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Li H, Husain AN, Moffat D, Klebe S. Nonmesothelial Spindle Cell Tumors of Pleura and Pericardium. Surg Pathol Clin 2024; 17:257-270. [PMID: 38692809 DOI: 10.1016/j.path.2024.01.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Spindle cell lesions of the pleura and pericardium are rare. Distinction from sarcomatoid mesothelioma, which has a range of morphologic patterns, can be difficult, but accurate diagnosis matters. This article provides practical guidance for the diagnosis of pleural spindle cell neoplasms, focusing on primary lesions.
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Affiliation(s)
- Huihua Li
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Aliya N Husain
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | - David Moffat
- Department of Anatomical Pathology, SA Pathology and Flinders University, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia
| | - Sonja Klebe
- Department of Anatomical Pathology, SA Pathology and Flinders University, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia.
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2
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Kim C, Moffat D, Brennan C. Comment on 'Is it necessary to block an entire appendix to exclude acute appendicitis?', a previously published article by Newton ACS Wong. Histopathology 2024. [PMID: 38651318 DOI: 10.1111/his.15201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Chankyung Kim
- Department of Anatomical Pathology, SA Pathology, Adelaide, South Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia
| | - David Moffat
- Department of Anatomical Pathology, SA Pathology, Adelaide, South Australia
- College of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Catriona Brennan
- Department of Anatomical Pathology, SA Pathology, Adelaide, South Australia
- College of Medicine, Flinders University, Bedford Park, South Australia, Australia
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Russell PA, Farrall AL, Prabhakaran S, Asadi K, Barrett W, Cooper C, Cooper W, Cotton S, Duhig E, Egan M, Fox S, Godbolt D, Gupta S, Hassan A, Leslie C, Leong T, Moffat D, Qiu MR, Sivasubramaniam V, Skerman J, Snell C, Walsh M, Whale K, Klebe S. Real-world prevalence of PD-L1 expression in non-small cell lung cancer: an Australia-wide multi-centre retrospective observational study. Pathology 2023; 55:922-928. [PMID: 37833206 DOI: 10.1016/j.pathol.2023.08.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/30/2023] [Accepted: 08/17/2023] [Indexed: 10/15/2023]
Abstract
An investigator-initiated, Australia-wide multi-centre retrospective observational study was undertaken to investigate the real-world prevalence of programmed death ligand-1 (PD-L1) expression in non-small cell lung carcinoma (NSCLC). Multiple centres around Australia performing PD-L1 immunohistochemistry (IHC) were invited to participate. Histologically confirmed NSCLC of any stage with a PD-L1 IHC test performed for persons aged ≥18 years between 1 January 2018 and 1 January 2020, and eligible for review, were identified at each centre, followed by data extraction and de-identification, after which data were submitted to a central site for collation and analysis. In total data from 6690 eligible PD-L1 IHC tests from histologically (75%) or cytologically (24%) confirmed NSCLC of any stage were reviewed from persons with a median age of 70 years, 43% of which were female. The majority (81%) of tests were performed using the PD-L1 IHC SP263 antibody with the Ventana BenchMark Ultra platform and 19% were performed using Dako PD-L1 IHC 22C3 pharmDx assay. Reported PD-L1 tumour proportion score (TPS) was ≥50% for 30% of all tests, with 62% and 38% scoring PD-L1 ≥1% and <1%, respectively. Relative prevalence of clinicopathological features with PD-L1 scores dichotomised to <50% and ≥50%, or to <1% and ≥1%, were examined. Females scored ≥1% slightly more often than males (64% vs 61%, respectively, p=0.013). However, there was no difference between sexes or age groups (<70 or ≥70 years) where PD-L1 scored ≥50%. Specimens from patients with higher stage (III/IV) scored ≥1% or ≥50% marginally more often compared to specimens from patients with lower stage (I/II) (p≤0.002). Proportions of primary and metastatic specimens did not differ where PD-L1 TPS was ≥1%, however more metastatic samples scored TPS ≥50% than primary samples (metastatic vs primary; 34% vs 27%, p<0.001). Cytology and biopsy specimens were equally reported, at 63% of specimens, to score TPS ≥1%, whereas cytology samples scored TPS ≥50% slightly more often than biopsy samples (34% vs 30%, respectively, p=0.004). Resection specimens (16% of samples tested) were reported to score TPS ≥50% or ≥1% less often than either biopsy or cytology samples (p<0.001). There was no difference in the proportion of tests with TPS ≥1% between PD-L1 IHC assays used, however the proportion of tests scored at TPS ≥50% was marginally higher for 22C3 compared to SP263 (34% vs 29%, respectively, p<0.001). These real-world Australian data are comparable to some previously published global real-world data, with some differences noted.
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Affiliation(s)
- Prudence A Russell
- LifeStrands Genomics and, TissuPath Pathology, Mount Waverley, Vic, Australia
| | - Alexandra L Farrall
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Sarita Prabhakaran
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - Wade Barrett
- Anatomical Pathology, St Vincent's Hospital Sydney, NSW, Australia
| | - Caroline Cooper
- Pathology Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Wendy Cooper
- Anatomical Pathology, Royal Prince Alfred Hospital, NSW, Australia
| | - Samuel Cotton
- Anatomical Pathology, Royal Hobart Hospital, Tas, Australia
| | - Edwina Duhig
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Matthew Egan
- Anatomical Pathology, St Vincent's Hospital Melbourne, Vic, Australia
| | - Stephen Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - David Godbolt
- Pathology Queensland, Prince Charles Hospital, Brisbane, Qld, Australia
| | - Shilpa Gupta
- Pathology Queensland, Prince Charles Hospital, Brisbane, Qld, Australia
| | - Aniza Hassan
- SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Connull Leslie
- Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Trishe Leong
- Anatomical Pathology, St Vincent's Hospital Melbourne, Vic, Australia
| | - David Moffat
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Min Ru Qiu
- Anatomical Pathology, St Vincent's Hospital Sydney, NSW, Australia
| | - Vanathi Sivasubramaniam
- Anatomical Pathology, St Vincent's Hospital Sydney, NSW, Australia; Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Joanna Skerman
- Pathology Queensland, Prince Charles Hospital, Brisbane, Qld, Australia
| | - Cameron Snell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - Michael Walsh
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Karen Whale
- Anatomical Pathology, Royal Hobart Hospital, Tas, Australia
| | - Sonja Klebe
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia.
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Abstract
Cells with 'signet-ring' appearance were found at post-mortem examination of a man with a history of chronic illness, weight loss and multiple regions of 'bowel thickening' during life. Due to the decedent's history, the finding raised the possibility of disseminated signet-ring adenocarcinoma. However, the vacuoles did not stain for mucin and the cells did not stain for keratin. The cells did stain for calretinin and so a diagnosis of signet ring mesothelioma was considered. However, it was suggested that the cells with a cytoplasmic vacuole displacing the nucleus to one side producing the signet-ring appearance were instead atrophic fat cells. This was subsequently proven by Oil Red O staining.
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Affiliation(s)
- John D Gilbert
- Forensic Science SA, GPO Box 2790, Adelaide, South Australia, 5001, Australia
| | - Neil E I Langlois
- Forensic Science SA, GPO Box 2790, Adelaide, South Australia, 5001, Australia. .,School of Medical and Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - Andrew Ruszkiewicz
- School of Medical and Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Anatomical Pathology, SA Pathology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Moffat
- Anatomical Pathology, SA Pathology, Flinders Medical Centre, Bedford Park, South Australia
| | - Kathy Cash
- Anatomical Pathology, SA Pathology, Frome Rd, Adelaide, South Australia, Australia
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5
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Moffat D. Quality assurance in anatomical pathology. Pathology 2019. [DOI: 10.1016/j.pathol.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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6
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Tiong HB, Moffat D. Alveolar soft part sarcoma of the uterine cervix – a case report. Pathology 2019. [DOI: 10.1016/j.pathol.2018.12.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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7
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Moffat D. Pulmonary histology for forensic pathologists. Pathology 2019. [DOI: 10.1016/j.pathol.2018.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Peck M, Moffat D, Latham B, Badrick T. Review of diagnostic error in anatomical pathology and the role and value of second opinions in error prevention. J Clin Pathol 2018; 71:995-1000. [DOI: 10.1136/jclinpath-2018-205226] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/15/2018] [Accepted: 07/06/2018] [Indexed: 11/03/2022]
Abstract
AimsDiagnostic/interpretative accuracy can be challenging in anatomical pathology due to the subjective element of the diagnostic process. This can lead to false-negative or false-positive diagnoses of malignancy, variations in grading and diagnostic misclassification of a condition.It is imperative that an accurate diagnosis is achieved so that an appropriate and timely treatment is administered to the patient, for example, the success of targeted molecular therapeutic options for treatment of cancer is dependent on accurate anatomical pathology diagnoses being issued.MethodsA literature review of diagnostic accuracy in selected specimen categories was undertaken and was compared with data on metropolitan and regional pathologist diagnostic proficiency performance in an external quality assurance programme from surveys provided 2015–2017. For each specimen category, cases having attracted a diagnostic inaccuracy (ie, major discordance) of ≥20% and cases attracting a combined error rate (ie, major and minor discordance) of ≥30% are reviewed and discussed.ResultsThe rate of inaccurate diagnoses (assessed as a major discordance) ranged from 3% to 9% among the different specimen groups, with highest mean percentage of inaccurate diagnoses in gynaecology, dermatopathology and gastrointestinal specimens.ConclusionsIt was possible to ascertain that gynaecology, dermatopathology and gastrointestinal specimens had presented the greatest diagnostic challenge to the participant pathologists, determined as highest rate of diagnostic inaccuracy, that is, major discordance with respective case target diagnoses.Through a combination of routine second opinions, directed retrospective peer review and participation in appropriate external quality assurance schemes, the risk associated with these diagnoses can be minimised.
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Moffat D, Perry M, Heeren AM, Gruijl TDD, Rzepecka J, Janicova L, Nika A, Turner D, Doris C, Tebbutt C, Chapman K, Newton G, Anderton S. Abstract 3877: MPL-5821, a macrophage targeted ESMTM p38 MAPK inhibitor, inhibits the production of TLR agonist induced IL-10 whilst sparing T-cell functionality. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3877] [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
Compensatory release of immunosuppressive cytokines, such as IL-10, by macrophages present in the tumor microenvironment has been implicated as a mechanism for adaptive resistance to a number of immunotherapies. Our drug discovery effort utilises Esterase Motif TechnologyTM (ESMTM) which selectively targets myelomonocytic cells sparing the concomitant lymphocyte anti-tumor immune response. TLR agonists are known to be stimulators of the immune response, a key component of which is the production of myeloid cell IL-12p70. However, their therapeutic potential has been limited by their accompanying induction of IL-10 and other factors. MPL-5821 is an ESMTM p38 MAPK inhibitor which not only inhibits IL-10 but also enhances LPS stimulated IL-12p70 and in contrast to conventional p38 MAPK inhibitors provides enhancement of lymphocyte IFNγ production.
The present studies contrast MPL-5821 with multiple non-targeted agents, including inhibitors of HDAC, JAK, PI3K, MEK and CSF-1R, in human PBMC assays. These demonstrated the benefit of ESMTM-targeting as applied to p38 MAP kinase inhibition to not only inhibit TLR agonist induced immunosuppression but also enhance IFNγ due to its sparing of the myeloid-lymphocyte axis. None of the other modalities were able to achieve the effects observed for MPL-5821.
Having established the unique ability of MPL-5281 to inhibit LPS induced IL-10 production whilst still maintaining lymphocyte IFNγ production, we extended our studies to human cancer ex vivo models. We chose to evaluate MPL-5821 in combination with TLR agonists in ex vivo assays using tissue and ascites derived from ovarian and cervical cancer patients. A single cell suspension was prepared from cervical cancer tumor draining lymph nodes and incubated with MPL-5821 +/- the TLR 7/8 agonist R848 for 24 and 48 hours. MPL-5821 potently inhibited the R848 induced IL-10 production as measured by Cytometric Bead Array and in contrast to a conventional p38 MAP inhibitor LY2228820 also enhanced IFNγ production.
We studied MPL-5821 in cell suspensions prepared from human ovarian tumor and ascites. For the tumor sample, a single cell homogenate was prepared by mechanical and enzymatic digestion and for the ascites the cells were isolated by centrifugation. The cell populations were then analysed by flow cytometry and the cell preparation cultured for 72 hours with anti-CD3 or TLR agonist in the presence of test compound. Cytokine production was measured after 72 hours by ELISA or Luminex bead array. MPL-5821 again showed potent inhibition of TLR agonist induced IL-10 with concomitant enhancement of IFNγ production. We conclude that application of ESMTM technology to macrophage selective delivery of p38 MAPK inhibitors has the potential to inhibit TLR agonist induction of IL-10, which is implicated in limiting the performance of TLR agonists in the clinic.
Citation Format: David Moffat, Martin Perry, A. Marijne Heeren, Tanja D. de Gruijl, Justyna Rzepecka, Lucia Janicova, Anastasia Nika, Darryl Turner, Clare Doris, Claire Tebbutt, Kathryn Chapman, Gary Newton, Stephen Anderton. MPL-5821, a macrophage targeted ESMTM p38 MAPK inhibitor, inhibits the production of TLR agonist induced IL-10 whilst sparing T-cell functionality [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 3877.
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Affiliation(s)
| | | | - A. Marijne Heeren
- 2Center Gynecological Oncology Amsterdam (CGOA), Amsterdam, Netherlands
| | | | | | | | | | | | - Clare Doris
- 4Aquila BioMedical Ltd, Edinburgh, United Kingdom
| | | | | | - Gary Newton
- 5Domainex Ltd, Saffron Walden, United Kingdom
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10
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Hopkins E, Moffat D, Smith C, Wong M, Parkinson I, Nespolon W, Buckseall J, Hill M, Jersmann H, Nguyen P. Accuracy of rapid on-site evaluation of endobronchial ultrasound guided transbronchial needle aspirates by respiratory registrars in training and medical scientists compared to specialist pathologists-an initial pilot study. J Thorac Dis 2018; 10:3922-3927. [PMID: 30174833 DOI: 10.21037/jtd.2018.06.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/06/2022]
Abstract
Background Rapid on-site evaluation (ROSE) of endobronchial ultrasound guided transbronchial needle aspirates (EBUS-TBNA) increases diagnostic accuracy but in many institutions requires a specialist pathologist. This study aimed to determine if medical scientists or respiratory registrars could adequately perform ROSE to determine sufficiency of EBUS samples. Methods ROSE was performed on the first two EBUS-TBNA passes per patient by a pathologist, a medical scientist and two respiratory registrars. The medical scientists involved had all previously performed ROSE on over 50 procedures. The two respiratory registrars received cytology education from a pathologist in four separate hour-long training sessions. Each ROSE reviewer recorded whether each sample was sufficient or insufficient. Pathologist interpretation was taken as gold standard. Specific diagnosis was not required. Final diagnosis and the total number of passes were also recorded. This study recruited 25 patients (50 passes) for statistical evaluation. Results Assessment by specialist pathologists deemed 16/50 (32%) to be sufficient and 34/50 (68%) insufficient respectively. Medical scientists were 90% concordant with the pathologist (K =0.774; 95% CI, 0.587-0.961). The two respiratory registrars were 78% (K =0.568; 95% CI, 0.338-0.798) and 72% (K =0.448; 95% CI, 0.222-0.674) concordant, respectively. The mean number of passes per patient was 4.9 (range, 3-7). A diagnosis was established in 21/25 (82%) patients from the first EBUS-TBNA procedures with the remaining four patients requiring a further procedure or monitoring with serial CT scans to establish the diagnosis. Malignancy was found in 14/25 (56%) patients and a benign process in 11/25 (44%) patients. Conclusions Medical scientist review of ROSE samples is not significantly different to a specialist pathologist and is an acceptable alternative. Respiratory registrars are not a realistic alternative for ROSE without more intensive training, which may be difficult to facilitate in addition to existing respiratory training commitments.
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Affiliation(s)
- Emily Hopkins
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - David Moffat
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | - Caroline Smith
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | - Michelle Wong
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Ian Parkinson
- Department of Surgical Pathology/Cytopathology, SA Pathology, SA, Australia
| | - Walter Nespolon
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | | | - Madeline Hill
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | - Hubertus Jersmann
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Phan Nguyen
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
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11
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Yang Y, Gunawardane D, Moffat D, Carter C. Metastatic primary peritoneal malignant mesothelioma mimicking primary diffuse gastric carcinoma: a rare encounter in gastric biopsy. Pathology 2017; 49:317-319. [PMID: 28245936 DOI: 10.1016/j.pathol.2016.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/04/2016] [Indexed: 11/25/2022]
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12
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Jolley A, Brennan C, Jonavicius L, Moffat D, Astill D. A case report of dedifferentiated endometrioid carcinoma arising in the ovary and review of flinders medical centre’s experience with mismatch repair immunohistochemistry for screening of lynch syndrome. Pathology 2017. [DOI: 10.1016/j.pathol.2016.12.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Cooper W, Russell P, Huot-Marchand P, Cherian M, Duhig E, Godbolt D, Jessup P, Khoo C, Leslie C, Mahar A, Moffat D, Sivasubramaniam V, Grattan A, Reznichenko A, Woodgate AM, Fox S. P2.01-047 Intra- and Inter-Observer Reproducibility Study of PD-L1 Biomarker in Non-Small Cell Lung Cancer (NSCLC) - The DREAM STUDY. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Hopkins E, Moffat D, Parkinson I, Robinson P, Jersmann H, Dougherty B, Birader MI, Francis K, Nguyen P. Cell block samples from endobronchial ultrasound transbronchial needle aspiration provide sufficient material for ancillary testing in lung cancer-a quaternary referral centre experience. J Thorac Dis 2016; 8:2544-2550. [PMID: 27747007 DOI: 10.21037/jtd.2016.08.74] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 12/25/2022]
Abstract
BACKGROUND Rapid on site examination (ROSE) is encouraged at endobronchial ultrasound transbronchial needles aspiration (EBUS-TBNA) to improve diagnostic yield. Due to new therapeutic options in lung cancer, it is not sufficient to merely distinguish between non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). Immunohistochemistry (IHC) distinction is now standard practice, as well as additional molecular testing where clinically indicated. We investigated the diagnostic yield of on-site smears vs. cell block and the provision of cellular material for ancillary testing at our centre. METHODS A retrospective audit of all EBUS-TBNA procedures performed until July 2012 was undertaken. Diagnostic yield on smears versus cell block was recorded. Cell blocks were reviewed by an experienced pathologist to determine diagnostic accuracy and whether IHC and molecular testing were possible. RESULTS In total, 234 procedures were recorded with 101 (43.2%) malignant cases, 107 (45.7%) benign cases and an initial 26/234 (11.1%) insufficient for diagnosis of which 11/234 (4.7%) were false negatives for malignancy after further follow up. The average number of passes was 4.5. For malignancies, smear diagnosis was possible in 95% (96/101) of cases and cell block diagnosis in 93.5% (87/93) of cases. There was sufficient material for IHC in 97.7% (85/87) of malignant cases. In 79.3% (69/87) of NSCLCs molecular testing for epidermal growth factor receptor (EGFR) mutation analysis was theoretically possible on samples obtained. CONCLUSIONS Cell blocks are not inferior to smears for diagnostic accuracy and provide sufficient samples for histology. However, ROSE assists the physician on how best to manage samples for ancillary testing.
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Affiliation(s)
- Emily Hopkins
- The Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia;; The University of Adelaide, Adelaide 5000, Australia
| | - David Moffat
- The Department of Surgical Pathology/Cytopathology, SA Pathology, SA 5000, Australia
| | - Ian Parkinson
- The University of Adelaide, Adelaide 5000, Australia;; The Department of Anatomical Pathology, SA Pathology, SA 5000, Australia
| | - Peter Robinson
- The Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Hubertus Jersmann
- The Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia;; The University of Adelaide, Adelaide 5000, Australia
| | - Brendan Dougherty
- The Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Mohammed I Birader
- The Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Kate Francis
- The Department of Surgical Pathology/Cytopathology, SA Pathology, SA 5000, Australia
| | - Phan Nguyen
- The Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia;; The University of Adelaide, Adelaide 5000, Australia
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15
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Kumar B, Peck M, Haffajee Z, Moffat D, Latham B, Badrick T. RCPA QAP immunohistochemistry module – Recent changes and what the future holds. Pathology 2016. [DOI: 10.1016/j.pathol.2015.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Latham B, Peck M, Caruana P, Moffat D, Kumar B, Badrick T. RCPA QAP general module – Recent changes and what the future holds. Pathology 2016. [DOI: 10.1016/j.pathol.2015.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cooper W, Fox S, O'Toole S, Morey A, Frances G, Pavlakis N, O'Byrne K, Dettrick A, Leong T, Rathi V, Spagnolo D, Hemmings C, Singh M, Moffat D, Tsao MS, Wilner K, Buller R, Pitman Lowenthal S, Arifeen S, Binko J, Alam M. National Working Group Meeting on ALK diagnostics in lung cancer. Asia Pac J Clin Oncol 2014; 10 Suppl 2:11-7. [PMID: 24673736 DOI: 10.1111/ajco.12190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2014] [Indexed: 11/27/2022]
Abstract
The global landscape of molecular testing is rapidly changing, with the recent publication of the International Association for the Study of Lung Cancer (IASLC)/College of American Pathologists (CAP) guidelines and the ALK Atlas. The IASLC/CAP guidelines recommend that tumors from patients with non-small cell lung cancer (NSCLC) be tested for ALK rearrangements in addition to epidermal growth factor receptor (EGFR) mutations. The spur for this recommendation is the availability of novel therapies that target these rearrangements. This article is based on coverage of a Pfizer-sponsored National Working Group Meeting on ALK Diagnostics in Lung Cancer, held around the 15th World Lung Cancer Conference, in Sydney on October 31, 2013. It is based on the presentations given by the authors at the meeting and the discussion that ensued. The content for this article was discussed and agreed on by the authors.
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Affiliation(s)
- Wendy Cooper
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
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Hodge G, Barnawi J, Jurisevic C, Moffat D, Holmes M, Reynolds PN, Jersmann H, Hodge S. Lung cancer is associated with decreased expression of perforin, granzyme B and interferon (IFN)-γ by infiltrating lung tissue T cells, natural killer (NK) T-like and NK cells. Clin Exp Immunol 2014; 178:79-85. [PMID: 24894428 PMCID: PMC4360197 DOI: 10.1111/cei.12392] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 01/05/2023] Open
Abstract
There is a limited understanding how of lung cancer cells evade cytotoxic attack. Previously, we have shown reduced production of the cytotoxic mediator granzyme B by CD8(+) T cells in lung cancer tissue. We hypothesized that lung cancer would be further associated with decreased production of granzyme B, perforin and proinflammatory cytokines by other cytotoxic lymphocytes, natural killer (NK) T-like and NK cells, and that this would result from soluble mediators released by the cancer cells. Lung cancer and non-cancer tissue from five patients was identified by experienced pathologists. Tumour necrosis factor (TNF)-α, interferon (IFN)-γ, granzyme B and perforin were measured in CD4 and CD8(+) T, NK T-like cells and NK cells by flow cytometry. Correlation between cancer stage and granzyme B was analysed retrospectively for 21 patients. The effects of soluble factors released by lung cancer cells on production of cytotoxic mediators and cytokines was assessed, and the role of prostaglandin E2 (PGE)2 /COX investigated using indomethacin inhibition. There were significantly decreased percentages of T, NK T-like and NK cells expressing perforin, TNF-α and IFN-γ in cancer versus non-cancer tissue, and of CD8(+) T cells and CD8(+) NK T-like cells expressing granzyme B (e.g. NK T-like cells: non-cancer 30% ± 7 versus cancer 6% ± 2·5). Cancer cells released soluble factors that inhibited granzyme B, perforin and IFN-γ production that was partially associated with the PGE2 /COX2 pathway. Thus, lung cancer is associated with decreased expression of granzyme B, perforin and IFN-γ by infiltrating T cells, NK T-like and NK cells, possibly as a result of soluble factors produced by the cancer cells including PGE2 . This may be an important immune evasion mechanism.
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Affiliation(s)
- G Hodge
- Lung Research, Department of Thoracic Medicine, Hanson Institute, Royal Adelaide Hospital, Adelaide, SA, Australia; Department of Medicine, University of Adelaide, Adelaide, SA, Australia
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Okiror L, Peleki A, Moffat D, Bille A, Rajesh PB, Grimer R, Kalkat MS. 034 * SURVIVAL FOLLOWING PULMONARY METASTASECTOMY FOR SARCOMA. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moffat D, Parker R, Hardy D, Macfarlane R. Factors Affecting Facial Nerve Outcome of Vestibular Schwannoma Surgery: Unit- and Multivariate Analyses. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Dehle FC, Mukaro VR, Jurisevic C, Moffat D, Ahern J, Hodge G, Jersmann H, Reynolds PN, Hodge S. Defective lung macrophage function in lung cancer ± chronic obstructive pulmonary disease (COPD/emphysema)-mediated by cancer cell production of PGE2? PLoS One 2013; 8:e61573. [PMID: 23637858 PMCID: PMC3637201 DOI: 10.1371/journal.pone.0061573] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/11/2013] [Indexed: 11/30/2022] Open
Abstract
In chronic obstructive pulmonary disease (COPD/emphysema) we have shown a reduced ability of lung and alveolar (AM) macrophages to phagocytose apoptotic cells (defective ‘efferocytosis’), associated with evidence of secondary cellular necrosis and a resultant inflammatory response in the airway. It is unknown whether this defect is present in cancer (no COPD) and if so, whether this results from soluble mediators produced by cancer cells. We investigated efferocytosis in AM (26 controls, 15 healthy smokers, 37 COPD, 20 COPD+ non small cell lung cancer (NSCLC) and 8 patients with NSCLC without COPD) and tumor and tumor-free lung tissue macrophages (21 NSCLC with/13 without COPD). To investigate the effects of soluble mediators produced by lung cancer cells we then treated AM or U937 macrophages with cancer cell line supernatant and assessed their efferocytosis ability. We qualitatively identified Arachidonic Acid (AA) metabolites in cancer cells by LC-ESI-MSMS, and assessed the effects of COX inhibition (using indomethacin) on efferocytosis. Decreased efferocytosis was noted in all cancer/COPD groups in all compartments. Conditioned media from cancer cell cultures decreased the efferocytosis ability of both AM and U937 macrophages with the most pronounced effects occurring with supernatant from SCLC (an aggressive lung cancer type). AA metabolites identified in cancer cells included PGE2. The inhibitory effect of PGE2 on efferocytosis, and the involvement of the COX-2 pathway were shown. Efferocytosis is decreased in COPD/emphysema and lung cancer; the latter at least partially a result of inhibition by soluble mediators produced by cancer cells that include PGE2.
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Affiliation(s)
- Francis C. Dehle
- Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Violet R. Mukaro
- Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Craig Jurisevic
- Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Moffat
- Department of Surgical Pathology, SA Pathology, Adelaide, South Australia, Australia
| | - Jessica Ahern
- Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Greg Hodge
- Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Hubertus Jersmann
- Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul N. Reynolds
- Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sandra Hodge
- Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- * E-mail:
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Moffat D, Parker R, Hardy D, Macfarlane R. Factors Affecting Final Facial Nerve Outcome in Vestibular Schwannoma Surgery. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mannion R, Patel P, Gaastra B, Axon P, Donnelly N, Moffat D, Tysome J, Macfarlane R. Combined Retrolabyrinthine Middle Fossa Transtentorial Approach to Tumors of the Petroclival Region: Clinical Outcome and Hearing Preservation. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kasbekar A, Tam Y, Carlyon R, Deeks J, Donnelly N, MacFarlane R, Moffat D, Mannion R, Axon P. Developing Intraoperative Cochlear Nerve Monitoring during Vestibular Schwannoma Surgery. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tysome J, MacFarlane R, Durie-Gair J, Donnelly N, Mannion R, Knight R, Harris F, Vanat Z, Tam Y, Hensiek A, Raymond F, Moffat D, Axon P. Surgical Management of Vestibular Schwannomas in Neurofibromatosis Type 2. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Martin T, Patel P, Moffat D, Axon P. The Management of Petrous Apex Cholesteatomas in the Era of Diffusion-Weighted MRI Imaging: Scanning Frequency, Growth Rates, and the Timing of Intervention. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Patel P, Durie-Gair J, Taylor S, Tysome J, Donnelly N, Vanat Z, Tam Y, Harris F, Knight R, Mannion R, Axon P, Moffat D, MacFarlane R. Auditory Implantation in Neurofibromatosis Type 2: A Cambridge Experience. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tysome J, Moffat D. Magnetic Resonance Imaging after Translabyrinthine Complete Excision of Vestibular Schwannomas. J Neurol Surg B Skull Base 2012. [DOI: 10.1055/s-0032-1312113] [Citation(s) in RCA: 3] [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: 10/28/2022] Open
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Huertas D, Soler M, Moreto J, Villanueva A, Martinez A, Vidal A, Charlton M, Moffat D, Patel S, McDermott J, Owen J, Brotherton D, Krige D, Cuthill S, Esteller M. Antitumor activity of a small-molecule inhibitor of the histone kinase Haspin. Oncogene 2011; 31:1408-18. [PMID: 21804608 PMCID: PMC3312407 DOI: 10.1038/onc.2011.335] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The approval of histone deacetylase inhibitors for treatment of lymphoma subtypes has positioned histone modifications as potential targets for the development of new classes of anticancer drugs. Histones also undergo phosphorylation events, and Haspin is a protein kinase the only known target of which is phosphorylation of histone H3 at Thr3 residue (H3T3ph), which is necessary for mitosis progression. Mitotic kinases can be blocked by small drugs and several clinical trials are underway with these agents. As occurs with Aurora kinase inhibitors, Haspin might be an optimal candidate for the pharmacological development of these compounds. A high-throughput screening for Haspin inhibitors identified the CHR-6494 compound as being one promising such agent. We demonstrate that CHR-6494 reduces H3T3ph levels in a dose-dependent manner and causes a mitotic catastrophe characterized by metaphase misalignment, spindle abnormalities and centrosome amplification. From the cellular standpoint, the identified small-molecule Haspin inhibitor causes arrest in G2/M and subsequently apoptosis. Importantly, ex vivo assays also demonstrate its anti-angiogenetic features; in vivo, it shows antitumor potential in xenografted nude mice without any observed toxicity. Thus, CHR-6494 is a first-in-class Haspin inhibitor with a wide spectrum of anticancer effects that merits further preclinical research as a new member of the family of mitotic kinase inhibitors.
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Affiliation(s)
- D Huertas
- Bellvitge Biomedical Research Institute, Barcelona, Catalonia, Spain
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Needham LA, Davidson AH, Bawden LJ, Belfield A, Bone EA, Brotherton DH, Bryant S, Charlton MH, Clark VL, Davies SJ, Donald A, Day FA, Krige D, Legris V, McDermott J, McGovern Y, Owen J, Patel SR, Pintat S, Testar RJ, Wells GMA, Moffat D, Drummond AH. Drug targeting to monocytes and macrophages using esterase-sensitive chemical motifs. J Pharmacol Exp Ther 2011; 339:132-42. [PMID: 21778281 DOI: 10.1124/jpet.111.183640] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The therapeutic and toxic effects of drugs are often generated through effects on distinct cell types in the body. Selective delivery of drugs to specific cells or cell lineages would, therefore, have major advantages, in particular, the potential to significantly improve the therapeutic window of an agent. Cells of the monocyte-macrophage lineage represent an important target for many therapeutic agents because of their central involvement in a wide range of diseases including inflammation, cancer, atherosclerosis, and diabetes. We have developed a versatile chemistry platform that is designed to enhance the potency and delivery of small-molecule drugs to intracellular molecular targets. One facet of the technology involves the selective delivery of drugs to cells of the monocyte-macrophage lineage, using the intracellular carboxylesterase, human carboxylesterase-1 (hCE-1), which is expressed predominantly in these cells. Here, we demonstrate selective delivery of many types of intracellularly targeted small molecules to monocytes and macrophages by attaching a small esterase-sensitive chemical motif (ESM) that is selectively hydrolyzed within these cells to a charged, pharmacologically active drug. ESM versions of histone deacetylase (HDAC) inhibitors, for example, are extremely potent anticytokine and antiarthritic agents with a wider therapeutic window than conventional HDAC inhibitors. In human blood, effects on monocytes (hCE-1-positive) are seen at concentrations 1000-fold lower than those that affect other cell types (hCE-1-negative). Chemical conjugates of this type, by limiting effects on other cells, could find widespread applicability in the treatment of human diseases where monocyte-macrophages play a key role in disease pathology.
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Abstract
The goals of this retrospective case review were to analyze the long-term results of surgery for petrous temporal bone cholesteatomas and to propose a new classification system for these lesions. Patients with a surgically confirmed petrous temporal bone cholesteatoma were treated at Addenbrooke's Hospital, a tertiary referral center. Postoperative facial function, hearing, residual/recurrent cholesteatoma, and other complications were assessed in relation to preoperative signs, intraoperative findings, and surgical approach. Between 1983 and 2004, 43 patients were treated. There were no perioperative deaths. There was no long-term recurrence in 95.4% of the patients, possibly because of meticulous surgical technique, bipolar diathermy, and use of the laser to denature the cholesteatoma matrix that was adherent to the dura. At presentation, 95% of the patients had no socially useful hearing in the affected ear. Facial nerve function, however, was usually preserved. Both direct anastomosis and nerve grafting can improve facial nerve function from House-Brackmann grade VI to grade III if the palsy is not longstanding. Four patients had cerebrospinal fluid leakage; other complications were rare. The proposed classification facilitates surgical planning and predicts the postoperative outcome with regards to hearing.
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Affiliation(s)
- David Moffat
- Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital NHS Trust, Cambridge, United Kingdom
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Abstract
Pathologic proliferation of the plasma cell population can produce a wide spectrum of disorders, ranging from benign solitary plasmacytoma to malignant multiple myeloma. The presentation of the resulting disease can be either localized or systemic, depending on the affected area. Multiple myeloma typically presents with systemic symptoms secondary to skeletal lytic lesions, anemia, renal failure, infection, and hyperviscosity syndrome; a diagnosis of multiple myeloma is not suspected in the absence of these features. Multiple myeloma of the skull base is very rare. We present the case of a 66-year-old man who came to us with a 2-year history of disequilibrium and who was found to have multiple myeloma with extensive involvement of the skull base.
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Affiliation(s)
- Anil Joshi
- Neurotology and Skull Base Surgery Unit, Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK.
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Cheema F, Graham J, Moffat D, Gordon C. Improving physical health of patients with mental health problems. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
It is well recognised that individuals with severe mental health difficulties have increased risks of significant physical health problems and that some of the treatments for mental health problems can cause physical health difficulties as side effects. It is also known that people with mental health difficulties do not present themselves regularly for physical health monitoring as suggested by national and international guidelines. We show how a secondary care community mental health service cooperated with primary care general medical services to increase the take up of physical health monitoring by patients with severe and enduring mental health problems.Staff in the community mental health team which served a rural/small urban population identified patients with severe and enduring mental health difficulties or those patients on medications linked to physical problems and contacted the primary care physicians responsible for the patients’ general care with patient details and encouraged patient attendance for physical health monitoring. Physical monitoring included blood pressure, ECG, glucose, thyroid, lipids, height and weight. Post-intervention attendance figures show an increase of 30% in patients attending physical health reviews compared with pre-intervention figures. The intervention has been now rolled out to a larger catchment area of 25000 persons.[Physical health monitoring by individual parameter]
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Moffat D, Patel S, Day F, Belfield A, Donald A, Rowlands M, Wibawa J, Brotherton D, Stimson L, Clark V, Owen J, Bawden L, Box G, Bone E, Mortenson P, Hardcastle A, van Meurs S, Eccles S, Raynaud F, Aherne W. Discovery of 2-(6-{[(6-fluoroquinolin-2-yl)methyl]amino}bicyclo[3.1.0]hex-3-yl)-N-hydroxypyrimidine-5-carboxamide (CHR-3996), a class I selective orally active histone deacetylase inhibitor. J Med Chem 2010; 53:8663-78. [PMID: 21080647 DOI: 10.1021/jm101177s] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A novel series of HDAC inhibitors demonstrating class I subtype selectivity and good oral bioavailability is described. The compounds are potent enzyme inhibitors (IC₅₀ values less than 100 nM), and improved activity in cell proliferation assays was achieved by modulation of polar surface area (PSA) through the introduction of novel linking groups. Employing oral pharmacokinetic studies in mice, comparing drug levels in spleen to plasma, we selected compounds that were tested for efficacy in human tumor xenograft studies based on their potential to distribute into tumor. One compound, 21r (CHR-3996), showed good oral activity in these models, including dose-related activity in a LoVo xenograft. In addition 21r showed good activity in combination with other anticancer agents in in vitro studies. On the basis of these results, 21r was nominated for clinical development.
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Affiliation(s)
- David Moffat
- Chroma Therapeutics Ltd., Abingdon, OX14 4RY, UK.
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Sharma S, Moffat D, Gorog DA. Coronary spasm: an unusual cause of ST elevation. Case Reports 2010; 2010:2010/nov11_1/bcr0120102644. [DOI: 10.1136/bcr.01.2010.2644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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36
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Okera M, Moffat D, Selva-Nayagam S. Desmoplastic small round cell tumour: an unusual presentation of an unusual tumour. Med J Aust 2010; 192:172-3. [PMID: 20121690 DOI: 10.5694/j.1326-5377.2010.tb03463.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 11/15/2009] [Indexed: 11/17/2022]
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Evans DGR, Baser ME, O'Reilly B, Rowe J, Gleeson M, Saeed S, King A, Huson SM, Kerr R, Thomas N, Irving R, MacFarlane R, Ferner R, McLeod R, Moffat D, Ramsden R. Management of the patient and family with neurofibromatosis 2: a consensus conference statement. Br J Neurosurg 2009; 19:5-12. [PMID: 16147576 DOI: 10.1080/02688690500081206] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A consensus conference on neurofibromatosis 2 (NF2) was held in 2002 at the request of the United Kingdom (UK) Neurofibromatosis Association, with particular emphasis on vestibular schwannoma (VS) surgery. NF2 patients should be managed at specialty treatment centres, whose staff has extensive experience with the disease. All NF2 patients and their families should have access to genetic testing because presymptomatic diagnosis improves the clinical management of the disease. Some clinical manifestations of NF2, such as ocular abnormalities, can be detected in infancy; therefore, clinical screening for at-risk members of NF2 families can start at birth, with the first magnetic resonance (MRI) scan at 10-12 years of age. Minimal interference, maintenance of quality of life, and conservation of function or auditory rehabilitation are the cornerstones of NF2 management, and the decision points to achieve these goals for patients with different clinical presentations are discussed.
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Affiliation(s)
- D G R Evans
- Department of Medical Genetics, St Mary's Hospital, Manchester, UK.
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Jassal D, Moffat D, Krahn J, Ahmadie R, Fang T, Eschun G, Sharma S. Cardiac Injury Markers in Non-elite Marathon Runners. Int J Sports Med 2009; 30:75-9. [DOI: 10.1055/s-0028-1104572] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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39
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Kasbekar A, Tam Y, Lloyd S, Macfarlane R, Baguley D, Moffat D, Axon P. Intraoperative Monitoring of the Cochlear Nerve during Vestibular Schwannoma Surgery. Skull Base 2008. [DOI: 10.1055/s-2008-1093304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sudhoff H, Rajagopal S, Mani N, Moumoulidis I, Axon PR, Moffat D. Usefulness of CT scans in malignant external otitis: effective tool for the diagnosis, but of limited value in predicting outcome. Eur Arch Otorhinolaryngol 2007; 265:53-6. [PMID: 17680261 DOI: 10.1007/s00405-007-0416-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Accepted: 07/25/2007] [Indexed: 10/23/2022]
Abstract
Computerized tomography (CT) scanning is a well recognised tool for the diagnosis of malignant external otitis. To investigate the degree of correlation between CT findings scan and the patients clinical status focusing on a subgroup of patients with cranial nerve palsies. Diagnosis of malignant external otitis was confirmed in 23 patients (average age 71 years, age range 39-87) based on criteria of severe pain, otitis externa refractory to conventional treatments and possibly diabetes mellitus and pseudomonas detection. CT was performed on 23 of these patients. Results from these scans were analysed and correlated with patient clinical status. Retrospective analysis of CT images and medical notes were used for data analysis.The CT scans of all 23 patients showed evidence of involvement of disease outside the external auditory canal, confirming the diagnosis. Sixteen out of 23 patients (70%) demonstrated evidence of bone erosion. Four of the 16 showed involvement of the petrous apex. From our subset of ten patients with cranial nerve involvement, eight demonstrated evidence of bone erosion and two showed mastoid and middle ear involvement without bone erosion. All four patients with petrous apical involvement presented with cranial nerve palsies (two lower cranial nerve palsies, one seventh nerve palsy and one combined lower and seventh nerve palsy). CT scanning was found to be a fast and economical tool in the initial assessment of patients with malignant external otitis. Petrous apex involvement was constantly associated with cranial nerve palsies, usually the lower cranial nerves. CT findings of temporal bone in itself however, were not closely correlated to the clinical outcome of the patients.
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Affiliation(s)
- Holger Sudhoff
- Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital, Cambridge, UK.
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Abstract
BACKGROUND Malignant external otitis is an uncommon, potentially lethal infection of the temporal bone primarily affecting elderly diabetic patients. OBJECTIVE To determine whether cranial nerve involvement in malignant external otitis affects or predicts the clinical outcome in terms of morbidity and mortality. METHODS Diagnosis of malignant external otitis was established in 23 patients (average age, 71 yr; range, 39-87) based on inclusion criteria of severe pain, otitis externa refractory to conventional treatments, diabetes mellitus, and Pseudomonas aeruginosa detection. Computed tomography confirmed temporal bone involvement extending outside the external auditory canal. DATA ANALYSIS Retrospective analysis of hospital records. RESULTS Ten of 23 (43.5%) patients showed cranial nerve involvement. The following cranial nerves were affected: facial nerve (6/10), lower cranial nerves (combination of IX, X, XI, XII) (3/10), and extended nerve palsy (VI, VII, IX, X, XI) (1/10). Thirteen of 23 (56.5%) patients displayed no cranial nerve involvement. All patients were treated with long-term, high-dose antibiotic treatment dependent on the microbiological findings. CONCLUSIONS All patients with lower cranial nerve palsy recovered normal function; however, the facial nerve palsy was significantly less likely to improve by medical treatment. Cranial nerve involvement did not affect the patient survival rate under an optimized medical treatment in our series.
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Affiliation(s)
- Navin Mani
- Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital, Cambridge, UK
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Martinez Del Pero M, Moffat D, Sudhoff H. Unusual presentation of temporal bone involvement in Churg-Strauss syndrome. J Laryngol Otol 2007; 122:425-7. [PMID: 17419894 DOI: 10.1017/s0022215107007232] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To present a case of a 60-year-old male with a history of sudden onset sensorineural hearing loss due to Churg-Strauss syndrome. CASE REPORT The patient had a 20-year history of asthma and recurrent right otitis media and a nasal polypectomy four years prior to presenting with ear symptoms. Ear, nose and throat involvement is common in Churg-Strauss syndrome, usually manifesting as allergic rhinitis and chronic rhinosinusitis with or without polyps. CONCLUSIONS Otolaryngologists play an important role in making an early diagnosis of this disease. To our knowledge this is the first case of Churg-Strauss syndrome primarily presenting with otological pathology: left sensorineural hearing loss and right otitis media.
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Affiliation(s)
- M Martinez Del Pero
- Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital, Cambridge, UK
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Moffat D, Jones S, Smith W, Axon P. Petrous Temporal Bone Cholesteatoma: A New Classification and the Long-Term Results of Surgery. Skull Base 2007. [DOI: 10.1055/s-2007-984198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Moffat D, De R, Hardy D, Moumoulidis I. Surgical management of trigeminal neuromas: a report of eight cases. J Laryngol Otol 2006; 120:631-7. [PMID: 16707037 DOI: 10.1017/s0022215106001484] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/17/2006] [Indexed: 11/06/2022]
Abstract
Objective: Trigeminal neuromas are rare tumours that may involve any part of the Vth nerve complex, including extracranial peripheral divisions of the nerve. A series of eight patients with intracranial trigeminal neuromas who underwent surgical management are presented.Methods: The hospital records and radiological images were reviewed with regard to clinical presentation, surgical approach, operative findings, peri-operative morbidity and neurological outcome, and percentage of tumour recurrence.Results: The principal presenting symptoms were those of involvement of the trigeminal nerve with sensory impairment in one or more of the three divisions. Tumour location was the prime determinant of surgical approach. Lateral skull base approaches were used as they are considered to be superior for identifying tumour origin, extension, and relationship to surrounding structures. Total excision of the tumour was carried out in three of the eight patients. In the remaining five patients some tumour was left purposely in order to minimize neurological deficit and optimize post-operative quality of life. There was no peri-operative mortality or major morbidity in our series. Five patients experienced symptomatic tumour recurrence and revision surgery was performed.Conclusion: Management of trigeminal neuromas is complex and requires a multidisciplinary approach. Pre-operative surgical planning allows tumour removal with preservation of important neural structures in the majority of cases. For large tumours occupying both the middle and posterior cranial fossae, the retrosigmoid/retrolabyrinthine/middle cranial fossa approach provides good exposure and results in minimal brain retraction. A Fisch type C approach is necessary for the largest tumours. Long-term follow up with interval imaging is mandatory to exclude long-term tumour recurrence.
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Affiliation(s)
- D Moffat
- Department of Neuro-Otology and Skull Base Surgery, University of Cambridge, Addenbrookes NHS Trust, Cambridge, UK
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Moumoulidis I, De R, Ramsden R, Moffat D. Unusual otological manifestations in Camurati-Engelmann's Disease. J Laryngol Otol 2006; 120:892-5. [PMID: 16707036 DOI: 10.1017/s0022215106001551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2006] [Indexed: 11/07/2022]
Abstract
Camurati-Engelmann's disease (CED) is a rare hereditary disorder affecting mainly the diaphysis of long bones but multiple cranial nerve deficits may also develop secondary to bony sclerosis of their foramina, including visual loss, facial palsy, deafness, vestibular disturbances and sensory deficits along the distribution of the trigeminal nerve. Deafness has been reported in about 18 per cent of these cases due to narrowing of the internal auditory canals caused by bony encroachment on nerves and vessels. We report an extremely rare case of a patient with CED who presented with deafness due to gross abnormalities affecting both middle ear and cochlea. The issues relating to the management of these patients with temporal bone involvement are discussed.
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Affiliation(s)
- I Moumoulidis
- Department of Neuro-Otology and Skull Base Surgery, University of Cambridge, Addenbrookes NHS Trust, Cambridge, UK.
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Abstract
We report the case of a 76-year-old woman with a diagnosis of Primary Hyperparathyroidsm and Systemic Amyloidosis, in whom subsequent investigations revealed the presence of Multiple Myeloma. We discuss the relationship between these conditions and the implications for management.
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Affiliation(s)
- E P Pest
- Department of Gastroenterology, Glasgow Royal Infirmary
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Abstract
A range of functionalised indolocarbazoles, related to the natural product K-252a, have been prepared, starting from a readily available bridged cyclopentene. Sequences of transformations, involving initial hydroboration-oxidation to give a ketone, or by dihydroxylation and cyclic sulfate formation, enable the preparation of diverse indolocarbazole products. Issues of imide nitrogen protection for the indolocarbazole, and opportunities for asymmetric desymmetrisation of key intermediates were also explored. A novel chiral lithium amide base mediated transformation of a cyclic sulfate intermediate gave the anticipated ketone product in up to 87% ee. A number of compounds, in the form of unprotected imide substituted indolocarbazoles, were screened for biological activity and were found to be potent inhibitors of a number of kinase enzymes.
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Affiliation(s)
- David Moffat
- Celltech Therapeutics Ltd, 216 Bath Road, Slough, SL1 4EN, UK
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Abstract
Chondrosarcomas (CSA) of the temporal bone are rare primary malignant tumours that are slow growing, but locally aggressive. The management of CSAs involving the temporal bone is challenging and necessitates a multidisciplinary approach in a tertiary referral unit well practised in skull base surgery. Their management with particular reference to modes of presentation and treatment strategies has been reviewed here.
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Affiliation(s)
- Mallappa Raghu
- Department of Neuro-Otology and Skull Base Surgery, University of Cambridge, Addenbrookes NHS Trust, Cambridge, UK
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Abstract
Post-menopausal frontal fibrosing alopecia (PFFA) has become an increasingly recognized distinct clinical entity in recent years. Most cases have been reported from Australia; however, it seems likely that the condition is under-recognized. PFFA has similarities to lichen planopilaris but is differentiated by a distinctive symmetrical fronto-temporal distribution and progressive course. We report two cases from the UK and review the literature.
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Affiliation(s)
- G Dawn
- Department of Dermatology, Southern General Hospital, Glasgow, UK.
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