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Chen A, Sharma N, Patel P, Olivares S, Bahrami A, Barnhill RL, Blokx WAM, Bosenberg M, Busam KJ, de La Fouchardière A, Duncan LM, Elder DE, Ko JS, Landman G, Lazar AJ, Lezcano C, Lowe L, Maher N, Massi D, Messina J, Mihic-Probst D, Parker DC, Redpath M, Scolyer RA, Shea CR, Spatz A, Tron V, Xu X, Yeh I, Jung Yun S, Zembowicz A, Gerami P. The Impact of Next-generation Sequencing on Interobserver Agreement and Diagnostic Accuracy of Desmoplastic Melanocytic Neoplasms. Am J Surg Pathol 2024:00000478-990000000-00332. [PMID: 38590014 DOI: 10.1097/pas.0000000000002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Next-generation sequencing (NGS) is increasingly being utilized as an ancillary tool for diagnostically challenging melanocytic neoplasms. It is incumbent upon the pathology community to perform studies assessing the benefits and limitations of these tools in specific diagnostic scenarios. One of the most challenging diagnostic scenarios faced by skin pathologists involves accurate diagnosis of desmoplastic melanocytic neoplasms (DMNs). In this study, 20 expert melanoma pathologists rendered a diagnosis on 47 DMNs based on hematoxylin and eosin sections with demographic information. After submitting their diagnosis, the experts were given the same cases, but this time with comprehensive genomic sequencing results, and asked to render a diagnosis again. Identification of desmoplastic melanoma (DM) improved by 7%, and this difference was statistically significant (P<0.05). In addition, among the 15 melanoma cases, in the pregenomic assessment, only 12 were favored to be DM by the experts, while after genomics, this improved to 14 of the cases being favored to be DM. In fact, some cases resulting in metastatic disease had a substantial increase in the number of experts recognizing them as DM after genomics. The impact of the genomic findings was less dramatic among benign and intermediate-grade desmoplastic tumors (BIDTs). Interobserver agreement also improved, with the Fleiss multirater Kappa being 0.36 before genomics to 0.4 after genomics. NGS has the potential to improve diagnostic accuracy in the assessment of desmoplastic melanocytic tumors. The degree of improvement will be most substantial among pathologists with some background and experience in bioinformatics and melanoma genetics.
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Affiliation(s)
- Alice Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Natasha Sharma
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pragi Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Armita Bahrami
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Raymond L Barnhill
- Department of Translational Research, Institut Curie, Paris Sciences and Lettres Research University, and UFR of Medicine, University of Paris Cité, Paris
| | - Willeke A M Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics University Medical Center Utrecht, The Netherlands
| | | | - Klaus J Busam
- Department of Pathology, Dermatopathology Service, Memorial Sloan Kettering Cancer Center, New York City, NY
| | | | - Lyn M Duncan
- Department of Dermatopathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology, Hospital of the University of Pennsylvania
| | - Jennifer S Ko
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
| | - Gilles Landman
- Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cecilia Lezcano
- Department of Pathology, Dermatopathology Service, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Lori Lowe
- Departments of Dermatology and Pathology, University of Michigan Medical School, Ann Arbor, MI
| | - Nigel Maher
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, and NSW Health Pathology, Sydney, NSW, Australia
- Faculty of Medicine and Health
- Melanoma Institute Australia
| | - Daniela Massi
- Department of Health Sciences, Section of Anatomic Pathology, University of Florence, Florence, Italy
| | - Jane Messina
- Departments of Pathology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | - Daniela Mihic-Probst
- Institute for Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Douglas C Parker
- Departments of Pathology and Dermatology, Emory University School of Medicine, Atlanta, GA
| | | | - Richard A Scolyer
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, and NSW Health Pathology, Sydney, NSW, Australia
- Faculty of Medicine and Health
- Melanoma Institute Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Christopher R Shea
- Department of Medicine, Section of Dermatology, University of Chicago, Chicago, IL
| | - Alan Spatz
- Department of Pathology, McGill University, Montreal, QC
| | - Victor Tron
- Department of Dermatopathology, University of Toronto, Toronto, ON, Canada
| | - Xiaowei Xu
- Departments of Pathology and Dermatology, University of Pennsylvania, Philadelphia, PA
| | - Iwei Yeh
- Departments of Dermatology and Pathology, University of California, San Francisco, San Francisco, CA
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Artur Zembowicz
- Dermatopathology Consultations LLC, Lahey Clinic and Tufts Medical School, Boston, MA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Nocco SE, Ewalt MD, Moy AP, Lewis NE, Zhu M, Lezcano C, Busam K, Pulitzer M. TRBC1 immunohistochemistry distinguishes cutaneous T-cell lymphoma from inflammatory dermatitis: A retrospective analysis of 39 cases. J Am Acad Dermatol 2024; 90:839-841. [PMID: 38061444 PMCID: PMC10960695 DOI: 10.1016/j.jaad.2023.11.051] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/20/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Sarah E Nocco
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Mark D Ewalt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrea P Moy
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Natasha E Lewis
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Menglei Zhu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cecilia Lezcano
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Klaus Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Pulitzer
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Lezcano C, Jungbluth AA, Busam KJ. Immunohistochemistry for PRAME in Dermatopathology. Am J Dermatopathol 2023; 45:733-747. [PMID: 37856737 PMCID: PMC10593485 DOI: 10.1097/dad.0000000000002440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
ABSTRACT Preferentially expressed antigen in melanoma (PRAME) is a tumor-associated antigen first identified in a melanoma patient and found to be expressed in most melanomas as well as in variable levels in other malignant neoplasms of epithelial, mesenchymal, or hematolymphoid lineage. Detection of PRAME expression in formalin-fixed paraffin-embedded tissue is possible by immunohistochemistry (IHC) with commercially available monoclonal antibodies. In situ and invasive melanoma frequently show a diffuse pattern of nuclear PRAME immunoreactivity which contrasts with the infrequent and typically nondiffuse staining seen in nevi. In many challenging melanocytic tumors, results of PRAME IHC and other ancillary tests correlate well, but not always: The tests are not interchangeable. Most metastatic melanomas are positive for PRAME, whereas nodal nevi are not. Numerous studies on PRAME IHC have become available in the past few years with results supporting the value of PRAME IHC as an ancillary tool in the evaluation of melanocytic lesions and providing insights into limitations in sensitivity and specificity as well as possible pitfalls that need to be kept in mind by practicing pathologists.
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Affiliation(s)
- Cecilia Lezcano
- Pathologist, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Achim A Jungbluth
- Pathologist, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and
| | - Klaus J Busam
- Pathologist, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Lezcano C, Berwick M, Luo L, Barnhill R, Duncan LM, Gerami P, Lowe L, Messina JL, Scolyer RA, Wood B, Yeh I, Zembowicz A, Busam KJ. Interobserver agreement in the histopathological classification of desmoplastic melanomas. Pathology 2023; 55:223-226. [PMID: 36653238 PMCID: PMC9974895 DOI: 10.1016/j.pathol.2022.12.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 01/03/2023]
Abstract
Desmoplastic melanoma is a subtype of melanoma characterised by amelanotic fusiform melanocytes dispersed in a collagenous stroma. Cell-poor and fibrous stroma-rich 'pure' variants have been distinguished from 'mixed' variants with areas of higher cell density and/or less desmoplastic stroma. This distinction is relevant because patients whose tumours display a pure phenotype have a lower risk for regional lymph node metastasis and distant recurrence. However, little is known about interobserver agreement among pathologists in the subclassification of desmoplastic melanoma. To address this issue, we conducted a study in which eleven dermatopathologists independently evaluated whole slide scanned images of excisions from 30 desmoplastic melanomas. The participating pathologists were asked to classify the tumours as pure or mixed. They were also asked to record the presence or absence of neurotropism and angiotropism. We found substantial interobserver agreement between the 11 dermatopathologists in the classification of tumours as pure versus mixed desmoplastic melanoma (kappa=0.64; p<0.0001). There was fair agreement between the 11 dermatopathologists in the evaluation of presence versus absence of neurotropism (kappa=0.26; p<0.0001), and slight agreement in the assessment of angiotropism (kappa=0.13; p<0.0001). The level of concordance in the subclassification of desmoplastic melanomas is encouraging for the acceptance of this prognostic parameter in the real-world practice of melanoma pathology.
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Affiliation(s)
- Cecilia Lezcano
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA.
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Raymond Barnhill
- Department of Translational Research, Institut Curie, Université de Paris UFR de Médecine, Paris, France
| | - Lyn M Duncan
- Pathology Service, Dermatopathology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lori Lowe
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Jane L Messina
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Benjamin Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Iwei Yeh
- Departments of Dermatology and Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Artur Zembowicz
- Dermatopathology Consultations LLC, Lahey Clinic and Tufts Medical School, Boston, MA, USA
| | - Klaus J Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
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Abdalla BMZ, Posner J, Harris U, Reiter O, Payulert CM, Lezcano C, Marghoob AA, Jain M. Features of an Atypical Vascular Lesion on Dermoscopy, Reflectance Confocal Microscopy, and Optical Coherence Tomography. JAAD Case Rep 2023; 35:8-11. [PMID: 37082652 PMCID: PMC10111935 DOI: 10.1016/j.jdcr.2022.12.029] [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: 03/07/2023] Open
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Navarrete-Dechent C, Cordova M, Aleissa S, Liopyris K, Dusza SW, Kose K, Busam KJ, Hollman T, Lezcano C, Pulitzer M, Chen CSJ, Lee EH, Rossi AM, Nehal KS. Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study. J Am Acad Dermatol 2023; 88:371-379. [PMID: 31812621 PMCID: PMC10210015 DOI: 10.1016/j.jaad.2019.11.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/03/2019] [Accepted: 11/25/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lentigo maligna/lentigo maligna melanoma (LM/LMM) can present with subclinical extension that may be difficult to define preoperatively and lead to incomplete excision and potential recurrence. Preliminarily studies have used reflectance confocal microscopy (RCM) to assess LM/LMM margins. OBJECTIVE To evaluate the correlation of LM/LMM subclinical extension defined by RCM compared with the gold standard histopathology. METHODS Prospective study of LM/LMM patients referred for dermatologic surgery. RCM was performed at the clinically defined initial surgical margin followed by margin-controlled staged excision with paraffin-embedded tissue, and histopathology was correlated with RCM results. RESULTS Seventy-two patients were included. Mean age was 66.8 years (standard deviation, 11.1; range, 38-89); 69.4% were men. Seventy of 72 lesions (97.2%) were located on the head and neck with mean largest clinical diameter of 1.3 cm (range, 0.3-5). Diagnostic accuracy for detection of residual melanoma in the tumor debulk (after biopsy) had a sensitivity of 96.7% and a specificity of 66.7% when compared with histopathology. RCM margin assessment revealed an overall agreement with final histopathology of 85.9% (κ = 0.71; P < .001). LIMITATIONS No RCM imaging beyond initial planned margins was performed. CONCLUSION RCM showed moderate to excellent overall agreement between RCM imaging of LM/LMM and histopathology of staged excision margins.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Saud Aleissa
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantinos Liopyris
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Stephen W Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kivanc Kose
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Travis Hollman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chih-Shan J Chen
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
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Gu L, Lin E, Liu S, Yang N, Kurtansky N, Neumann N, Stoll J, Lezcano C, Pulitzer M, Noor S, Markova A, Rossi A, Dickson MA, Deng L. Efficacy of immunotherapy with combination of cryotherapy and topical imiquimod for treatment of Kaposi sarcoma. J Med Virol 2023; 95:e28396. [PMID: 36504005 PMCID: PMC10461380 DOI: 10.1002/jmv.28396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Multiple treatment modalities for Kaposi sarcoma (KS) have been reported, including chemotherapy, radiation therapy, surgical excision, electrochemotherapy, and cryotherapy. Common topical treatments include timolol, imiquimod, and alitretinoin. We searched our institutional database for patients with ICD-9 or 10 codes for KS seen by a dermatologist with experience in KS management from July 1, 2004 to January 1, 2022. We screened patient charts to include patients who received combination therapy of cryotherapy followed by topical imiquimod three times a week for 2 months (n = 9). Patients were followed in the clinic every 3 months. Time to resolution was assessed by photographic evidence of resolution as determined by a dermatologist and corroborated with clinical documentation in patient charts. Median age (IQR) at KS diagnosis was 58 (27.5) years. All patients were male (n = 9, 100%). Majority were white (n = 7, 78%) and non-Hispanic (n = 8, 89%). Five (56%) had classic KS, one (11%) had HIV-associated KS, and three (33%) were HIV-negative men who have sex with men. Median time to resolution was 30.5 weeks, with a median of two treatments. In our study, 93% (n = 42/45) of lesions and 89% (n = 8/9) of patients experienced complete resolution during a median (range) duration of follow-up of 58 (13-209) weeks. Side effects were limited to pain during cryotherapy, occasional blister formation after cryotherapy, and mild inflammation due to imiquimod. No infections were observed. Combination therapy of cryotherapy and topical imiquimod may be an efficacious and comparatively low-risk treatment for limited, cutaneous KS.
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Affiliation(s)
- Lilly Gu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10065
| | - Erica Lin
- Warren Alpert Medical School of Brown University, Providence, RI 02903
| | - Shuaitong Liu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ning Yang
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nicholas Kurtansky
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Neil Neumann
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Joseph Stoll
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10065
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sarah Noor
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Anthony Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mark A. Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Liang Deng
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10065
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Orlow I, Sadeghi KD, Edmiston SN, Kenney JM, Lezcano C, Wilmott JS, Cust AE, Scolyer RA, Mann GJ, Lee TK, Burke H, Jakrot V, Shang P, Ferguson PM, Boyce TW, Ko JS, Ngo P, Funchain P, Rees JR, O'Connell K, Hao H, Parrish E, Conway K, Googe PB, Ollila DW, Moschos SJ, Hernando E, Hanniford D, Argibay D, Amos CI, Lee JE, Osman I, Luo L, Kuan PF, Aurora A, Gould Rothberg BE, Bosenberg MW, Gerstenblith MR, Thompson C, Bogner PN, Gorlov IP, Holmen SL, Brunsgaard EK, Saenger YM, Shen R, Seshan V, Nagore E, Ernstoff MS, Busam KJ, Begg CB, Thomas NE, Berwick M. InterMEL: An international biorepository and clinical database to uncover predictors of survival in early-stage melanoma. PLoS One 2023; 18:e0269324. [PMID: 37011054 PMCID: PMC10069769 DOI: 10.1371/journal.pone.0269324] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION We are conducting a multicenter study to identify classifiers predictive of disease-specific survival in patients with primary melanomas. Here we delineate the unique aspects, challenges, and best practices for optimizing a study of generally small-sized pigmented tumor samples including primary melanomas of at least 1.05mm from AJTCC TNM stage IIA-IIID patients. We also evaluated tissue-derived predictors of extracted nucleic acids' quality and success in downstream testing. This ongoing study will target 1,000 melanomas within the international InterMEL consortium. METHODS Following a pre-established protocol, participating centers ship formalin-fixed paraffin embedded (FFPE) tissue sections to Memorial Sloan Kettering Cancer Center for the centralized handling, dermatopathology review and histology-guided coextraction of RNA and DNA. Samples are distributed for evaluation of somatic mutations using next gen sequencing (NGS) with the MSK-IMPACTTM assay, methylation-profiling (Infinium MethylationEPIC arrays), and miRNA expression (Nanostring nCounter Human v3 miRNA Expression Assay). RESULTS Sufficient material was obtained for screening of miRNA expression in 683/685 (99%) eligible melanomas, methylation in 467 (68%), and somatic mutations in 560 (82%). In 446/685 (65%) cases, aliquots of RNA/DNA were sufficient for testing with all three platforms. Among samples evaluated by the time of this analysis, the mean NGS coverage was 249x, 59 (18.6%) samples had coverage below 100x, and 41/414 (10%) failed methylation QC due to low intensity probes or insufficient Meta-Mixed Interquartile (BMIQ)- and single sample (ss)- Noob normalizations. Six of 683 RNAs (1%) failed Nanostring QC due to the low proportion of probes above the minimum threshold. Age of the FFPE tissue blocks (p<0.001) and time elapsed from sectioning to co-extraction (p = 0.002) were associated with methylation screening failures. Melanin reduced the ability to amplify fragments of 200bp or greater (absent/lightly pigmented vs heavily pigmented, p<0.003). Conversely, heavily pigmented tumors rendered greater amounts of RNA (p<0.001), and of RNA above 200 nucleotides (p<0.001). CONCLUSION Our experience with many archival tissues demonstrates that with careful management of tissue processing and quality control it is possible to conduct multi-omic studies in a complex multi-institutional setting for investigations involving minute quantities of FFPE tumors, as in studies of early-stage melanoma. The study describes, for the first time, the optimal strategy for obtaining archival and limited tumor tissue, the characteristics of the nucleic acids co-extracted from a unique cell lysate, and success rate in downstream applications. In addition, our findings provide an estimate of the anticipated attrition that will guide other large multicenter research and consortia.
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Affiliation(s)
- Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Keimya D Sadeghi
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Sharon N Edmiston
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jessica M Kenney
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Cecilia Lezcano
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Tim K Lee
- British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
| | - Hazel Burke
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Valerie Jakrot
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Ping Shang
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter M Ferguson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Tawny W Boyce
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Peter Ngo
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Pauline Funchain
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Judy R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
| | - Kelli O'Connell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Honglin Hao
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Eloise Parrish
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathleen Conway
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Paul B Googe
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - David W Ollila
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stergios J Moschos
- Department of Medicine, Division of Medical Oncology, The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, United States of America
| | - Eva Hernando
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Douglas Hanniford
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Diana Argibay
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Christopher I Amos
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jeffrey E Lee
- Department of Surgical Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Iman Osman
- Department of Urology, New York University Grossman School of Medicine, New York, NY, United States of America
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
- Department of Dermatology, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Pei-Fen Kuan
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, United States of America
| | - Arshi Aurora
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Bonnie E Gould Rothberg
- Smilow Cancer Hospital, Yale-New Haven Health System, New Haven, Connecticut, United States of America
| | - Marcus W Bosenberg
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Meg R Gerstenblith
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Cheryl Thompson
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Paul N Bogner
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Ivan P Gorlov
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Sheri L Holmen
- Department of Oncological Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Elise K Brunsgaard
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Yvonne M Saenger
- Department of Medicine, Division of Hematology/Oncology, Columbia University Irving Medical Center, New York, New York, United States of America
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Ronglai Shen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Venkatraman Seshan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Marc S Ernstoff
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, ImmunoOncology Branch, Developmental Therapeutics Program, Rockville, Maryland, United States of America
| | - Klaus J Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Colin B Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Nancy E Thomas
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
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9
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Luo L, Shen R, Arora A, Orlow I, Busam KJ, Lezcano C, Lee TK, Hernando E, Gorlov I, Amos C, Ernstoff MS, Seshan VE, Cust AE, Wilmott J, Scolyer R, Mann G, Nagore E, Funchain P, Ko J, Ngo P, Edmiston SN, Conway K, Googe PB, Ollila D, Lee JE, Fang S, Rees JR, Thompson CL, Gerstenblith M, Bosenberg M, Gould Rothberg B, Osman I, Saenger Y, Reynolds AZ, Schwartz M, Boyce T, Holmen S, Brunsgaard E, Bogner P, Kuan PF, Wiggins C, Thomas N, Begg CB, Berwick M. Landscape of mutations in early stage primary cutaneous melanoma: An InterMEL study. Pigment Cell Melanoma Res 2022; 35:605-612. [PMID: 35876628 PMCID: PMC9640183 DOI: 10.1111/pcmr.13058] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
Abstract
It is unclear why some melanomas aggressively metastasize while others remain indolent. Available studies employing multi-omic profiling of melanomas are based on large primary or metastatic tumors. We examine the genomic landscape of early-stage melanomas diagnosed prior to the modern era of immunological treatments. Untreated cases with Stage II/III cutaneous melanoma were identified from institutions throughout the United States, Australia and Spain. FFPE tumor sections were profiled for mutation, methylation and microRNAs. Preliminary results from mutation profiling and clinical pathologic correlates show the distribution of four driver mutation sub-types: 31% BRAF; 18% NRAS; 21% NF1; 26% Triple Wild Type. BRAF mutant tumors had younger age at diagnosis, more associated nevi, more tumor infiltrating lymphocytes, and fewer thick tumors although at generally more advanced stage. NF1 mutant tumors were frequent on the head/neck in older patients with severe solar elastosis, thicker tumors but in earlier stages. Triple Wild Type tumors were predominantly male, frequently on the leg, with more perineural invasion. Mutations in TERT, TP53, CDKN2A and ARID2 were observed often, with TP53 mutations occurring particularly frequently in the NF1 sub-type. The InterMEL study will provide the most extensive multi-omic profiling of early-stage melanoma to date. Initial results demonstrate a nuanced understanding of the mutational and clinicopathological landscape of these early-stage tumors.
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10
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Kuo AM, Hassoun H, Shah U, Gordon A, Hollmann TJ, Landau HJ, Lezcano C, Mailankody S, Tan CC, Lesokhin AM, Markova A. Dupilumab for the treatment of refractory lenalidomide rash in patients with multiple myeloma. Leuk Lymphoma 2022; 63:2233-2237. [PMID: 35532206 PMCID: PMC9680041 DOI: 10.1080/10428194.2022.2068002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/23/2022] [Accepted: 04/09/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Alyce M. Kuo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allison Gordon
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Travis J. Hollmann
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Heather J. Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cecilia Lezcano
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carlyn C. Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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11
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Weiss JM, Hunter MV, Cruz NM, Baggiolini A, Tagore M, Ma Y, Misale S, Marasco M, Simon-Vermot T, Campbell NR, Newell F, Wilmott JS, Johansson PA, Thompson JF, Long GV, Pearson JV, Mann GJ, Scolyer RA, Waddell N, Montal ED, Huang TH, Jonsson P, Donoghue MTA, Harris CC, Taylor BS, Xu T, Chaligné R, Shliaha PV, Hendrickson R, Jungbluth AA, Lezcano C, Koche R, Studer L, Ariyan CE, Solit DB, Wolchok JD, Merghoub T, Rosen N, Hayward NK, White RM. Anatomic position determines oncogenic specificity in melanoma. Nature 2022; 604:354-361. [PMID: 35355015 PMCID: PMC9355078 DOI: 10.1038/s41586-022-04584-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/25/2022] [Indexed: 12/19/2022]
Abstract
Oncogenic alterations to DNA are not transforming in all cellular contexts1,2. This may be due to pre-existing transcriptional programmes in the cell of origin. Here we define anatomic position as a major determinant of why cells respond to specific oncogenes. Cutaneous melanoma arises throughout the body, whereas the acral subtype arises on the palms of the hands, soles of the feet or under the nails3. We sequenced the DNA of cutaneous and acral melanomas from a large cohort of human patients and found a specific enrichment for BRAF mutations in cutaneous melanoma and enrichment for CRKL amplifications in acral melanoma. We modelled these changes in transgenic zebrafish models and found that CRKL-driven tumours formed predominantly in the fins of the fish. The fins are the evolutionary precursors to tetrapod limbs, indicating that melanocytes in these acral locations may be uniquely susceptible to CRKL. RNA profiling of these fin and limb melanocytes, when compared with body melanocytes, revealed a positional identity gene programme typified by posterior HOX13 genes. This positional gene programme synergized with CRKL to amplify insulin-like growth factor (IGF) signalling and drive tumours at acral sites. Abrogation of this CRKL-driven programme eliminated the anatomic specificity of acral melanoma. These data suggest that the anatomic position of the cell of origin endows it with a unique transcriptional state that makes it susceptible to only certain oncogenic insults.
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Affiliation(s)
- Joshua M Weiss
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Cell and Developmental Biology Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
| | - Miranda V Hunter
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nelly M Cruz
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arianna Baggiolini
- Developmental Biology, The Center for Stem Cell Biology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mohita Tagore
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yilun Ma
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Cell and Developmental Biology Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
| | - Sandra Misale
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelangelo Marasco
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Theresa Simon-Vermot
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nathaniel R Campbell
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Computational and Systems Biology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Physiology, Biophysics & Systems Biology Graduate Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
| | - Felicity Newell
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter A Johansson
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - John V Pearson
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- John Curtin School of Medical Research, Australian National University, Acton, Australian Capital Territory, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Emily D Montal
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ting-Hsiang Huang
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip Jonsson
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark T A Donoghue
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher C Harris
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Barry S Taylor
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tianhao Xu
- Computational and Systems Biology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronan Chaligné
- Computational and Systems Biology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pavel V Shliaha
- Department of Biochemistry and Molecular Biology, VILLUM Center for Bioanalytical Sciences, University of Southern Denmark, Odense, Denmark
- Microchemistry and Proteomics Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald Hendrickson
- Microchemistry and Proteomics Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Koche
- Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lorenz Studer
- Developmental Biology, The Center for Stem Cell Biology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jedd D Wolchok
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Weill Cornell Medicine, New York, NY, USA
| | | | - Neal Rosen
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicholas K Hayward
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Richard M White
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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12
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Muzzi E, Ronfani L, Bossini B, Lezcano C, Orzan E, Barbi E. Effects of Intraoperative Auditory Stimulation on Pain and Agitation on Awakening After Pediatric Adenotonsillectomy: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2021; 147:638-645. [PMID: 34014258 PMCID: PMC8138746 DOI: 10.1001/jamaoto.2021.0870] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/11/2022]
Abstract
Importance Severe pain on awakening (POA) and emergence delirium (ED) are common following pediatric adenotonsillectomy. Effective preventive interventions are lacking. Objective To determine the effects of intraoperative auditory stimulation on reduction of POA and ED after pediatric adenotonsillectomy. Design, Setting, and Participants Single-center, double-blinded, 4-armed, randomized clinical trial of children undergoing adenotonsillectomy from March 2018 to May 2019 at a tertiary care pediatric referral center. Interventions Children were randomized to 1 of the following groups: auditory stimulation with music, auditory stimulation with noise, ambient noise insulation with masking earplugs, and a control group receiving no intervention. Ear inserts were placed in the operating room once general anesthesia was administered. Stimulation parameters were based on the preoperative audiological evaluation and the appropriate fitting of the transduction system, including ambient noise level monitoring. Main Outcomes and Measures The primary outcome was POA levels measured on 10-point scales according to age-appropriate validated tools. The secondary outcome was ED levels assessed according to the Pediatric Anesthesia Emergence Delirium 20-point scale. Results A total of 104 consecutive healthy children (median [interquartile range] age at surgery, 5.0 [3.8-6.4] years) were included in the analysis. Music had a large effect size on POA (0.63; 98% CI, 0.43-0.84) and a medium effect size on ED (0.47; 98% CI, 0.21-0.75), while noise had a medium effect size on POA (0.47; 98% CI, 0.22-0.73) and a large effect size on ED (0.63; 98% CI, 0.44-0.85) compared with controls. The earplugs group showed a small effect size on POA and ED. Considering a clinically meaningful threshold of greater than 4 for POA and 10 or greater for ED at dichotomized analysis, a large effect size was achieved by music (1.39; odds ratio [OR], 0.08; 98% CI, 0.02-0.29; and 0.84; OR, 0.22; 98% CI, 0.06-0.75, respectively) and noise (0.97; OR, 0.17; 98% CI, 0.05-0.6; and 1.48; OR, 0.07; 98% CI, 0.02-0.26, respectively), while earplugs resulted in a small effect size. Conclusions and Relevance In this randomized clinical trial, children undergoing adenotonsillectomy who received intraoperative auditory stimulation demonstrated a clinically meaningful decrease in POA and ED in the immediate postoperative period. Further research is needed to assess whether intraoperative auditory stimulation may decrease POA and ED in children undergoing other types of surgical procedures. Trial Registration ClinicalTrials.gov Identifier: NCT04112979.
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Affiliation(s)
- Enrico Muzzi
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Eva Orzan
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- University of Trieste School of Medicine, Trieste, Italy
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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13
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Abstract
PRAME (PReferentially expressed Antigen in MElanoma) is a melanoma-associated antigen expressed in cutaneous and ocular melanomas and some other malignant neoplasms, while its expression in normal tissue and benign tumors is limited. Detection of PRAME protein expression by immunohistochemistry in a cohort of 400 melanocytic tumors showed diffuse nuclear immunoreactivity for PRAME in most metastatic and primary melanomas. In contrast, most nevi were negative for PRAME or showed nondiffuse immunoreactivity. The difference in the extent of immunoreactivity for PRAME in unambiguous melanocytic tumors prompted the study of PRAME as an ancillary tool for evaluating melanocytic lesions in more challenging scenarios.
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Affiliation(s)
- Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Lezcano C, Müller AM, Frosina D, Hernandez E, Geronimo JA, Busam KJ, Jungbluth AA. Immunohistochemical Detection of Cancer-Testis Antigen PRAME. Int J Surg Pathol 2021; 29:826-835. [PMID: 33890816 DOI: 10.1177/10668969211012085] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cancer-testis (CT) antigens were identified by their ability to elicit T- or B-cell immune responses in the autologous host. They are typically expressed in a wide variety of neoplasms and in normal adult tissues are restricted to testicular germ cells. PReferentially expressed Antigen of Melanoma (PRAME) is a member of the family of nonclassical CT antigens being expressed in a few other normal tissues besides testis. Interestingly, knowledge about the protein expression of many CT antigens is still incomplete due to the limited availability of reagents for their immunohistochemical detection. Here, we tested several commercially available serological reagents and identified a monoclonal antibody suitable for the immunohistochemical detection of PRAME in formalin-fixed paraffin-embedded specimens. We also tested a wide array of normal and neoplastic tissues. PRAME protein expression in normal tissues is congruent with original molecular data being present in the testis, and at low levels in the endometrium, adrenal cortex, and adult as well as fetal ovary. In tumors, there is diffuse PRAME immunoreactivity in most metastatic melanomas, myxoid liposarcomas, and synovial sarcomas. Other neoplasms such as seminomas and carcinomas of various origins including endometrial, serous ovarian, mammary ductal, lung, and renal showed an intermediate proportion of cases and variable extent of tumor cells positive for PRAME protein expression. As seen with other CT antigens, hepatocellular and colorectal carcinoma, Leydig cell tumors, mesothelioma, and leiomyosarcoma are poor expressers of PRAME.
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Affiliation(s)
| | | | - Denise Frosina
- 5803Memorial Sloan-Kettering Cancer Center, New York, USA
| | | | | | - Klaus J Busam
- 5803Memorial Sloan-Kettering Cancer Center, New York, USA
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15
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Navarrete-Dechent C, Aleissa S, Cordova M, Hibler BP, Erlendsson AM, Polansky M, Cordova F, Lee EH, Busam KJ, Hollmann T, Lezcano C, Moy A, Pulitzer M, Leitao MM, Rossi AM. Treatment of Extramammary Paget Disease and the Role of Reflectance Confocal Microscopy: A Prospective Study. Dermatol Surg 2021; 47:473-479. [PMID: 33625139 PMCID: PMC10599152 DOI: 10.1097/dss.0000000000002934] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Extramammary Paget disease (EMPD) poses treatment challenges. Invasive and noninvasive treatment modalities exist with variable success reported. Reflectance confocal microscopy (RCM) is emerging as an adjuvant diagnostic tool. OBJECTIVE To evaluate the treatment of EMPD patients and the role of RCM. METHODS Prospective study. Demographic and tumor characteristics were recorded. Handheld-RCM was performed and correlated with histology. Treatment, clearance, pathology, and follow-up were all recorded. RESULTS Thirty-six EMPD lesions in 33 patients were included. Mean age was 71.7 years, and 23 were men. Mean number of surgical stages needed to clear margins was 1.9 (SD, 0.9; 1.0-3.0 stages), and mean margin needed to clear was 1.8 cm. Reflectance confocal microscopy correlated well with scouting punch biopsies (kappa, 0.93; p < .001). Disruption of the dermoepidermal junction was associated with invasive EMPD versus in situ (83.3% vs 25.9%) on histology (p = .01). LIMITATIONS Relatively small sample size. CONCLUSION Extramammary Paget disease is challenging, and lesion demarcation is of the utmost importance. Using a staged surgical excision approach, the mean margins needed were 1.8 cm, less than previously reported. Nonsurgical modalities, including radiation therapy, imiquimod, or photodynamic therapy can be considered if surgery is not pursued. Reflectance confocal microscopy is a valuable noninvasive imaging modality for the management of EMPD.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian P. Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andres M. Erlendsson
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Max Polansky
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank Cordova
- Department of Biology, Stony Brook University, Stony Brook, NY, USA
| | - Erica H. Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Travis Hollmann
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Moy
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony M. Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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16
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Lezcano C, Yeh I, Eslamdoost N, Fang Y, LeBoit PE, McCalmont TH, Moy AP, Zhang Y, Busam KJ. Expanding the Spectrum of Microscopic and Cytogenetic Findings Associated With Spitz Tumors With 11p Gains. Am J Surg Pathol 2021; 45:277-285. [PMID: 33428338 PMCID: PMC7808272 DOI: 10.1097/pas.0000000000001607] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A subset of Spitz tumors is associated with a copy number increase of chromosome 11p and activating mutations of HRAS. These aberrations have been reported to occur in association with desmoplastic Spitz nevi. Little is known to what extent 11p gains can also be found in nondesmoplastic tumors. To learn more about the spectrum of microscopic and cytogenetic changes that can be seen in Spitz lesions in association with 11p gains, we reviewed the clinical and pathologic features of 40 cases. Patient ages ranged from 3 to 75 years. The most common anatomic site was the head and neck region, followed by the upper extremities. Prominent desmoplasia was present in 10 cases. Seven tumors lacked significant stromal fibrosis. Twenty tumors were mitotically active. Novel microscopic features encountered in a few cases include a tumor with a polypoid silhouette and papillomatous surface and rare atypical tumors with a deep bulbous growth pattern. Among 36 cases analyzed by single-nucleotide polymorphism array or comparative genomic hybridization, 28 tumors had gains of the entire or near-entire p-arm of chromosome 11 with no other coexisting unbalanced genomic aberration. Eight cases had additional changes; 6 of these with 1 additional aberration per case, and 2 cases had several chromosomal aberrations. We also examined a subset of tumors by fluorescence in situ hybridization for the HRAS gene locus (11p15.5). All tumors were fluorescence in situ hybridization-positive. In conclusion, we expand the spectrum of pathologic findings associated with Spitz tumors with 11p gains. This cytogenetic aberration is not restricted to desmoplastic Spitz nevi. It can also be seen in nondesmoplastic and papillomatous lesions and atypical melanocytic tumors with a deep bulbous growth. We also document that in some Spitz tumors additional cytogenetic aberrations may be found, the significance of which remains to be determined.
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Affiliation(s)
- Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Iwei Yeh
- Dermatopathology Section, Departments of Pathology and Dermatology, University of California, San Francisco, CA
| | - Nasrin Eslamdoost
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yuqiang Fang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Philip E. LeBoit
- Dermatopathology Section, Departments of Pathology and Dermatology, University of California, San Francisco, CA
| | - Timothy H. McCalmont
- Dermatopathology Section, Departments of Pathology and Dermatology, University of California, San Francisco, CA
| | - Andrea P. Moy
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yanming Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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17
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Ko YCK, Markova A, Cho C, Kamboj M, Busam KJ, Lezcano C. Perianal cutaneous malakoplakia in an allogeneic stem cell transplant recipient. J Cutan Pathol 2021; 48:829-832. [PMID: 33470456 DOI: 10.1111/cup.13761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yen Chen Kevin Ko
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alina Markova
- Dermatology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Christina Cho
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mini Kamboj
- Infectious Disease Services, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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18
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Wu J, Liu D, Offin M, Lezcano C, Torrisi JM, Brownstein S, Hyman DM, Gounder MM, Abida W, Drilon A, Harding JJ, Sullivan RJ, Janku F, Welsch D, Varterasian M, Groover A, Li BT, Lacouture ME. Characterization and management of ERK inhibitor associated dermatologic adverse events: analysis from a nonrandomized trial of ulixertinib for advanced cancers. Invest New Drugs 2021; 39:785-795. [PMID: 33389388 DOI: 10.1007/s10637-020-01035-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/22/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022]
Abstract
Background Ulixertinib is the first-in-class ERK1/2 kinase inhibitor with encouraging clinical activity in BRAF- and NRAS-mutant cancers. Dermatologic adverse events (dAEs) are common with ulixertinib, so management guidelines like those established for epidermal growth factor receptor inhibitor (EGFRi)-associated dAEs are needed. Patients and Methods This was an open-label, multicenter, phase I dose escalation and expansion trial of ulixertinib evaluating data from 135 patients with advanced malignancies enrolled between March 2013 and July 2017. Histopathological features, management, and dAEs in 34 patients are also reported. Twice daily oral ulixertinib was administered at 10 to 900 mg in the dose escalation cohort (n = 27) and at 600 mg in 21-day cycles in the expansion cohort (n = 108). Results The incidence of ulixertinib-induced dAEs and combined rash were 79% (107/135) and 76% (102/135). The most common dAEs included acneiform rash (45/135, 33%), maculopapular rash (36/135, 27%), and pruritus (34/135, 25%). Grade 3 dAEs were observed in 19% (25/135) of patients; no grade 4 or 5 dAEs were seen. The presence of at least 1 dAE was associated with stable disease (SD) or partial response (PR) (OR = 3.64, 95% CI 1.52-8.72; P = .003). Acneiform rash was associated with a PR (OR = 10.19, 95% CI 2.67-38.91; P < .001). Conclusion The clinical spectrum of ulixertinib-induced dAEs was similar to EGFR and MEK inhibitors; dAEs may serve as a surrogate marker of tumor response. We propose treatment algorithms for common ERK inhibitor-induced dAEs to maintain patients' quality of life and dose intensity for maximal clinical benefit. Clinical Trial Registration: NCT01781429.
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Affiliation(s)
- J Wu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Linkou, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - D Liu
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - M Offin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - C Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - J M Torrisi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - S Brownstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - D M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - M M Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - W Abida
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - A Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.,Thoracic Oncology and Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA
| | - J J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - R J Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, 02114, USA
| | - F Janku
- MD Anderson Cancer Center, The University of Texas, Houston, TX, 77030, USA
| | - D Welsch
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - M Varterasian
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - A Groover
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - B T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA. .,Thoracic Oncology and Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA.
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA.
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19
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Navarrete-Dechent C, Aleissa S, Cordova M, Liopyris K, Lee EH, Rossi AM, Hollman T, Pulitzer M, Lezcano C, Busam KJ, Marghoob AA, Chen CCJ, Nehal KS. Incompletely excised lentigo maligna melanoma is associated with unpredictable residual disease: clinical features and the emerging role of reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2020; 34:2280-2287. [PMID: 32030827 PMCID: PMC8409509 DOI: 10.1111/jdv.16272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lentigo maligna/lentigo maligna melanoma (LM/LMM) poses a treatment and surgical challenge given unpredictable subclinical extension resulting in incomplete excision. OBJECTIVES To describe the demographic, clinical and pathologic characteristics of incompletely excised LM/LMM. To evaluate the potential role of reflectance confocal microscopy (RCM). PATIENTS AND METHODS A retrospective review of a melanoma database at a tertiary cancer centre for patients referred with 'incompletely excised LM/LMM' or 'incompletely excised melanoma' between October 2006 and July 2017. We recorded clinical and pathological data and surgical margins needed to clear the residual LM/LMM. The second part consisted of a prospective cohort of patients in which RCM was performed when presenting with incompletely excised LM/LMM. RESULTS We included a total of 67 patients (retrospective + prospective cohort); mean age was 64.9 (standard deviation: 11.3) years and 52.2% were males. For the retrospective cohort (n = 53), the mean scar size was 3.4 cm. The average initial margins excised prior to presentation were 4.8 mm (range 3-7 mm). The average additional margin needed to clear the residual, incompletely excised LM/LMM was 7.8 mm. For the prospective cohort (n = 14), there were no differences in age, gender or size when compared to the retrospective cohort. RCM had a diagnostic accuracy of 78.6%, a sensitivity of 90.9%, a specificity of 33.3% and a positive predictive value of 83.3% for the detection of incompletely excised LM/LMM. CONCLUSIONS Incompletely excised LM/LMM is a poorly characterized clinical-pathological scenario that may require considerable extra margins for microscopic clearance. RCM may emerge as a valuable tool for the evaluation of patients with incompletely excised LM/LMM.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saud Aleissa
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Erica H. Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony M. Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Travis Hollman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashfaq A. Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chih-Chan J. Chen
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kishwer S. Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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20
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Vaidya T, Schmidt E, Papanicolaou G, Hauser J, Lezcano C, Tang YW, Markova A. Cutaneous Legionella infections in allogeneic hematopoietic cell transplantation recipients. Dermatol Online J 2020; 26:13030/qt05f926n7. [PMID: 32815687 PMCID: PMC8381373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
To date, only twenty cases of cutaneous legionellosis have been reported. Cutaneous legionellosis has heterogeneous manifestations including abscesses, nodules, and cellulitis. The detection of most cutaneous Legionella species requires specific diagnostic cultures and assays. Herein, we report a case of cutaneous legionella in a hematopoietic cell transplantation recipient with culture-negative nodules unresponsive to empiric antibiotics. We also discuss the varied morphology of cutaneous legionellosis and important diagnostic considerations.
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Affiliation(s)
- Toral Vaidya
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Schmidt
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Genovefa Papanicolaou
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jocelyn Hauser
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cecilia Lezcano
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yi-Wei Tang
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA,Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA,Department of Dermatology, Weill Cornell Medical College, New York, New York, USA
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21
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Piris A, Sanchez DF, Fernandez-Nestosa MJ, Cañete-Portillo S, Campagnoli T, Gonzalez Stark L, Zarza P, Oneto S, Lezcano C, Rodriguez I, Velazquez EF, Mihm M, Cubilla AL. Topographical Evaluation of Penile Lichen Sclerosus Reveals a Lymphocytic Depleted Variant, Preferentially Associated With Neoplasia: A Report of 200 Cases. Int J Surg Pathol 2020; 28:468-476. [PMID: 31969038 DOI: 10.1177/1066896920901333] [Citation(s) in RCA: 1] [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] [Indexed: 11/15/2022]
Abstract
Since the seminal study of Hart and Helwig in 1975, there are few detailed pathological studies of lichen sclerosus (LS). The aims of this study were to provide a detailed histopathological description of penile LS, as well as to explore its relationship with penile intraepithelial neoplasia (PeIN) or invasive carcinoma. We evaluated 200 patients and designed a topographical approach for the histological evaluation focusing in alterations of the following anatomical layers: squamous epithelium, lamina propria, dartos, and corpus spongiosum. We documented the quantity and topographical location of stromal lymphocytes. The prevalent lesions found were epithelial hyperplasia, atrophy, PeIN, basal cell vacuolization, lamina propria sclerosis, and variable patterns of lymphocytic infiltration. Various unique patterns of stromal sclerosis were described: perivascular, globular, linear, and solid fibrosis/hyalinization; any of them were found to be diagnostic for LS. The variation in the topography and density of lymphocytes was determinant for the identification of LS morphological variants: lichenoid, band-like, lymphocytic depleted, and mixed. A major finding was the identification of the variant designated as lymphocytic depleted LS, which we considered as the morphological prototype of LS associated with penile neoplasia. The detailed description of this complex lesion presented in this study may help pathologists in practice to identify and better define LS. The identification of the special variants suggests a role of the stromal lymphocytes in the process of carcinogenesis. Confirmation of the observations with more studies is necessary to determine the significance of these findings.
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Affiliation(s)
- Adriano Piris
- Brigham and Women Hospital, Boston, MA, USA.,Harvard University, Cambridge, MA, USA
| | - Diego F Sanchez
- Instituto de Patología e Investigación, Asunción, Paraguay.,Universidad Nacional de Asunción, Asunción, Paraguay
| | - Maria José Fernandez-Nestosa
- Instituto de Patología e Investigación, Asunción, Paraguay.,Universidad Nacional de Asunción, Asunción, Paraguay
| | | | | | | | - Patricia Zarza
- Instituto de Patología e Investigación, Asunción, Paraguay
| | - Sabrina Oneto
- Instituto de Patología e Investigación, Asunción, Paraguay
| | | | - Ingrid Rodriguez
- Instituto de Patología e Investigación, Asunción, Paraguay.,Universidad Nacional de Asunción, Asunción, Paraguay
| | - Elsa F Velazquez
- Miraca Life Sciences, Irving, TX, USA.,Tufts University, Boston, MA, USA
| | - Martin Mihm
- Brigham and Women Hospital, Boston, MA, USA.,Harvard University, Cambridge, MA, USA
| | - Antonio L Cubilla
- Instituto de Patología e Investigación, Asunción, Paraguay.,Universidad Nacional de Asunción, Asunción, Paraguay
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22
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Vaidya T, Schmidt E, Papanicolaou G, Hauser J, Lezcano C, Tang YW, Markova A. Cutaneous Legionella infections in allogeneic hematopoietic cell transplantation recipients. Dermatol Online J 2020. [DOI: 10.5070/d3266049314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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23
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Chan KK, Magro C, Shoushtari A, Rudin C, Rotemberg V, Rossi A, Lezcano C, Carrino J, Fernandez D, Postow MA, Apollo A, Lacouture ME, Bass AR. Eosinophilic Fasciitis Following Checkpoint Inhibitor Therapy: Four Cases and a Review of Literature. Oncologist 2019; 25:140-149. [PMID: 32043775 DOI: 10.1634/theoncologist.2019-0508] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Checkpoint inhibitor therapy is widely known to cause a number of immune-related adverse events. One rare adverse effect that is emerging is eosinophilic fasciitis, a fibrosing disorder causing inflammatory infiltration of subcutaneous fascia. It is characterized clinically by edema and subsequent induration and tightening of the skin and subcutaneous tissues. The condition is rare, yet at our institutions we have seen four cases in the past 3 years. We describe our 4 cases and review 11 other cases reported in the literature. CASE PRESENTATION We present four cases of eosinophilic fasciitis following treatment with programmed cell death protein 1 or programmed cell death-ligand 1 blockade. All patients had extremity involvement with characteristic skin changes ranging from peripheral edema to induration, tightening, and joint limitation. The patients had varying degrees of peripheral eosinophilia. In two of our patients, the diagnosis was made by full-thickness skin biopsy showing lymphocytic infiltration of the subcutaneous fascia, with CD4+ T cells predominating in one case and CD8+ T cells in the other. In the other two cases, the diagnosis was made on the basis of characteristic imaging findings in the context of clinical features consistent with the diagnosis. All four patients were treated with glucocorticoids with varying degrees of success; immunotherapy had to be discontinued in all four. Patients with advanced melanoma who experienced this adverse effect had either a partial response or a complete response to therapy. CONCLUSION Eosinophilic fasciitis can occur as a result of checkpoint inhibitor therapy. Although a tissue diagnosis is the gold standard, imaging studies may facilitate the diagnosis in the presence of consistent clinical features, but a degree of suspicion is key to recognizing the condition early. Therapy requires a collaborative approach by oncology, rheumatology, and dermatology; physical therapy is an important adjunct in treatment. For advanced melanoma, it may be a good prognostic indicator. IMPLICATIONS FOR PRACTICE It is important for clinicians to recognize that eosinophilic fasciitis is a potential immune-related adverse event (irAE) as a consequence of immune checkpoint inhibitor therapy. The presentation is quite stereotypical; the diagnosis can be made by imaging in the absence of a full-thickness skin biopsy. Early intervention is important to limit morbidity. This irAE may be a good prognostic sign among patients with melanoma.
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Affiliation(s)
- Karmela Kim Chan
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Alexander Shoushtari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Charles Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Veronica Rotemberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anthony Rossi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John Carrino
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - David Fernandez
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Michael A Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Arlyn Apollo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mario E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anne R Bass
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
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24
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Navarrete-Dechent C, Cordova M, Postow MA, Pulitzer M, Lezcano C, Halpern AC, Rossi AM. Evaluation of the Response of Unresectable Primary Cutaneous Melanoma to Immunotherapy Visualized With Reflectance Confocal Microscopy: A Report of 2 Cases. JAMA Dermatol 2019; 155:347-352. [PMID: 30624578 PMCID: PMC6440283 DOI: 10.1001/jamadermatol.2018.3688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/22/2018] [Indexed: 12/19/2022]
Abstract
Importance Melanoma incidence and the use of systemic treatments for it are rising. Current treatment monitoring uses clinical examination and radiologic examinations; however, cutaneous involvement and cutaneous metastasis may not be well visualized. Reflectance confocal microscopy (RCM) is a US Food and Drug Administration-approved, noninvasive technology that enables visualization of the skin with quasihistological resolution. Objective To evaluate the feasibility of using RCM to monitor advanced melanomas treated with immunotherapy. Design, Setting, and Participants This case report study took place from March 2017 to June 2018 and included 2 patients with locally advanced melanoma who were not candidates for surgery or were not willing to have surgery and who were started on an immunotherapy regimen at a tertiary care cancer hospital. Main Outcomes and Measures Clinical and RCM findings correlated with histopathology. Results In the patients, locally advanced melanoma with cutaneous involvement was treated with immunotherapy (pembrolizumab in 1 patient and an ipilimumab-nivolumab combination in the other) with resulting clearance of the lesions. Use of RCM showed the disappearance of clear melanoma features seen at baseline; these findings correlated with histopathology. The response was not seen with radiologic images, such as magnetic resonance imaging and computed tomography. Conclusions and Relevance Although RCM will not replace larger field imaging (such as magnetic resonance imaging, positron emission tomography, and computed tomography) in the management and follow-up of melanoma or other tumors, for imaging of cutaneous involvement and disease monitoring, RCM holds promise as a novel noninvasive technique.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A. Postow
- Melanoma and Immunotherapeutics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allan C. Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M. Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
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25
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Gunasekera NS, Maniar LEG, Lezcano C, Laga AC, Merola JF. Intralesional Sodium Thiosulfate Treatment for Calcinosis Cutis in the Setting of Lupus Panniculitis. JAMA Dermatol 2019; 153:944-945. [PMID: 28564698 DOI: 10.1001/jamadermatol.2017.0966] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nicole S Gunasekera
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lia E Gracey Maniar
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cecilia Lezcano
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alvaro C Laga
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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26
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Cañete-Portillo S, Sanchez DF, Fernández-Nestosa MJ, Piris A, Zarza P, Oneto S, Gonzalez Stark L, Lezcano C, Ayala G, Rodriguez I, Hoang MP, Mihm MC, Cubilla AL. Continuous Spatial Sequences of Lichen Sclerosus, Penile Intraepithelial Neoplasia, and Invasive Carcinomas: A Study of 109 Cases. Int J Surg Pathol 2019; 27:477-482. [DOI: 10.1177/1066896918820960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lichen sclerosus (LSc) with penile cancer is found in about two thirds of specimens. It has been hypothesized that LSc represents a precancerous condition. To qualify as such, in addition to cytological atypia and similarity with the invasive tumor, a spatial correlation between LSc and neoplastic lesions needs to be demonstrated. The purpose of this study was to evaluate such a spatial relationship. Circumcision (28 cases) and penectomy (81 cases) specimens were evaluated. All cases had LSc, penile intraepithelial neoplasia (PeIN), and/or invasive squamous cell carcinomas. We examined LSc in relation to invasive carcinoma, PeIN, and normal epithelia. Invasive squamous cell carcinomas, classified according to the World Health Organization criteria as non–human papillomavirus (HPV)-related and HPV-related PeIN, were present in 100 cases. Non-HPV-related (differentiated) PeIN was the most common subtype associated with LSc (89%). There were 5 spatial patterns identified: (1) LSc adjacent to PeIN (23%), (2) LSc adjacent and comprising PeIN (42%), (3) LSc next to and within invasive carcinomas (8%), (4) LSc throughout the sequence PeIN-invasive carcinoma (24%), and (5) LSc was separate (with normal tissue between the lesions) from PeIN and/or invasive carcinomas in a minority of cases (3%). LSc within the cancer was not previously described. In this series, we found 35 cases with LSc within invasive carcinomas. The striking continuous spatial relationship among LSc, PeIN, and/or invasive carcinoma as shown in this study may be a necessary (but not sufficient) condition for the hypothesis postulating LSc as a penile precancerous lesion.
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Affiliation(s)
- Sofía Cañete-Portillo
- Instituto de Patología e Investigación, Asunción, Paraguay
- Instituto de Previsión Social, Hospital Central, Asunción, Paraguay
| | - Diego F. Sanchez
- Instituto de Patología e Investigación, Asunción, Paraguay
- Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Asunción, Paraguay
| | - María José Fernández-Nestosa
- Instituto de Patología e Investigación, Asunción, Paraguay
- Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Adriano Piris
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patricia Zarza
- Instituto de Patología e Investigación, Asunción, Paraguay
| | - Sabrina Oneto
- Instituto de Patología e Investigación, Asunción, Paraguay
| | | | | | - Gustavo Ayala
- University of Texas Health Science Center at Houston, TX, USA
| | - Ingrid Rodriguez
- Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Asunción, Paraguay
| | - Mai P. Hoang
- Harvard Medical School, Boston, MA, USA
- Massachussets General Hospital, Boston, MA, USA
| | - Martin C. Mihm
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Antonio L. Cubilla
- Instituto de Patología e Investigación, Asunción, Paraguay
- Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Asunción, Paraguay
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27
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Tsai JJ, Velardi E, Shono Y, Argyropoulos KV, Holland AM, Smith OM, Yim NL, Rao UK, Kreines FM, Lieberman SR, Young LF, Lazrak A, Youssef S, Fu YY, Liu C, Lezcano C, Murphy GF, Na IK, Jenq RR, Hanash AM, Dudakov JA, van den Brink MRM. Nrf2 regulates CD4 + T cell-induced acute graft-versus-host disease in mice. Blood 2018; 132:2763-2774. [PMID: 30381375 PMCID: PMC6307985 DOI: 10.1182/blood-2017-10-812941] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/01/2018] [Indexed: 02/07/2023] Open
Abstract
Nuclear factor erythroid-derived 2-like 2 (Nrf2) is a ubiquitously expressed transcription factor that is well known for its role in regulating the cellular redox pathway. Although there is mounting evidence suggesting a critical role for Nrf2 in hematopoietic stem cells and innate leukocytes, little is known about its involvement in T-cell biology. In this study, we identified a novel role for Nrf2 in regulating alloreactive T-cell function during allogeneic hematopoietic cell transplantation (allo-HCT). We observed increased expression and nuclear translocation of Nrf2 upon T-cell activation in vitro, especially in CD4+ donor T cells after allo-HCT. Allo-HCT recipients of Nrf2 -/- donor T cells had significantly less acute graft-versus-host disease (GVHD)-induced mortality, morbidity, and pathology. This reduction in GVHD was associated with the persistence of Helios+ donor regulatory T cells in the allograft, as well as defective upregulation of the gut-homing receptor LPAM-1 on alloreactive CD8+ T cells. Additionally, Nrf2 -/- donor CD8+ T cells demonstrated intact cytotoxicity against allogeneic target cells. Tumor-bearing allo-HCT recipients of Nrf2 -/- donor T cells had overall improved survival as a result of preserved graft-versus-tumor activity and reduced GVHD activity. Our findings characterized a previously unrecognized role for Nrf2 in T-cell function, as well as revealed a novel therapeutic target to improve the outcomes of allo-HCT.
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Affiliation(s)
- Jennifer J Tsai
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Immunology and Microbial Pathogenesis, Weill Cornell Graduate School of Medical Sciences, New York, NY
- Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY
| | - Enrico Velardi
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatric Hematology and Oncology, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Yusuke Shono
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY
| | - Kimon V Argyropoulos
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amanda M Holland
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Odette M Smith
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nury L Yim
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Uttam K Rao
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fabiana M Kreines
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sophie R Lieberman
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lauren F Young
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amina Lazrak
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Salma Youssef
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ya-Yuan Fu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chen Liu
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School and Rutgers Robert Wood Johnson Medical School, Newark, NJ
| | - Cecilia Lezcano
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - George F Murphy
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Il-Kang Na
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert R Jenq
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alan M Hanash
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jarrod A Dudakov
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Program in Immunology and Immunotherapy Integrated Research Center, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Immunology, University of Washington, Seattle, WA; and
- Cell and Gene Therapy Program and Immunotherapy Integrated Research Center, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marcel R M van den Brink
- Department of Immunology, and
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Immunology and Microbial Pathogenesis, Weill Cornell Graduate School of Medical Sciences, New York, NY
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28
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Martins CO, Lezcano C, Yi SS, Landau HJ, Chapman JR, Dogan A. Novel iatrogenic amyloidosis caused by peptide drug liraglutide: a clinical mimic of AL amyloidosis. Haematologica 2018; 103:e610-e612. [PMID: 30262557 DOI: 10.3324/haematol.2018.203000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | | | | | - Heather J Landau
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
A number of oncogenic driver mutations have been identified in melanocytic nevi and melanoma, but translocations also play a role in tumorigenesis and provide potential therapeutic targets for malignant lesions. Various translocations, such as those involving the anaplastic lymphoma kinase (ALK), neurotrophic tropomyosin receptor kinase 1 (NTRK1), and NTRK3 have been reported in spitzoid melanocytic neoplasms leading to kinase-fusion proteins that result in immunohistochemically detectable ALK or NTRK expression. We have previously reported that ALK expression can be found in nonspitzoid primary and metastatic cutaneous melanomas. In this study we report that nonspitzoid metastasizing melanomas of adults may also harbor NTRK fusions and that NTRK expression can be immunohistochemically detected in these tumors. Of 751 melanomas analyzed by next-generation sequencing, 4 metastatic melanomas were identified with NTRK fusions, 3 involving NTRK1, 1 involving NTRK2. They occurred in 3 women and 1 man. Two of the corresponding primary tumors were from the trunk, 1 from an extremity and 1 tumor arose in anal skin. One primary tumor displayed features of superficial spreading melanoma and 3 were nodular melanomas. All tumors were cytologically characterized by the presence of large epithelioid melanocytes. All tumors were immunoreactive with anti-Trk antibody. Next-generation sequencing documented that the NTRK1 fusion partners included TRIM63, DDR2, and GON4L. One tumor harbored an NTRK2-TRAF2 fusion. Thus, our findings document that NTRK kinase fusions can occur in nonspitzoid metastasizing melanomas of adults. The presence of an NTRK family fusion in these tumors may provide a therapeutic opportunity in a small subset of patients with metastatic melanoma.
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30
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Mori S, Lezcano C, Miraflor AP, Busam KJ, Lee EH. Solitary fibrous tumor presenting on the scalp: a potential diagnostic pitfall. J Cutan Pathol 2018; 45:557-560. [PMID: 30004148 PMCID: PMC6614870 DOI: 10.1111/cup.13272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 04/20/2018] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shoko Mori
- SUNY Downstate College of Medicine, Brooklyn, New York
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allen P. Miraflor
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica H. Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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31
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Berwick M, Gorlov IP, Orlow I, Ringelberg C, Ernstoff M, Parker J, Gerstenblith M, Thompson C, Hernando E, Busam K, Lezcano C, Corrales S, Leong S, Thomas NE, Amos CI. Abstract 3682: Expression levels of genes in primary melanoma associated with clinically meaningful characteristics. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Melanoma survival appears to be improving; however, between 13-68% of individuals with melanoma diagnosed with Stages II-III ultimately die from their melanoma. Factors influencing melanoma survival include sex, age, clinical stage, lymph node involvement and several primary tumor characteristics, such as Breslow thickness, presence of infiltrating lymphocytes (TILs), mitotic rate and ulceration. Identification of genes whose expression in primary tumors is associated with these key tumor/patient characteristics can shed light on molecular mechanisms of melanoma survival. Here we show results from a gene expression analysis of 32 formalin-fixed, paraffin embedded (FFPE) primary melanomas with extensive clinical annotation. We extracted RNA, and measured the expression of 760 genes selected based on published evidence of association with melanoma initiation or outcome using NanoString. The Cancer Genome Atlas (TCGA) data on primary melanomas was used for validation of nominally significant associations. We identified 5 genes that were significantly associated with the presence of TILs in the combined analysis of both datasets after adjustment for multiple testing using the Benjamini-Hochberg false discovery rate method: IL1R2, PPL, PLA2G3, RASAL1, and SGK2. We also identified two genes significantly associated with lymph node status (PIK3CG and IL2RA), and two genes significantly associated with sex (KDM5C and KDM6A). We found that LEF1 was significantly associated with Breslow thickness and CCNA2 with mitosis. These results demonstrate that genetic expression in primary tumors is associated with clinically meaningful characteristics of cutaneous melanoma.
Citation Format: Marianne Berwick, Ivan P. Gorlov, Irene Orlow, Carol Ringelberg, Marc Ernstoff, Joel Parker, Meg Gerstenblith, Cheryl Thompson, Eva Hernando, Klaus Busam, Cecilia Lezcano, Sergio Corrales, Siok Leong, Nancy E. Thomas, Christopher I. Amos. Expression levels of genes in primary melanoma associated with clinically meaningful characteristics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3682.
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Affiliation(s)
- Marianne Berwick
- 1Univ. of New Mexico Health Sciences Ctr. - Albuquerque, Albuquerque, NM
| | | | - Irene Orlow
- 3Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Joel Parker
- 5University of North Carolina, Chapel Hill, NC
| | | | | | - Eva Hernando
- 8New York University Medical Center, New Yrok, NY
| | - Klaus Busam
- 9Memorial Sloan Kettering Cancer Center, New Yrok, NY
| | | | | | - Siok Leong
- 3Memorial Sloan Kettering Cancer Center, New York, NY
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32
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Rabinowits G, Lezcano C, Catalano PJ, McHugh P, Becker H, Reilly MM, Huang J, Tyagi A, Thakuria M, Bresler SC, Sholl LM, Shapiro GI, Haddad R, DeCaprio JA. Cabozantinib in Patients with Advanced Merkel Cell Carcinoma. Oncologist 2018; 23:814-821. [PMID: 29445030 DOI: 10.1634/theoncologist.2017-0552] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/27/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study sought to determine the efficacy and safety profile of cabozantinib in patients with advanced Merkel cell carcinoma (MCC). EXPERIMENTAL DESIGN This prospective, phase II, single-institution trial enrolled patients with platinum-failure, recurrent/metastatic MCC to receive cabozantinib 60 mg orally daily until disease progression, withdrawal from study, or severe toxicity. The primary endpoint was disease control rate. Secondary endpoints included overall survival (OS), progression-free survival (PFS), and toxicity. Immunohistochemistry for VEGFR-2, MET, and HGF expression and next-generation sequencing of tumor tissue were performed and correlated with outcome. RESULTS Eight patients were accrued from January 24, 2014, to June 8, 2016. The study was closed prematurely because of toxicity and lack of responses. The most frequent adverse events were grades 1 and 2 and included anorexia, fatigue, nausea, hypothyroidism, and dysgeusia. Two patients developed nonhealing, painful ulcers and tumor-skin fistula. One patient had stable disease for 8 months. One patient withdrew from the study after 2 weeks of therapy because of adverse events. Three patients required dose reduction because of toxicity. Median PFS and OS were 2.1 and 11.2 months, respectively. No expression of MET, HGF, or VEGFR-2 was identified in tumor cells by immunohistochemistry of patients' tissue samples. CONCLUSION Cabozantinib was poorly tolerated and did not demonstrate activity in patients with recurrent/metastatic, platinum-failure MCC. It is unclear whether preselection of patients with the specific upregulation or genetic alteration in the targets for cabozantinib would have changed the results of this study. (Clinical trial identification number: NCT02036476) IMPLICATIONS FOR PRACTICE: This phase II study demonstrated poor tolerability and lack of activity of cabozantinib in an unselected group of patients with advanced Merkel cell carcinoma. Although it is unclear whether preselection of patients with the specific upregulation and genetic alterations in targets for cabozantinib would have changed the results of this study, this would have likely led to an extremely rare patient population that would take many years to accrue.
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Affiliation(s)
- Guilherme Rabinowits
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Cecilia Lezcano
- Department of Anatomic Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Paul J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Patricia McHugh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Hailey Becker
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Megan M Reilly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Julian Huang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ayushi Tyagi
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Manisha Thakuria
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Scott C Bresler
- Department of Anatomic Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lynette M Sholl
- Department of Anatomic Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Geoffrey I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - James A DeCaprio
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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33
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Singer SB, Thomas C, Lezcano C, Robbins M, Gordian A, Nori S, Granter SR, Merola JF, O'Malley JT. Polyarthralgias and Papulonodules in a 56-Year-Old Woman. Arthritis Care Res (Hoboken) 2018; 70:925-930. [PMID: 29342504 DOI: 10.1002/acr.23516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/09/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Sean B Singer
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cristina Thomas
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cecilia Lezcano
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark Robbins
- Harvard Vanguard Medical Associates/Atrius Health, Boston, Massachusetts
| | - Amparo Gordian
- Harvard Vanguard Medical Associates/Atrius Health, Boston, Massachusetts
| | - Sarita Nori
- Harvard Vanguard Medical Associates/Atrius Health, Boston, Massachusetts
| | - Scott R Granter
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John T O'Malley
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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34
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Font R, Espinas J, Layos L, Martinez Villacampa M, Capdevila J, Tobeña M, Pisa A, Pericay C, Lezcano C, Fort E, Cardona I, Berga N, Solà J, Borras J. Adherence to capecitabine in preoperative treatment of stage II and III rectal cancer: do we need to worry? Ann Oncol 2017; 28:831-835. [DOI: 10.1093/annonc/mdx006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Prieto-Granada CN, Lezcano C, Scolyer RA, Mihm MC, Piris A. Lethal melanoma in children: a clinicopathological study of 12 cases. Pathology 2016; 48:705-711. [PMID: 27956274 DOI: 10.1016/j.pathol.2016.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/11/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 10/20/2022]
Abstract
Melanoma in children is rare, representing 3% of paediatric malignancies and <1% of all melanomas. Very few detailed descriptions of bona fide lethal childhood melanomas exist in the literature. We performed a retrospective clinicopathological review of 12 paediatric (≤16 years) melanoma patients who died of metastatic disease, including detailed assessment of architectural and cytomorphological features. There were nine prepubertal patients (median age 7 years old) and three postpubertal cases (median age 15 years old). The patients died on average 45.7 months after diagnosis with the prepubertal subcohort showing a relatively longer time from diagnosis to death. The tumours were bulky (average tumour thickness=10mm), showed brisk mitotic activity (average mitotic count per mm2=7), and were formed by large expansile nodules with sheet-like growth pattern and infiltrative borders in the majority of cases (83%). Cytologically, large grossly pleomorphic epithelioid cells with massive eosinophilic macronucleoli were present in most cases (75%). In this cohort, we did not identify specific features of melanoma that were unique to children. Although melanomas are extremely rarely encountered in childhood, the above-cited unequivocal malignant features should prompt an outright diagnosis of melanoma even in a paediatric patient.
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Affiliation(s)
- Carlos N Prieto-Granada
- Department of Pathology and Dermatology, Moffitt Cancer Center/University of South Florida, Tampa, FL, United States.
| | - Cecilia Lezcano
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Richard A Scolyer
- Melanoma Institute Australia, North Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Martin C Mihm
- Dermatology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Adriano Piris
- Dermatology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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36
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Kleffel S, Lee N, Lezcano C, Wilson BJ, Sobolewski K, Saab KR, Mueller H, Zhan Q, Posch C, Elco CP, DoRosario A, Garcia SS, Thakuria M, Wang YE, Wang LC, Murphy GF, Frank MH, Schatton T. ABCB5-Targeted Chemoresistance Reversal Inhibits Merkel Cell Carcinoma Growth. J Invest Dermatol 2016; 136:838-846. [PMID: 26827764 DOI: 10.1016/j.jid.2015.12.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 12/09/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine skin cancer with profound but poorly understood resistance to chemotherapy, which poses a significant barrier to clinical MCC treatment. Here we show that ATP-binding cassette member B5 (ABCB5) confers resistance to standard-of-care MCC chemotherapeutic agents and provide proof-of-principle that ABCB5 blockade can inhibit human MCC tumor growth through sensitization to drug-induced cell cytotoxicity. ABCB5 expression was detected in both established MCC lines and clinical MCC specimens at levels significantly higher than those in normal skin. Carboplatin- and etoposide-resistant MCC cell lines exhibited increased expression of ABCB5, along with enhanced ABCB1 and ABCC3 transcript expression. ABCB5-expressing MCC cells in heterogeneous cancers preferentially survived treatment with carboplatin and etoposide in vitro and in human MCC xenograft-bearing mice in vivo. Moreover, patients with MCC also exhibited enhanced ABCB5 positivity after carboplatin- and etoposide-based chemotherapy, pointing to clinical significance of this chemoresistance mechanism. Importantly, ABCB5 blockade reversed MCC drug resistance and impaired tumor growth in xenotransplantation models in vivo. Our results establish ABCB5 as a chemoresistance mechanism in MCC and suggest utility of this molecular target for improved MCC therapy.
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Affiliation(s)
- Sonja Kleffel
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nayoung Lee
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cecilia Lezcano
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian J Wilson
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristine Sobolewski
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karim R Saab
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hansgeorg Mueller
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Qian Zhan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Posch
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Elco
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew DoRosario
- Dana Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah S Garcia
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Dana Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Manisha Thakuria
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Dana Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yaoyu E Wang
- Center for Cancer Computational Biology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Linda C Wang
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Dana Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - George F Murphy
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Markus H Frank
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - Tobias Schatton
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Lezcano C, Clarke MR, Zhang L, Antonescu CR, Seethala RR. Adamantinoma-like Ewing sarcoma mimicking basal cell adenocarcinoma of the parotid gland: a case report and review of the literature. Head Neck Pathol 2015; 9:280-5. [PMID: 25081914 PMCID: PMC4424212 DOI: 10.1007/s12105-014-0558-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/23/2014] [Indexed: 12/27/2022]
Abstract
Adamantinoma-like Ewing sarcoma (AES) is a rare variant of the Ewing family of tumors that resembles classic adamantinoma of bone. AES shows epithelial differentiation and a more complex immunohistochemical expression profile with keratin and basal marker immunoreactivity and can resemble a variety of carcinomas. We report an unusual case of an AES of the parotid gland that mimicked a basal cell adenocarcinoma. Like basal cell adenocarcinoma, this AES showed a nested basaloid proliferation with peripheral palisading in tumor nests with 'basaloid' epithelial differentiation as highlighted by cytokeratin AE1/3 and p40 positivity. However, unlike most basal cell adenocarcinomas, this tumor demonstrated high grade morphology, showed no true ductal or myoepithelial component, and also showed a tendency towards neuroectodermal phenotype with focal rosette formation, CD99 and weak synaptophysin immunoreactivity. EWSR1 and FLI1 fluorescence in situ hybridization confirmed the presence of a translocation supporting the diagnosis of AES. This is the first case of AES presenting as a primary parotid mass highlighting the potential to be mistaken for primary salivary gland carcinomas, which in addition to basal cell adenocarcinoma include other basaloid tumors such as adenoid cystic carcinoma.
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Affiliation(s)
- Cecilia Lezcano
- Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop St, Scaife Hall A615, Pittsburgh, PA, 15213, USA,
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Sanchez DF, Cañete S, Fernández-Nestosa MJ, Lezcano C, Rodríguez I, Barreto J, Alvarado-Cabrero I, Cubilla AL. HPV- and non-HPV-related subtypes of penile squamous cell carcinoma (SCC): Morphological features and differential diagnosis according to the new WHO classification (2015). Semin Diagn Pathol 2015; 32:198-221. [DOI: 10.1053/j.semdp.2014.12.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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40
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Goldberg JM, Fisher DE, Demetri GD, Neuberg D, Allsop SA, Fonseca C, Nakazaki Y, Nemer D, Raut CP, George S, Morgan JA, Wagner AJ, Freeman GJ, Ritz J, Lezcano C, Mihm M, Canning C, Hodi FS, Dranoff G. Biologic Activity of Autologous, Granulocyte-Macrophage Colony-Stimulating Factor Secreting Alveolar Soft-Part Sarcoma and Clear Cell Sarcoma Vaccines. Clin Cancer Res 2015; 21:3178-86. [PMID: 25805798 DOI: 10.1158/1078-0432.ccr-14-2932] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/20/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Alveolar soft-part sarcoma (ASPS) and clear cell sarcoma (CCS) are rare mesenchymal malignancies driven by chromosomal translocations that activate members of the microphthalmia transcription factor (MITF) family. However, in contrast to malignant melanoma, little is known about their immunogenicity. To learn more about the host response to ASPS and CCS, we conducted a phase I clinical trial of vaccination with irradiated, autologous sarcoma cells engineered by adenoviral-mediated gene transfer to secrete granulocyte-macrophage colony-stimulating factor (GM-CSF). EXPERIMENTAL DESIGN Metastatic tumors from ASPS and CCS patients were resected, processed to single-cell suspensions, transduced with a replication-defective adenoviral vector encoding GM-CSF, and irradiated. Immunizations were administered subcutaneously and intradermally weekly three times and then every other week. RESULTS Vaccines were successfully manufactured for 11 of the 12 enrolled patients. Eleven subjects received from three to 13 immunizations. Toxicities were restricted to grade 1-2 skin reactions at inoculation sites. Vaccination elicited local dendritic cell infiltrates and stimulated T cell-mediated delayed-type hypersensitivity reactions to irradiated, autologous tumor cells. Antibody responses to tissue-type plasminogen activator (tTPA) and angiopoietins-1/2 were detected. Tumor biopsies showed programmed death-1 (PD-1)-positive CD8(+) T cells in association with PD ligand-1 (PD-L1)-expressing sarcoma cells. No tumor regressions were observed. CONCLUSIONS Vaccination with irradiated, GM-CSF-secreting autologous sarcoma cell vaccines is feasible, safe, and biologically active. Concurrent targeting of angiogenic cytokines and antagonism of the PD-1-negative regulatory pathway might intensify immune-mediated tumor destruction.
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Affiliation(s)
- John M Goldberg
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Pediatrics, Children's Hospital, Harvard Medical School, Boston, Massachusetts. Department of Pediatrics, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - David E Fisher
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Pediatrics, Children's Hospital, Harvard Medical School, Boston, Massachusetts. Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - George D Demetri
- Ludwig Center at Harvard, Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts. Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Stephen A Allsop
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Cancer Vaccine Center, Center for Immuno-oncology, and Melanoma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Catia Fonseca
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Cancer Vaccine Center, Center for Immuno-oncology, and Melanoma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yukoh Nakazaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Cancer Vaccine Center, Center for Immuno-oncology, and Melanoma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David Nemer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Cancer Vaccine Center, Center for Immuno-oncology, and Melanoma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chandrajit P Raut
- Department of Surgical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Suzanne George
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey A Morgan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Wagner
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Pediatrics, Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Cancer Vaccine Center, Center for Immuno-oncology, and Melanoma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jerome Ritz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Cancer Vaccine Center, Center for Immuno-oncology, and Melanoma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Cecilia Lezcano
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin Mihm
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christine Canning
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Cancer Vaccine Center, Center for Immuno-oncology, and Melanoma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - F Stephen Hodi
- Ludwig Center at Harvard, Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Cancer Vaccine Center, Center for Immuno-oncology, and Melanoma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Glenn Dranoff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Cancer Vaccine Center, Center for Immuno-oncology, and Melanoma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts.
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41
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Lezcano C, Simons JP, Colman KL, Cohen MS, Lin PL, Reyes-Múgica M. Actinomycotic mastoiditis complicated by sigmoid sinus thrombosis and labyrinthine fistula. Pediatr Dev Pathol 2014; 17:478-81. [PMID: 25133452 DOI: 10.2350/14-05-1492-cr.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Actinomyces is a rare pathogen that can be the cause of infections in the digestive and urinary tracts, skin, genitalia, and lungs, which generally have an indolent clinical course. However, in some cases these can be locally destructive and become generalized infections. Actinomyces has been previously implicated in infections of the middle ear, nasopharynx, and sinuses, occasionally causing complications such as chronic mastoiditis. Here we describe the case of a 10-year-old-male presenting with nausea, vomiting, and headache who developed intracranial complications of actinomycotic mastoiditis.
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Affiliation(s)
- Cecilia Lezcano
- 1 Department of Pathology, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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42
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Hubbard-Lucey VM, Shono Y, Maurer K, West ML, Singer NV, Ziegler CGK, Lezcano C, Motta ACF, Schmid K, Levi SM, Murphy GF, Liu C, Winkler JD, Amaravadi RK, Rogler G, Dickinson AM, Holler E, van den Brink MRM, Cadwell K. Autophagy gene Atg16L1 prevents lethal T cell alloreactivity mediated by dendritic cells. Immunity 2014; 41:579-91. [PMID: 25308334 DOI: 10.1016/j.immuni.2014.09.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/13/2014] [Indexed: 02/02/2023]
Abstract
Atg16L1 mediates the cellular degradative process of autophagy and is considered a critical regulator of inflammation based on its genetic association with inflammatory bowel disease. Here we find that Atg16L1 deficiency leads to an exacerbated graft-versus-host disease (GVHD) in a mouse model of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Atg16L1-deficient allo-HSCT recipients with GVHD displayed increased T cell proliferation due to increased dendritic cell (DC) numbers and costimulatory molecule expression. Reduced autophagy within DCs was associated with lysosomal abnormalities and decreased amounts of A20, a negative regulator of DC activation. These results broaden the function of Atg16L1 and the autophagy pathway to include a role in limiting a DC-mediated response during inflammatory disease, such as GVHD.
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Affiliation(s)
- Vanessa M Hubbard-Lucey
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York, NY 10016, USA; Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | - Yusuke Shono
- Department of Immunology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Katie Maurer
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York, NY 10016, USA; Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY 10016, USA
| | - Mallory L West
- Department of Immunology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Natalie V Singer
- Department of Immunology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Carly G K Ziegler
- Department of Computational Biology and Immunology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Cecilia Lezcano
- Program in Dermatopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ana Carolina Fragoso Motta
- Program in Dermatopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Karin Schmid
- Department of Haematology and Oncology, University Medical Centre University of Regensburg, Regensburg, 93053, Germany
| | - Samuel M Levi
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - George F Murphy
- Program in Dermatopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Chen Liu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL 32611, USA
| | - Jeffrey D Winkler
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ravi K Amaravadi
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Gerhard Rogler
- Department of Gastroenterology, University Hospital Zürich, Rämistrasse 100, 8006 Zurich, Switzerland
| | - Anne M Dickinson
- Haematological Sciences, Institute of Cellular Medicine, Newcastle University, NE2 4HH Tyne and Wear, UK
| | - Ernst Holler
- Department of Haematology and Oncology, University Medical Centre University of Regensburg, Regensburg, 93053, Germany
| | - Marcel R M van den Brink
- Department of Immunology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Ken Cadwell
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York, NY 10016, USA; Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA.
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43
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Lezcano C, Kleffel S, Lee N, Larson AR, Zhan Q, DoRosario A, Wang LC, Schatton T, Murphy GF. Merkel cell carcinoma expresses vasculogenic mimicry: demonstration in patients and experimental manipulation in xenografts. J Transl Med 2014; 94:1092-102. [PMID: 25111691 PMCID: PMC4236190 DOI: 10.1038/labinvest.2014.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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] [Received: 03/13/2014] [Revised: 06/24/2014] [Accepted: 06/27/2014] [Indexed: 12/31/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a highly virulent cutaneous neoplasm that, like melanoma, is a frequent cause of patient morbidity and mortality. The cellular mechanisms responsible for the aggressive behavior of MCC remain unknown. Vasculogenic mimicry (VM) is a phenomenon associated with cancer virulence, including in melanoma, whereby anastomosing laminin networks form in association with tumor cells that express certain endothelial genes. To determine whether VM is a factor in MCC, we employed a relevant xenograft model using two independent human MCC lines. Experimentally induced tumors were remarkably similar histologically to patient MCC, and both contained laminin networks associated with vascular endothelial-cadherin (CD144) and vascular endothelial growth factor receptor 1, as well as Nodal expression typical of VM in melanoma. Moreover, two established chemotherapeutic agents utilized for human MCC, etoposide and carboplatin, induced necrosis in xenografts on systemic administration while enriching for laminin networks in apparently resistant viable tumor regions that persisted. These findings for the first time establish VM-like laminin networks as a biomarker in MCC, demonstrate the experimental utility of the MCC xenograft model, and suggest that VM-rich regions of MCC may be refractory to conventional chemotherapeutic agents.
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Affiliation(s)
- Cecilia Lezcano
- Department of Pathology, University of Pittsburgh Medical Center,
Pittsburgh, PA
| | - Sonja Kleffel
- Department of Dermatology, Brigham and Women’s Hospital,
Boston, MA,Harvard Medical School, Boston, MA
| | - Nayoung Lee
- Department of Dermatology, Brigham and Women’s Hospital,
Boston, MA,Harvard Medical School, Boston, MA
| | - Allison R. Larson
- Department of Dermatology, Brigham and Women’s Hospital,
Boston, MA,Harvard Medical School, Boston, MA
| | - Qian Zhan
- Harvard Medical School, Boston, MA,Department of Pathology, Brigham and Women’s Hospital,
Boston, MA
| | - Andrew DoRosario
- Harvard Medical School, Boston, MA,Center for Cutaneous Oncology, Dana-Farber/Brigham and
Women’s Cancer Center, Boston, MA
| | - Linda C. Wang
- Institute for Cancer Care, Mercy Medical Center, Baltimore,
MD
| | - Tobias Schatton
- Harvard Medical School, Boston, MA,Transplantation Research Center, Children’s Hospital
Boston, MA
| | - George F. Murphy
- Harvard Medical School, Boston, MA,Department of Pathology, Brigham and Women’s Hospital,
Boston, MA
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44
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Larson AR, Lee CW, Lezcano C, Zhan Q, Huang J, Fischer AH, Murphy GF. Melanoma spheroid formation involves laminin-associated vasculogenic mimicry. Am J Pathol 2014; 184:71-8. [PMID: 24332013 DOI: 10.1016/j.ajpath.2013.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/30/2013] [Accepted: 09/18/2013] [Indexed: 10/25/2022]
Abstract
Melanoma is a tumor where virulence is conferred on transition from flat (radial) to three-dimensional (tumorigenic) growth. Virulence of tumorigenic growth is governed by numerous attributes, including presence of self-renewing stem-like cells and related formation of patterned networks associated with the melanoma mitogen, laminin, a phenomenon known as vasculogenic mimicry. Vasculogenic mimicry is posited to contribute to melanoma perfusion and nutrition in vivo; we hypothesized that it may also play a role in stem cell-driven spheroid formation in vitro. Using a model of melanoma in vitro tumorigenesis, laminin-associated networks developed in association with three-dimensional melanoma spheroids. Real-time PCR analysis of laminin subunits showed that spheroids formed from anchorage-independent melanoma cells expressed increased α4 and β1 laminin chains and α4 laminin expression was confirmed by in situ hybridization. Association of laminin networks with melanoma stem cell-associated nestin and vascular endothelial growth factor receptor-1 also was documented. Moreover, knockdown of nestin gene expression impaired laminin expression and network formation within spheroids. Laminin networks were remarkably similar to those observed in melanoma xenografts in mice and to those seen in patient melanomas. These data indicate that vasculogenic mimicry-like laminin networks, in addition to their genesis in vivo, are integral to the extracellular architecture of melanoma spheroids in vitro, where they may serve as stimulatory scaffolds to support three-dimensional growth.
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Affiliation(s)
- Allison R Larson
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chung-Wei Lee
- Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cecilia Lezcano
- Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Qian Zhan
- Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - John Huang
- Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrew H Fischer
- Department of Pathology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - George F Murphy
- Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
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45
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Larson AR, Dresser K, Zhan Q, Lezcano C, Woda BA, Yosufi B, Thompson JF, Scolyer RA, Mihm MC, Shi YG, Murphy GF, Lian CG. Loss of 5-hydroxymethylcytosine correlates with increasing morphologic dysplasia in melanocytic tumors. Mod Pathol 2014; 27:936-44. [PMID: 24390216 PMCID: PMC4077910 DOI: 10.1038/modpathol.2013.224] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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] [Received: 06/19/2013] [Accepted: 10/16/2013] [Indexed: 12/31/2022]
Abstract
DNA methylation is the most well-studied epigenetic modification in cancer biology. 5-hydroxymethylcytosine is an epigenetic mark that can be converted from 5-methylcytosine by the ten-eleven translocation gene family. We recently reported the loss of 5-hydroxymethylcytosine in melanoma compared with benign nevi and suggested that loss of this epigenetic marker is correlated with tumor virulence based on its association with a worse prognosis. In this study, we further characterize the immunoreactivity patterns of 5-hydroxymethylcytosine in the full spectrum of melanocytic lesions to further validate the potential practical application of this epigenetic marker. One hundred and seventy-five cases were evaluated: 18 benign nevi, 20 dysplastic nevi (10 low-grade and 10 high-grade lesions), 10 atypical Spitz nevi, 20 borderline tumors, 5 melanomas arising within nevi, and 102 primary melanomas. Progressive loss of 5-hydroxymethylcytosine from benign dermal nevi to high-grade dysplastic nevi to borderline melanocytic neoplasms to melanoma was observed. In addition, an analysis of the relationship of nuclear diameter with 5-hydroxymethylcytosine staining intensity within lesional cells revealed a significant correlation between larger nuclear diameter and decreased levels of 5-hydroxymethylcytosine. Furthermore, borderline lesions uniquely exhibited a diverse spectrum of staining of each individual case. This study further substantiates the association of 5-hydroxymethylcytosine loss with dysplastic cytomorphologic features and tumor progression and supports the classification of borderline lesions as a biologically distinct category of melanocytic lesions.
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Affiliation(s)
- Allison R. Larson
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School,Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School
| | - Karen Dresser
- Department of Pathology, University of Massachusetts Medical Center
| | - Qian Zhan
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School
| | - Cecilia Lezcano
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School
| | - Bruce A. Woda
- Department of Pathology, University of Massachusetts Medical Center
| | - Benafsha Yosufi
- Royal Prince Alfred Hospital, Melanoma Institute Australia and Sydney Medical School, The University of Sydney
| | - John F. Thompson
- Royal Prince Alfred Hospital, Melanoma Institute Australia and Sydney Medical School, The University of Sydney
| | - Richard A. Scolyer
- Royal Prince Alfred Hospital, Melanoma Institute Australia and Sydney Medical School, The University of Sydney
| | - Martin C. Mihm
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School
| | - Yujiang G. Shi
- Divison of Endocrinology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
| | - George F. Murphy
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School,Co-corresponding authors, George F. Murphy, MD, Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, EBRC Suite 401, Boston MA 02115, , telephone 617-525-7484, fax 617-264-5149, Christine G. Lian, MD, Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, EBRC Suite 401, Boston MA 02115, , telephone 617-525-7484, fax 617-264-5149
| | - Christine Guo Lian
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School,Co-corresponding authors, George F. Murphy, MD, Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, EBRC Suite 401, Boston MA 02115, , telephone 617-525-7484, fax 617-264-5149, Christine G. Lian, MD, Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, EBRC Suite 401, Boston MA 02115, , telephone 617-525-7484, fax 617-264-5149
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Hodi FS, Lawrence D, Lezcano C, Wu X, Zhou J, Sasada T, Zeng W, Giobbie-Hurder A, Atkins MB, Ibrahim N, Friedlander P, Flaherty KT, Murphy GF, Rodig S, Velazquez EF, Mihm MC, Russell S, DiPiro PJ, Yap JT, Ramaiya N, Van den Abbeele AD, Gargano M, McDermott D. Bevacizumab plus ipilimumab in patients with metastatic melanoma. Cancer Immunol Res 2014; 2:632-42. [PMID: 24838938 DOI: 10.1158/2326-6066.cir-14-0053] [Citation(s) in RCA: 433] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ipilimumab improves survival in advanced melanoma and can induce immune-mediated tumor vasculopathy. Besides promoting angiogenesis, vascular endothelial growth factor (VEGF) suppresses dendritic cell maturation and modulates lymphocyte endothelial trafficking. This study investigated the combination of CTLA4 blockade with ipilimumab and VEGF inhibition with bevacizumab. Patients with metastatic melanoma were treated in four dosing cohorts of ipilimumab (3 or 10 mg/kg) with four doses at 3-week intervals and then every 12 weeks, and bevacizumab (7.5 or 15 mg/kg) every 3 weeks. Forty-six patients were treated. Inflammatory events included giant cell arteritis (n = 1), hepatitis (n = 2), and uveitis (n = 2). On-treatment tumor biopsies revealed activated vessel endothelium with extensive CD8(+) and macrophage cell infiltration. Peripheral blood analyses demonstrated increases in CCR7(+/-)/CD45RO(+) cells and anti-galectin antibodies. Best overall response included 8 partial responses, 22 instances of stable disease, and a disease-control rate of 67.4%. Median survival was 25.1 months. Bevacizumab influences changes in tumor vasculature and immune responses with ipilimumab administration. The combination of bevacizumab and ipilimumab can be safely administered and reveals VEGF-A blockade influences on inflammation, lymphocyte trafficking, and immune regulation. These findings provide a basis for further investigating the dual roles of angiogenic factors in blood vessel formation and immune regulation, as well as future combinations of antiangiogenesis agents and immune checkpoint blockade.
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Affiliation(s)
| | - Donald Lawrence
- Massachusetts General Hospital Cancer Center; Departments of
| | - Cecilia Lezcano
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xinqi Wu
- Authors' Affiliations: Departments of Medical Oncology
| | - Jun Zhou
- Authors' Affiliations: Departments of Medical Oncology
| | | | - Wanyong Zeng
- Authors' Affiliations: Departments of Medical Oncology
| | | | - Michael B Atkins
- Lombardi Cancer Center Georgetown University, Washington, District of Columbia; and
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Gargano
- Authors' Affiliations: Departments of Medical Oncology
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47
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Luke JJ, Lezcano C, Hodi FS, Murphy GF. Antitumor granuloma formation by CD4+ T cells in a patient with rapidly progressive melanoma experiencing spiking fevers, neuropathy, and other immune-related toxicity after treatment with ipilimumab. J Clin Oncol 2014; 33:e32-5. [PMID: 24616309 DOI: 10.1200/jco.2013.49.7735] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jason J Luke
- Melanoma Disease Center of Dana-Farber Cancer Institute; Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Cecilia Lezcano
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - F Stephen Hodi
- Melanoma Disease Center of Dana-Farber Cancer Institute; Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - George F Murphy
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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48
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Shono Y, Tuckett AZ, Ouk S, Liou HC, Altan-Bonnet G, Tsai JJ, Oyler JE, Smith OM, West ML, Singer NV, Doubrovina E, Pankov D, Undhad CV, Murphy GF, Lezcano C, Liu C, O'Reilly RJ, van den Brink MRM, Zakrzewski JL. A small-molecule c-Rel inhibitor reduces alloactivation of T cells without compromising antitumor activity. Cancer Discov 2014; 4:578-91. [PMID: 24550032 DOI: 10.1158/2159-8290.cd-13-0585] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Preventing unfavorable GVHD without inducing broad suppression of the immune system presents a major challenge of allogeneic hematopoietic stem cell transplantation (allo-HSCT). We developed a novel strategy to ameliorate GVHD while preserving graft-versus-tumor (GVT) activity by small molecule-based inhibition of the NF-κB family member c-Rel. Underlying mechanisms included reduced alloactivation, defective gut homing, and impaired negative feedback on interleukin (IL)-2 production, resulting in optimal IL-2 levels, which, in the absence of competition by effector T cells, translated into expansion of regulatory T cells. c-Rel activity was dispensable for antigen-specific T-cell receptor (TCR) activation, allowing c-Rel-deficient T cells to display normal GVT activity. In addition, inhibition of c-Rel activity reduced alloactivation without compromising antigen-specific cytotoxicity of human T cells. Finally, we were able to demonstrate the feasibility and efficacy of systemic c-Rel inhibitor administration. Our findings validate c-Rel as a promising target for immunomodulatory therapy and demonstrate the feasibility and efficacy of pharmaceutical inhibition of c-Rel activity.
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Affiliation(s)
- Yusuke Shono
- Departments of 1Immunology, 2Computational Biology and Immunology, 3Pediatrics, and 4Medicine and Immunology, Memorial Sloan-Kettering Cancer Center; 5Department of Immunology, Weill-Cornell Medical Center, New York, New York; 6Program in Dermatopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and 7Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
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49
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Bankova LG, Lezcano C, Pejler G, Stevens RL, Murphy GF, Austen KF, Gurish MF. Mouse mast cell proteases 4 and 5 mediate epidermal injury through disruption of tight junctions. J Immunol 2014; 192:2812-20. [PMID: 24523504 DOI: 10.4049/jimmunol.1301794] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We previously established a mast cell (MC)-dependent thermal injury model in mice with ulceration and scar formation that depended on nonredundant functions of mouse MC protease (mMCP)4 and mMCP5. We hypothesized that MC activation is an early event and now find by histology that exocytosis of granule contents occurred by 2 min after thermal injury in wild-type (WT) C57BL/6 mice and in the mMCP4- or mMCP5-deficient mice. The degranulation was equivalent for MCs in the dermis and hypodermis of all three strains, but only the WT mice showed an appreciable increase in epidermal thickness. There was no loss of total MCs, partially degranulated plus intact, during the 4 h of observation. By electron microscopy, MCs in all strains showed early zonal degranulation at 30 s with marked progression in magnitude by 120 s and no mitochondrial injury or cellular necrosis. Concomitantly there was an increase in intercellular spaces indicative of tight junction (TJ) disruption in WT mice but not in the mMCP4- or mMCP5-deficient strains. The desmosomes were intact in all strains. Immunodetection of the TJ protein claudin 4 in WT and mMCP5-deficient mice indicated a significant reduction after scald injury whereas mMCP4(-/-) mice showed no significant changes. Taken together, these findings reveal that a second-degree burn injury can initiate an immediate novel zonal degranulation of MCs throughout all skin layers and a disruption of the epidermal TJs dependent on the nonredundant presence of mMCP4 and mMCP5.
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Affiliation(s)
- Lora G Bankova
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
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50
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Ghosh A, Holland AM, Dogan Y, Yim NL, Rao UK, Young LF, West ML, Singer NV, Lee H, Na IK, Tsai JJ, Jenq RR, Penack O, Hanash AM, Lezcano C, Murphy GF, Liu C, Sadelain M, Sauer MG, Sant'angelo D, van den Brink MRM. PLZF confers effector functions to donor T cells that preserve graft-versus-tumor effects while attenuating GVHD. Cancer Res 2013; 73:4687-96. [PMID: 23733752 DOI: 10.1158/0008-5472.can-12-4699] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Efforts to limit GVHD mediated by alloreactive donor T cells after allogeneic bone marrow transplantation are limited by a concomitant decrease in graft-versus-tumor (GVT) activity and increased possibilities of tumor relapse. Using a novel approach, we adoptively transferred conventional T cells expressing the transcription factor promyelocytic leukemia zinc finger (PLZF), which confers effector properties resembling invariant natural killer T cells, such as copious production of cytokines under suboptimal stimulation. PLZF expression in T-cell allografts attenuates expansion of alloreactive T cells, leading to lower GVHD. Intact alloreactivity-driven antitumor cytokine responses result in preserved GVT effects, leading to improved survival. Our findings suggest that therapy with PLZF-overexpressing T cells would result in overall improved outcomes due to less GVHD and intact GVT effects.
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Affiliation(s)
- Arnab Ghosh
- Departments of Immunology and Medicine, and Cell Biology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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