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Stolnicu S, Praiss AM, Allison D, Tessier-Cloutier B, Flynn J, Iasonos A, Hoang L, Terinte C, Pesci A, Mateoiu C, Lastra RR, Kiyokawa T, Ali-Fehmi R, Kheil M, Oliva E, Devins K, Abu-Rustum N, Soslow RA. Proposal of Novel Binary Grading Systems for Cervical Squamous Cell Carcinoma. Int J Gynecol Pathol 2024; 43:203-214. [PMID: 38085957 PMCID: PMC11031322 DOI: 10.1097/pgp.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
We compared grading systems and examined associations with tumor stroma and survival in patients with cervical squamous cell carcinoma. Available tumor slides were collected from 10 international institutions. Broders tumor grade, Jesinghaus grade (informed by the pattern of tumor invasion), Silva pattern, and tumor stroma were retrospectively analyzed; associations with overall survival (OS), progression-free survival (PFS), and presence of lymph node metastases were examined. Binary grading systems incorporating tumor stromal changes into Broders and Jesinghaus grading systems were developed. Of 670 cases, 586 were reviewed for original Broders tumor grade, 587 for consensus Broders grade, 587 for Jesinghaus grade, 584 for Silva pattern, and 556 for tumor stroma. Reproducibility among grading systems was poor (κ = 0.365, original Broders/consensus Broders; κ = 0.215, consensus Broders/Jesinghaus). Median follow-up was 5.7 years (range, 0-27.8). PFS rates were 93%, 79%, and 71%, and OS rates were 98%, 86%, and 79% at 1, 5, and 10 years, respectively. On univariable analysis, original Broders ( P < 0.001), consensus Broders ( P < 0.034), and Jesinghaus ( P < 0.013) grades were significant for OS; original Broders grade was significant for PFS ( P = 0.038). Predictive accuracy for OS and PFS were 0.559 and 0.542 (original Broders), 0.542 and 0.525 (consensus Broders), 0.554 and 0.541 (Jesinghaus grade), and 0.512 and 0.515 (Silva pattern), respectively. Broders and Jesinghaus binary tumor grades were significant on univariable analysis for OS and PFS, and predictive value was improved. Jesinghaus tumor grade ( P < 0.001) and both binary systems (Broders, P = 0.007; Jesinghaus, P < 0.001) were associated with the presence of lymph node metastases. Histologic grade has poor reproducibility and limited predictive accuracy for squamous cell carcinoma. The proposed binary grading system offers improved predictive accuracy for survival and the presence of lymph none metastases.
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Affiliation(s)
- Simona Stolnicu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology “George E Palade” of Targu Mures, Targu Mures, Romania
| | - Aaron M. Praiss
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Douglas Allison
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lien Hoang
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | - Anna Pesci
- IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Claudia Mateoiu
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | - Mira Kheil
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | | | - Kyle Devins
- Massachusetts General Hospital, Boston, MA, USA
| | - Nadeem Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Robert A. Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bennett L, Jaiswal PK, Harkless RV, Long TM, Gao N, Vandenburg B, Selman P, Durdana I, Lastra RR, Vander Griend D, Adelaiye-Ogala R, Szmulewitz RZ, Conzen SD. Glucocorticoid Receptor (GR) Activation Is Associated with Increased cAMP/PKA Signaling in Castration-Resistant Prostate Cancer. Mol Cancer Ther 2024; 23:552-563. [PMID: 38030378 PMCID: PMC10985475 DOI: 10.1158/1535-7163.mct-22-0479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/04/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
In castration-resistant prostate cancer (CRPC), increased glucocorticoid receptor (GR) expression and ensuing transcriptional activity have been proposed as an oncogenic "bypass" mechanism in response to androgen receptor (AR) signaling inhibition (ARSi). Here, we report that GR transcriptional activity acquired following ARSi is associated with the upregulation of cyclic adenosine monophosphate (cAMP)-associated gene expression pathways in both model systems and metastatic prostate cancer patient samples. In the context of ARSi, the expression of GR-mediated genes encoding cAMP signaling pathway-associated proteins can be inhibited by treatment with selective GR modulators (SGRMs). For example, in the context of ARSi, we found that GR activation resulted in upregulation of protein kinase inhibitor beta (PKIB) mRNA and protein levels, leading to nuclear accumulation of the cAMP-dependent protein kinase A catalytic subunit (PKA-c). Increased PKA-c, in turn, is associated with increased cAMP response element-binding protein phosphorylation and activity. Furthermore, enzalutamide and SGRM combination therapy in mice bearing CRPC xenografts delayed CRPC progression compared with enzalutamide therapy alone, and reduced tumor PKIB mRNA expression. Supporting the clinical importance of GR/PKA signaling activation in CRPC, we found a significant enrichment of both cAMP pathway signaling-associated gene expression and high NR3C1 (GR) activity in patient-derived xenograft models and metastatic human CRPC samples. These findings suggest a novel mechanism linking CRPC-induced GR transcriptional activity with increased cAMP signaling in AR-antagonized CRPC. Furthermore, our findings suggest that GR-specific modulation in addition to AR antagonism may delay GR+ CRPC time to recurrence, at least in part, by inhibiting tumor cAMP/PKA pathways.
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Affiliation(s)
- Lynda Bennett
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Praveen Kumar Jaiswal
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Ryan V. Harkless
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Tiha M. Long
- Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Ning Gao
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Brianna Vandenburg
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Phillip Selman
- Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Ishrat Durdana
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Ricardo R. Lastra
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | | | - Remi Adelaiye-Ogala
- Division of Hematology and Oncology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, New York
| | - Russell Z. Szmulewitz
- Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Suzanne D. Conzen
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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Mendoza RP, Doytcheva K, Ud Dean M, Jorgenson KM, Choi D, Segal J, Wang P, Lastra RR. Whole exome sequencing of placental chorangioma. Placenta 2024; 149:13-17. [PMID: 38484495 DOI: 10.1016/j.placenta.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Placental chorangioma is a benign non-trophoblastic vascular proliferation of the placental chorion favored to represent hamartoma-like or hyperplastic capillary lesions. As the exact pathophysiology has not been established, we investigated the molecular characteristics of placental chorangiomas using exploratory whole exome sequencing. METHODS Three cases were retrospectively selected and whole exome sequencing was performed on macrodissected lesions. DNA extraction, DNA quantification, library preparation and sequencing were performed with IDT xGen™ Exome Hybridization Panel v2 for library capture. Sequencing data was analyzed with an in-house bioinformatics pipeline for single-nucleotide variants and insertions/deletions. RESULTS All neonates were delivered at term and had birth weights ranging from 11th-35th percentile for gestational age. All mothers presented with hypertensive disorder during pregnancy. Chorangiomas ranged from 0.7 cm to 5.1 cm and were well-circumscribed near the fetal surface. Case 1 showed a background of chorangiosis and acute subchorionitis, while case 2 had foci of chronic lymphocytic villitis. Whole exome sequencing did not reveal any significant pathologic variants. DISCUSSIONS The absence of molecular alteration in placental chorangioma is likely indicative of the reactive/non-neoplastic nature of this lesion. The presence of compromised blood flow in the form of hypertensive disorders in our cases may be one of its underlying pathophysiologic mechanisms.
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Affiliation(s)
- Rachelle P Mendoza
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Kristina Doytcheva
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Minhaz Ud Dean
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Kyla M Jorgenson
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Donghyuk Choi
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Jeremy Segal
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Peng Wang
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA.
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Rau TT, Cross W, Lastra RR, Lo RC, Matoso A, Herrington CS. Closing the loop - the role of pathologists in digital and computational pathology research. J Pathol Clin Res 2024; 10:e12366. [PMID: 38462794 PMCID: PMC10925822 DOI: 10.1002/2056-4538.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
An increasing number of manuscripts related to digital and computational pathology are being submitted to The Journal of Pathology: Clinical Research as part of the continuous evolution from digital imaging and algorithm-based digital pathology to computational pathology and artificial intelligence. However, despite these technological advances, tissue analysis still relies heavily on pathologists' annotations. There are three crucial elements to the pathologist's role during annotation tasks: granularity, time constraints, and responsibility for the interpretation of computational results. Granularity involves detailed annotations, including case level, regional, and cellular features; and integration of attributions from different sources. Time constraints due to pathologist shortages have led to the development of techniques to expedite annotation tasks from cell-level attributions up to so-called unsupervised learning. The impact of pathologists may seem diminished, but their role is crucial in providing ground truth and connecting pathological knowledge generation with computational advancements. Measures to display results back to pathologists and reflections about correctly applied diagnostic criteria are mandatory to maintain fidelity during human-machine interactions. Collaboration and iterative processes, such as human-in-the-loop machine learning are key for continuous improvement, ensuring the pathologist's involvement in evaluating computational results and closing the loop for clinical applicability. The journal is interested particularly in the clinical diagnostic application of computational pathology and invites submissions that address the issues raised in this editorial.
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Elmuti L, Amundson J, Oberman E, Kamat A, Sedig L, Lastra RR, Aldape K, Quezado M, Pratt DW, Cimino PJ, Abdullaev Z, Pytel P, Applebaum MA, Bennett JA. Diffuse Pediatric-type High-grade Glioma Arising in an Ovarian Mature Cystic Teratoma. Int J Gynecol Pathol 2024; 43:90-96. [PMID: 37046379 PMCID: PMC10715565 DOI: 10.1097/pgp.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Immature neuroectodermal tissue can be found in the ovary as part of an immature teratoma or as part of a teratoma with malignant neuroectodermal transformation. Such lesions may closely resemble central nervous system tumors, but their biologic similarity is unclear. We describe an 18-yr-old female who presented with abdominal pain caused by an ovarian mass with widespread metastases. Histology showed a primitive, high-grade tumor arising in the background of a mature teratoma. The tumor was SOX10 positive, with focal expression of GFAP, S100, NSE, and synaptophysin. Molecular analysis demonstrated co-amplification of PDGFRA and KIT , alterations common in high-grade gliomas. By whole-genome methylation profiling, it clustered into the "diffuse pediatric-type high-grade glioma, RTK1 subtype, subclass c" group. Despite progressing through 2 lines of chemotherapy with widespread metastatic disease, she achieved an excellent response to chemotherapy directed toward aggressive germ cell tumors. This case emphasizes the importance of immunohistochemical, genomic, and epigenetic analyses to accurately classify these exceedingly rare tumors and determine the optimal therapy.
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Stolnicu S, Allison D, Praiss AM, Tessier-Cloutier B, Momeni Boroujeni A, Flynn J, Iasonos A, Serrette R, Hoang L, Patrichi A, Terinte C, Pesci A, Mateoiu C, Lastra RR, Kiyokawa T, Ali-Fehmi R, Kheil M, Oliva E, Devins KM, Abu-Rustum NR, Soslow RA. Incidence and Clinicopathologic Characteristics of Human Papillomavirus-independent Invasive Squamous Cell Carcinomas of the Cervix: A Morphologic, Immunohistochemical, and Human Papilloma-Virologic Study of 670 Cases. Am J Surg Pathol 2023; 47:1376-1389. [PMID: 37702216 PMCID: PMC10840845 DOI: 10.1097/pas.0000000000002122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
We aimed to determine the frequency of human papillomavirus-independent (HPVI) cervical squamous cell carcinoma (SCC) and to describe clinicopathologic characteristics. Among 670 patients with surgically treated SCCs in an established multi-institutional cohort, 447 had available tissue. Tissue microarrays were constructed and studied by in situ hybridization (ISH) for high-risk and low-risk human papillomavirus (HPV) mRNA and immunohistochemistry for p16 and p53. Tumors were HPVI if negative by HPV ISH and they failed to show diffuse p16 positivity by immunohistochemistry, and human papillomavirus-associated (HPVA) if positive by HPV ISH. Ten HPVI SCCs and 435 HPVA SCCs were identified; 2 cases were equivocal and excluded from analysis. The overall rate of HPVI SCC was low (2%) but was higher among older patients (7% in patients above 60 y of age and 17% in patients above 70 y of age). Compared with HPVA, patients with HPVI SCC were significantly older (median age, 72 vs. 49, P <0.001) and diagnosed at a higher stage (40% vs. 18% with stage III/IV disease, P =0.055). p53 expression was varied; 2 cases (20%) had null expression and 8 (80%) had wild-type expression. HPVI SCCs were heterogenous, with keratinizing, nonkeratinizing, and warty morphologies observed. Several cases had a precursor lesion reminiscent of differentiated vulvar intraepithelial neoplasia, with prominent basal atypia and hypereosinophilia or a basaloid-like morphology. Two patients (20%) had distant recurrences within 12 months, and 3 (30%) died of disease during follow-up. HPVI SCCs are rare tumors that are more common among older patients with higher stage disease and have important clinical and histologic differences from HPVA SCCs.
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Affiliation(s)
- Simona Stolnicu
- Department of Pathology, University of Medicine, Pharmacy, Science and Technology "George E Palade" of Targu Mures, Targu Mures
| | | | | | | | | | - Jessica Flynn
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Alexia Iasonos
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | | | - Lien Hoang
- Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Andrei Patrichi
- Department of Pathology, University of Medicine, Pharmacy, Science and Technology "George E Palade" of Targu Mures, Targu Mures
| | | | - Anna Pesci
- Hospital "Sacro Cuore Don Calabria", Negrar, Italy
| | - Claudia Mateoiu
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Takako Kiyokawa
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University, Detroit, MI
| | - Mira Kheil
- Department of Pathology, Wayne State University, Detroit, MI
| | | | | | - Nadeem R Abu-Rustum
- Surgery
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
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Weigert M, Li Y, Zhu L, Eckart H, Bajwa P, Krishnan R, Ackroyd S, Lastra RR, Bilecz A, Basu A, Lengyel E, Chen M. A Cellular atlas of the human fallopian tube reveals the metamorphosis of secretory epithelial cells during the menstrual cycle and menopause. medRxiv 2023:2023.11.22.23298470. [PMID: 38045369 PMCID: PMC10690352 DOI: 10.1101/2023.11.22.23298470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The fallopian tube, connecting the uterus with the ovary, is a dynamic organ that undergoes cyclical changes and is the site of several diseases, including serous cancer. Here, we use single-cell technologies to construct a comprehensive cell map of healthy pre-menopausal fallopian tubes, capturing the impact of the menstrual cycle and menopause on different fallopian tube cells at the molecular level. The comparative analysis between pre- and post-menopausal fallopian tubes reveals substantial shifts in cellular abundance and gene expression patterns, highlighting the physiological changes associated with menopause. Further investigations into menstrual cycle phases illuminate distinct molecular states in secretory epithelial cells caused by hormonal fluctuations. The markers we identified characterizing secretory epithelial cells provide a valuable tool for classifying ovarian cancer subtypes. Graphical summary Graphical summary of results. During the proliferative phase (estrogen high ) of the menstrual cycle, SE2 cells (OVGP1 + ) dominate the fallopian tube (FT) epithelium, while SE1 cells (OVGP1 - ) dominate the epithelium during the secretory phase. Though estrogen levels decrease during menopause, SE post-cells (OVGP1 + , CXCL2 + ) make up most of the FT epithelium.
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Schweizer L, Krishnan R, Shimizu A, Metousis A, Kenny H, Mendoza R, Nordmann TM, Rauch S, Kelliher L, Heide J, Rosenberger FA, Bilecz A, Borrego SN, Strauss MT, Thielert M, Rodriguez E, Müller-Reif JB, Chen M, Yamada SD, Mund A, Lastra RR, Mann M, Lengyel E. Spatial proteo-transcriptomic profiling reveals the molecular landscape of borderline ovarian tumors and their invasive progression. medRxiv 2023:2023.11.13.23298409. [PMID: 38014221 PMCID: PMC10680885 DOI: 10.1101/2023.11.13.23298409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Serous borderline tumors (SBT) are epithelial neoplastic lesions of the ovaries that commonly have a good prognosis. In 10-15% of cases, however, SBT will recur as low-grade serous cancer (LGSC), which is deeply invasive and responds poorly to current standard chemotherapy1,2,3. While genetic alterations suggest a common origin, the transition from SBT to LGSC remains poorly understood4. Here, we integrate spatial proteomics5 with spatial transcriptomics to elucidate the evolution from SBT to LGSC and its corresponding metastasis at the molecular level in both the stroma and the tumor. We show that the transition of SBT to LGSC occurs in the epithelial compartment through an intermediary stage with micropapillary features (SBT-MP), which involves a gradual increase in MAPK signaling. A distinct subset of proteins and transcripts was associated with the transition to invasive tumor growth, including the neuronal splicing factor NOVA2, which was limited to expression in LGSC and its corresponding metastasis. An integrative pathway analysis exposed aberrant molecular signaling of tumor cells supported by alterations in angiogenesis and inflammation in the tumor microenvironment. Integration of spatial transcriptomics and proteomics followed by knockdown of the most altered genes or pharmaceutical inhibition of the most relevant targets confirmed their functional significance in regulating key features of invasiveness. Combining cell-type resolved spatial proteomics and transcriptomics allowed us to elucidate the sequence of tumorigenesis from SBT to LGSC. The approach presented here is a blueprint to systematically elucidate mechanisms of tumorigenesis and find novel treatment strategies.
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Affiliation(s)
- Lisa Schweizer
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Rahul Krishnan
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Aasa Shimizu
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Andreas Metousis
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Hilary Kenny
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Rachelle Mendoza
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Thierry M. Nordmann
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Sarah Rauch
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Lucy Kelliher
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Janna Heide
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Florian A. Rosenberger
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Agnes Bilecz
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Sanaa Nakad Borrego
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Maximillian T. Strauss
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marvin Thielert
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Edwin Rodriguez
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Johannes B. Müller-Reif
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Mengjie Chen
- Medicine/Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | - S. Diane Yamada
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Andreas Mund
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ricardo R. Lastra
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Matthias Mann
- Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
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Praiss AM, Allison D, Tessier-Cloutier B, Flynn J, Iasonos A, Hoang L, Patrichi A, Terinte C, Pesci A, Mateoiu C, Lastra RR, Puscasiu L, Kiyokawa T, Ali-Fehmi R, Kheil M, Oliva E, Devins KM, Abu-Rustum NR, Soslow RA, Stolnicu S. Extensive versus focal lymphovascular invasion in squamous cell carcinoma of the cervix: A comprehensive international, multicenter, retrospective clinicopathologic study. Gynecol Oncol 2023; 176:147-154. [PMID: 37541128 PMCID: PMC10809424 DOI: 10.1016/j.ygyno.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE We evaluated clinicopathologic parameters of patients with cervical squamous cell carcinoma (SCC) who were treated with initial surgical management and assessed their relation to survival outcomes. Specifically, we evaluated the relation between extent of lymphovascular invasion (LVI) and survival outcomes. METHODS All available tumor slides from patients with initially surgically treated cervical SCC were collected from 10 institutions and retrospectively analyzed. Standard clinicopathological parameters, tumor stroma, and extent of LVI were assessed (focal: <5 spaces, extensive: ≥5 spaces). PFS and OS were evaluated using Kaplan-Meier methodology. Univariable and multivariable Cox proportional hazards models were created to determine prognostic survival-related risk factors. RESULTS A total of 670 tumor samples were included in the analysis. Median age at diagnosis was 47 years (IQR: 38-60), 457 patients (72%) had a 2018 International Federation of Gynecology and Obstetrics (FIGO) stage I tumor, and 155 tumors (28%) were flat and/or ulcerated. There were 303 nonkeratinizing tumors (51%), 237 keratinizing tumors (40%), and 356 histologic grade 2 tumors (61%). Quantifiable LVI was present in 321 cases (51%; 23% focal and 33% extensive). On multivariable analysis for PFS, extensive and focal LVI had worse outcomes compared to negative LVI (HR: 2.38 [95% CI: 1.26-4.47] and HR: 1.54 [95% CI: 0.76-3.11], respectively; P = 0.02). The difference did not reach statistical significance for OS. CONCLUSION Presence of LVI is a prognostic marker for patients with cervical SCC. Quantification (extensive vs. focal vs. negative) of LVI may be an important biomarker for oncologic outcome.
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Affiliation(s)
- Aaron M Praiss
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Douglas Allison
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lien Hoang
- Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Andrei Patrichi
- Department of Pathology, University of Medicine, Pharmacy, Science and Technology "George E Palade" of Targu Mures, Targu Mures, Romania
| | | | - Anna Pesci
- Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Claudia Mateoiu
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Lucian Puscasiu
- Department of Gynecology, University of Medicine, Pharmacy, Sciences and Technology "George E Palade" of Targu Mures, Romania
| | | | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | - Mira Kheil
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | | | | | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA..
| | - Simona Stolnicu
- Department of Pathology, University of Medicine, Pharmacy, Science and Technology "George E Palade" of Targu Mures, Targu Mures, Romania
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10
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Tran L, Christensen P, Barroeta JE, Hunter K, Sookram J, McGregor SM, Wilkinson N, Orsi NM, Lastra RR. Prognostic Significance of Size, Location, and Number of Lymph Node Metastases in Endometrial Carcinoma. Int J Gynecol Pathol 2023; 42:376-389. [PMID: 36044323 DOI: 10.1097/pgp.0000000000000897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Regional lymph node metastasis is a well-established negative predictive prognostic factor in endometrial carcinomas. Recently, our approach to the pathologic evaluation of lymph nodes in endometrial carcinomas has changed, mainly due to the utilization of immunohistochemical stains in the assessment of sentinel lymph nodes, which may result in the identification of previously unrecognized disease [particularly isolated tumor cells (ITCs)] on hematoxylin and eosin stained slides. However, the clinical significance of this finding is not entirely clear. Following the experience in other organs systems such as breast, the Eight Edition of the American Joint Committee on Cancer's Cancer Staging Manual has recommended utilizing the N0(i+) terminology for this finding, without impact in the final tumor stage. We performed a comparative retrospective multi-institutional survival analysis of 247 patients with endometrial carcinoma with regional lymph node metastasis of various sizes identified in nonsentinel lymphadenectomy, demonstrating that the cumulative survival of patients with isolated tumor cells in regional lymph nodes is not statistically different from patient with negative lymph nodes, and is statistically different from those with lymph nodes showing micrometastasis or larger metastatic deposits. In addition, we evaluated the prognostic implications of the number of involved regional lymph nodes, demonstrating a worsening prognosis as the number of involved lymph nodes increases from none to one, and from one to more than one. Our data suggests that regional lymph nodes with isolated tumor cells in patients with endometrial carcinoma should likely be considered, for staging purposes, as negative lymph nodes, simply indicating their presence with the (i+) terminology.
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11
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Bajwa P, Kordylewicz K, Bilecz A, Lastra RR, Wroblewski K, Rinkevich Y, Lengyel E, Kenny HA. Cancer-associated mesothelial cell-derived ANGPTL4 and STC1 promote the early steps of ovarian cancer metastasis. JCI Insight 2023; 8:163019. [PMID: 36795484 PMCID: PMC10070116 DOI: 10.1172/jci.insight.163019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Ovarian cancer (OvCa) preferentially metastasizes in association with mesothelial cell-lined surfaces. We sought to determine if mesothelial cells are required for OvCa metastasis and detect alterations in mesothelial cell gene expression and cytokine secretion upon interaction with OvCa cells. Using omental samples from patients with high-grade serous OvCa and mouse models with Wt1-driven GFP-expressing mesothelial cells, we validated the intratumoral localization of mesothelial cells during human and mouse OvCa omental metastasis. Removing mesothelial cells ex vivo from human and mouse omenta or in vivo using diphtheria toxin-mediated ablation in Msln-Cre mice significantly inhibited OvCa cell adhesion and colonization. Human ascites induced angiopoietin-like 4 (ANGPTL4) and stanniocalcin 1 (STC1) expression and secretion by mesothelial cells. Inhibition of STC1 or ANGPTL4 via RNAi obstructed OvCa cell-induced mesothelial cell to mesenchymal transition while inhibition of ANGPTL4 alone obstructed OvCa cell-induced mesothelial cell migration and glycolysis. Inhibition of mesothelial cell ANGPTL4 secretion via RNAi prevented mesothelial cell-induced monocyte migration, endothelial cell vessel formation, and OvCa cell adhesion, migration, and proliferation. In contrast, inhibition of mesothelial cell STC1 secretion via RNAi prevented mesothelial cell-induced endothelial cell vessel formation and OvCa cell adhesion, migration, proliferation, and invasion. Additionally, blocking ANPTL4 function with Abs reduced the ex vivo colonization of 3 different OvCa cell lines on human omental tissue explants and in vivo colonization of ID8p53-/-Brca2-/- cells on mouse omenta. These findings indicate that mesothelial cells are important to the initial stages of OvCa metastasis and that the crosstalk between mesothelial cells and the tumor microenvironment promotes OvCa metastasis through the secretion of ANGPTL4.
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Affiliation(s)
- Preety Bajwa
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology
| | | | - Agnes Bilecz
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology
- Department of Pathology, and
| | | | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Yuval Rinkevich
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München, Munich, Germany
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology
| | - Hilary A Kenny
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology
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12
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Barroeta JE, Lastra RR. Editorial - Cytopathology in Gynecology and Gynecologic Oncology: Updates, Recent Advances, and Practical Considerations. Acta Cytol 2023; 67:109-110. [PMID: 36603562 DOI: 10.1159/000528944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
The role of cytopathology in the diagnosis, management, and follow-up of patients with gynecologic neoplasms has expanded tremendously since the introduction of the Papanicolaou test, more than 50 years ago. Evidently, advances in HPV testing have revolutionized cervical cancer screening, which now faces new challenges in the setting of increasingly available HPV vaccines. In addition, recent changes in gynecologic tumor nomenclature and staging of gynecologic neoplasms have introduced challenges specific to cytopathology, which if not taken into consideration, might lead to incorrect diagnoses, confusion on the part of the patients and their clinical teams, and potentially suboptimal patient care. We are pleased to present this Special Issue of Acta Cytologica entitled Cytopathology in Gynecology and Gynecologic Oncology: Updates, Recent Advances, and Practical Considerations, aiming to shed light on some of these issues in a concise and practical manner, to serve as an easy reference for all our cytopathology colleagues dealing with these situations in their daily practice.
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Affiliation(s)
- Julieta E Barroeta
- Department of Pathology, Cooper University Hospital, Camden, New Jersey, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
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13
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Olivas AD, Barroeta JE, Lastra RR. Overview of Ancillary Techniques in Cervical Cytology. Acta Cytol 2023; 67:119-128. [PMID: 36599328 DOI: 10.1159/000528931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The association between high-risk serotypes of human papillomavirus (hr-HPV) and cervical cancer is well-established. SUMMARY In order to improve the sensitivity of cervical cytology testing, hr-HPV testing has rapidly become part of routine cervical cancer screening, either in conjunction with cytology or as primary testing. In this review, we discuss the overall utility and strategies of hr-HPV testing, as well as the advantages and limitations of potential triage strategies for hr-HPV positive women, including HPV genotyping, p16/Ki-67 dual staining, and methylation assays. KEY MESSAGE hr-HPV testing is discussed as primary screening and HPV genotyping, p16/Ki-67 dual staining, and methylation assays are discussed as ancillary techniques to cytology in the triage of hr-HPV positive women undergoing cervical cancer screening.
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Affiliation(s)
- Andrea D Olivas
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Julieta E Barroeta
- Department of Pathology, Cooper University Hospital, Camden, New Jersey, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
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14
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Mendoza RP, Lastra RR. Practical Approach to the Evaluation of Malignant Peritoneal Fluids in the Setting of Gynecologic Neoplasms. Acta Cytol 2022; 67:143-175. [PMID: 36572015 DOI: 10.1159/000528800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Abstract
Background: Evaluation of peritoneal fluid cytology, either from ascitic fluids or as result of peritoneal washings, is a fundamental aspect in the evaluation of women presenting with clinically concerning or histologically confirmed gynecologic neoplasms.
Summary: Ascitic fluid samples are often the initial and only source of diagnostic material in women presenting with gynecologic malignancies, and important therapeutic decisions will result from the information provided in the cytology report. On the other hand, cytologic evaluation of peritoneal washing specimens obtained during surgical excision of a presumed gynecologic neoplasm provides crucial information to the clinical team regarding tumor staging, often with significant therapeutic implications. While recognition of high-grade tumors in either of these samples is generally straightforward, low-grade tumors and unusual neoplasms can prove to be more difficult to recognize, differentiate from benign mimics, and correctly diagnose, particularly in low-cellularity specimens. Even with high grade tumors, a mere diagnosis of “Positive for malignancy” in diagnostic ascitic fluid specimens might not suffice to guide clinical management, and the use of ancillary techniques to further and more definitively characterize the lesional cells is required.
Key Messages: This review will focus on the clinically relevant issues surrounding interpretation of peritoneal fluid cytology specimens in the setting of gynecologic neoplasms, making emphasis on the salient cytomorphologic and immunocytochemical features of the various neoplastic processes, in an attempt to provide a practical yet effective guide on how to best evaluate, diagnose, and report these samples.
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Affiliation(s)
- Rachelle P Mendoza
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
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15
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Laberiano-Fernández C, Luján JM, de Carvalho Dornelas B, Benites MF, Quispe PG, Vásquez VA, Espinoza AG, Guerra EG, Álvarez GGA, Astigueta-Pérez J, de Dávila MTG, Zambrano SC, Rojas TV, Mariños A, González ES, Lazcano R, Lastra RR, Alvarado-Cabrero I, Miller HG, Bardales RH, Abad-Licham M. Highlights from the 7th Oncological Pathology Conference 'Pathological Anatomy in the context of the National Cancer Law: An overview of the Latin American experience', 15, 22 and 23 July 2022, Trujillo, Peru. Ecancermedicalscience 2022; 16:1462. [PMID: 36819804 PMCID: PMC9934878 DOI: 10.3332/ecancer.2022.1462] [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: 08/04/2021] [Indexed: 11/06/2022] Open
Abstract
The seventh session of the Oncological Pathology Conference (JoPaO) entitled 'Pathological Anatomy in the context of the National Cancer Law: An overview of the Latin American experience', was held virtually on July 15, 22 and 23. Peru was the headquarters for this event, where 17 national and international professors of high academic standing participated. They interacted in a multidisciplinary context through talks with national panellists and the general public. The recent promulgation of the 'National Cancer Law' fosters the development of discussion forums to analyse the national realities and uphold continuous learning about experiences in other Latin American countries with successful cancer programmes, in which pathology holds a principal role. The topics addressed during this JoPaO included the exchange of Latin American cancer management experiences, an emphasis on investments in and the development of strategic plans to improve care, the use of new technologies, laboratory quality control, and the need to advance scientific research.
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Affiliation(s)
| | - Joan Moreno Luján
- Peruvian Society of Medical Oncology, Lima 15037, Peru,https://orcid.org/0000-0003-2621-7198
| | - Bruno de Carvalho Dornelas
- Clinical Hospital of the Federal University of Uberlandia, Uberlândia, MG, 38405-320,,https://orcid.org/0000-0003-1404-8876
| | - Magali Franco Benites
- Ramiro Prialé Prialé National Hospital, Huancayo 12006, Peru,https://orcid.org/0000-0002-4872-1646
| | - Patricia Gutiérrez Quispe
- Carlos Alberto Seguín Escobedo National Hospital, EsSalud, Arequipa 04001, Peru,https://orcid.org/0000-0002-1491-1556
| | - Valeria Aguilar Vásquez
- Northern Regional Institute of Neoplastic Diseases, Trujillo 13008, Peru,https://orcid.org/0000-0001-6889-0175
| | - Andric Guerrero Espinoza
- Northern Regional Institute of Neoplastic Diseases, Trujillo 13008, Peru,https://orcid.org/0000-0002-2619-1920
| | - Elsa Guerra Guerra
- Alberto Sabogal Sologuren National Hospital, Callao 07011, Peru,https://orcid.org/0000-0002-6320-1278
| | | | - Juan Astigueta-Pérez
- Antenor Orrego Private University School of Medicine, Trujillo 13008, Peru,https://orcid.org/0000-0001-5984-3270
| | - Maria Teresa Garcia de Dávila
- Garrahan and British Paediatric Hospital of Buenos Aires, Buenos Aires C1245 CABA, Argentina,https://orcid.org/0000-0002-3561-5035
| | - Sandro Casavilca Zambrano
- National Institute of Neoplastic Diseases, Lima, Surquillo 15038, Peru,https://orcid.org/0000-0001-8406-739X
| | - Tatiana Vidaurre Rojas
- National Institute of Neoplastic Diseases, Lima, Surquillo 15038, Peru,https://orcid.org/0000-0003-1995-4560
| | - Alejandro Mariños
- MD Anderson Cancer Center, Houston, TX 77030, United States,https://orcid.org/0000-0001-8179-5789
| | - Emmanuel S González
- Dr. Enrique Baltodano Briceño Hospital (HEBB), CCSS, Liberia 50101, Costa Rica,https://orcid.org/0000-0001-6204-3231
| | - Rossana Lazcano
- MD Anderson Cancer Center, Houston, TX 77030, United States,https://orcid.org/0000-0001-9890-2325
| | - Ricardo R Lastra
- The University of Chicago Medical Center, Chicago, IL 60637, United States,https://orcid.org/0000-0003-0691-5685
| | - Isabel Alvarado-Cabrero
- Star Medica Central Hospital, Mexico,Mexican Oncology Hospital, Mexico City 14080, Mexico,https://orcid.org/0000-0003-4000-9280
| | - Henry Guerra Miller
- National Institute of Neoplastic Diseases, Lima, Surquillo 15038, Peru,https://orcid.org/0000-0002-4894-5631
| | - Ricardo H Bardales
- Outpatient Pathology Associates/Precision Pathology, Sacramento, CA 95826, United States,https://orcid.org/0000-0003-1238-8535
| | - Milagros Abad-Licham
- Northern Regional Institute of Neoplastic Diseases, Trujillo 13008, Peru,Antenor Orrego Private University School of Medicine, Trujillo 13008, Peru,Centre of Excellence in Pathological Oncology, Trujillo 13011, Perú,https://orcid.org/0000-0002-3530-6937
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16
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Yang Q, Bariani MV, Falahati A, Khosh A, Lastra RR, Siblini H, Boyer TG, Al-Hendy A. The Functional Role and Regulatory Mechanism of Bromodomain-Containing Protein 9 in Human Uterine Leiomyosarcoma. Cells 2022; 11:2160. [PMID: 35883603 PMCID: PMC9323884 DOI: 10.3390/cells11142160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 06/06/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/22/2022] Open
Abstract
Uterine leiomyosarcoma (uLMS) is the most common type of uterine sarcoma associated with poor prognosis, high rates of recurrence, and metastasis. There is currently limited information about uLMS molecular mechanisms of origin and development. Bromodomain (BRD)-containing proteins are involved in many biological processes, most notably epigenetic regulation of transcription, and BRD protein dysfunction has been linked to many diseases including tumorigenesis. However, the role of BRD proteins in the pathogenesis of uLMS is unknown. Here, we show for the first time that BRD9 is aberrantly overexpressed in uLMS tissues compared to adjacent myometrium. BRD9 expression is also upregulated in uLMS cell lines compared to benign uterine fibroid and myometrium cell lines. Inhibition of BRD9 using the specific inhibitor (TP-472) suppressed uLMS cell proliferation via inducing apoptosis and cell cycle arrest. To further characterize the mechanistic basis for TP-472 inhibition of uLMS cell growth, we performed a comparative RNA-seq analysis of vehicle-treated and TP-472-treated uLMS cells (n = 4 each). Bioinformatics analysis revealed that TP-472 treatment distinctly altered the uLMS cell transcriptome. Gene set enrichment analysis identified critical pathways altered by BRD9 inhibition, including interferon-alpha response, KRAS signaling, MYC targets, TNF-a signaling via NFkB, and MTORC1 signaling. Parsimonious gene correlation network analysis identified nine enriched modules, including cell cycle and apoptosis modules. Moreover, the ENCODE Histone Modifications gene set and TargetScan microRNA analysis in Enrichr suggested that TP-472-induced BRD9 inhibition may alter the uLMS cell transcriptome by reprograming the oncogenic epigenome and inducing miRNA-mediated gene regulation. Therefore, BRD9 constitutes a specific vulnerability in malignant uLMS, and targeting non-BET BRD proteins in uLMS may provide a promising and novel strategy for treating patients with this aggressive uterine cancer.
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Affiliation(s)
- Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (M.V.B.); (H.S.); (A.A.-H.)
| | - Maria Victoria Bariani
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (M.V.B.); (H.S.); (A.A.-H.)
| | - Ali Falahati
- Department of Biology, Yazd University, Yazd 8915818411, Iran; (A.F.); (A.K.)
| | - Azad Khosh
- Department of Biology, Yazd University, Yazd 8915818411, Iran; (A.F.); (A.K.)
| | - Ricardo R. Lastra
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA;
| | - Hiba Siblini
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (M.V.B.); (H.S.); (A.A.-H.)
| | - Thomas G. Boyer
- Department of Molecular Medicine, Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (M.V.B.); (H.S.); (A.A.-H.)
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17
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Chapel DB, Sharma A, Lastra RR, Maccio L, Bragantini E, Zannoni GF, George S, Quade BJ, Parra-Herran C, Nucci MR. A novel morphology-based risk stratification model for stage I uterine leiomyosarcoma: an analysis of 203 cases. Mod Pathol 2022; 35:794-807. [PMID: 35121810 DOI: 10.1038/s41379-022-01011-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/23/2022]
Abstract
Uterine leiomyosarcoma is the most common uterine mesenchymal malignancy. The majority present at stage I, and clinical outcomes vary widely. However, no widely accepted risk stratification system for stage I uterine leiomyosarcoma is currently available. We studied 17 routinely evaluated clinicopathologic parameters in 203 stage I uterine leiomyosarcoma from three institutions to generate a novel risk stratification model for these tumors. Mitoses >25 per 2.4 mm2 (10 high-power fields), atypical mitoses, coagulative necrosis, lymphovascular invasion, and serosal abutment were significantly associated with disease-free and disease-specific survival in univariate and multivariate analyses. These prognostic parameters were each scored as binary ("yes" or "no") variables and fitted to a single optimized algebraic risk model:Risk score = (coagulative necrosis)(1) + (mitoses > 25 per 2.4 mm2)(2) + (atypical mitoses)(2) + (lymphovascular invasion)(3) + (serosal abutment)(5)By logistic regression, the risk model was significantly associated with 5-year disease-free (AUC = 0.9270) and 5-year disease-specific survival (AUC = 0.8517). Internal and external validation substantiated the model. The continuous score (range, 0-13) was optimally divided into 3 risk groups with distinct 5-year disease-free and disease-specific survival: low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-13 points) groups. Our novel risk model performed significantly better than alternative uterine leiomyosarcoma risk stratification systems in predicting 5-year disease-free and disease-specific survival in stage I tumors. A simplified risk model, omitting terms for serosal abutment and lymphovascular invasion, can be accurately applied to myomectomy or morcellated specimens. We advocate routine application of this novel risk model in stage I uterine leiomyosarcoma to facilitate patient counseling and proper risk stratification for clinical trials.
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Affiliation(s)
- David B Chapel
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Department of Pathology, University of Michigan - Michigan Medicine, Ann Arbor, MI, 48109, USA.
| | - Aarti Sharma
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Department of Pathology, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Livia Maccio
- Unit of Surgical Pathology, S. Chiara Hospital, Trient, Italy
| | - Emma Bragantini
- Unit of Surgical Pathology, S. Chiara Hospital, Trient, Italy
| | | | - Suzanne George
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Bradley J Quade
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Carlos Parra-Herran
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
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18
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Javellana M, Eckert MA, Heide J, Zawieracz K, Weigert M, Ashley S, Stock E, Chapel D, Huang L, Yamada SD, Ahmed AA, Lastra RR, Chen M, Lengyel E. Neoadjuvant chemotherapy induces genomic and transcriptomic changes in ovarian cancer. Cancer Res 2021; 82:169-176. [PMID: 34737212 DOI: 10.1158/0008-5472.can-21-1467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/12/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022]
Abstract
The growing use of neoadjuvant chemotherapy to treat advanced-stage high-grade serous ovarian cancer (HGSOC) creates an opportunity to better understand chemotherapy-induced mutational and gene expression changes. Here we performed a cohort study including 34 patients with advanced stage IIIC or IV HGSOC to assess changes in the tumor genome and transcriptome in women receiving neoadjuvant chemotherapy. RNA-sequencing and panel DNA-sequencing of 596 cancer-related genes was performed on paired FFPE specimens collected before and after chemotherapy, and differentially expressed genes (DEGs) and CNVs in pre- and post-chemotherapy samples were identified. Following tissue and sequencing quality control, the final patient cohort consisted of 32 paired DNA and 20 paired RNA samples. Genomic analysis of paired samples did not reveal any recurrent chemotherapy-induced mutations. Gene expression analyses found that most DEGs were upregulated by chemotherapy, primarily in the chemotherapy resistant specimens. AP-1 transcription factor family genes (FOS, FOSB, FRA-1) were particularly upregulated in chemotherapy resistant samples. CNV analysis identified recurrent 11q23.1 amplification, which encompasses SIK2. In vitro, combined treatment with AP-1 or SIK2 inhibitors with carboplatin or paclitaxel demonstrated synergistic effects. These data suggest that AP-1 activity and SIK2 copy number amplification are induced by chemotherapy and may represent mechanisms by which chemotherapy resistance evolves in HGSOC. AP-1 and SIK2 are druggable targets with available small molecule inhibitors and represent potential targets to circumvent chemotherapy resistance.
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Affiliation(s)
| | | | - Janna Heide
- Department of Obstetrics and Gynecology, University of Chicago
| | | | | | - Sarah Ashley
- Department of Obstetrics and Gynecology, University of Chicago
| | - Elizabeth Stock
- Department of Obstetrics and Gynecology, University of Chicago
| | - David Chapel
- Department of Pathology, University of Michigan Medical School
| | - Lei Huang
- Center for Research Informatics, University of Chicago
| | - S Diane Yamada
- Departments of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago
| | | | | | | | - Ernst Lengyel
- Department of Obstetrics and Gynecology, University of Chicago
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19
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Jani I, Lastra RR, Brito KS, Liao C, Lazo I, Lee NK, Yamada SD, Kurnit KC. Chemotherapy response score as a prognostic tool in patients with advanced stage endometrial carcinoma treated with neoadjuvant chemotherapy. Int J Gynecol Cancer 2021; 31:852-858. [PMID: 33833085 DOI: 10.1136/ijgc-2020-002202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chemotherapy response score (CRS) applied to interval debulking specimens quantifies histopathologic response to neoadjuvant chemotherapy in patients with advanced ovarian carcinoma and correlates with progression-free and overall survival. OBJECTIVE To investigate whether the chemotherapy response score could be applied to interval debulking specimens in patients with advanced endometrial carcinoma and be a prognostic indicator. METHODS The study included patients with clinical stage III-IV endometrial carcinoma who received neoadjuvant chemotherapy followed by interval debulking surgery. Chemotherapy response scores were assigned to omental and adnexal metastases, and categorized as no/minimal (CRS1), partial (CRS2), and complete/near-complete (CRS3) response to neoadjuvant chemotherapy. Descriptive statistics were used to evaluate baseline characteristics and feasibility of chemotherapy response score assessment. Univariate analyses were used to evaluate associations between the chemotherapy response score, complete cytoreduction, and survival. RESULTS This study included 40 patients. The median age was 63.5 years, and 31 patients (78%) had stage IV disease. Thirty patients had an omentectomy, 22 patients (73%) had an omental chemotherapy response score assigned. Thirty-nine patients had a bilateral salpingo-oophorectomy, 28 patients (72%) had an adnexal chemotherapy response score assigned. Omental CRS2 and CRS3 were associated with improved progression-free survival (CRS2: HR=0.18, p<0.01; CRS3: HR=0.11, p<0.01) and overall survival (CRS2: HR=0.10, p<0.01; CRS3: HR=0.16, p=0.04). Adnexal CRS2 and CRS3 were associated with improved progression-free survival (CRS2: HR=0.23, p<0.01; CRS3: HR=0.20, p=0.03). Chemotherapy response scores were also associated with an increased likelihood of having a complete cytoreduction. CONCLUSION Chemotherapy response score can be applied to omental and adnexal metastases in patients with advanced endometrial carcinoma and was associated with survival and complete cytoreduction. The score may be a prognostic indicator and help to guide first-line treatment of patients with endometrial carcinoma.
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Affiliation(s)
- Ina Jani
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Katherine S Brito
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Isabel Lazo
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Nita Karnik Lee
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - S Diane Yamada
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Katherine C Kurnit
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
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20
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Johnson DN, Antic T, Reeves W, Mueller J, Lastra RR, Cipriani NA, Biernacka A. Histopathologic and clinical outcomes of Milan System categories "non-diagnostic" and "non-neoplastic" of salivary gland fine needle aspirations. J Am Soc Cytopathol 2021; 10:349-356. [PMID: 33867311 DOI: 10.1016/j.jasc.2021.03.001] [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: 01/07/2021] [Revised: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) specifies six categories with estimated risks of malignancy (ROM) and suggested management. The estimated ROM is 25% for Non-Diagnostic (ND) category, and 10% for Non-Neoplastic (NN). This study aimed to investigate histopathologic and clinical outcomes of MSRSGC categories ND and NN at the authors' institution. MATERIALS AND METHODS Cytopathology fine needle aspiration reports from 2008-2020 were searched for the word "salivary", "parotid", and "submandibular". Cases fitting Non-Diagnostic (ND) and Non-Neoplastic (NN) categories were identified. Follow-up cyto-/histopathologic and clinical data were extracted. RESULTS There were 43 ND and 46 NN cases. The average age was 58.3 years. Neoplastic lesions were found in 13 of 43 (30%) ND and 3 of 46 (6.5%) NN. The rate of malignancy in ND category was 14.0% (6/43) and 0% (0/46) in NN category. Four cases in ND (9.3%) and 6 (13.0%) in NN had no neoplasm and instead had an underlying reactive condition (e.g., chronic sialadenitis) or inflammatory lesion (e.g., lymphoepithelial cyst) on histologic follow-up. There was no follow-up pathology in 46.5% NDs (20/43) and 82.6% NNs (38/46); however, no lesions were apparent clinically with a mean follow-up of 3 years and 1.5 years, respectively. CONCLUSIONS MSRSGC categories ND and NN are helpful for reporting salivary gland FNA results. With proper clinical and radiologic correlation, ROM of NN is low; however, ROM of ND remains significant. Repeat FNA after correlation for ND cases seems prudent as neoplasms and malignancies may have gone undetected.
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Affiliation(s)
- Daniel N Johnson
- Department of Pathology, Northwestern University, Chicago, Illinois.
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ward Reeves
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Jeffrey Mueller
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Anna Biernacka
- Department of Pathology, The University of Chicago, Chicago, Illinois
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21
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Chen HIH, Lapadat R, Lastra RR, Biernacka A, Reeves W, Mueller J, Pambuccian SE, Barkan GA, Wojcik EM, Antic T. Accuracy of Subclassification and Grading of Renal Tumors on Fine Needle Aspiration Cytology Alone. Acta Cytol 2021; 65:140-149. [PMID: 33535202 DOI: 10.1159/000513065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fine needle aspiration (FNA) of renal masses can distinguish between benign and malignant neoplasms in 73-94% of cases. Previous studies suggested the correct subclassification of renal cell carcinomas (RCCs) by cytomorphology can be achieved in up to 80% of cases. However, as RCCs become increasingly subclassified by molecular signatures, correct subclassification based on cytology alone is increasingly difficult. DESIGN Two FNA passes (2 stained with Diff-Quik® and 2 with the Papanicolaou method) were performed on all fresh nephrectomy specimens for a 1-year period. There were 30 cases in this study, with 29 primary renal tumors and 1 case of metastatic lung adenocarcinoma. Each case was assigned a random number and came with 2 slides (1 from each staining method). Eight cytopathologists were asked to provide a diagnosis and the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading if applicable. Fleiss' Kappa and Cohen's Kappa equations were used to look at inter-rater variability. RESULTS When compared to the surgical pathology diagnosis, the average percent correct diagnosis for all cytopathologist was 35%. Chromophobe RCCs had the best average percent accuracy at 72% followed by clearcell RCC at 48%. Average accuracy for grading RCCs was 40%. Inter-rater variability among the cytopathologists for all RCC diagnoses was fair with a Fleiss' Kappa coefficient of 0.28. For the WHO/ISUP grade, the weighted coefficient for each pathologist ranged from 0.11 to 0.45, ranging from fair to moderate, respectively. CONCLUSIONS Renal tumors are difficult to classify on cytopathology alone. Core needle biopsy and ancillary studies are necessary if diagnosis will change management.
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Affiliation(s)
- Heather I-Hsuan Chen
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA,
| | - Razvan Lapadat
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Anna Biernacka
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Ward Reeves
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Jeffrey Mueller
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
| | - Stefan E Pambuccian
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Eva M Wojcik
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Tatjana Antic
- Department of Pathology, The University of Chicago Hospitals, Chicago, Illinois, USA
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22
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Jani I, Lastra RR, Brito K, Liao C, Lazo IM, Kurnit KC, Lee NK, Yamada SD. Chemotherapy response score is a prognostic tool in advanced stage endometrial cancer patients treated with neoadjuvant chemotherapy. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.07.068] [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: 11/29/2022]
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23
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Jani I, Lastra RR, Brito K, Liao C, Lazo I, Lee NK, Yamada SD. Chemotherapy response score as a prognostic tool in advanced-stage endometrial cancer patients treated with neoadjuvant chemotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e18095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18095 Background: Chemotherapy response score (CRS) applied to omental metastases obtained at the time of interval debulking surgery (IDS) has been used to quantify response to neoadjuvant chemotherapy (NACT) in advanced stage ovarian cancer patients. The score has been correlated with both progression free survival (PFS) and overall survival (OS). This CRS score has not been studied in advanced stage endometrial cancer. The aim of the current study is 1) to apply the CRS to omental and adnexal metastases obtained at IDS of advanced stage endometrial cancer patients and 2) to investigate the association between the CRS score and surgical outcome, PFS and OS. Methods: Patients with clinical stage III-IV endometrial cancer (endometrioid, serous, clear cell, carcinosarcoma) were identified through the endometrial cancer database, billing data and tumor board notes (2003-2019) from the University of Chicago. Patients were included if they received NACT followed by IDS (R0 no gross residual, optimal < 1 cm residual or suboptimal ≥ 1 cm residual disease). Patients who received pre-operative radiotherapy were excluded. Pathology specimens from primary and metastatic sites were reviewed by the study pathologist blinded to clinical outcome. Histologic specimens from the omental and adnexal metastases were assigned a single quantitative score of 1 (no/minimal tumor response), 2 (appreciable tumor response with viable tumor) or 3 (complete/near complete response) using the CRS system as previously described by Bohm et al (JCO 2015; 33:2457-63). Results: A total of 40 patients were available for analysis. Median age 63.5, median BMI 32 kg/m2. There is a significant association between omental CRS and optimal IDS (p = 0.029) but no significant association between the adnexal CRS and optimal IDS (p = 0.145). Cox regression analysis identified CRS omentum [2: HR = 0.095, p = 0.001; 3 HR = 0.088, p = 0.004] and CRS adnexa [2: HR = 0.24, p = 0.007] predictive of PFS. There was not enough evidence to comment on any association between CRS with OS. Conclusions: Omental CRS2, CRS3 are associated with optimal IDS. Omental CRS2, CRS3 and adnexal CRS2 are prognostic for improved PFS in stage III – IV endometrial cancer patients after neoadjuvant chemotherapy. [Table: see text]
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Affiliation(s)
- Ina Jani
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | | | - Katherine Brito
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Isabel Lazo
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Nita Karnik Lee
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Seiko Diane Yamada
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
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24
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Mukherjee A, Chiang CY, Daifotis HA, Nieman KM, Fahrmann JF, Lastra RR, Romero IL, Fiehn O, Lengyel E. Adipocyte-Induced FABP4 Expression in Ovarian Cancer Cells Promotes Metastasis and Mediates Carboplatin Resistance. Cancer Res 2020; 80:1748-1761. [PMID: 32054768 PMCID: PMC10656748 DOI: 10.1158/0008-5472.can-19-1999] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/05/2019] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
Abstract
Adipocytes are critical for ovarian cancer cells to home to the omentum, but the metabolic changes initiated by this interaction are unknown. To this end, we carried out unbiased mass spectrometry-based metabolomic and proteomic profiling of cancer cells cocultured with primary human omental adipocytes. Cancer cells underwent significant proteo-metabolomic alteration(s), typified by changes in the lipidome with corresponding upregulation of lipid metabolism proteins. FABP4, a lipid chaperone protein, was identified as the critical regulator of lipid responses in ovarian cancer cells cocultured with adipocytes. Subsequently, knockdown of FABP4 resulted in increased 5-hydroxymethylcytosine levels in the DNA, downregulation of gene signatures associated with ovarian cancer metastasis, and reduced clonogenic cancer cell survival. In addition, clustered regularly interspaced short palindromic repeats (CRISPR)-mediated knockout of FABP4 in high-grade serous ovarian cancer cells reduced metastatic tumor burden in mice. Consequently, a small-molecule inhibitor of FABP4 (BMS309403) not only significantly reduced tumor burden in a syngeneic orthotopic mouse model but also increased the sensitivity of cancer cells toward carboplatin both in vitro and in vivo. Taken together, these results show that targeting FABP4 in ovarian cancer cells can inhibit their ability to adapt and colonize lipid-rich tumor microenvironments, providing an opportunity for specific metabolic targeting of ovarian cancer metastasis. SIGNIFICANCE: Ovarian cancer metastatic progression can be restricted by targeting a critical regulator of lipid responses, FABP4.
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Affiliation(s)
- Abir Mukherjee
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois
| | - Chun-Yi Chiang
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois
| | - Helen A Daifotis
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois
| | - Kristin M Nieman
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois
| | - Johannes F Fahrmann
- University of California, Davis Genome, Center, Metabolomics, Davis, California
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Iris L Romero
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois
| | - Oliver Fiehn
- University of California, Davis Genome, Center, Metabolomics, Davis, California
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois.
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25
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Kanabolo D, Rodriguez J, Waggoner D, Tucker S, Deplewski D, Kaumeyer B, Lastra RR, Gundeti M. A Phenotypic Female Adolescent with Primary Amenorrhea and Dysmorphic Features. Pediatr Ann 2019; 48:e495-e500. [PMID: 31830290 DOI: 10.3928/19382359-20191118-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report on a case of a 14-year-old phenotypic female with a microdeletion at 13q31.1-q31.3, dysmorphic facial and limb features, and neurologic symptoms. She presented to her pediatrician with concerns for delayed puberty, and laboratory analysis revealed hypergonadotropic hypogonadism. She was found to have an XY karyotype and streak gonads. Further genetic studies did not reveal another cause for her gonadal dysgenesis and, to our knowledge, an association with her known 13q-microdeletion has not yet been reported. Given the risk of malignancy with XY gonadal dysgenesis, the patient had surgery to remove the gonads and had no postoperative complications after a 6-month follow-up visit. We also discuss the role of the pediatrician in cases of delayed puberty, from initial diagnosis to definitive management. [Pediatr Ann. 2019;48(12):e495-e500.].
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26
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Chapel DB, Choy B, Pytel P, Husain AN, Lastra RR. Mucolipidosis Type II Affecting 1 Fetus and Placental Disk of a Dichorionic-Diamnionic Twin Gestation: A Case Report and Review of the Literature. Int J Gynecol Pathol 2019; 38:346-352. [PMID: 29620587 DOI: 10.1097/pgp.0000000000000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mucolipidosis type II, also known as I-cell disease, is an autosomal recessive inborn error of metabolism, resulting from loss-of-function mutations in GNPTAB. Affected infants exhibit multiple physical anomalies and developmental delay, and death from disease follows in early childhood. Here we present an instructive case of mucolipidosis type II affecting 1 fetus and placental disk in a dichorionic-diamnionic twin pregnancy delivered at 36-wk gestation. The second twin and placental disk showed no abnormality. On microscopic examination, the affected placenta displayed marked vacuolization of the syncytiotrophoblast and Hofbauer cells, which was confirmed on ultrastructural examination. To our knowledge, this is the first description of placental findings in a twin pregnancy, wherein only 1 twin is affected by an inborn error of metabolism. This provides an opportunity to highlight the placental abnormalities seen in this group of diseases, and to emphasize the role of pathologic examination in early detection of otherwise unsuspected inborn errors of metabolism.
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Affiliation(s)
- David B Chapel
- Department of Pathology, The University of Chicago, Chicago, Illinois
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27
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Tonsing-Carter E, Hernandez KM, Kim CR, Harkless RV, Oh A, Bowie KR, West-Szymanski DC, Betancourt-Ponce MA, Green BD, Lastra RR, Fleming GF, Chandarlapaty S, Conzen SD. Glucocorticoid receptor modulation decreases ER-positive breast cancer cell proliferation and suppresses wild-type and mutant ER chromatin association. Breast Cancer Res 2019; 21:82. [PMID: 31340854 PMCID: PMC6651939 DOI: 10.1186/s13058-019-1164-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/25/2019] [Indexed: 12/25/2022] Open
Abstract
Background Non-ER nuclear receptor activity can alter estrogen receptor (ER) chromatin association and resultant ER-mediated transcription. Consistent with GR modulation of ER activity, high tumor glucocorticoid receptor (GR) expression correlates with improved relapse-free survival in ER+ breast cancer (BC) patients. Methods In vitro cell proliferation assays were used to assess ER-mediated BC cell proliferation following GR modulation. ER chromatin association following ER/GR co-liganding was measured using global ChIP sequencing and directed ChIP analysis of proliferative gene enhancers. Results We found that GR liganding with either a pure agonist or a selective GR modulator (SGRM) slowed estradiol (E2)-mediated proliferation in ER+ BC models. SGRMs that antagonized transcription of GR-unique genes both promoted GR chromatin association and inhibited ER chromatin localization at common DNA enhancer sites. Gene expression analysis revealed that ER and GR co-activation decreased proliferative gene activation (compared to ER activation alone), specifically reducing CCND1, CDK2, and CDK6 gene expression. We also found that ligand-dependent GR occupancy of common ER-bound enhancer regions suppressed both wild-type and mutant ER chromatin association and decreased corresponding gene expression. In vivo, treatment with structurally diverse SGRMs also reduced MCF-7 Y537S ER-expressing BC xenograft growth. Conclusion These studies demonstrate that liganded GR can suppress ER chromatin occupancy at shared ER-regulated enhancers, including CCND1 (Cyclin D1), regardless of whether the ligand is a classic GR agonist or antagonist. Resulting GR-mediated suppression of ER+ BC proliferative gene expression and cell division suggests that SGRMs could decrease ER-driven gene expression. Electronic supplementary material The online version of this article (10.1186/s13058-019-1164-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Tonsing-Carter
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Kyle M Hernandez
- Center for Research Informatics, The University of Chicago, Chicago, IL, 60637, USA.,Department of Pediatrics, The University of Chicago, Chicago, IL, 60637, USA
| | - Caroline R Kim
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Ryan V Harkless
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Alyce Oh
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Kathleen R Bowie
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | | | | | - Bradley D Green
- Ben May Department for Cancer Research, The University of Chicago, 900 E 57th St, Chicago, IL, 60637, USA
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, IL, 60637, USA
| | - Gini F Fleming
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Sarat Chandarlapaty
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Suzanne D Conzen
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA. .,Ben May Department for Cancer Research, The University of Chicago, 900 E 57th St, Chicago, IL, 60637, USA.
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28
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Abstract
Endometrial cancer is the most common gynecologic cancer in the United States, and its incidence is rising. Although there have been significant recent advances in our understanding of endometrial cancer biology, many aspects of treatment remain mired in controversy, including the role of surgical lymph node assessment and the selection of patients for adjuvant radiation or chemotherapy. For the subset of women with microsatellite-instable, metastatic disease, anti- programmed cell death protein 1 immunotherapy (pembrolizumab) is now approved by the US Food and Drug Administration, and numerous trials are attempting to build on this early success.
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Affiliation(s)
- Rebecca A Brooks
- Associate Professor, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
- Dr. Brooks is now the Associate Professor and Chief of the Division of Gynecologic Oncology, University of California Davis School of Medicine, Davis, CA
| | - Gini F Fleming
- Professor of Medicine and Director, Medical Oncology Breast Program, Department of Medical Oncology, The University of Chicago, Chicago, IL
| | - Ricardo R Lastra
- Assistant Professor, Department of Pathology, The University of Chicago, Chicago, IL
| | - Nita K Lee
- Assistant Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - John W Moroney
- Associate Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - Christina H Son
- Assistant Professor, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Ken Tatebe
- Resident, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Jennifer L Veneris
- Instructor of Medicine, Division of Gynecologic Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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29
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Eckert MA, Coscia F, Chryplewicz A, Chang JW, Hernandez KM, Pan S, Tienda SM, Nahotko DA, Li G, Blaženović I, Lastra RR, Curtis M, Yamada SD, Perets R, McGregor SM, Andrade J, Fiehn O, Moellering RE, Mann M, Lengyel E. Proteomics reveals NNMT as a master metabolic regulator of cancer-associated fibroblasts. Nature 2019; 569:723-728. [PMID: 31043742 PMCID: PMC6690743 DOI: 10.1038/s41586-019-1173-8] [Citation(s) in RCA: 270] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 03/27/2019] [Indexed: 12/23/2022]
Abstract
High-grade serous carcinoma has a poor prognosis, owing primarily to its early dissemination throughout the abdominal cavity. Genomic and proteomic approaches have provided snapshots of the proteogenomics of ovarian cancer1,2, but a systematic examination of both the tumour and stromal compartments is critical in understanding ovarian cancer metastasis. Here we develop a label-free proteomic workflow to analyse as few as 5,000 formalin-fixed, paraffin-embedded cells microdissected from each compartment. The tumour proteome was stable during progression from in situ lesions to metastatic disease; however, the metastasis-associated stroma was characterized by a highly conserved proteomic signature, prominently including the methyltransferase nicotinamide N-methyltransferase (NNMT) and several of the proteins that it regulates. Stromal NNMT expression was necessary and sufficient for functional aspects of the cancer-associated fibroblast (CAF) phenotype, including the expression of CAF markers and the secretion of cytokines and oncogenic extracellular matrix. Stromal NNMT expression supported ovarian cancer migration, proliferation and in vivo growth and metastasis. Expression of NNMT in CAFs led to depletion of S-adenosyl methionine and reduction in histone methylation associated with widespread gene expression changes in the tumour stroma. This work supports the use of ultra-low-input proteomics to identify candidate drivers of disease phenotypes. NNMT is a central, metabolic regulator of CAF differentiation and cancer progression in the stroma that may be therapeutically targeted.
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Affiliation(s)
- Mark A Eckert
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Fabian Coscia
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
- Clinical Proteomics Group, Proteomics Program, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Agnieszka Chryplewicz
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Jae Won Chang
- Department of Chemistry, University of Chicago, Chicago, IL, USA
| | - Kyle M Hernandez
- Center for Research Informatics, University of Chicago, Chicago, IL, USA
| | - Shawn Pan
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Samantha M Tienda
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Dominik A Nahotko
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Gang Li
- Department of Chemistry, University of Chicago, Chicago, IL, USA
| | - Ivana Blaženović
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Marion Curtis
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA
| | - Ruth Perets
- Division of Oncology, Clinical Research Institute at Rambam, Rambam Health Care Campus, Haifa, Israel
| | | | - Jorge Andrade
- Center for Research Informatics, University of Chicago, Chicago, IL, USA
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA, USA
| | | | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
- Clinical Proteomics Group, Proteomics Program, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, IL, USA.
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30
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Lastra RR, Newman JG, Brooks JS, Huang JH. Ossifying Fibromyxoid Tumor Metastatic to the Thyroid: A Case Report and Review of the Literature. Ear Nose Throat J 2019. [DOI: 10.1177/014556131409300608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ricardo R. Lastra
- Department of Pathology and Laboratory Medicine,
Hospital of the University of Pennsylvania, Philadelphia
| | - Jason G. Newman
- Department of Otorhinolaryngology, Center of Head and
Neck Surgery, Pennsylvania Hospital, Philadelphia
| | - John S. Brooks
- Department of Pathology and Laboratory Medicine,
Pennsylvania Hospital, Philadelphia
| | - Jui-Han Huang
- Department of Pathology and Laboratory Medicine,
Pennsylvania Hospital, Philadelphia
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31
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Eckert MA, Coscia F, Chryplewicz AA, Chang JW, Hernandez KM, Pan S, Tienda SM, Nahotko DA, Li G, Blaženović I, Lastra RR, Curtis M, Yamada SD, Perets R, McGregor S, Andrade J, Fiehn O, Moellering RE, Mann M, Lengyel E. Metabolic reprogramming of the stromal epigenome in ovarian cancer metastasis. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.lb240] [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: 11/11/2022]
Affiliation(s)
- Mark A Eckert
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Fabian Coscia
- Department of Proteomics and Signal TransductionMax Planck Institute of BiochemistryMartinsriedGermany
| | | | | | | | - Shawn Pan
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Samantha M Tienda
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Dominik A Nahotko
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Gang Li
- ChemistryUniversity of ChicagoChicagoIL
| | - Ivana Blaženović
- West Coast Metabolomics Center, University of California, DavisDavisCA
| | | | - Marion Curtis
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - S. Diane Yamada
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
| | - Ruth Perets
- Division of OncologyRambam Health Care CampusHaifaIsrael
| | | | - Jorge Andrade
- Center for Research InformaticsUniversity of ChicagoChicagoIL
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California, DavisDavisCA
| | | | - Matthias Mann
- Department of Proteomics and Signal TransductionMax Planck Institute of BiochemistryMartinsriedGermany
| | - Ernst Lengyel
- Obstetrics & Gynecology/Section of Gynecologic OncologyUniversity of ChicagoChicagoIL
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Olivas AD, Barroeta JE, Lastra RR. Role of Ancillary Techniques in Gynecologic Cytopathology Specimens. Acta Cytol 2019; 64:63-70. [PMID: 30889579 DOI: 10.1159/000496569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/02/2019] [Indexed: 12/15/2022]
Abstract
The association between high-risk genotypes of human papillomavirus (hr-HPV) and cervical cancer is well established. As hr-HPV testing is rapidly becoming a part of routine cervical cancer screening, either in conjunction with cytology or as primary testing, the management of hr-HPV-positive women has to be tailored in a way that increases the detection of cervical abnormalities while decreasing unnecessary colposcopic biopsies or other invasive procedures. In this review, we discuss the overall utility and strategies of hr-HPV testing, as well as the advantages and limitations of potential triage strategies for hr-HPV-positive women, including HPV genotyping, p16/Ki-67 dual staining, and methylation assays.
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Affiliation(s)
- Andrea D Olivas
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Julieta E Barroeta
- Department of Pathology, Cooper University Hospital, Camden, New Jersey, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA,
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33
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Choy B, Venkataraman G, Biernacka A, Lastra RR, Mueller J, Setia N, Reeves W, Antic T. Correlation of cytopathology with flow cytometry and histopathology for the diagnosis of hematologic malignancies in young adults presenting with cervical lymphadenopathy. Diagn Cytopathol 2019; 47:579-583. [PMID: 30794347 DOI: 10.1002/dc.24157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/31/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is frequently utilized in the diagnostic workup of lymphadenopathy. We evaluated the correlation of cytopathology with flow cytometry and tissue biopsy results and assessed the prevalence of specific malignancies in young adults presenting with cervical lymphadenopathy. METHODS Database was searched for cervical lymph node FNA performed by a cytopathologist in patients aged 18-30 years from 2005 to 2017. RESULTS Cervical lymph node FNA was performed on 48 patients without prior history of malignancy. Nineteen patients had cytology results only, of which all were interpreted as benign reactive lymph node. None developed subsequent malignancies. The remaining 29 patients had cytology with flow cytometry and/or tissue biopsy results. A benign reactive cytology diagnosis was rendered in 18 (62%) cases, of which 11 had concordant diagnosis on flow cytometry, 2 had tissue biopsy, and 3 had both. Eleven (38%) patients had cytology results concerning for a hematologic malignancy, of which 7 were confirmed by flow cytometry and 3 by both flow cytometry and tissue biopsy. Cervical lymph node FNA has 94.1% sensitivity, 83.3% specificity, 88.9% positive predictive value, and 90.9% negative predictive value. The most common hematologic malignancy in our young adult population presenting with cervical lymphadenopathy was Hodgkin lymphoma. CONCLUSION FNA is a useful first-line diagnostic procedure for assessing cervical lymphadenopathy in young adults to allow for better triage of specimens for flow cytometry and/or tissue biopsy concerning for a hematologic malignancy and potentially avoid invasive excisional biopsy in a proportion of cases.
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Affiliation(s)
- Bonnie Choy
- Department of Pathology, University of Chicago, Chicago, Illinois.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Anna Biernacka
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Jeffery Mueller
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Namrata Setia
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Ward Reeves
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, Illinois
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34
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Johnson DN, Cavallo AB, Uraizee I, Tanager K, Lastra RR, Antic T, Cipriani NA. A Proposal for Separation of Nuclear Atypia and Architectural Atypia in Bethesda Category III (AUS/FLUS) Based on Differing Rates of Thyroid Malignancy. Am J Clin Pathol 2019; 151:86-94. [PMID: 30212867 DOI: 10.1093/ajcp/aqy109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) includes sparsely cellular specimens with nuclear atypia (3N) and/or architectural atypia (3A). This study investigates whether the two types of atypia have different rates of malignancy (ROMs). Methods Cytologic and histologic diagnoses of resected thyroid nodules were recorded. ROM was calculated for all Bethesda categories and for 3N and 3A subcategories. Possible noninvasive follicular thyroid neoplasms with papillary-like nuclear features were reviewed and removed from malignancies, and ROM was recalculated. Results A total of 1,396 nodules were included. ROM of 3N (33.3%-26.0%) was higher than 3A (7.7%-5.0%) (P < .0001) and was similar to suspicious for follicular neoplasm (25.0%-20.3%) (P = .3). ROM of 3A approached benign (2.4%-1.5%) (P = .02). Conclusions Strong consideration should be given to separating 3N (nuclear atypia with higher risk for papillary thyroid carcinoma) from 3A (architectural atypia with higher chance of being benign) to convey different ROMs.
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Affiliation(s)
| | | | - Imran Uraizee
- Department of Pathology, University of Chicago, Chicago, IL
| | - Kevin Tanager
- Department of Pathology, University of Chicago, Chicago, IL
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL
- Division of Cytopathology, University of Chicago, Chicago, IL
- Division of Surgical Pathology, University of Chicago, Chicago, IL
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, IL
- Division of Cytopathology, University of Chicago, Chicago, IL
- Division of Surgical Pathology, University of Chicago, Chicago, IL
| | - Nicole A Cipriani
- Department of Pathology, University of Chicago, Chicago, IL
- Division of Surgical Pathology, University of Chicago, Chicago, IL
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35
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Fidai SS, Sharma AE, Johnson DN, Segal JP, Lastra RR. Dihydropyrimidine dehydrogenase deficiency as a cause of fatal 5-Fluorouracil toxicity. Autops Case Rep 2018; 8:e2018049. [PMID: 30775324 PMCID: PMC6360833 DOI: 10.4322/acr.2018.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 07/25/2018] [Accepted: 09/11/2018] [Indexed: 12/13/2022] Open
Abstract
5-Fluorouracil (5-FU), in combination with other cytotoxic drugs, is commonly used to treat a variety of cancers. Dihydropyrimidine dehydrogenase (DPD) catalyzes the first catabolic step of the 5-FU degradation pathway, converting 80% of 5-FU to its inactive metabolite. Approximately 0.3% of the population demonstrate complete DPD deficiency, translating to extreme toxicity of 5-FU. Here we present a case of a patient who had a fatal outcome after treatment with 5-FU who was found to have an unknown DPD deficiency discovered at autopsy.
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Affiliation(s)
- Shiraz S Fidai
- University of Chicago Medicine, Department of Pathology. Chicago, IL, USA
| | - Aarti E Sharma
- University of Chicago Medicine, Department of Pathology. Chicago, IL, USA
| | - Daniel N Johnson
- University of Chicago Medicine, Department of Pathology. Chicago, IL, USA
| | - Jeremy P Segal
- University of Chicago Medicine, Department of Pathology. Chicago, IL, USA
| | - Ricardo R Lastra
- University of Chicago Medicine, Department of Pathology. Chicago, IL, USA
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36
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Cowan M, Suntum T, Olivas AD, Perpich M, Applebaum MA, Lastra RR, Yamada SD. Second primary rhabdomyosarcoma of the uterine cervix presenting with synchronous ovarian Sertoli-Leydig cell tumor: An illustrative case of DICER1 syndrome. Gynecol Oncol Rep 2018; 25:94-97. [PMID: 30014022 PMCID: PMC6019406 DOI: 10.1016/j.gore.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 11/16/2022] Open
Abstract
•Embryonal rhabdomyosarcoma of the uterine cervix and ovarian Sertoli-Leydig cell tumors are associated with DICER1 mutation•DICER1-associated tumors should prompt genetic counseling and testing•Somatic and germline genetic mutation profiles can be used to differentiate second primary from recurrent tumors.
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Affiliation(s)
- Matthew Cowan
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Tara Suntum
- Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Andrea D Olivas
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Melody Perpich
- Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Mark A Applebaum
- Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, USA
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37
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Chapel DB, Yamada SD, Cowan M, Lastra RR. Immunohistochemistry for mismatch repair protein deficiency in endometrioid endometrial carcinoma yields equivalent results when performed on endometrial biopsy/curettage or hysterectomy specimens. Gynecol Oncol 2018; 149:570-574. [DOI: 10.1016/j.ygyno.2018.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/02/2018] [Accepted: 04/06/2018] [Indexed: 12/21/2022]
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38
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Johnson MB, Hoffmann JN, You HM, Lastra RR, Fernandez S, Strober JW, Allaw AB, Brady MJ, Conzen SD, McClintock MK. Psychosocial Stress Exposure Disrupts Mammary Gland Development. J Mammary Gland Biol Neoplasia 2018; 23:59-73. [PMID: 29687293 PMCID: PMC6207373 DOI: 10.1007/s10911-018-9392-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/22/2018] [Indexed: 01/18/2023] Open
Abstract
Exposure to psychosocial stressors and ensuing stress physiology have been associated with spontaneous invasive mammary tumors in the Sprague-Dawley rat model of human breast cancer. Mammary gland (MG) development is a time when physiologic and environmental exposures influence breast cancer risk. However, the effect of psychosocial stress exposure on MG development remains unknown. Here, in the first comprehensive longitudinal study of MG development in nulliparous female rats (from puberty through young adulthood; 8-25 wks of age), we quantify the spatial gradient of differentiation within the MG of socially stressed (isolated) and control (grouped) rats. We then demonstrate that social isolation increased stress reactivity to everyday stressors, resulting in downregulation of glucocorticoid receptor (GR) expression in the MG epithelium. Surprisingly, given that chemical carcinogens increase MG cancer risk by preventing normal terminal end bud (TEB) differentiation, chronic isolation stress did not alter TEBs. Instead, isolation blunted MG growth and alveolobular differentiation and reduced epithelial cell proliferation in these structures. Social isolation also enhanced corpora luteal progesterone at all ages but reduced estrogenization only in early adulthood, a pattern that precludes modulated ovarian function as a sufficient mechanism for the effects of isolation on MG development. This longitudinal study of natural variation provides an integrated view of MG development and the importance of increased GR activation in nulliparous ductal growth and alveolobular differentiation. Thus, social isolation and its physiological sequelae disrupt MG growth and differentiation and suggest a contribution of stress exposure during puberty and young adulthood to the previously observed increase in invasive MG cancer observed in chronically socially-isolated adult Sprague-Dawley rats.
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Affiliation(s)
- Marianna B Johnson
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Hannah M You
- Institute for Mind and Biology, The University of Chicago, Chicago, IL, USA
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Sully Fernandez
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Jordan W Strober
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Ahmad B Allaw
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Matthew J Brady
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Suzanne D Conzen
- Committee on Molecular Metabolism and Nutrition, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
- Ben May Department of Cancer Research, The University of Chicago, Chicago, IL, USA
| | - Martha K McClintock
- Institute for Mind and Biology, The University of Chicago, Chicago, IL, USA.
- Departments of Psychology and Comparative Human Development, The University of Chicago, 940 East 57th Street, Chicago, IL, 60637, USA.
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West DC, Kocherginsky M, Tonsing-Carter EY, Dolcen DN, Hosfield DJ, Lastra RR, Sinnwell JP, Thompson KJ, Bowie KR, Harkless RV, Skor MN, Pierce CF, Styke SC, Kim CR, de Wet L, Greene GL, Boughey JC, Goetz MP, Kalari KR, Wang L, Fleming GF, Györffy B, Conzen SD. Discovery of a Glucocorticoid Receptor (GR) Activity Signature Using Selective GR Antagonism in ER-Negative Breast Cancer. Clin Cancer Res 2018; 24:3433-3446. [PMID: 29636357 DOI: 10.1158/1078-0432.ccr-17-2793] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/14/2018] [Accepted: 04/04/2018] [Indexed: 12/30/2022]
Abstract
Purpose: Although high glucocorticoid receptor (GR) expression in early-stage estrogen receptor (ER)-negative breast cancer is associated with shortened relapse-free survival (RFS), how associated GR transcriptional activity contributes to aggressive breast cancer behavior is not well understood. Using potent GR antagonists and primary tumor gene expression data, we sought to identify a tumor-relevant gene signature based on GR activity that would be more predictive than GR expression alone.Experimental Design: Global gene expression and GR ChIP-sequencing were performed to identify GR-regulated genes inhibited by two chemically distinct GR antagonists, mifepristone and CORT108297. Differentially expressed genes from MDA-MB-231 cells were cross-evaluated with significantly expressed genes in GR-high versus GR-low ER-negative primary breast cancers. The resulting subset of GR-targeted genes was analyzed in two independent ER-negative breast cancer cohorts to derive and then validate the GR activity signature (GRsig).Results: Gene expression pathway analysis of glucocorticoid-regulated genes (inhibited by GR antagonism) revealed cell survival and invasion functions. GR ChIP-seq analysis demonstrated that GR antagonists decreased GR chromatin association for a subset of genes. A GRsig that comprised n = 74 GR activation-associated genes (also reversed by GR antagonists) was derived from an adjuvant chemotherapy-treated Discovery cohort and found to predict probability of relapse in a separate Validation cohort (HR = 1.9; P = 0.012).Conclusions: The GRsig discovered herein identifies high-risk ER-negative/GR-positive breast cancers most likely to relapse despite administration of adjuvant chemotherapy. Because GR antagonism can reverse expression of these genes, we propose that addition of a GR antagonist to chemotherapy may improve outcome for these high-risk patients. Clin Cancer Res; 24(14); 3433-46. ©2018 AACR.
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Affiliation(s)
- Diana C West
- Department of Medicine, The University of Chicago, Chicago, Illinois.,Department of Chemistry and Physics, Ave Maria University, Ave Maria, Florida
| | - Masha Kocherginsky
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | | | - D Nesli Dolcen
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - David J Hosfield
- Ben May Department for Cancer Research, The University of Chicago, Chicago, Illinois
| | - Ricardo R Lastra
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Jason P Sinnwell
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kevin J Thompson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kathleen R Bowie
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Ryan V Harkless
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Maxwell N Skor
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Charles F Pierce
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Sarah C Styke
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Caroline R Kim
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Larischa de Wet
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Geoffrey L Greene
- Ben May Department for Cancer Research, The University of Chicago, Chicago, Illinois
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Goetz
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Krishna R Kalari
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Gini F Fleming
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Balázs Györffy
- MTA-TTK Lendület Cancer Biomarker Research Group, Institute of Enzymology, Budapest, Hungary.,Semmelweis University, Second Department of Pediatrics, Budapest, Hungary
| | - Suzanne D Conzen
- Department of Medicine, The University of Chicago, Chicago, Illinois. .,Ben May Department for Cancer Research, The University of Chicago, Chicago, Illinois
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40
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Lwanga A, Kamson DO, Wilkins TE, Sharma V, Schulte JJ, Miller J, Hassan I, Lastra RR. Occult teratoma in a case of N-methyl-D-aspartate receptor encephalitis. Neuroradiol J 2018. [PMID: 29513076 DOI: 10.1177/1971400918763578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
N-methyl-D-aspartate receptor encephalitis (NMDARe) is one of 13 autoimmune-mediated encephalitides that have been discovered over the last decade. This case report describes the course of a 26-year-old female who presented with new-onset seizures and insomnia, complicated by encephalitis. The initial workup ruled out common causes of encephalitis, while a transvaginal ultrasound (TVUS), and computed tomography (CT) scans of the chest, abdomen, and pelvis did not identify a mass. Based on the suspicion that she may have autoimmune encephalitis, the patient was treated with intravenous immunoglobulins and plasma exchange, but continued to deteriorate. Whole-body positron emission tomography (PET) scan identified a small hypermetabolic pelvic mass. Shortly thereafter serum and cerebral spinal fluid NMDAR antibody titers were reported as positive, prompting repetition of the TVUS, which confirmed the presence of an ovarian teratoma. The patient had a laparoscopic oophorectomy with subsequent resolution of her symptoms, further confirming the diagnosis. Despite the sensitivities of TVUS and CT of up to 94% and 98%, respectively, the teratoma was unusually small, necessitating the addition of a PET scan to identify the lesion. These neoplasms are thought to have low uptake on PET; however, it is possible that focal inflammation may have enhanced the detection. It is unlikely that the teratoma grew during hospitalization as the average growth rate is 1.8 mm per year. Regardless, the lesson that can be learned is that imaging modalities beyond CT and TVUS, such as PET, can be helpful, as identification of a resectable tumor may alter management and ultimately improve outcomes.
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Affiliation(s)
- Anita Lwanga
- 1 Division of Academic Internal Medicine and Geriatrics, University of Illinois, Chicago IL USA
| | - David O Kamson
- 2 Department of Neurology, The University of Chicago, Chicago IL USA
| | | | - Vinny Sharma
- 4 Department of Neurology and Rehabilitation, University of Illinois, Chicago IL USA
| | - Jefree J Schulte
- 5 Department of Pathology, The University of Chicago, Chicago IL USA
| | - James Miller
- 6 Department of Internal Medicine, Mount Sinai Hospital, Chicago IL USA
| | - Ikram Hassan
- 7 Illinois School of Professional Psychology at Argosy University, Chicago IL USA
| | - Ricardo R Lastra
- 5 Department of Pathology, The University of Chicago, Chicago IL USA
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41
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Lastra RR, Birdsong G, Hwang DH, Jorda M, Kerr DA, McGrath C, Odronic S, Rao R, VanderLaan PA, Walker JW, Antic T. Preoperative cytologic interpretation of noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a 1-year multi-institutional experience. J Am Soc Cytopathol 2018; 7:79-85. [PMID: 31043256 DOI: 10.1016/j.jasc.2017.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Encapsulated follicular variant of papillary thyroid carcinoma (PTC) has an indolent behavior; hence, a change in terminology to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)" has been proposed. Data are scant on the fine-needle aspiration (FNA) diagnosis of nodules proven to be NIFTP upon resection. The aim was to evaluate the FNA diagnosis of nodules diagnosed as NIFTP upon resection. MATERIALS AND METHODS The archives of 8 participating institutions were searched for thyroid resection specimens obtained in a 1-year period, and pertinent demographic and pathology data were recorded. RESULTS 2226 thyroid surgeries were performed over the indicated time period. NIFTP was diagnosed in 6.3% of cases; 118 patients (119 nodules) with NIFTP and available preoperative thyroid FNA were included. Preoperative cytologic diagnosis were: non-diagnostic: 0.8%; benign: 5.9%; atypia of undetermined significance/follicular lesion of undetermined significance: 42.9%; follicular neoplasm/suspicious for a follicular neoplasm: 31.0%; suspicious for malignancy: 15.9%; malignant: 3.4%. Molecular data was available for 49 cases, either by Afirma or ThyGenX/ThyroSeq. Of the Afirma cases, 11% were classified as "benign", 2% as "indeterminate", and 87% as "suspicious"; of the ThyGenX/ThyroSeq cases, 50% had NRAS mutations, 20% demonstrated KRAS mutations, 20% showed HRAS mutations, and 10% showed a BRAF mutation (K601E). CONCLUSIONS NIFTP are tumors demonstrating nuclear features similar to those seen in PTC. Our series shows that a preoperative diagnosis of "suspicious for malignancy" or "malignant" is uncommon in NIFTP, suggesting that there are sufficient cytomorphologic differences between PTC and NIFTP to allow for the suspicion of NIFTP on FNA specimens.
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Affiliation(s)
- Ricardo R Lastra
- Department of Pathology and Laboratory Medicine, University of Chicago Medical Center, Chicago, Illinois.
| | - George Birdsong
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - David H Hwang
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Merce Jorda
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida
| | - Darcy A Kerr
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida
| | - Cindy McGrath
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shelley Odronic
- Lima Pathology Associates, St. Rita's Medical Center, Lima, Ohio
| | - Rema Rao
- Papanicolaou Cytopathology Laboratory, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joe W Walker
- Department of Pathology, Rutland Regional Medical Center, Rutland, Vermont
| | - Tatjana Antic
- Department of Pathology and Laboratory Medicine, University of Chicago Medical Center, Chicago, Illinois
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42
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Johnson DN, Barroeta JE, Antic T, Lastra RR. Cytomorphologic features of metastatic endometrioid carcinoma by fine needle aspiration. Diagn Cytopathol 2017; 46:105-110. [PMID: 29105363 DOI: 10.1002/dc.23855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 10/02/2017] [Accepted: 10/17/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although metastatic disease is commonly seen in high grade carcinomas of gynecologic origin, it also occurs in low to intermediate grade endometrioid carcinomas (LGEMCAs), and may even be the primary presentation of disease. Tissue confirmation is necessary to guide therapy, but performing biopsies might not always be feasible or practical. In such instances, fine needle aspiration (FNA) is a safe and efficient alternative. No comprehensive series describing the cytomorphologic features of metastatic LGEMCA on FNA samples has been published. This study describes clinical and cytomorphologic features of metastatic LGEMCA diagnosed by FNA. METHODS The pathology archives at 2 academic institutions were searched for patients with endometrial or ovarian endometrioid carcinoma, with concurrent or subsequent sampling of metastatic sites by FNA. RESULTS Twelve cases were identified; all slides were reviewed and cytomorphologic features recorded. Four cases were obtained from metastatic sites as primary presentation of disease, and 8 cases were obtained from metastatic sites in patients with known history of LGEMCA. Metastatic LGEMCAs generate cellular specimens composed of cohesive clusters of cells with areas of gland formation. Consistent cytomorphologic features included nuclear overlapping, low to intermediate nuclear to cytoplasmic ratios, round to elongated nuclear shape, finely vacuolated cytoplasm, mild to moderate nuclear membrane irregularities, squamous metaplasia, and inconspicuous nucleoli. Variability was seen with regards to the presence of necrosis (50% of cases) and mitosis (25% of cases). CONCLUSION The presence of these features on FNA samples should raise concern for an underlying gynecologic malignancy.
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Affiliation(s)
- Daniel N Johnson
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | | | - Tatjana Antic
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, Illinois
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43
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Veneris JT, Darcy KM, Mhawech-Fauceglia P, Tian C, Lengyel E, Lastra RR, Pejovic T, Conzen SD, Fleming GF. High glucocorticoid receptor expression predicts short progression-free survival in ovarian cancer. Gynecol Oncol 2017; 146:153-160. [PMID: 28456378 DOI: 10.1016/j.ygyno.2017.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the association of tumor glucocorticoid receptor (GR) expression and patient outcome in ovarian cancer. METHODS GR expression was evaluated by immunohistochemistry using tissue microarrays of specimens from 481 patients with ovarian cancer and 4 patients with benign conditions. Low GR expression was defined as an intensity of 0 or 1+ and high GR as 2+ or 3+ in >1% of tumor cells. Analyses were performed to evaluate the relationship of GR expression with clinical characteristics, progression-free survival (PFS) and overall survival (OS). RESULTS GR protein was highly expressed in 133 of 341 (39.0%) tumors from patients who underwent upfront cytoreduction surgery followed by adjuvant chemotherapy. High GR expression was more common in serous tumors (p<0.001), high grade tumors (p<0.001), and advanced stage tumors (p=0.037). Median PFS was significantly decreased in cases with high GR (20.4months) compared to those with low GR (36.0months, HR=1.66, 95% CI 1.29-2.14, p<0.001). GR remained an independent prognostic factor for PFS in multivariate analysis. OS was not associated with GR status. CONCLUSIONS These data suggest that high GR expression correlates with poor prognosis and support the hypothesis that modulating GR activity in combination with chemotherapy may improve outcomes.
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Affiliation(s)
- Jennifer Taylor Veneris
- Department of Medicine, Section of Hematology-Oncology, The University of Chicago, Chicago, IL, United States.
| | - Kathleen M Darcy
- Women's Health Integrated Research Center, Inova Health System, Annandale, VA, United States
| | | | - Chunqiao Tian
- Women's Health Integrated Research Center, Inova Health System, Annandale, VA, United States
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, The University of Chicago, Chicago, IL, United States; The University of Chicago Comprehensive Cancer Center, Chicago, IL, United States
| | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, IL, United States
| | - Tanja Pejovic
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Oregon Health & Science University, Portland, OR, United States
| | - Suzanne D Conzen
- Department of Medicine, Section of Hematology-Oncology, The University of Chicago, Chicago, IL, United States; Ben May Department for Cancer Biology, The University of Chicago, Chicago, IL, United States; The University of Chicago Comprehensive Cancer Center, Chicago, IL, United States
| | - Gini F Fleming
- Department of Medicine, Section of Hematology-Oncology, The University of Chicago, Chicago, IL, United States; The University of Chicago Comprehensive Cancer Center, Chicago, IL, United States.
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44
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Kach J, Long TM, Selman P, Tonsing-Carter EY, Bacalao MA, Lastra RR, de Wet L, Comiskey S, Gillard M, VanOpstall C, West DC, Chan WC, Griend DV, Conzen SD, Szmulewitz RZ. Selective Glucocorticoid Receptor Modulators (SGRMs) Delay Castrate-Resistant Prostate Cancer Growth. Mol Cancer Ther 2017; 16:1680-1692. [PMID: 28428441 DOI: 10.1158/1535-7163.mct-16-0923] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/29/2017] [Accepted: 04/14/2017] [Indexed: 01/26/2023]
Abstract
Increased glucocorticoid receptor (GR) expression and activity following androgen blockade can contribute to castration-resistant prostate cancer (CRPC) progression. Therefore, we hypothesized that GR antagonism will have therapeutic benefit in CRPC. However, the FDA-approved nonselective, steroidal GR antagonist, mifepristone, lacks GR specificity, reducing its therapeutic potential. Here, we report that two novel nonsteroidal and highly selective GR modulators (SGRM), CORT118335 and CORT108297, have the ability to block GR activity in prostate cancer and slow CRPC progression. In contrast to mifepristone, these novel SGRMs did not affect androgen receptor (AR) signaling, but potently inhibited GR transcriptional activity. Importantly, SGRMs decreased GR-mediated tumor cell viability following AR blockade. In vivo, SGRMs significantly inhibited CRPC progression in high GR-expressing, but not in low GR-expressing xenograft models. Transcriptome analysis following AR blockade and GR activation revealed that these SGRMs block GR-mediated proliferative gene expression pathways. Furthermore, GR-regulated proliferation-associated genes AKAP12, FKBP5, SGK1, CEBPD, and ZBTB16 are inhibited by CORT108297 treatment in vivo Together, these data suggest that GR-selective nonsteroidal SGRMs potently inhibit GR activity and prostate cancer growth despite AR pathway inhibition, demonstrating the therapeutic potential of SGRMs in GR-expressing CRPC. Mol Cancer Ther; 16(8); 1680-92. ©2017 AACR.
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Affiliation(s)
- Jacob Kach
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Tiha M Long
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Phillip Selman
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | | | - Maria A Bacalao
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Ricardo R Lastra
- Department of Anatomical Pathology, The University of Chicago, Chicago, Illinois
| | - Larischa de Wet
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Shane Comiskey
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Marc Gillard
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | | | - Diana C West
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Wen-Ching Chan
- Center for Research Informatics, The University of Chicago, Chicago, Illinois
| | | | - Suzanne D Conzen
- Department of Medicine, The University of Chicago, Chicago, Illinois.,Ben May Department for Cancer Research, The University of Chicago, Chicago, Illinois
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45
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Chiyoda T, Hart PC, Eckert MA, McGregor SM, Lastra RR, Hamamoto R, Nakamura Y, Yamada SD, Olopade OI, Lengyel E, Romero IL. Loss of BRCA1 in the Cells of Origin of Ovarian Cancer Induces Glycolysis: A Window of Opportunity for Ovarian Cancer Chemoprevention. Cancer Prev Res (Phila) 2017; 10:255-266. [PMID: 28264838 PMCID: PMC5425093 DOI: 10.1158/1940-6207.capr-16-0281] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/06/2017] [Accepted: 02/27/2017] [Indexed: 12/21/2022]
Abstract
Mutations in the breast cancer susceptibility gene 1 (BRCA1) are associated with an increased risk of developing epithelial ovarian cancer. However, beyond the role of BRCA1 in DNA repair, little is known about other mechanisms by which BRCA1 impairment promotes carcinogenesis. Given that altered metabolism is now recognized as important in the initiation and progression of cancer, we asked whether the loss of BRCA1 changes metabolism in the cells of origin of ovarian cancer. The findings show that silencing BRCA1 in ovarian surface epithelial and fallopian tube cells increased glycolysis. Furthermore, when these cells were transfected with plasmids carrying deleterious BRCA1 mutations (5382insC or the P1749R), there was an increase in hexokinase-2 (HK2), a key glycolytic enzyme. This effect was mediated by MYC and the STAT3. To target the metabolic phenotype induced by loss of BRCA1, a drug-repurposing approach was used and aspirin was identified as an agent that counteracted the increase in HK2 and the increase in glycolysis induced by BRCA1 impairment. Evidence from this study indicates that the tumor suppressor functions of BRCA1 extend beyond DNA repair to include metabolic endpoints and identifies aspirin as an ovarian cancer chemopreventive agent capable of reversing the metabolic derangements caused by loss of BRCA1. Cancer Prev Res; 10(4); 255-66. ©2017 AACR.
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Affiliation(s)
- Tatsuyuki Chiyoda
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Peter C Hart
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Mark A Eckert
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | | | - Ricardo R Lastra
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Ryuji Hamamoto
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Yusuke Nakamura
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - S Diane Yamada
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Olufunmilayo I Olopade
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois
| | - Iris L Romero
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois.
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46
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Schulte JJ, Lastra RR. Abdominopelvic washings in gynecologic pathology: A comprehensive review. Diagn Cytopathol 2016; 44:1039-1057. [DOI: 10.1002/dc.23569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/09/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Jefree J. Schulte
- Department of Pathology; The University of Chicago; Chicago Illinois
| | - Ricardo R. Lastra
- Department of Pathology; The University of Chicago; Chicago Illinois
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47
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Coscia F, Watters KM, Curtis M, Eckert MA, Chiang CY, Tyanova S, Montag A, Lastra RR, Lengyel E, Mann M. Integrative proteomic profiling of ovarian cancer cell lines reveals precursor cell associated proteins and functional status. Nat Commun 2016; 7:12645. [PMID: 27561551 PMCID: PMC5007461 DOI: 10.1038/ncomms12645] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [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: 02/23/2016] [Accepted: 07/19/2016] [Indexed: 12/11/2022] Open
Abstract
A cell line representative of human high-grade serous ovarian cancer (HGSOC) should not only resemble its tumour of origin at the molecular level, but also demonstrate functional utility in pre-clinical investigations. Here, we report the integrated proteomic analysis of 26 ovarian cancer cell lines, HGSOC tumours, immortalized ovarian surface epithelial cells and fallopian tube epithelial cells via a single-run mass spectrometric workflow. The in-depth quantification of >10,000 proteins results in three distinct cell line categories: epithelial (group I), clear cell (group II) and mesenchymal (group III). We identify a 67-protein cell line signature, which separates our entire proteomic data set, as well as a confirmatory publicly available CPTAC/TCGA tumour proteome data set, into a predominantly epithelial and mesenchymal HGSOC tumour cluster. This proteomics-based epithelial/mesenchymal stratification of cell lines and human tumours indicates a possible origin of HGSOC either from the fallopian tube or from the ovarian surface epithelium. High-grade serous ovarian cancer is the most common and aggressive ovarian cancer, with uncertain cell of origin. Here, the authors undertake a mass spectrometric analysis of 26 cancer cell lines and identify a protein signature that classifies ovarian cancer tissues into epithelial and mesenchymal groups.
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Affiliation(s)
- F Coscia
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - K M Watters
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois 60637, USA
| | - M Curtis
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois 60637, USA
| | - M A Eckert
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois 60637, USA
| | - C Y Chiang
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois 60637, USA
| | - S Tyanova
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - A Montag
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois 60637, USA
| | - R R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois 60637, USA
| | - E Lengyel
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois 60637, USA
| | - M Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
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48
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Parra-Herran C, Taljaard M, Djordjevic B, Reyes MC, Schwartz L, Schoolmeester JK, Lastra RR, Quick CM, Laury A, Rasty G, Nucci MR, Howitt BE. Pattern-based classification of invasive endocervical adenocarcinoma, depth of invasion measurement and distinction from adenocarcinoma in situ: interobserver variation among gynecologic pathologists. Mod Pathol 2016; 29:879-92. [PMID: 27174588 DOI: 10.1038/modpathol.2016.86] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/09/2022]
Abstract
A pattern-based classification for invasive endocervical adenocarcinoma has been proposed as predictive of the risk of nodal metastases. We aimed to determine the reproducibility of such classification in the context of common diagnostic challenges: distinction between in situ and invasive adenocarcinoma and depth of invasion measurement. Nine gynecologic pathologists independently reviewed 96 cases of endocervical adenocarcinoma (two slides per case). They diagnosed each case as in situ or invasive carcinoma classifying the latter following the pattern-based classification as pattern A (non-destructive), B (focally destructive) or C (diffusely destructive). Depth of invasion, when applicable, was measured (mm). Overall, diagnostic reproducibility of pattern diagnosis was good (κ=0.65). Perfect agreement (9/9 reviewers) was seen in only 11 cases (11%), all destructively invasive (10 pattern C and 1 pattern B). In all, ≥5/9 reviewer concordance was achieved in 82/96 cases (85%). Distinction between in situ and invasive carcinoma, regardless of the pattern, showed only slight agreement (κ=0.37). Likewise, distinction restricted to in situ versus pattern A was poor (κ=0.23). Distinction between non-destructive (in situ+pattern A) and destructive (patterns B+C) carcinoma showed significantly higher agreement (κ=0.62). Estimation of depth of invasion showed excellent reproducibility (ICC=0.82). However, different measurements resulting in differing FIGO stages were common (from at least 1 reviewer in 79% cases). On the basis of interobserver agreement, the pattern-based classification is best at diagnosing destructive invasion, which carries a risk for nodal metastases. Agreement in diagnosing in situ versus invasive carcinoma, including pattern A, was poor. Given the nil risk of nodal spread in in situ and pattern A lesions, the term 'endocervical adenocarcinoma with non-destructive growth' can be considered when the distinction is difficult, after excluding destructive invasion. Depth of invasion measurement was highly reproducible among pathologists; thus, the pattern-based approach can complement, but should not replace, the depth of invasion metric.
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Affiliation(s)
- Carlos Parra-Herran
- Department of Laboratory Medicine and Pathobiology, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bojana Djordjevic
- Department of Pathology and Laboratory Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - M Carolina Reyes
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Schwartz
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John K Schoolmeester
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Charles M Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Anna Laury
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Golnar Rasty
- Department of Pathology, Toronto East General Hospital, University of Toronto, Toronto, ON, Canada
| | - Marisa R Nucci
- Department of Pathology, Women's and Perinatal Pathology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brooke E Howitt
- Department of Pathology, Women's and Perinatal Pathology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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49
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Schoolmeester JK, Lastra RR. Granular cell tumors overexpress TFE3 without corollary gene rearrangement. Hum Pathol 2015; 46:1242-3. [DOI: 10.1016/j.humpath.2015.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 04/02/2015] [Indexed: 11/25/2022]
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50
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Lastra RR, Pramick MR, Crammer CJ, LiVolsi VA, Baloch ZW. Implications of a suspicious afirma test result in thyroid fine-needle aspiration cytology: An institutional experience. Cancer Cytopathol 2014; 122:737-44. [DOI: 10.1002/cncy.21455] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Ricardo R. Lastra
- Department of Pathology and Laboratory Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Michelle R. Pramick
- Department of Pathology and Laboratory Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Cody J. Crammer
- Department of Pathology and Laboratory Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Virginia A. LiVolsi
- Department of Pathology and Laboratory Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Zubair W. Baloch
- Department of Pathology and Laboratory Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
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