Epithelioid Variant of Angiosarcoma Associated with an Arteriovenous Fistula in the Setting of Post-Renal Transplant

Introduction/Objective

Angiosarcomas are rare malignant tumors that mimic the function and morphologic features of endothelium. They are commonly associated with prior radiation exposure, but have rarely been reported arising in synthetic graft material, congenital syndromes, or in the vicinity of an ateriovenous fistula (AVF). Herein, we report the clinical and histologic features of an epithelioid angiosarcoma arising in an AFV in the setting of post-renal transplant.

Methods

A 67-year-old Native American man with a cadaveric kidney transplant twelve years earlier for end-stage renal disease presented with pain at the site of his wrist AVF. The initial clinical impression was of a thrombosed fistula, and a routine AVF revision was performed. Histologic sections demonstrated an infiltrative neoplasm comprised of round, moderately pleomorphic, epithelioid cells with centrally located nuclei and prominent nucleoli, which was associated with a large thrombosed vessel. By immunohistochemistry the neoplastic cells expressed CD31 and ERG, with patchy reactivity for CD34, pan-cytokeratin, and SMA. Desmin, caldesmon, calponin, EMA, and SOX10 were negative. INI-1 was retained. A re-excision was necessary for complete margination of the lesion, and demonstrated similar histologic findings to the initial specimen.

Conclusion

Angiosarcoma specimens in which epithelioid appearing cells predominate are classified as epithelioid angiosarcomas, a highly aggressive variant that conveys a comparatively worse prognosis than their non-epithelioid counterparts. These classically are positive for CD31, Fli-1, Factor VIII and vimentin, with variable staining for EMA, cytokeratins, and CD34. Epithelioid angiosarcoma arising from an AVF is a rare entity, with less than 30 cases reported in the literature. The diagnosis should be considered in patients presenting with an enlarging mass, pain, or bruising near a previously quiescent AVF site. Given the aggressive nature of this disease process, there may be consideration for routine submission of AVF revision specimens for histologic evaluation.

Comparing Deep Learning and Immunohistochemistry in Determining the Site of Origin for Well-Differentiated Neuroendocrine Tumors

Background

Determining the site of origin for metastatic well-differentiated neuroendocrine tumors (WDNETs) is challenging, and immunohistochemical (IHC) profiles do not always lead to a definitive diagnosis. We sought to determine if a deep-learning convolutional neural network (CNN) could improve upon established IHC profiles in predicting the site of origin in a cohort of WDNETs from the common primary sites.

Materials and Methods

Hematoxylin and eosin (H&E)-stained tissue microarrays (TMAs) were created using 215 WDNETs arising from the known primary sites. A CNN trained and tested on 60% (n = 130) and 40% (n = 85) of these cases, respectively. One hundred and seventy-nine cases had TMA tissue remaining for the IHC analysis. These cases were stained with IHC markers pPAX8, CDX2, SATB2, and thyroid transcription factor-1 (markers of pancreas/duodenum, ileum/jejunum/duodenum, colorectum/appendix, and lung WDNET sites of origin, respectively). The CNN diagnosis was deemed correct if it designated a majority or plurality of the tumor area as the known site of origin. The IHC diagnosis was deemed correct if the most specific marker for a particular site of origin met an H-score threshold determined by two pathologists.

Results

When all cases were considered, the CNN correctly identified the site of origin at a lower rate compared to IHC (72% vs. 82%, respectively). Of the 85 cases in the CNN test set, 66 had sufficient TMA material for IHC stains, thus 66 cases were available for a direct case-by-case comparison of IHC versus CNN. The CNN correctly identified 70% of these cases, while IHC correctly identified 76%, a finding that was not statistically significant (P = 0.56).

Conclusion

A CNN can identify WDNET site of origin at an accuracy rate close to the current gold standard IHC methods.

A-29 The Mediating Effects of Personality on Sleep Quality and Executive Dysfunction

Objective

This study examined the relationship between personality traits, sleep quality, and executive dysfunction.

Method

Participants were 195 college students (65.6% female; 53.8% Caucasian, 33.3% African American, 4.1% Asian,; age range 17 – 46 years, Mage = 19.58 years, SD = 3.41; 73.3% no psychological diagnosis) who completed the following attention tasks: 120-item IPIP Neo (NEO), the Pittsburgh Sleep Quality Index (PSQI), and the Barkley Deficits in Executive Functioning Rating Scale-IV (BDEFS-IV).

Results

Mediation analyses were tested using 5000 bootstrapping resamples with bias-corrected 95% confidence estimates to investigate if personality traits mediated the effect of sleep quality on executive dysfunction. The total effect between PSQI and BDEFS-IV was significant, F(1,193) = 15.80, p < .001, r2 = .08, 95% CI = 1.79, 5.31). The model was significant when examining the relationship between the independent variable, mediators, and dependent variable, F(6,188) = 29.31, p < .000, r2 = .48. Three of the five mediators demonstrated significant indirect effects: neuroticism, (B = 1.07, t (188) = 5.39, p = .000, 95% CI = .68, 1.46), extraversion (B = .63, t (188) = 3.46, p = .000, 95% CI = .27, .99), and conscientiousness (B = -1.91, t (188) = -7.46, p = .000, 95% CI = -2.42, -1.41). The direct effect of PSQI and BDEFS-IV was not significant (B = .731, t (188) = .99, p = .32, 95% CI = -.72, 2.18) when controlling for all five mediators, confirming a full mediation.

Conclusions

Neuroticism, Extraversion, and Conscientiousness significantly mediated the relationship between self-reported sleep quality and executive dysfunction.

A-64 The Relationship between Big-5 Personality Factors and Cognitive Health

Objective

The purpose of the current study was to examine the relationship between factors of personality and cognitive health.

Methods

Two hundred and two participants (M age = 19.51, SD = 3.33; M education = 12.40, SD = .75; 72.3% Female, 55.3% White, 36.0% African American, 4.6% Asian, 4.1% Other) completed the cognitive health questionnaire (CHQ) and a 120-item International Personality Item Pool Representation of the NEO-PI-R (IPIP-NEO) as a part of a larger battery in an institutional setting. A CHQ total score was calculated based on items of four positive factors of cognitive health including social/intellectual activities, nutrition, exercise, and eating habits.

Results

A multiple linear regression using backwards elimination was calculated to predict scores on the Cognitive Health Questionnaire utilizing the five personality factors of the IPIP-NEO. The overall five-factor regression model yielded a significant regression equation (F(5,196) = 7.76, p < .001), with an R2 of .165. The final three-factor regression model consisting of extraversion, openness, and consciousness yielded significant results (F(3,198) = 12.70, p < .001), with an R2 of .161.

Conclusions

This exploratory study investigated the relationship between factors of personality and cognitive health. Although a multiple regression model involving all five factors of personality were significantly predictive of cognitive health, the results of this study indicate that greater variance of cognitive health is predicted by extraversion, openness and conscientiousness than neuroticism and agreeableness. Further research should investigate each factor of cognitive health and how these components are predicted by features of personality.

Abstract AS09: Germline mutations in cancer susceptibility genes in BRCA1 and BRCA2 negative families with ovarian and breast cancer

Objectives: Germline mutations in cancer susceptibility genes other than BRCA1 and BRCA2 (BRCA1/2) are found in approximately 6% of women with ovarian, fallopian tube, or primary peritoneal cancer. Our objective was to sequence BRCA1/2-negative ovarian cancer patients with a family history of ovarian or breast cancer to identify inherited mutations that may explain the familial risk.

Methods: We used a targeted capture, massively parallel sequencing test called BROCA on ovarian cancer probands with a family history of ovarian or breast cancer, or a personal history of breast cancer. BROCA testing included all known breast and ovarian cancer genes. Only clear loss of function mutations were included. 118 probands were ascertained from a gynecologic oncology tissue bank or outside referrals and provided informed consent. A family history of ovarian cancer was defined as having a first or second degree relative with ovarian cancer. A family history of breast cancer was defined as having a first or second degree relative with pre-menopausal breast cancer, or 2 or more regardless of menopausal status. Subjects were only included in one category.

Results: Of 118 ovarian cancer probands, 22 (18.6%) were found to carry deleterious mutations in non-BRCA1/2 cancer susceptibility genes. 8/29 (27.6%) ovarian cancer patients with a personal history of breast cancer had mutations in 7 genes (2 CHEK2, 2 RAD51D, 1 BRIP1, 1 TP53, 1 ATM, and one with both PALB2 and PMS2). This included mutations found in 2/5 (40%) who also had a family history of ovarian cancer and 4/10 (40%) who also had a family history of breast cancer. 38 patients had a family history of ovarian cancer with no personal history of breast cancer; 9/38 (23.7%) had mutations in 5 genes (3 BRIP1, 3 RAD51C, 1 RAD51D, 1 TP53, and 1 ATM). Finally, 5/51 (9.8%) ovarian cancer patients with a family history of breast cancer and no personal history of breast cancer had mutations in 5 genes (1 MSH6, 1 FAM175A, 1 NBN, 1 PALB2, and 1 CHEK2).

Conclusions: Germline mutations in DNA-repair genes are present in a substantial fraction of BRCA1/2-negative ovarian cancer patients with a personal or family history suggestive of inherited disease. These women may benefit from multiplex gene testing. The detection of inherited mutations in these women may be useful to identify the risk of other cancers, to inform family members of possible risk, and to direct therapy by suggesting candidates for PARP inhibitor therapy.

Citation Format: B. Norquist, M. Harrell, T. Walsh, J. Mandell, S. Bernards, K. Agnew, M. Lee, K. Pennington, M.C. King, E. Swisher. Germline mutations in cancer susceptibility genes in BRCA1 and BRCA2 negative families with ovarian and breast cancer [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr AS09.

Chaperoning of glucocorticoid receptors

A multiprotein hsp90/hsp70-based chaperone machinery functions as a 'cradle-to-grave' system for regulating the steroid binding, trafficking and turnover of the glucocorticoid receptor (GR). In an ATP-dependent process where hsp70 and hsp90 act as essential chaperones and Hop, hsp40, and p23 act as nonessential co-chaperones, the machinery assembles complexes between the ligand binding domain of the GR and hsp90. During GR-hsp90 heterocomplex assembly, the hydrophobic ligand-binding cleft is opened to access by steroid, and subsequent binding of steroid within the cleft triggers a transformation of the receptor such that it engages in more dynamic cycles of assembly/disassembly with hsp90 that are required for rapid dynein-dependent translocation to the nucleus. Within the nucleus, the hsp90 chaperone machinery plays a critical role both in GR movement to transcription regulatory sites and in the disassembly of regulatory complexes as the hormone level declines. The chaperone machinery also plays a critical role in stabilization of the GR to ubiquitylation and proteasomal degradation. The initial GR interaction with hsp70 appears to be critical for the triage between hsp90 heterocomplex assembly and preservation of receptor function vs CHIP-dependent ubiquitylation and proteasomal degradation. The hsp90 chaperone machinery is ubiquitous and functionally conserved among eukaryotes, and it is possible that all physiologically significant actions of hsp90 require the hsp70-dependent assembly of client protein-hsp90 heterocomplexes.

[Socioeconomic and nutritional localization, quantification and characterization of functional groups in Panama]

Even though there has been an increase in the coverage of governmental services and an adequate national food availability, malnutrition continues to exist in Panamanian children. In order to geographically and administratively identify those groups more seriously affected by this problem and orient governmental actions towards them, data from the National Nutrition Survey carried out in 1980 in 14 occupational (functional) groups were classified. Social, economic and cultural characteristics of each functional group were associated with food and nutrition problems. More than half of the malnourished children fall within the functional groups who work in the agricultural/sector. Within them, more than 40% of the malnourished live in homes where two-thirds of their income is derived from work performed outside their own farms. In urban as well as in rural areas low food availability exists at the family level in 25% of the families with inadequate diets studied. The food problem in the rural area is worsened due to limited access to health services and poor environmental conditions. Therefore, the malnutrition problem in Panama is linked to low incomes that prevent acquisition of sufficient foods and other goods and services, as well as to the difficulty of accessibility to public services by an important part of the population.