1
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Hagemann IS, Deng W, Zaino RJ, Powell MA, Gunderson Jackson C, Cosgrove C, Mathews C, Pearl ML, Waggoner S, Ghebre R, Lele S, Guntupalli S, Secord AA, Ioffe O, Rasty G, Singh M, Soslow R, Creasman W, Mutch DG. Mixed clear cell/endometrioid and clear cell/serous carcinoma of the uterus are clinicopathologically similar to pure clear cell carcinoma: An NRG Oncology/Gynecologic Oncology Group (GOG-210) study of 311 women. Gynecol Oncol 2023; 177:38-45. [PMID: 37634258 PMCID: PMC10806844 DOI: 10.1016/j.ygyno.2023.08.005] [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: 05/16/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Clear cell carcinoma is a high-risk subtype of endometrial cancer. Some patients have a mixture of clear cell carcinoma with other histologic types (endometrioid or serous) or cannot be neatly assigned to one of these types. Protocol GOG-8032 within GOG-210 was designed to determine whether these tumors differ from pure clear cell carcinoma in stage at diagnosis, initial pattern of spread, or patient survival. METHODS The term "mixed" was applied to tumors with multiple identifiable components, and "indeterminate" was applied to tumors with features intermediate between different histologic types. Three hundred eleven women with pure, mixed, or indeterminate clear cell carcinoma were identified in a larger cohort of patients undergoing hysterectomy for endometrial cancer in GOG-210. Histologic slides were centrally reviewed by expert pathologists. Baseline and follow-up data were analyzed. RESULTS One hundred thirty-six patients had pure clear cell carcinoma and 175 had a mixed or indeterminate clear cell pattern. Baseline clinicopathologic characteristics were similar except for a small difference in age at presentation. Univariate survival analysis confirmed the significance of typical endometrial cancer prognostic factors. Patients in the mixed categories had disease-free and overall survival similar to pure clear cell carcinoma, but the indeterminate clear cell/endometrioid group had longer survival. CONCLUSION In clear cell endometrial cancer, the presence of a definite admixed endometrioid or serous component did not correlate with a significant difference in prognosis. Patients whose tumors had indeterminate clear cell features had better prognosis. Some of these tumors may be endometrioid tumors mimicking clear cell carcinoma.
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Affiliation(s)
- Ian S Hagemann
- Washington University School of Medicine, St. Louis, MO, United States of America.
| | - Wei Deng
- NRG Oncology, Clinical Trial Development Division; Biostatistics & Bioinformatics: Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Richard J Zaino
- Pennsylvania State University, Hershey, PA, United States of America.
| | - Matthew A Powell
- Washington University School of Medicine, St. Louis, MO, United States of America.
| | - Camille Gunderson Jackson
- University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, United States of America.
| | - Casey Cosgrove
- Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America.
| | - Cara Mathews
- Women & Infants Hospital, Providence, RI, United States of America.
| | - Michael L Pearl
- Stony Brook University Medical Center, Stony Brook, NY, United States of America.
| | | | - Rahel Ghebre
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States of America.
| | - Shashikant Lele
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Saketh Guntupalli
- University of Colorado Cancer Center, Aurora, CO, United States of America.
| | | | - Olga Ioffe
- University of Maryland School of Medicine, Baltimore, MD, United States of America.
| | - Golnar Rasty
- University of Toronto, Markham, Ontario, Canada.
| | - Meenakshi Singh
- Stony Brook University Medical Center, Stony Brook, NY, United States of America
| | - Robert Soslow
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - William Creasman
- Medical University of South Carolina Medical Center, Charleston, SC, United States of America.
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, United States of America.
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Kommoss FKF, Chiang S, Köbel M, Koelsche C, Chang KTE, Irving JA, Dickson B, Thiryayi S, Rouzbahman M, Rasty G, von Deimling A, Lee CH, Turashvili G. Endometrial Stromal Sarcomas With BCOR Internal Tandem Duplication and Variant BCOR/BCORL1 Rearrangements Resemble High-grade Endometrial Stromal Sarcomas With Recurrent CDK4 Pathway Alterations and MDM2 Amplifications. Am J Surg Pathol 2022; 46:1142-1152. [PMID: 35499168 DOI: 10.1097/pas.0000000000001909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The distinction between low-grade and high-grade endometrial stromal sarcomas (LGESS, HGESS) is increasingly defined by genetics. Recently, variant genomic alterations involving BCOR or BCORL1 have been reported in endometrial stromal sarcoma (ESS), although it remains unclear whether these justify a diagnosis of LGESS or HGESS. In this study, we describe clinicopathologic and molecular features of ESS with such alterations to help clarify their classification in the spectrum of ESS. We collected a cohort of 13 ESS harboring variant alteration involving BCOR (6 with internal tandem duplication, 1 with EP300::BCOR fusion, 1 with BCOR::LPP fusion) and BCORL1 ( 4 with JAZF1::BCORL1 fusion, 1 with EPC1::BCORL1 fusion). The median patient age at primary diagnosis was 51 years (range: 18 to 70 y). Median tumor size at primary diagnosis was 9.3 cm (range: 4.5 to 21 cm), and extrauterine disease spread (stage IIIB-C) was present in 27%. The tumors were composed of round to spindled cells with cellularity and cytologic atypia ranging from mild to marked and a median mitotic count of 18/10 HPFs (range: 2 to 85/10 HPFs). At least focally myopermeative growth was noted in 8/8 assessable cases. Of 12 patients with follow-up data (median: 25 mo), 4 patients died of disease and 3 were alive with recurrent disease. Unsupervised hierarchical clustering of DNA methylation data together with a large cohort of uterine mesenchymal tumors that included YWHAE::NUTM2 and Z C3H7B::BCOR HGESS and molecularly confirmed LGESS revealed a common methylation signature for all ESS with variant BCOR and BCORL1 alterations and HGESS with YWHAE::NUTM2 and ZC3H7B::BCOR gene fusion. Copy number analysis revealed amplifications of CDK4 and MDM2 , as well as homozygous deletions of CDKN2A/B and NF1 in a subset of tumors. Our results indicate that ESS with BCOR internal tandem duplication and variant BCOR and BCORL1 rearrangements clinically and molecularly resemble conventional HGESS.
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Affiliation(s)
| | - Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin Köbel
- Department of Laboratory Medicine and Pathology, University of Calgary, Calgary
| | | | - Kenneth Tou-En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Julie A Irving
- Department of Laboratory Medicine, Pathology, and Medical Genetics, Royal Jubilee Hospital, Victoria, BC
| | - Brendan Dickson
- Department of Pathology and Laboratory Medicine, Sinai Health System and University of Toronto
| | - Sakinah Thiryayi
- Department of Pathology and Laboratory Medicine, Sinai Health System and University of Toronto
| | - Marjan Rouzbahman
- Department of Pathology, University Health Network, University of Toronto, Toronto
| | - Golnar Rasty
- Department of Laboratory Medicine, Markham Stouffville Hospital, Markham, ON, Canada
| | - Andreas von Deimling
- Neuropathology, Heidelberg University Hospital
- Clinical Cooperation Unit Neuropathology, DKFZ, Heidelberg, Germany
| | - Cheng-Han Lee
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Sinai Health System and University of Toronto
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA
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Hagemann IS, Deng W, Zaino RJ, Powell MA, Gunderson C, Cosgrove C, Mathews C, Pearl ML, Waggoner S, Ghebre R, Lele S, Guntupalli S, Secord AA, Ioffe O, Park K, Rasty G, Singh M, Soslow R, Creasman W, Mutch DG. The presence of an endometrioid component does not alter the clinicopathologic profile or survival of patients with uterine serous cancer: A gynecologic oncology group (GOG/NRG) study of 934 women. Gynecol Oncol 2021; 160:660-668. [PMID: 33423806 DOI: 10.1016/j.ygyno.2020.12.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE While most cases of endometrial cancer can readily be classified as pure endometrioid, pure serous, or another type, others show an apparent mixture of serous and endometrioid components, or indeterminate serous versus endometrioid features. Since serous histology carries a worse prognosis than endometrioid, Gynecologic Oncology Group protocol GOG-8032 was established to examine whether the presence of a non-serous component is a favorable feature in an otherwise serous cancer. METHODS 934 women with serous cancer were prospectively identified among a larger group enrolled in GOG-0210. Six expert gynecologic pathologists classified each case as pure serous (SER, n=663), mixed serous and endometrioid (SER-EM-M, n=138), or indeterminate serous v. endometrioid (SER-EM-I, n=133) by H&E morphology. Follow-up data from GOG-0210 were analyzed. RESULTS The subgroups did not differ on BMI, race, ethnicity, lymphovascular invasion, cervical invasion, ovary involvement, peritoneal involvement, omental involvement, FIGO stage, or planned adjuvant treatment. SER-EM-M patients were younger (p=0.0001) and less likely to have nodal involvement (p=0.0287). SER patients were less likely to have myoinvasion (p=0.0002), and more likely to have adnexal involvement (p=0.0108). On univariate analysis, age, serous subtype, race, and components of FIGO staging predicted both progression-free and overall survival. On multiple regression, however, serous subtype (SER, SER-EM-M, or SER-EM-I) did not significantly predict survival. CONCLUSIONS There were few clinicopathologic differences between cases classified as SER, SER-EM-M, and SER-EM-I. Cases with a mixture of serous and endometrioid morphology, as well as cases with morphology indeterminate for serous v. endometrioid type, had the same survival as pure serous cases. NCT#: NCT00340808.
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Affiliation(s)
- Ian S Hagemann
- Washington University School of Medicine, St. Louis, MO, USA.
| | - Wei Deng
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics: Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | | | | | - Camille Gunderson
- University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, USA.
| | - Casey Cosgrove
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | | | - Michael L Pearl
- Stony Brook University Medical Center, Stony Brook, NY, USA.
| | | | - Rahel Ghebre
- University of Minnesota Medical School, Minneapolis, MN, USA.
| | | | | | | | - Olga Ioffe
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Kay Park
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | | | - Robert Soslow
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - William Creasman
- Medical University of South Carolina Medical Center, Charleston, SC, USA.
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, USA.
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Jeske YW, Ali S, Byron SA, Gao F, Mannel RS, Ghebre RG, DiSilvestro PA, Lele SB, Pearl ML, Schmidt AP, Lankes HA, Ramirez NC, Rasty G, Powell M, Goodfellow PJ, Pollock PM. FGFR2 mutations are associated with poor outcomes in endometrioid endometrial cancer: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017; 145:366-373. [PMID: 28314589 DOI: 10.1016/j.ygyno.2017.02.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 11/16/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Activating FGFR2 mutations have been identified in ~10% of endometrioid endometrial cancers (ECs). We have previously reported that mutations in FGFR2 are associated with shorter disease free survival (DFS) in stage I/II EC patients. Here we sought to validate the prognostic importance of FGFR2 mutations in a large, multi-institutional patient cohort. METHODS Tumors were collected as part of the GOG 210 clinical trial "Molecular Staging of Endometrial Cancer" where samples underwent rigorous pathological review and had more than three years of detailed clinical follow-up. DNA was extracted and four exons encompassing the FGFR2 mutation hotspots were amplified and sequenced. RESULTS Mutations were identified in 144 of the 973 endometrioid ECs, of which 125 were classified as known activating mutations and were included in the statistical analyses. Consistent with FGFR2 having an association with more aggressive disease, FGFR2 mutations were more common in patients initially diagnosed with stage III/IV EC (29/170;17%) versus stage I/II EC (96/803; 12%; p=0.07, Chi-square test). Additionally, incidence of progression (progressed, recurred or died from disease) was significantly more prevalent (32/125, 26%) among patients with FGFR2 mutation versus wild type (120/848, 14%; p<0.001, Chi-square test). Using Cox regression analysis adjusting for known prognostic factors, patients with FGFR2 mutation had significantly (p<0.025) shorter progression-free survival (PFS; HR 1.903; 95% CI 1.177-3.076) and endometrial cancer specific survival (ECS; HR 2.013; 95% CI 1.096-3.696). CONCLUSION In summary, our findings suggest that clinical trials testing the efficacy of FGFR inhibitors in the adjuvant setting to prevent recurrence and death are warranted.
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Affiliation(s)
- Yvette W Jeske
- Queensland University of Technology (QUT) at the Translational Research Institute, Brisbane, Australia
| | - Shamshad Ali
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Sara A Byron
- Cancer and Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Feng Gao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Robert S Mannel
- Gynecologic Oncology, The Peggy and Charles Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rahel G Ghebre
- University of Minnesota Medical Center - Fairview, Minneapolis, MN, USA
| | | | - Shashikant B Lele
- Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Michael L Pearl
- Obstetrics and Gynecology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Amy P Schmidt
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Heather A Lankes
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Nilsa C Ramirez
- GOG Tissue Bank/NRG Oncology Biospecimen Bank - Columbus, Biopathology Center, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Golnar Rasty
- Department of Laboratory Medicine, University of Toronto, ON, M5G2C, CANADA
| | - Matthew Powell
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Paul J Goodfellow
- Department of Obstetrics and Gynecology, The Ohio State University and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Pamela M Pollock
- Queensland University of Technology (QUT) at the Translational Research Institute, Brisbane, Australia; Cancer and Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA.
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5
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Roma AA, Mistretta TA, Diaz De Vivar A, Park KJ, Alvarado-Cabrero I, Rasty G, Chanona-Vilchis JG, Mikami Y, Hong SR, Teramoto N, Ali-Fehmi R, Barbuto D, Rutgers JKL, Silva EG. New pattern-based personalized risk stratification system for endocervical adenocarcinoma with important clinical implications and surgical outcome. Gynecol Oncol 2016; 141:36-42. [PMID: 27016227 DOI: 10.1016/j.ygyno.2016.02.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [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: 09/10/2015] [Revised: 01/18/2016] [Accepted: 02/21/2016] [Indexed: 11/26/2022]
Abstract
We present a recently introduced three tier pattern-based histopathologic system to stratify endocervical adenocarcinoma (EAC) that better correlates with lymph node (LN) metastases than FIGO staging alone, and has the advantage of safely predicting node-negative disease in a large proportion of EAC patients. The system consists of stratifying EAC into one of three patterns: pattern A tumors characterized by well-demarcated glands frequently forming clusters or groups with relative lobular architecture and lacking destructive stromal invasion or lymphovascular invasion (LVI), pattern B tumors demonstrating localized destructive invasion (small clusters or individual tumor cells within desmoplastic stroma often arising from pattern A glands), and pattern C tumors with diffusely infiltrative glands and associated desmoplastic response. Three hundred and fifty-two cases were included; mean follow-up 52.8 months. Seventy-three patients (21%) had pattern A tumors; all were stage I and there were no LN metastases or recurrences. Pattern B was seen in 90 tumors (26%); all were stage I and LVI was seen in 24 cases (26.6%). Nodal disease was found in only 4 (4.4%) pattern B tumors (one IA2, two IB1, one IB not further specified (NOS)), each of which showed LVI. Pattern C was found in 189 cases (54%), 117 had LVI (61.9%) and 17% were stage II or greater. Forty-five (23.8%) patients showed LN metastases (one IA1, 14 IB1, 5 IB2, 5 IB NOS, 11 II, 5 III and 4 IV) and recurrences were recorded in 41 (21.7%) patients. This new risk stratification system identifies a subset of stage I patients with essentially no risk of nodal disease, suggesting that patients with pattern A tumors can be spared lymphadenectomy. Patients with pattern B tumors rarely present with LN metastases, and sentinel LN examination could potentially identify these patients. Surgical treatment with nodal resection is justified in patients with pattern C tumors.
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Affiliation(s)
| | - Toni-Ann Mistretta
- Baylor College of Medicine, Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - Andrea Diaz De Vivar
- Baylor College of Medicine, Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - Kay J Park
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Golnar Rasty
- University Health Network, University of Toronto, Toronto, Canada
| | | | | | - Sung R Hong
- Cheil General Hospital & Women's Healthcare Center, Dankook University, Seoul, Republic of Korea
| | | | | | | | | | - Elvio G Silva
- Cedars-Sinai Medical Center, Los Angeles, CA, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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6
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Parra-Herran C, Taljaard M, Djordjevic B, Reyes MC, Schwartz L, Schoolmeester JK, Lastra RR, Quick CM, Laury A, Rasty G, Nucci MR, Howitt BE. Pattern-based classification of invasive endocervical adenocarcinoma, depth of invasion measurement and distinction from adenocarcinoma in situ: interobserver variation among gynecologic pathologists. Mod Pathol 2016; 29:879-92. [PMID: 27174588 DOI: 10.1038/modpathol.2016.86] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/09/2022]
Abstract
A pattern-based classification for invasive endocervical adenocarcinoma has been proposed as predictive of the risk of nodal metastases. We aimed to determine the reproducibility of such classification in the context of common diagnostic challenges: distinction between in situ and invasive adenocarcinoma and depth of invasion measurement. Nine gynecologic pathologists independently reviewed 96 cases of endocervical adenocarcinoma (two slides per case). They diagnosed each case as in situ or invasive carcinoma classifying the latter following the pattern-based classification as pattern A (non-destructive), B (focally destructive) or C (diffusely destructive). Depth of invasion, when applicable, was measured (mm). Overall, diagnostic reproducibility of pattern diagnosis was good (κ=0.65). Perfect agreement (9/9 reviewers) was seen in only 11 cases (11%), all destructively invasive (10 pattern C and 1 pattern B). In all, ≥5/9 reviewer concordance was achieved in 82/96 cases (85%). Distinction between in situ and invasive carcinoma, regardless of the pattern, showed only slight agreement (κ=0.37). Likewise, distinction restricted to in situ versus pattern A was poor (κ=0.23). Distinction between non-destructive (in situ+pattern A) and destructive (patterns B+C) carcinoma showed significantly higher agreement (κ=0.62). Estimation of depth of invasion showed excellent reproducibility (ICC=0.82). However, different measurements resulting in differing FIGO stages were common (from at least 1 reviewer in 79% cases). On the basis of interobserver agreement, the pattern-based classification is best at diagnosing destructive invasion, which carries a risk for nodal metastases. Agreement in diagnosing in situ versus invasive carcinoma, including pattern A, was poor. Given the nil risk of nodal spread in in situ and pattern A lesions, the term 'endocervical adenocarcinoma with non-destructive growth' can be considered when the distinction is difficult, after excluding destructive invasion. Depth of invasion measurement was highly reproducible among pathologists; thus, the pattern-based approach can complement, but should not replace, the depth of invasion metric.
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Affiliation(s)
- Carlos Parra-Herran
- Department of Laboratory Medicine and Pathobiology, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bojana Djordjevic
- Department of Pathology and Laboratory Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - M Carolina Reyes
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Schwartz
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John K Schoolmeester
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Charles M Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Anna Laury
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Golnar Rasty
- Department of Pathology, Toronto East General Hospital, University of Toronto, Toronto, ON, Canada
| | - Marisa R Nucci
- Department of Pathology, Women's and Perinatal Pathology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brooke E Howitt
- Department of Pathology, Women's and Perinatal Pathology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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7
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Mirham L, Naugler C, Hayes M, Ismiil N, Belisle A, Sade S, Streutker C, MacMillan C, Rasty G, Popovic S, Joseph M, Gabril M, Barnes P, Hegele RG, Carter B, Yousef GM. Performance of residents using digital images versus glass slides on certification examination in anatomical pathology: a mixed methods pilot study. CMAJ Open 2016; 4:E88-94. [PMID: 27280119 PMCID: PMC4866926 DOI: 10.9778/cmajo.20140075] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND It is anticipated that many licensing examination centres for pathology will begin fully digitizing the certification examinations. The objective of our study was to test the feasibility of a fully digital examination and to assess the needs, concerns and expectations of pathology residents in moving from a glass slide-based examination to a fully digital examination. METHODS We conducted a mixed methods study that compared, after randomization, the performance of senior residents (postgraduate years 4 and 5) in 7 accredited anatomical pathology training programs across Canada on a pathology examination using either glass slides or digital whole-slide scanned images of the slides. The pilot examination was followed by a post-test survey. In addition, pathology residents from all levels of training were invited to participate in an online survey. RESULTS A total of 100 residents participated in the pilot examination; 49 were given glass slides instead of digital images. We found no significant difference in examination results between the 2 groups of residents (estimated marginal mean 8.23/12, 95% confidence interval [CI] 7.72-8.87, for glass slides; 7.84/12, 95% CI 7.28-8.41, for digital slides). In the post-test survey, most of the respondents expressed concerns with the digital examination, including slowly functioning software, blurring and poor detail of images, particularly nuclear features. All of the respondents of the general survey (n = 179) agreed that additional training was required if the examination were to become fully digital. INTERPRETATION Although the performance of residents completing pathology examinations with glass slides was comparable to that of residents using digital images, our study showed that residents were not comfortable with the digital technology, especially given their current level of exposure to it. Additional training may be needed before implementing a fully digital examination, with consideration for a gradual transition.
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Affiliation(s)
- Lorna Mirham
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Christopher Naugler
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Malcolm Hayes
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Nadia Ismiil
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Annie Belisle
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Shachar Sade
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Catherine Streutker
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Christina MacMillan
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Golnar Rasty
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Snezana Popovic
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Mariamma Joseph
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Manal Gabril
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Penny Barnes
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Richard G Hegele
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Beverley Carter
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - George M Yousef
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
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Spreafico A, Oza AM, Clarke B, Mackay H, Shaw P, Rasty G, Butler MO, Dhani NC, Lheureux S, Wilson M, Welch S, Siu LL, Zhang T, Yu C, Krishna GD, Chow H, Stockley T, Kamel-Reid S, Bedard PL. Genotype matched treatment for patients with advanced type I epithelial ovarian cancer (EOC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.5506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Amit M. Oza
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Blaise Clarke
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Helen Mackay
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Neesha C. Dhani
- Princess Margaret Cancer Center, University Health Network, Division of Medical Oncology & Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Michelle Wilson
- Department of Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Tong Zhang
- Department of Pathology and Laboratory Medicine, Toronto, ON, Canada
| | - Celeste Yu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Helen Chow
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Suzanne Kamel-Reid
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
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9
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Rasty G, Park K, Alvarado-Cabrero I, Diaz De-Vivar A, Rutgers J, Barbuto D, Roma A, Mikami Y, Ali R, Silva E. Invasive endocervical adenocarcinoma – How a new proposal for a pattern-based classification can influence clinical management decisions. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.150] [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: 11/28/2022]
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10
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Jakate K, Azimi F, Ali RH, Lee CH, Clarke BA, Rasty G, Shaw PA, Melnyk N, Huntsman DG, Laframboise S, Rouzbahman M. Endometrial sarcomas: an immunohistochemical and JAZF1 re-arrangement study in low-grade and undifferentiated tumors. Mod Pathol 2013; 26:95-105. [PMID: 22918161 DOI: 10.1038/modpathol.2012.136] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The current World Health Organization classification divides endometrial sarcomas into low-grade endometrial stromal sarcoma and undifferentiated endometrial sarcoma. Recent studies suggest undifferentiated endometrial sarcoma is a heterogeneous group and a subgroup with uniform nuclei is more akin to low-grade endometrial stromal sarcoma in terms of morphologic, immunohistochemical and genetic features. We classified endometrial sarcomas treated at our institution from 1998 to 2011 into low-grade endometrial stromal sarcoma and undifferentiated endometrial sarcoma, the latter being further categorized into a group with either uniform or pleomorphic nuclei. Morphological features, immunoprofile and fluorescence in situ hybridization rearrangements of JAZF1 and PHF1 genes were correlated with tumor category and outcome. A total of 40 cases were evaluated comprising 23 low-grade endometrial stromal sarcomas, 10 undifferentiated endometrial sarcomas with nuclear uniformity and 7 undifferentiated endometrial sarcomas with nuclear pleomorphism. Low-grade endometrial stromal sarcomas were more often estrogen and progesterone receptor positive (83%) compared with undifferentiated endometrial sarcoma with nuclear uniformity (10%) or with nuclear pleomorphism (0%) (P<0.001). Positivity for p53 was restricted to undifferentiated endometrial sarcomas with more frequent expression in the group with nuclear pleomorphism (57%) than with nuclear uniformity (10%) (P=0.06). Ki-67 proliferation index in >10% of tumor cells more frequent in undifferentiated endometrial sarcoma than low-grade endometrial stromal sarcoma (P=<0.001). JAZF1 rearrangement was detected in 32% of low-grade endometrial stromal sarcomas and in none of the undifferentiated sarcomas. Rearrangement of PHF1 was found in two patients, one with JAZF1-PHF1 fusion. There were no significant differences in clinical behavior between undifferentiated endometrial sarcoma with nuclear uniformity versus nuclear pleomorphism. In conclusion, we found undifferentiated endometrial sarcoma subtypes and low-grade endometrial stromal sarcoma have distinct immunohistochemical and cytogentic profiles. Our data do not show any difference in clinical behavior between subgroups in undifferentiated sarcomas.
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Affiliation(s)
- Kiran Jakate
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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11
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De Vivar AD, Roma AA, Park KJ, Alvarado-Cabrero I, Rasty G, Chanona-Vilchis JG, Mikami Y, Hong SR, Arville B, Teramoto N, Ali-Fehmi R, Rutgers JK, Tabassum F, Aguilera-Barrantes I, Silva E. New Pattern-Based Classification System for Invasive Endocervical Adenocarcinomas With Emphasis on "Pattern A": A Multi-Institutional Study. Am J Clin Pathol 2012. [DOI: 10.1093/ajcp/138.suppl2.218] [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: 11/14/2022] Open
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12
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Alvarado-Cabrero I, Park K, Rasty G, Hong S, Chanona-Vilchis J, Diaz De Vivar A, Barbuto D, Roma A, Ali-Fehmi R, Silva E. Classifying endocervical adenocarcinoma (EADC) by pattern correlates better with the presence or absence of lymph node (LN) metastasis than using tumor depth of invasion. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.062] [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: 11/26/2022]
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13
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Bodurka DC, Deavers MT, Tian C, Sun CC, Malpica A, Coleman RL, Lu KH, Sood AK, Birrer MJ, Ozols R, Baergen R, Emerson RE, Steinhoff M, Behmaram B, Rasty G, Gershenson DM. Reclassification of serous ovarian carcinoma by a 2-tier system. Cancer 2011; 118:3087-94. [DOI: 10.1002/cncr.26618] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/25/2011] [Accepted: 09/07/2011] [Indexed: 11/08/2022]
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14
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Atri M, Rao A, Boylan C, Rasty G, Gerber D. Best predictors of grayscale ultrasound combined with color Doppler in the diagnosis of retained products of conception. J Clin Ultrasound 2011; 39:122-127. [PMID: 21387325 DOI: 10.1002/jcu.20779] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 10/15/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To determine the best predictors of the presence of retained products of conception (RPOC) on grayscale and color Doppler transvaginal sonographic examination. METHODS This was a retrospective study of 91 consecutive patients who underwent transvaginal sonography (TVS) with color Doppler to evaluate for the presence of RPOC. The images of TVS studies were reviewed by two radiologists in consensus blinded to the final outcome. Data on a number of variables including endometrial measurable mass and focal increased color vascularity were collected as predictors of RPOC. The patients' ages ranged from 17 to 48 years (mean, 31.8 ± 6.8) and gestational age from 5 to 24 weeks (mean, 9.2 ± 3.8). Thirty-six were confirmed as RPOC by dilatation and curettage (D&C) and pathology. Fifty-five were considered negative, 9 based on D&C results and 46 on clinical grounds. RESULTS Sensitivity, specificity, negative- and positive-predictive and accuracy values were 81% (CI: 68%-94%), 71% (CI: 59%-83%), 85% (CI: 74%-95%), 64% (CI: 50%-78%), and 75% (CI: 66%-84%) to detect RPOC when a mass was present. The corresponding numbers for the presence of focal color vascularity were 94% (CI: 87%-100%) (p = 0.07), 67% (CI: 55%-80%) (p > 0.05), 95% (CI: 88%-100%) (p = 0.1), 65% (CI: 52%-78%) (p > 0.05), and 78% (CI: 70%-87%) (p > 0.05). Of the patients with confirmed RPOC on pathology, five had focal increased vascularity and no massand none had a mass without focal increased vascularity. CONCLUSION An area of focal increased vascularity with or without a mass is the best predictor of the presence of RPOC.
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Affiliation(s)
- M Atri
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5.
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Bandarchi B, Ma L, Marginean C, Hafezi S, Zubovits J, Rasty G. D2-40, a novel immunohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protuberans. Mod Pathol 2010; 23:434-8. [PMID: 20062007 DOI: 10.1038/modpathol.2009.176] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The distinction between dermatofibroma, particularly cellular variant, and dermatofibrosarcoma protuberans in excisional biopsies is usually straightforward. However, a separation between the two may be sometimes challenging, especially in superficial biopsies. Although factor XIIIa and CD34 immunostains are useful in differentiating dermatofibroma and dermatofibrosarcoma protuberans in most instances, focal CD34 positivity may be seen in cellular fibrous histiocytoma. Some cases reveal overlapping immunostain results. D2-40 identifies a 40-kDa O-linked sialoglycoprotein present on a variety of tissues including testicular germ cell tumors as well as lymphatic endothelium. In this study, we investigated the utility of D2-40 in separating dermatofibroma from dermatofibrosarcoma protuberans and compared the results with other commonly used immunostains. Fifty-six cases of dermatofibroma (including six cellular variant) and 29 cases of dermatofibrosarcoma protuberans were retrieved from the archives of Department of Anatomic Pathology at Sunnybrook Health Sciences Center in University of Toronto. We applied factor XIIIa, CD34, and monoclonal mouse anti-D2-40 immunostains to formalin-fixed, paraffin-embedded tissue sections. All 56 (100%) cases of dermatofibroma demonstrated strong and diffuse immunoreactivity to D2-40 in the spindle cells and stroma. Similarly, factor XIIIa showed strong and diffuse positivity in the spindle cells. Nearly all dermatofibromas were negative for CD34 except one case revealing focal positivity. None of dermatofibrosarcoma protuberans cases were labeled by D2-40, although four cases showed weak and patchy background staining in contrary to diffuse, strong, and crisp staining seen in dermatofibromas. Our results indicate that D2-40 seems to be a sensitive immunohistochemical marker for dermatofibromas, including cellular variant. Focal and faint D2-40 staining may be seen in the stroma of dermatofibrosarcoma protuberans. Our findings suggest that D2-40 can be used as a complementary immunostain to factor XIIIa and CD34 in problematic and challenging cases on superficial biopsies.
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Affiliation(s)
- Bizhan Bandarchi
- Department of Anatomic Pathology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.
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16
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Abstract
Sentinel lymph node biopsy is a novel method for the surgical management of patients with cervical cancer. Sentinel nodes have a higher chance of harbouring metastases than non-sentinel nodes. Assessment of sentinel nodes provides an opportunity to stage patients intraoperatively and avoid complete pelvic lymph node dissection and hence its morbidities. The aim of this article is to review the diagnostic performance of sentinel node detection, to determine which technique (blue dye, Tc or both) has the highest detection rate and sensitivity, and also to illustrate different approaches of histological assessment of the sentinel lymph node biopsy.
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Affiliation(s)
- G Rasty
- Department of Anatomic Pathology, University Health Network, University of Toronto, Toronto, Canada M5G 2C4.
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Beiner M, Hauspy J, Rosen B, Murphy J, Laframboise S, Nofech-Mozes S, Ismiil N, Rasty G, Khalifa M, Covens A. Radical vaginal trachelectomy vs. radical hysterectomy for small early stage cervical cancer: A matched case–control study. Gynecol Oncol 2008; 110:168-71. [DOI: 10.1016/j.ygyno.2008.04.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/22/2008] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
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19
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Ismiil N, Rasty G, Ghorab Z, Nofech-Mozes S, Bernardini M, Ackerman I, Thomas G, Covens A, Khalifa MA. Adenomyosis involved by endometrial adenocarcinoma is a significant risk factor for deep myometrial invasion. Ann Diagn Pathol 2007; 11:252-7. [PMID: 17630108 DOI: 10.1016/j.anndiagpath.2006.08.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adenomyosis is commonly seen in association with endometrial adenocarcinoma where it may or may not be involved by malignancy. This study of grade 1 endometrioid adenocarcinoma investigates whether patients with cancer-positive adenomyosis are at a different risk for deep myometrial invasion compared with those with cancer-negative adenomyosis. Ninety-three hysterectomy specimens with FIGO (International Federation of Gynecologists and Obstetricians) grade 1 endometrial endometrioid adenocarcinoma associated with adenomyosis were studied. Four experienced gynecologic pathologists retrospectively reviewed all hematoxylin and eosin-stained sections. Myometrial invasion was confirmed by CD10-negative staining around glands with jagged outline surrounded by inflamed desmoplastic stroma. Adenomyosis was involved by adenocarcinoma in 46 cases, whereas it was carcinoma-negative in 47 cases. Myometrial invasion was found in significantly more carcinoma-positive adenomyosis cases (n = 42, 91.3%) than with carcinoma-negative adenomyosis cases (n = 30, 63.8%) (chi(2) = 12.10; P = .0005). Moreover, myometrial invasion in the outer half was also seen in significantly more carcinoma-positive adenomyosis cases (n = 16, 34.8%) than with carcinoma-negative adenomyosis cases (n = 3, 6.4%) (chi(2) = 11.53; P = .0007). Among all cases of FIGO grade 1 endometrial endometrioid adenocarcinoma associated with adenomyosis, the ones that extend in the adenomyosis gain more invasive advantage, probably through increasing the surface area of its interface with the adjacent myometrium. When compared with tumors that do not involve adenomyosis, these tumors are not only more likely to invade the myometrium but are significantly more prone to achieve deep invasion into the outer half.
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Affiliation(s)
- Nadia Ismiil
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5.
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Ismiil ND, Rasty G, Ghorab Z, Nofech-Mozes S, Bernardini M, Thomas G, Ackerman I, Covens A, Khalifa MA. Adenomyosis is Associated With Myometrial Invasion by FIGO 1 Endometrial Adenocarcinoma. Int J Gynecol Pathol 2007; 26:278-83. [PMID: 17581412 DOI: 10.1097/01.pgp.0000235064.93182.ec] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study investigated the expression of poly(adenosine diphosphate-ribose) polymerase (PARP) in a cohort of ovarian serous carcinomas by immunohistochemistry with regard to outcome, clinicopathologic parameters, proliferation as assessed by MIB-1 labeling indices (LIs), and p53 immunoexpression. Formalin-fixed, paraffin-embedded archival tissues of 50 ovarian serous carcinomas were immunostained with antibodies to PARP, MIB-1, and p53. In addition, 10 benign serous cystadenomas and 10 typical serous borderline ovarian tumors were included in the PARP immunostudy. Immunostaining for PARP was scored with regard to quantity and intensity of positively stained nuclei as negative, low, or strong. The MIB-1 LIs were quantitated as the percentage of positively stained nuclei in 1000 nuclei. For p53, at least 10% of tumor cells had to display nuclear staining. The expression of PARP was scored negative in all serous cystadenomas and low in serous borderline ovarian tumors. Strong PARP expression was determined in 38 cases (76%), and low expression in 12 cases (12%) of ovarian serous carcinomas; MIB-1 staining was noted in all cases (mean, 44.2; range, 10.8-66.5), positivity for p53 in 39 cases (78%). The PARP immunoreactivity increased with the International Federation of Gynecology and Obstetrics stage (P = 0.0075), as well as p53 positivity (P = 0.0141) and MIB-1 LIs (P = 0.0102), with grade determined after Malpica et al. (P = 0.0445) but not with grade assessed after Shimizu et al. (P = 0.1495). A trend for poor outcome was observed in patients whose tumors displayed high levels of PARP immunoexpression (P = 0.0196, log-rank test). This study indicates that PARP expression is frequently upregulated in ovarian serous carcinomas, related with MIB-1 LIs and p53 expression, and may serve as a marker of aggressive behavior with prognostic value.
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Affiliation(s)
- Nadia D Ismiil
- Department of Pathology, Sunnybrook and Women's College Health Sciences Center, Toronto, Ontario, Canada.
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Hauspy J, Beiner M, Harley I, Ehrlich L, Rasty G, Covens A. Sentinel lymph nodes in early stage cervical cancer. Gynecol Oncol 2007; 105:285-90. [PMID: 17368525 DOI: 10.1016/j.ygyno.2007.02.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [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: 11/01/2006] [Revised: 02/02/2007] [Accepted: 02/07/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Lymph node status is the most important prognostic factor in cervical cancer. Sentinel lymph node (SLN) procedures have been purported to reduce peri- and postoperative morbidity and operative time. METHODS All patients with surgically managed clinical FIGO stage IA/B1 cervical cancer underwent SLN followed by pelvic lymphadenectomy with technetium+/-lymphazurin from April 2004 to April 2006. 0.1-0.2 mci of filtered sulfur colloid technetium was injected submucosally into 4 quadrants of the exocervix. Lymphazurin (4cc) was only used if technetium was unsuccessful in identifying bilateral sentinel lymph nodes. Serial microsections at 5 microm intervals were performed and stained intraoperatively. Complete pelvic node dissections were performed in all patients. RESULTS Forty-two patients underwent SLN, prior to full pelvic lymphadenectomy. Thirty-nine patients were included for the purposes of this study. The incidence in detecting at least one sentinel node was 98% per patient, and 85% per side. Identification of bilateral sentinel lymph nodes was successful in 28 cases (72%). The median number of SLN/side was 2. Three patients were found to have metastatic tumor to lymph nodes. No false negatives were identified. No adverse effects were noted. CONCLUSIONS SLN biopsy in cervical cancer is feasible to do, with a low false negative rate. We believe SLN should be evaluated per side and not per patient, that a pelvic lymphadenectomy is otherwise required. By following this protocol, the false negative rate can be minimized. The combined reported FN rate in the literature is 1.8%. If our definition is applied, the majority of reported false negative SLN is not actual false negatives.
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Affiliation(s)
- J Hauspy
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Abstract
BACKGROUND The aim of the study was to assess the feasibility, efficacy, and accuracy of the sentinel lymph node (SLN) procedure in vulvar cancer. METHODS From April 2004 to September 2006, all patients with vulvar cancer, clinical stages I and II, underwent SLN detection, followed by a complete inguinofemoral lymphadenectomy. Demographic, surgical, and pathologic data on all patients were prospectively entered in a database. RESULTS Forty-two patients underwent the SLN procedure. One patient was excluded from further analysis due to metastases to the vulva. The detection rate for at least 1 SLN per patient was 95%, with bilateral SLNs detected in 46% of patients. There was a trend toward improved ability to detect bilateral SLNs and proximity of the cancer to the midline (r = 0.996; P = .057). No contralateral SLNs were identified in patients with lateral vulvar lesions (>1 cm from the midline). For 'close-to-midline' (< or =1 cm from the midline) lesions, SLNs were detected in 93% of ipsilateral groins and bilateral SLNs were found in 46% of patients, whereas lesions abutting the midline had unilateral and bilateral SLN detected in 100% and 93%, respectively. Sixteen of 41 patients (39%) and 18 of 68 groins (26%) revealed metastatic disease in the lymph nodes; all were correctly identified by the SLN procedure. There were no false-negative SLN results. CONCLUSIONS SLN dissection is feasible and safe to perform in vulvar cancer. The ability to identify bilateral sentinel inguinal lymph nodes appears to be related to the proximity of the vulvar cancer to the midline.
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Affiliation(s)
- Jan Hauspy
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Nofech-Mozes S, Kupets R, Rasty G, Ismiil N, Covens A, Khalifa MA. Cyclooxygenase-2 (COX-2) Immunostaining Does Not Correlate With the Degree of Vulvar Neoplasia. Journal of Obstetrics and Gynaecology Canada 2006; 28:290-294. [PMID: 16776905 DOI: 10.1016/s1701-2163(16)32134-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The cyclooxygenase-2 (COX-2) enzyme is up-regulated in inflammatory and neoplastic conditions. In the last decade, its biological role has been investigated in various pre-invasive and invasive cancers with the hope that it can serve as a target for cancer prevention and treatment. METHODS We evaluated the expression of COX-2 in vulvar biopsies to determine its relationship to the degree of dysplasia. COX-2 expression was studied by immunohistochemistry in 62 consecutive vulvar biopsies divided into four diagnostic groups. Group 1 included inflamed vulva (n = 14); group 2, vulvar intraepithelial neoplasia (VIN) I and VIN II (n = 20); group 3, VIN III and carcinoma in situ (n = 18); and group 4, invasive squamous cell carcinoma (n = 10). Representative sections were immunostained using polyclonal anti-COX-2 antibodies at concentration 1:25 without pretreatment. Immunostaining was scored according to the proportion of positive epithelial cells in the vulvar mucosa as 0 (no positive cells), 1(< 5% positive), 2 (6-50% positive), or 3 (> 50% positive). RESULTS Mean immunostaining scores were 1.6, 1.4, 0.7, and 1.2 for groups 1, 2, 3, and 4, respectively. Scores were different between the groups (chi(2) = 9.908, P = 0.019) as shown by Cochran-Mantel-Haenszel statistical analysis (modified ridit scores), but did not correlate with age or the degree of dysplasia. The strongest staining for COX-2 was in the inflammatory group. CONCLUSION COX-2 staining in inflamed, dysplastic, and malignant vulvar epithelium is variable but, as shown in this study, does not correlate with the degree of vulvar dysplasia or malignancy.
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Affiliation(s)
- Sharon Nofech-Mozes
- Department of Pathology, Sunnybrook and Women's College Health Sciences Centre, Toronto ON
| | - Rachel Kupets
- Division of Gynaecologic Oncology, Toronto Sunnybrook Regional Cancer Centre, Toronto ON
| | - Golnar Rasty
- Department of Pathology, Sunnybrook and Women's College Health Sciences Centre, Toronto ON
| | - Nadia Ismiil
- Department of Pathology, Sunnybrook and Women's College Health Sciences Centre, Toronto ON
| | - Allan Covens
- Division of Gynaecologic Oncology, Toronto Sunnybrook Regional Cancer Centre, Toronto ON
| | - Mahmoud A Khalifa
- Department of Pathology, Sunnybrook and Women's College Health Sciences Centre, Toronto ON
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Nofech-Mozes S, Rasty G, Ismiil N, Covens A, Khalifa MA. Immunohistochemical characterization of endocervical papillary serous carcinoma. Int J Gynecol Cancer 2006; 16 Suppl 1:286-92. [PMID: 16515605 DOI: 10.1111/j.1525-1438.2006.00514.x] [Citation(s) in RCA: 28] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Endocervical adenocarcinomas are rare and aggressive neoplasms. Papillary serous endocervical adenocarcinomas are the rarest form of endocervical adenocarcinomas. This tumor exhibits morphologic similarities to its counterparts commonly seen in the endometrium, fallopian tubes, ovaries, and peritoneum, which are known to have an aggressive behavior. Because of the rarity of this tumor, little is known about its immunophenotyping. In this study, we included ten cases of papillary serous carcinomas arising from the uterine cervix (PSCC) diagnosed in the absence of a primary endometrial malignancy. We studied their immunohistochemical profile, using a panel of antibodies against Ki67, bcl-2, p53, carcinoembryonic antigen (CEA), and CD10, and compared them to 20 consecutive cases of cervical adenocarcinoma of conventional cell subtypes (CAC) (15 mucinous, 3 adenosquamous, and 2 endometrioid). Immunostaining was recorded semiquantitatively. Patients with PSCC ranged in age from 27 to 79 years (mean = 51.6 +/- 19.1), while the conventional cell subtypes control group were 28-90 years old (mean = 47.5 +/- 16.9). Only p53 and CEA immunostaining significantly correlated with the PSCC morphology (P= 0.001 and P= 0.016, respectively) as shown by Cochran-Mantel-Haenszel Statistics (Modified Ridit Scores). PSCC is a distinctive immunophenotypic subtype of endocervical adenocarcinoma with significantly higher p53 and lower CEA reactivity than other more common histologic subtypes.
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Affiliation(s)
- S Nofech-Mozes
- Department of Pathology, Sunnybrook and Women's College Health Sciences Center, Toronto, Canada
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Nofech-Mozes S, Rasty G, Ismiil N, Covens A, Khalifa MA. Immunohistochemical characterization of endocervical papillary serous carcinoma. Int J Gynecol Cancer 2006. [DOI: 10.1136/ijgc-00009577-200602001-00046] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Endocervical adenocarcinomas are rare and aggressive neoplasms. Papillary serous endocervical adenocarcinomas are the rarest form of endocervical adenocarcinomas. This tumor exhibits morphologic similarities to its counterparts commonly seen in the endometrium, fallopian tubes, ovaries, and peritoneum, which are known to have an aggressive behavior. Because of the rarity of this tumor, little is known about its immunophenotyping. In this study, we included ten cases of papillary serous carcinomas arising from the uterine cervix (PSCC) diagnosed in the absence of a primary endometrial malignancy. We studied their immunohistochemical profile, using a panel of antibodies against Ki67, bcl-2, p53, carcinoembryonic antigen (CEA), and CD10, and compared them to 20 consecutive cases of cervical adenocarcinoma of conventional cell subtypes (CAC) (15 mucinous, 3 adenosquamous, and 2 endometrioid). Immunostaining was recorded semiquantitatively. Patients with PSCC ranged in age from 27 to 79 years (mean = 51.6 ± 19.1), while the conventional cell subtypes control group were 28–90 years old (mean = 47.5 ± 16.9). Only p53 and CEA immunostaining significantly correlated with the PSCC morphology (P= 0.001 and P= 0.016, respectively) as shown by Cochran–Mantel–Haenszel Statistics (Modified Ridit Scores). PSCC is a distinctive immunophenotypic subtype of endocervical adenocarcinoma with significantly higher p53 and lower CEA reactivity than other more common histologic subtypes.
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Rasty G, Masood S. Breast Carcinoma with Metastasis to the Heart. Breast J 1998. [DOI: 10.1046/j.1524-4741.1998.460458.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rasty G, Murray R, Lu L, Kubilis P, Benrubi G, Masood S. Expression of HER-2/neu oncogene in normal, hyperplastic, and malignant endometrium. Ann Clin Lab Sci 1998; 28:138-43. [PMID: 9646853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
HER-2/neu oncogene is believed to be involved in tumorigenesis of several human malignancies. To assess the pattern of expression of this oncogene in normal, hyperplastic, and neoplastic endometrium, immunocytochemistry was applied to paraffin-embedded tissue sections obtained from 146 patients with endometrial adenocarcinoma. A spectrum of hyperplastic changes ranging from simple hyperplasia to atypical hyperplasia was seen in 15 percent (22/146) of cases. Expression for HER-2/neu oncogene was demonstrated as cell membrane staining. Normal, hyperplastic and neoplastic epithelial cells showed a heterogeneous expression for HER-2/neu oncogene. The intensity of the immunostaining and the number of cells stained for HER-2/neu oncogene had no significant association with surgical stage or histologic grade, although the proportion of patients demonstrating overexpression increased significantly as the histologic grade of their tumor increased (p = 0.030). Furthermore, in a multivariate analysis, a statistically significant correlation was found between the level of expression of HER-2/neu oncogene and overall survival (p = 0.025). This study demonstrated that HER-2/neu oncogene expression is variably present in normal and hyperplastic endometrium. Association between HER-2/neu oncogene expression, higher grade lesions and poor survival in patients with endometrial cancer may also justify assessment of HER-2/neu oncogene as a reliable prognostic indicator.
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Affiliation(s)
- G Rasty
- Department of Pathology, University of Florida Health Science Center, Jacksonville 32209, USA
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