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Tran L, Christensen P, Barroeta JE, Hunter K, Sookram J, McGregor SM, Wilkinson N, Orsi NM, Lastra RR. Prognostic Significance of Size, Location, and Number of Lymph Node Metastases in Endometrial Carcinoma. Int J Gynecol Pathol 2023; 42:376-389. [PMID: 36044323 DOI: 10.1097/pgp.0000000000000897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Regional lymph node metastasis is a well-established negative predictive prognostic factor in endometrial carcinomas. Recently, our approach to the pathologic evaluation of lymph nodes in endometrial carcinomas has changed, mainly due to the utilization of immunohistochemical stains in the assessment of sentinel lymph nodes, which may result in the identification of previously unrecognized disease [particularly isolated tumor cells (ITCs)] on hematoxylin and eosin stained slides. However, the clinical significance of this finding is not entirely clear. Following the experience in other organs systems such as breast, the Eight Edition of the American Joint Committee on Cancer's Cancer Staging Manual has recommended utilizing the N0(i+) terminology for this finding, without impact in the final tumor stage. We performed a comparative retrospective multi-institutional survival analysis of 247 patients with endometrial carcinoma with regional lymph node metastasis of various sizes identified in nonsentinel lymphadenectomy, demonstrating that the cumulative survival of patients with isolated tumor cells in regional lymph nodes is not statistically different from patient with negative lymph nodes, and is statistically different from those with lymph nodes showing micrometastasis or larger metastatic deposits. In addition, we evaluated the prognostic implications of the number of involved regional lymph nodes, demonstrating a worsening prognosis as the number of involved lymph nodes increases from none to one, and from one to more than one. Our data suggests that regional lymph nodes with isolated tumor cells in patients with endometrial carcinoma should likely be considered, for staging purposes, as negative lymph nodes, simply indicating their presence with the (i+) terminology.
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Devins KM, Wilkinson N, Barton-Smith P, Jaio L, Young RH. Cystic Walthard Nests of the Peritoneal Diaphragm: A Report of 3 Cases of a Common Process at an Unusual Site and Occurring in Patients With Endometriosis. Int J Gynecol Pathol 2023; 42:196-200. [PMID: 36731091 DOI: 10.1097/pgp.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nests of cells resembling urothelium, eponymously named "Walthard nests," are well-known incidental findings over the fallopian tube and occasionally undergo cystification resulting in clinical detection and surgical removal. Only rarely is this process noted outside the pelvic peritoneum. Herein we describe cystic Walthard nests occurring in the diaphragmatic peritoneum of three patients (aged 25, 36, and 39 yr) undergoing surgical evaluation for presumed endometriosis. In each case, small pearly white nodules on the diaphragmatic peritoneum were noted and biopsied. Microscopic examination revealed cystic spaces filled with pale eosinophilic secretion. The cysts were lined mostly by stratified transitional cells with pale eosinophilic to focally clear cytoplasm. Umbrella cells were focally present in all cases, and 1 showed focal glandular differentiation resembling cystitis glandularis. In areas, the epithelial cells became flattened and attenuated and nuclei were bland. By immunohistochemistry, all were positive for GATA3, cytokeratin 7, and BEREP4 and negative for cytokeratin 20, estrogen receptor, and WT-1. Walthard nests can rarely occur outside the pelvic peritoneum where they may be noted incidentally during surgery for other indications. This should be readily distinguished pathologically from other peritoneal lesions but lack of significant prior comment of them occurring on the diaphragm may result in diagnostic difficulty.
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Lewin J, Egbe A, Ellery P, Wilkinson N, MacDonald N, Kotsopoulos IC, Olaitan A. Female Genital Tract Melanoma: 10 Years of Experience at a Single Tertiary Center. J Low Genit Tract Dis 2021; 25:142-145. [PMID: 33587530 DOI: 10.1097/lgt.0000000000000591] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Malignant melanoma of the female genital tract is a rare disease with poor prognosis, with controversies remaining in its staging and management. In this study, we investigate clinical, pathological, and outcome data for patients referred to a tertiary cancer center with female genital tract melanoma over a decade. METHODS Patients were retrospectively identified using a search of pathology reports to identify all cases of female genital tract melanoma from 2007 to 2019. Electronic patient records were used to record clinical information. Histopathology specimens were reviewed by a gynecological and dermatological pathology specialist. RESULTS We identified 30 cases of genital tract melanoma, of which 19 were vulvar, 10 were vaginal, and 1 cervical. Overall survival at 1, 3, and 5 years was found to be 80%, 60%, and 57%. Patients who died were not significantly older at presentation than patients who survived (62 y vs 69 y, p = .215). No association was found between mortality and microscopic ulceration, lymphovascular invasion, pigmentation, resection margins, or radical versus local surgery.Nonvulvar lesions were significantly associated with mortality compared with vulvar lesions (p = .0018), despite similar age and Breslow thickness. Five patients were diagnosed at in situ stage, all of these were vulvar. Even after excluding these melanomas in situ, nonvulvar melanomas still had a significantly worse mortality rate (p = .048). A higher proportion of nonvulvar lesions than vulvar lesions displayed loss of pigmentation (p = .026). CONCLUSIONS Nonvulvar genital tract melanomas carry a significantly worse prognosis. Survival was not related to resection margins, supporting the use of more conservative surgical margins.
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Affiliation(s)
- Jonathan Lewin
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Azelle Egbe
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Peter Ellery
- Department of Cellular Pathology, University College London Hospital, London, United Kingdom
| | - Nafisa Wilkinson
- Department of Cellular Pathology, University College London Hospital, London, United Kingdom
| | - Nicola MacDonald
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Ioannis C Kotsopoulos
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Adeola Olaitan
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
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Gaba F, Robbani S, Singh N, McCluggage WG, Wilkinson N, Ganesan R, Bryson G, Rowlands G, Tyson C, Arora R, Saridogan E, Hanson H, Burnell M, Legood R, Evans DG, Menon U, Manchanda R. Preventing Ovarian Cancer through early Excision of Tubes and late Ovarian Removal (PROTECTOR): protocol for a prospective non-randomised multi-center trial. Int J Gynecol Cancer 2020; 31:286-291. [PMID: 32907814 DOI: 10.1136/ijgc-2020-001541] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy is the 'gold standard' for preventing tubo-ovarian cancer in women at increased risk. However, when performed in pre-menopausal women, it results in premature menopause and associated detrimental health consequences. This, together with acceptance of the central role of the fallopian tube in etiopathogenesis of high-grade serous carcinoma, by far the most common type of tubo-ovarian cancer, has led to risk-reducing early salpingectomy with delayed oophorectomy being proposed as a two-step surgical alternative for pre-menopausal women declining/delaying oophorectomy. PRIMARY OBJECTIVE To evaluate the impact on sexual function of risk-reducing early salpingectomy, within a two-step, risk-reducing, early salpingectomy with delayed oophorectomy tubo-ovarian cancer prevention strategy in pre-menopausal women at increased risk of tubo-ovarian cancer. STUDY HYPOTHESIS Risk-reducing early salpingectomy is non-inferior for sexual and endocrine function compared with controls; risk-reducing early salpingectomy is superior for sexual/endocrine function, non-inferior for quality-of-life, and equivalent in satisfaction to the standard risk-reducing salpingo-oophorectomy. TRIAL DESIGN Multi-center, observational cohort trial with three arms: risk-reducing early salpingectomy with delayed oophorectomy; risk-reducing salpingo-oophorectomy; controls (no surgery). Consenting individuals undergo an ultrasound, serum CA125, and follicle-stimulating hormone measurements and provide information on medical history, family history, quality-of-life, sexual function, cancer worry, psychological well-being, and satisfaction/regret. Follow-up by questionnaire takes place annually for 3 years. Women receiving risk-reducing early salpingectomy can undergo delayed oophorectomy at a later date of their choosing, or definitely by the menopause. MAJOR INCLUSION/EXCLUSION CRITERIA Inclusion criteria: pre-menopausal; aged >30 years; at increased risk of tubo-ovarian cancer (mutation carriers or on the basis of a strong family history); completed their family (for surgical arms). EXCLUSION CRITERIA post-menopausal; previous bilateral salpingectomy or bilateral oophorectomy; pregnancy; previous tubal/ovarian/peritoneal malignancy; <12 months after cancer treatment; clinical suspicion of tubal/ovarian cancer at baseline. PRIMARY ENDPOINT Sexual function measured by validated questionnaires. SAMPLE SIZE 1000 (333 per arm). ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS It is estimated recruitment will be completed by 2023 and results published by 2027. TRIAL REGISTRATION NUMBER ISRCTN registry: 25 173 360 (https://doi.org/10.1186/ISRCTN25173360).
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Affiliation(s)
- Faiza Gaba
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | | | - Naveena Singh
- Barts Health NHS Trust, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - W Glenn McCluggage
- Department of Pathology, Royal Belfast Hospital; United Kingdom, Belfast, UK
| | - Nafisa Wilkinson
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Raji Ganesan
- Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Rupali Arora
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ertan Saridogan
- Department of Gynaecology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen Hanson
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Rosa Legood
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK .,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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5
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Massias JS, Smith EMD, Al-Abadi E, Armon K, Bailey K, Ciurtin C, Davidson J, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, McErlane F, Mewar D, Modgil G, Moots R, Pilkington C, Ramanan AV, Rangaraj S, Riley P, Sridhar A, Wilkinson N, Beresford MW, Hedrich CM. Clinical and laboratory characteristics in juvenile-onset systemic lupus erythematosus across age groups. Lupus 2020; 29:474-481. [PMID: 32233733 PMCID: PMC7528537 DOI: 10.1177/0961203320909156] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [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] [Indexed: 12/19/2022]
Abstract
Background Systemic lupus erythematous (SLE) is a systemic autoimmune/inflammatory condition. Approximately 15–20% of patients develop symptoms before their 18th birthday and are diagnosed with juvenile-onset SLE (JSLE). Gender distribution, clinical presentation, disease courses and outcomes vary significantly between JSLE patients and individuals with adult-onset SLE. This study aimed to identify age-specific clinical and/or serological patterns in JSLE patients enrolled to the UK JSLE Cohort Study. Methods Patient records were accessed and grouped based on age at disease-onset: pre-pubertal (≤7 years), peri-pubertal (8–13 years) and adolescent (14–18 years). The presence of American College of Rheumatology (ACR) classification criteria, laboratory results, disease activity [British Isles Lupus Assessment Group (BILAG) and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) scores] and damage [Systemic Lupus International Collaborating Clinics (SLICC) damage index] were evaluated at diagnosis and last follow up. Results A total of 418 JSLE patients were included in this study: 43 (10.3%) with pre-pubertal disease onset; 240 (57.4%) with peri-pubertal onset and 135 (32.3%) were diagnosed during adolescence. At diagnosis, adolescent JSLE patients presented with a higher number of ACR criteria when compared with pre-pubertal and peri-pubertal patients [pBILAG2004 scores: 9(4–20] vs. 7(3–13] vs. 7(3–14], respectively, p = 0.015] with increased activity in the following BILAG domains: mucocutaneous (p = 0.025), musculoskeletal (p = 0.029), renal (p = 0.027) and cardiorespiratory (p = 0.001). Furthermore, adolescent JSLE patients were more frequently ANA-positive (p = 0.034) and exhibited higher anti-dsDNA titres (p = 0.001). Pre-pubertal individuals less frequently presented with leukopenia (p = 0.002), thrombocytopenia (p = 0.004) or low complement (p = 0.002) when compared with other age groups. No differences were identified in disease activity (pBILAG2004 score), damage (SLICC damage index) and the number of ACR criteria fulfilled at last follow up. Conclusions Disease presentations and laboratory findings vary significantly between age groups within a national cohort of JSLE patients. Patients diagnosed during adolescence exhibit greater disease activity and “classic” autoantibody, immune cell and complement patterns when compared with younger patients. This supports the hypothesis that pathomechanisms may vary between patient age groups.
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Affiliation(s)
- J S Massias
- School of Medicine, University of Liverpool, UK
| | - E M D Smith
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - E Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - K Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - K Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Davidson
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - K Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - D P Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - A Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - V Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds, UK
| | - F McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - D Mewar
- Department of Rheumatology, Royal Liverpool University Hospital, Liverpool, UK
| | - G Modgil
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
| | - R Moots
- Department of Rheumatology, University Hospital Aintree, Liverpool, UK
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - A V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - S Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals Nottingham, UK
| | - P Riley
- Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - A Sridhar
- Department of Paediatrics, Leicester Royal Infirmary, Leicester, UK
| | - N Wilkinson
- Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
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Gore M, Hackshaw A, Brady WE, Penson RT, Zaino R, McCluggage WG, Ganesan R, Wilkinson N, Perren T, Montes A, Summers J, Lord R, Dark G, Rustin G, Mackean M, Reed N, Kehoe S, Frumovitz M, Christensen H, Feeney A, Ledermann J, Gershenson DM. An international, phase III randomized trial in patients with mucinous epithelial ovarian cancer (mEOC/GOG 0241) with long-term follow-up: and experience of conducting a clinical trial in a rare gynecological tumor. Gynecol Oncol 2019; 153:541-548. [PMID: 31005287 PMCID: PMC6559214 DOI: 10.1016/j.ygyno.2019.03.256] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 02/07/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
Abstract
Objectives We evaluated four different treatment regimens for advanced-stage mucinous epithelial ovarian cancer. Methods We conducted a multicenter randomized factorial trial (UK and US). Patients were diagnosed with primary mEOC: FIGO stage II–IV or recurrence after stage I disease. Treatment arms were paclitaxel-carboplatin, oxaliplatin-capecitabine, paclitaxel-carboplatin-bevacizumab, or oxaliplatin-capecitabine-bevacizumab. Chemotherapy was given 3-weekly for 6 cycles, and bevacizumab (3-weekly) was continued as maintenance (for 12 cycles). Endpoints included overall-survival (OS), progression-free survival (PFS), toxicity and quality of life (QoL). Results The trial stopped after 50 patients were recruited due to slow accrual. Median follow-up was 59 months. OS hazard ratios (HR) for the two main comparisons were: 0.78 (p = 0.48) for Oxal-Cape vs. Pac-Carbo (each with/without bevacizumab), and 1.04 (p = 0.92) for bevacizumab vs. no bevacizumab. Corresponding PFS HRs were: 0.84 and 0.80. Retrospective central pathology review revealed only 45% (18/40) cases with available material had confirmed primary mEOC. Among these, OS HR for Oxal-Cape vs. Pac-Carbo was 0.36 (p = 0.14); PFS HR = 0.62 (p = 0.40). Grade 3–4 toxicity was seen in 61% Pac-Carbo, 61% Oxal-Cape, 54% Pac-Carbo-Bev, and 85% Oxal-Cape-Bev. QoL was similar between the four arms. Conclusion mEOC/GOG0241 represents an example of a randomized rare tumor trial. Logistical challenges led to early termination, including difficulties in local histopathological diagnosis and accessing drugs outside their labelled indication. There was misalignment between central funders who support clinical trials in rare cancers and the deprioritisation of such work by those managing and funding research at a local level. Rare cancer trials should include centralised pathology review before treatment. Clinical trial registry number: ISRCTN83438782. mEOC/GOG-0241 is one of the first international rare tumor trials. Oxaliplatin/capecitabine might be worth further study. Long-term follow-up is feasible in rare tumors. Challenges were lack of local resources and funding for experimental licenced therapies.
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Affiliation(s)
- Martin Gore
- Royal Marsden NHS Foundation Trust, London, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.
| | | | | | - Richard Zaino
- Penn State Health Milton S. Hershey Medical Centre, PA, USA
| | | | | | - Nafisa Wilkinson
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ana Montes
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeffrey Summers
- Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK
| | - Rosemary Lord
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Graham Dark
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Sean Kehoe
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | | | | | - Amanda Feeney
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
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7
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Smith EMD, Al-Abadi E, Armon K, Bailey K, Ciurtin C, Davidson J, Gardner-Medwin J, Haslam K, Hawley D, Leahy A, Leone V, McErlane F, Mewar D, Modgil G, Moots R, Pilkington C, Ramanan A, Rangaraj S, Riley P, Sridhar A, Wilkinson N, Beresford MW, Hedrich CM. Outcomes following mycophenolate mofetil versus cyclophosphamide induction treatment for proliferative juvenile-onset lupus nephritis. Lupus 2019; 28:613-620. [DOI: 10.1177/0961203319836712] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Juvenile-onset systemic lupus erythematosus (JSLE) is more severe than adult-onset disease, including more lupus nephritis (LN). Despite differences in phenotype/pathogenesis, treatment is based upon adult trials. This study aimed to compare treatment response, damage accrual, time to inactive LN and subsequent flare, in JSLE LN patients treated with mycophenolate mofetil (MMF) versus intravenous cyclophosphamide (IVCYC). Methods UK JSLE Cohort Study participants, ≤16 years at diagnosis, with ≥4 American College of Rheumatology criteria for SLE, with class III or IV LN, were eligible. Mann–Whitney U tests, Fisher's exact test and Chi-squared tests were utilized for statistical analysis. Results Of the patients, 34/51 (67%) received MMF, and 17/51 (33%) received IVCYC. No significant differences were identified at 4–8 and 10–14 months post-renal biopsy and last follow-up, in terms of renal British Isles Lupus Assessment Grade scores, urine albumin/creatinine ratio, serum creatinine, ESR, anti-dsDNA antibody, C3 levels and patient/physician global scores. Standardized Damage Index scores did not differ between groups at 13 months or at last follow-up. Inactive LN was attained 262 (141–390) days after MMF treatment, and 151 (117–305) days following IVCYC ( p = 0.17). Time to renal flare was 451 (157–1266) days for MMF, and 343 (198–635) days for IVCYC ( p = 0.47). Conclusion This is the largest study to date investigating induction treatments for proliferative LN in children, demonstrating comparability of MMF and IVCYC.
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Affiliation(s)
- EMD Smith
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - K Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - K Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals, Oxford, UK
| | - C Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Davidson
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | - J Gardner-Medwin
- Department of Paediatric Rheumatology, NHS Greater Glasgow and Clyde (Yorkhill Division), Glasgow, UK
| | - K Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - D Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - A Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - V Leone
- Department of Paediatric Rheumatology, Leeds General Infirmary, Leeds, UK
| | - F McErlane
- Department of Paediatric Rheumatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - D Mewar
- Department of Rheumatology, Royal Liverpool University Hospital, Liverpool, UK
| | - G Modgil
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
| | - R Moots
- Department of Rheumatology, University Hospital Aintree, Liverpool, UK
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - A Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
| | - S Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham, UK
| | - P Riley
- Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - A Sridhar
- Department of Paediatrics, Leicester Royal Infirmary, Leicester, UK
| | - N Wilkinson
- Guy's and St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - M W Beresford
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - C M Hedrich
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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8
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Cummings M, Massey KA, Mappa G, Wilkinson N, Hutson R, Munot S, Saidi S, Nugent D, Broadhead T, Wright AI, Barber S, Nicolaou A, Orsi NM. Integrated eicosanoid lipidomics and gene expression reveal decreased prostaglandin catabolism and increased 5-lipoxygenase expression in aggressive subtypes of endometrial cancer. J Pathol 2018; 247:21-34. [PMID: 30168128 DOI: 10.1002/path.5160] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/30/2018] [Accepted: 08/26/2018] [Indexed: 02/06/2023]
Abstract
Eicosanoids comprise a diverse group of bioactive lipids which orchestrate inflammation, immunity, and tissue homeostasis, and whose dysregulation has been implicated in carcinogenesis. Among the various eicosanoid metabolic pathways, studies of their role in endometrial cancer (EC) have very much been confined to the COX-2 pathway. This study aimed to determine changes in epithelial eicosanoid metabolic gene expression in endometrial carcinogenesis; to integrate these with eicosanoid profiles in matched clinical specimens; and, finally, to investigate the prognostic value of candidate eicosanoid metabolic enzymes. Eicosanoids and related mediators were profiled using liquid chromatography-tandem mass spectrometry in fresh frozen normal, hyperplastic, and cancerous (types I and II) endometrial specimens (n = 192). Sample-matched epithelia were isolated by laser capture microdissection and whole genome expression analysis was performed using microarrays. Integration of eicosanoid and gene expression data showed that the accepted paradigm of increased COX-2-mediated prostaglandin production does not apply in EC carcinogenesis. Instead, there was evidence for decreased PGE2 /PGF2α inactivation via 15-hydroxyprostaglandin dehydrogenase (HPGD) in type II ECs. Increased expression of 5-lipoxygenase (ALOX5) mRNA was also identified in type II ECs, together with proportional increases in its product, 5-hydroxyeicosatetraenoic acid (5-HETE). Decreased HPGD and elevated ALOX5 mRNA expression were associated with adverse outcome, which was confirmed by immunohistochemical tissue microarray analysis of an independent series of EC specimens (n = 419). While neither COX-1 nor COX-2 protein expression had prognostic value, low HPGD combined with high ALOX5 expression was associated with the worst overall and progression-free survival. These findings highlight HPGD and ALOX5 as potential therapeutic targets in aggressive EC subtypes. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Michele Cummings
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer & Pathology, St James's University Hospital, Leeds, UK
| | - Karen A Massey
- School of Pharmacy and Centre for Skin Sciences, Bradford School of Pharmacy, School of Life Sciences, University of Bradford, Bradford, UK
| | - Georgia Mappa
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer & Pathology, St James's University Hospital, Leeds, UK
| | - Nafisa Wilkinson
- Department of Cellular Pathology, University College London Hospital NHS Trust, London, UK
| | - Richard Hutson
- Department of Gynaecological Oncology, St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - Sarika Munot
- Department of Gynaecological Oncology, St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - Sam Saidi
- Department of Obstetrics and Gynaecology, Central Clinical School, University of Sydney, Camperdown, Australia
| | - David Nugent
- Department of Gynaecological Oncology, St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - Timothy Broadhead
- Department of Gynaecological Oncology, St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - Alexander I Wright
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer & Pathology, St James's University Hospital, Leeds, UK
| | - Stuart Barber
- Department of Statistics, University of Leeds, Leeds, UK
| | - Anna Nicolaou
- Laboratory for Lipidomics and Lipid Biology, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicolas M Orsi
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer & Pathology, St James's University Hospital, Leeds, UK
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9
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Devlin MJ, Ledermann J, Lockley M, Wilkinson N, McDermott J, Kristeleit R, Miller R. Clear cell ovarian cancer (CCOC): Predicting risk of relapse (ROR). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Devlin MJ, Chandrasekaran D, Singh N, Ledermann JA, Lockley M, McCormack M, Wilkinson N, Miller R, Kristeleit RS. Clear cell ovarian cancer (CCOC): 115 patient (pt) series showing access to experimental therapy may improve response rates in recurrent disease. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rowan Miller
- University College London Cancer Institute, London, United Kingdom
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11
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Cooke SL, Ennis D, Evers L, Dowson S, Chan MY, Paul J, Hirschowitz L, Glasspool RM, Singh N, Bell S, Day E, Kochman A, Wilkinson N, Beer P, Martin S, Millan D, Biankin AV, McNeish IA. The Driver Mutational Landscape of Ovarian Squamous Cell Carcinomas Arising in Mature Cystic Teratoma. Clin Cancer Res 2017; 23:7633-7640. [PMID: 28954785 DOI: 10.1158/1078-0432.ccr-17-1789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 06/29/2017] [Revised: 08/09/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
Purpose: We sought to identify the genomic abnormalities in squamous cell carcinomas (SCC) arising in ovarian mature cystic teratoma (MCT), a rare gynecological malignancy of poor prognosis.Experimental design: We performed copy number, mutational state, and zygosity analysis of 151 genes in SCC arising in MCT (n = 25) using next-generation sequencing. The presence of high-/intermediate-risk HPV genotypes was assessed by quantitative PCR. Genomic events were correlated with clinical features and outcome.Results: MCT had a low mutation burden with a mean of only one mutation per case. Zygosity analyses of MCT indicated four separate patterns, suggesting that MCT can arise from errors at various stages of oogenesis. A total of 244 abnormalities were identified in 79 genes in MCT-associated SCC, and the overall mutational burden was high (mean 10.2 mutations per megabase). No SCC was positive for HPV. The most frequently altered genes in SCC were TP53 (20/25 cases, 80%), PIK3CA (13/25 cases, 52%), and CDKN2A (11/25 cases, 44%). Mutation in TP53 was associated with improved overall survival. In 8 of 20 cases with TP53 mutations, two or more variants were identified, which were bi-allelic.Conclusions: Ovarian SCC arising in MCT has a high mutational burden, with TP53 mutation the most common abnormality. The presence of TP53 mutation is a good prognostic factor. SCC arising in MCT share similar mutation profiles to other SCC. Given their rarity, they should be included in basket studies that recruit patients with SCC of other organs. Clin Cancer Res; 23(24); 7633-40. ©2017 AACR.
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Affiliation(s)
- Susanna L Cooke
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Darren Ennis
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Lisa Evers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Suzanne Dowson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mei Yen Chan
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - James Paul
- Cancer Research UK Clinical Trials Unit, Glasgow, United Kingdom
| | - Lynn Hirschowitz
- Department of Pathology, Birmingham Women's NHS Trust, Birmingham, United Kingdom
| | | | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, United Kingdom
| | - Sarah Bell
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Elizabeth Day
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Agata Kochman
- Department of Pathology, Monklands Hospital, Airdrie, United Kingdom
| | - Nafisa Wilkinson
- Department of Pathology, University College London Hospital, London, United Kingdom
| | - Philip Beer
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Sancha Martin
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David Millan
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Andrew V Biankin
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Iain A McNeish
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom.
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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12
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Nott JP, Pervolaraki E, Benson AP, Bonney EA, Pickering JD, Wilkinson N, Simpson N. Diffusion tensor imaging determines three-dimensional architecture of human cervix: a cross-sectional study. BJOG 2017; 125:812-818. [PMID: 29226548 DOI: 10.1111/1471-0528.15002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the microarchitecture of the cervix using high-resolution diffusion tensor (DT) magnetic resonance imaging (MRI). DESIGN Cross-sectional study. SETTING Leeds, UK. SAMPLE Women undergoing hysterectomy for benign pathology. METHODS Ex-vivo DT-MRI measurements were obtained using a 9.4-T Bruker nuclear magnetic resonance (NMR) spectrometer on seven fixed human cervices obtained at hysterectomy. A deterministic fibre-tracking algorithm was used to indirectly visualise underlying fibre organisation. Inter-regional differences in tissue structure were sought using quantitative measurements of diffusion. MAIN OUTCOME MEASURE The identification of an occlusive structure in the region corresponding to the internal cervical os. RESULTS Fibre tracking demonstrated two regions: an outer circular and inner longitudinal layer. The total circumferential tract volume (TV) was greatest in the proximal region of the cervix (TV: proximal, 271 ± 198 mm3 ; middle, 186 ± 119 mm3 ; distal, 38 ± 36 mm3 ). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measurements were significantly different between regions in all samples (P < 0.0005), indicating greater tract density and organisation towards the internal os. CONCLUSION Fibre tracking infers a system of dense, well-defined, encircling fibres in the proximal region of the cervix, corresponding to the location of the internal os. These findings may provide evidence of specific anatomic microarchitecture within the cervix able to resist intrauterine forces associated with pregnancy. TWEETABLE ABSTRACT Diffusion-tensor MRI derived tractography identified well-defined encircling fibres at the internal os.
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Affiliation(s)
- J P Nott
- Division of Women's and Children's Health, University of Leeds, Leeds, UK
| | - E Pervolaraki
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - A P Benson
- School of Biomedical Sciences, University of Leeds, Leeds, UK.,Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - E A Bonney
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J D Pickering
- Division of Anatomy, School of Medicine, University of Leeds, Leeds, UK
| | - N Wilkinson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nab Simpson
- Division of Women's and Children's Health, University of Leeds, Leeds, UK
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13
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Godbold E, Merriman C, Wilkinson N. 43. National survey of administration of live-vaccines to children on methotrexate or biologic therapies for JIA. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex390.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Lythgoe H, Morgan T, Heaf E, Lloyd O, Al-Abadi E, Armon K, Bailey K, Davidson J, Friswell M, Gardner-Medwin J, Haslam K, Ioannou Y, Leahy A, Leone V, Pilkington C, Rangaraj S, Riley P, Tizard EJ, Wilkinson N, Beresford MW. Evaluation of the ACR and SLICC classification criteria in juvenile-onset systemic lupus erythematosus: a longitudinal analysis. Lupus 2017; 26:1285-1290. [PMID: 28361566 DOI: 10.1177/0961203317700484] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The Systemic Lupus International Collaborating Clinics (SLICC) group proposed revised classification criteria for systemic lupus erythematosus (SLICC-2012 criteria). This study aimed to compare these criteria with the well-established American College of Rheumatology classification criteria (ACR-1997 criteria) in a national cohort of juvenile-onset systemic lupus erythematosus (JSLE) patients and evaluate how patients' classification criteria evolved over time. Methods Data from patients in the UK JSLE Cohort Study with a senior clinician diagnosis of probable evolving, or definite JSLE, were analyzed. Patients were assessed using both classification criteria within 1 year of diagnosis and at latest follow up (following a minimum 12-month follow-up period). Results A total of 226 patients were included. The SLICC-2012 was more sensitive than ACR-1997 at diagnosis (92.9% versus 84.1% p < 0.001) and after follow up (100% versus 92.0% p < 0.001). Most patients meeting the SLICC-2012 criteria and not the ACR-1997 met more than one additional criterion on the SLICC-2012. Conclusions The SLICC-2012 was better able to classify patients with JSLE than the ACR-1997 and did so at an earlier stage in their disease course. SLICC-2012 should be considered for classification of JSLE patients in observational studies and clinical trial eligibility.
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Affiliation(s)
- H Lythgoe
- 1 Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK
- 2 NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - T Morgan
- 1 Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK
| | - E Heaf
- 3 Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - O Lloyd
- 3 Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Al-Abadi
- 4 Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - K Armon
- 5 Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Bailey
- 6 Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, UK
| | - J Davidson
- 7 Royal Hospital for Sick Children, Edinburgh, UK
| | - M Friswell
- 8 The Great North Children's Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - K Haslam
- 10 Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Y Ioannou
- 11 Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - A Leahy
- 12 Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - V Leone
- 13 Leeds Children's Hospital NHS Trust, Leeds, UK
| | - C Pilkington
- 14 Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S Rangaraj
- 15 Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, UK
| | - P Riley
- 16 Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - E J Tizard
- 17 Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | - N Wilkinson
- 18 Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, UK
| | - M W Beresford
- 1 Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK
- 2 NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- 3 Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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15
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Nott J, Pervolaraki E, Benson A, Bonney E, Pickering J, Wilkinson N, Walker J, Simpson N. 135: High field strength small bore magnetic resonance imaging identifies dense, organized, encircling fibers at the cervical internal os. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Dadayal G, Weston M, Young A, Graham J, Mehta K, Wilkinson N, Spencer J. Transvaginal ultrasound (TVUS)-guided biopsy is safe and effective in diagnosing peritoneal carcinomatosis and recurrent pelvic malignancy. Clin Radiol 2016; 71:1184-92. [DOI: 10.1016/j.crad.2016.06.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 05/08/2016] [Accepted: 06/23/2016] [Indexed: 11/29/2022]
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17
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Dyson JK, Wilkinson N, Jopson L, Mells G, Bathgate A, Heneghan MA, Neuberger J, Hirschfield GM, Ducker SJ, Sandford R, Alexander G, Stocken D, Jones DEJ. The inter-relationship of symptom severity and quality of life in 2055 patients with primary biliary cholangitis. Aliment Pharmacol Ther 2016; 44:1039-1050. [PMID: 27640331 PMCID: PMC5082554 DOI: 10.1111/apt.13794] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/06/2016] [Accepted: 08/15/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Age at presentation with primary biliary cholangitis (PBC) is associated with differential response to ursodeoxycholic acid (UDCA) therapy. Younger-presenting patients are less likely to respond to treatment and more likely to need transplant or die from the disease. PBC has a complex impact on quality of life (QoL), with systemic symptoms often having significant impact. AIM To explain the impact of age at presentation on perceived QoL and the inter-related symptoms which impact upon it. METHODS Using the UK-PBC cohort, symptoms were assessed using the PBC-40 and other validated tools. Data were available on 2055 patients. RESULTS Of the 1990 patients reporting a global PBC-QoL score, 66% reported good/neutral scores and 34% reported poor scores. Each 10-year increase in age at presentation was associated with a 14% decrease in risk of poor perceived QoL (OR = 0.86, 95% CI: 0.75-0.98, P < 0.05). All symptom domains were similarly age-associated (P < 0.01). Social dysfunction was the symptom factor with the greatest impact on QoL. Median (interquartile range) PBC-40 social scores for patients with good perceived QoL were 18 (14-23) compared with 34 (29-39) for those with poor QoL. CONCLUSION The majority of patients with primary biliary cholangitis do not feel their QoL is impaired, although impairment is reported by a sizeable minority. Age at presentation is associated with impact on perceived QoL and the symptoms impairing it, with younger patients being more affected. Social dysfunction makes the greatest contribution to QoL impairment, and it should be targeted in trials aimed at improving life quality.
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Affiliation(s)
- J. K Dyson
- Institute of Cellular MedicineNewcastle UniversityNewcastle‐upon‐TyneUK,NIHR Newcastle Biomedical Research CentreNewcastle UniversityNewcastle‐upon‐TyneUK
| | - N. Wilkinson
- Institute of Health and SocietyNewcastle UniversityNewcastle‐upon‐TyneUK
| | - L. Jopson
- Institute of Cellular MedicineNewcastle UniversityNewcastle‐upon‐TyneUK
| | - G. Mells
- Department of HepatologyCambridge University Hospitals NHS Foundation TrustCambridgeUK,Academic Department of Medical GeneticsUniversity of CambridgeCambridgeUK
| | - A. Bathgate
- Scottish Liver Transplant UnitRoyal Infirmary of EdinburghEdinburghUK
| | - M. A. Heneghan
- Institute of Liver StudiesKing's College Hospital NHS Foundation TrustLondonUK
| | - J. Neuberger
- Centre for Liver ResearchNIHR Biomedical Research UnitUniversity of BirminghamBirminghamUK
| | - G. M. Hirschfield
- Centre for Liver ResearchNIHR Biomedical Research UnitUniversity of BirminghamBirminghamUK
| | - S. J. Ducker
- Institute of Cellular MedicineNewcastle UniversityNewcastle‐upon‐TyneUK,NIHR Newcastle Biomedical Research CentreNewcastle UniversityNewcastle‐upon‐TyneUK
| | | | - R. Sandford
- Academic Department of Medical GeneticsUniversity of CambridgeCambridgeUK
| | - G. Alexander
- Department of HepatologyCambridge University Hospitals NHS Foundation TrustCambridgeUK,Academic Department of Medical GeneticsUniversity of CambridgeCambridgeUK
| | - D. Stocken
- Institute of Health and SocietyNewcastle UniversityNewcastle‐upon‐TyneUK
| | - D. E. J. Jones
- Institute of Cellular MedicineNewcastle UniversityNewcastle‐upon‐TyneUK,NIHR Newcastle Biomedical Research CentreNewcastle UniversityNewcastle‐upon‐TyneUK
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18
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Glasspool RM, McNeish IA, Paul J, Lawless CA, Taggart D, Millan DWM, McCluggage WG, Wilkinson N, Barlow CS, Hall G, Waters JS, Banerjee SN, Alexandre J, LE Fur N, Westermann A, Coens C, Jederud C, Mirza MR. NiCCC (ENGOT-GYN1): A randomized phase II study of nintedanib (BIBF1120) compared to chemotherapy in patients with recurrent clear-cell carcinoma of the ovary or endometrium. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps5603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Iain A. McNeish
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
| | - James Paul
- University of Glasgow, Cancer Research UK Clinical Trials Unit,, Glasgow, United Kingdom
| | - Claire A Lawless
- NHS Greater Glasgow & Clyde, Cancer Research UK Clinical Trials Unit, Glasgow, Glasgow, United Kingdom
| | - Diann Taggart
- NHS Greater Glasgow & Clyde, CRUK Clinical Trials Unit, Glasgow, United Kingdom
| | | | - W. Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | | | | | - Geoff Hall
- Leeds Cancer Centre, Leeds, United Kingdom
| | | | | | - Jerome Alexandre
- Department of Medical Oncology, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, Immunomodulatory Therapies Multidisciplinary Study group (CERTIM), Paris, France
| | | | | | - Corneel Coens
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | | | - Mansoor Raza Mirza
- Department of Oncology 5073 Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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19
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Cartwright T, Fraser E, Edmunds S, Wilkinson N, Jacobs K. Journeys of adjustment: the experiences of adolescents living with juvenile idiopathic arthritis. Child Care Health Dev 2015; 41:734-43. [PMID: 25287720 DOI: 10.1111/cch.12206] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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] [Accepted: 09/08/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is one of the most common diseases of childhood causing pain, swelling of joints and reduced mobility. Previous research has focused on the challenges and psychosocial impact of JIA, but there has been limited attention given to how young people adjust and adapt to living with a long-term condition such as JIA. The aim of this qualitative study was therefore to explore adolescents' experiences of living with JIA, with particular focus on the process of adjustment. METHODS Ten adolescents (7 female, 3 male) aged 13-17 years with good treatment adherence were recruited from an adolescent arthritis clinic. In-depth interviews were conducted, and data were analysed by two researchers independently using interpretative phenomenological analysis. RESULTS These adolescents described the physical and psychosocial 'burden of living with JIA' and the challenges faced by an underlying preoccupation 'to be a normal teenager'. However, their accounts also revealed ways in which they regained agency and developed 'resilience through taking control' over their lives. This resilience helped the adolescents re-establish a sense of well-being through an ongoing process of 'acceptance and self-growth'. CONCLUSIONS Although much research has adopted a deficit model that focuses on adjustment problems, the current study highlights the resourcefulness of young people in managing the challenges of living with a long-term condition. These experiences of successful adjustment can be used as the basis of positive, strength-based intervention approaches for adolescents with arthritis to enhance resilience and well-being.
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Affiliation(s)
- T Cartwright
- Department of Psychology, University of Westminster, London, UK
| | - E Fraser
- Medical Paediatric Psychology Service, Crosshouse Hospital, Kilmarnock, Scotland
| | - S Edmunds
- Department of Psychology, University of Westminster, London, UK
| | - N Wilkinson
- Oxford Paediatric and Adolescent Rheumatology Centre (OxPARC), Nuffield Orthopaedic Centre, Oxford, UK
| | - K Jacobs
- Oxford Paediatric and Adolescent Rheumatology Centre (OxPARC), Nuffield Orthopaedic Centre, Oxford, UK.,Department of Paediatric Psychology, The Children's Hospital, Oxford, UK
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20
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Gore ME, Hackshaw A, Brady WE, Penson RT, Zaino RJ, McCluggage WG, Ganesan R, Wilkinson N, Perren T, Montes A, Summers J, Lord R, Dark GG, Rustin GJS, Mackean MJ, Reed N, Kehoe S, Christensen H, Ledermann JA, Gershenson DM. Multicentre trial of carboplatin/paclitaxel versus oxaliplatin/capecitabine, each with/without bevacizumab, as first line chemotherapy for patients with mucinous epithelial ovarian cancer (mEOC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5528] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Allan Hackshaw
- University College London Cancer Institute/CRUK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Richard T. Penson
- Massachusetts General Hospital and Harvard Medical School, Braintree, MA
| | | | - W. Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Raji Ganesan
- Birmingham Women's NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Ana Montes
- Guy`s and St Thomas NHS Trust, London, United Kingdom
| | - Jeffrey Summers
- Maidstone and Medway Maritime Hospital, Maidstone, United Kingdom
| | - Rosemary Lord
- Clatterbridge Cancer Centre, Bebington, United Kingdom
| | - Graham G. Dark
- Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | | | | | - Sean Kehoe
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
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21
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Singh N, Gilks CB, Wilkinson N, McCluggage WG. Assessment of a new system for primary site assignment in high-grade serous carcinoma of the fallopian tube, ovary, and peritoneum. Histopathology 2015; 67:331-7. [DOI: 10.1111/his.12651] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 01/12/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Naveena Singh
- Department of Cellular Pathology; Barts Health NHS Trust; London UK
| | - C Blake Gilks
- Department of Pathology; Vancouver General Hospital and University of British Columbia; Vancouver BC Canada
| | | | - W Glenn McCluggage
- Department of Pathology; Belfast Health and Social Care Trust; Belfast UK
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22
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Dolezalova P, Wilkinson N, Brogan P, Anton J, Benseler S, Brunner J, Cabral D, Cimaz R, O'Neil K, Özen S, Luqmani R. SAT0286 Paediatric Vasculitis Damage Index: A New Tool for Standardised Disease Assessment. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5893] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Singh N, Gilks CB, Wilkinson N, McCluggage WG. Assignment of primary site in high-grade serous tubal, ovarian and peritoneal carcinoma: a proposal. Histopathology 2014; 65:149-54. [PMID: 24660659 DOI: 10.1111/his.12419] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The revised FIGO 2013 staging for carcinomas of the ovary, fallopian tube and peritoneum has introduced a single system for tumours originating at these sites. The system requires pathologists to assign a primary site (ovary, tube or peritoneum), but does not provide guidance to aid this assignment. This is particularly problematic in cases of advanced-stage (stage II or greater) high-grade serous carcinoma (HGSC), where there is commonly involvement of two or more sites by tumour, and practice among pathologists in determining where a tumour has arisen varies widely. This has significant implications for recording of tumour incidence and mortality, data collection by cancer registries, and entry into clinical trials. We propose guidelines for assigning the primary site of HGSC based on careful macroscopic and histological assessment. The use of these guidelines, in conjunction with the new FIGO staging system, is intended to act as an impetus to promote debate and provide a uniform and consistent approach in assigning primary tumour site which will facilitate comparison of data between centres.
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Affiliation(s)
- Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
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24
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Laufer M, A. ter Veer, Bekaii-Saab T, Engstrom P, Lai L, Schrag D, Skibber J, Small W, Wilkinson N, Goodman K. Trends in Intensity Modulated Radiation Therapy Use for Locally-Advanced Rectal Cancer at National Comprehensive Cancer Network (NCCN) Centers. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Keidel S, Wilkinson N. FRI0361 The use of leflunomide in a paediatric rheumatology clinic. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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Wilkinson N. Diagnostic Pathology of Ovarian Tumors. Histopathology 2012. [DOI: 10.1111/j.1365-2559.2012.04292.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brüning-Richardson A, Bond J, Alsiary R, Richardson J, Cairns DA, McCormac L, Hutson R, Burns PA, Wilkinson N, Hall GD, Morrison EE, Bell SM. NuMA overexpression in epithelial ovarian cancer. PLoS One 2012; 7:e38945. [PMID: 22719996 PMCID: PMC3375276 DOI: 10.1371/journal.pone.0038945] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/14/2012] [Indexed: 11/18/2022] Open
Abstract
Highly aneuploid tumours are common in epithelial ovarian cancers (EOC). We investigated whether NuMA expression was associated with this phenomenon.NuMA protein levels in normal and tumour tissues, ovarian cell lines and primary cultures of malignant cells derived from ovarian ascitic fluids were analysed by Affymetrix microarray analysis, immunoblotting, immunohistochemistry (IHC) and immunofluorescence (IF), with results correlated to associated clinical data. Aneuploidy status in primary cultures was determined by FACS analysis.Affymetrix microarray data indicated that NuMA was overexpressed in tumour tissue, primary cultures and cell lines compared to normal ovarian tissue. IHC revealed low to weak NuMA expression in normal tissues. Expression was upregulated in tumours, with a significant association with disease stage in mucinous EOC subtypes (p = 0.009), lymph node involvement (p = 0.03) and patient age (p = 0.04). Additional discontinuous data analysis revealed that high NuMA levels in tumours decreased with grade (p = 0.02) but increased with disease stage (p = 0.04) in serous EOC. NuMA expression decreased in late disease stage 4 endometrioid EOCs. High NuMA levels decreased with increased tumour invasion in all subtypes (p = 0.03). IF of primary cultures revealed that high NuMA levels at mitotic spindle poles were significantly associated with a decreased proportion of cells in cytokinesis (p = 0.05), increased binucleation (p = 0.021) and multinucleation (p = 0.007), and aneuploidy (p = 0.008).NuMA is highly expressed in EOC tumours and high NuMA levels correlate with increases in mitotic defects and aneuploidy in primary cultures.
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Affiliation(s)
- Anke Brüning-Richardson
- Section of Ophthalmology and Neuroscience, Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds, United Kingdom.
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Dolezalova P, Brogan PA, Özen S, Benseler S, Anton J, Brunner J, Cabral DA, Cimaz R, O´Neil KM, Wallace C, Wilkinson N, Luqmani R. Disease activity in paediatric vasculitis: development of a generic assessment tool - PVAS. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194755 DOI: 10.1186/1546-0096-9-s1-p92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mckenzie M, Pintilie H, Wilkinson N, Lane G, Orton J, El-Ghobashy A. A rare case of vulval leiomyosarcoma: Management and an updated review of the literature. J OBSTET GYNAECOL 2011; 31:675-6. [DOI: 10.3109/01443615.2011.595519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cummings M, McGinley CV, Wilkinson N, Field SL, Duffy SR, Orsi NM. A robust RNA integrity-preserving staining protocol for laser capture microdissection of endometrial cancer tissue. Anal Biochem 2011; 416:123-5. [DOI: 10.1016/j.ab.2011.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 04/14/2011] [Accepted: 05/06/2011] [Indexed: 12/31/2022]
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Jang S, Dukes B, Wilkinson N. SU-E-T-474: Long Term Variation of ExacTrac Image Isocenter and Evaluation of Congruence between EXACTRAC KV-Image Isocenter and Radiation Isocenter. Med Phys 2011. [DOI: 10.1118/1.3612428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Brüning-Richardson A, Bond J, Alsiary R, Richardson J, Cairns DA, McCormack L, Hutson R, Burns P, Wilkinson N, Hall GD, Morrison EE, Bell SM. ASPM and microcephalin expression in epithelial ovarian cancer correlates with tumour grade and survival. Br J Cancer 2011; 104:1602-10. [PMID: 21505456 PMCID: PMC3101901 DOI: 10.1038/bjc.2011.117] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 03/09/2011] [Accepted: 03/13/2011] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The clinico-pathological and molecular heterogeneity of epithelial ovarian cancer (EOC) complicates its early diagnosis and successful treatment. Highly aneuploid tumours and the presence of ascitic fluids are hallmarks of EOC. Two microcephaly-associated proteins, abnormal spindle-like microcephaly-associated protein (ASPM) and microcephalin, are involved in mitosis and DNA damage repair. Their expression is deregulated at the RNA level in EOC. Here, ASPM and microcephalin protein expression in primary cultures established from the ascites of patients with EOC was determined and correlated with clinical data to assess their suitability as biomarkers. METHODS Five established ovarian cancer cell lines, cells derived from two benign ovarian ascites samples and 40 primary cultures of EOC derived from ovarian ascites samples were analysed by protein slot blotting and/or immunofluorescence to determine ASPM and microcephalin protein levels and their cellular localisation. Results were correlated with clinico-pathological data. RESULTS A statistically significant correlation was identified for ASPM localisation and tumour grade, with high levels of cytoplasmic ASPM correlating with grade 1 tumours. Conversely, cytoplasmic microcephalin was only identified in high-grade tumours. Furthermore, low levels of nuclear microcephalin correlated with reduced patient survival. CONCLUSION Our results suggest that ASPM and microcephalin have the potential to be biomarkers in ovarian cancer.
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Affiliation(s)
- A Brüning-Richardson
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - J Bond
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - R Alsiary
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - J Richardson
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - D A Cairns
- Section of Oncology and Clinical Research, Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds LS9 7TF, UK
| | - L McCormack
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - R Hutson
- St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - P Burns
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - N Wilkinson
- St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - G D Hall
- St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK
| | - E E Morrison
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - S M Bell
- Section of Ophthalmology and Neurosciences, Leeds Institute of Molecular Medicine, Welcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, UK
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Spencer JA, Weston MJ, Saidi SA, Wilkinson N, Hall GD. Clinical utility of image-guided peritoneal and omental biopsy. Nat Rev Clin Oncol 2010; 7:623-31. [DOI: 10.1038/nrclinonc.2010.155] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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El-Ghobashy A, Ohadike C, Wilkinson N, Lane G, Campbell JD. Recurrent urachal mucinous adenocarcinoma presenting as bilateral ovarian tumors on cesarean delivery. Int J Gynecol Cancer 2009; 19:1539-41. [PMID: 19955933 DOI: 10.1111/igc.0b013e3181a84177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Secondary ovarian cancers, Krukenberg tumors, are a distinctive subset of metastatic tumors arising from the gastrointestinal tract (stomach, colon, and appendix), the biliary system, the breast, or other genital organs. These tumors account for 5% of all ovarian malignancies. Such metastases could mimic primary mucinous ovarian adenocarcinomas. Metastases from the urinary tract are uncommon. Primary adenocarcinoma of the bladder accounts for less than 1% of all bladder malignancies; one third of these tumors are urachal in origin. Urachal cancers are rare and tend to occur in older men (mean age, 50-60 years); however, it was described previously in a 15-year-old girl. Symptoms include hematuria, dysuria, frequency, urgency, and recurrent urinary tract infections. These tumors have a predilection to locally spread to the surrounding organs. Ovarian metastasis is a rare event and is infrequently reported in literature.
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Affiliation(s)
- Alaa El-Ghobashy
- Department of Gynaecological Oncology, St James's University Hospital, Yorkshire, United Kingdom.
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Wilkinson N. Philip Arthur Wilkinson. West J Med 2008. [DOI: 10.1136/bmj.a2770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jackson D, Craven RA, Hutson RC, Graze I, Lueth P, Tonge RP, Hartley JL, Nickson JA, Rayner SJ, Johnston C, Dieplinger B, Hubalek M, Wilkinson N, Perren TJ, Kehoe S, Hall GD, Daxenbichler G, Dieplinger H, Selby PJ, Banks RE. Proteomic profiling identifies afamin as a potential biomarker for ovarian cancer. Clin Cancer Res 2008; 13:7370-9. [PMID: 18094419 DOI: 10.1158/1078-0432.ccr-07-0747] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To discover and validate serum glycoprotein biomarkers in ovarian cancer using proteomic-based approaches. EXPERIMENTAL DESIGN Serum samples from a "discovery set" of 20 patients with ovarian cancer or benign ovarian cysts or healthy volunteers were compared by fluorescence two-dimensional differential in-gel electrophoresis and parallel lectin-based two-dimensional profiling. Validation of a candidate biomarker was carried out with Western blotting and immunoassay (n = 424). RESULTS Twenty-six proteins that changed significantly were identified by mass spectrometric sequencing. One of these, confirmed by Western blotting, was afamin, a vitamin E binding protein, with two isoforms decreasing in patients with ovarian cancer. Validation using cross-sectional samples from 303 individuals (healthy controls and patients with benign, borderline, or malignant ovarian conditions and other cancers) assayed by ELISA showed significantly decreased total afamin concentrations in patients with ovarian cancer compared with healthy controls (P = 0.002) and patients with benign disease (P = 0.046). However, the receiver operating characteristic areas for total afamin for the comparison of ovarian cancer with healthy controls or benign controls were only 0.67 and 0.60, respectively, with comparable figures for CA-125 being 0.92 and 0.88 although corresponding figures for a subgroup of samples analyzed by isoelectric focusing for afamin isoform 2 were 0.85 and 0.79. Analysis of a further 121 samples collected prospectively from 9 patients pretreatment through to relapse indicated complementarity of afamin with CA-125, including two cases in whom CA-125 was noninformative. CONCLUSIONS Afamin shows potential complementarity with CA-125 in longitudinal monitoring of patients with ovarian cancer, justifying prospective larger-scale investigation. Changes in specific isoforms may provide further information.
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Affiliation(s)
- David Jackson
- Cancer Research UK Clinical Centre, St James's University Hospital, Leeds, United Kingdom
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Cook N, Nichols RAB, Wilkinson N, Paton CA, Barker K, Smith HV. Development of a method for detection of Giardia duodenalis cysts on lettuce and for simultaneous analysis of salad products for the presence of Giardia cysts and Cryptosporidium oocysts. Appl Environ Microbiol 2007; 73:7388-91. [PMID: 17890337 PMCID: PMC2168210 DOI: 10.1128/aem.00552-07] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 09/10/2007] [Indexed: 11/20/2022] Open
Abstract
We report a method for detecting Giardia duodenalis cysts on lettuce, which we subsequently use to examine salad products for the presence of Giardia cysts and Cryptosporidium oocysts. The method is based on four basic steps: extraction of cysts from the foodstuffs, concentration of the extract and separation of the cysts from food materials, staining of the cysts to allow their visualization, and identification of cysts by microscopy. The concentration and separation steps are performed by centrifugation, followed by immunomagnetic separation using proprietary kits. Cyst staining is also performed using proprietary reagents. The method recovered 46.0% +/- 19.0% (n = 30) of artificially contaminating cysts in 30 g of lettuce. We tested the method on a variety of commercially available natural foods, which we also seeded with a commercially available internal control, immediately prior to concentration of the extract. Recoveries of the Texas Red-stained Giardia cyst and Cryptosporidium oocyst internal controls were 36.5% +/- 14.3% and 36.2% +/- 19.7% (n = 20), respectively. One natural food sample of organic watercress, spinach, and rocket salad contained one Giardia cyst 50 g(-1) of sample as an indigenous surface contaminant.
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Affiliation(s)
- N Cook
- Central Science Laboratory, Sand Hutton, York YO41 1LZ, United Kingdom
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Hewitt MJ, Anderson K, Hall GD, Weston M, Hutson R, Wilkinson N, Perren TJ, Lane G, Spencer JA. Women with peritoneal carcinomatosis of unknown origin: efficacy of image-guided biopsy to determine site-specific diagnosis. BJOG 2006; 114:46-50. [PMID: 17233859 DOI: 10.1111/j.1471-0528.2006.01176.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the use of image-guided biopsy (IGB) in routine clinical practice to obtain site-specific diagnoses in women presenting with peritoneal carcinomatosis (PC). STUDY DESIGN Retrospective case study. SETTING Tertiary referral centre. POPULATION A total of 149 consecutive women with PC who underwent IGB. METHODS Biopsy was performed in women considered unsuitable for primary surgery because of poor performance status or disease unlikely to be optimally debulked, with a prior history of malignancy or where there was clinicoradiological uncertainty about primary tumour site. Standard haematoxylin-eosin histological analysis was supplemented with immunohistochemistry. MAIN OUTCOME MEASURES The rate of site-specific diagnosis. RESULTS A total of 149 women underwent IGB using computed tomography or ultrasound over a 6-year period. The only complication was one rectus sheath haematoma. In 138 (93%) women, a site-specific cancer diagnosis was made on the IGB (including 111 müllerian tract, 8 gastrointestinal tract, 4 breast and 3 lymphoma); in ten women, a repeat biopsy was necessary, giving an overall failure rate of 7%. In a further six women, malignancy was confirmed but a site-specific diagnosis could not be made, and in four women, biopsy showed benign tissue. A site-specific diagnosis was obtained in 29 of the 32 women (94%) with previous malignancy, of which 18/32 (56%) showed a new primary cancer. CONCLUSIONS IGB is a safe and accurate technique for providing site-specific diagnoses in women with PC in routine clinical practice, including those with a previous relevant malignancy. IGB can replace laparoscopic or open biopsy in defining primary therapeutic options. The data would suggest that the biopsy should be performed with ultrasound where feasible.
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Affiliation(s)
- M J Hewitt
- Department of Obstetrics and Gynaecology UCC, BUPA Ireland Research Centre, Cork University Maternity Hospital, Cork, Ireland
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Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, Baratti D, Bartlett D, Barone R, Barrios P, Bieligk S, Bretcha-Boix P, Chang CK, Chu F, Chu Q, Daniel S, de Bree E, Deraco M, Dominguez-Parra L, Elias D, Flynn R, Foster J, Garofalo A, Gilly FN, Glehen O, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Goodman M, Gushchin V, Hanna N, Hartmann J, Harrison L, Hoefer R, Kane J, Kecmanovic D, Kelley S, Kuhn J, Lamont J, Lange J, Li B, Loggie B, Mahteme H, Mann G, Martin R, Misih RA, Moran B, Morris D, Onate-Ocana L, Petrelli N, Philippe G, Pingpank J, Pitroff A, Piso P, Quinones M, Riley L, Rutstein L, Saha S, Alrawi S, Sardi A, Schneebaum S, Shen P, Shibata D, Spellman J, Stojadinovic A, Stewart J, Torres-Melero J, Tuttle T, Verwaal V, Villar J, Wilkinson N, Younan R, Zeh H, Zoetmulder F, Sebbag G. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 2006. [PMID: 17072675 DOI: 10.1245/s10434-007-9599-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, Baratti D, Bartlett D, Barone R, Barrios P, Bieligk S, Bretcha-Boix P, Chang CK, Chu F, Chu Q, Daniel S, de Bree E, Deraco M, Dominguez-Parra L, Elias D, Flynn R, Foster J, Garofalo A, Gilly FN, Glehen O, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Goodman M, Gushchin V, Hanna N, Hartmann J, Harrison L, Hoefer R, Kane J, Kecmanovic D, Kelley S, Kuhn J, Lamont J, Lange J, Li B, Loggie B, Mahteme H, Mann G, Martin R, Misih RA, Moran B, Morris D, Onate-Ocana L, Petrelli N, Philippe G, Pingpank J, Pitroff A, Piso P, Quinones M, Riley L, Rutstein L, Saha S, Alrawi S, Sardi A, Schneebaum S, Shen P, Shibata D, Spellman J, Stojadinovic A, Stewart J, Torres-Melero J, Tuttle T, Verwaal V, Villar J, Wilkinson N, Younan R, Zeh H, Zoetmulder F, Sebbag G. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 2006; 14:128-33. [PMID: 17072675 DOI: 10.1245/s10434-006-9185-7] [Citation(s) in RCA: 294] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 06/02/2006] [Accepted: 06/02/2006] [Indexed: 12/11/2022]
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Abstract
When used in the context of multidisciplinary team discussion, image guided biopsy using ultrasound (US) or computed tomography (CT) guidance is of value in planning management of women with suspected ovarian cancer and peritoneal carcinomatosis (PC) of uncertain aetiology. It is essential in women believed to have ovarian cancer but with poor performance status or with advanced disease believed beyond the scope of primary cytoreductive surgery for whom staging surgical pathology will not be obtained. It provides a site-specific primary tumour diagnosis in 93% of cases and it should replace diagnostic laparoscopy or laparotomy for this purpose. It allows provision of primary (neoadjuvant) chemotherapy based on a firm histological diagnosis. It is mandatory in women with a history of cancer whose metastases may mimic ovarian cancer (e.g. breast, GI tract, melanoma). More women with prior breast cancer who re-present with peritoneal cancer will have a new gynaecological primary than recurrence of their original primary tumour; the two options require radically different therapies. Finally it is a valuable problem solving tool in situations of diagnostic uncertainty, e.g. unusual imaging patterns of disease such as PC with bilateral solid ovarian masses or non-enlarged ovaries and with an unusual tumour marker profiles suggesting primary tumours outwith the ovary. The technique is simple, safe and effective and can be combined with palliative drainage of ascites at the same procedure.
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Affiliation(s)
- John A Spencer
- Department of Clinical Radiology, Leeds Cancer Centre at St James’s University Hospital, Leeds, UK
| | - Kirsty Anderson
- Department of Clinical Radiology, Leeds Cancer Centre at St James’s University Hospital, Leeds, UK
| | - Michael Weston
- Department of Clinical Radiology, Leeds Cancer Centre at St James’s University Hospital, Leeds, UK
| | - Nafisa Wilkinson
- Department of Pathology, Leeds Cancer Centre at St James’s University Hospital, Leeds, UK
| | - Matt Hewitt
- Department of Gynaecological Oncology, Leeds Cancer Centre at St James’s University Hospital, Leeds, UK
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Hewitt MJ, Hall GD, Wilkinson N, Perren TJ, Lane G, Spencer JA. Image-guided biopsy in women with breast cancer presenting with peritoneal carcinomatosis. Int J Gynecol Cancer 2006; 16 Suppl 1:108-10. [PMID: 16515576 DOI: 10.1111/j.1525-1438.2006.00322.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
When women with a history of breast cancer present with peritoneal carcinomatosis, the differential diagnosis lies between recurrent breast cancer or a new primary tumor. This scenario is of particular relevance to women with a BRCA gene mutation, who have a genetic predisposition to develop second primary tumors of the ovary, fallopian tube, and peritoneum. We describe the use of image-guided core biopsy as an alternative to laparoscopy or exploratory laparotomy in providing minimally invasive diagnosis in this increasingly common clinical dilemma.
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Affiliation(s)
- M J Hewitt
- Department of Gynaecology, St. James's University Hospital, Leeds, England.
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Scott-Conner CE, Romitti PA, Lynch CF, Wilkinson N, Lal G, Zhou L, Smith BJ. Influence of pregnancy on breast cancer tumor characteristics and mortality in Iowa women. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
584 Background: Hormonal factors such as pregnancy influence development and course of breast cancer. We identified women who became pregnant during the preclinical phase or shortly after diagnosis of breast cancer, compared them with similar women who had not been pregnant in that time period, and studied tumor characteristics and mortality. Methods: Birth and fetal death certificates were linked with Iowa Cancer Registry information for 10,624 women ≤50 years of age diagnosed with breast cancer as a first invasive primary between January 1, 1975 and December 31, 2002. Women who were pregnant two years before (n=160) or after diagnosis of breast cancer (n=53)and those who had not been pregnant (NP) (n=5008) were identified using probabilistic computer matching with manual review confirmation. Clinical, pathological and 10-year survival data were compared between these groups. Preliminary analysis revealed similarities between women who were pregnant before and after diagnosis. These were combined for analysis (P). Results: The study subjects distributed themselves across two SEER stages of disease: 1) localized, and 2) locally advanced or regional nodal disease (LABC). SEER stage (50% LABC vs. 39% LABC) and grade (75% high grade vs. 56% high grade) were higher in P than in NP cases. Ten-year survival for localized disease was 0.766 (95% CI 0.649–0.848) for P and 0.874 (95% CI 0.858–0.888) for NP (log rank test p= 0.0178). Ten-year survival for LABC was 0.520 (95% CI 0.373–0.649) for P and 0.629 (95% CI 0.601–0.655) for NP (log rank test p= 0.0234). Multivariate analysis ( table below) showed an adverse effect of pregnancy status on survival, independent of stage, grade, age or progesterone receptor (PR) status. Conclusions: Women who are pregnant within two years of diagnosis of breast cancer have higher grade, more locally-advanced tumors and experience a higher mortality than similar women who are never pregnant. Pregnancy persists as a significant adverse survival variable after adjustment for age, grade, stage, and PR status. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- C. E. Scott-Conner
- University of Iowa Carver College of Medicine, Iowa City, IA; University of Iowa College of Public Health, Iowa City, IA
| | - P. A. Romitti
- University of Iowa Carver College of Medicine, Iowa City, IA; University of Iowa College of Public Health, Iowa City, IA
| | - C. F. Lynch
- University of Iowa Carver College of Medicine, Iowa City, IA; University of Iowa College of Public Health, Iowa City, IA
| | - N. Wilkinson
- University of Iowa Carver College of Medicine, Iowa City, IA; University of Iowa College of Public Health, Iowa City, IA
| | - G. Lal
- University of Iowa Carver College of Medicine, Iowa City, IA; University of Iowa College of Public Health, Iowa City, IA
| | - L. Zhou
- University of Iowa Carver College of Medicine, Iowa City, IA; University of Iowa College of Public Health, Iowa City, IA
| | - B. J. Smith
- University of Iowa Carver College of Medicine, Iowa City, IA; University of Iowa College of Public Health, Iowa City, IA
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Cook N, Paton CA, Wilkinson N, Nichols RAB, Barker K, Smith HV. Towards standard methods for the detection of Cryptosporidium parvum on lettuce and raspberries. Part 2: validation. Int J Food Microbiol 2006; 109:222-8. [PMID: 16546283 DOI: 10.1016/j.ijfoodmicro.2005.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2004] [Revised: 12/14/2005] [Accepted: 12/31/2005] [Indexed: 10/24/2022]
Abstract
We report the results of interlaboratory collaborative trials of methods to detect oocysts of the protozoan parasite Cryptosporidium parvum on lettuce and raspberries. The trials involved eight expert laboratories in the United Kingdom. Samples comprised 30 g lettuce, and 60 g raspberries. Lettuce samples were artificially contaminated at three levels: low (8.5-14.2 oocysts), medium (53.5-62.6 oocysts), and high (111.3-135.0 oocysts). Non-contaminated lettuce samples were also tested. The method had an overall sensitivity (correct identification of all artificially contaminated lettuce samples) of 89.6%, and a specificity (correct identification of non-contaminated samples) of 85.4%. The total median percentage recovery (from all artificially contaminated samples) produced by the method was 30.4%. The method was just as reproducible between laboratories, as repeatable within a laboratory. Raspberry samples were artificially contaminated at three levels: low (8.5-26.8 oocysts), medium (29.7-65.7 oocysts), and high (53.9-131.3 oocysts). Non-contaminated raspberry samples were also tested. The method had an overall sensitivity (correct identification of all artificially contaminated raspberry samples) of 95.8%, and a specificity (correct identification of non-contaminated samples) of 83.3%. The total median percentage recovery (from all artificially contaminated samples) produced by the method was 44.3%. The method was just as reproducible between laboratories, as repeatable within a laboratory. The results of the collaborative trial indicate that these assays can be used effectively in analytical microbiological laboratories.
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Affiliation(s)
- N Cook
- Central Science Laboratory, Sand Hutton, York YO41 1LZ, UK
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Cook N, Paton CA, Wilkinson N, Nichols RAB, Barker K, Smith HV. Towards standard methods for the detection of Cryptosporidium parvum on lettuce and raspberries. Part 1: development and optimization of methods. Int J Food Microbiol 2006; 109:215-21. [PMID: 16529835 DOI: 10.1016/j.ijfoodmicro.2005.12.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2004] [Revised: 12/14/2005] [Accepted: 12/31/2005] [Indexed: 11/18/2022]
Abstract
No standard method is available for detecting protozoan parasites on foods such as soft fruit and salad vegetables. We report on optimizing methods for detecting Cryptosporidium parvum on lettuce and raspberries. These methods are based on four basic stages: extraction of oocysts from the foodstuffs, concentration of the extract and separation of the oocysts from food materials, staining of the oocysts to allow their visualization, and identification of oocysts by microscopy. The concentration and separation steps are performed by centrifugation, followed by immunomagnetic separation using proprietary kits. Oocyst staining is also performed using proprietary reagents. The performance parameters of the extraction steps were extensively optimized, using artificially contaminated samples. The fully developed methods were tested several times to determine their reliability. The method to detect C. parvum on lettuce recovered 59.0+/-12.0% (n=30) of artificially contaminated oocysts. The method to detect C. parvum on raspberries recovered 41.0+/-13.0% (n=30) of artificially contaminated oocysts.
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Affiliation(s)
- N Cook
- Central Science Laboratory, Sand Hutton, York YO41 1LZ, UK
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Ferguson RE, Jackson DH, Hutson R, Wilkinson N, Harnden P, Selby P, Banks RE. Detection of glycosylation changes in serum and tissue proteins in cancer by lectin blotting. Adv Exp Med Biol 2006; 564:113-4. [PMID: 16400815 DOI: 10.1007/0-387-25515-x_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- R E Ferguson
- Cancer Research UK Clinical Centre, St. James's University Hospital, Leeds L59 7TF, UK
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Hewitt MJ, Hall GD, Wilkinson N, Perren TJ, Lane G, Spencer JA. Image-guided biopsy in women with breast cancer presenting with peritoneal carcinomatosis. Int J Gynecol Cancer 2006. [DOI: 10.1136/ijgc-00009577-200602001-00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
When women with a history of breast cancer present with peritoneal carcinomatosis, the differential diagnosis lies between recurrent breast cancer or a new primary tumor. This scenario is of particular relevance to women with a BRCA gene mutation, who have a genetic predisposition to develop second primary tumors of the ovary, fallopian tube, and peritoneum. We describe the use of image-guided core biopsy as an alternative to laparoscopy or exploratory laparotomy in providing minimally invasive diagnosis in this increasingly common clinical dilemma.
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Abstract
The ovary is a common site of metastatic tumour. In many cases of ovarian metastasis there is a known history of malignancy but in other cases the ovarian tumour is the first manifestation of disease. In this review metastatic colorectal, appendiceal, gastric, breast, pancreatic and biliary tract, hepatocellular, renal, transitional and cervical carcinomas and metastatic malignant melanoma involving the ovary are discussed, as is the issue of synchronous ovarian and endometrial carcinomas. Peritoneal tumours, including primary peritoneal carcinoma, mesothelioma and intra-abdominal desmoplastic small round cell tumour, involving the ovary are also discussed, together with a variety of other rare, metastatic ovarian neoplasms. Many metastatic adenocarcinomas involving the ovary, especially those exhibiting mucinous differentiation, closely mimic primary ovarian adenocarcinomas with morphologically bland areas simulating benign and borderline cystadenoma. This is referred to as a maturation phenomenon. In recent years immunohistochemistry, especially but not exclusively differential cytokeratin (CK7 and CK20) staining, has been widely used as an aid to distinguish between a primary and secondary ovarian adenocarcinoma. While immunohistochemistry undoubtedly has a valuable role to play and is paramount in diagnosis in some cases, the results must be interepreted with caution, especially in mucinous tumours, and within the relevant clinical context. We feel the significance of differential cytokeratin staining is not always understood by histopathologists and this can result in erroneous interpretation. We critically discuss the value of immunohistochemistry and associated pitfalls with each tumour type described.
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Affiliation(s)
- W G McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Belfast, and Department of Pathology, St James's University Hospital, Leeds, UK.
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Iyer R, Wilkinson N, Demmy T, Javle M. Controversies in the multimodality management of locally advanced esophageal cancer: evidence-based review of surgery alone and combined-modality therapy. Ann Surg Oncol 2004; 11:665-73. [PMID: 15197012 DOI: 10.1245/aso.2004.10.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Most patients with esophageal cancer present with locoregional disease, and the optimal initial management is controversial. The current National Comprehensive Cancer Network (NCCN) practice guidelines support diverse treatment options for locoregional disease, including surgical resection alone, definitive chemoradiation therapy, and preoperative combined-modality (neoadjuvant/trimodality) therapy. Many cancer centers worldwide favor a neoadjuvant approach, although the evidence supporting this practice is inconsistent. A concise review of the literature is presented. The topics discussed do not necessarily reflect each author's opinions or clinical practices.
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Affiliation(s)
- R Iyer
- Department of Medical Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
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