factor in the aspiration material. The authors conclude that most non-small cell lung carcinomas express DNA stability; FNA provides adequate cellular material for FCM in most cases.

Clear cell sarcomas and metastatic soft tissue melanomas. A flow cytometric comparison and prognostic implications

Eleven soft tissue clear cell sarcomas (CCS) were examined flow cytometrically for their DNA content with a correlation of the DNA with the patients' survival. Diploidy was expressed in six sarcomas and it conferred a longer survival (mean, 68.6 months) than aneuploid sarcomas (mean, 8.2 months). For comparison, 13 metastases to soft tissues from cutaneous melanomas were assessed by flow cytometric study. The aneuploid neoplasms of both entities were categorized into low and high degree based on extent of the DNA index (DI). Low degree was defined by a DI of less than or equal to 1.5 and high degree by a DI of greater than 1.5. Significant differences in DNA content between CCS and metastatic melanomas were observed. Melanomas were preponderantly aneuploid (11/13) of high degree (mean DI, 1.7) whereas CCS manifested more diploidy (six of 11) and their aneuploidy was of a low degree (mean DI, 1.2; P = 0.001). Clear cell sarcomas and melanomas were also examined for their immunoreactivity to S-100 protein and HMB-45 antigen. All CCS reacted with S-100 protein and HMB-45. In CCS the reactions were diffuse for both in six tumors, diffuse with HMB-45 and moderate to S-100 protein in three tumors and diffuse with S-100 and moderate with HMB-45 in two tumors. All melanomas reacted diffusely to S-100 protein except for one heavily pigmented tumor which reacted only focally. The reaction to HMB-45 was diffuse in nine and focal in three melanomas. These data suggest that measurements of DNA content in CCS may be valuable in predicting clinical outcome and that there are quantitative differences in DNA content between CCS and metastatic melanoma in soft tissues.

Efficacy of funnel-web spider antivenom in human envenomation by Hadronyche species

We describe the envenomation of three patients by Hadronyche versuta, Hadronyche infensa and Hadronyche cerberea (which all are species of funnel-web spider) and the reversal of symptoms by funnel-web spider antivenom. The importance of continuing to administer antivenom until symptoms are reversed is emphasized; all three patients required further doses of antivenom to reverse the symptoms completely. None of the patients had received first aid.