Endoscopic Ultrasound-Guided Fine-Needle Biopsy Versus Aspiration for Tissue Sampling Adequacy for Molecular Testing in Pancreatic Ductal Adenocarcinoma

BACKGROUND AND AIMS

There is limited literature on sample adequacy for molecular testing in pancreatic ductal adenocarcinoma obtained via endoscopic ultrasound (EUS) fine-needle aspiration (FNA) versus EUS fine-needle biopsy (FNB). We aimed to compare these two modalities regarding sample adequacy for molecular and genomic sequencing.

METHODS

We reviewed all patients with pancreatic ductal adenocarcinoma who underwent EUS at Saint Luke's Hospital from 2018 to 2021. The patients were categorized based on the method of EUS tissue acquisition, specifically FNA or FNB. A comprehensive evaluation was conducted for all cases by cytotechnologists.

RESULTS

Out of 132 patients who underwent EUS-guided biopsies, 76 opted for FNA, 48 opted for FNB, and 8 opted for a combination of both. The average number of passes required for FNB and FNA was 2.58 ± 1.06 and 2.49 ± 1.07, respectively (p = 0.704), indicating no significant difference. Interestingly, 71.4% (35) of FNB-obtained samples were deemed adequate for molecular testing, surpassing the 32.1% (26) adequacy observed with FNA (p < 0.001). Additionally, 46.4% (26) of FNB-obtained samples were considered adequate for genomic testing, a notable improvement over the 23.8% (20) adequacy observed with FNA (p = 0.005).

CONCLUSION

Although the number of passes required for cytologic diagnosis did not differ significantly between EUS-FNB and EUS-FNA, the former demonstrated superiority in obtaining samples adequate for molecular testing. Tumor surface area and cellularity were crucial parameters in determining sample adequacy for molecular testing, irrespective of the chosen tissue acquisition modality.

Elevated NRAS expression during DCIS is a potential driver for progression to basal-like properties and local invasiveness

BACKGROUND

Ductal carcinoma in situ (DCIS) is the most common type of in situ premalignant breast cancers. What drives DCIS to invasive breast cancer is unclear. Basal-like invasive breast cancers are aggressive. We have previously shown that NRAS is highly expressed selectively in basal-like subtypes of invasive breast cancers and can promote their growth and progression. In this study, we investigated whether NRAS expression at the DCIS stage can control transition from luminal DCIS to basal-like invasive breast cancers.

METHODS

Wilcoxon rank-sum test was performed to assess expression of NRAS in DCIS compared to invasive breast tumors in patients. NRAS mRNA levels were also determined by fluorescence in situ hybridization in patient tumor microarrays (TMAs) with concurrent normal, DCIS, and invasive breast cancer, and association of NRAS mRNA levels with DCIS and invasive breast cancer was assessed by paired Wilcoxon signed-rank test. Pearson's correlation was calculated between NRAS mRNA levels and basal biomarkers in the TMAs, as well as in patient datasets. RNA-seq data were generated in cell lines, and unsupervised hierarchical clustering was performed after combining with RNA-seq data from a previously published patient cohort.

RESULTS

Invasive breast cancers showed higher NRAS mRNA levels compared to DCIS samples. These NRAS^high lesions were also enriched with basal-like features, such as basal gene expression signatures, lower ER, and higher p53 protein and Ki67 levels. We have shown previously that NRAS drives aggressive features in DCIS-like and basal-like SUM102PT cells. Here, we found that NRAS-silencing induced a shift to a luminal gene expression pattern. Conversely, NRAS overexpression in the luminal DCIS SUM225 cells induced a basal-like gene expression pattern, as well as an epithelial-to-mesenchymal transition signature. Furthermore, these cells formed disorganized mammospheres containing cell masses with an apparent reduction in adhesion.

CONCLUSIONS

These data suggest that elevated NRAS levels in DCIS are not only a marker but can also control the emergence of basal-like features leading to more aggressive tumor activity, thus supporting the therapeutic hypothesis that targeting NRAS and/or downstream pathways may block disease progression for a subset of DCIS patients with high NRAS.

Abstract 1167: A syngeneic MIND model for triple-negative breast cancer: A novel metastatic mouse model for disease progression and therapeutic studies

Background and Objective: In the era of targeted therapy mouse models have significantly contributed to our understanding of cancer biology. Insight into the molecular pathways has opened new avenues for cancer therapeutic strategies. Majority of the available mouse models depict a portion of the breast cancer progression cascade to be investigated. Some mimic the tumorigenesis at an early stage, some portray the later stage of metastatic process. Additionally, most of the mouse models lack the ability to depict the functional contribution of immune system during metastatic progression because very often they deal with immune-compromised mice. Hence a mouse model that can represent all the stages of breast cancer tumorigenesis and metastasis in native microenvironment in presence of immunity is exceptionally essential. This notion gave us an idea to develop a syngeneic mice model that will epitomize all the breast cancer progression stages and in very short time.

Methods: A modified mouse mammary intraductal (MIND) method was adopted for this study. MVT-1 and 4T1 cells were injected into cleaved nipples of 4th inguinal mammary glands of FVB/N and BALB/c wild-type female mice, respectively. The concentration of cells was 10,000 cells/µL. The final volume did not exceed 5 µL per injection per gland. Tissues were harvested at required time points. Histopathology was confirmed by haematoxylin-eosin staining and was further confirmed by immunohistochemical markers for cell proliferation, epithelial-to-mesenchymal transition (EMT), invasion, intravasation, extravasation and metastasis.

Results and Conclusions: Primary tumor had been established by the end of first week of injection and was confirmed by histopathology and whole mount analysis of 4th inguinal mammary gland. During second week after cell inoculation, cells had gone through EMT and had prepared and started invasion. Invasion was followed by intravasation and metastasis. Microscopic metastatic patches in the lungs were observed during third week and visible patches were observed during fourth week after injection. The main advantage of this model is short time span. Our model becomes more relevant as the origin of primary tumor and metastasis takes place in same animal, closely resembling biologic progression of breast cancer with the ability to depict the functional contribution of immune system during metastatic progression. A syngeneic mice model like ours can recapitulate the successive stages of breast cancer tumor progression and metastasis and could give the entire picture of metastatic process. We believe that our syngeneic mouse model will facilitate “drug-hunters” and basic science researchers towards developing improved breast cancer treatment.

Citation Format: Arnab Ghosh, Sandipto Sarkar, Fariba Behbod, Snigdha Banerjee, Ossama W. Tawfik, Sushanta K. Banerjee. A syngeneic MIND model for triple-negative breast cancer: A novel metastatic mouse model for disease progression and therapeutic studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1167.

Macrophage Migration Inhibitory Factor Receptor, CD74, is Overexpressed in Human and Baboon ( Papio Anubis) Endometriotic Lesions and Modulates Endometriotic Epithelial Cell Survival and Interleukin 8 Expression

CD74 is the primary receptor for macrophage migration inhibitory factor (MIF). Although expression of MIF has been described in endometriotic lesions, the cellular localization and function of the MIF receptor, CD74, are poorly understood. To further explore the role of CD74 in the pathophysiology of endometriosis, we utilized specimens from women with diagnostically confirmed endometriosis, women with no signs or symptoms of endometriosis (controls), and 8 baboons with experimentally induced endometriosis. Compared to eutopic endometrium from women with endometriosis, CD74 transcript expression was significantly increased in endometriotic lesion tissue. Similarly, cellular expression of CD74 was significantly greater in ectopic lesion tissue compared to paired eutopic endometrium, which both expressed greater CD74 expression compared to eutopic endometrium from control patients. Localization of CD74 was predominant to epithelial cells of ectopic and matched eutopic endometrium and was not influenced by the stage of the menstrual cycle. Eutopic endometrium from control patients did not express detectable levels of CD74 protein by immunohistochemistry. This pattern of expression and CD74 protein localization could be recapitulated in endometriotic lesion tissue from baboons with experimentally induced disease. Transfection of the endometriotic epithelial cell lines, 12Z with CD74 short hairpin RNA (shRNA), resulted in a significant decrease in CD74 protein expression, which was associated with a significant reduction in cellular proliferation as well as the expression of the prosurvival cytokine interleukin 8. Together, these data support the hypothesis that CD74 is elevated in endometriotic lesion tissue and may contribute to the pathogenesis of endometriosis by promoting cell survival.

Abstract 3227: Novel Marmelin analog DBQ targets Notch signaling pathway in colon cancer stem cells

Background: Colon cancer is the second leading cause of death in the United States. Previously, we have reported that the identification of a novel compound Marmelin from Aegle marmelos and potent anti-colon cancer activity. We have developed novel Marmelin analogue THB from this structure showed potent anti-cancer activity and its inhibitory constant value was 10 µM. From this, we developed a second series of analogs, of which DBQ is even more potent than THB. The current study is designed to determine whether DBQ affects colon cancer stem cells and identify a mechanism.

Method: Colon cancer cell lines HCT116 and SW480 and normal colon epithelial cells were used in the study. Cell growth was measured by hexoseaminidase and clonogenicity assays. Apoptosis was determined by measuring caspase 3/7 activities. Colosphere formation assay and FACS sorting were used for stem cells. For in vivo effects, we performed studies in HCT116 tumor xenografts. Immunohistochemistry was determined for stem cell markers and Notch signaling proteins.

Results: DBQ treatment induced significant dose-dependent inhibition of proliferation and colony formation of HCT116 and SW480 cells, but not that of the normal FHC colon epithelial cells. DBQ also significantly reduced the number and size of colospheres, suggesting effects on stem cells. In addition, DBQ reduced the levels of colon stem cell marker proteins DCLK1, LGR5, and CD44. We obtained further confirmation by flow cytometry, where DBQ treatment reduced the number of DCLK1+ cells. We next determined whether DBQ affects the Notch signaling, a pathway that is important in maintaining CSC population. Notch receptor and its ligands are up-regulated in human colon cancer tissues. DBQ treatment significantly downregulated the expression of all four Notch isoforms, its ligands Jagged 1, 2 and DLL1, 3, 4 and downstream target protein Hes1. Notch activation requires cleavage by the γ-secretase complex. DBQ treatment inhibits the expression of γ-secretase complex proteins. To confirm that DBQ effect is thorough downregulating Notch activation, we ectopically expressed the Notch Intracellular domain. DBQ effect was significantly mitigated in this condition. To determine the effect of DBQ on tumor growth in vivo, we administered DBQ intraperitoneally (5mg/kg bw) every day for 21 days in mice carrying HCT116 tumor xenografts. DBQ treatment significantly suppressed tumor xenograft growth, with notably lower tumor volume and weight. Western blot and immunohistochemistry analyses demonstrated significant inhibition of CSC marker proteins DCLK1, LGR5 and CD44 and also the Notch signaling proteins in the DBQ-treated xenograft tissues.

Conclusion: Together, these data suggest that DBQ treatment suppresses colon cancer growth that targets stem cells in part by inhibiting Notch signaling pathway.

Citation Format: Dharmalingam Subramaniam, Sivapriya Ponnurangam, Prasad R. Dandawate, Gaurav Kaushik, Ossama W. Tawfik, Roy A. Jensen, Santimukul Santra, Subhash B. Padhye, Scott J. Weir, Shrikant Anant. Novel Marmelin analog DBQ targets Notch signaling pathway in colon cancer stem cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3227. doi:10.1158/1538-7445.AM2017-3227

Quinomycin A targets Notch signaling pathway in pancreatic cancer stem cells

Cancer stem cells (CSCs) appear to explain many aspects of the neoplastic evolution of tumors and likely account for enhanced therapeutic resistance following treatment. Dysregulated Notch signaling, which affects CSCs plays an important role in pancreatic cancer progression. We have determined the ability of Quinomycin to inhibit CSCs and the Notch signaling pathway. Quinomycin treatment resulted in significant inhibition of proliferation and colony formation in pancreatic cancer cell lines, but not in normal pancreatic epithelial cells. Moreover, Quinomycin affected pancreatosphere formation. The compound also decreased the expression of CSC marker proteins DCLK1, CD44, CD24 and EPCAM. In addition, flow cytometry studies demonstrated that Quinomycin reduced the number of DCLK1+ cells. Furthermore, levels of Notch 1–4 receptors, their ligands Jagged1, Jagged2, DLL1, DLL3, DLL4 and the downstream target protein Hes-1 were reduced. The γ-secretase complex proteins, Presenilin 1, Nicastrin, Pen2, and APH-1, required for Notch activation also exhibited decreased expression. Ectopic expression of the Notch Intracellular Domain (NICD) partially rescued the cells from Quinomycin mediated growth suppression. To determine the effect of Quinomycin on tumor growth in vivo, nude mice carrying tumor xenografts were administered Quinomycin intraperitoneally every day for 21 days. Treatment with the compound significantly inhibited tumor xenograft growth, coupled with significant reduction in the expression of CSC markers and Notch signaling proteins. Together, these data suggest that Quinomycin is a potent inhibitor of pancreatic cancer that targets the stem cells by inhibiting Notch signaling proteins.

Genome-wide RNAi screening identifies TMIGD3 isoform1 as a suppressor of NF-κB and osteosarcoma progression

The ability of cancer cells to survive and grow in anchorage- and serum-independent conditions is well correlated with their aggressiveness. Here, using a human whole-genome shRNA library, we identify TMIGD3 isoform1 (i1) as a factor that suppresses this ability in osteosarcoma (OS) cells, mainly by inhibiting NF-κB activity. Knockdown of TMIGD3 increases proliferation, tumour formation and metastasis of OS cells. Overexpression of TMIGD3 isoform1 (i1), but not isoform3 (i3) which shares a common C-terminal region, suppresses these malignant properties. Adenosine A3 receptor (A3AR) having an identical N-terminal region shows similar biological profiles to TMIGD3 i1. Protein expression of TMIGD3 and A3AR is lower in human OS tissues than normal tissues. Mechanistically, TMIGD3 i1 and A3AR commonly inhibit the PKA−Akt−NF-κB axis. However, TMIGD3 i1 only partially rescues phenotypes induced by A3AR knockdown, suggesting the presence of distinct pathways. Our findings reveal an unappreciated role for TMIGD3 i1 as a suppressor of NF-κB activity and OS progression.

The ability of cancer cells to survive in anchorage-independent conditions correlates with cancer aggressiveness. Here, by screening a human whole-genome shRNA library for the ability of osteosarcoma cells to form spheres in vitro, the authors identify a role for TMIGD3 isoform 1 in suppressing the metastatic potential of osteosarcoma.

Abstract 4748: Targeting colon cancer stem cells: Novel marmelin analog THB suppresses DCLK1 and Notch Signaling

Background: Despite therapeutic advances, colon cancer remains the second leading cause of death in the United States. Previously, we have reported that the identification of a novel compound, HDNC or Marmelin from Aegle marmelos with potent anti-colon cancer activity. We have now developed a novel marmelin analogue THB and made it water soluble THB using β-cyclodextrin (THBCD). The current study is designed to determine whether THB affects stem cells and to identify a mechanism.

Method: Colon cancer cell lines HCT116 and SW480 and normal colon epithelial cells were used in the study. Cell growth was measured by hexoseaminidase and clonogenicity assays. Apoptosis was determined by measuring caspase 3/7 activities. Colosphere formation assay and FACS sorting were used for stem cells. For in vivo effects, we have performed HCT116 cells induced tumor xenografts. Immunohistochemistry was determined for stem cell markers and Notch signaling proteins.

Results: THB treatment induced a significant dose-dependent inhibition of proliferation and colony formation of the two colon cancer cell lines, but not that of the normal cells. To demonstrate THB effects on stem cells, we performed colosphere assays. THB treatment significantly reduced the number and size of colospheres, suggesting effects on stem cells. In addition, colon stem cell marker proteins DCLK1, LGR5, and CD44 were also decreased. Further proof was obtained by flow cytometry analyses, where THB reduced the number of DCLK1+ cells. We next determined whether THB affects the Notch signaling pathway, a pathway that is important in maintaining CSC population. Notch receptor and its ligands are up-regulated in human colon cancer tissues. THB treatment significantly downregulated the expression of Notch1, its ligand Jagged1 and downstream target protein Hes1. Notch activation requires cleavage by the γ-secretase complex. THB treatment inhibits the expression of γ-secretase complex proteins Presenilin1, Nicastrin, APH1 and PEN2. Moreover, ectopic expression of the Notch Intracellular domain (NICD) rescued the cells from THB mediated growth suppression. These data demonstrate that THB mediated effects of colon cancer stem cells is in part through downregulating Notch1 activation. To determine the effect of THB on tumor growth in vivo, mice carrying HCT116 tumor xenografts were administered the compound intraperitoneally (5mg/kg bw) every day for 21 days. THB treatment significantly suppressed tumor xenograft growth, with notably lower tumor volume and weight. Western blot and immunohistochemistry analyses demonstrated significant inhibition of CSC marker proteins DCLK1, LGR5 and CD44 and also the Notch signaling proteins in the THB-treated xenograft tissues.

Conclusion: Together, these data suggest that THB treatment suppresses colon cancer growth that targets stem cells by inhibiting Notch1 signaling pathway.

Citation Format: Dharmalingam Subramaniam, Sivapriya Ponnurangam, Prasad R. Dandawate, Ossama W. Tawfik, Roy A. Jensen, Scott J. Weir, Subhash B. Padhye, Shrikant Anant. Targeting colon cancer stem cells: Novel marmelin analog THB suppresses DCLK1 and Notch Signaling. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4748.

Abstract 1727: Quinomycin A inhibits pancreatic cancer growth and affects stem cell viability by inhibiting oncogenic YAP1 function

Background: Pancreatic cancer (PCa) remains a leading cause of death in the United States. Cancer stem cells (CSC) are responsible for tumor behavior, and therapeutic resistance. Quinomycin (Qui) is an orally administered quinoxaline antibiotic that bifunctionally intercalates with double stranded DNA. As a first step for repurposing this drug, we determined whether Qui affects PCa growth, and if so whether this is by suppressing stem cells.

Method: Growth and apoptosis of PCa lines (MiaPaCa-2, PanC-1, BxPC-3) and normal ductal epithelial cells (HPNE) was measured by hexosaminidase and clonogenicity, and caspase 3/7 assays, respectively. Pancosphere formation and FACS sorting were used to identify effects on stem cells. For in vivo, MiaPaCa-2 xenografts were developed in the flanks of nude mice. Immunohistochemistry was performed for stem cell markers and Hippo signaling proteins.

Results: Qui demonstrated a dose- and time-dependent inhibition of proliferation and colony formation in all three PCa lines but not HPNE cells. Qui induced PCa cells to undergo apoptosis. It also significantly reduced the number and size of pancospheres, and flow cytometry and western blot analyses confirmed that Qui suppressed PCa stem cell marker proteins DCLK1, CD44, CD24 and EPCAM. We next determined whether Hippo signaling pathway is affected. For this, we tested the effect of Qui on Hippo signaling pathway, which is an active pathway in CSCs including in PCa. The key effector protein, YAP1 has been shown to be oncogenic in many cancer types. In the canonical Hippo signaling pathway, YAP1 function is inhibited. When YAP1 is phosphorylated at Ser127 by the action of upstream Mst1/2 and Lats1/2 kinases, it is sequestered in the cytoplasm, and therefore no induction of downstream gene expression. Qui significantly decreased the phosphorylation oncogenic YAP1. Furthermore, Qui inhibited the expression of YAP interacting proteins TEAD1, TEAD2, and TEAD4. On the other hand, ectopic expression of the TEAD1 partially rescued the cells from Qui-mediated growth suppression. To determine the effect of Qui on tumor growth in vivo, mice carrying MiaPaCa-2 tumor xenografts were administered the compound intraperitoneally (20 μg/kg bw) every day for 21 days. Qui treatment significantly suppressed tumor xenograft growth, with notably lower tumor volume and weight. Western blot and immunohistochemistry analyses demonstrated significant inhibition in the expression of CSC marker proteins, oncogenic YAP1 phosphorylation and YAP1 interacting proteins TEAD1 in the Qui-treated xenograft tissues.

Conclusion: Together, these data suggest that Qui suppresses PCa growth that targets that targets stem cells by inhibiting oncogenic YAP1 in Hippo signaling pathway.

Citation Format: Dharmalingam Subramaniam, Sivapriya Ponnurangam, Gaurav Fnu, Prabhu Ramamoorthy, Animesh Dhar, Ossama W. Tawfik, Shahid Umar, Scott J. Weir, Roy A. Jensen, Arun Balakrishnan, Shrikant Anant. Quinomycin A inhibits pancreatic cancer growth and affects stem cell viability by inhibiting oncogenic YAP1 function. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1727.

Utility of peritoneal washing cytology in staging and prognosis of ovarian and fallopian tube neoplasms: a 10-year retrospective analysis

The prognostic significance of peritoneal washing cytology in gynecologic neoplasms is controversial. The presence of neoplastic cells in peritoneal washings is currently part of the Federation of Gynecology and Obstetrics and American Joint Committee on Cancer TNM staging systems in cases of ovarian and fallopian tube neoplasms without metastasis beyond the pelvis. In this study, we retrospectively reviewed all cases of ovarian and fallopian tube neoplasms in which cytologic studies were performed. The utility of cytology in tumor staging and the relationship between cytology results and patient outcome are studied. All cases of ovarian and fallopian tube neoplasms in our institution between July 2002 and July 2012 were reviewed. Primary tumor characteristics including type and pelvic extension were collected, categorized, and correlated with peritoneal washing cytology. Final tumor staging was reviewed and the impact of positive cytology was evaluated. A total of 120 cases of ovarian and fallopian tube neoplasms without extrapelvic metastasis were identified within the study period. Peritoneal washing cytology was positive in 24% (29/120) of neoplasms and upstaged the tumor 83% (24/29) of the time when positive. Overall, 20% (24/120) of reviewed cases were upstaged based on positive cytology results. Peritoneal washing cytology remains a useful staging tool for ovarian and fallopian tube neoplasms limited to the pelvic cavity. Positive cytology results in upstaging in a significant proportion of the cases regardless of the tumor type. A larger study is needed to analyze follow-up data to determine if upstaging based on positive cytology adversely affects outcome.

Abstract 2338: Histone demethylase KDM3A: Epigenetic target for pancreatic ductal adenocarcinoma (PDAC)

Purpose: A growing body of evidence suggests that cancer stem cells/tumor initiating cells (CSC/TIC) within a solid tumor including in pancreatic cancer initiate and sustain tumor growth. Our preliminary data implicates KDM3A (histone lysine demethylase 3A)/Jmjd1A (jumonji domain demethylase 1A), non-heme iron (II)- α-ketoglutarate (kg) dependent enzyme, as a prime regulator of stems cell self-renewability for cancer progression and is overexpressed in PDAC. Hypoxia most prominently controls malignant properties of cancer cells by stimulating hypoxia inducible factor 1 (HIF1). The fact that HIF1 binds to its responsible elements (HREs) in the KDM3A promoters and subsequently up-regulates its expression could explain why hypoxia exacerbates malignancy. Based on these observations, we hypothesize that hypoxia induces KDM3A that regulates self-renewability of CSC/TIC, thereby promoting tumor initiation.

Experimental Procedure: We have used RNA technology to silence KDM3A in different pancreatic cancer cells and overexpressed KDM3A in non-cancerous immortal pancreatic ductal epithelial cells (HPNE). We have determined KDM3A expression in pancreatic cancer patient's samples. We performed quantitative chromatin immunoprecipitation (ChIP) analysis as an indicator of KDM3A recruitment.

Results: KDM3A was overexpressed in human pancreatic cancer patient tissue samples particularly in the area of the pancreatic ducts and also in pancreatic cancer cells. Knockdown of KDM3A in pancreatic cancer cells significantly reduced the enzyme activity resulting in increased substrate (H3K9Me2) expression. KDM3A knockdown cells decreased oncogenic potential as demonstrated by inhibition of proliferation, clonogenicity, sphere-forming potential, migration and tumor formation in orthotopic mouse model (immunocompromised mice). KDM3A overexpressed transformed HPNE cells increased oncogenic potential as evidenced by foci formation, pancosphere formation and tumor formation in orthotopic mouse model. ChIP following deep sequencing analysis suggested that KDM3A recruited one of the CSC stem cell markers, DCLK1. N-oxaloglycine, α-kg inhibitor, inhibited KDM3A enzyme activity and spheroid formation in overexpressing HPNE cells and in pancreatic cancer cells.Conclusions: KDM3A was overexpressed in PDAC. ChIP-seq analysis revealed that KDM3A recruitment was higher when DCLK1 is expressed. Taken together, KDM3A appears to be responsible, at least in part, for PDAC progression and could be a novel preventive or therapeutic target in pancreatic cancer.

Citation Format: Satheesh K. Sainathan, Santanu Paul, Kanagaraj Palaniyandi, Dharmalingam Subramaniam, Satish Ramalingam, Ossama W. Tawfik, Tomoo Iwakuma, Danny R. Welch, Subhash B. Padhye, Shrikant Anant, Animesh Dhar. Histone demethylase KDM3A: Epigenetic target for pancreatic ductal adenocarcinoma (PDAC). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2338. doi:10.1158/1538-7445.AM2015-2338

PTN signaling: Components and mechanistic insights in human ovarian cancer

Molecular vulnerabilities represent promising candidates for the development of targeted therapies that hold the promise to overcome the challenges encountered with non-targeted chemotherapy for the treatment of ovarian cancer. Through a synthetic lethality screen, we previously identified pleiotrophin (PTN) as a molecular vulnerability in ovarian cancer and showed that siRNA-mediated PTN knockdown induced apoptotic cell death in epithelial ovarian cancer (EOC) cells. Although, it is well known that PTN elicits its pro-tumorigenic effects through its receptor, protein tyrosine phosphatase receptor Z1 (PTPRZ1), little is known about the potential importance of this pathway in the pathogenesis of ovarian cancer. In this study, we show that PTN is expressed, produced, and secreted in a panel of EOC cell lines. PTN levels in serous ovarian tumor tissues are on average 3.5-fold higher relative to normal tissue and PTN is detectable in serum samples of patients with EOC. PTPRZ1 is also expressed and produced by EOC cells and is found to be up-regulated in serous ovarian tumor tissue relative to normal ovarian surface epithelial tissue (P < 0.05). Gene silencing of PTPRZ1 in EOC cell lines using siRNA-mediated knockdown shows that PTPRZ1 is essential for viability and results in significant apoptosis with no effect on the cell cycle phase distribution. In order to determine how PTN mediates survival, we silenced the gene using siRNA mediated knockdown and performed expression profiling of 36 survival-related genes. Through computational mapping of the differentially expressed genes, members of the MAPK (mitogen-activated protein kinase) family were found to be likely effectors of PTN signaling in EOC cells. Our results provide the first experimental evidence that PTN and its signaling components may be of significance in the pathogenesis of epithelial ovarian cancer and provide a rationale for clinical evaluation of MAPK inhibitors in PTN and/or PTPRZ1 expressing ovarian tumors.

Fungal Sinusitis: Fact or Fiction?

Objectives:

Participants should be able to: (1) Recognize chronic fungal sinusitis based on clinical examination and radiologic imaging; (2) Analyze the implications of nasal flora contents in suspected chronic fungal sinusitis patients; and (3) Implement surgical and medical treatment of chronic fungal sinusitis.

Methods:

A retrospective review of the senior author’s patients from 1990 to 2014 was completed in which 50 immunocompetent patients thought to have evidence of fungal sinusitis were identified by the following criteria: Classic “high density” material seen on computed tomography (CT), fungal mycelium seen at surgery/fungal smears, and “Fig Newton” material visualized endoscopically in sinuses. Endoscopic surgery was performed on patients with emphasis to widely open sinuses and trim turbinates, allowing postoperative access to affected areas. Intraoperatively, material from sinus cavities was sent for microbiological and pathological analysis. Postoperatively, patients used saline irrigations to remove debris and potent topical steroids to reduce mucosal reactivity and edema. Antifungal agents were not employed. Regular debridements were carried out in the clinic until healing was complete.

Results:

Fungus was present in 29% of cultures/smears, while staphylococcus, pseudomonas, and other organisms were present in 44%. Nasal sinus mucosa returned to normal appearance in the majority of patients with topical treatment. Some patients with a strong allergy history had persistence of hypertrophic mucosa. A pulsed course of oral prednisone generally resolved this.

Conclusions:

Wide surgical drainage of affected sinus areas in combination with saline/acetic acid irrigations and topical steroids were successful in nearly all patients without the use of antifungal agents.

Chronic ingestion of H1-antihistamines increase progression of atherosclerosis in apolipoprotein E-/- mice

Although increased serum histamine levels and H1R expression in the plaque are seen in atherosclerosis, it is not known whether H1R activation is a causative factor in the development of the disease, or is a host defense response to atherogenic signals. In order to elucidate how pharmacological inhibition of histamine receptor 1 (H1R) signaling affects atherogenesis, we administered either cetirizine (1 and 4 mg/kg. b.w) or fexofenadine (10 and 40 mg/kg. b.w) to ApoE^−/− mice maintained on a high fat diet for three months. Mice ingesting a low dose of cetirizine or fexofenadine had significantly higher plaque coverage in the aorta and cross-sectional lesion area at the aortic root. Surprisingly, the higher doses of cetirizine or fexofenadine did not enhance atherosclerotic lesion coverage over the controls. The low dose of fexofenadine, but not cetirizine, increased serum LDL cholesterol. Interestingly, the expression of iNOS and eNOS mRNA was increased in aortas of mice on high doses of cetirizine or fexofenadine. This may be a compensatory nitric oxide (NO)-mediated vasodilatory mechanism that accounts for the lack of increase in the progression of atherosclerosis. Although the administration of cetirizine did not alter blood pressure between the groups, there was a positive correlation between blood pressure and lesion/media ratio at the aortic root in mice receiving the low dose of cetirizine. However, this association was not observed in mice treated with the high dose of cetirizine or either doses of fexofenadine. The macrophages or T lymphocytes densities were not altered by low doses of H1-antihistamines, whereas, high doses decreased the number of macrophages but not T lymphocytes. The number of mast cells was decreased only in mice treated with low dose of fexofenadine. These results demonstrate that chronic ingestion of low therapeutic doses of cetirizine or fexofenadine enhance progression of atherosclerosis.

The prognostic value of BRCA1 promoter methylation in early stage triple negative breast cancer

Introduction

Methylation of the BRCA1 promoter is frequent in triple negative breast cancers (TNBC) and results in a tumor phenotype similar to BRCA1-mutated tumors. BRCA1 mutation-associated cancers are more sensitive to DNA damaging agents as compared to conventional chemotherapy agents. It is not known if there is an interaction between the presence of BRCA1 promoter methylation (PM) and response to chemotherapy agents in sporadic TNBC. We sought to investigate the prognostic significance of BRCA1 PM in TNBC patients receiving standard chemotherapy.

Methods

Subjects with stage I-III TNBC treated with chemotherapy were identified and their formalin-fixed paraffin-embedded (FFPE) tumor specimens retrieved. Genomic DNA was isolated and subjected to methylation-specific PCR (MSPCR).

Results

DNA was isolated from primary tumor of 39 subjects. BRCA1 PM was detected in 30% of patients. Presence of BRCA1 PM was associated with lower BRCA1 transcript levels, suggesting epigenetic BRCA1 silencing. All patients received chemotherapy (anthracycline:90%, taxane:69%). At a median follow-up of 64 months, 46% of patients have recurred and 36% have died. On univariate analysis, African-American race, node positivity, stage, and BRCA1 PM were associated with worse RFS and OS. Five year OS was 36% for patients with BRCA1 PM vs. 77% for patients without BRCA1 PM (p=0.004). On multivariable analysis, BRCA1 PM was associated with significantly worse RFS and OS.

Conclusions

We show that BRCA1 PM is common in TNBC and has the potential to identify a significant fraction of TNBC patients who have suboptimal outcomes with standard chemotherapy.

Prolactin signaling enhances colon cancer stemness by modulating Notch signaling in a Jak2-STAT3/ERK manner

Prolactin (PRL) is a secretory cytokine produced by various tissues. Binding to the cognate PRL receptor (PRLR), it activates intracellular signaling via janus kinase (JAK), extracellular signal-regulated kinase (ERK) and signal transducer and activator of transcription (STAT) proteins. PRL regulates diverse activities under normal and abnormal conditions, including malignancies. Previous clinical data suggest serum PRL levels are elevated in colorectal cancer (CRC) patients. In this study, we first determined the expression of PRL and PRLR in colon cancer tissue and cell lines. Higher levels of PRLR expression were observed in the cancer cells and cell lines compared with normal colonic epithelial cells. Incubation of colon cancer cells with PRL-induced JAK2, STAT3 and ERK1/2 phosphorylation and increased expression of Jagged 1, which is a Notch-1 receptor ligand. Notch signaling regulates CRC stem cell population. We observed increased accumulation of the cleaved/active form of Notch-1 receptor (Notch intracellular domain) and increased expression of Notch responsive genes HEY1, HES1 and stem cell marker genes DCLK1, LGR5, ALDH1 and CD44. Finally, inhibiting PRL induced JAK2-STAT3 and JAK2-ERK1/2 using AG490 and PD98059, respectively, leads to complete abrogation of Notch signaling, suggesting a role for this pathway in regulating CRC stem cells. Together, our results demonstrate that cytokine signaling induced by PRL is active in colorectal cancers and may provide a novel target for therapeutic intervention.

Abstract PD09-02: BRCA1 insufficiency is predictive of superior survival in patients with triple negative breast cancer treated with platinum based chemotherapy

Introduction: Triple negative breast cancer (TNBC) and BRCA1-associated breast cancers share many histopathologic and molecular features. BRCA1 plays a crucial role in HR-dependent DNA repair and BRCA1-deficient cells are particularly susceptible to the DNA damaging agents like platinums. Increasing evidence suggests that in addition to germline BRCA defects, other mechanisms (like epigenetic BRCA1 silencing) can lead to BRCA1 insufficiency in TNBC. However, the impact of BRCA1 insufficiency on the efficacy of DNA damaging agents in TNBC is not known.

Aim: To investigate the impact of BRCA1 insufficiency on relapse-free survival (RFS) and overall survival (OS) in patients with stage II-III TNBC treated with neoadjuvant platinum-based chemotherapy. BRCA1 insufficiency (BRCA1insuf) state was defined as presence of germline BRCA1/2 mutation or BRCA1 promoter methylation (PM) and/or low BRCA1 expression (lowest quartile).

Methods: Thirty patients with stage II/III TNBC received neoadjuvant chemotherapy (6 cycles of Carboplatin AUC 6, Docetaxel 75mg/m2 and Erlotinib 150 mg PO) on a phase II trial between 8/2007–6/2010. All but one patient underwent comprehensive BRCA analysis (Myriad Genetic Laboratories). Pre-treatment tumor specimens were used for evaluation of BRCA1 PM and expression. Genomic DNA was isolated from FFPE samples, bisulfite converted and then subjected to methylation-specific PCR (MSP). RNA was isolated, reverse transcribed to cDNA and assayed by quantitative real-time PCR (qRT-PCR) for determination of BRCA1 mRNA transcript levels. RFS and OS were estimated according to the Kaplan-Meier method and compared among groups with log-rank statistic. Cox proportional hazards models were fit to determine the association of BRCA1insuf with the risk of death after adjustment for other characteristics.

Results: Median age: 51yrs, African American: 20%, Median tumor size: 3.3 cm, LN positive: 40%. Six of 30 patients (20%) harbored germline BRCA mutation (4 BRCA1, 2 BRCA2). Baseline tumor specimen was available for 26/30 patients. BRCA1 MSP was successful in 92% and BRCA1 qRT-PCR was successful in 84% of specimens. BRCA1 PM and low BRCA1 expression was present in 30% and 15% of subjects, respectively. There was evidence of BRCA1insuf in 53% (16/30) of subjects. At a median time from diagnosis of 42 months (range, 23–59 months) there have been 9(30%) recurrences and 7(23%) deaths. On univariate analysis node negativity, lower stage and presence of BRCA1insuf were associated with better OS. At the median follow up, RFS is 81% for patients with BRCA1insuf versus 54% for patients without BRCA1insuf (p = 0.16); OS is 83% for patients with BRCA1insuf versus 46% for patients without BRCA1insuf (p = 0.021). After adjustment for clinical variables patients with BRCA1insuf had a significantly better OS compared to patients without BRCA1insuf (p = 0.036).

Conclusions: Germline BRCA testing plus tissue BRCA1 PM/expression can be used to identify a BRCA1insuf sub-population within TNBC demonstrating a favorable outcome with platinum treatment. This BRCA1insuf criteria can be easily used to select TNBC patients likely to benefit from DNA damaging agents like platinums and PARP inhibitors.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD09-02.

Outcomes of breast cancer patients with micrometastases and isolated tumor cells in sentinel lymph nodes

BACKGROUND

The prognostic value and clinical implication of micrometastases and isolated tumor cells (ITCs) in sentinel lymph nodes are still not clearly defined. This study was designed to collect clinical pathological data in our Institution.

PATIENTS AND METHODS

Twenty-five cases of micrometastases and nine cases of ITCs were identified among 1,000 sentinel lymph node biopsies performed at our institution in the last 10 years.

RESULTS

In the 25 patients with sentinel node micrometastases, 12 had completion axillary node dissection, and only one of these twelve had non-sentinel node micrometastasis. In this group, two patients developed local recurrence, and two patients developed distant metastases (one with and one without prior local recurrence) and later died. Both patients had negative non-sentinel lymph nodes. In the 9 patients with sentinel node ITCs, no patient had completion axillary node dissection and no patient developed local or distant metastases.

CONCLUSION

Completion axillary node dissection may not be necessary in patients with sentinel node micrometastases and ITCs as it does not impact local recurrence. ITCs do not seem to have prognostic significance. Micrometastases, however, may be associated with local and/or distant metastasis.

Organotropism and prognostic marker discordance in distant metastases of breast carcinoma: fact or fiction? A clinicopathologic analysis

Prior studies have suggested that the type of breast cancer influences the location of distant metastases ("organotropism") and that there may be discordance of estrogen receptor and human epidermal growth factor receptor 2 (Her2) expression between primaries and metastases. Our aims were to investigate the relationship between tumor type and metastatic site and to compare biomarker expression between primary and metastatic tumors. We retrospectively reviewed 102 biopsy-proven cases of breast cancer metastatic to distant sites from 2000 to 2010 and 34 corresponding primaries for histologic subtype, grade, lymphovascular invasion, lymph node metastasis, and expression of estrogen receptor and Her2. Most metastases were of ductal (88) and lobular (11) histologic types. Available data on primaries indicated that the majority were grade III with positive lymph node metastasis and lymphovascular invasion. Biomarkers on 73 metastases showed 37 estrogen receptor positive/Her2-, 6 estrogen receptor positive/Her2+, 8 estrogen receptor negative/Her2+, and 22 estrogen receptor negative/Her2-. The most common metastatic sites were the lung (26%), bone (32%), and liver (21%). We found no association between estrogen receptor/Her2 profile and metastatic site (P = .16). When compared with ductal carcinoma, lobular carcinoma showed a unique metastatic pattern to gastrointestinal tract/gynecologic sites (P = .014). Of 34 cases with paired prognostic markers for primary and metastatic sites, 7 (20%) demonstrated discordance in estrogen receptor-positive/Her2 profile between the primary and the metastasis. Because the estrogen receptor-positive/Her2 profile of metastatic breast cancer did not always match that of the primary tumor, it is important to repeat the prognostic markers of metastasis.

Organotropism and prognostic marker discordance in distant metastases of breast carcinoma: fact or fiction? A clinicopathologic analysis

Prior studies have suggested that the type of breast cancer influences the location of distant metastases ("organotropism") and that there may be discordance of estrogen receptor and human epidermal growth factor receptor 2 (Her2) expression between primaries and metastases. Our aims were to investigate the relationship between tumor type and metastatic site and to compare biomarker expression between primary and metastatic tumors. We retrospectively reviewed 102 biopsy-proven cases of breast cancer metastatic to distant sites from 2000 to 2010 and 34 corresponding primaries for histologic subtype, grade, lymphovascular invasion, lymph node metastasis, and expression of estrogen receptor and Her2. Most metastases were of ductal (88) and lobular (11) histologic types. Available data on primaries indicated that the majority were grade III with positive lymph node metastasis and lymphovascular invasion. Biomarkers on 73 metastases showed 37 estrogen receptor positive/Her2-, 6 estrogen receptor positive/Her2+, 8 estrogen receptor negative/Her2+, and 22 estrogen receptor negative/Her2-. The most common metastatic sites were the lung (26%), bone (32%), and liver (21%). We found no association between estrogen receptor/Her2 profile and metastatic site (P = .16). When compared with ductal carcinoma, lobular carcinoma showed a unique metastatic pattern to gastrointestinal tract/gynecologic sites (P = .014). Of 34 cases with paired prognostic markers for primary and metastatic sites, 7 (20%) demonstrated discordance in estrogen receptor-positive/Her2 profile between the primary and the metastasis. Because the estrogen receptor-positive/Her2 profile of metastatic breast cancer did not always match that of the primary tumor, it is important to repeat the prognostic markers of metastasis.

Grading ductal carcinoma in situ of the breast using an automated proliferation index

Tumor grade, size and margin status are the most significant factors in predicting the behavior of ductal carcinoma in-situ (DCIS). The inclusion of necrosis and nuclear grade in the grading of DCIS has demonstrated a fair but suboptimal agreement between pathologists. The grading of DCIS was studied and compared to the Van Nuys (VN) system, by using our newly proposed unifying "nuclear grade + proliferation index (N+P) grading system for invasive carcinomas. 162 DCIS tumors were studied including 49 VN I, 31 VN II, and 82 VN III cases. The VN and N+P systems were compared with each other and correlated with tumor size, ER, PR, p53, Her-2, EGFR, Bcl-2, p27 and p21 status. The two systems demonstrated similar frequencies for the different grades and an agreement with each other for all of the biomarkers studied. The greatest difference between the two systems was observed for those tumors initially classified as VN II (94% being down-graded to N+P I) and VN III (80% being down-graded to N+P II). These results suggest that the N+P system, combining nuclear grade with automated MIB-1 count, is a potentially valid and reproducible grading system for both non-invasive and invasive mammary carcinomas. It is automated, less subjective in assessing mitotic activity and necrosis and correlates with other prognostic biomarkers.

Lobular carcinoma in situ/atypical lobular hyperplasia on breast needle biopsies: does it warrant surgical excisional biopsy? A study of 27 cases

Lobular neoplasia including lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) may be identified in breast core needle biopsies as incidental findings or associated with microcalcifications. There are no general consensus guidelines for follow-up management in patients when lobular neoplasia is the only abnormal finding on core needle biopsy. The aim of this study was to evaluate our experience in the follow-up of these patients. A total of 3163 breast core needle biopsies were retrieved from the surgical pathology files between 2003 and 2009; among them, 56 (1.8%) cases were identified with a diagnosis of ALH or LCIS. Eleven cases were excluded because of the presence of a concurrent more severe lesion in the biopsies that mandated excision. The remaining 45 cases contained only ALH or LCIS and otherwise benign breast tissue; 27 had surgical excision follow-up. In the surgical excision specimens, 5 (19%) of 27 cases showed more severe lesions or were "upgraded" (3 invasive ductal carcinomas, 1 invasive lobular carcinoma, and 1 ductal carcinoma in situ). Histologic features of the lobular neoplasia on the cores, including association with microcalcifications, pagetoid involvement of ducts, and extensive lobular involvement, were retrospectively evaluated. These histologic features were found to have no predictive value for a more severe lesion in the subsequent excision. We suggest that patients with LCIS/ALH on core needle biopsy should be considered for surgical excision to rule out a more significant lesion regardless of the histologic features.

Angiosarcoma of the breast: a clinicopathologic analysis of cases from the last 10 years

Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. In our effort to characterize the clinicopathologic features of breast angiosarcoma, we reviewed all breast angiosarcoma cases in the University of Kansas Medical Center and Ohio State University Medical Center archives from 1997 to 2007. Clinical histories and follow-up data for identified patients were reviewed. The tumors were graded histologically according to Rosen's method. Only 11 angiosarcomas were identified among more than 5000 malignant breast neoplasms (0.1%-0.2% incidence) for the last 10 years. Eight cases (6 high grade, 1 intermediate grade, 1 low grade) were identified as postradiation angiosarcoma (postradiation time interval, 4-12 years), and 3 cases were identified as primary angiosarcomas (1 high grade, 2 low grade). Follow-up (median, 36 months) revealed that 3 cases of postradiation angiosarcoma recurred as skin and/or chest wall lesions and 1 case of primary angiosarcoma developed liver metastases (all high-grade). In conclusion, breast angiosarcoma remains a rare disease. Rosen's method for grading breast angiosarcoma is easy to implement and correlates well with clinical outcome. There are no distinct clinical or histologic differences between primary and postradiation breast angiosarcomas.

A newly proposed semi-automated method of grading invasive lobular carcinoma: a unifying concept and correlation with prognostic markers and patient survival

Invasive ductal carcinoma (IDC) of the breast is currently graded according to the Nottingham modification of the Scarff-Bloom-Richardson system (SBR). This system involves subjective evaluation of 3 morphologic features: tubule formation, nuclear pleomorphism, and mitosis. Our recently proposed semi-automated Nuclear and Proliferation Index [N+P] grading system for IDC has demonstrated agreement among grades and prognostic markers with better prediction of patient survival than the SBR system. Our present objective is to expand the utilization of the N+P system to grading invasive lobular carcinoma (ILC). Fifty-eight ILC cases were evaluated by the SBR and N+P systems. The 2 systems were compared in terms of correlation with patient survival, tumor size, grade, angiolymphatic invasion, lymph node status, ploidy status, and ER, PR, Her-2, p53, EGFR, and Bcl-2 staining. The N+P and SBR systems demonstrated overall agreement when correlated with clinical and prognostic parameters. Twenty-four of 30 tumors initially classified as SBR Grade II were down-graded to N+P I. Three of 26 tumors initially classified as SBR Grade I were up-graded to N+P II. Grading of ILC provides valuable predictive and prognostic information. The N+P grading system for ILC decreases the element of subjectivity for assessing mitotic activity and appears to be superior to the SBR system in predicting patient survival.

Prognostic significance of CD44, platelet-derived growth factor receptor alpha, and cyclooxygenase 2 expression in renal cell carcinoma

CONTEXT

Pathologic stage is the main prognostic factor for predicting outcome in renal cell carcinoma (RCC). Because of its unreliability in predicting tumor progression, other factors are needed to provide additional prognostic information.

OBJECTIVE

The expression of CD44, cyclooxygenase 2, and platelet-derived growth factor receptor alpha (PDGFR-alpha) was evaluated as a potential prognostic factor for survival in patients with RCC.

DESIGN

Sixty-two patients (42 men and 20 women; median age, 61 years), undergoing partial (10 cases) or radical (55 cases) nephrectomy for RCC were retrospectively analyzed by immunohistochemical analysis for CD44, cyclooxygenase 2, and PDGFR-alpha expression. Impact of various factors on disease-specific and overall survival was calculated using Cox proportional hazards models.

RESULTS

There was a gradual increase in CD44 and cyclooxygenase 2 expression with increasing RCC nuclear grade. In contrast, PDGFR-alpha expression showed no consistent relationship with nuclear grade. On univariate analysis, metastasis at time of surgery (P < .001), tumor size (P = .004), pathologic stage group (P = .001), and nuclear grade (P = .004) were correlated with disease-specific survival. On multivariate analysis, only the presence of metastasis at diagnosis (P < .001) was significant. For overall survival, metastasis (P < .001), tumor size (P = .02), pathologic stage group (P = .01), nuclear grade (P = .003), and PDGFR-alpha (P = .03) were significant on univariate analysis. Only metastasis (P = .001) and PDGFR-alpha (P = .03) were significant on multivariate analysis.

CONCLUSIONS

When combined with other variables, PDGFR-alpha expression in RCC may provide additional predictive value related to the patient's overall survival. However, CD44 and cyclooxygenase 2 do not seem to be independent prognostic indicators in predicting outcomes for patients with RCC.

Proposed prognostic score for breast carcinoma on fine needle aspiration based on nuclear grade, cellular dyscohesion and bare atypical nuclei

Fine needle aspiration is an established diagnostic tool in breast carcinoma. Although the potential of using the same diagnostic aspirate material to provide additional cytomorphologic prognostic or predictive information has been investigated, no well-recognized, practical grading system has been established. Such system is necessary in guiding treatment, monitoring neoadjuvant chemotherapy effect and predicting outcome. We herein propose a new grading system, combining nuclear grade, cellular dyscohesion, and bare atypical nuclei to arrive at one cytoprognostic score. Cytoprognostic scores were compared with other known prognostic factors. Fine needle aspirations of breast diagnosed as adenocarcinoma from 55 patients were reviewed. The cytoprognostic score combined three features including nuclear grade (score 1-3), cellular dyscohesion (score 1-3), and bare atypical nuclei (score 0, 1). A cytoprognostic score of 3 and below was considered a low score, and a score of 4-7 was considered a high score. The cytoprognostic score was then compared to histologic grade, lymph node status, and expressions of estrogen receptor, progesterone receptor, Her2-Neu, Ki-67, and p53 in the subsequently excised tumor. A low cytoprognostic score predicted a low to intermediate grade carcinoma and a high score predicted an intermediate to high-grade carcinoma. A high cytoprognostic score also correlated with more positive lymph node metastasis, and poor expression of prognostic markers. In conclusion, cytoprognostic score is performed with ease and shows a great promise as a cost-effective way to predict biological behavior of breast carcinoma and guide clinical management.

Comparison of immunohistochemistry by automated cellular imaging system (ACIS) versus fluorescence in-situ hybridization in the evaluation of HER-2/neu expression in primary breast carcinoma

AIMS

Immunohistochemistry (IHC) and fluorescence in-situ hybridization (FISH) are both commonly used assays for evaluation of HER-2/neu status in breast cancer. However, there is still no consensus on which method is most predictive of patient response to Herceptin. Recently, the automated cellular imaging system (ACIS) has been shown to improve the accuracy and reproducibility in scoring IHC. Our aim was to compare the results of HER-2/neu expression and gene amplification in the same patients by IHC using the ACIS system and by FISH.

METHODS AND RESULTS

Two hundred and forty-seven breast cancer cases were studied. The concordance rate between IHC-ACIS (> or = 2.2) and FISH (> or = 2.0) was 94%. Fifteen patients were discordant; three had borderline FISH values and three had borderline IHC values. The other nine discordant cases consisted of five IHC-ACIS+, FISH- and six IHC-ACIS-, FISH+. HER-2/neu overexpression was more common in tumours that were high-grade, aneuploid, progesterone receptor and bcl-2 negative, with MIB-1 > 10%.

CONCLUSION

HER-2/neu assessment by the ACIS is reliable, rapid and inexpensive, and correlates highly with results obtained by FISH.

Adrenal pseudocyst: a unique case with adrenal renal fusion, mimicking a cystic renal mass

We describe an unusual adrenal pseudocyst mimicking radiologically and clinically renal mass. The cyst measured 12 cm in diameter and had a fibrotic external envelope that was fused with the renal capsule. The possible diagnostic pitfalls encountered in this case are discussed.

Breast Cancer Chemoprevention Phase I Evaluation of Biomarker Modulation by Arzoxifene, a Third Generation Selective Estrogen Receptor Modulator

PURPOSE

Arzoxifene, a new selective estrogen receptor modulator with strong breast antiestrogen activity and absence of uterine agonist activity, was explored as a potential chemoprevention agent. We performed a multi-institutional evaluation of arzoxifene in women with newly diagnosed ductal carcinoma in situ or T1/T2 invasive cancer.

EXPERIMENTAL DESIGN

In a Phase IA trial, 50 pre- or postmenopausal women were randomized to 10, 20, or 50 mg of arzoxifene daily in the interval between biopsy and re-excision or were enrolled as no-treatment controls. In a Phase IB trial, 76 postmenopausal women were randomized to 20 mg of arzoxifene versus matched placebo. Serum specimens collected at entry and at re-excision were assayed for various hormones and growth factors. Tissue from biopsies (estrogen receptor + and/or progesterone receptor +) and re-excision specimens was evaluated immunohistochemically for proliferation (Ki-67 by MIB-1 and proliferating cell nuclear antigen) and other biomarkers.

RESULTS

In both trials, increases in serum sex hormone binding globulin were noted, as were decreases in insulin-like growth factor (IGF)-I and the IGF-I:IGF binding protein-3 ratio (P < 0.007 versus control/placebo). For 45 evaluable women in Phase IA, decreases in proliferation indices were more prevalent for arzoxifene (particularly 20 mg) than for controls. For 58 evaluable women in Phase IB, a decrease in estrogen receptor expression for arzoxifene was observed compared with no change with placebo (P = 0.0068). However, decreases in proliferation indices for arzoxifene were not statistically different from placebo, perhaps due to a confounding effect of stopping hormone replacement therapy before entry.

CONCLUSION

Given the favorable side effect profile and the biomarker modulations reported here, arzoxifene remains a reasonable candidate for additional study as a breast cancer chemoprevention agent.

Telomerase reverse transcriptase subunit immunoreactivity: a marker for high-grade prostate carcinoma

BACKGROUND

Telomerase, a ribonucleoprotein complex that maintains telomeric DNA, has been detected in 67-93% of prostate carcinomas by telomeric repeat-amplification protocol assay (involving polymerase chain reaction). One study used in situ hybridization in nine patients; however, to date, no immunohistochemical results have been published.

METHODS

From two hospitals, the authors compiled data on 62 patients who underwent prostatectomy from January 1996 to May 2001. Representative tissue sections were immunostained with a polyclonal antibody to telomerase reverse transcriptase (TERT), the catalytic subunit of telomerase. Staining was evaluated by two observers and was correlated with grade, stage, and biochemical failure. There were 28 sections from low-grade to intermediate-grade tumors (Gleason score, 3-6), 14 sections with a Gleason score of 3 + 4 = 7, 9 sections with a Gleason score of 4 + 3 = 7, and 11 sections from high-grade tumors (Gleason score, 8-10).

RESULTS

From low-grade to high-grade tumors, the four groups described above disclosed nuclear reactivity in 64%, 100%, 100%, and 100% of sections, respectively. Mean percentages of 5%, 15%, 40%, and 51% of nuclei were reactive in the respective groups (P < 0.0001) with intratumoral heterogeneity. The percent of reactive tumor nuclei was not correlated with pathologic stage (P = 0.32) or margin status (P = 0.35). The basal cell layer in sections of high-grade prostatic intraepithelial neoplasia (HGPIN) and benign/atrophic acini was reactive; secretory cells were reactive in 13 of 34 HGPIN foci (38%) in 1-20% of nuclei and were never reactive in benign acini. Lymphocytes and skeletal muscle were reactive. Weak, nonspecific, cytoplasmic staining was noted in benign and tumor acini.

CONCLUSIONS

Like cytokeratin 34betaE12, nuclear anti-TERT reactivity is a basal cell marker in nonneoplastic prostatic acini. Anti-TERT reactivity is acquired by secretory cells in tumorigenesis, but consistent reactivity is restricted to high-grade carcinoma (Gleason primary pattern >or=4). This histologic evidence suggests that higher grade tumors have maximally activated telomerase and may be most responsive to antitelomerase therapy.

A comparison of prognostic tumor markers obtained on image-guided breast biopsies and final surgical specimens

BACKGROUND

This study was initiated to determine whether tumor markers obtained on image-guided breast biopsy specimens provide accurate prognostic information for women with invasive breast cancer.

METHODS

Prognostic tumor markers on preoperative image-guided biopsy and final surgical specimens were compared in 44 patients with invasive breast cancer.

RESULTS

Progesterone receptor (PR) discordance was 18%. In 87% of PR discordant cases, the image-guided biopsy was positive and the final specimen was negative (P = 0.03). Tumor grade was discordant in 36% of patients Discordance for estrogen receptor (ER) = 2%; MIB-1 = 18%; Her2/neu = 9%; EGFR = 10%; p53 = 9%; and bcl-2 = 0%. The discordance for these markers was random and did not reach statistical significance.

CONCLUSION

Image-guided core needle biopsies provide reliable information for the majority of prognostic tumor makers. A positive progesterone receptor is significantly more likely to be determined by core biopsy rather than the final surgical specimen. Tumor grade should be based upon the final surgical specimen whenever possible.

Langerhans cell granulomatosis manifested as pigmented villonodular synovitis

We report an unusual case of Langerhans cell granulomatosis (LCG) manifested as a villous synovial proliferation in a 38-year-old female jogger. One year after the onset of joint symptoms, she had a classical LCG presentation with skin and visceral lymph node involvement. Review of the literature revealed only one case of synovial shoulder joint tenosynovitis associated with LCG in a middle-aged woman. Ours is the first reported case presenting clinically in the synovium of the hip joint as pigmented villonodular synovitis. Histiocytic/dendritic proliferations involving the synovial tissues are not uncommon. These lesions as well as the rare multicentric reticulohistiocytosis (MRH), a systemic monocytoid/histiocytic disorder with multinucleated giant cells, polyarthritis, and papulonodular skin lesions, should be considered in the differential diagnosis. Clinical and pathologic features will distinguish LCG from MRH.

CD44s expression is reduced in endometriotic lesions compared to eutopic endometrium in women with endometriosis

Immunohistochemical expression of the standard form of CD44 (CD44s) was examined in archival formalin-fixed endometriotic and matching eutopic endometrial tissue obtained from 25 patients in proliferative (N = 16) and secretory (N = 9) stages of the cycle. CD44s was expressed in most eutopic endometria and endometriotic tissue. Its expression was significantly higher in secretory than in proliferative phase endometrium. It was low but detectable in 13 of 16 proliferative phase biopsies. The majority of these endometria exhibited both glandular and stromal staining (63%). In the secretory phase, glandular cells exhibited a significantly greater intensity of staining compared to stromal cells. In endometriotic tissue, stromal cell CD44s expression did not differ between tissue types in either stage of the cycle. In contrast, glandular expression in endometriotic tissue during the secretory phase was reduced (p < 0.05) compared to eutopic endometrium. It was absent in 66% of cases and reduced in the remaining cases. Our results indicate a correlation between CD44s expression and secretory differentiation of endometrial glands in the cycle, suggesting hormonal regulation of its expression. This cyclic pattern of CD44s expression was lost in corresponding endometriotic tissue. Reduced expression of CD44s in endometriotic tissue may provide insight into the pathophysiology of endometriosis.

Breast conservation therapy with tumor bed irradiation alone in a selected group of patients with stage I breast cancer

Radiotherapy after breast-conserving surgery increases local control. We tested the feasibility of limited surgery with tumor bed irradiation only with 192Ir in a selected group of patients with stage I breast cancer. Twenty-five breasts in 24 women more than 60 years old with low- or intermediate-grade stage I tumors were treated with placement of interstitial catheters at the time of lumpectomy and axillary node dissection. This procedure was followed by after-loading with low-dose 192Ir to deliver 20-25 Gy to the tumor bed over 24-48 hours. There were neither local recurrences in the breast nor distant recurrences at a median follow-up of 47 months (range 25-90 months). Cosmetic appearance ranged from very good to excellent. There were no long-term complications. It is feasible to treat a select group of patients with tumor bed irradiation, using relatively low doses of interstitial irradiation, with excellent local control and no significant morbidity.

Tumor necrosis factor-alpha response to infection with Chlamydia trachomatis in human fallopian tube organ culture

OBJECTIVE

Our purpose was to determine whether tumor necrosis factor-alpha is produced in response to infection with Chlamydia trachomatis in the fallopian tube.

STUDY DESIGN

Fallopian tubes were harvested at the time of abdominal hysterectomy and processed by standard tissue culture techniques. Tubal segments were inoculated with Chlamydia trachomatis serotype E/UW-5/CX. At 48 hours of incubation supernatant fluid was assayed for tumor necrosis factor-alpha. Tubal segments were stained for chlamydial inclusions and tumor necrosis factor-alpha by use of immunohistochemical techniques.

RESULTS

Mean tumor necrosis factor-alpha levels for infected segments were 92.1 +/- 21.3 pg/ml (mean +/- SEM) and for control segments were 61.9 +/- 13.9 pg/ml (p = 0.03 by paired t test). Tumor necrosis factor-alpha was predominantly localized in the tubal epithelium.

CONCLUSIONS

Tumor necrosis factor-alpha is produced in response to chlamydial infection by the human fallopian tube. It is an important proinflammatory cytokine and may promote the production of other cytokines and immune-mediated damage of the fallopian tube.

Multicentric bilateral renal cell carcinomas and a vascular leiomyoma in a child

We report a unique case of multicentric bilateral renal cell carcinomas and a simultaneous large renal vascular leiomyoma in an 11-year-old child with sickle cell anemia. The patient presented with several episodes of massive hematuria. Abdominal sonography and computed tomography demonstrated bilateral renal neoplasms and the patient was clinically thought to have bilateral Wilms' tumor. An initial biopsy of the lower pole of right kidney revealed a renal cell carcinoma. Accordingly, bilateral renal angiography followed by right total nephrectomy and left upper pole partial nephrectomy were performed. Pathologic studies showed multicentric, bilateral renal cell carcinomas (two in the right kidney and one in the left kidney), of clear, granular, and oncocytic cell types. A simultaneous large vascular leiomyoma was also present in the right kidney. The smooth muscle nature of the leiomyoma was determined by light microscopy, immunohistology, and electron microscopy. The diagnostic difficulties in distinguishing them from other renal tumors are discussed.

Lipohyperplasia of the ileocecal valve

Submucosal lipohyperplasia of the ileocecal valve (ICV) is reportedly a rarely diagnosed lesion of uncertain significance. Eight cases of ICV lipohyperplasia diagnosed in surgical specimens (seven resections, one biopsy) are reviewed: three cases were associated with right lower abdominal quadrant pain and ICV mass on barium enema or operative examination, two were associated with ICV mucosal acute inflammation and necrosis, and three were incidental in resections for cecal, appendiceal, and sigmoid neoplasia. To evaluate the frequency of ICV lipohyperplasia and any associated processes, a series of 51 autopsies was studied. Regarding lipohyperplasia in these valves, 10 (19.6%) were determined to have none, 14 (27.5%) were mild, 20 (39.2%) were moderate, and 7 (13.7%) were marked cases. Degree of lipohyperplasia correlated statistically with degree of cardiac right ventricular fatty infiltration (p = 0.0001), pancreatic fatty infiltration (p = 0.0314), and greater body weight of patient (p = 0.0009). No definite correlation was demonstrated with left ventricular, adrenal, or lymph node fatty infiltration, or with hepatic fatty change, body height, age of patient, or blood glucose. Various gastrointestinal symptoms and lesions accompanied lipohyperplasia, but no definite causal relationship was identified, except for one case of marked lipohyperplasia associated with marked mucosal necrosis and acute inflammation of ICV. In conclusion, ICV lipohyperplasia is a common finding that occasionally may be associated with clinical symptoms and other valve pathology. It correlates to some extent with right ventricular and pancreatic fatty infiltration and with greater body weight.

Saccharomyces cerevisiae pneumonia in a patient with acquired immune deficiency syndrome

The clinical course of a patient with a polymicrobial pneumonia that included Saccharomyces cerevisiae infection is described. S. cerevisiae was recovered from autopsy cultures of the lungs, spleen, oral mucosa, and small intestine, and organisms morphologically consistent with S. cerevisiae were visualized in histologic sections of the lung. The role of this organism as a human pathogen is reviewed.

Epidermal growth factor binding in rat uterus during the peri-implantation period

The profile of epidermal growth factor (EGF) binding to uterine membranes of rats on Day 1 through Day 7 of pregnancy was studied. The binding was lowest on Day 1 and increased gradually through the pre- and postimplantation periods. Binding affinity of the Day 7 uterine membranes was considerably higher than that of the Day 1. Apparent affinity constants (Ka) of Day 1 and Day 7 membranes were 0.29 X 10(-8) M and 1.03 X 10(-8) M respectively. To our knowledge, this is the first report of the modulation of EGF binding to uterine membranes by progesterone-estrogen interaction during early pregnancy.

Further evidence for role of leukotrienes as mediators of decidualization in the rat

Inhibitors of leukotrienes were utilized to investigate the role of leukotrienes (LTs) in the induction of decidualization in the rat. Alzet osmotic minipumps, filled with either FPL 55712 (FPL, a specific antagonist of peptidoleukotrienes), nordihydroguaiaretic acid (NDGA, an inhibitor of LT synthesis) or in combination with leukotriene C4 (LTC4) and/or prostaglandin E2 (PGE2), were instilled at the ovarian end of uterine horns of day 5 pseudopregnant rats. Intraluminal infusion of FPL or NDGA, for 4 days, induced a dose dependent decrease in the uterine wet weights when compared to that induced by the infusion of their corresponding vehicles (1 microliter/h). Furthermore, simultaneous infusion of LTC4 (10 ng/h) with different doses of FPL (1, 0.5, or 0.25 microgram/h) produced an increase in uterine weights as compared to that produced by FPL alone. Maximum response, however, was noted when LTC4 (10 ng/h) was infused with FPL at a rate of 0.5 microgram/h. The infusion of LTC4 (10 ng/h) or PGE2 (1 microgram/h) with NDGA, at 1 and 5 micrograms/h, could not overcome its inhibitory effect on decidualization. On the contrary, a combination of LTC4 (10 ng/h) and PGE2 (1 microgram/h) along with NDGA (5 micrograms/h) significantly increased the uterine weight to a level that was comparable to that induced by the infusion of the vehicle. To determine if the synthesis of PGs and LTs was inhibited by NDGA, one uterine horn was infused with NDGA (5 micrograms/h) and the other horn with the vehicle. The intrauterine infusion of NDGA for 24 h inhibited the release of PGE2, PGF2 alpha, LTC4 and LTB4 as compared to those released by the vehicle-infused horns. These data suggest that both PGs and LTs are required for the induction and progression of decidualization.

Release of prostaglandins and leukotrienes from the rat uterus is an early estrogenic response

The early estrogenic responses are considered to be involved in inducing embryo implantation in a progesterone (P4)-primed uterus. Because of their involvement in the process of implantation and decidualization, prostaglandins (PGs) and leukotrienes (LTs) could be the mediators of early estrogenic responses in a P4-primed uterus. Therefore, temporal effects of estrogen on the production and/or release of PGF2, PGF2 alpha, LTB4 and LTC4 by the P4-primed uterus of hypophysectomized rats were examined. Hypophysectomized mature female rats were injected for 4 days with P4 (2 mg/rat, s.c.) or with P4 plus a single injection of estradiol-17 beta (E2) (100 ng or 200 ng/rat, i.v.) on the last day of P4 treatment. In one set of experiments, animals were killed at 0.5, 2, 4, 8, 12 and 30th after the last steroid treatment. The production of PGs and Lts by uterine homogenates was measured by radioimmunoassays (RIAs). The production of PGE2 and PGF2 alpha in P4-treated animals showed peaks at 2, 6 and 12h. The superimposition of E2 on P4 treatment induced a higher production rate of PGE2 and PGF2 alpha at 0.5h and abolished the peaks induced by P4 at 2h, but not the peaks at 6 or 12h. Irrespective of the kind of steroid hormonal treatments, uterine production of LTs showed a rapid decline between 6 and 8h followed by a sharp rise at 12h. The superimposition of E2 on P4-treatment again increased the production rates of LTB4 and LTC4 at early hours, i.e. at 0.5 and 2h, respectively, as compared to P4 treatment only.

Decidualization in the rat: role of leukotrienes and prostaglandins

The role of prostaglandins (PGs) and leukotrienes (LTs) in the induction of decidualization in the rat uterus was investigated. In the hypophysectomized progesterone (P4) primed rat, intraluminal infusion for four days by osmotic minipump, of PGE2 (1 ug/h), LTC4 (10 ng/h) or 0.15M saline (1 ul/h) significantly elevated uterine weight when compared to the noninfused horn: all were equally effective. In contrast, simultaneous infusion of PGE2 and LTC4 produced an increase in uterine weight which was markedly higher than any other conditions and the reaction was elicited along the entire length of the uterine horn. Infusion of PGE2, LTC4, a combination of the two or vehicle, into one uterine horn of day-5 pseudopregnant rats elicited a huge decidual response. Infusion of indomethacin, an inhibitor of PG synthesis, FPL 55712 (FPL), an antagonist of LTs, or a combination of these inhibitors evoked a minimal decidual response. In addition, FPL infused along with PGE2 or LTC4 markedly reduced the response that could be induced by these arachidonate metabolites alone. Furthermore, infusion of indomethacin along with LTC4 resulted in a far smaller response than that obtained with LTC4 alone. These results are interpreted to indicate that there is an interaction between LTs and PGs in the induction of the uterine decidual response.

Implication of prostaglandin E2 in soluble factor-mediated immune suppression by murine decidual cells

Cells from the uteri of pregnant mice mediate profound nonantigen-specific and nonmajor histocompatibility complex-restricted immune suppression in vitro. In part, those cells accomplish suppression by releasing soluble suppressor factors. The purpose of the present study was to initiate identification of uterine cell suppressor factors. Immune suppression was assayed by the effect of decidual cells or in vitro generated supernatants of decidual cells on mixed lymphocyte reactions (MLR). The following findings support the designation of prostaglandin E2 (PGE2) as a primary suppressor molecule originating with decidual cells: Suppression mediated by supernatants of decidual cells was relieved by removal of lipids but not proteins; indomethacin, an inhibitor of prostaglandin synthesis, produced partial relief of suppression mediated by uterine cells and totally inhibited soluble suppressor factor generation by those cells; decidual cells produced high levels of both PGE2 and PGF2a; the addition of exogenous PGE2 at levels comparable to those found in the decidual cell supernatants restored suppression by decidual cells and their supernatants whereas the addition of PGF2a had no effect; inhibition of the lipoxygenase pathway of arachidonate metabolism had no effect on cell or supernatant mediated suppression; nonspecific suppressor mechanisms, such as arginine depletion and peroxide generation, were excluded as possible mediators of MLR suppression by decidual cells and their supernatants. Fractionation of decidual cells revealed at least three indomethacin-sensitive cell types: small, lymphocyte-like cells, macrophages, and a third population of large decidual cells that was not identified by specific markers.(ABSTRACT TRUNCATED AT 250 WORDS)

Partial characterization of uterine cells responsible for suppression of murine maternal anti-fetal immune responses

Several studies have demonstrated that uterine cells are capable of suppressing in vitro immune responses in a nonspecific manner. Two types of cells have been implicated as responsible for suppression, cells with the features of macrophages and a small lymphocyte-like cell. In the present study the maternal anti-paternal mixed lymphocyte reaction was used to investigate further the characteristics of uterine suppressor cells. Three distinct suppressor cell populations were identified: highly suppressive macrophages, small lymphocyte-like cells, and a morphologically heterogeneous third population of highly suppressive cells. The data from this study suggest that pregnant murine uteri contain a variety of cells capable of discouraging lymphocyte proliferation in vitro.