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Martin D, Smith SC, Chesney A, Jackson-Cook C, Pillappa R. Too Sensitive or Just Right? Am J Clin Pathol 2022; 158:283-290. [PMID: 35482487 DOI: 10.1093/ajcp/aqac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare the performance of the rabbit monoclonal antihuman CD246 antibody (D5F3 clone) with the established ALK1 clone for immunohistochemical assessment of anaplastic large cell lymphoma (ALCL). METHODS Archival cases of ALCL (n = 27) were assessed immunohistochemically by use of ALK1 and D5F3 clones under standard Clinical Laboratory Improvement Amendments-compliant conditions. The intensity of cytoplasmic staining (0 = none; 1 = faint; 2 = moderate; 3+ = strong) and proportion of neoplastic cells (0%, <5%, 5%-50%, >50%) were evaluated and compared with clinical ALK break-apart fluorescence in situ hybridization (FISH) assays. RESULTS Nine ALCL specimens were positive for ALK expression by ALK1 staining (33%; 1 = 1+; 0 = 2+; 8 = 3+), while 14 were positive by D5F3 staining (48%; 3 = 1+; 1 = 2+; 10 = 3+). Across the cohort, D5F3 staining showed a significantly greater proportion of cells staining positive (P = .02) and greater intensity (P = .03). Of 3 cases positive for D5F3 only with FISH results, none showed rearrangements, although 1 showed copy number gains at the ALK locus in a subset of cells. CONCLUSIONS Overall, D5F3 showed greater stain intensity and proportion staining than ALK1 in ALK-positive ALCL cases, which is especially helpful in limited samples. Caution and consideration of orthogonal ALK testing types is recommended, especially for cases with weak or focal staining.
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Affiliation(s)
- Dana Martin
- Department of Pathology, Virginia Commonwealth University (VCU) School of Medicine, Richmond, VA, USA
| | - Steven C Smith
- Department of Pathology, Virginia Commonwealth University (VCU) School of Medicine, Richmond, VA, USA
- Department of Surgery, Virginia Commonwealth University (VCU) School of Medicine, Richmond, VA, USA
| | - Alden Chesney
- Department of Pathology, Virginia Commonwealth University (VCU) School of Medicine, Richmond, VA, USA
| | - Colleen Jackson-Cook
- Department of Pathology, Virginia Commonwealth University (VCU) School of Medicine, Richmond, VA, USA
- Department of Human and Molecular Genetics, VCU Health, Richmond, VA, USA
| | - Raghavendra Pillappa
- Department of Pathology, Virginia Commonwealth University (VCU) School of Medicine, Richmond, VA, USA
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2
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Kim M, Vu NT, Wang X, Bulut GB, Wang MH, Uram-Tuculescu C, Pillappa R, Kim S, Chalfant CE. Caspase-9b drives cellular transformation, lung inflammation, and lung tumorigenesis. Mol Cancer Res 2022; 20:1284-1294. [PMID: 35412615 DOI: 10.1158/1541-7786.mcr-21-0905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/28/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
Abstract
Caspase 9 undergoes alternative splicing to produce two opposing isoforms: pro-apoptotic Caspase-9a (C9a) and pro-survival Caspase-9b (C9b). Previously, our laboratory reported that C9b is expressed in majority of non-small cell lung cancer tumors and directly activates the NF-κB pathway. In this study, the role of C9b in activation of the NF-κB pathway in vivo, lung inflammation and immune responses, and lung tumorigenesis were examined. Specifically, a transgenic mouse model expressing human C9b in the lung pneumocytes developed inflammatory lung lesions, which correlated with enhanced activation of the NF-κB pathway and increased influx of immunosuppressive MDSCs in contrast to wild-type mice. C9b mice presented with facial dermatitis, a thickened and disorganized dermis, enhanced collagen depth, and increased serum levels of IL-6. C9b mice also developed spontaneous lung tumors, and C9b cooperated with oncogenic KRAS in lung tumorigenesis. C9b expression also cooperated with oncogenic KRAS and p53 downregulation to drive the full cell transformation of human bronchial epithelial cells (e.g., tumor formation). Implications: Our findings show that C9b can directly activate NF-κB pathway in vivo to modulate lung inflammation, immune cell influx, and peripheral immune responses, which demonstrates that C9b is key factor in driving cell transformation and lung tumorigenesis.
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Affiliation(s)
- Minjung Kim
- University of South Florida, Tampa, FL, United States
| | - Ngoc T Vu
- University of South Florida, United States
| | - Xue Wang
- University of South Florida, Tampa, Virginia, United States
| | - Gamze B Bulut
- Virginia Commonwealth University-School of Medicine, Richmond, Virginia, United States
| | - Min-Hsuan Wang
- H. Lee Moffitt Cancer Center & Research, Tampa, Florida, United States
| | | | - Raghavendra Pillappa
- Virginia Commonwealth University-School of Medicine, Richmond, Virginia, United States
| | | | - Charles E Chalfant
- University of Virginia School of Medicine, Charlottesville, Virginia, United States
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Pillappa R, Wiles A, Sayeed S, Robila V. Usefulness of Cyclin D1/Podoplanin Dual Immunohistochemical Stain to Differentiate Malignant Mesothelioma From Reactive Mesothelial Proliferations. Am J Clin Pathol 2022; 158:187-198. [PMID: 35285890 DOI: 10.1093/ajcp/aqac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/01/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine the potential of cyclin D1/podoplanin dual immunohistochemical stain to differentiate malignant mesothelioma from reactive mesothelial proliferations. METHODS Cyclin D1/podoplanin dual immunohistochemistry was performed on 34 surgical cases of reactive mesothelial proliferations, malignant mesothelioma, and nonmesothelioma malignancies. RESULTS All 15 reactive mesothelial proliferations demonstrated less than 50% cyclin D1 staining with variable to diffuse podoplanin staining. In 6 (60%) of 10 cases of epithelioid malignant mesothelioma, the dual stain supported the diagnosis. Less than 50% cyclin D1 staining was noted in the remaining four cases, including small biopsy specimens or cases with focal papillary architecture. The five cases of sarcomatoid/desmoplastic/biphasic mesothelioma showed more than 50% cyclin D1 staining with focal to absent podoplanin staining. Well-differentiated papillary mesothelioma appears to demonstrate less than 25% cyclin D1 staining. CONCLUSIONS The cyclin D1/podoplanin dual stain is reliable and may be used to aid in differentiation of benign mesothelial proliferations from malignant tumors. In addition, histologic features and other ancillary testing may support the classification of cases with an inconclusive cyclin D1/podoplanin staining.
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Affiliation(s)
- Raghavendra Pillappa
- Department of Pathology and Laboratory Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Austin Wiles
- Department of Pathology and Laboratory Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Sadia Sayeed
- Department of Pathology and Laboratory Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Valentina Robila
- Department of Pathology and Laboratory Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Gillam J, Pillappa R, Idowu M, Boardman C, Sullivan SA, Sayeed S. Preferential human epidermal growth factor receptor 2 expression in myometrial and lymphovascular invasion of a uterine carcinosarcoma: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221081361. [PMID: 35273799 PMCID: PMC8902189 DOI: 10.1177/2050313x221081361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
This case report describes a unique pattern of human epidermal growth factor receptor 2
expression in a patient with uterine carcinosarcoma. The endometrial tumor showed biphasic
morphology composed of serous carcinoma and a heterologous high-grade sarcoma component.
Human epidermal growth factor receptor 2 immunostaining showed positive (3+) expression in
foci of myoinvasion, lymphovascular invasion, and lymph node metastasis but was negative
in both the endometrial surface tumor and sarcomatous component. Fluorescent in situ
hybridization testing for human epidermal growth factor receptor 2 confirmed no
amplification within the endometrial surface carcinoma component and amplification of the
lymphovascular invasion component. As the use of human epidermal growth factor receptor 2
immunohistochemical evaluation becomes more commonplace for therapeutic consideration in
patients with uterine carcinosarcoma, interpretation of the immunohistochemical should be
performed preferentially on large tissue sections including both a surface, myoinvasive
portions, and suspected areas of lymphovascular invasion and lymph node metastasis.
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Affiliation(s)
- Joseph Gillam
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Michael Idowu
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | - Cecelia Boardman
- Division of Gynecologic Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephanie A Sullivan
- Division of Gynecologic Oncology, Virginia Commonwealth University, Richmond, VA, USA
- Massey Cancer Center, Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sadia Sayeed
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
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Fadl SA, Pillappa R, Parker MS. Minute Pulmonary Meningothelial-like Nodules. Radiol Cardiothorac Imaging 2021; 3:e210219. [PMID: 34778789 DOI: 10.1148/ryct.2021210219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/30/2021] [Accepted: 09/17/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Shaimaa A Fadl
- Departments of Radiology (S.A.F., M.S.P.) and Pathology (R.P.), Virginia Commonwealth University Health System, 1200 E Marshall St, Richmond, VA 23298
| | - Raghavendra Pillappa
- Departments of Radiology (S.A.F., M.S.P.) and Pathology (R.P.), Virginia Commonwealth University Health System, 1200 E Marshall St, Richmond, VA 23298
| | - Mark S Parker
- Departments of Radiology (S.A.F., M.S.P.) and Pathology (R.P.), Virginia Commonwealth University Health System, 1200 E Marshall St, Richmond, VA 23298
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Yekelchyk M, Madan E, Wilhelm J, Short KR, Palma AM, Liao L, Camacho D, Nkadori E, Winters MT, Rice ES, Rolim I, Cruz‐Duarte R, Pelham CJ, Nagane M, Gupta K, Chaudhary S, Braun T, Pillappa R, Parker MS, Menter T, Matter M, Haslbauer JD, Tolnay M, Galior KD, Matkwoskyj KA, McGregor SM, Muller LK, Rakha EA, Lopez‐Beltran A, Drapkin R, Ackermann M, Fisher PB, Grossman SR, Godwin AK, Kulasinghe A, Martinez I, Marsh CB, Tang B, Wicha MS, Won KJ, Tzankov A, Moreno E, Gogna R. Flower lose, a cell fitness marker, predicts COVID-19 prognosis. EMBO Mol Med 2021; 13:e13714. [PMID: 34661368 PMCID: PMC8573598 DOI: 10.15252/emmm.202013714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023] Open
Abstract
Risk stratification of COVID-19 patients is essential for pandemic management. Changes in the cell fitness marker, hFwe-Lose, can precede the host immune response to infection, potentially making such a biomarker an earlier triage tool. Here, we evaluate whether hFwe-Lose gene expression can outperform conventional methods in predicting outcomes (e.g., death and hospitalization) in COVID-19 patients. We performed a post-mortem examination of infected lung tissue in deceased COVID-19 patients to determine hFwe-Lose's biological role in acute lung injury. We then performed an observational study (n = 283) to evaluate whether hFwe-Lose expression (in nasopharyngeal samples) could accurately predict hospitalization or death in COVID-19 patients. In COVID-19 patients with acute lung injury, hFwe-Lose is highly expressed in the lower respiratory tract and is co-localized to areas of cell death. In patients presenting in the early phase of COVID-19 illness, hFwe-Lose expression accurately predicts subsequent hospitalization or death with positive predictive values of 87.8-100% and a negative predictive value of 64.1-93.2%. hFwe-Lose outperforms conventional inflammatory biomarkers and patient age and comorbidities, with an area under the receiver operating characteristic curve (AUROC) 0.93-0.97 in predicting hospitalization/death. Specifically, this is significantly higher than the prognostic value of combining biomarkers (serum ferritin, D-dimer, C-reactive protein, and neutrophil-lymphocyte ratio), patient age and comorbidities (AUROC of 0.67-0.92). The cell fitness marker, hFwe-Lose, accurately predicts outcomes in COVID-19 patients. This finding demonstrates how tissue fitness pathways dictate the response to infection and disease and their utility in managing the current COVID-19 pandemic.
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Affiliation(s)
- Michail Yekelchyk
- Department of Cardiac Development and RemodellingMax Planck Institute for Heart and Lung ResearchBad NauheimGermany
| | - Esha Madan
- Champalimaud Centre for the UnknownLisbonPortugal
| | - Jochen Wilhelm
- Universities Giessen & Marburg Lung CenterGerman Center for Lung Research (DZL)Justus‐Liebig‐UniversityGiessenGermany
- Institute for Lung Health (ILH)Universities Giessen & Marburg Lung CenterGerman Center for Lung Research (DZL)Justus‐Liebig‐University GiessenGiessenGermany
| | - Kirsty R Short
- School of Chemistry and Molecular BiosciencesThe University of QueenslandBrisbaneQldAustralia
| | | | - Linbu Liao
- Biotech Research and Innovation Centre (BRIC)University of CopenhagenCopenhagen NDenmark
| | | | - Everlyne Nkadori
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Michael T Winters
- Department of MicrobiologyImmunology & Cell Biology and WVU Cancer InstituteWest Virginia UniversityMorgantownWVUSA
| | - Emily S Rice
- Department of MicrobiologyImmunology & Cell Biology and WVU Cancer InstituteWest Virginia UniversityMorgantownWVUSA
| | - Inês Rolim
- Champalimaud Centre for the UnknownLisbonPortugal
| | - Raquel Cruz‐Duarte
- Instituto de Medicina Molecular João Lobo AntunesFaculdade de MedicinaUniversidade de LisboaLisboaPortugal
| | | | - Masaki Nagane
- Department of BiochemistrySchool of Veterinary MedicineAzabu UniversityKanagawaJapan
| | - Kartik Gupta
- Department of SurgerySchool of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - Sahil Chaudhary
- Department of SurgerySchool of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - Thomas Braun
- Department of Cardiac Development and RemodellingMax Planck Institute for Heart and Lung ResearchBad NauheimGermany
- Member of the German Center for Cardiovascular Research (DZHK)GreifswaldGermany
| | - Raghavendra Pillappa
- Department of PathologyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Mark S Parker
- Department of Diagnostic Radiology and Internal Medicine, Early Detection Lung Cancer Screening Program, Thoracic Imaging Division, Thoracic Imaging Fellowship ProgramVCU Health SystemsRichmondVAUSA
| | - Thomas Menter
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Matthias Matter
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Jasmin Dionne Haslbauer
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Markus Tolnay
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Kornelia D Galior
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Kristina A Matkwoskyj
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Stephanie M McGregor
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Laura K Muller
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Emad A Rakha
- Division of Cancer and Stem CellsDepartment of PathologySchool of MedicineNottingham University HospitalsUniversity of NottinghamNottinghamUK
| | - Antonio Lopez‐Beltran
- Champalimaud Centre for the UnknownLisbonPortugal
- Department of Morphological SciencesCordoba UniversityCordobaSpain
| | - Ronny Drapkin
- Penn Ovarian Cancer Research CenterDepartment of Obstetrics and GynecologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
- Graduate Program in Cell and Molecular BiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
- Basser Center for BRCAAbramson Cancer CenterUniversity of Pennsylvania School of MedicinePhiladelphiaPAUSA
| | - Maximilian Ackermann
- Institute of Pathology and Molecular PathologyHelios University Clinic WuppertalUniversity of Witten/HerdeckeWuppertalGermany
- Institute of Functional and Clinical AnatomyUniversity Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Paul B Fisher
- Department of Human and Molecular GeneticsSchool of MedicineVirginia Commonwealth UniversityRichmondVAUSA
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVAUSA
- Department of Human and Molecular GeneticsInstitute of Molecular MedicineSchool of MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | - Steven R Grossman
- Department of Internal MedicineKeck School of MedicineNorris Comprehensive Cancer CenterLos AngelesCAUSA
- University of Southern CaliforniaLos AngelesCAUSA
| | - Andrew K Godwin
- Department of Pathology and Laboratory MedicineUniversity of Kansas Medical CenterKansas CityKSUSA
- University of Kansas Cancer CenterKansas CityKSUSA
| | - Arutha Kulasinghe
- The University of Queensland Diamantina InstituteThe University of QueenslandBrisbaneQldAustralia
| | - Ivan Martinez
- Department of MicrobiologyImmunology & Cell Biology and WVU Cancer InstituteWest Virginia UniversityMorgantownWVUSA
| | - Clay B Marsh
- Department of MicrobiologyImmunology & Cell Biology and WVU Cancer InstituteWest Virginia UniversityMorgantownWVUSA
| | - Benjamin Tang
- Department of Intensive Care MedicineNepean HospitalPenrithNSWAustralia
| | - Max S Wicha
- Rogel Cancer CenterUniversity of MichiganAnn ArborMIUSA
- Department of Internal MedicineMichigan MedicineUniversity of MichiganAnn ArborMIUSA
| | - Kyoung Jae Won
- Biotech Research and Innovation Centre (BRIC)University of CopenhagenCopenhagen NDenmark
- Faculty of Health and Medical SciencesNovo Nordisk Foundation Center for Stem Cell Biology, DanStemUniversity of CopenhagenCopenhagen NDenmark
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | | | - Rajan Gogna
- Champalimaud Centre for the UnknownLisbonPortugal
- Biotech Research and Innovation Centre (BRIC)University of CopenhagenCopenhagen NDenmark
- Faculty of Health and Medical SciencesNovo Nordisk Foundation Center for Stem Cell Biology, DanStemUniversity of CopenhagenCopenhagen NDenmark
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Camp R, Smith ML, Larsen BT, Roden AC, Farver C, Moreira AL, Attanoos R, Pillappa R, Sansano I, Fabro AT, Homer RJ. Reliability of histopathologic diagnosis of fibrotic interstitial lung disease: an international collaborative standardization project. BMC Pulm Med 2021; 21:184. [PMID: 34074264 PMCID: PMC8170950 DOI: 10.1186/s12890-021-01522-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background Current interstitial lung disease (ILD) diagnostic guidelines assess criteria across clinical, radiologic and pathologic domains. Significant interobserver variation in histopathologic evaluation has previously been shown but the specific source of these discrepancies is poorly documented. We sought to document specific areas of difficulty and develop improved criteria that would reduce overall interobserver variation. Methods Using an internet-based approach, we reviewed selected images of specific diagnostic features of ILD histopathology and whole slide images of fibrotic ILD. After an initial round of review, we confirmed the presence of interobserver variation among our group. We then developed refined criteria and reviewed a second set of cases. Results The initial round reproduced the existing literature on interobserver variation in diagnosis of ILD. Cases which were pre-selected as inconsistent with usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) were confirmed as such by multi-observer review. Cases which were thought to be in the spectrum of chronic fibrotic ILD for which UIP/IPF were in the differential showed marked variation in nearly all aspects of ILD evaluation including extent of inflammation and extent and pattern of fibrosis. A proposed set of more explicit criteria had only modest effects on this outcome. While we were only modestly successful in reducing interobserver variation, we did identify specific reasons that current histopathologic criteria of fibrotic ILD are not well defined in practice. Conclusions Any additional classification scheme must address interobserver variation in histopathologic diagnosis of fibrotic ILD order to remain clinically relevant. Improvements to tissue-based diagnostics may require substantial resources such as larger datasets or novel technologies to improve reproducibility. Benchmarks should be established for expected outcomes among clinically defined subgroups as a quality metric. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01522-6.
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Affiliation(s)
- Robert Camp
- Department of Pathology, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Maxwell L Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Brandon T Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Carol Farver
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Andre L Moreira
- Department of Pathology, New York University School of Medicine, New York, NY, 10016, USA
| | - Richard Attanoos
- Department of Cellular Pathology, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, CF14 4XW, UK
| | - Raghavendra Pillappa
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
| | - Irene Sansano
- Department of Pathology, Vall d'Hebron Hospital, Barcelona, 08035, Spain
| | - Alexandre Todorovic Fabro
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Robert J Homer
- Department of Pathology, Yale University School of Medicine, New Haven, CT, 06510, USA. .,Pathology and Laboratory Medicine Service, VA Connecticut HealthCare System, West Haven, CT, 06516, USA.
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8
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Allen A, Smith SC, Pillappa R, Boikos S, Medalion B, Grizzard J, Cassano A, Harris T. Intimal sarcoma of the pulmonary artery treated with neoadjuvant radiation prior to pulmonary artery resection and reconstruction. Respir Med Case Rep 2021; 33:101414. [PMID: 34401262 PMCID: PMC8348529 DOI: 10.1016/j.rmcr.2021.101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022] Open
Abstract
Intimal sarcoma (IS) is a rare malignancy arising in the great vessels or heart, most commonly in the pulmonary artery, primarily treated with surgical intervention. We report a case of IS of the pulmonary artery diagnosed after an endarterectomy to remove a suspected pulmonary embolism. The tumor could not be entirely resected and showed interval growth at post-operative follow up. Neoadjuvant radiotherapy was then delivered to improve resectability. Imaging confirmed decreased tumor size, and a surgical resection with pulmonary artery reconstruction and right upper lobectomy was then successfully performed. Adjuvant gemcitabine and docetaxel was later initiated. Four months post-operatively, the patient is alive without disease recurrence. While prior reports in the literature document use of adjuvant chemotherapy and radiotherapy for treatment of IS of the pulmonary artery, no prior experience has documented utility of neoadjuvant radiotherapy for improvement of resectability. Our experience suggests that neoadjuvant radiation should be considered to improve resectability in cases of borderline resectable IS of the pulmonary artery.
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Affiliation(s)
- Alexander Allen
- Department of Radiation Oncology, Virginia Commonwealth University School of Medicine, 401 College Street, Richmond, VA, 23298-0037, USA
| | - Steven C Smith
- Department of Pathology, Division of Anatomic Pathology, Virginia Commonwealth University School of Medicine, 1200 East Marshall Street, Gateway Building, 6th Floor, Room 205, Box 980662, Richmond, VA, 23298-0662, USA
| | - Raghavendra Pillappa
- Department of Pathology, Division of Anatomic Pathology, Virginia Commonwealth University School of Medicine, 1200 East Marshall Street, Gateway Building, 6th Floor, Room 204, Box 980662, Richmond, VA, 23298-0662, USA
| | - Sosipatros Boikos
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University School of Medicine, 1201, East Marshall Street, 11th Floor, Suite 11-206, Box 980070, Richmond, VA, 23298-0230, USA
| | - Benjamin Medalion
- Department of Surgery, Division of Cardiothoracic Surgery, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 7th Floor, Box 980645, Richmond, VA, 23298-0068, USA
| | - John Grizzard
- Department of Radiology, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, North Wing, Room 2-013, Box 980470, Richmond, VA, 23298-0470, USA
| | - Anthony Cassano
- Department of Surgery, Division of Cardiothoracic Surgery, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 7th Floor, Box 980645, Richmond, VA, 23298-0068, USA
| | - Timothy Harris
- Department of Radiation Oncology, Virginia Commonwealth University School of Medicine, 401 College Street, Box 980058, Richmond, VA, 23298-0037, USA
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Cartagena LC, McGuire K, Zot P, Pillappa R, Idowu M, Robila V. Breast-Conserving Surgeries With and Without Cavity Shave Margins Have Different Re-excision Rates and Associated Overall Cost: Institutional and Patient-Driven Decisions for Its Utilization. Clin Breast Cancer 2021; 21:e594-e601. [PMID: 33814286 DOI: 10.1016/j.clbc.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reducing the rate of margin positivity and reoperations remains a paramount goal in breast-conserving surgery (BCS). This study assesses the effectiveness of standard partial mastectomy with cavity shave margins (CSM) compared with partial mastectomy with selective margin resection (SPM), with regard to outcomes of the initial surgeries, re-excisions, and overall costs. PATIENTS AND METHODS This is a retrospective review of 122 eligible breast cancer patients who underwent BCS at one institution. The CSM and SPM groups each included 61 patients, matched for presurgical diagnoses and clinical stage. Data including margin status, rates and reason for re-excision, associated operation times, and costs were analyzed. RESULTS Patients undergoing CSM had less than half the rate of positive margins (PMs) (10% vs. 23%; P = .03) and re-excisions (8% vs. 23%; P = .02) compared with SPM. In the former group, the margin involvement was focal, and re-excisions were performed almost exclusively for PMs. For SPM, the majority (92%) of PMs were on the main lumpectomy specimen rather than the selective margins, and re-excisions included, in addition to PMs, extensive or multifocal negative but close margins. Reduced breast tissue volumes were removed with CSM, particularly for patients undergoing a single surgery (47 vs. 165 cm3; P < .001). The initial surgery with CSM is on average 27% more costly than that for SPM (P < .001), due to the increased pathology costs which are partially offset by the increased re-excision rates in SPM. CONCLUSION Circumferential cavity shaving, associated with consistent lower PMs, tissue volumes excised, and re-excision rates, is appropriate for routine implementation as a method offering superior surgical outcomes.
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Affiliation(s)
| | - Kandace McGuire
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
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Iness AN, Rubinsak L, Meas SJ, Chaoul J, Sayeed S, Pillappa R, Temkin SM, Dozmorov MG, Litovchick L. Oncogenic B-Myb Is Associated With Deregulation of the DREAM-Mediated Cell Cycle Gene Expression Program in High Grade Serous Ovarian Carcinoma Clinical Tumor Samples. Front Oncol 2021; 11:637193. [PMID: 33747961 PMCID: PMC7969987 DOI: 10.3389/fonc.2021.637193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/02/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
Cell cycle control drives cancer progression and treatment response in high grade serous ovarian carcinoma (HGSOC). MYBL2 (encoding B-Myb), an oncogene with prognostic significance in several cancers, is highly expressed in most HGSOC cases; however, the clinical significance of B-Myb in this disease has not been well-characterized. B-Myb is associated with cell proliferation through formation of the MMB (Myb and MuvB core) protein complex required for transcription of mitotic genes. High B-Myb expression disrupts the formation of another transcriptional cell cycle regulatory complex involving the MuvB core, DREAM (DP, RB-like, E2F, and MuvB), in human cell lines. DREAM coordinates cell cycle dependent gene expression by repressing over 800 cell cycle genes in G0/G1. Here, we take a bioinformatics approach to further evaluate the effect of B-Myb expression on DREAM target genes in HGSOC and validate our cellular model with clinical specimens. We show that MYBL2 is highly expressed in HGSOC and correlates with expression of DREAM and MMB target genes in both The Cancer Genome Atlas (TCGA) as well as independent analyses of HGSOC primary tumors (N = 52). High B-Myb expression was also associated with poor overall survival in the TCGA cohort and analysis by a DREAM target gene expression signature yielded a negative impact on survival. Together, our data support the conclusion that high expression of MYBL2 is associated with deregulation of DREAM/MMB-mediated cell cycle gene expression programs in HGSOC and may serve as a prognostic factor independent of its cell cycle role. This provides rationale for further, larger scale studies aimed to determine the clinical predictive value of the B-Myb gene expression signature for treatment response as well as patient outcomes.
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Affiliation(s)
- Audra N Iness
- Division of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Lisa Rubinsak
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Steven J Meas
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Jessica Chaoul
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Sadia Sayeed
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, United States.,Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Raghavendra Pillappa
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, United States
| | - Sarah M Temkin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Mikhail G Dozmorov
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States.,Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States.,Department of Pathology, Virginia Commonwealth University, Richmond, VA, United States
| | - Larisa Litovchick
- Division of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States.,Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
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11
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Toldo S, Bussani R, Nuzzi V, Bonaventura A, Mauro AG, Cannatà A, Pillappa R, Sinagra G, Nana-Sinkam P, Sime P, Abbate A. Inflammasome formation in the lungs of patients with fatal COVID-19. Inflamm Res 2020; 70:7-10. [PMID: 33079210 PMCID: PMC7572246 DOI: 10.1007/s00011-020-01413-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
Objective The orf8b protein of the coronavirus SARS-CoV, analogous to SARS-CoV-2, triggers the NLRP3 inflammasome in macrophages in vitro. Deregulated inflammasome-mediated release of interleukin-1 family cytokines is important in hyper-inflammatory syndromes, like happens in SARS-CoV-2-mediated cytokine release syndrome. We propose that an intense inflammasome formation characterizes the lungs of patients with fatal COVID-19 disease due to pneumonia and acute respiratory distress syndrome (ARDS). Methods Samples from four patients with confirmed COVID-19 pneumonia who had been hospitalized at the Hospital of the University of Trieste (Italy) and died of ARDS and four lung samples from a historical repository from subjects who had died of cardiopulmonary arrest and had not been placed on mechanical ventilation and without evidence of pulmonary infection at postmortem examination were collected. Pathology samples had been fixed in formalin 10% at time of collection and subsequently embedded in paraffin. We conducted staining for ASC (Apoptosis-associated Speck-like protein containing a Caspase recruitment domain), NLRP3 (NACHT, LRR, and PYD domains-containing protein 3), and cleaved caspase-1. Results Intense expression of the inflammasome was detected, mainly in leukocytes, within the lungs of all patients with fatal COVID-19 in the areas of lung injury. The number of ASC inflammasome specks per high power fields was significantly higher in the lungs of patients with fatal COVID-19 as compared with the lungs of control subjects (52 ± 22 vs 6 ± 3, P = 0.0064). Conclusions These findings identify the presence of NLRP3 inflammasome aggregates in the lungs of fatal COVID-19 pneumonia thus providing the potential molecular link between viral infection and cytokine release syndrome. Electronic supplementary material The online version of this article (10.1007/s00011-020-01413-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefano Toldo
- VCU Pauley Heart Center, Virginia Commonwealth University, 1220 E Broad St, Richmond, VA, 23298, USA.
| | - Rossana Bussani
- Istituto di Anatomia Patologica, Università di Trieste, Trieste, Italy
| | - Vincenzo Nuzzi
- Istitituto di Cardiologia, Università di Trieste, Trieste, Italy
| | - Aldo Bonaventura
- VCU Pauley Heart Center, Virginia Commonwealth University, 1220 E Broad St, Richmond, VA, 23298, USA
| | - Adolfo G Mauro
- VCU Pauley Heart Center, Virginia Commonwealth University, 1220 E Broad St, Richmond, VA, 23298, USA
| | - Antonio Cannatà
- Istitituto di Cardiologia, Università di Trieste, Trieste, Italy
| | | | | | - Patrick Nana-Sinkam
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia Sime
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, 1220 E Broad St, Richmond, VA, 23298, USA
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12
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Pillappa R, Robila V, King C, Kraft A. Can You Detect Spread Through Air Spaces (STAS) in Lung Needle Core Biopsies? An Initial Investigation. Am J Clin Pathol 2019. [DOI: 10.1093/ajcp/aqz113.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The debate of spread through air spaces (STAS) as a newly described pattern of invasion in lung cancer is ongoing. Some authors argue that the inclusion of STAS in the CAP synoptic template is premature and controversial as it is difficult to exclude an artifactual process. However, assessment of STAS in needle core biopsies has not been pursued. Hence, we intended to evaluate STAS in needle core biopsies, with an added emphasis on the specimen requirements for detection. Finally, correlation with the corresponding available resections was performed.
Methods
Fifty-four needle core biopsies of adenocarcinomas were examined by three pathologists. For each case, the extent of both tumor (1-12 mm) and nonneoplastic alveolated parenchyma (NNT) (2-6 mm) was measured. STAS was defined as presence of only micropapillary clusters, solid nests, and single cells in NNT adjacent to the main tumor. Corresponding lung resections available in 12 cases were also examined.
Results
Nests highly suspicious for STAS were demonstrated in 4 (7%) cases, predominantly micropapillary clusters and single cells. Of those, only one case had a surgical resection and showed STAS. When the NNT was present, then absence of STAS was determined in 20/54 (37%) tumors, all exhibiting a lepidic/acinar growth pattern. Finally, the presence of STAS could not be evaluated in 30 (55%) cases. This was due to extensive core fragmentation, sampling only from the center of the tumor, with no adjacent NNT, necrosis, or fibrotic background.
Conclusion
STAS evaluation may be performed in core needle biopsies and depends on the core quality and tumor/NNT content. Despite appropriate material, STAS was not identified in approximately one-third of cases. Rare cases with small groups suspicious for STAS were seen. These findings may provide additional information for further therapeutic/surgical guidance.
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Affiliation(s)
| | | | - Caleb King
- Virginia Commonwealth University Health System
| | - Adele Kraft
- Virginia Commonwealth University Health System
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13
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Pillappa R, Kraft AO. Immunohistochemical validation studies in effusion cytology: A cautionary tale. Cancer Cytopathol 2019; 127:680-683. [DOI: 10.1002/cncy.22149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Raghavendra Pillappa
- Department of Pathology Virginia Commonwealth University School of Medicine Richmond Virginia
| | - Adele O. Kraft
- Department of Pathology Virginia Commonwealth University School of Medicine Richmond Virginia
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Pillappa R, O'Brien TF, Sullivan JL, Weksler B. Esophageal Actinomycoses Mimicking Malignancy. Ann Thorac Surg 2016; 101:1967-70. [PMID: 27106429 DOI: 10.1016/j.athoracsur.2015.07.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/03/2015] [Accepted: 07/09/2015] [Indexed: 11/26/2022]
Abstract
Actinomycosis is caused by anaerobic bacteria and rarely affects the esophagus. We present a case of esophageal actinomycosis in a 55-year old woman that mimicked malignancy. The patient presented with dysphagia and weight loss. Preoperative esophagogastroscopic biopsy revealed purulent material, but was inconclusive. Endoscopic ultrasonography suggested esophageal cancer, and chest computed tomography showed a mass in the lower esophagus surrounded by inflammation. The patient underwent esophagogastrectomy, and histopathology examination of the specimen revealed distal esophageal actinomycosis. Preoperative diagnosis of esophageal actinomycosis is difficult, but clinicians should be aware of its unusual presentations and its ability to mimic malignancy.
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Affiliation(s)
- Raghavendra Pillappa
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Methodist University Hospital, Memphis, Tennessee
| | - Thomas F O'Brien
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Methodist University Hospital, Memphis, Tennessee
| | - Jennifer L Sullivan
- Division of Thoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, Methodist University Hospital, Memphis, Tennessee
| | - Benny Weksler
- Division of Thoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, Methodist University Hospital, Memphis, Tennessee.
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15
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Pearlman E, Pillappa R, Minor S, Bailey K. Emergency Transfusions of Uncrossmatched Blood: Demographic and Clinical Features. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.027] [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: 11/12/2022] Open
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16
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Pillappa R, Zafar N. A Case of Intrahepatic Cholangiocarcinoma With Epidermal Growth Factor Receptor Expression: Possible Marker for Targeted Chemotherapy. Am J Clin Pathol 2014. [DOI: 10.1093/ajcp/142.suppl1.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Nadeem Zafar
- University of Tennessee Health Science Center, Memphis
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Gupta R, Pillappa R, Stone I, Zafar N. Basaloid carcinoma: Rare human papillomavirus-related variant of squamous cell carcinoma of the anorectum: A case report. INDIAN J PATHOL MICR 2014; 57:345-7. [DOI: 10.4103/0377-4929.134747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Pillappa R, Gupta R, Zafar N, Stone I. Isolated Small Intestinal Histoplasmosis Causing Intestinal Obstruction in a HIV-Positive Patient: A Rare Presentation. Am J Clin Pathol 2013. [DOI: 10.1093/ajcp/140.suppl1.182] [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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