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Nelson AT, Harris AK, Watson D, Kamihara J, Chen KS, Stall JN, Devins KM, Young RH, Olson DR, Mallinger PHR, Mitchell SG, Hoffman LM, Halliday G, Suleymanova AM, Glade Bender JL, Messinger YH, Herzog CE, Field AL, Frazier AL, Stewart DR, Dehner LP, Hill DA, Billmire DF, Schneider DT, Schultz KAP. Outcomes in ovarian Sertoli-Leydig cell tumor: A report from the International Pleuropulmonary Blastoma/DICER1 and Ovarian and Testicular Stromal Tumor Registries. Gynecol Oncol 2024; 186:117-125. [PMID: 38657450 DOI: 10.1016/j.ygyno.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/02/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Sertoli-Leydig cell tumors (SLCTs) are rare sex cord-stromal tumors, representing <0.5% of all ovarian tumors. We sought to describe prognostic factors, treatment and outcomes for individuals with ovarian SLCT. METHODS Individuals with SLCT were enrolled in the International Pleuropulmonary Blastoma/DICER1 Registry and/or the International Ovarian and Testicular Stromal Tumor Registry. Medical records were systematically abstracted, and pathology was centrally reviewed when available. RESULTS In total, 191 participants with ovarian SLCT enrolled, with most (92%, 175/191) presenting with FIGO stage I disease. Germline DICER1 results were available for 156 patients; of these 58% had a pathogenic or likely pathogenic germline variant. Somatic (tumor) DICER1 testing showed RNase IIIb hotspot variants in 97% (88/91) of intermediately and poorly differentiated tumors. Adjuvant chemotherapy was administered in 40% (77/191) of cases, and among these, nearly all patients received platinum-based regimens (95%, 73/77), and 30% (23/77) received regimens that included an alkylating agent. Three-year recurrence-free survival for patients with stage IA tumors was 93.6% (95% CI: 88.2-99.3%) compared to 67.1% (95% CI: 55.2-81.6%) for all stage IC and 60.6% (95% CI: 40.3-91.0%) for stage II-IV (p < .001) tumors. Among patients with FIGO stage I tumors, those with mesenchymal heterologous elements treated with surgery alone were at higher risk for recurrence (HR: 74.18, 95% CI: 17.99-305.85). CONCLUSION Most individuals with SLCT fare well, though specific risk factors such as mesenchymal heterologous elements are associated with poor prognosis. We also highlight the role of DICER1 surveillance in early detection of SLCT, facilitating stage IA resection.
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Affiliation(s)
- Alexander T Nelson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN, USA; International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, USA; Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, USA; University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anne K Harris
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN, USA; International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, USA; Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, USA
| | - Dave Watson
- Research Institute, Children's Minnesota, Minneapolis, MN, USA
| | - Junne Kamihara
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Kenneth S Chen
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA; Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Kyle M Devins
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert H Young
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Damon R Olson
- Department of Pathology and Laboratory Medicine, Children's Minnesota, Minneapolis, MN, USA
| | - Paige H R Mallinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN, USA; International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, USA; Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, USA
| | - Sarah G Mitchell
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Lindsey M Hoffman
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gail Halliday
- Department of Paediatric Oncology, Great North Children's Hospital, Newcastle-upon-Tyne, UK
| | - Amina M Suleymanova
- Institute of Pediatric Oncology, Federal State Budgetary Institution N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Julia L Glade Bender
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yoav H Messinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN, USA; International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, USA; Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, USA
| | - Cynthia E Herzog
- Division of Pediatrics, Department of Pediatric Patient Care, The University of Texas MD Anderson Cancer Care Center, Houston, TX, USA
| | | | - A Lindsay Frazier
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Douglas R Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - D Ashley Hill
- ResourcePath LLC, Sterling, VA, USA; Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Deborah F Billmire
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dominik T Schneider
- Clinic of Pediatrics, Municipal Hospital Dortmund, University Witten/Herdecke, Germany
| | - Kris Ann P Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN, USA; International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, USA; Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, USA.
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2
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Nelson AT, Vasta LM, Watson D, Kim J, Harris AK, Best AF, Harney LA, Carr AG, Frederickson N, Dehner LP, Kratz CP, Hagedorn KN, Mize WA, Ling A, Messinger YH, Hill DA, Schultz KAP, Stewart DR. Prevalence of lung cysts in adolescents and adults with a germline DICER1 pathogenic/likely pathogenic variant: a report from the National Institutes of Health and International Pleuropulmonary Blastoma/ DICER1 Registry. Thorax 2024:thorax-2023-221024. [PMID: 38508719 DOI: 10.1136/thorax-2023-221024] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/17/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Pleuropulmonary blastoma (PPB), the hallmark tumour associated with DICER1-related tumour predisposition, is characterised by an age-related progression from a cystic lesion (type I) to a high-grade sarcoma with mixed cystic and solid features (type II) or purely solid lesion (type III). Not all cystic PPBs progress; type Ir (regressed), hypothesised to represent regressed or non-progressed type I PPB, is an air-filled, cystic lesion lacking a primitive sarcomatous component. This study aims to evaluate the prevalence of non-progressed lung cysts detected by CT scan in adolescents and adults with germline DICER1 pathogenic/likely pathogenic (P/LP) variants. METHODS Individuals were enrolled in the National Cancer Institute Natural History of DICER1 Syndrome study, the International PPB/DICER1 Registry and/or the International Ovarian and Testicular Stromal Tumor Registry. Individuals with a germline DICER1 P/LP variant with first chest CT at 12 years of age or older were selected for this analysis. RESULTS In the combined databases, 110 individuals with a germline DICER1 P/LP variant who underwent first chest CT at or after the age of 12 were identified. Cystic lung lesions were identified in 38% (42/110) with a total of 72 cystic lesions detected. No demographic differences were noted between those with lung cysts and those without lung cysts. Five cysts were resected with four centrally reviewed as type Ir PPB. CONCLUSION Lung cysts are common in adolescents and adults with germline DICER1 variation. Further study is needed to understand the mechanism of non-progression or regression of lung cysts in childhood to guide judicious intervention.
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Affiliation(s)
- Alexander T Nelson
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Lauren M Vasta
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Dave Watson
- Research Institute, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Jung Kim
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Anne K Harris
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Ana F Best
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Nicole Frederickson
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Kelly N Hagedorn
- Department of Radiology, Children's Minnesota, Minneapolis, Minnesota, USA
| | - William A Mize
- Department of Radiology, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Alexander Ling
- Department of Radiology, NIH Clinical Center, Bethesda, Maryland, USA
| | - Yoav H Messinger
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - D Ashley Hill
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
- ResourcePath LLC, Sterling, Virginia, USA
| | - Kris Ann P Schultz
- International Pleuropulomary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Douglas R Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Dehner LP. The Placenta and Neonatal Encephalopathy with a Focus on Hypoxic-Ischemic Encephalopathy. Fetal Pediatr Pathol 2023; 42:950-971. [PMID: 37766587 DOI: 10.1080/15513815.2023.2261051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
Background: Placental examination is important for its diagnostic immediacy to correlate with maternal and/or fetal complications and parturitional difficulties. In a broader context, clinicopathologic studies of the placenta have addressed a range of pathogenetic questions that have led to conclusive and inconclusive results and interpretations. Methods: Recent standardized morphologic criteria and terminology of placental lesions have facilitated the ability to compare findings from studies that have focused on complications and outcomes of pregnancy. This review is an evaluation of recent studies on placental lesions associated with hypoxic-ischemic encephalopathy (HIE). Conclusion: No apparent consensus exists on whether it is fetal inflammation with the release of cytokines or chronic maternal and/or fetal vascular malperfusion is responsible for HIE with a lowering of the threshold for hypoxic ischemia. The counter argument is that HIE occurs solely as an intrapartum event. Additional investigation is necessary.
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Affiliation(s)
- Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, State of Washington University in St. Louis Medical Center, St. Louis, MO, USA
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4
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Hagedorn KN, Nelson AT, Towbin AJ, Frederickson N, Mallinger P, Lucas JT, Dehner LP, Messinger YH, Shulkin BL, Mize WA, Schultz KAP. Assessing the role of positron emission tomography and bone scintigraphy in imaging of pleuropulmonary blastoma (PPB): A report from the International PPB/DICER1 Registry. Pediatr Blood Cancer 2023; 70:e30628. [PMID: 37592371 PMCID: PMC10538369 DOI: 10.1002/pbc.30628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/11/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Pleuropulmonary blastoma (PPB) is the most common primary lung neoplasm of infancy and early childhood. Given the rarity of PPB, the role of positron emission tomography (PET) and bone scintigraphy (bone scans) in diagnostic evaluation and surveillance has not been documented to date. Available PET and bone scan data are presented in this study. PROCEDURES Patients with PPB enrolled in the International PPB/DICER1 Registry and available PET imaging and/or bone scan reports were retrospectively abstracted. RESULTS On retrospective analysis, 133 patients with type II and III (advanced) PPB were identified with available report(s) (PET scan only = 34, bone scan only = 83, and both bone scan and PET = 16). All advanced primary PPB (n = 11) and recurrent (n = 8) tumors prior to treatment presented with 18 F-fluorodeoxyglucose (FDG)-avid lesions, with median maximum standardized uptake values of 7.4 and 6.7, respectively. False positive FDG uptake in the thorax was noted during surveillance (specificity: 59%). Bone metastases were FDG-avid prior to treatment. Central nervous system metastases were not discernable on PET imaging. Sensitivity and specificity of bone scans for metastatic bone disease were 89% and 92%, respectively. Bone scans had a negative predictive value of 99%, although positive predictive value was 53%. Four patients with distant bone metastases had concordant true positive bone scan and PET. CONCLUSION Primary, recurrent, and/or extracranial metastatic PPB presents with an FDG-avid lesion on PET imaging. Additional prospective studies are needed to fully assess the utility of nuclear medicine imaging in surveillance for patients with advanced PPB.
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Affiliation(s)
| | - Alexander T. Nelson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - Alexander J. Towbin
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Nicole Frederickson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Paige Mallinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - John T. Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Louis P. Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Yoav H. Messinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - William A. Mize
- Department of Radiology, Children’s Minnesota, Minneapolis, MN
| | - Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
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5
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Dehner LP. Richard L. Kempson, MD, RIP. Am J Surg Pathol 2023; 47:1332. [PMID: 37750507 DOI: 10.1097/pas.0000000000002128] [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: 09/27/2023]
Affiliation(s)
- Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology Washington University Medical Center St. Louis, MO
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6
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Nelson AT, Dybvik A, Mallinger P, McQuaid SW, Watson D, Harney LA, Stewart DR, Dehner LP, Messinger YH, Kunin-Batson A, Schultz KAP. Health-related quality of life in children and adolescents with pleuropulmonary blastoma: A report from the International PPB/DICER1 Registry. Pediatr Blood Cancer 2023; 70:e30077. [PMID: 36424733 PMCID: PMC9974753 DOI: 10.1002/pbc.30077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Pleuropulmonary blastoma (PPB) is the most common lung cancer of infancy and early childhood and is associated with germline DICER1 variants. Type I and Ir PPB are cystic lesions treated surgically, with a subset of children with type I receiving chemotherapy. Type II and III are more aggressive lesions, treated with surgery, intensive chemotherapy and potentially radiation. We sought to assess health-related quality of life (HRQoL) in children with PPB and known germline DICER1 variants. METHODS Children with a diagnosis of PPB or germline DICER1 pathogenic variant without history of PPB or other DICER1-related neoplasm (DICER1+ only) were enrolled in the International PPB/DICER1 Registry. Parent reports for participants aged 2-17 years for the PedsQL v.4 and PedsQL Multidimensional Fatigue Scale v.3 were collected. Fatigue, physical, and psychosocial function scores were compared. RESULTS Analysis included 84 participants (PPB type Ir = 20, type I = 15, type II/III = 27, DICER1+ only = 22). Total fatigue scores of participants with type I and II/III PPB were lower compared to DICER1+ only, with effect size larger in type II/III (-0.82 vs. -0.40). Total psychosocial and physical functioning scores were lower in participants with type I and type II/III PPB compared to DICER1+ only, with larger effects noted in type II/III. Female sex was suggestive of worse HRQoL for both type I/Ir and type II/III cohorts. CONCLUSIONS These data demonstrate the importance of regular HRQoL assessment in patients with a history of PPB as well as the importance and feasibility of studying HRQoL in children with rare tumors.
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Affiliation(s)
- Alexander T. Nelson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN;,University of Minnesota Medical School, Minneapolis, MN
| | - Anna Dybvik
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Paige Mallinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Shelly Weiss McQuaid
- Department of Genetics, Birth Defects & Metabolism, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Dave Watson
- Research Institute, Children’s Minnesota, Minneapolis, MN
| | | | - Douglas R. Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Louis P. Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University Medical Center, St. Louis, MO
| | - Yoav H. Messinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Alicia Kunin-Batson
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
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7
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McCluggage WG, Rivera B, Chong AS, Clarke BA, Schultz KAP, Dehner LP, Tchrakian N, Apellaniz-Ruiz M, Gilks CB, Kommoss F, Stewart CJR, Foulkes WD. Well-differentiated Sertoli-Leydig Cell Tumors (SLCTs) Are Not Associated With DICER1 Pathogenic Variants and Represent a Different Tumor Type to Moderately and Poorly Differentiated SLCTs. Am J Surg Pathol 2023; 47:490-496. [PMID: 36583307 DOI: 10.1097/pas.0000000000002010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sertoli-Leydig cell tumors (SLCTs) are uncommon ovarian sex cord-stromal neoplasms which are currently classified into well, moderately, and poorly differentiated and retiform types. Well-differentiated SLCT is the least common and typically occurs in pure form, whereas moderately and poorly differentiated and retiform types often comprise a morphologic spectrum with an admixture of all 3. DICER1 pathogenic variants are very common in SLCTs but, as far as we are aware, have not been reported in well-differentiated neoplasms, although the number of cases studied is small due to the rarity of this neoplasm. We undertook DICER1 molecular testing in a cohort of 18 well-differentiated SLCTs and show all these to be DICER1 wild-type. None of the cases harbored the p. FOXL2 C134W hotspot mutation. Based upon the DICER1 molecular results, together with morphologic observations, we propose that well-differentiated SLCT is an unrelated neoplasm to the more common moderately/poorly differentiated and retiform SLCTs and is a fundamentally distinct and unrelated tumor type within the ovarian sex cord-stromal tumor family. The implications for tumor nomenclature and recommendations for future tumor classification are discussed within the context of tumors collectively known as SLCTs.
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Affiliation(s)
| | - Barbara Rivera
- Molecular Mechanisms and Experimental Therapy in Oncology Program, Bellvitge Biomedical Research Institute, Idibell
- Gerald Bronfman Department of Oncology
| | - Anne-Sophie Chong
- Molecular Mechanisms and Experimental Therapy in Oncology Program, Bellvitge Biomedical Research Institute, Idibell
| | - Blaise A Clarke
- Department of Laboratory Medicine and Pathobiology, University of Toronto, University Health Network, Toronto, ON
| | - Kris Ann P Schultz
- International Pleuropulmonary Blastoma (PPB)/DICER1 Registry, Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, MO
| | | | - Maria Apellaniz-Ruiz
- Genomics Medicine Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, WA, Australia
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8
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Nelson AT, Harris AK, Watson D, Miniati D, Finch M, Kamihara J, Mitchell SG, Wilson DB, Gettinger K, Rangaswami AA, Campos JM, Lederman S, Feltis BA, Vasta LM, Harney LA, Stewart DR, Dehner LP, Messinger YH, Hill DA, Schultz KAP. Type I and Ir pleuropulmonary blastoma (PPB): A report from the International PPB/DICER1 Registry. Cancer 2023; 129:600-613. [PMID: 36541021 DOI: 10.1002/cncr.34593] [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: 06/02/2022] [Revised: 10/14/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pleuropulmonary blastoma (PPB) is the most common lung cancer of infancy and early childhood. Type I PPB is a purely cystic lesion that has a microscopic population of primitive small cells with or without rhabdomyoblastic features and may progress to type II or III PPB, whereas type Ir lacks primitive small cells. METHODS Children with suspected PPB were enrolled in the International PPB/DICER1 Registry. Pathology was centrally reviewed, and follow-up was ascertained annually. RESULTS Between 2006 and 2022, 205 children had centrally reviewed type I or Ir PPB; 39% of children with type I and 5% of children with type Ir PPB received chemotherapy. Outcomes were favorable, although 11 children (nine with type I and two with type Ir PPB) experienced progression to type II/III (n = 8) or regrowth of type I PPB at the surgical site (n = 3), none of whom received chemotherapy before progression. Age and cyst size in combination were more suitable than either factor alone in predicting whether a particular lesion was type I or Ir PPB. CONCLUSIONS For young children with type I PPB, outcomes are favorable, but complete resection is indicated because of the risk for progression. Chemotherapy may be useful in a subset of children at increased risk for recurrence/progression. Efforts to risk stratify children with type I PPB to optimize outcomes while reducing treatment-related side effects are underway.
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Affiliation(s)
- Alexander T Nelson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA.,University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Anne K Harris
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Dave Watson
- Research and Sponsored Programs, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Northern California, Roseville, California, USA
| | - Mike Finch
- Research and Sponsored Programs, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Junne Kamihara
- Pediatric Oncology, Boston Children's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah G Mitchell
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, USA
| | - Katie Gettinger
- Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, USA
| | - Arun A Rangaswami
- Division of Pediatric Hematology and Oncology, University of California San Francisco, San Francisco, California, USA
| | - José M Campos
- Division of Pediatric Surgery, Hospital Sotero del Rio, Santiago, Chile
| | - Sara Lederman
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA.,University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Brad A Feltis
- Division of Pediatric Surgery, East Tennessee State University, Johnson City, Tennessee, USA
| | - Lauren M Vasta
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | | | - Douglas R Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University Medical Center, St Louis, Missouri, USA
| | - Yoav H Messinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - D Ashley Hill
- Department of Pathology and Laboratory Medicine, Children's National Medical Center, Washington, District of Columbia, USA.,ResourcePath LLC, Sterling, Virginia, USA
| | - Kris Ann P Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, Minnesota, USA.,Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
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9
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Schultz KAP, Harris AK, Nelson AT, Watson D, Lucas JT, Miniati D, Stewart DR, Hagedorn KN, Mize W, Kamihara J, Mitchell SG, Wilson DB, Gettinger K, Rangaswami AA, Harney LA, Rodriguez Galindo C, Bisogno G, Dehner LP, Hill DA, Messinger YH. Outcomes for Children With Type II and Type III Pleuropulmonary Blastoma Following Chemotherapy: A Report From the International PPB/ DICER1 Registry. J Clin Oncol 2023; 41:778-789. [PMID: 36137255 PMCID: PMC9901992 DOI: 10.1200/jco.21.02925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Pleuropulmonary blastoma (PPB) is the most common primary lung neoplasm of infancy and early childhood. Type II and type III PPB have historically been associated with a poor prognosis. METHODS Patients with known or suspected PPB were enrolled in the International PPB/DICER1 Registry. Medical records were abstracted with follow-up ascertained annually. All PPB diagnoses were confirmed by central pathology review. Beginning in 2007, the IVADo regimen (ifosfamide, vincristine, actinomycin-D, and doxorubicin) was recommended as a potential treatment regimen for children with type II and type III PPB. This regimen was compared with a historical control cohort. RESULTS From 1987 to 2021, 314 children with centrally confirmed type II and type III PPB who received upfront chemotherapy were enrolled; 132 children (75 with type II and 57 with type III) received IVADo chemotherapy. Adjusted analyses suggest improved overall survival for children treated with IVADo in comparison with historical controls with an estimated hazard ratio of 0.65 (95% CI, 0.39 to 1.08). Compared with localized disease, distant metastasis at diagnosis was associated with worse PPB event-free survival and overall survival with hazard ratio of 4.23 (95% CI, 2.42 to 7.38) and 4.69 (95% CI, 2.50 to 8.80), respectively. CONCLUSION The use of IVADo in children with type II and type III PPB resulted in similar-to-improved outcomes compared with historical controls. Inferior outcomes with metastatic disease suggest the need for novel therapies. This large cohort of uniformly treated children with advanced PPB serves as a benchmark for future multicenter therapeutic studies for this rare pediatric tumor.
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Affiliation(s)
- Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN
| | - Anne K. Harris
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN
| | - Alexander T. Nelson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - Dave Watson
- Research Institute, Children's Minnesota, Minneapolis, MN
| | - John T. Lucas
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Northern California, Roseville, CA
| | - Douglas R. Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | | | - William Mize
- Department of Radiology, Children's Minnesota, Minneapolis, MN
| | - Junne Kamihara
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Sarah G. Mitchell
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - David B. Wilson
- Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO
| | - Katie Gettinger
- Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO
| | - Arun A. Rangaswami
- Division of Pediatric Hematology and Oncology, University of California San Francisco, San Francisco, CA
| | | | | | - Gianni Bisogno
- Hematology, Oncology and Stem Cell Transplant Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Louis P. Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - D. Ashley Hill
- Division of Pathology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
- ResourcePath LLC, Sterling, VA
| | - Yoav H. Messinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN
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10
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Jabbari S, Salari B, He M, Dehner LP. Infantile Fibrosarcoma and Other Spindle Cell Neoplasms of Infancy. A Review of Morphologically Overlapping yet Molecularly Distinctive Entities. Fetal Pediatr Pathol 2022; 41:996-1014. [PMID: 35044292 DOI: 10.1080/15513815.2021.2024631] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND Regardless of age at presentation, many soft tissue neoplasms have overlapping histopathologic and immunophenotypic features to serve as a diagnostic challenge. CASE REPORT We reported a case of a spindle cell neoplasm in an infant, which was initially considered a vascular anomaly clinically and an eventual biopsy revealed marked inflammation with a spindle cell component that was resolved as an infantile fibrosarcoma with an ETV6 break-apart. CONCLUSION The context of this case lead to a further consideration of various other spindle cell neoplasms arising predominantly in the soft tissues during the infancy period as defined by the first two years of age. Though sharing similar morphologic features, these tumors can be categorized into several molecular genetic groups, which have provided both diagnostic and pathogenetic insights as well as treatment options in some cases.
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Affiliation(s)
- Shiva Jabbari
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA
| | - Behzad Salari
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA
| | - Mai He
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA.,St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, MO, USA
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA.,St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, MO, USA
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11
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Logan SJ, Yin H, Rogers B, Arva N, Conces MR, Cope-Yokoyama S, Dehner LP, Galliani C, Garg S, He M, Husain AN, Keisling M, Krishnan C, Puscasiu E, Rossi C, Siddiqui F, Sutton L, Terry J, Thaker AI, Huang Y, Zhang J, McCracken C, Rytting H. Calretinin Staining in Anorectal Line Biopsies Accurately Distinguished Hirschsprung Disease in a Retrospective Study. Pediatr Dev Pathol 2022; 25:645-655. [PMID: 36408569 DOI: 10.1177/10935266221132602] [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] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The absence of submucosal ganglion cells does not reliably distinguish Hirschsprung disease from non Hirschsprung disease in anorectal line biopsies. Calretinin staining might be helpful in these biopsies. To determine its value, we analyzed calretinin positive mucosal neurites in anorectal line biopsies. METHODS Two pediatric pathologists, without access to patient data, evaluated calretinin positive mucosal neurites in anorectal line junctional mucosa in archival rectal biopsies contributed by 17 institutions. A separate investigator compiled patient information and sent data for statistical analysis. RESULTS Biopsies with anorectal junctional mucosa from 115 patients were evaluated for calretinin positive mucosal neurites. 20/20 Hirschsprung disease biopsies were negative. 87/88 non Hirschsprung disease biopsies and 7/7 post pullthrough Hirschsprung disease neorectal biopsies were positive. Statistical analysis of the 108 non pullthrough biopsies yielded an accuracy of 99.1% (sensitivity 100%, specificity 98.9%). Age range was preterm to 16 years. Biopsy size was less than 1 mm to over 1 cm. CONCLUSIONS Absence of calretinin positive mucosal neurites at the anorectal line was highly accurate in distinguishing Hirschsprung disease from non Hirschsprung disease cases in this blinded retrospective study. Calretinin staining is useful for interpreting biopsies from the physiologic hypoganglionic zone up to the anorectal line.
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Affiliation(s)
- Suzanna J Logan
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Hong Yin
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Beverly Rogers
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Nicoleta Arva
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Miriam R Conces
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sandy Cope-Yokoyama
- Department of Pathology and Laboratory Medicine, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Louis P Dehner
- Department of Pathology and Immunology, Washington University Medical Center, St. Louis, MO, USA
| | - Carlos Galliani
- Department of Pathology, University of South Alabama Children's and Women's Hospital, Mobile, AL, USA
| | - Shipra Garg
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Mai He
- Department of Pathology and Immunology, Washington University Medical Center, St. Louis, MO, USA
| | - Aliya N Husain
- Department of Pathology, University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Matthew Keisling
- Department of Pathology and Laboratory Medicine, Akron Children's Hospital, Akron, OH, USA
| | - Chandra Krishnan
- Pathology and Laboratory Medicine, Dell Children's Medical Center, Austin, TX, USA
| | - Elena Puscasiu
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | - Christopher Rossi
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | - Faiza Siddiqui
- Department of Pathology, University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Lisa Sutton
- Pathology and Laboratory Medicine, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Jefferson Terry
- Department of Pathology and Laboratory Medicine, BC Children's Hospital, Vancouver, BC, Canada
| | - Ameet I Thaker
- Department of Pathology, UT Southwestern Children's Health, Dallas, TX, USA
| | - Yuan Huang
- Department of Pathology and Laboratory Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jie Zhang
- Department of Pathology, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Courtney McCracken
- Department of Pediatrics Biostatistics Core, Emory School of Medicine, Atlanta, GA, USA
| | - Heather Rytting
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA, USA
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12
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Affiliation(s)
- Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, MO, USA.,International Pleuropulmonary Blastoma/DICER1 Registry, Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, USA
| | - Kris Ann Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, USA
| | - D Ashley Hill
- Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, MO, USA.,Department of Pathology, Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC, USA
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13
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Zhou HF, Amarillo IE, Snyder S, Granadillo JL, O'Conor CJ, Dillon P, Wilson D, Huang FS, Dehner LP, He M. Confirmation of Xp22.11 Duplication as a Germline Susceptibility Alteration in a Wilms Tumor Arising in Horseshoe Kidney. Fetal Pediatr Pathol 2022; 41:682-688. [PMID: 33960268 DOI: 10.1080/15513815.2021.1921892] [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] [Indexed: 10/21/2022]
Abstract
BackgroundThere is strong evidence of a genetic contribution to Wilms tumor, such as WT1 gene variation or epigenetic changes at chromosome locus 11p15. A previous genome wide association study (GWAS) of Wilms tumor identified other significant association loci including Xp22. Case report: A 4-year-old girl developed a Wilms tumor of the left isthmus of a horseshoe kidney. Chromosomal microarray analysis (CMA) of peripheral blood showed a 563 kb copy number gain at Xp22.11 that included PRDX4 and ZFX. PRDX4 has been shown to play an active role in the tumorigenesis of malignant neoplasms in various organs. Beckwith-Wiedemann methylation analysis and WT1 sequencing were negative. Whole exome sequencing of peripheral blood revealed pathogenic variant in PMS2 gene (c.765C > A), which is consistent with Lynch syndrome. Conclusion: We report a case of Wilms tumor with germline Xp22.11 duplication which further supports this locus as germline susceptibility alteration for Wilms Tumor.
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Affiliation(s)
- Hui-Fang Zhou
- The Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Ina E Amarillo
- The Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Stacy Snyder
- The Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jorge L Granadillo
- The Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Christopher J O'Conor
- The Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Patrick Dillon
- The Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - David Wilson
- The Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Frederick S Huang
- The Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Louis P Dehner
- The Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Mai He
- The Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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14
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Aggarwal A, Lang A, Krigman HR, Dehner LP. Vascular Malformation and CAP Polyposis: A New Insight into Pathophysiology or Fortuitous Association? Fetal Pediatr Pathol 2022; 41:670-676. [PMID: 33872119 DOI: 10.1080/15513815.2021.1913537] [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] [Indexed: 10/21/2022]
Abstract
INTRODUCTION CAP polyposis is a benign colorectal process presenting with multiple colorectal polyps with a "CAP" of inflammatory granulation tissue whose etiology has remained largely unknown. CASE A 24-year-old male presented with a long-standing history of repeated multiple sessile colonic polyps over a period of 17 years. RESULTS The numerous polyps showed consistent histologic features of superficial erosion with a surface "CAP" of granulation tissue with minimal submucosa to evaluate over this period. A left hemicolectomy disclosed an extensive vascular malformation. CONCLUSION The underlying vascular malformation may have an etiologic correlation to the overlying CAP polyps in this patient. Future cases may benefit from an evaluation of the underlying submucosa for the presence of possible vascular malformation likely to be missed on superficial polypectomy.
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Affiliation(s)
- Ashna Aggarwal
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St. Louis Children's Hospital, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
| | - Adam Lang
- Department of Pathology, Blessing Health System, Quincy, IL, USA
| | - Hannah R Krigman
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St. Louis Children's Hospital, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
| | - Louis P Dehner
- Department of Pathology and Immunology, Barnes-Jewish Hospital/St. Louis Children's Hospital, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA
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15
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Jaeger ZJ, Dehner C, Dehner LP. Rosette-like formations in melanocytic neoplasms: A case report and literature review. J Cutan Pathol 2022; 49:818-823. [PMID: 35679430 DOI: 10.1111/cup.14270] [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: 03/18/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 11/29/2022]
Abstract
Homer-Wright-like rosettes are a common finding in neural tumors but seldom seen in melanocytic nevi and melanoma. We report a case of a 23-year-old male with a compound melanocytic nevus with such rosette-like structures and summarize the current literature on this histopathological feature in melanocytic neoplasms. A symmetric, well-circumscribed, compound nevus consisting of aggregations of epithelioid melanocytes with eccentric nuclei and central eosinophilic cytoplasm, resembling Homer-Wright rosettes, was present on biopsy. Immunohistochemical stains strongly supported a melanocytic entity and were negative for NTRK1/2/3, a fusion protein potentially associated with rosette-like structures. We found 17 other cases of benign melanocytic nevi, including 9 atypical Spitz tumors and 6 Spitz nevi, and 11 malignant melanomas, including 3 Spitz melanomas and 4 metastases. We observed remarkable diversity among lesion morphologies containing rosettes, as well as level of prominence and cytology of the rosettes themselves. This case illustrates the morphologic malleability of neural-crest-derived lesions to share microscopic and phenotypic attributes.
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Affiliation(s)
- Zachary J Jaeger
- Office of Medical Student Education, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carina Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology and Dermatopathology Center, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology and Dermatopathology Center, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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16
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He M, Skaria P, Kreutz K, Chen L, Hagemann IS, Carter EB, Mysorekar IU, Nelson DM, Pfeifer J, Dehner LP. Histopathology of Third Trimester Placenta from SARS-CoV-2-Positive Women. Fetal Pediatr Pathol 2022; 41:403-412. [PMID: 33040615 DOI: 10.1080/15513815.2020.1828517] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: This study aims to investigate whether maternal SARS-CoV-2 status affects placental pathology. Methods: A retrospective case-control study was conducted by reviewing charts and slides of placentas delivered between April 1 to July 24, 2020. Clinical history of "COVID-19" was searched in Pathology Database (CoPath). Controls were matched with SARS-CoV-2-negative women with singleton deliveries in the 3rd-trimester. Pathological features were extracted from placental pathology reports. Results: Twenty-one 3rd trimester placentas from SARS-CoV-2-positive women were identified and compared to 20 placentas from SARS-CoV-2-negative women. There were no significant differences in individual or group gross or microscopic pathological features. Within the SARS-CoV-2+ group, there are no differences between symptomatic and asymptomatic women. Conclusion: Placentas from SARS-CoV-2-positive women do not demonstrate a specific pathological pattern. Pregnancy complicated with COVID-19 during the 3rd trimester does not have a demonstrable effect on placental structure and pathology.
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Affiliation(s)
- Mai He
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Priya Skaria
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Kasey Kreutz
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Ian S Hagemann
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Ebony B Carter
- Department of Obstetrics & Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Indira U Mysorekar
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.,Department of Obstetrics & Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - D Michael Nelson
- Department of Obstetrics & Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - John Pfeifer
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Louis P Dehner
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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17
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Salari B, Dehner LP. Pseudo-Roberts Syndrome: An Entity or Not? Fetal Pediatr Pathol 2022; 41:396-402. [PMID: 33026893 DOI: 10.1080/15513815.2020.1827320] [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] [Indexed: 10/23/2022]
Abstract
Background: Roberts syndrome is a genetic disorder characterized by tetra-phocomelia with abnormalities of ESCO2. We report a male stillborn with tetra-phocomelia and no ESCO2 mutation. Case report: Pre- and post-natal imaging and autopsy findings included schizencephaly, phocomelia of four limbs, micrognathia, oligodactyly, and cardiopulmonary malformations. Microcephaly on pre-natal imaging was not confirmed by autopsy examination. Karyotype, prenatal chromosome microarray and ESCO2 gene testing were normal. Conclusion: Given the various skeletal anomalies found on autopsy and imaging evaluations, at least phenotypically, our case appeared to conform into Roberts syndrome spectrum. Since the infant did not have the mutation associated with this disorder, this infant could be labeled as the first report of a pseudo-Roberts syndrome because many of his phenotypic anomalies are characteristic of Roberts syndrome in absence of the ESCO2 gene mutation.
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Affiliation(s)
- Behzad Salari
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Louis P Dehner
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri, USA
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18
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Salari B, Dehner LP. Juvenile and adult xanthogranuloma: A 30-year single-center experience and review of the disorder and its relationship to other histiocytoses. Ann Diagn Pathol 2022; 58:151940. [DOI: 10.1016/j.anndiagpath.2022.151940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 11/01/2022]
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19
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Roy P, Das A, Singh A, Panda J, Bhattacharya A, Gehani A, Parihar M, KS R, Achari R, Alaggio R, Field A, Hill DA, Dehner LP, Schultz KAP. Phenotypic similarities within the morphologic spectrum of DICER1-associated sarcomas and pleuropulmonary blastoma: Histopathologic features guide diagnosis in the LMIC setting. Pediatr Blood Cancer 2022; 69:e29466. [PMID: 34913555 PMCID: PMC9248686 DOI: 10.1002/pbc.29466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/10/2021] [Accepted: 11/01/2021] [Indexed: 11/08/2022]
Abstract
Extrapulmonary DICER1-associated sarcomas (DS) can harbor morphological features overlapping with pleuropulmonary blastoma. We report three children with intracranial and genital tract sarcomas, suspected to have DS based on a heterogeneous yet defining combination of spindle-cell sarcomatous and blastemal morphology, with rhabdomyomatous differentiation. Foci of immature cartilage at diagnosis (n = 2/3) and increased neuroepithelial differentiation at recurrence (n = 1) were noted. Morphological suspicion prompted somatic testing at reference centers, confirming likely biallelic, loss-of-function, and "hotspot" missense DICER1 variants in all three tumors. This can serve as a model for this diagnosis in resource-limited settings and has implications for germline testing, surveillance, and tumor management.
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Affiliation(s)
| | | | | | - Joyshree Panda
- Department of Pathology, Tata Medical Center, Kolkata, India
| | | | - Anisha Gehani
- Department of Radiology, Tata Medical Center, Kolkata, India
| | - Mayur Parihar
- Department of Cytogenetics, Tata Medical Center, Kolkata, India
| | - Reghu KS
- Department of Pediatric Oncology, Tata Medical Center, Kolkata, India
| | - Rimpa Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - Rita Alaggio
- IRCCS Ospedale Pediatrico Bambino Gesu, Roma; Professor university of Padova, Italy; Adjunct Professor University of Pittsburgh
| | | | - D. Ashley Hill
- Division of Pathology, Children’s National Medical Center, George Washington University School of Health Sciences, Washington DC, USA and ResourcePath LLC, Sterling, VA, USA
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University Medical Center, St. Louis, MO, USA
| | - Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Hospitals and Clinics of Minnesota, Minneapolis, USA
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González IA, Stewart DR, Schultz KAP, Field AP, Hill DA, Dehner LP. DICER1 tumor predisposition syndrome: an evolving story initiated with the pleuropulmonary blastoma. Mod Pathol 2022; 35:4-22. [PMID: 34599283 PMCID: PMC8695383 DOI: 10.1038/s41379-021-00905-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023]
Abstract
DICER1 syndrome (OMIM 606241, 601200) is a rare autosomal dominant familial tumor predisposition disorder with a heterozygous DICER1 germline mutation. The most common tumor seen clinically is the pleuropulmonary blastoma (PPB), a lung neoplasm of early childhood which is classified on its morphologic features into four types (IR, I, II and III) with tumor progression over time within the first 4-5 years of life from the prognostically favorable cystic type I to the unfavorable solid type III. Following the initial report of PPB, its association with other cystic neoplasms was demonstrated in family studies. The detection of the germline mutation in DICER1 provided the opportunity to identify and continue to recognize a number seemingly unrelated extrapulmonary neoplasms: Sertoli-Leydig cell tumor, gynandroblastoma, embryonal rhabdomyosarcomas of the cervix and other sites, multinodular goiter, differentiated and poorly differentiated thyroid carcinoma, cervical-thyroid teratoma, cystic nephroma-anaplastic sarcoma of kidney, nasal chondromesenchymal hamartoma, intestinal juvenile-like hamartomatous polyp, ciliary body medulloepithelioma, pituitary blastoma, pineoblastoma, primary central nervous system sarcoma, embryonal tumor with multilayered rosettes-like cerebellar tumor, PPB-like peritoneal sarcoma, DICER1-associated presacral malignant teratoid neoplasm and other non-neoplastic associations. Each of these neoplasms is characterized by a second somatic mutation in DICER1. In this review, we have summarized the salient clinicopathologic aspects of these tumors whose histopathologic features have several overlapping morphologic attributes particularly the primitive mesenchyme often with rhabdomyoblastic and chondroid differentiation and an uncommitted spindle cell pattern. Several of these tumors have an initial cystic stage from which there is progression to a high grade, complex patterned neoplasm. These pathologic findings in the appropriate clinical setting should serve to alert the pathologist to the possibility of a DICER1-associated neoplasm and initiate appropriate testing on the neoplasm and to alert the clinician about the concern for a DICER1 mutation.
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Affiliation(s)
- Iván A. González
- grid.239552.a0000 0001 0680 8770Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Douglas R. Stewart
- grid.48336.3a0000 0004 1936 8075Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD USA
| | - Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN USA ,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN USA
| | | | - D. Ashley Hill
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN USA ,ResourcePath LLC, Sterling, VA USA ,grid.253615.60000 0004 1936 9510Division of Pathology, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Louis P. Dehner
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN USA ,grid.411019.cThe Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children’s Hospitals, Washington University Medical Center, St. Louis, MO USA
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21
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Terry W, Carlisle EM, Mallinger P, Nelson A, Gordon D, Messinger YH, Field A, Dehner LP, Hill DA, Schultz KAP. Thoracic Sertoli-Leydig cell tumor: An alternative type of pleuropulmonary blastoma associated with DICER1 variation. Pediatr Blood Cancer 2021; 68:e29284. [PMID: 34398502 PMCID: PMC8463509 DOI: 10.1002/pbc.29284] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022]
Abstract
A 2-year-old boy presented with a large cystic and solid chest mass arising from the lung, radiographically consistent with pleuropulmonary blastoma (PPB). He underwent right lower lobectomy with resection of a well-circumscribed, mixed solid and cystic mass. The solid areas were composed of cords and nests of tumor cells in the myxoid stroma and retiform foci whose pathologic and immunophenotypic findings were consistent with a sex cord-stromal tumor with features of a Sertoli-Leydig cell tumor. Tumor testing showed a pathogenic variant in the DICER1 RNase IIIb hotspot domain. Family history was suggestive of DICER1 germline pathogenic DICER1 variation in absence of a detectable germline variant. He received 12 cycles of chemotherapy with ifosfamide, vincristine, dactinomycin and doxorubicin (IVADo) and surgery with complete response. One year after completion of chemotherapy, imaging studies showed concern for recurrence confirmed by thorascopic biopsy of a pleural-based mass. He is currently receiving cisplatin-based chemotherapy with reduction in tumor size. Review of the literature showed no similar cases; however, review of our pathology files revealed a single similar case of anterior mediastinal Sertoli cell tumor in a 3-year-old girl.
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Affiliation(s)
- William Terry
- Division of Pediatric Hematology/Oncology, Stead Family Children’s Hospital, Iowa City, IA
| | - Erica M. Carlisle
- Division of Pediatric Surgery, Stead Family Children’s Hospital, Iowa City, IA
| | - Paige Mallinger
- International PPB/DICER1 Registry, Children’s Minnesota, Minneapolis, MN,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Alexander Nelson
- International PPB/DICER1 Registry, Children’s Minnesota, Minneapolis, MN,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - David Gordon
- Division of Pediatric Hematology/Oncology, Stead Family Children’s Hospital, Iowa City, IA
| | - Yoav H. Messinger
- International PPB/DICER1 Registry, Children’s Minnesota, Minneapolis, MN,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | | | - Louis P. Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University Medical Center, St. Louis, MO
| | - D. Ashley Hill
- Department of Pathology and Laboratory Medicine, Children’s National Medical Center, Washington, DC
| | - Kris Ann P. Schultz
- International PPB/DICER1 Registry, Children’s Minnesota, Minneapolis, MN,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
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23
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Dehner LP, Hill DA, Stewart DR, Schultz KAP. Reply: pleuropulmonary blastoma-like peritoneal sarcoma and DICER1-associated sarcomas: toward a unified nomenclature. Mod Pathol 2021; 34:1229-1230. [PMID: 33875804 PMCID: PMC9191827 DOI: 10.1038/s41379-021-00810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Louis P. Dehner
- Department of Pathology and Immunology, Washington
University in St. Louis School of Medicine, St. Louis, Missouri
| | - D. Ashley Hill
- Department of Pathology, Center for Cancer and Immunology
Research, Children’s National Medical Center, Washington D.C
| | - Douglas R. Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology
and Genetics, National Cancer Institute, Rockville, Maryland
| | - Kris Ann P. Schultz
- International Pleuropulmonary
Blastoma/DICER1 Registry, Children’s Minnesota,
Minneapolis, Minnesota,Cancer and Blood Disorders Program, Children’s
Minnesota, Minneapolis, Minnesota
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24
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Wong GJ, Gaudioso CM, Castro E, Sharifai N, Dahiya S, Dehner LP, Griffith JL. Clinical Reasoning: A 7-Year-Old Boy With Acute-Onset Altered Mental Status. Neurology 2021; 96:e2774-e2778. [PMID: 33849990 DOI: 10.1212/wnl.0000000000012034] [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: 11/15/2022] Open
Affiliation(s)
- Gregory J Wong
- From the Departments of Neurology (G.J.W., C.M.G., J.L.G.) and Pathology and Immunology (E.C., N.S., S.D., L.P.D.), Washington University School of Medicine, St. Louis, MO
| | - Cristina M Gaudioso
- From the Departments of Neurology (G.J.W., C.M.G., J.L.G.) and Pathology and Immunology (E.C., N.S., S.D., L.P.D.), Washington University School of Medicine, St. Louis, MO
| | - Eleanor Castro
- From the Departments of Neurology (G.J.W., C.M.G., J.L.G.) and Pathology and Immunology (E.C., N.S., S.D., L.P.D.), Washington University School of Medicine, St. Louis, MO
| | - Nima Sharifai
- From the Departments of Neurology (G.J.W., C.M.G., J.L.G.) and Pathology and Immunology (E.C., N.S., S.D., L.P.D.), Washington University School of Medicine, St. Louis, MO
| | - Sonika Dahiya
- From the Departments of Neurology (G.J.W., C.M.G., J.L.G.) and Pathology and Immunology (E.C., N.S., S.D., L.P.D.), Washington University School of Medicine, St. Louis, MO
| | - Louis P Dehner
- From the Departments of Neurology (G.J.W., C.M.G., J.L.G.) and Pathology and Immunology (E.C., N.S., S.D., L.P.D.), Washington University School of Medicine, St. Louis, MO
| | - Jennifer L Griffith
- From the Departments of Neurology (G.J.W., C.M.G., J.L.G.) and Pathology and Immunology (E.C., N.S., S.D., L.P.D.), Washington University School of Medicine, St. Louis, MO.
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Nelson A, Harris A, Watson D, Pyper SR, Hall N, Kamihara J, Stewart DR, Dehner LP, Hill DA, Messinger YH, Frazier LL, Billmire DF, Schneider DT, Schultz KAP. Stage I Sertoli-Leydig cell tumors: An interim report from the International PPB/ DICER1 & OTST Registry. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5547] [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: 11/20/2022] Open
Abstract
5547 Background: Sertoli-Leydig cell tumors (SLCT) are rare ovarian sex cord-stromal tumors which occur primarily in adolescents and young adults and are associated with DICER1 pathogenic variants. Methods: Informed consent for participation in the International PPB/ DICER1 or OTST Registry was obtained. When available, pathology was centrally reviewed. Staging was evaluated by Registry review using the International Federation of Gynecology and Obstetrics (FIGO) classification system. Results: Eighty-three patients with stage I SLCT were enrolled. Median age at diagnosis was 15 (range 1-60) years. Most (57/83) patients had germline DICER1 testing; 35/57 (61%) had germline pathogenic variants. Fifty-six patients had Ia and 27 had Ic SLCT. The distribution of patients receiving chemo based on histology and stage is displayed in Table. One patient with poorly differentiated stage Ia SLCT with sarcomatous elements and no chemo at diagnosis recurred 6 months after surgery and died of disease. Three patients with local diagnosis of stage Ia SLCT, with data unavailable for Registry confirmation of stage, developed a subsequent SLCT 33 to 74 months after diagnosis; of these, 2 died, and 1 remains in treatment for recurrence. Available records and molecular testing in these 3 cases have not provided a distinction between recurrent and metachronous disease. Excluding the latter 3 patients, 3-year overall survival was 97.3% for stage Ia SLCT. Six patients with stage Ic SLCT recurred (Stage Ic1=5 and Stage Ic2=1) with a median time to recurrence of 25 (range 3-53) months. In stage Ic1, 18% (2/11) recurred after upfront chemo compared to 33% (3/9) after surgery alone. Of the 5 patients with stage Ic1 disease that recurred, 4 had intermediate and 1 had poorly differentiated SLCT. One patient had sarcomatous elements and 2 received upfront chemo. Two of the 5 patients are alive, neither received upfront chemo. One patient with poorly differentiated stage Ic2 SLCT with sarcomatous elements and no upfront chemo recurred and died of disease. Three-year event free and overall survival were 86.9 and 88.6% for stage Ic SLCT. Four patients had metachronous SLCT in the contralateral ovary confirmed by clinical review or somatic testing at a median time from diagnosis of 33 (range 28-104) months. All 4 have germline pathogenic variants and no evidence of disease at last follow-up. Conclusions: Individuals with early stage SLCT generally fare well, however, ongoing surveillance for recurrence and metachronous disease is indicated. Novel therapies are needed to address recurrent SLCT.[Table: see text]
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Affiliation(s)
| | - Anne Harris
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Dave Watson
- Children's Hospital and Clinics of Minnesota, Minneapolis, MN
| | | | | | - Junne Kamihara
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Douglas R Stewart
- National Institutes of Health/National Cancer Institute, Rockville, MD
| | | | - D. Ashley Hill
- ResourcePath Laboratory, Sterling, VA and Center for Cancer and Immunology Research, Children's National Health System, Washington, DC
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Ferguson MJ, Ivanovich J, Stansell P, Vik TA, Helvie AE, Schmitt MR, Schultz KA, Dehner LP, Renbarger JL, Marshall MA. Previously unreported somatic variants in two patients with pleuropulmonary blastoma with metastatic brain recurrence. Pediatr Blood Cancer 2021; 68:e28825. [PMID: 33258270 PMCID: PMC9677809 DOI: 10.1002/pbc.28825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Michael J Ferguson
- Indiana University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Indianapolis, IN 46202
| | - Jennifer Ivanovich
- Indiana University School of Medicine, Department of Genetics, Indianapolis, IN 46202
| | - Paige Stansell
- Indiana University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Indianapolis, IN 46202
| | - Terry A Vik
- Indiana University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Indianapolis, IN 46202
| | - Amy E Helvie
- Department of Pharmacy, Riley Hospital for Children at IU Health, Indianapolis, IN 46202
| | - Morgan R Schmitt
- Indiana University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Indianapolis, IN 46202
| | - Kris Ann Schultz
- Children’s Minnesota, Cancer and Blood Disorders, International PPB/DICER1 Registry, Minneapolis, MN 55404
| | - Louis P Dehner
- Children’s Minnesota, Cancer and Blood Disorders, International PPB/DICER1 Registry, Minneapolis, MN 55404,Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO 63110
| | - Jamie L Renbarger
- Indiana University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Indianapolis, IN 46202
| | - Mark A Marshall
- Indiana University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Indianapolis, IN 46202
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27
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Wongkittichote P, Upchurch GM, Dehner LP, Wood T, Granadillo JL. Placental pathology in an unsuspected case of mucolipidosis type II with secondary hyperparathyroidism in a premature infant. Mol Genet Metab Rep 2021; 27:100747. [PMID: 33854947 PMCID: PMC8025142 DOI: 10.1016/j.ymgmr.2021.100747] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/14/2021] [Accepted: 03/14/2021] [Indexed: 11/06/2022] Open
Abstract
Mucolipidosis type II (MLII, MIM 252500) is a lysosomal storage disorders caused by defects in GNPTAB gene which encodes alpha and beta subunits of N-acetylglucosamine (GlcNAc)-1-phosphotransferase. Neonatal presentation includes coarse facial features, restricted postnatal growth, generalized hypotonia, gingival hypertrophy and multiple skeletal anomalies. Here we present a case of a 26-week gestational age preterm infant with MLII who did not exhibit the typical facial features at birth; however, the diagnosis was suggested from abnormal placental pathology showing trophoblastic lipidosis and initial skeletal abnormalities from chest radiograph revealing generalized diffuse severe bone demineralizing disease and multiple fractures. Biochemical testing revealed elevation of plasma lysosomal enzymes. Homozygous pathogenic variant, designated c.3505_3504del, was discovered from GNPTAB sequencing. Her course was complicated by respiratory distress, secondary hyperparathyroidism, abdominal distention and feeding difficulties. Urine mucopolysaccharides analysis revealed mild elevation of total and individual glycosaminoglycan species in a non-specific pattern. To our knowledge, our case is the most premature example of mucolipidosis type II that has ever been reported to date. This report highlights the importance of placental pathological studies in the diagnosis of lysosomal storage disorders.
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Affiliation(s)
- Parith Wongkittichote
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, United States of America
| | - Garland Michael Upchurch
- Department of Pathology and Immunology (Lauren V. Ackerman Laboratory of Surgical Pathology), Washington University School of Medicine, St Louis, MO, United States of America
| | - Louis P Dehner
- Department of Pathology and Immunology (Lauren V. Ackerman Laboratory of Surgical Pathology), Washington University School of Medicine, St Louis, MO, United States of America
| | - Timothy Wood
- Greenwood Genetic Center, Greenwood, SC, United States of America
| | - Jorge L Granadillo
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, United States of America
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28
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González IA, Lu HC, Alipour Z, Kulkarni SS, Stoll JM, Liss KH, Dehner LP, He M. Clinicopathologic Characteristics of Centrilobular Injury in Pediatric Liver Transplantation. Liver Transpl 2021; 27:416-424. [PMID: 33253466 PMCID: PMC10619582 DOI: 10.1002/lt.25958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/18/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022]
Abstract
Centrilobular injury (CLI) is defined as the presence of perivenular mononuclear inflammation, hepatocyte dropout, and extravasated erythrocytes. In pediatric liver allografts, CLI has been associated with advanced fibrosis and chronic rejection (CR). We sought to better characterize the clinicopathologic features of CLI in the setting of T cell-mediated rejection (TCMR) and its association with complement component 4d (C4d) deposition. A total of 206 posttransplant pediatric patients (491 allograft liver biopsies) were available from 2000 to 2018, of which 63 patients (102 biopsies) showed evidence of TCMR and were included in the study. Of the patients, 35 (55.6%) had CLI on their initial episode of TCMR; those patients with CLI were significantly associated with the type of immunosuppression treatment (P = 0.03), severity of TCMR (P < 0.001), higher gamma-glutamyltransferase (P = 0.01), and advanced fibrosis (P = 0.03). There was a trend to shorter time interval from transplantation to presentation of CLI compared with those without CLI (P = 0.06). No difference was observed in graft or overall survival in the patients with CLI. In 20 patients with CLI, additional biopsies were available; in 45% of these patients, CLI was a persistent/recurrent finding. C4d deposition was noted in 12% of all biopsies (6 patients) with CLI. No significant correlation was noted in C4d deposition and CLI, CR, or graft/overall survival. In conclusion, CLI, although not significantly associated with worse graft survival, was significantly associated with severe TCMR and degree of fibrosis, which highlights the importance of active clinical management and follow-up for these patients.
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Affiliation(s)
- Iván A. González
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology
| | - Hsiang-Chih Lu
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology
| | - Zahra Alipour
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology
| | - Sakil S. Kulkarni
- Department of Pediatrics, St. Louis Children’s Hospital, Washington University Medical Center, St. Louis, MO
| | - Janis M. Stoll
- Department of Pediatrics, St. Louis Children’s Hospital, Washington University Medical Center, St. Louis, MO
| | - Kim H. Liss
- Department of Pediatrics, St. Louis Children’s Hospital, Washington University Medical Center, St. Louis, MO
| | - Louis P. Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology
| | - Mai He
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology
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29
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Byers J, Yin H, Rytting H, Logan S, He M, Yu Z, Wang D, Warren M, Mangray S, Dehner LP, Zhou S. PD-L1 expression in angiomatoid fibrous histiocytoma. Sci Rep 2021; 11:2183. [PMID: 33500467 PMCID: PMC7838166 DOI: 10.1038/s41598-021-81746-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/11/2021] [Indexed: 01/22/2023] Open
Abstract
Angiomatoid fibrous histiocytoma (AFH) is a rare tumor of intermediate malignancy. Treatment options for unresectable and/or metastatic tumors are very limited. Immunotherapy with PD-1/PD-L1 inhibitors may be worth exploring. The aim of this study was to evaluate the expression of PD-L1 in AFHs. PD-L1 expression was assessed on 36 AFHs from 36 pediatric patients by immunohistochemical staining of PD-L1 (clone 22C3). Positivity was defined as membranous expression in ≥ 1% of either tumor or immune cells. The correlations between PD-L1 expression and clinicopathologic features were assessed. Two patients had lymph node metastasis. All patients underwent surgical resection; three of them also had systemic chemotherapy. Three patients had recurrence after initial resection; all patients were alive with a median follow-up of 2.5 years. Overall, twenty-two (61%) tumors were positively stained for PD-L1 and positivity was seen on both tumor and immune cells in eighteen of the 22 tumors. A positive correlation was found between tumor cell PD-L1 expression and CD8+ T-cell infiltration. There were no statistically significant differences between the status of PD-L1 expression and the clinicopathological features assessed. PD-L1 expression was identified in 61% of AFHs with a predominantly adaptive pattern. Our findings provide a rationale for future studies evaluating the potential of checkpoint immunotherapy for patients with unresectable and/or metastatic tumor.
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Affiliation(s)
- Joshua Byers
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, MS 43, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
| | - Hong Yin
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | - Mai He
- Washington University in Saint Louis, Saint Louis, MO, USA
| | - Zhongxin Yu
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dehua Wang
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Mikako Warren
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, MS 43, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
| | | | - Louis P Dehner
- Washington University in Saint Louis, Saint Louis, MO, USA
| | - Shengmei Zhou
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, MS 43, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA.
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30
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Alipour Z, Schultz KAP, Chen L, Harris AK, Gonzalez IA, Pfeifer J, Hill DA, He M, Dehner LP. Programmed Death Ligand 1 Expression and Related Markers in Pleuropulmonary Blastoma. Pediatr Dev Pathol 2021; 24:523-530. [PMID: 34266329 PMCID: PMC9196202 DOI: 10.1177/10935266211027417] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Pleuropulmonary blastoma (PPB), a rare childhood neoplasm of the lung, is linked to pathogenic DICER1 variants. We investigated checkpoint inhibitor markers including Programmed Death Ligand 1 (PD-L1), PD1, CD8 and tumor mutational burden (TMB) in PPB. MATERIAL AND METHODS Cases were collected from departmental archives and the International PPB/DICER1 Registry. Immunohistochemistry (IHC) for PD-L1, PD-1, CD8 and DNA mismatch repair (MMR) genes were performed. In addition, normal-tumor paired whole exome sequencing (WES) was performed in two cases. RESULTS Twenty-five PPB cases were studied, consisting of Type I (n = 8, including 2 Ir), Type II (n = 8) and Type III (n = 9). PD-L1 combined positive score (CPS) of 1, 4 and 80 was seen in three (3/25, 12.0%) cases of Type II PPB with negative staining in the remaining cases. PD-1 and CD8 stains demonstrated positive correlation (P < .05). The density of PD1 and CD8 in the interface area was higher than within tumor (P < .05). The MMR proteins were retained. TMB was 0.65 mutations/Mb in type II PPB with high expression of PD-L1, and 0.94 mutations/Mb in one negative PD-L1 case with metastatic tumor. CONCLUSION A small subpopulation of PPB patient might benefit from checkpoint immunotherapy due to positive PD-L1 staining.
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Affiliation(s)
- Zahra Alipour
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, Minnesota
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Anne K. Harris
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, Minnesota
| | - Ivan A. Gonzalez
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - John Pfeifer
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - D. Ashley Hill
- Department of Pathology, Center for Cancer and Immunology Research, Children's National Medical Center, Washington D.C
| | - Mai He
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Louis P. Dehner
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Dehner LP. Juan Rosai, MD. Arch Pathol Lab Med 2020; 145:448206. [PMID: 33212473 DOI: 10.5858/arpa.2020-0567-ed] [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] [Accepted: 09/01/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Louis P Dehner
- From the Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, Barnes-Jewish and St Louis Children's Hospitals, St Louis, Missouri
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González IA, Dehner LP. Smooth muscle hamartoma and striated muscle hamartoma: Clinicopathologic characterization of two rare entities and literature review. J Cutan Pathol 2020; 48:237-246. [PMID: 32804407 DOI: 10.1111/cup.13850] [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] [Received: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
Smooth muscle hamartoma (SMH) and striated muscle hamartoma (STH) are anomalous proliferations of smooth muscle or striated muscle, respectively, in anatomic sites where these tissues are normally present. To date, only limited cases have been reported describing these lesions. In this study, we sought to characterize the clinicopathologic features of both SMH and STH. A total of 27 cases of SMH and 12 cases of STH from 1990 to 2020 were identified. SMH cases had a slight male predominance (63%) and a mean age of presentation of 20 years (range: 4 months-91 years), with a mean size of 9.3 mm (±13.3). In contrast, STH were equally distributed in gender, with a mean age of presentation of 40 years (range: 3 months-66 years) and a mean size of 5.7 mm (±3.6). SMH were more commonly located in the torso and extremities (70%) and STH in the head and neck area (92%). One case of SMH recurred after 1.1 years and in the initial diagnosis the lesion was present at the tissue edge. None of the cases of STH had a recurrence. We present the largest cohort of SMH and STH, and report the first case of a recurrent SMH, suggesting the importance of obtaining a clean margin for these lesions.
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Affiliation(s)
- Iván A González
- The Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.,The Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Louis P Dehner
- The Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
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Schultz KAP, Nelson A, Harris A, Finch M, Field A, Jarzembowski JA, Wilhelm M, Mize W, Kreiger P, Conard K, Walter A, Olson T, Mitchell S, Runco DV, Bechtel A, Klawinski D, Bradfield S, Gettinger K, Stewart DR, Messinger Y, Dehner LP, Hill DA. Pleuropulmonary blastoma-like peritoneal sarcoma: a newly described malignancy associated with biallelic DICER1 pathogenic variation. Mod Pathol 2020; 33:1922-1929. [PMID: 32415267 PMCID: PMC7529703 DOI: 10.1038/s41379-020-0558-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
Since the original description of pathogenic germline DICER1 variation underlying pleuropulmonary blastoma (PPB), the spectrum of extrapulmonary neoplasms known to be associated with DICER1 has continued to expand and now includes tumors of the ovary, thyroid, kidney, eye, and brain among other sites. This report documents our experience with another manifestation: a primitive sarcoma that resembles PPB and DICER1-associated sarcoma of the kidney. These tumors are distinguished by their unusual location in the peritoneal cavity, associated with visceral and/or parietal mesothelium. A total of seven cases were identified through pathology review in children presenting at a median age of 13 years (range 3-14 years). Primary sites of origin included the fallopian tube (four cases), serosal surface of the colon (one case), and pelvic sidewall (two cases). One case had pathologic features of type I PPB, another type Ir (regressed) PPB, and the remaining five had features of type II or III PPB with a mixed primitive sarcomatous pattern with or without cystic elements. All had a pathogenic DICER1 variation identified in germline and/or tumor DNA. PPB-like peritoneal tumors represent a newly described manifestation of DICER1 pathogenic variation whose pathologic features are also recapitulated in DICER1-related renal sarcoma, cervical embryonal rhabdomyosarcoma, and some Sertoli-Leydig cell tumors with heterologous elements. Tumors arising from the fallopian tube or elsewhere in the abdomen/pelvis, especially those with heterogeneous rhabdomyosarcomatous and/or cartilaginous differentiation, should prompt consideration of germline and tumor DICER1 testing.
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Affiliation(s)
- Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Alexander Nelson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Anne Harris
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Mike Finch
- Research and Sponsored Programs, Children’s Minnesota, Minneapolis, MN
| | | | - Jason A. Jarzembowski
- Department of Pathology, Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, WI
| | - Mercedes Wilhelm
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - William Mize
- Department of Radiology, Children’s Minnesota, Minneapolis, MN
| | - Portia Kreiger
- Department of Anatomical Pathology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Katrina Conard
- Department of Clinical & Anatomic Pathology, Nemours/ Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Andrew Walter
- Department of Oncology, Nemours/ Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Thomas Olson
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Sarah Mitchell
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Daniel V. Runco
- Division of Hematology/Oncology, Riley Hospital for Children at Indiana University Health/Indiana University School of Medicine, Indianapolis, IN
| | - Allison Bechtel
- Division of Hematology/Oncology, Nemours Children’s Specialty Care, Jacksonville, FL
| | - Darren Klawinski
- Division of Hematology/Oncology, Nemours Children’s Specialty Care, Jacksonville, FL
| | - Scott Bradfield
- Division of Hematology/Oncology, Nemours Children’s Specialty Care, Jacksonville, FL
| | - Katie Gettinger
- Department of Oncology, Washington University Medical Center, St. Louis, MO
| | - Douglas R. Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Yoav Messinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Louis P. Dehner
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University Medical Center, St. Louis, MO
| | - D. Ashley Hill
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN;,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN;,ResourcePath, Sterling, VA;,Department of Pathology and Laboratory Medicine, Children’s National Medical Center, Washington, DC
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Vural C, Skaria P, Dehner LP, Khanna G. Gastrointestinal neuroendocrine tumors in Fontan patients. Radiol Case Rep 2020; 15:2153-2156. [PMID: 32952754 PMCID: PMC7484531 DOI: 10.1016/j.radcr.2020.08.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/29/2022] Open
Abstract
The Fontan procedure used for palliation of single ventricle physiology is associated with multisystemic morbidity. With improving survival and increased use of surveillance imaging in this patient population, long-term complications associated with Fontan circuits are commonly encountered by radiologists. One interesting observation is the apparent increased risk of paragangliomas and pheochromocytomas in this group of patients and perhaps a pathogenetic role of chronic hypoxia. We report 2 cases of gastrointestinal neuroendocrine tumors (NET) in the setting of Fontan circuit. The first is a 20-year-old female with history of hypoplastic left heart and Fontan palliation who presented with hematochezia and was diagnosed with a jejunal grade 2 NET. The second case is of a 12-year-old boy with history Fontan palliation for single ventricle physiology, incidentally found to have a well-differentiated pancreatic NET during precardiac transplant workup. These cases should alert the radiologists to be aware of the apparent association between Fontan procedure and NET.
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Affiliation(s)
- Corey Vural
- Washington University School of Medicine, Campus Box 8131, 510 S. Kingshighway, St Louis, MO 63110 USA
| | - Priya Skaria
- Department of Pathology, Washington University School of Medicine, St Louis, MO, USA
| | - Louis P Dehner
- Department of Pathology, Washington University School of Medicine, St Louis, MO, USA
| | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO¸USA
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35
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Harris A, Nelson A, Watson D, Mallinger P, Langford M, Stering A, Turk F, Billmire DF, Schneider DT, Frazier AL, Dehner LP, Hill A, Messinger YH, Schultz KAP. Juvenile granulosa cell tumor: An interim report from the international ovarian and testicular stromal tumor (OTST) registry. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6064] [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: 11/20/2022] Open
Abstract
6064 Background: Juvenile granulosa cell tumors (JGCT) are rare sex cord-stromal tumors which occur primarily in children and adolescents. Methods: All individuals or proxy caregivers provided informed consent/assent for participation in the International OTST Registry. Clinical data was collected. When available, pathology was centrally reviewed. Staging was evaluated using the International Federation of Gynecology and Obstetrics (FIGO) classification. Kaplan-Meier survival analyses and exact permutation tests were performed. Results: Forty-two individuals with ovarian JGCT were enrolled. Median age at diagnosis was 9 years (range 0-27). Most individuals had Stage I disease (Stage Ia=16; Stage Ib=1; Stage Ic=16). Seven individuals presented with higher stage (Stage II=2; Stage III=5). Stage was unknown for 2 individuals. Three-year overall survival (OS) was 88% (CI 77%, 100%) and event-free survival (EFS) was 69% (CI 54%, 88%). At median follow-up time of 25 months (range 0-416), 9 patients (Stage Ia=1, Stage Ic=5, Stage III=3) had recurrent disease. Use of post-operative adjuvant chemotherapy varied by stage and timing of rupture. Of those with Stage Ic JGCT, 2/7 with preoperative rupture and 3/9 with intraoperative rupture recurred. Among individuals with recurrence, median time to recurrence was 11.5 months (range 3-19). Four of 9 individuals with recurrence survived (no evidence of disease n=2; alive with disease n=2). All individuals who died presented with extrapelvic recurrence. Median time from recurrence to death was 10 months (range 2-53). In individuals with recurrence, advanced stage at diagnosis (HR 5.1; p-value 0.087) and recurrence outside the tumor bed (HR Infinity; p-value 0.048) were associated with inferior OS. Three-year OS for individuals with recurrence was 57% (CI 30%, 100%). Conclusions: Low stage JGCT is associated with a favorable prognosis, however, recurrence is associated with lower survival rate. Within this series, recurrences presented within 2 years of diagnosis. Novel strategies are needed to address recurrent and extrapelvic disease.
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Affiliation(s)
- Anne Harris
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | | | - David Watson
- Children's Hospital & Clinics Minnesota, Minneapolis, MN
| | | | | | | | | | | | | | | | | | - Ashley Hill
- George Washington University School of Medicine and Health Sciences, Dept. of Pathology, Washington, WA
| | | | - Kris Ann P Schultz
- The International Ovarian and Testicular Stromal Tumor Registry, Children's Hospital and Clinics of Minnesota, Minneapolis, MN
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36
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He M, Abro B, Kaushal M, Chen L, Chen T, Gondim M, Yan W, Neidich J, Dehner LP, Pfeifer JD. Tumor mutation burden and checkpoint immunotherapy markers in primary and metastatic synovial sarcoma. Hum Pathol 2020; 100:15-23. [PMID: 32387103 DOI: 10.1016/j.humpath.2020.04.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 10/02/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 12/29/2022]
Abstract
Synovial sarcoma (SS) is a soft-tissue malignancy that most often affects patients aged between 15 and 40 years, and the prognosis for patients with metastatic disease is generally poor. This study was performed to evaluate checkpoint blockade immunotherapy markers in SS, including tumor mutational burden (TMB), DNA mismatch repair (MMR) status, and PDL-1 (programmed cell death ligand 1), PD1 (programmed cell death 1), and CD8 expression by normal-tumor paired whole-exome sequencing (WES) and immunohistochemistry (IHC). Outcomes evaluated included event-free and overall survival. Twenty one (21) FISH (Fluorescence In Situ Hybridization)-confirmed SS cases (11 F, 10 M) were studied, with age ranging from 8 to 89 years at diagnosis and follow-up ranging from 1 to 16 years. TMB (n = 16) ranged from 0.83 to 212/Mb (median, 1.7). Only one case showed a high TMB of 212/Mb and missense variants of MMR genes in the primary tumor, while the other 15 cases had a low TMB of less than 5/Mb. IHC was performed on all 21 tumor samples for PD-L1, PD1, CD8, and MMR proteins. PD-L1 membranous staining was detected in 3 of 21 cases (14.3%), ranging from 1 to 5% for tumor proportion score and 1-10 for combined positive score. PD1 was detected in 15 of 21 cases (71.4%), ranging from 1 to 25/HPF (high power field) (median, 2). CD8 stain was seen in all cases, ranging from 2 to 60/HPF (median, 5). PD1 staining results correlated with CD8 staining results (P < 0.0001). No correlation of TMB or IHC markers was found with survival. No fixed pattern of TMB or IHCs between primary and metastatic tumors was observed; there was no correlation between TMB or IHCs and age, location, or diagnosis subtype. All of the cases tested showed retained expression of MMR proteins. The results show that for SS, a tumor with strong driver translocation, most cases have a low TMB, but occasionally a high TMB may be present, as observed in 1 of the 16 (6.25%) cases. The demonstration of a subgroup of SS cases with high TMB might explain the 10% response rate to checkpoint immunotherapy observed in clinical trials in patients with SS.
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Affiliation(s)
- Mai He
- Department of Pathology & Immunology, Washington University at St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Brooj Abro
- Department of Pathology & Immunology, Washington University at St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Madhurima Kaushal
- Institute of Bioinformatics, Washington University at St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Ling Chen
- Division of Statistics, Washington University at St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Tiffany Chen
- Department of Pathology & Immunology, Washington University at St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Mercia Gondim
- Department of Pathology & Immunology, Washington University at St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Weisi Yan
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Julie Neidich
- Department of Pathology & Immunology, Washington University at St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Louis P Dehner
- Department of Pathology & Immunology, Washington University at St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - John D Pfeifer
- Department of Pathology & Immunology, Washington University at St. Louis School of Medicine, St. Louis, MO, 63110, USA
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Salari B, Sheinbein DM, Rosman IS, Dehner LP. Metastatic pancreatic adenosquamous carcinoma to the scalp: A case report and review of the literature. J Cutan Pathol 2020; 47:263-268. [PMID: 31587324 DOI: 10.1111/cup.13582] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 12/30/2022]
Abstract
Metastatic carcinoma to the skin occurs in only a minority of patients with a visceral or internal malignancy, with breast, lung, and colorectum accounting for the majority of cases. We present the case of a 66-year-old man with a recent violaceous nodule of the left scalp (1.2 × 1.0 × 0.2 cm) that was a metastatic pancreatic adenosquamous carcinoma, representing a seemingly rare event. Two months prior, after complaining of right hip pain, an image revealed a right femoral lesion. A biopsy of that lesion showed moderately differentiated adenocarcinoma. Subsequent imaging showed a mass in the pancreatic tail and also markedly elevated serum tumor markers, CA 19-9 and carcinoembryonic antigen (5325 and 111.5 U/mL, respectively). Before the appearance of the scalp nodule, the patient received radiotherapy and was started on chemotherapy, which was continued after diagnosis and resection of the nodule. Subsequent metastases developed in the liver, lung and additional cutaneous lesions. He died 11 months after initial presentation with right hip pain. As this case shows, cutaneous metastases confer a poor prognosis, often with less than a year survival following their appearance.
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Affiliation(s)
- Behzad Salari
- Lauren V. Ackerman Laboratory of Surgical Pathology, School of Medicine, Washington University Medical Center, St. Louis, Missouri
| | - David M Sheinbein
- Division of Dermatology, School of Medicine, Washington University Medical Center, St. Louis, Missouri
| | - Ilana S Rosman
- Lauren V. Ackerman Laboratory of Surgical Pathology, School of Medicine, Washington University Medical Center, St. Louis, Missouri
- Division of Dermatology, School of Medicine, Washington University Medical Center, St. Louis, Missouri
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, School of Medicine, Washington University Medical Center, St. Louis, Missouri
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Abstract
Introduction: Endobronchial granular cell tumors are uncommon in the pediatric population. Case report: A 9-year-old female presented with respiratory failure due to an endobronchial tumor. After debulking and diagnosis, she underwent thoracotomy with right upper lobe resection and bronchoplasty. Pathology demonstrated an endobronchial S-100 negative granular cell tumor, which to our knowledge, is the first such report in the literature. Conclusion: Endobronchial granular cell tumors may cause obstructive respiratory failure, are amenable to surgery, and may be S-100 negative.
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Affiliation(s)
- Stephanie Y Chen
- Otolaryngology - Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Arhanti Sadanand
- Department of Pediatrics, Washington University School of Medicine in Saint Louis, Saint Louis, MO, USA
| | - Patrick A Dillon
- Department of Pediatric Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, MO, USA
| | - Mai He
- Division of Pediatric Pathology, Washington University in Saint Louis School of Medicine, Pathology and Laboratory Medicine, Saint Louis, MO, USA
| | - Louis P Dehner
- Pathology and Immunology, Washington University in St. Louis, Saint Louis, MO, USA
| | - David S Leonard
- Otolaryngology - Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
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Merideth MA, Harney LA, Vyas N, Bachi A, Carr AG, Hill DA, Dehner LP, Schultz KAP, Stewart DR, Stratton P. Gynecologic and reproductive health in patients with pathogenic germline variants in DICER1. Gynecol Oncol 2020; 156:647-653. [PMID: 31952842 DOI: 10.1016/j.ygyno.2019.12.037] [Citation(s) in RCA: 9] [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: 09/19/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Germline pathogenic variation in DICER1 underlies a tumor-predisposition disorder with increased risk for cervical embryonal rhabdomyosarcoma and ovarian sex-cord stromal tumors, particularly Sertoli-Leydig cell tumors. The gynecologic and reproductive health of these females has not yet been described. METHODS All female subjects recruited from November 2011 to July 2018 participating in an epidemiologic study of families with pathogenic DICER1 germline variation were included in this cross-sectional analysis. Participant evaluation included obstetric-gynecologic history, physical examination, hormone testing, pelvic ultrasound and record review. RESULTS Of 64 females aged 2-72 years, fifteen underwent treatment for pleuropulmonary blastoma as children and three were treated for cervical embryonal rhabdomyosarcoma. Of nine patients reporting a history of ovarian tumors, all presented with virilization or amenorrhea; eight occurred in adolescence. Post-pubertal females with no history of ovarian tumors experienced normal pubertal development, reported regular menstrual cycles, were fertile and underwent natural menopause at median age of 52 years. Thirty-two of 33 women who tried to conceive successfully delivered liveborn children. Of these 32, 10 experienced pregnancy-related thyroid enlargement resulting in thyroidectomy within one year of pregnancy; nine others had undergone pre-pregnancy thyroidectomy. CONCLUSION In these DICER1-carrier females, DICER1-related gynecological tumors occurred during childhood or adolescence in some after which women generally experienced healthy reproductive lives. Individual education and screening for these tumors is warranted. The high rate of DICER1-related multinodular goiter resulting in pre- and post-pregnancy thyroidectomy underscores the importance of thyroid monitoring during pregnancy to ensure maternal and fetal wellbeing.
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Affiliation(s)
- Melissa A Merideth
- National Human Genome Research Institute, National Institutes of Health, Dpt. Health & Human Services, Bethesda, MD 20892, USA.
| | | | - Nina Vyas
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Averyl Bachi
- Department of Obstetrics and Gynaecology, Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom
| | | | - D Ashley Hill
- Department of Pathology, Center for Cancer and Immunology Research, Children's National Medical Center, Washington, D.C. 20010, USA; International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN 55404, USA; International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN 55404, USA
| | - Louis P Dehner
- Division of Anatomic and Molecular Pathology, Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, MO 63110, USA
| | - Kris Ann P Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN 55404, USA; International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN 55404, USA; Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN 55404, USA
| | - Douglas R Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Pamela Stratton
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA
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González I, Lu HC, Ritter JH, Maluf HM, Dehner LP, He M. Clinicopathologic characteristics of de novo nodular regenerative hyperplasia in pediatric liver transplant. Pediatr Transplant 2019; 23:e13471. [PMID: 31124197 DOI: 10.1111/petr.13471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/17/2018] [Revised: 04/02/2019] [Accepted: 04/15/2019] [Indexed: 12/23/2022]
Abstract
Liver NRH is seen in all patients age; however, more frequently in those over the age of 60 years and associated with multiple systemic diseases. In liver allograft recipients, the development of DnNRH has been linked with the use of azathioprine or vascular abnormalities. We present the clinicopathologic characteristics of 17 pediatric patients who underwent liver transplantation and subsequently developed DnNRH. The patients were divided into early and late onset depending if DnNRH was diagnosed within or beyond 4 years after transplant. Eight patients (47%) presented as early onset, of which two had normal ultrasound at time of diagnosis. One patient (12.5%) with early onset lost the graft secondary to DnNRH. Nine patients (53%) presented as late onset, of which two (22%) had normal ultrasound at time of diagnosis. Two patients (25%) of the late onset lost their graft secondary to chronic rejection and DnNRH. Two patients (12%) died secondary to cytomegalovirus pneumonitis and pancolitis. Furthermore, both groups presented with symptoms differing from the adult population in prior studies and were not associated with the use of azathioprine or vascular abnormalities. Interestingly, episodes of acute cellular rejection were more common in the early-onset group compared to the late-onset group. In conclusion, DnNRH in the pediatric age group has a different clinical presentation, possibly reflecting a different pathogenesis compared to the adult population.
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Affiliation(s)
- Iván González
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri
| | - Hsiang-Chih Lu
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri
| | - Jon H Ritter
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri
| | - Horacio M Maluf
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri
| | - Louis P Dehner
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri
| | - Mai He
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri
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41
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Abro B, Kaushal M, Chen L, Wu R, Dehner LP, Pfeifer JD, He M. Tumor mutation burden, DNA mismatch repair status and checkpoint immunotherapy markers in primary and relapsed malignant rhabdoid tumors. Pathol Res Pract 2019; 215:152395. [DOI: 10.1016/j.prp.2019.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 12/27/2022]
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42
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Dehner LP, Schultz KA, Hill DA. Pleuropulmonary Blastoma: More Than a Lung Neoplasm of Childhood. Mo Med 2019; 116:206-210. [PMID: 31527943 PMCID: PMC6690274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pleuropulmonary blastoma (PPB), the most common primary malignant neoplasm of the lung in childhood, occurs in the same early age group (0-6 years) as the other more common solid tumors such as neuroblastoma and Wilms tumor. The tumor begins as a cystic lung lesion with the potential over a period of 3-5 years to progress to a high grade multipatterned primitive sarcoma in the absence of a malignant epithelial component. Several years after its initial description as a unique clinicopathologic entity, this and other tumors appeared to have a familial predilection which was later confirmed with the discovery of a heterozygous germline mutation in DICER1 whose protein is a member of ribonuclease III family of enzymes. It is estimated that 75%-80% of children with a PPB have the germline mutation. The other notable finding from our studies is the identification of a family of extrapulmonary neoplasms, including cystic nephroma and Sertoli-Leydig cell tumor of the ovary as two examples, also with DICER1 mutations.
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Affiliation(s)
- Louis P Dehner
- Louis P. Dehner, MD, MSMA member since 1990 and Missouri Medicine Editorial Board member for Pathology, is Professor of Pathology at Washington University School of Medicine, St. Louis, Missouri
| | - Kris Ann Schultz
- Kris Ann Schultz, MD, Director, International Pleuropulmonary Blastoma and DICER1 Registry, and pediatric hematologist-oncologist of Children's Minnesota-Children's - Children's Hospital and Clinics, Minneapolis, MN
| | - D Ashley Hill
- D. Ashley Hill, MD, Professor of Pathology, George Washington University School of Medicine and Health Sciences, and Children's National Medical Center, Washington, D.C
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Stewart DR, Best AF, Williams GM, Harney LA, Carr AG, Harris AK, Kratz CP, Dehner LP, Messinger YH, Rosenberg PS, Hill DA, Schultz KAP. Neoplasm Risk Among Individuals With a Pathogenic Germline Variant in DICER1. J Clin Oncol 2019; 37:668-676. [PMID: 30715996 PMCID: PMC6553836 DOI: 10.1200/jco.2018.78.4678] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE DICER1 syndrome is an autosomal-dominant, pleiotropic tumor-predisposition disorder caused by pathogenic germline variants in DICER1. We sought to quantify risk, hazard rates, and the probability of neoplasm incidence accounting for competing risks ("cumulative incidence") of neoplasms (benign and malignant) and standardized incidence ratios for malignant tumors in individuals with DICER1 pathogenic variation. PATIENTS AND METHODS We combined data from three large cohorts of patients who carry germline pathogenic variation in DICER1. To reduce ascertainment bias, we distinguished probands from nonprobands. Neoplasm diagnoses were confirmed by review of pathology reports and/or central review of surgical pathology materials. Standardized cancer incidence ratios were determined relative to the SEER program, which does not capture all DICER1-associated neoplasms. For all malignancies and benign tumors ("neoplasms," excluding type Ir pleuropulmonary blastoma and thyroid nodules), we used the Kaplan-Meier method and nonparametric cumulative incidence curves to estimate neoplasm-free survival. RESULTS We calculated the age at first neoplasm diagnosis (systematically ascertained cancers plus DICER1-associated neoplasms pleuropulmonary blastoma, cystic nephroma, and nasal chondromesenchymal hamartoma) in 102 female and male nonproband DICER1 carriers. By age 10 years, 5.3% (95% CI, 0.6% to 9.7%) of nonproband DICER1 carriers had developed a neoplasm (females, 4.0%; males, 6.6%). By age 50 years, 19.3% (95% CI, 8.4% to 29.0%) of nonprobands had developed a neoplasm (females, 26.5%; males, 10.2%). After age 10 years, female risk was elevated compared with male risk. Standardized cancer incidence ratio analysis of 102 nonproband DICER1 carriers, which represented 3,344 person-years of observation, showed significant cancer excesses overall, particularly of gynecologic and thyroid cancers. CONCLUSION This work provides the first quantitative analysis of site-specific neoplasm risk and excess malignancy risk in 102 systematically characterized nonproband DICER1 carriers. Our findings inform DICER1 syndrome phenotype, natural history, and genetic counseling.
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Affiliation(s)
| | | | - Gretchen M. Williams
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
- International Pleuropulmonary Blastoma/DICER1 Registry, Minneapolis, MN
| | | | | | - Anne K. Harris
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
- International Pleuropulmonary Blastoma/DICER1 Registry, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Minneapolis, MN
| | | | - Louis P. Dehner
- International Pleuropulmonary Blastoma/DICER1 Registry, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Minneapolis, MN
- Washington University, St. Louis, MO
| | - Yoav H. Messinger
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
- International Pleuropulmonary Blastoma/DICER1 Registry, Minneapolis, MN
| | | | - D. Ashley Hill
- Children's National Health System, Washington, DC
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kris Ann P. Schultz
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
- International Pleuropulmonary Blastoma/DICER1 Registry, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Minneapolis, MN
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Siller AF, Shimony A, Shinawi M, Amarillo I, Dehner LP, Semenkovich K, Arbeláez AM. Inherited Deletion of 1q, Hyperparathyroidism and Signs of Y-chromosomal Influence in a Patient with Turner Syndrome. J Clin Res Pediatr Endocrinol 2019; 11:88-93. [PMID: 29739732 PMCID: PMC6398186 DOI: 10.4274/jcrpe.galenos.2018.2018.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 12/01/2022] Open
Abstract
We report a detailed phenotypic, cytogenetic and molecular characterization of a patient prenatally diagnosed with Turner syndrome (TS). In addition to having typical TS clinical characteristics including webbed neck, high arched palate and coarctation of the aorta, the patient had features less frequently seen in TS. These included recurrent parathyroid adenomas, growth along the 75th-90th centiles on the TS height curve despite minimal treatment with growth hormone, behavioral problems and evidence of gonadal dysgenesis with testicular-like structures, such as seminiferous tubules lined by Sertoli cells and a contiguous nodule of Leydig cells. While fluorescence in situ hybridization (FISH) failed to detect Y-chromosome material in gonadal tissue or blood samples, chromosomal microarray analysis (CMA) confirmed X monosomy and a 4.69 Mb copy number loss on 1q31.2q31.3 (bp 192,715,814 to 197,401,180). This region contains the CDC73 gene which has been associated with hyperparathyroidism-jaw tumor syndrome, features of which include recurrent, functional parathyroid adenomas and behavioral issues. This case illustrates how atypical features in a TS patient, such as robust growth and recurrent parathyroid adenomas, may suggest an underlying molecular etiology that should be explored by additional genetic diagnostic modalities. It is therefore appropriate in such cases to conduct further genetic testing, such as CMA and FISH, to explore other diagnostic possibilities and possibly prevent further complications.
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Affiliation(s)
- Alejandro F. Siller
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Alex Shimony
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Marwan Shinawi
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Ina Amarillo
- Washington University Faculty of Medicine, Department of Pathology and Immunology, Washington, USA
| | - Louis P. Dehner
- Washington University Faculty of Medicine, Department of Pathology and Immunology, Washington, USA
| | - Katherine Semenkovich
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Ana María Arbeláez
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA,* Address for Correspondence: Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA Phone: +3144546051 E-mail:
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Khan NE, Ling A, Raske ME, Harney LA, Carr AG, Field A, Harris AK, Williams GM, Dehner LP, Messinger YH, Hill DA, Schultz KAP, Stewart DR. Structural renal abnormalities in the DICER1 syndrome: a family-based cohort study. Pediatr Nephrol 2018; 33:2281-2288. [PMID: 30178239 PMCID: PMC6203641 DOI: 10.1007/s00467-018-4040-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 06/07/2018] [Revised: 07/20/2018] [Accepted: 08/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The DICER1 syndrome is a tumor-predisposition disorder caused by germline pathogenic variation in DICER1 and is associated with cystic nephroma and other renal neoplasms. Dicer1 mouse and rare human DICER1 syndrome case reports describe structural kidney and collecting system anomalies. We investigated renal function and the frequency of structural abnormalities of the kidney and collecting system in individuals with germline loss-of-function variants in DICER1. METHODS In this family-based cohort study, prospectively ascertained germline DICER1-mutation carriers (DICER1-carriers) and unaffected family controls were evaluated at the National Institutes of Health Clinical Center with renal ultrasound and comprehensive laboratory testing. Two radiologists reviewed the imaging studies from all participants for structural abnormalities, cysts, and tumors. RESULTS Eighty-nine DICER1-carriers and 61 family controls were studied. Renal cysts were detected in 1/33 DICER1-carrier children without history of cystic nephroma. Similar proportions of adult DICER1-carriers (8/48; 17%) and controls (11/50; 22%) had ultrasound-detected renal cysts (P = 0.504). 8/89 (9%) DICER1-carriers harbored ultrasound-detected structural abnormalities of varying severity within the collecting system or kidney, nephrolithiasis, or nephrocalcinosis. None of the family controls (0/61) had similar findings on ultrasound (P = 0.02). No meaningful differences in renal laboratory values between DICER1-carriers and unaffected family controls were observed. CONCLUSIONS Our report is the first to systematically characterize renal function and anatomy in a large prospective cohort of DICER1-carriers and DICER1-negative family controls. DICER1-carriers may be at increased risk of structural anomalies of the kidney or collecting system. The role for DICER1 in renal morphogenesis merits additional investigation.
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Affiliation(s)
- Nicholas E. Khan
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850
| | - Alexander Ling
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892
| | - Molly E. Raske
- Department of Radiology, Children’s Minnesota, Minneapolis, MN 55404
| | | | | | - Amanda Field
- Division of Pathology and Center for Clinical and Immunology Research, Children’s National Health System, Washington, DC, 20010;,Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC, 20037
| | - Anne K. Harris
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN 55404;,International Pleuropulmonary Blastoma Registry, Minneapolis, MN, 55404;,International Ovarian and Testicular Stromal Tumor Registry, Minneapolis, MN, 55404
| | - Gretchen M. Williams
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN 55404;,International Pleuropulmonary Blastoma Registry, Minneapolis, MN, 55404
| | - Louis P. Dehner
- Department of Pathology, Washington University in St. Louis, St. Louis, MS, 63130
| | - Yoav H. Messinger
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN 55404;,International Pleuropulmonary Blastoma Registry, Minneapolis, MN, 55404
| | - D. Ashley Hill
- Division of Pathology and Center for Clinical and Immunology Research, Children’s National Health System, Washington, DC, 20010;,Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC, 20037
| | - Kris Ann P. Schultz
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN 55404;,International Pleuropulmonary Blastoma Registry, Minneapolis, MN, 55404;,International Ovarian and Testicular Stromal Tumor Registry, Minneapolis, MN, 55404
| | - Douglas R. Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850
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Chen L, Hsi AC, Kothari A, Dehner LP, Hayashi RJ, Coughlin CC. Granulomatous dermatitis secondary to vemurafenib in a child with Langerhans cell histiocytosis. Pediatr Dermatol 2018; 35:e402-e403. [PMID: 30216522 DOI: 10.1111/pde.13613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We present a 3-year-old boy with Langerhans cell histiocytosis who developed granulomatous dermatitis while taking vemurafenib. Vemurafenib currently has Food and Drug Administration approval for the treatment of BRAF V600E+ metastatic melanoma in adults, but recent discoveries of BRAF V600E in more than half of tested Langerhans cell histiocytosis lesions have prompted clinical trials of vemurafenib therapy for children with refractory, multisystem Langerhans cell histiocytosis. This report contributes to the knowledge of its potential side effects when used in children.
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Affiliation(s)
- Lily Chen
- School of Medicine, Washington University, St. Louis, Missouri
| | - Andy C Hsi
- Department of Pathology, California Skin Institute, San Jose, California.,Lauren V. Ackerman Laboratory of Surgical Pathology and Dermatopathology Center, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri
| | - Alok Kothari
- Division of Hematology/Oncology, Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology and Dermatopathology Center, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri
| | - Robert J Hayashi
- Division of Hematology/Oncology, Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, School of Medicine, Washington University, St. Louis, Missouri
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Abstract
INTRODUCTION Clear cell sarcoma of the kidney (CCSK) is childhood neoplasm with its own distinctive pattern of metastasis and may appear after a disease free interval of 5 years or more. MATERIALS AND METHODS Histopathology and immunohistochemistry were available from the radical nephrectomy and the later partial cystectomy, which was performed after a seven disease-free interval. RESULTS The pathologic features of the primary tumor were those of a classic CCSK with a monotypic pattern of uniform rounded to ovoid tumor cells with a background network of delicate blood vessels. By contrast, the bladder recurrence had a myxoid hypocellular appearance (one of the known variant patterns of CCSK). Both tumors displayed immunopositivity for Cyclin-D1 and CD117 with a less intense reaction in the bladder metastasis. CONCLUSIONS This case demonstrates that CCSK has the potential to metastasize after a prolonged disease-free interval and may have deceptively bland histopathologic features.
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Affiliation(s)
- Adam Lang
- a Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish Hospital/St. Louis Children's Hospital , Washington University Medical Center , St. Louis , Missouri , USA
| | - Louis P Dehner
- a Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish Hospital/St. Louis Children's Hospital , Washington University Medical Center , St. Louis , Missouri , USA
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Abstract
The acquired melanocytic nevus is the most common lesion encountered by pediatric pathologists and dermatopathologists in their daily practice. In most cases, there are few difficulties in histopathologic diagnosis. However, it is the acquired melanocytic lesion known as the Spitz nevus, with its intrinsic atypical features which becomes the challenge since it exists along a histopathologic and biologic continuum from the atypical Spitz tumor to spitzoid melanoma. The frustration with some of these spitzoid lesions is that even the "experts" cannot agree as to the differentiation of one from the other even at the level of molecular genetics. Other melanocytic lesions are discussed including the congenital melanocytic nevus with its proliferative nodule(s) and melanoma as the ultimate complication. Although uncommon, cutaneous melanoma in the first 2 decades is emerging as a clinical problem especially in young women in the second decade of life. These are ultraviolet-associated neoplasms whose histopathologic and prognostic features are identical to the adult experience. Considerable progress has been made over the past 15 to 20 years in our understanding of cutaneous melanocytic lesions, but gaps still exist in the important group of spitzoid lesions. It can also be anticipated that more cutaneous melanomas in children will be seen in the future based upon epidemiologic studies.
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Affiliation(s)
- Chen Yang
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 2 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri
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Abstract
This overview of mesenchymal tumors presenting in the skin and/or subcutis in children brings together the range of neoplasms and hamartomas which are seen in this age-group. It is not surprising from the perspective of the pediatric or general surgical pathologist that vascular anomalies, including true neoplasms and vascular malformations, are the common phenotypic category. Since there is considerable morphologic overlap among these lesions, clinicopathologic correlation may be more important than for many of the other mesenchymal tumors. The skin and subcutis are the most common sites of clinical presentation for the infantile myofibroma which is the most common of fibrous mesenchymal tumors in children. Several of the other mesenchymal tumors are more common adults-like dermatofibrosarcoma protuberans, but nonetheless have an important presence in children, even as a congenital neoplasm. A lipomatous tumor in a young child should be considered as a possible manifestation of an overgrowth syndrome.
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Affiliation(s)
- Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri.,2 Dermatopathology Center and Division of Dermatology, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 3 Department of Pathology, University of Virginia, Charlottesville, Virginia.,4 Department of Dermatology, University of Virginia, Charlottesville, Virginia
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Abstract
This article focuses on cutaneous hematopoietic neoplasms that are more likely to be encountered in the pediatric age-group and includes both lymphoproliferative and histiocytic disorders. The cutaneous hematologic disorders in children have a different epidemiologic profile to what is seen during adulthood. Although mycosis fungoides is the most frequent form of cutaneous lymphoma in adults, it is very rare in children. Because lymphoblastic leukemias and lymphomas are more frequent in the pediatric setting, cutaneous leukemic infiltrates are relatively common in this age-group. Similarly, histiocytic disorders are more common in children, particularly Langerhans cell histiocytosis and juvenile xanthogranuloma. Notably, the histiocytic disorders have undergone significant modifications on their nomenclature in the basis of the molecular characteristics that are present in them. A summary of the most frequent cutaneous hematopoietic disorders in children will be discussed further in this review.
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Affiliation(s)
- Alejandro A Gru
- 1 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 2 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital and Dermatopathology, Washington University Medical Center, St. Louis, Missouri
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