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Diaz-Perez JA, Kerr DA. Gene of the month: DDIT3. J Clin Pathol 2024; 77:211-216. [PMID: 38053287 DOI: 10.1136/jcp-2023-208963] [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] [Accepted: 11/09/2023] [Indexed: 12/07/2023]
Abstract
DNA damage-inducible transcript 3 (DDIT3) gene, mapped to the human chromosome 12q13.3, encodes a protein that belongs to the CCAAT/enhancer-binding protein family of transcription factors. DDIT3 is involved in the proliferative control that responds to endoplasmic reticulum stress in normal conditions, dimerising other transcription factors with basic leucine zipper (bZIP) structural motifs. DDIT3 plays a significant role during cell differentiation, especially adipogenesis, arresting the maturation of adipoblasts. In disease, FUS/EWSR1::DDIT3 fusion is the pathogenic event that drives the development of myxoid liposarcoma. The amplification of DDIT3 in other adipocytic neoplasms mediates the presence of adipoblast-like elements. Another fusion, GLI1::DDIT3, has rarely been documented in other tumours. This paper reviews the structure and function of DDIT3, its role in disease-particularly cancer-and its use and pitfalls in diagnostic testing, including immunohistochemistry as a tissue-based marker.
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Affiliation(s)
- Julio A Diaz-Perez
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Fan J, Tang R, Zhang L, Hoang PT, Ayoade F, Diaz-Perez JA, Moss HE, Jiang H. Atypical Presentations of Extraparenchymal Neurocysticercosis. J Neuroophthalmol 2023; 43:370-375. [PMID: 36637411 PMCID: PMC10318114 DOI: 10.1097/wno.0000000000001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and is typically diagnosed through visualization of the cysts in the cerebral parenchyma by neuro-imaging. However, neuro-imaging may not detect extraparenchymal neurocysticercosis (EPNCC), which is a rare manifestation of the disease involving the subarachnoid, meningeal, and intraventricular spaces. We report 2 cases of extraparenchymal neurocysticercosis, and discuss the diagnostic challenges and management of this entity. METHODS Two cases were identified through clinical records. RESULTS Both patients had an insidious onset with slow progression of disease, and presented with papilledema and cerebrospinal fluid (CSF) eosinophilia. One case was diagnosed with spinal cord biopsy. The other was diagnosed with CSF serology and next-generation sequencing-based pathogen analysis. Both patients were treated with ventriculoperitoneal shunt, systemic antiparasitic agents, and immunosuppression. CONCLUSIONS EPNCC is less common than parenchymal NCC. A high level of clinical suspicion is required given its rarity, long incubation period, and slow progression. Diagnosis and treatment can be challenging and requires a multidisciplinary approach.
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Affiliation(s)
- Jason Fan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Rui Tang
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX
| | - Lily Zhang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Phuong T. Hoang
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA
| | - Folusakin Ayoade
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Julio A. Diaz-Perez
- Department of Pathology & Laboratory Medicine, University of Miami, Miami, FL
- Department of Dermatology, University of Tennessee, Memphis, TN
| | - Heather E. Moss
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA
- Department of Ophthalmology, Stanford University, Palo Alto, CA
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
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Diaz-Perez JA, Kerr DA. Benign and low-grade superficial endothelial cell neoplasms in the molecular era. Semin Diagn Pathol 2023:S0740-2570(23)00041-2. [PMID: 37149395 DOI: 10.1053/j.semdp.2023.04.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Vascular tumors are the most common mesenchymal neoplasms of the skin and subcutis, and they encompass a heterogeneous group with diverse clinical, histological, and molecular features, as well as biological behavior. Over the past two decades, molecular studies have enabled the identification of pathogenic recurrent genetic alterations that can be used as additional data points to support the correct classification of these lesions. The purpose of this review is to summarize the available data related to superficially located benign and low-grade vascular neoplasms and to highlight recent molecular advances with the role of surrogate immunohistochemistry to target pathogenic proteins as diagnostic biomarkers.
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Affiliation(s)
- Julio A Diaz-Perez
- Departments of Dermatology and Pathology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Asadbeigi SN, Diaz-Perez JA, Rosenberg AE, Pettus JR, Kerr DA, Linos K. Highlighting the Diversity of Desmoplastic Small Round Cell Tumor: A Case Series. Int J Surg Pathol 2023; 31:142-151. [PMID: 35466756 DOI: 10.1177/10668969221095178] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Desmoplastic small round cell tumor (DSRCT) is a rare malignant tumor that occurs mainly in the retroperitoneum of children and young adults. In its prototypical form, DSCRT displays characteristic morphology with nested primitive small round cells in a desmoplastic stroma and a distinctive immunophenotype with polyphenotypic differentiation. However, DSCRT can also exhibit a broader clinical, histologic and immunohistochemical spectrum and, therefore, cause diagnostic difficulties. Given that DSCRT is an aggressive and nearly universally fatal disease, making the correct diagnosis is critically important. Herein, we report three patients with DSRCT and unusual clinical, morphologic or immunohistochemical characteristics, in order to highlight its remarkable diversity and increase awareness of this unusual, distinctive neoplasm.
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Affiliation(s)
- Sepideh Nikki Asadbeigi
- Department of Dermatology, 12244McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Julio A Diaz-Perez
- Department of Pathology, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew E Rosenberg
- Department of Pathology, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jason R Pettus
- Department of Pathology and Laboratory Medicine, 22916Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, 22916Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, 22916Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Li YM, Diaz-Perez JA, Obayomi A, Galimberti F, Romanelli P, Tosti A. A review of bubble hair deformity. Int J Dermatol 2023; 62:428-431. [PMID: 35486091 DOI: 10.1111/ijd.16200] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/17/2022] [Accepted: 03/22/2022] [Indexed: 12/01/2022]
Abstract
Bubble hair deformity is an acquired abnormality characterized by air-filled cavity formations within the hair shaft, usually because of heat damage. Traditionally, bubble hair is diagnosed by visualization of characteristic bubbles under light microscopy. The increased utilization of trichoscopy (scalp dermoscopy) has led to its adoption in the diagnosis of many hair and scalp conditions, including bubble hair deformity. We sought to review clinical reports evaluating the patient profile, use of diagnostic imaging, and treatment options for bubble hair deformity. A systematic search of PubMed was performed in February 2021 using various keywords. Titles and abstracts were screened, leading to the selection of 11 case reports or series. The majority of patients were middle-aged Caucasian women who had used a heated tool to dry or style wet hair. Treatment consisted of cessation of heated tool usage. Light microscopy visualization of characteristic hair shaft cavities was used for diagnosis of bubble hair deformity in reports published prior to 2012. Diagnosis by trichoscopy was used in more recent reports. Our findings support the use of trichoscopy as a convenient and noninvasive method of diagnosing bubble hair deformity. More clinical studies are needed to evaluate the development of bubble hair deformity in ethnic hair.
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Affiliation(s)
- Yumeng M Li
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Dermatology, Jackson Memorial Hospital, Miami, Florida, USA.,Conway Medical Center, Conway, South Carolina, USA
| | - Julio A Diaz-Perez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Dermatology, Jackson Memorial Hospital, Miami, Florida, USA
| | - Aderonke Obayomi
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Dermatology, Jackson Memorial Hospital, Miami, Florida, USA
| | - Fabrizio Galimberti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Dermatology, Jackson Memorial Hospital, Miami, Florida, USA.,Conway Medical Center, Conway, South Carolina, USA
| | - Paolo Romanelli
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Dermatology, Jackson Memorial Hospital, Miami, Florida, USA
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Dermatology, Jackson Memorial Hospital, Miami, Florida, USA
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Ju T, Ingrasci G, Diaz-Perez JA, Obayomi A, Yosipovitch G. Development of squamous cell carcinoma in the setting of chronic discoid lupus erythematosus may be associated with plasmacytoid dendritic cell inflammation. J Cutan Pathol 2023; 50:19-23. [PMID: 35922371 DOI: 10.1111/cup.14304] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 01/03/2023]
Abstract
Discoid lupus erythematosus (DLE) is the most common type of cutaneous lupus and is clinically characterized by alopecia, depigmentation, and scars on sun-exposed skin. Squamous cell carcinoma is a potential long-term complication. The most important risk factor for squamous cell carcinoma development in people with dark skin is chronic scarring and inflammation, such as those seen in long-standing discoid plaques. African Americans who develop squamous cell carcinoma in the setting of chronic scarring and inflammation have a greater risk of metastasis and recurrence compared to sun-induced squamous cell carcinoma seen in whites. Despite this, the pathogenesis of squamous cell carcinoma development in chronic DLE is not fully understood. Herein, we describe a case of an African American patient who developed squamous cell carcinoma on a long-standing discoid plaque. Analysis of the lesion revealed a null type pattern of p53 protein expression and abundant CD123+ plasmacytoid dendritic cells, as potential drivers of oncogenesis and inflammation, respectively. Dermatologists should be aware of the increased risk of squamous cell carcinoma development within long-standing discoid plaques for a prompt early diagnosis and active long-term surveillance.
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Affiliation(s)
- Teresa Ju
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, Florida, USA
| | - Giuseppe Ingrasci
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, Florida, USA
| | - Julio A Diaz-Perez
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, Florida, USA.,Department of Dermatology, University of Tennessee, Memphis, Tennessee, USA
| | - Aderonke Obayomi
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, Florida, USA
| | - Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, Florida, USA
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Diaz-Perez JA, Poveda JC, Chapman JR, Velez-Torres JM, Vega F, Rosenberg AE. Unexpected Primary Extranodal Marginal Zone Lymphoma of Bone in Amputation and Arthroplasty Specimens. Am J Clin Pathol 2021; 156:1038-1043. [PMID: 34075398 DOI: 10.1093/ajcp/aqab067] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Amputation due to gangrene and arthroplasty for degenerative joint disease are common orthopedic procedures and are expected to increase as populations age. Histopathologic examination of these specimens can identify unsuspected diseases. METHODS We reviewed gangrenous amputations and large joint arthroplasty specimens for diagnosis of unexpected lymphoma, January 2014 to January 2020. Pathology and medical records were reviewed to determine diagnosis, treatment, and outcome. RESULTS Five cases (0.08%) of unexpected primary extranodal marginal zone lymphoma (MZL) centered in bone were identified in 1,624 amputations for gangrene and 4,163 arthroplasty specimens. The female-to-male distribution was 3:2. Median age was 71 years (range, 62-87). The 3 cases arising in the setting of gangrene involved the first toe phalanges and metatarsals, and the femoral head was involved in all cases of joint disease (2 cases). The bone showed variable (10%-80%) infiltration by dense populations of small lymphoid cells with MZL immunophenotype. One patient died from sepsis 18.5 months after diagnosis; all others are alive with a median follow-up of 27.45 months. CONCLUSIONS Histopathologic examination of nonneoplastic orthopedic specimens identifies unexpected primary bone extranodal MZL in a small percentage of cases. This neoplasm may be the result of chronic antigenic stimulation in some circumstances.
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Affiliation(s)
- Julio A Diaz-Perez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julio C Poveda
- Division of Hematopathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jennifer R Chapman
- Division of Hematopathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jaylou M Velez-Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Francisco Vega
- Division of Hematopathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Diaz-Perez JA, Conway SA, Zuo Y, Nielsen GP, Selig M, Rosenberg AE. Amyloid Arthropathy: A Review. Adv Anat Pathol 2021; 28:415-425. [PMID: 34516450 DOI: 10.1097/pap.0000000000000317] [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
Amyloid arthropathy is a joint disease associated with systemic amyloidosis. Herein, we present a model case and review the clinicopathologic features and pathophysiology of this disorder. Amyloid arthropathy results from elevation of serum amyloidogenic proteins and their deposition as aggregates in synovial fluid and articular tissues. The most common proteins are beta-2-microglobulin in the context of long-term hemodialysis therapy and immunoglobulin light chains associated with plasma cell proliferations. We provide a comprehensive update on the pathogenesis, clinical manifestations, and pathologic features of amyloid arthropathy. We provide detailed insights on amyloid protein deposition and aggregation in joints and proper details for diagnosis.
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Affiliation(s)
| | - Sheila A Conway
- Orthopaedic Surgery, Miller School of Medicine, University of Miami, Miami, FL
| | - Yiqin Zuo
- Departments of Pathology and Laboratory Medicine
| | - Gunnlaugur Petur Nielsen
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Harvard University, Boston, MA
| | - Martin Selig
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Harvard University, Boston, MA
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Espejo-Freire AP, Elliott A, Rosenberg A, Costa PA, Barreto-Coelho P, Jonczak E, D’Amato G, Subhawong T, Arshad J, Diaz-Perez JA, Korn WM, Oberley MJ, Magee D, Dizon D, von Mehren M, Khushman MM, Hussein AM, Leu K, Trent JC. Genomic Landscape of Angiosarcoma: A Targeted and Immunotherapy Biomarker Analysis. Cancers (Basel) 2021; 13:cancers13194816. [PMID: 34638300 PMCID: PMC8507700 DOI: 10.3390/cancers13194816] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Angiosarcomas (AS) are rare, highly aggressive sarcomas with limited therapeutic options. Genomic sequencing techniques have identified recurrent genetic abnormalities. Nevertheless, the association of these findings with etiology, site of origin, prognosis, and therapeutic implications is not well understood. We analyzed Next Generation Sequencing (NGS) and Whole Transcriptome Sequencing (WTS) data in a cohort of 143 AS cases. We identified distinct genomic biology according to the AS primary site. Head and neck AS cases primarily have Immunotherapy (IO) response markers and mutations in TP53 and POT1. On the other hand, breast AS is enriched for cell cycle alterations, predominately MYC amplification. Additionally, a microenvironment with abundant immune cells is present in a minority of cases but distributed evenly among primary sites. Our findings can facilitate the design and optimization of therapeutic strategies for AS according to its biology at different primary sites. Abstract We performed a retrospective analysis of angiosarcoma (AS) genomic biomarkers and their associations with the site of origin in a cohort of 143 cases. Primary sites were head and neck (31%), breast (22%), extremity (11%), viscera (20%), skin at other locations (8%), and unknown (9%). All cases had Next Generation Sequencing (NGS) data with a 592 gene panel, and 53 cases had Whole Exome Sequencing (WES) data, which we used to study the microenvironment phenotype. The immunotherapy (IO) response biomarkers Tumor Mutation Burden (TMB), Microsatellite Instability (MSI), and PD-L1 status were the most frequently encountered alteration, present in 36.4% of the cohort and 65% of head and neck AS (H/N-AS) (p < 0.0001). In H/N-AS, TMB-High was seen in 63.4% of cases (p < 0.0001) and PDL-1 positivity in 33% of cases. The most common genetic alterations were TP53 (29%), MYC amplification (23%), ARID1A (17%), POT1 (16%), and ATRX (13%). H/N-AS cases had predominantly mutations in TP53 (50.0%, p = 0.0004), POT1 (40.5%, p < 0.0001), and ARID1A (33.3%, p = 0.5875). In breast AS, leading alterations were MYC amplification (63.3%, p < 0.0001), HRAS (16.1%, p = 0.0377), and PIK3CA (16.1%, p = 0.2352). At other sites, conclusions are difficult to generate due to the small number of cases. A microenvironment with a high immune signature, previously associated with IO response, was evenly distributed in 13% of the cases at different primary sites. Our findings can facilitate the design and optimization of therapeutic strategies for AS.
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Affiliation(s)
- Andrea P. Espejo-Freire
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Andrew Elliott
- Department of Clinical and Translational Research, Caris Life Sciences, Phoenix, AZ 85040, USA;
| | - Andrew Rosenberg
- Department of Pathology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.R.); (J.A.D.-P.)
| | - Philippos Apolinario Costa
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Priscila Barreto-Coelho
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Emily Jonczak
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Gina D’Amato
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Ty Subhawong
- Department of Radiology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Junaid Arshad
- Department of Medicine, Medical Oncology, The University of Arizona College of Medicine, University of Arizona Cancer Center, Tucson, AZ 85724, USA;
| | - Julio A. Diaz-Perez
- Department of Pathology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.R.); (J.A.D.-P.)
| | - William M. Korn
- Department of Medical Affairs, Caris Life Sciences, Phoenix, AZ 85040, USA;
| | - Matthew J. Oberley
- Department of Pathology and Genetics, Caris Life Sciences, Phoenix, AZ 85040, USA;
| | - Daniel Magee
- Department of Cognitive Computing, Caris Life Sciences, Phoenix, AZ 85040, USA;
| | - Don Dizon
- Department of Medical Oncology and Gynecologic Medical Oncology, Lifespan Cancer Institute, Rode Island Hospital, Providence, RI 02903, USA;
| | - Margaret von Mehren
- Department of Hematology & Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA 19111, USA;
| | - Moh’d M. Khushman
- O’Neal Comprehensive Cancer Center, Department of Medicine, Hematology & Oncology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Atif Mahmoud Hussein
- Department of Hematology & Oncology, Memorial Health Care System, Memorial Cancer Institute, Hollywood, FL 33021, USA;
| | - Kirsten Leu
- Medical Oncology, Nebraska Cancer Specialists, Omaha, NE 68114, USA;
| | - Jonathan C. Trent
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
- Correspondence:
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Velez Torres JM, Duarte EM, Diaz-Perez JA, Leibowitz J, Weed DT, Thomas G, Sargi Z, Civantos FJ, Arnold DJ, Gomez-Fernandez C, Montgomery EA, Rosenberg AE. Mesenchymal Neoplasms of Salivary Glands: A Clinicopathologic Study of 68 Cases. Head Neck Pathol 2021; 16:353-365. [PMID: 34251596 PMCID: PMC9187808 DOI: 10.1007/s12105-021-01360-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/06/2021] [Indexed: 12/13/2022]
Abstract
Salivary gland neoplasms are uncommon, and most exhibit epithelial differentiation. Mesenchymal neoplasms of the salivary gland are rare, and the incidence ranges from 1.9% to 5%. The aim of this study is to identify the types and clinical-pathological features of mesenchymal salivary neoplasm and review their differential diagnosis. A retrospective search for mesenchymal neoplasms of salivary glands from our institution's pathology archives from the 2004-2021 period and consultation files of one of the authors (AER) was performed. The clinical data were obtained from available medical records, and the histological slides and ancillary studies were retrieved and reviewed. We identified a total of 68 cases that form the study cohort. Thirty-five patients were male, and thirty-three patients were female, with a mean age of 48 years (range, 7 months-79 years), and the male to female ratio was 1:.94. Sixty-three (92.6%) of sixty-eight tumors were benign and included: 38 (56%) lipomas, 9 (13%) hemangiomas, 7 (10.3%) schwannomas, 3 (4.4%) neurofibromas, 3 (4.4%) lymphangioma, 2 (3%) solitary fibrous tumors, 1 (1.5%) myofibroma. Five of sixty-eight (7.4%) were malignant and included: 3 (4.4%) Adamantinoma-like Ewing sarcomas, 1 (1.5%) malignant peripheral nerve sheath tumor (MPNST), and 1 (1.5%) malignant solitary fibrous tumor. The involved sites included: parotid (55), submandibular gland (5), parapharyngeal space (5), buccal mucosa minor salivary gland (2), and sublingual gland (1). Sixty-seven patients underwent surgical resection. One patient with lymphangioma manifested a recurrence/persistence a week post-surgery. One patient with a parotid hemangioma developed post-operative numbness, and another patient developed chronic postauricular pain after surgery. Two patients with MPNST and one patient with adamantinoma-like Ewing sarcoma underwent neoadjuvant chemoradiation and were disease-free after treatment. The remaining 37 patients with available follow-up ranging from 7 days to 96 months (mean, 18 months) had a favorable outcome and were disease-free after treatment. Mesenchymal neoplasms of salivary gland are rare; most are benign and demonstrate adipocytic, endothelial, and schwannian differentiation; awareness of their development is important for adequate diagnosis. The mainstay of treatment is surgical excision, with the extent determined by tumor type. Adjuvant therapy is reserved for high-grade sarcomas and may be given in a neoadjuvant or adjuvant setting.
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Affiliation(s)
- Jaylou M. Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL 33136 USA
| | | | - Julio A. Diaz-Perez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL 33136 USA
| | - Jason Leibowitz
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL USA
| | - Donald T. Weed
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL USA
| | - Giovanna Thomas
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL USA
| | - Zoukaa Sargi
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL USA
| | - Francisco J. Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL USA
| | - David J. Arnold
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL USA
| | - Carmen Gomez-Fernandez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL 33136 USA
| | - Elizabeth A. Montgomery
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL 33136 USA
| | - Andrew E. Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL 33136 USA
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Montoya-Cerrillo DM, Diaz-Perez JA, Velez-Torres JM, Montgomery EA, Rosenberg AE. Novel fusion genes in spindle cell rhabdomyosarcoma: The spectrum broadens. Genes Chromosomes Cancer 2021; 60:687-694. [PMID: 34184341 DOI: 10.1002/gcc.22978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 02/26/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/12/2022] Open
Abstract
Rhabdomyosarcoma (RMS) encompasses a heterogeneous group of tumors with striated muscle differentiation. RMSs are classified as alveolar, embryonal, spindle cell/sclerosing, and pleomorphic types and molecular analysis of these tumors has identified aberrations that are useful in their further subclassification. Spindle cell rhabdomyosarcoma (SpRMS) is uncommon and has been described with VGLL2 fusions, EWSR1/FUS-TFCP2 rearrangements, and myoD1 mutations-the mutations are associated with significantly different prognoses. In addition, the NCOA2-MEIS1 fusion gene was recently described in two primary intraosseous RMS that contained spindle cell components. Herein, we report three cases of SpRMS harboring different novel fusion genes, one possessing EP300-VGLL3, a second with NCOA2-MEIS1 and CAV1-MET, and the third case had HMGA2-NEGR1 and multiple amplified genes.
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Affiliation(s)
- Diego M Montoya-Cerrillo
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Julio A Diaz-Perez
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jaylou M Velez-Torres
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Elizabeth A Montgomery
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
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12
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Diaz-Perez JA, Spasic S, Velez-Torres JM, McCarthy EF, Rosenberg AE. Epithelioid Sarcoma of the Peripheral Nerve: Clinicopathologic Series of Three Cases and Literature Review. Am J Clin Pathol 2021; 155:729-737. [PMID: 33247294 DOI: 10.1093/ajcp/aqaa180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Epithelioid sarcoma (ES) rarely arises in the nerve. To increase our understanding of this unusual tumor originating in the nerve, we describe the features of three cases and review the literature. METHODS Clinical data, imaging, pathology, treatment, and follow-up are detailed. A systematic literature review was conducted. RESULTS Two patients were male and one female; the median age was 24 years. The patients had neurologic symptoms, and the tumors arose in large nerves and ranged from 2.4 to 5.8 cm. The tumors were avid on positron emission tomography-computed tomography and showed increased signal intensity on T2-weighted magnetic resonance imaging. Centered in the nerve, the tumors grew with an infiltrative pattern and encased the nerve fascicles. All were treated with wide resection, and adjuvant treatment included combinations of chemotherapy and radiation. One recurred, and the limb was amputated. Metastases were documented to lymph nodes, lung, pleura, and skin. One patient died of disease after 54 months. Literature review including our cases showed that tumors stained with pancytokeratin (9/9), EMA (4/4), and CD34 (7/7); there was loss of INI1 in all six cases tested. CONCLUSIONS ES rarely arises in the peripheral nerve, and its infiltrative nature often requires morbid surgery. The differential includes a variety of benign and malignant epithelioid neoplasms.
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Affiliation(s)
- Julio A Diaz-Perez
- Department of Pathology and Laboratory Medicine, Miller School of Medicine University of Miami, Miami, FL
| | - Smiljana Spasic
- Department of Pathology and Laboratory Medicine, Miller School of Medicine University of Miami, Miami, FL
| | - Jaylou M Velez-Torres
- Department of Pathology and Laboratory Medicine, Miller School of Medicine University of Miami, Miami, FL
| | - Edward F McCarthy
- Department of Pathology, The Johns Hopkins University Hospital, Baltimore, MD
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Miller School of Medicine University of Miami, Miami, FL
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13
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Brčić I, Spasić S, England JS, Zuo Y, Velez-Torres J, Diaz-Perez JA, Gorkiewicz G, Rosenberg AE. Clear Cell Change in Reactive Angiogenesis: A Potential Diagnostic Pitfall. Am J Surg Pathol 2021; 45:531-536. [PMID: 33002917 DOI: 10.1097/pas.0000000000001595] [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
Reactive angiogenesis is commonplace, occurs in many circumstances, and is important in the repair of injured tissue. Histologically, it is characterized by newly formed capillaries arranged in a lobular architecture and lined by plump endothelial cells. We have encountered a form of reactive angiogenesis not well described; composed of large endothelial cells with abundant clear cytoplasm that causes diagnostic challenges. The cohort includes 10 patients, aged 4 to 61, mean 40 years; 7 males, 3 females. One case involved bone (ilium), and 9 involved soft tissue: fingers (n=2), toes (n=2), hip joint (n=1), shoulder (n=1), thigh (n=2), and anal mucosa (n=1). Clinically, the patients had chronic ulcers, osteomyelitis, or localized infection. All cases exhibited a lobular proliferation of capillaries lined by large polyhedral endothelial cells that obscured the vessel lumens and were admixed with acute and chronic inflammation. The endothelial nuclei were vesicular with small nucleoli and the cytoplasm was abundant and clear or palely eosinophilic. The endothelial cells were stained with CD31 and ERG (7/7 cases), CD34 (6/6), FLI1 (4/4), and were negative for keratin and CD68 (6/6). Periodic acid-Schiff stain and periodic acid-Schiff stain-diastase on 3 cases did not demonstrate glycogen. Using a polymerase chain reaction, no Bartonella henselae was found in all 6 cases tested. Reactive angiogenesis with clear cell change unassociated with Bartonella spp. has not been described. It causes diagnostic challenges and the differential diagnosis includes benign and malignant tumors, as well as unusual infections. It is important to distinguish between these possibilities because of the significant impact on treatment and prognosis.
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Affiliation(s)
- Iva Brčić
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Smiljana Spasić
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Jonathan S England
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Yiqin Zuo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Jaylou Velez-Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Julio A Diaz-Perez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Gregor Gorkiewicz
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
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14
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Williams NM, Obayomi AO, Diaz-Perez JA, Morrison BW. Monodactylous Longitudinal Melanonychia: A Sign of Bowen's Disease in Skin of Color. Skin Appendage Disord 2021; 7:306-310. [PMID: 34307479 DOI: 10.1159/000514221] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/05/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Monodactylous longitudinal melanonychia (LM) may represent both benign and malignant dermatologic disorders. However, squamous cell carcinoma in situ (SCCis) is not commonly considered in this setting. Case Presentation In this report, we present 2 cases of SCCis of the nail matrix in patients with skin of color who presented with monodactylous LM involving the lateral aspect of the nail. Conclusion These cases suggest that SCCis should be included in the differential diagnosis for monodactylous LM, especially when involving the lateral nail plate in darker skin.
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Affiliation(s)
- Natalie M Williams
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aderonke O Obayomi
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Julio A Diaz-Perez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brian W Morrison
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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15
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Hung YP, Fisch AS, Diaz-Perez JA, Iafrate AJ, Lennerz JK, Nardi V, Bredella MA, Raskin KA, Lozano-Calderon SA, Rosenberg AE, Nielsen GP. Identification of EWSR1-NFATC2 fusion in simple bone cysts. Histopathology 2021; 78:849-856. [PMID: 33316098 DOI: 10.1111/his.14314] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
AIMS Simple bone cysts are benign intramedullary tumours primarily involving the long bones in skeletally immature individuals. Several mechanisms have been proposed for their pathogenesis. Although the diagnosis is typically straightforward, the interpretation can be problematic, because of superimposed fracture causing them to resemble aneurysmal bone cysts and other tumours. EWSR1-NFATC2 or FUS-NFATC2 fusions, which are characteristic of a subset of aggressive round cell sarcomas, have been recently detected in simple bone cysts. The aim of this study was to examine the clinicopathological and molecular features in a series of simple bone cysts. METHODS AND RESULTS Using RNA-based next-generation sequencing and/or fluorescence in-situ hybridisation, we investigated the presence of EWSR1 or FUS rearrangements in nine simple bone cysts. The patients were five females and four males, aged 3-23 years (median, 14 years); the tumours ranged from 19 mm to 160 mm (median, 46 mm) in size, and involved the femur (n = 3), humerus (n = 2), fibula (n = 2), tibia (n = 1), and iliac wing (n =1). We identified three cases with EWSR1-NFATC2 fusion (showing identical breakpoints to those in EWSR1-NFATC2 sarcomas) and one additional case with FUS rearrangement. Unlike in EWSR1-NFATC2 sarcomas, immunohistochemical expression of NKX3.1 and NKX2.2 was absent in two simple bone cysts tested. CONCLUSIONS More than 40% of simple bone cysts harbour genetic alterations confirming that they are neoplastic, investigation of EWSR1 and/or FUS rearrangement may help to distinguish simple bone cysts from mimics, and NFATC2 rearrangement is not pathognomonic of malignancy.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Adam S Fisch
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julio A Diaz-Perez
- Department of Pathology and Laboratory Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kevin A Raskin
- Department of Orthopedics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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16
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Velez Torres JM, Martinez Duarte E, Diaz-Perez JA, Leibowitz J, Weed DT, Thomas G, Civantos FJ, Arnold DJ, Gomez-Fernandez C, Rosenberg AE. Primary Sarcomas of the Larynx: A Clinicopathologic Study of 27 Cases. Head Neck Pathol 2021; 15:905-916. [PMID: 33686585 PMCID: PMC8384992 DOI: 10.1007/s12105-021-01314-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/19/2021] [Indexed: 01/21/2023]
Abstract
Primary sarcomas of the larynx are rare and are associated with diagnostic and treatment challenges. Studies of these tumors are limited, and most examples have been reported as small series. To further increase our understanding of laryngeal sarcomas, we reviewed our experience of an adult cohort. A retrospective search for laryngeal sarcomas from our pathology archives and consultation files of one of the authors was performed. We studied 27 primary laryngeal sarcomas that included 25 males, and 2 females, with a mean age of 60 years (range 33-85). The cases included conventional chondrosarcoma (16), well-differentiated liposarcoma (2), clear cell chondrosarcoma (1), leiomyosarcoma (2), high grade myxofibrosarcoma (2), high grade myofibroblastic sarcoma (1), low-grade myofibroblastic sarcoma (1), malignant granular cell tumor (1), and Kaposi sarcoma (1). Data on treatment and follow-up was available in 17 and 16 cases, respectively. 12 patients underwent partial laryngeal resection; five had total laryngectomy, and the patient with Kaposi sarcoma received combined highly active antiretroviral therapy and chemotherapy. Three patients developed local recurrence, and two patients developed metastases. The remaining patients with follow up had a favorable outcome and were disease-free after treatment. The important differential diagnosis of spindle cell sarcoma is sarcomatoid squamous cell carcinoma, and their distinction often requires extensive sampling of the mucosal surface and immunohistochemical analysis. The mainstay of treatment for laryngeal sarcomas is surgical removal, with the extent dictated by tumor type and grade. Adjuvant therapy is reserved for high-grade sarcomas and may be given in a neoadjuvant or adjuvant setting.
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Affiliation(s)
- Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Room 4078, Miami, FL, 33136, USA.
| | - Ernesto Martinez Duarte
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julio A Diaz-Perez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Room 4078, Miami, FL, 33136, USA
| | - Jason Leibowitz
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Donald T Weed
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Giovanna Thomas
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - David J Arnold
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Carmen Gomez-Fernandez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Room 4078, Miami, FL, 33136, USA
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Room 4078, Miami, FL, 33136, USA
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17
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Diaz-Perez JA, Desai KR, Li YM, Billero V, Rosenberg AE, Romanelli P. Delusional infestation complicated by gangrene and osteomyelitis requiring finger amputation. JAAD Case Rep 2021; 11:6-9. [PMID: 33869705 PMCID: PMC8042430 DOI: 10.1016/j.jdcr.2021.02.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Julio A Diaz-Perez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami, Florida.,Department of Pathology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Karishma R Desai
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami, Florida
| | - Yumeng M Li
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami, Florida
| | - Victoria Billero
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami, Florida
| | - Andrew E Rosenberg
- Department of Pathology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Paolo Romanelli
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami, Florida
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18
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Montoya-Cerrillo DM, Diaz-Perez JA, Rosenberg AE. Amyloid Deposition Within a Large Pelvic Chronic Expanding Hematoma. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.144] [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: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Chronic expanding hematoma (CEH) is a relatively rare complication of trauma that is usually mistaken for a soft tissue neoplasm. The identification of amyloid protein is of paramount clinical importance to exclude serious conditions causing systemic amyloidosis.
Methods
The case was retrieved from the pathology files at the University of Miami Hospital (UMH). Morphology and special stains were reviewed. The study was approved by the Institutional Review Board at UMH.
Results
A 44-year-old man with past history of a stab wound in the left buttock in the 1990s, was admitted with worsening abdominal pain, constipation, urinary obstruction and acute kidney injury. CT-scan showed a large mass involving the left gluteal area and pelvic cavity involving urinary bladder causing outlet obstruction and bilateral hydroureteronephrosis. Multiple radiology-guided biopsies were taken all identifying only fibrin, blood cells, and necrotic inflammatory cells. Excision of the gluteal mass and drainage of the pelvic component was performed confirming the diagnosis of CEH. Amyloid deposition with congo red stain birefringence under polarized light was identified. The patient’s symptoms and renal function improved and have been under follow-up for 1 month.
Conclusion
We have identified amyloid protein deposition whiting a CEH. This is an unusual finding with no previous description found in our search. The identification of amyloid whiting tumor-like lesions is relevant to exclude causes of systemic amyloidosis.
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Affiliation(s)
- D M Montoya-Cerrillo
- Pathology and Laboratory Medicine, University of Miami/ Jackson Memorial Hospital, Miami, Florida, UNITED STATES
| | - J A Diaz-Perez
- Pathology and Laboratory Medicine, University of Miami/ Jackson Memorial Hospital, Miami, Florida, UNITED STATES
| | - A E Rosenberg
- Pathology and Laboratory Medicine, University of Miami/ Jackson Memorial Hospital, Miami, Florida, UNITED STATES
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19
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Montoya-Cerrillo DM, Diaz-Perez JA, Rosenberg AE. Novel Gene Fusions in Rhabdomyosarcoma. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.341] [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: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Rhabdomyosarcoma (RMS) encompasses a heterogeneous group of tumors with striated muscle morphology and/or immunophenotype. Molecular analysis of rhabdomyosarcoma has identified a number of aberrations useful for classification. Initially, fusion associated RMS was restricted to tumors with FOXO1 rearrangements, confirming the diagnosis of alveolar RMS, and identifying patients with poor-outcome. Spindle cell RMS, have been described with VGLL2 fusions, EWSR1/FUS-TFCP2 rearrangements, and myoD1 mutations. In addition, NCOA2-MEIS1 fusion gene was recently described in two primary intraosseous RMSs sharing primitive histology. Herein we report two cases of spindle cell RMS, harboring different novel fusion genes, one presenting EP300-VGLL3, and the second with NCOA2-MEIS1 and CAV1-MET.
Methods
Two cases of RMS were retrieved from the pathology files at the University of Miami Hospital (UMH) and Jackson Memorial Hospital (JMH). Morphology and immunohistochemistry were reviewed. A commercial genomic profiling test for both cases was also analyzed. The study was approved by the Institutional Review Board at UMH.
Results
Case #1 is a 36-year-old man presented with a 1.5 cm submucosal mass in the ventral left tongue. The biopsy revealed a malignant spindle cell neoplasm and immunohistochemistry showed tumor cells positive for desmin, SMA, myogenin and MYOD-1. A partial glossectomy was performed, achieving negative resection margins. Next- generation sequencing (NGS) identified an EP300-VGLL3 fusion. The patient is currently being followed and has been disease-free for 6 months. Case #2 is a 19-years-old male with no medical history admitted with lower extremities weakness and a large expansile pelvic bone lesion and multiple spinal metastases. Biopsy from the pelvic lesion revealed malignant primitive round cells and short spindle cells arranged in fascicles which were positive for desmin, MYOD-1, TLE-1 and CD99 and focally positive for myogenin and WT-1. NGS identified two fusion genes, NCOA2- MEIS1 and CAV1-MET.
Conclusion
Different types of rhabdomyosarcoma are associated with a variety of different gene fusions and some may be of prognostic significance. Our two cases are the first reported with EP300-VGLL3 and CAV1-MET fusion genes. CAV1-MET oncogenic potential has been described only in lung cancer. The prognostic significance of rhabdomyosarcoma with novel gene fusions requires longer follow-up and the identification of additional cases.
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Affiliation(s)
- D M Montoya-Cerrillo
- Pathology and Laboratory Medicine, University of Miami/ Jackson Memorial Hospital, Miami, Florida, UNITED STATES
| | - J A Diaz-Perez
- Pathology and Laboratory Medicine, University of Miami/ Jackson Memorial Hospital, Miami, Florida, UNITED STATES
| | - A E Rosenberg
- Pathology and Laboratory Medicine, University of Miami/ Jackson Memorial Hospital, Miami, Florida, UNITED STATES
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20
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Sedighim S, Burke J, Schneider D, Kamdjou T, Diaz-Perez JA, Trent J, Möller M. CIC-rearranged round cell (Ewing-like) sarcoma of the uterus: Review of the literature. Gynecol Oncol Rep 2020; 33:100592. [PMID: 32529020 PMCID: PMC7280761 DOI: 10.1016/j.gore.2020.100592] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
CIC-rearranged round cell sarcoma (CRS) is a rare entity that presents in various anatomical locations and involves deep soft-tissue structures and skin. Although commonly confused with and clinically similar to Ewing sarcoma (ES), investigators have recently shown that this unique condition maintains morphologic and pathologic features that are distinct from ES. In this report, we present and discuss a case of CRS of the uterus, the first of its kind to be reported in the English-language literature. We urge the scientific community to continue its investigations in elucidating the features of this entity, as young women who suffer from this condition have dismal prognoses and currently do not have access to therapeutic options for cure.
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Affiliation(s)
- Shaina Sedighim
- University of Miami, Miller School of Medicine, Miami, FL, United States
- Corresponding author at: University of Miami, Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, United States.
| | - Jonathan Burke
- University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Douglas Schneider
- University of California, Irvine School of Medicine, Orange, CA, United States
| | - Talia Kamdjou
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Julio A. Diaz-Perez
- University of Miami, Miller School of Medicine Department of Pathology, Miami, FL, United States
| | - Jonathan Trent
- University of Miami, Miller School of Medicine Department of Hematology and Oncology, Miami, FL, United States
| | - Mecker Möller
- University of Miami, Miller School of Medicine, Miami, FL, United States
- University of Miami, Miller School of Medicine Department Surgery, Division of Surgical Oncology, Miami, FL, United States
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21
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Diaz-Perez JA, Nielsen GP, Antonescu C, Taylor MS, Lozano-Calderon SA, Rosenberg AE. EWSR1/FUS-NFATc2 rearranged round cell sarcoma: clinicopathological series of 4 cases and literature review. Hum Pathol 2019; 90:45-53. [PMID: 31078563 DOI: 10.1016/j.humpath.2019.05.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/05/2019] [Indexed: 12/27/2022]
Abstract
The classification of bone neoplasms composed of small round cells is experiencing a transformation after the discovery of various gene fusion rearrangements that determine diagnosis, behavior, and response to therapy. We present herein 4 new cases of small round cell tumor of the bone that harbor NFATc2 rearrangements involving either EWSR1 or FUS genes. We studied the clinical presentation, pathologic features, genetics (FISH, targeted RNA sequencing) and outcome in these 4 patients. We also reviewed the literature describing similar cases. All our patients were male. The median age at diagnosis was 33.5 years. All tumors presented in long bones of the extremities as a large destructive mass with a mean size of 12.5 cm. All cases were hypercellular with prominent collagenous stroma and consisted of small to medium size round cells arranged in cords, thin trabeculae, and pseudoacinar structures. Most cases showed focal or diffuse membrane staining for CD99; whereas S100, synaptophysin and chromogranin were negative. EMA showed cytoplasmic staining in one case. Genetic studies identified EWSR1-NFATc2 fusion in 3 cases, and FUS-NFATc2 fusion in one case. Two patients were treated with neoadjuvant chemotherapy using Ewing sarcoma regimens, and surgical excision was performed on 3 patients; necrosis was minimal. Follow-up is limited; after a median follow-up of 8.7 months, one patient developed local recurrence and metastases to the lungs. Poorly differentiated round cell sarcoma with EWSR1/FUS-NFATc2 fusions are uncommon. The tumors have consistent clinical findings, morphology, and immunoprofile that in combination are distinctive and differ from that of Ewing sarcoma. Importantly, these tumors do not respond to Ewing sarcoma chemotherapy regimens.
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Affiliation(s)
- Julio A Diaz-Perez
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL
| | - G Petur Nielsen
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Harvard University, Boston, MA
| | - Cristina Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin S Taylor
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Harvard University, Boston, MA
| | | | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL.
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22
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Diaz-Perez JA, Velez-Torres J, Iakymenko O, Villamizar N, Rosenberg AE. Epithelioid Hemangioendothelioma Arising Within Mediastinal Myelolipoma: A WWTR1-Driven Composite Neoplasm. Int J Surg Pathol 2019; 27:664-668. [PMID: 30942102 DOI: 10.1177/1066896919837611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this article, we describe a case of conventional epithelioid hemangioendothelioma (EHE) arising within an extra-adrenal myelolipoma. This composite neoplasm arose in the mediastinum of a 51-year-old female. The tumor was composed of a large myelolipoma that contained nodules of EHE consisting of CD31-positive epithelioid endothelial cells that grew in solid cords and were enmeshed in a basophilic hyalinized stroma. Both EHE and myelolipoma are characterized genetically by alterations of WWTR1. We demonstrated the expression of CAMTA-1 chimeric protein by immunohistochemistry both in the neoplastic endothelial cells of EHE and some of the endothelial cells lining the blood vessels in the myelolipoma. To the best of our knowledge, this is the first report of a malignant vascular neoplasm arising in association with myelolipoma.
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Affiliation(s)
- Julio A Diaz-Perez
- 1 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jaylou Velez-Torres
- 1 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Oleksii Iakymenko
- 1 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nestor Villamizar
- 2 Department of Surgery, Division of Cardiothoracic Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Andrew E Rosenberg
- 1 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA
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Watson AR, Dai H, Diaz-Perez JA, Killeen ME, Mathers AR, Thomson AW. mTORC2 deficiency in cutaneous dendritic cells potentiates CD8 + effector T cell responses and accelerates skin graft rejection. Am J Transplant 2019; 19:646-661. [PMID: 30129283 PMCID: PMC6384165 DOI: 10.1111/ajt.15083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 01/25/2023]
Abstract
Mechanistic target of rapamycin (mTOR) complex (mTORC)1 and mTORC2 regulate the differentiation and function of immune cells. While inhibition of mTORC1 antagonizes dendritic cell (DC) differentiation and suppresses graft rejection, the role of mTORC2 in DCs in determining host responses to transplanted tissue remains undefined. Using a mouse model in which mTORC2 was deleted specifically in CD11c+ DCs (TORC2DC-/- ), we show that the transplant of minor histocompatibility Ag (HY)-mismatched skin grafts from TORC2DC-/- donors into wild-type recipients results in accelerated rejection characterized by enhanced CD8+ T cell responses in the graft and regional lymphoid tissue [Correction added on January 9, 2019, after first online publication: in the previous sentence, major was changed to minor]. Similar enhancement of CD8+ effector T cell responses was observed in MHC-mismatched recipients of TORC2DC-/- grafts. Augmented CD8+ T cell responses were also observed in a delayed-type hypersensitivity model in which mTORC2 was absent in cutaneous DCs. These elevated responses could be ascribed to an increased T cell stimulatory phenotype of TORC2DC-/- and not to enhanced lymph node homing of the cells. In contrast, rejection of ovalbumin transgenic skin grafts in TORC2DC-/- recipients was unaffected. These findings suggest that mTORC2 in skin DCs restrains effector CD8+ T cell responses and have implications for understanding of the influence of mTOR inhibitors that target mTORC2 in transplant.
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Affiliation(s)
- Alicia R. Watson
- Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Helong Dai
- Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA,Department of Urological Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Julio A. Diaz-Perez
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Meaghan E. Killeen
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Alicia R. Mathers
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA,Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Angus W. Thomson
- Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA,Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA,Correspondence: Angus W. Thomson, PhD, DSc, Starzl Transplantation Institute, University of Pittsburgh School of Medicine, 200 Lothrop Street, BST W1540, Pittsburgh, PA 15261, , (412) 624-6392
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24
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Yang Y, Killeen ME, Diaz-Perez JA, Mathers AR. The respective contributions of P2X7 receptor variants to the development of psoriasiform dermatitis. The Journal of Immunology 2018. [DOI: 10.4049/jimmunol.200.supp.45.39] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Psoriasis is a chronic inflammatory cutaneous disease caused by environmental triggers in genetically predisposed individuals which account for 2–3% of the world population. However, the mechanisms contributing to the initialization of psoriasis are largely unknown. ATP is a particularly interesting candidate that, via P2X7 receptor (P2X7R) signaling, can activate NF-κB and the IL-23/IL-17 axis, both of which have been shown to be critical in psoriasis pathogenesis. Moreover, P2X7R expression is increased in lesional and non-lesional skin of psoriatic patients compared to healthy donors. Specifically, we have determined that the canonical P2X7R variant A (P2X7RA) is expressed comparably in both lesional psoriatic tissues and normal human skin. However, it is the alternatively spliced P2X7R variant B (P2X7RB) that is highly expressed in human psoriatic lesions. P2X7RB is widely distributed in human tissues and P2X7RB activation enhances cellular proliferation, decreases ATP-induced apoptosis, and in heterotrimers potentiates the inflammatory responses induced by P2X7RA. Importantly, our studies have established that signaling through the P2X7R induces an acute psoriasiform dermatitis in mice. Thus, our ongoing work is focusing on the specific role of P2X7R variants in inflammatory diseases. We confirmed in human blood derived DCs that signaling through the P2X7RB can induce proinflammatory cytokines, such as IL-1β, IL-6 and TNF-α, to same degree as P2X7RA. In conclusion, this work provides a basic mechanistic insight into local inflammation induced following purinergic signaling through the P2X7R that is likely involved in the pathogenesis and potential treatment of many cutaneous inflammatory diseases.
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25
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Diaz-Perez JA, Beveridge MG, Victor TA, Cibull TL. Granulomatous and lichenoid dermatitis after IgG4 anti-PD-1 monoclonal antibody therapy for advanced cancer. J Cutan Pathol 2018; 45:434-438. [PMID: 29468713 DOI: 10.1111/cup.13133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/10/2018] [Accepted: 02/16/2018] [Indexed: 01/14/2023]
Abstract
Nivolumab is a fully human IgG4 monoclonal antibody directed against programmed cell death protein 1 (PD-1). PD-1 inhibition allows T-cell activation and recruitment to destroy cancer cells. Checkpoint inhibitors have shown significant survival advantage and relatively low side-effects in comparison with conventional chemotherapy in several types of advanced cancer. Granulomatous cutaneous reactions have been reported showing sarcoidal and panniculitic morphology. Here we present a case of drug-induced lichenoid and granulomatous dermatitis after checkpoint inhibitor therapy observed in a 63-year-old male treated with nivolumab for advanced glioblastoma. This morphology has not been previously reported. We documented a high number of CD8+ T-cells within the lesions. Additionally, we review the side-effects observed with the use of checkpoint inhibitors, with special focus on cutaneous manifestations.
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Affiliation(s)
- Julio A Diaz-Perez
- Department of Pathology, NorthShore University Health System, University of Chicago, Evanston, Illinois
| | - Mara G Beveridge
- Department of Dermatology, NorthShore University Health System, University of Chicago, Evanston, Illinois
| | - Thomas A Victor
- Department of Pathology, NorthShore University Health System, University of Chicago, Evanston, Illinois
| | - Thomas L Cibull
- Department of Pathology, NorthShore University Health System, University of Chicago, Evanston, Illinois
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Abstract
Here, we present the case of a 16-year-old male who developed pityriasis amiantacea (PA) after the use of valproic acid. We propose that the keratinocyte proliferative activity of valproic acid mediated through the inhibition of glycogen synthase kinase-3β, and subsequent activation of the Wnt/β-catenin pathway could play a role in the development of PA. We additionally review the most relevant characteristics of this disease.
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Affiliation(s)
- Julio A Diaz-Perez
- Department of Pathology, Northshore University Health System, University of Chicago, Chicago, IL, USA.,Department of Pathology, Jackson Health System, University of Miami, Miami, FL, USA
| | - Joel C Joyce
- Division of Dermatology, Northshore University Health System, University of Chicago, Chicago, IL, USA
| | - Thomas L Cibull
- Department of Pathology, Northshore University Health System, University of Chicago, Chicago, IL, USA
| | - Thomas A Victor
- Department of Pathology, Northshore University Health System, University of Chicago, Chicago, IL, USA
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27
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Kikuchi M, Clump DA, Srivastava RM, Sun L, Zeng D, Diaz-Perez JA, Anderson CJ, Edwards WB, Ferris RL. Preclinical immunoPET/CT imaging using Zr-89-labeled anti-PD-L1 monoclonal antibody for assessing radiation-induced PD-L1 upregulation in head and neck cancer and melanoma. Oncoimmunology 2017; 6:e1329071. [PMID: 28811971 DOI: 10.1080/2162402x.2017.1329071] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/07/2017] [Indexed: 12/31/2022] Open
Abstract
Radiation therapy (RT) can induce upregulation of programmed death ligand 1 (PD-L1) on tumor cells or myeloid cells, which may affect response to PD-1-based immunotherapy. PD-L1 upregulation during RT is a dynamic process that has been difficult to monitor during treatment. The aim of this study was to evaluate the RT-induced PD-L1 upregulation in the tumor and its microenvironment using immunoPET/CT imaging of two syngeneic murine tumor models (HPV+ head and neck squamous cell carcinoma (HNSCC) or B16F10 melanoma). Tumors were established in two locations per mouse (neck and flank), and fractionated RT (2 Gy × 4 or 2 Gy × 10) was delivered only to the neck tumor, alone or during anti-PD-1 mAb immunotherapy. PD-L1 expression was measured by PET/CT imaging using Zr-89 labeled anti-mouse PD-L1 mAb, and results were validated by flow cytometry. PET/CT imaging demonstrated significantly increased tracer uptake in irradiated neck tumors compared with non-irradiated flank tumors. Ex vivo analysis by biodistribution and flow cytometry validated PD-L1 upregulation specifically in irradiated tumors. In the HNSCC model, RT-induced PD-L1 upregulation was only observed after 2 Gy × 10 fractionated RT, while in the B16F10 model upregulation of PD-L1 occurred after 2 Gy × 4 fractionated RT. Fractionated RT, but not anti-PD-1 therapy, upregulated PD-L1 expression on tumor and infiltrating inflammatory cells in murine models, which could be non-invasively monitored by immunoPET/CT imaging using Zr-89 labeled anti-mouse PD-L1 mAb, and differentially identified anti-PD-1 responsive as well as selectively irradiated tumors in vivo.
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Affiliation(s)
- Masahiro Kikuchi
- Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.,Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Clump
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lingyi Sun
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dexing Zeng
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julio A Diaz-Perez
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA, USA.,Translational Medicine Program, CEINDO, Madrid, Spain
| | - Carolyn J Anderson
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - W Barry Edwards
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA.,Cancer Immunology Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.,Tumor Microenvironment Center, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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28
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Browne SH, Diaz-Perez JA, Preziosi M, King CC, Jones GA, Jain S, Sun X, Reid EG, VandenBerg S, Wang HY. mTOR activity in AIDS-related diffuse large B-cell lymphoma. PLoS One 2017; 12:e0170771. [PMID: 28192480 PMCID: PMC5305194 DOI: 10.1371/journal.pone.0170771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/10/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients infected with HIV have a significantly increased risk of developing non-Hodgkin lymphomas despite the widespread use of HAART. To investigate mTOR pathway activity in acquired immunodeficiency syndrome (AIDS) related diffuse large B-cell lymphoma AR-DLBCL, we used immunohistochemistry to examine the presence of the phosphorylated 70 ribosomal S6 protein-kinase (p70S6K), an extensively studied effector of mTOR Complex 1 (mTORC1) and the phosphorylated phosphatase and tensin homolog (pPTEN), a negative regulator of mTORC1 pathway. MATERIALS AND METHODS We evaluated tissue samples from 126 patients with AR-DLBCL. Among them, 98 samples were from tissue microarrays (TMAs) supplied by the Aids and Cancer Specimen Resource (ACSR), the remaining 28 samples were from cases diagnosed and treated at the University of California, San Diego (UCSD). The presence of p70S6K was evaluated with two antibodies directed against the combined epitopes Ser235/236 and Ser240/244, respectively; and additional monoclonal anti-bodies were used to identify pPTEN and phosphorylated proline-rich Akt substrate of 40kDa (pPRAS40). The degree of intensity and percentage of cells positive for p70S6K and pPTEN were assessed in all the samples. In addition, a subgroup of 28 patients from UCSD was studied to assess the presence of pPRAS40, an insulin-regulated activator of the mTORC1. The expression of each of these markers was correlated with clinical and histopathologic features. RESULTS The majority of the patients evaluated were males (88%); only two cases (1.6%) were older than 65 years of age. We found high levels of both p70S6K-paired epitopes studied, 48% positivity against Ser235/236 (44% in ACSR and 64% in UCSD group), and 86% positivity against Ser240/244 (82% in ACSR and 100% in UCSD group). We observed more positive cells and stronger intensity with epitope Ser240/244 in comparison to Ser235/236 (p<0.0001). The degree of intensity and percentage of cells positive for pPTEN was positively correlated with p70S6K levels (p = 0.016 for 235/236 and p = 0.007 for 240/244). High levels of pPRAS40 were observed in the majority of the cases evaluated (64.3%), but no correlation was found with either pPTEN (p = 0.9) or p70S6K (p = 0.9) levels. CONCLUSION AR-DLBCL frequently contain p70S6K, a main downstream effector of the mTOR pathway. The presence of p70S6K is positively correlated with pPTEN, an inactive form of PTEN, which makes mTORC1 activated. The presence of p70S6K was independent of HIV viral load or CD4 (+) counts. These results suggest that the mTOR pathway is active in the majority of AR-DLBCL, and p70S6K, particularly the Ser240/244 epitope immunohistochemistry is an excellent surrogate biomarker, which could be used to identify cases expected to be responsive to mTOR inhibitors.
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Affiliation(s)
- Sara H. Browne
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, CA, United States of America
- * E-mail: (SHB); (HYW)
| | - Julio A. Diaz-Perez
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, CA, United States of America
| | - Michael Preziosi
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, CA, United States of America
| | - Charles C. King
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States of America
| | - George A. Jones
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States of America
| | - Sonia Jain
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Xiaoying Sun
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Erin G. Reid
- Division of Hematology, Department of Medicine, University of California, San Diego, La Jolla, CA, United States of America
| | - Scott VandenBerg
- Division of Clinical Pathology, Department of Pathology, University of California, San Diego, La Jolla, CA, United States of America
- Human Tissue Technology Core, University of California, San Diego, La Jolla, CA, United States of America
| | - Huan-You Wang
- Division of Clinical Pathology, Department of Pathology, University of California, San Diego, La Jolla, CA, United States of America
- * E-mail: (SHB); (HYW)
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29
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Orosco RK, Savariar EN, Weissbrod PA, Diaz-Perez JA, Bouvet M, Tsien RY, Nguyen QT. Molecular targeting of papillary thyroid carcinoma with fluorescently labeled ratiometric activatable cell penetrating peptides in a transgenic murine model. J Surg Oncol 2016; 113:138-43. [PMID: 26799257 DOI: 10.1002/jso.24129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/28/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Molecularly targeted fluorescent molecules may help detect tumors that are unseen by traditional white-light surgical techniques. We sought to evaluate a fluorescent ratiometric activatable cell penetrating peptide (RACPP) for tumor detection in a transgenic model of PTC. METHODS Thirteen BRAFV600E mice with PTC were studied-seven injected intravenously with RACPP, four controls with saline. Total thyroidectomy was performed with microscopic white-light visualization. Fluorescent imaging of post-thyroidectomy fields was performed, and tissue with increased signal was removed and evaluated for PTC. Final samples were analyzed by a pathologist blinded to conditions. Vocal cord function was evaluated postoperatively with video laryngoscopy. RESULTS The average in situ ratiometric (Cy5/Cy7) thyroid tumor-to-background contrast ratio was 2.27 +/- 0.91. Fluorescence-guided clean-up following thyroidectomy identified additional tumor in 2 of 7 RACPP animals (smallest dimension 1.2 mm), and decreased the number of animals with residual tumor from 4 to 3. All retained tumor foci on final pathology were smaller than 0.76 mm. Intact vocal abduction was present in all of the RACPP animals. CONCLUSIONS RACPPs successfully targeted PTC in a transgenic thyroidectomy model, and allowed for residual tumor detection that reduced positive margins beyond what was possible with white-light surgery alone.
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Affiliation(s)
- Ryan K Orosco
- Department of Surgery, Division of Head and Neck Surgery, University of California San Diego, San Diego, California
| | | | - Philip A Weissbrod
- Department of Surgery, Division of Head and Neck Surgery, University of California San Diego, San Diego, California
| | - Julio A Diaz-Perez
- Department of Pathology, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Michael Bouvet
- Department of Surgery, Division of Surgical Oncology, University of California San Diego, San Diego, California
| | - Roger Y Tsien
- Department of Pharmacology, University of California San Diego, San Diego, California.,Howard Hughes Medical Institute, University of California San Diego, San Diego, California
| | - Quyen T Nguyen
- Department of Surgery, Division of Head and Neck Surgery, University of California San Diego, San Diego, California
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30
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Hussain T, Savariar EN, Diaz-Perez JA, Messer K, Pu M, Tsien RY, Nguyen QT. Surgical molecular navigation with ratiometric activatable cell penetrating peptide for intraoperative identification and resection of small salivary gland cancers. Head Neck 2015; 38:715-23. [PMID: 25521629 DOI: 10.1002/hed.23946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 12/06/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We evaluated the use of intraoperative fluorescence guidance by enzymatically cleavable ratiometric activatable cell-penetrating peptide (RACPPPLGC(Me)AG) containing Cy5 as a fluorescent donor and Cy7 as a fluorescent acceptor for salivary gland cancer surgery in a mouse model. METHODS Surgical resection of small parotid gland cancers in mice was performed with fluorescence guidance or white light (WL) imaging alone. Tumor identification accuracy, operating time, and tumor-free survival were compared. RESULTS RACPP guidance aided tumor detection (positive histology in 90% [27/30] vs 48% [15/31] for WL; p < .001). An approximate 25% ratiometric signal increase as the threshold to distinguish between tumor and adjacent tissue, yielded >90% detection sensitivity and specificity. Operating time was reduced by 54% (p < .001), and tumor-free survival was increased with RACPP guidance (p = .025). CONCLUSION RACPP provides real-time intraoperative guidance leading to improved survival. Ratiometric signal thresholds can be set according to desired detection accuracy levels for future RACPP applications.
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Affiliation(s)
- Timon Hussain
- Division of Head and Neck Surgery, University of California San Diego, San Diego, California
| | | | - Julio A Diaz-Perez
- Division of Head and Neck Surgery, University of California San Diego, San Diego, California
| | - Karen Messer
- Division of Biostatistics, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Minya Pu
- Division of Biostatistics, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Roger Y Tsien
- Department of Pharmacology, University of California San Diego, San Diego, California.,Howard Hughes Medical Institute, University of California San Diego, San Diego, California
| | - Quyen T Nguyen
- Division of Head and Neck Surgery, University of California San Diego, San Diego, California
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31
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Romero-Rojas AE, Diaz-Perez JA, Raju S, Messa-Botero O, Prieto-Bletan A, Criollo-Palacios F. Primary diffuse large B-cell lymphoma associated with chronic osteomyelitis of the knee. Knee 2014; 21:1280-3. [PMID: 25199714 DOI: 10.1016/j.knee.2014.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 08/08/2014] [Accepted: 08/13/2014] [Indexed: 02/02/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) associated with chronic inflammation is a recently adopted category of DLBCL, which describes an aggressive B-cell lymphoma raised in the setting of non-immune chronic inflammation. Primary presentation of this subtype of DLBCL in bone is extremely rare. Here, we present the case of a 27 year old woman with DLBCL of the right distal femur, identified after a three-year history of chronic osteomyelitis. In this report, we describe the clinical and histopathologic features of this unusual presentation of DLBCL and discuss aspects relevant to diagnosis and treatment of this entity.
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Affiliation(s)
| | - Julio A Diaz-Perez
- University of California, San Diego, La Jolla, CA, United States; University of Santander, Bucaramanga, Colombia.
| | - Sharat Raju
- University of California, San Diego, La Jolla, CA, United States
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32
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Hauff SJ, Raju SC, Orosco RK, Gross AM, Diaz-Perez JA, Savariar E, Nashi N, Hasselman J, Whitney M, Myers JN, Lippman SM, Tsien RY, Ideker T, Nguyen QT. Matrix-metalloproteinases in head and neck carcinoma-cancer genome atlas analysis and fluorescence imaging in mice. Otolaryngol Head Neck Surg 2014; 151:612-8. [PMID: 25091190 DOI: 10.1177/0194599814545083] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 12/22/2022]
Abstract
OBJECTIVE (1) Obtain matrix-metalloproteinase (MMP) expression profiles for head and neck squamous cell carcinoma (HNSCC) specimens from the Cancer Genomic Atlas (TCGA). (2) Demonstrate HNSCC imaging using MMP-cleavable, fluorescently labeled ratiometric activatable cell-penetrating peptide (RACPP). STUDY DESIGN Retrospective human cohort study; prospective animal study. SETTING Translational research laboratory. SUBJECTS AND METHODS Patient clinical data and mRNA expression levels of MMP genes were downloaded from TCGA data portal. RACPP provides complementary ratiometric fluorescent contrast (increased Cy5 and decreased Cy7 intensities) when cleaved by MMP2/9. HNSCC-tumor bearing mice were imaged in vivo after RACPP injection. Histology was evaluated by a pathologist blinded to experimental conditions. Zymography confirmed MMP-2/9 activity in xenografts. RACPP was applied to homogenized human HNSCC specimens, and ratiometric fluorescent signal was measured on a microplate reader for ex vivo analysis. RESULTS Expression of multiple MMPs including MMP2/9 is greater in patient HNSCC tumors than matched control tissue. In patients with human papilloma virus positive (HPV+) tumors, higher MMP2 and MMP14 expression correlates with worse 5-year survival. Orthotopic tongue HNSCC xenografts showed excellent ratiometric fluorescent labeling with MMP2/9-cleavable RACPP (sensitivity = 95.4%, specificity = 95.0%). Fluorescence ratios were greater in areas of higher tumor burden (P < .03), which is useful for intraoperative margin assessment. Ex vivo, human HNSCC specimens showed greater cleavage of RACPP when compared to control tissue (P = .009). CONCLUSIONS Human HNSCC tumors show increased mRNA expression of multiple MMPs including MMP2/9. We used RACPP, a ratiometric fluorescence assay of MMP2/9 activity, to show improved occult tumor identification and margin clearance. Ex vivo assays using RACPP in biopsy specimens may identify patients who will benefit from intraoperative RACPP use.
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Affiliation(s)
- Samantha J Hauff
- Division of Head and Neck Surgery, University of California, San Diego, California, USA
| | - Sharat C Raju
- Division of Head and Neck Surgery, University of California, San Diego, California, USA
| | - Ryan K Orosco
- Division of Head and Neck Surgery, University of California, San Diego, California, USA
| | - Andrew M Gross
- Bioinformatics and Systems Biology Program, University of California, San Diego, California, USA
| | - Julio A Diaz-Perez
- Division of Head and Neck Surgery, University of California, San Diego, California, USA
| | - Elamprakash Savariar
- Department of Pharmacology, University of California, San Diego, California, USA
| | - Nadia Nashi
- Division of Head and Neck Surgery, University of California, San Diego, California, USA
| | - Jonathan Hasselman
- Division of Head and Neck Surgery, University of California, San Diego, California, USA
| | - Michael Whitney
- Department of Pharmacology, University of California, San Diego, California, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Scott M Lippman
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Roger Y Tsien
- Department of Pharmacology, University of California, San Diego, California, USA Howard Hughes Medical Institute, San Diego, California, USA
| | - Trey Ideker
- Bioinformatics and Systems Biology Program, University of California, San Diego, California, USA Division of Medical Genetics, University of California, San Diego, California, USA
| | - Quyen T Nguyen
- Division of Head and Neck Surgery, University of California, San Diego, California, USA Moores Cancer Center, University of California, San Diego, California, USA
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Diaz-Perez JA, Raju S, Echeverri JH. Evaluation of a teaching strategy based on integration of clinical subjects, virtual autopsy, pathology museum, and digital microscopy for medical students. J Pathol Inform 2014; 5:25. [PMID: 25191624 PMCID: PMC4141419 DOI: 10.4103/2153-3539.137729] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Learning pathology is fundamental for a successful medical practice. In recent years, medical education has undergone a profound transformation toward the development of an integrated curriculum incorporating both basic science and clinical material. Simultaneously, there has been a shift from a magisterial teaching approach to one centered around problem-based learning. Now-a-days, informatics tools are expected to help better implement these strategies. Aim: We applied and evaluated a new teaching method based on an active combination of clinical problems, gross pathology, histopathology, and autopsy pathology, all given through informatics tools, to teach a group of medical students at the Universidad de Santander, Colombia. Design: Ninety-four medical students were followed in two consecutive semesters. Students were randomized to receive teaching either through traditional methodology or through the new integrated approach. Results: There was no significant difference between the intervention group and the control group at baseline. At the end of the study, the scores in the intervention group were significantly higher compared to the control group (3.91/5.0 vs. 3.33/5.0, P = 0.0008). Students and tutors endorsed the benefits of the integrated approach. Participants were very satisfied with this training approach and rated the program an 8.7 out of 10, on average. Conclusion: This study confirms that an integrated curriculum utilizing informatics systems provides an excellent opportunity to associate pathology with clinical medicine early in training of medical students. This can be possible with the use of virtual microscopy and digital imaging.
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Affiliation(s)
- Julio A Diaz-Perez
- Department of Pathology, University of Santander, Bucaramanga, Colombia ; Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Sharat Raju
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jorge H Echeverri
- Department of Pathology, University of Santander, Bucaramanga, Colombia
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Romero-Rojas AE, Diaz-Perez JA, Reddy A. Mixed primary prostatic carcinoma with acinar, neuroendocrine and ductal components. ACTA ACUST UNITED AC 2014; 86:150-1. [PMID: 25017603 DOI: 10.4081/aiua.2014.2.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 11/23/2022]
Abstract
Mixed tumors in the prostate gland have been described; they are primarily originate in the gland or are the product of metastatic compromise. Mixed primary epithelial carcinomas of the prostate are very rare; here we report the case of a 72-years-old man with histopathologic findings of a primary prostate mixed carcinoma, showing characteristics of acinar, ductal and neuroendocrine adenocarcinoma. We also discuss the clinical, diagnostic, and therapeutic aspects of these uncommon mixed neoplasms.
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Romero-Rojas AE, Diaz-Perez JA, Raju S, Lozano-Castillo A. Neuroradiology and histopathology in two cases of adult medulloblastoma. Neuroradiol J 2014; 27:163-8. [PMID: 24750703 DOI: 10.15274/nrj-2014-10021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/01/2014] [Indexed: 12/16/2022] Open
Abstract
Medulloblastoma (MB) is the most common central nervous system neoplasm in children and only rarely presents in the adult population. Recent molecular biology findings have characterized MB as a heterogeneous neoplasm distinguished by well-defined tumour subsets each with specific histologic and molecular features. Available immunohistochemical stains can now be used to differentiate the distinct molecular types of MB. This report analyzed the histopathologic and neuroradiologic features of two new cases of adult MB. Imaging studies in these patients revealed the morphological appearance of high-grade, well-circumscribed heterogeneous tumours with necrosis, located laterally within the posterior cranial fossa. Histopathology of resected samples demonstrated high-grade tumours (WHO grade IV) containing sheets of undifferentiated neural cells with high mitotic activity and evidence of necrosis. The histopathologic and molecular characteristics of these cases of MB are reviewed for potential applications in new molecular methods of imaging.
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Affiliation(s)
| | - Julio A Diaz-Perez
- Moores Cancer Center, University of California; San Diego, La Jolla, CA, USA - Department of Pathology, University of Santander; Bucaramanga, Colombia
| | - Sharat Raju
- Moores Cancer Center, University of California; San Diego, La Jolla, CA, USA
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Romero-Rojas AE, Diaz-Perez JA, Ariza-Serrano LM, Amaro D, Lozano-Castillo A. Primary gliosarcoma of the brain: radiologic and histopathologic features. Neuroradiol J 2013; 26:639-48. [PMID: 24355182 DOI: 10.1177/197140091302600606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/25/2013] [Indexed: 11/16/2022] Open
Abstract
Gliosarcoma is a rare central nervous system (CNS) neoplasm with biphasic glial and non-glial malignant components. Here we describe the radiologic and histopathologic features observed in five cases of primary gliosarcoma. The mean age at diagnosis in the studied patients was 54.2 years; these patients were predominantly males (male:female ratio = 4:1). At diagnosis all patients had several clinical deterioration. The most common symptoms of presentation were: headache (5/5 cases), seizures (4/5 cases) and hemiparesis (1/5 cases). All the tumors were large (mean major diameter= 4.12±1.64 cm) at diagnosis as evidenced in computer tomography (CT) scans and magnetic resonance images (MRIs), with preferential involvement of the temporal lobe and frequent associated deviation of the midline structures. Other common characteristics identified on CT scans and MRIs were partial contrast medium uptake with annular pattern (5/5 cases), peripheral edema (5/5 cases), and central calcification (3/5 cases). In additional a peak of dye uptake was observed (4/5 cases) on MRI spectrometry. In the histopathology, the glial component showed malignant astrocytes, with high Ki67 (>60%) and p53 positivity; the sarcomatous components displayed pleomorphic spindle cells similarly with p53 positivity and high Ki67 (75-90%) in all cases. Dedifferentiation to pleomorphic sarcoma (two cases), fibrosarcoma (one case), leiomyosarcoma (one case) and MPNST (one case) were documented. All patients received radiotherapy/chemotherapy and had a median overall survival of ten months. The study of radiologic and histopathologic features in primary gliosarcomas of the brain is a priority to achieve early diagnosis that can be translated to better outcomes. Here we describe the radiologic and histopathologic features observed in a group of gliosarcoma patients with variable histopathologic dedifferentiation.
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Romero-Rojas AE, Diaz-Perez JA, Lozano-Castillo A. Desmoplastic infantile ganglioglioma with late presentation. A clinical, radiological and histopathological analysis. Neuroradiol J 2013; 26:649-54. [PMID: 24355183 DOI: 10.1177/197140091302600607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 11/19/2013] [Indexed: 01/26/2023] Open
Abstract
Desmoplastic infantile ganglioglioma (DIG) is a rare supratentorial tumor in the central nervous system. Definitive diagnosis of this neoplasm is based on histopathologic analysis evaluating distinctive findings such as the fibroblastic differentiation. Here we present a clinical case of DIG with a long follow-up in an eight-year-old boy with a six-month history of recurrent emesis, psychomotor hyperactivity and generalized tonic-clonic seizures. Computed tomography scan and magnetic resonance imaging (MRI) showed a cystic, heterogeneous, mass on the right temporal uncus. A histopathological diagnosis of late presentation DIG was made. We documented the immunohistochemical expression of a molecular soft tissue / muscle differentiation marker (h-CaD) in addition to a low proliferative index (Ki-67) in this case. After surgical intervention, a control MRI showed changes of right frontal-temporal craniotomy and a persistent mass in the anterior and medial temporal lobe with basal extension. Further surgical intervention was performed, completely removing the tumor, which had the same characteristics. The patient is asymptomatic while receiving anticonvulsant therapy (phenytoin) with no evidence of tumor recurrence on MRI after a follow-up of five years. The low grade and soft tissue appearance in images are correlated with the histopathologic and immunohistochemical profile of this tumor, but the rarity of this tumor makes a presumptive diagnosis by images a challenge. The above-mentioned molecular markers or new ones could be used as molecular targets for molecular imaging studies to increase the probability of a pre-operative diagnosis based on molecular features through images.
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Affiliation(s)
- Alfredo E Romero-Rojas
- Division of Neuropathology, Department of Neurological Surgery, National Institute of Cancer; Bogota, Colombia - -
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Romero-Rojas AE, Diaz-Perez JA, Mastrodimos M, Chinchilla SI. Follicular thyroid carcinoma with signet ring cell morphology: fine-needle aspiration cytology, histopathology, and immunohistochemistry. Endocr Pathol 2013; 24:239-45. [PMID: 24068558 DOI: 10.1007/s12022-013-9271-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Thyroid follicular neoplasms with signet ring cell morphology represent a challenging cytological and histopathologic diagnosis. The low frequency of these neoplasms and their broad differential diagnosis contribute to this difficult scenario. Here, we present an exceptionally rare case of thyroid follicular carcinoma with signet ring cell morphology in a 62-year-old female. We analyze the characteristics in fine-needle aspiration cytology, histopathology, and immunohistochemistry and compare our results in a discussion with previous literature reports.
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Romero-Rojas AE, Diaz-Perez JA, Ariza-Serrano LM, Neira-Escobar FE. Vertebral bone primary angiosarcoma: a case report. Orthop Surg 2013; 5:146-8. [PMID: 23658052 DOI: 10.1111/os.12041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 01/21/2013] [Indexed: 12/01/2022] Open
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Romero-Rojas AE, Diaz-Perez JA, Chinchilla-Olaya SI, Amaro D, Lozano-Castillo A, Restrepo-Escobar LI. Histopathological and immunohistochemical profile in anaplastic gangliogliomas. Neurocirugia (Astur) 2013; 24:237-43. [DOI: 10.1016/j.neucir.2013.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/17/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
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Romero-Rojas AE, Diaz-Perez JA, Mastrodimos M, Szelezsan J, Messa-Botero O. Primary intraocular inflammatory myofibroblastic tumor with anaplastic lymphoma kinase overexpression. Int Ophthalmol 2013; 34:667-73. [DOI: 10.1007/s10792-013-9845-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/14/2013] [Indexed: 11/25/2022]
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Diaz-Perez JA, Mastrodimos M, Reddy A. Gastrointestinal stromal tumor with synchronous gallbladder adenocarcinoma. J Gastrointest Cancer 2013; 45:387-91. [PMID: 23749654 DOI: 10.1007/s12029-013-9513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Muñoz A, Diaz-Perez JA, Romero-Rojas AE, Hernandez E, Martin-Berdazco F. Report of 2 Cases of Primary Epithelioid Hemangioendothelioma of the External Iliac Vein. Vasc Endovascular Surg 2013; 47:474-8. [DOI: 10.1177/1538574413492391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The epithelioid hemangioendothelioma (EHE) is a rare type of endothelial neoplasm found mainly in soft tissues and visceral organs and in extraordinary cases in large veins like the iliac veins. Currently, there is an active discussion in which EHE behavior, classification, new diagnostic tools, and treatment procedures are proposed. Here, we present 2 cases of EHE and discuss our experience in diagnosis and treatment of this neoplasm.
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Affiliation(s)
- Alberto Muñoz
- Department of Vascular Surgery, Palermo Clinic, Bogota Vascular Clinic, Bogota, Colombia
| | - Julio A. Diaz-Perez
- Department of Pathology, University of Santander, Bucaramanga, Colombia
- Department of Pathology, University of California, San Diego, La Jolla, CA, USA
| | | | - Elizabeth Hernandez
- Department of Vascular Surgery, Palermo Clinic, Bogota Vascular Clinic, Bogota, Colombia
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Romero-Rojas AE, Diaz-Perez JA, Amaro D, Lozano-Castillo A, Chinchilla-Olaya SI. Glioblastoma metastasis to parotid gland and neck lymph nodes: fine-needle aspiration cytology with histopathologic correlation. Head Neck Pathol 2013; 7:409-15. [PMID: 23637061 PMCID: PMC3824794 DOI: 10.1007/s12105-013-0448-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 04/26/2013] [Indexed: 11/24/2022]
Abstract
Glioblastoma (GBM) is one of the most highly aggressive neoplasms of the central nervous system. Extra-cranial metastases in GBM are rare. Here we present the case of a 26-year-old man with extra-cranial metastasis of a frontal lobe GBM to the parotid gland, cervical lymph nodes, and bones, with initial diagnosis made by fine needle aspiration cytology (FNAC) of the parotid gland. FNAC is a reliable technique in the study of primary and secondary parotid gland neoplasms, allowing a presumptive diagnosis in difficult cases. We correlate the cytologic, histopathologic, and immunohistochemical findings in this case and discuss previous literature reports.
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Affiliation(s)
| | - Julio A. Diaz-Perez
- />National Institute of Cancer, Bogotá, Colombia , />University of California, San Diego, Stein Clinical Research Building 245, 9500 Gilman Drive, La Jolla, CA 92093-0637 USA , />University of Santander, Bucaramanga, Colombia
| | - Deirdre Amaro
- />University of California, San Diego, Stein Clinical Research Building 245, 9500 Gilman Drive, La Jolla, CA 92093-0637 USA
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Barajas-Gamboa JS, Diaz-Perez JA, Leon-Camargo Y, Gonzalez-Gomez CA, Sandoval-Gomez C. Systolic heart murmur as first manifestation of high output heart failure due to the vein of galen malformation. Arch Cardiol Mex 2012; 82:214-7. [PMID: 23021358 DOI: 10.1016/j.acmx.2012.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/05/2012] [Accepted: 04/17/2012] [Indexed: 10/27/2022] Open
Abstract
The vein of Galen aneurysmal malformation (VGAM) is an extremely rare arterio-venous malformation. The VGAM clinical manifestations vary depending on the magnitude of vascular compromise and the age at initial presentation. Neonates typically present with severe congestive heart failure. Here we present a case in which a systolic heart murmur was the first manifestation of high output heart failure due to a VGAM.
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Herrera-Hernandez AA, Diaz-Perez JA, Barajas-Gamboa JS, Aranda-Valderrama P, Reddy A. Hyperparathyroidism in a Colombian City. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451426a113] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Hyperparathyroidism has a variable presentation. Clinical manifestations, histopathology, and treatment of patients with hyperparathyroidism in Bucaramanga City, Colombia, were analyzed. Method: A descriptive study was conducted. Results: Twenty-five patients (F:M ratio 1.5:1) with age ranging from 14 to 81 years (mean, 52.1 ± 18.15 years) were analyzed. Skeletal/osseous manifestations (100%), renal calculi (66%), muscle weakness (40%), and pruritus (24%) were the most common symptoms with mean duration of 24.2 months. Biochemical features included hypercalcemia (total corrected calcium 13.83 mg/dL), and high parathyroid hormone (mean, 1095.7). Twelve of 25 patients had primary hyperparathyroidism, 11 out of 25 secondary hyperparathyroidism, and 2 had tertiary hyperparathyroidism. A single patient had multinodular thyroid goiter. Parathyroidectomy was performed by Kocher’s incision in 21 out of 25 cases and minimally invasive open approach in 4 out of 25 cases. The following types of interventions have been performed: tumor resections (15/25), subtotal parathyroidectomies (6/25), and total parathyroidectomies (4/25). A total thyroidectomy was performed in the patient with associated thyroid disease (1/25). Histopathological examination revealed parathyroidian adenoma in 40% of patients, parathyroidian hyperplasia in 48%, and parathyroidian carcinoma in 4%. All symptoms and hypercalcemia resolved with the treatment. Such complication was observed in a case of hungry bone syndrome. No patients died within 15 months of follow-up. Conclusion: We described the clinical and histopathological features of patients with hyperparathyroidism in Colombia. Although pathologic features of parathyroid carcinoma are diagnostically reliable, those of the more commonly encountered lesions of adenoma and hyperplasia may be overlapping and, therefore, indistinctive, more so if only a single gland is available for examination.
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Herrera-Hernandez AA, Diaz-Perez JA, Aranda-Valderrama P, Barajas-Gamboa JS, Reddy A. Features of Patients with Eagle Syndrome. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451426a106] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Eagle syndrome is a rare syndrome in which pain occurs cervico-facially, due to the mineralization of the styloid process. We evaluated the features of Eagle syndrome in a Colombian (Latin American) population. Method: We described the clinical and pathological features of 5 patients with Eagle syndrome, and conducted a discussion of this disorder during an observational study from 2005 to 2008, with targeted sampling of patients with Eagle syndrome in the Centers of Head and Neck Surgery in Bucaramanga, Colombia. Results: The patients collectively consulted for sore throat and referred otodinia. Two patients had pain at the opening of the oral cavity, and no patient had foreign body sensation or syncope. On physical examination the patients had great tenderness from bimanual palpations on the postero-inferior face of the palatine tonsil. All patients underwent computed tomography and elongation of the styloid process was found. The patients underwent resection of the styloid process externally and endorally in 2 cases and in 3 cases respectively; none of them presented with disease recurrence after a mean follow-up period of 11.4 months. Conclusion: In conclusion, this rare disease must be considered in the differential diagnosis of cervical-facial pain, through imaging, plain radiography, or computed tomography. Treatment can be surgical or nonsurgical, although surgery is recommended.
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Montes-Moreno S, Odqvist L, Diaz-Perez JA, Lopez AB, de Villambrosía SG, Mazorra F, Castillo ME, Lopez M, Pajares R, García JF, Mollejo M, Camacho FI, Ruiz-Marcellán C, Adrados M, Ortiz N, Franco R, Ortiz-Hidalgo C, Suarez-Gauthier A, Young KH, Piris MA. EBV-positive diffuse large B-cell lymphoma of the elderly is an aggressive post-germinal center B-cell neoplasm characterized by prominent nuclear factor-kB activation. Mod Pathol 2012; 25:968-82. [PMID: 22538516 DOI: 10.1038/modpathol.2012.52] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Here, we report a retrospective series of 47 EBV-positive diffuse large B-cell lymphoma associated with advanced age. Histopathology allowed to the identification of different histological patterns: cases with polymorphic diffuse large B-cell lymphoma (29 cases), Hodgkin-like (8 cases) and polymorphic lymphoproliferative disorder-like (9 cases) patterns. One case was purely monomorphic diffuse large B-cell lymphoma. We show that this lymphoma type is a neoplasm with prominent classical and alternative nuclear factor-kB pathway activation in neoplastic cells (79% of the cases showed nuclear staining for p105/p50, 74% for p100/p52 and 63% for both proteins), with higher frequency than that observed in a control series of EBV-negative diffuse large B-cell lymphoma (χ(2) <0.001). Most cases showed an activated phenotype (95% non-germinal center (Hans algorithm); 78% activated B cell (Choi algorithm)). Clonality testing demonstrated IgH and/or K/Kde/L monoclonal rearrangements in 64% of cases and clonal T-cell populations in 24% of cases. C-MYC (1 case), BCL6 (2 cases) or IgH (3 cases) translocations were detected by FISH in 18% cases. These tumors had a poor overall survival and progression-free survival (the estimated 2-year overall survival was 40 ± 10% and the estimated 2-year progression-free survival was 36 ± 9%). Thus, alternative therapies, based on the tumor biology, need to be tested in patients with EBV-positive diffuse large B-cell lymphoma of the elderly.
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Affiliation(s)
- Santiago Montes-Moreno
- Pathology Department, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain.
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Diaz-Perez JA, Ariza-Serrano LM, Barajas-Gamboa JS. Like paper: a young woman delivered twins, but one was lost well before delivery. Am J Obstet Gynecol 2012; 206:534.e1. [PMID: 22425403 DOI: 10.1016/j.ajog.2012.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 11/24/2011] [Accepted: 02/13/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Julio A Diaz-Perez
- Department of Medicine, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
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