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Andriandi, Tirta C. Soft tissue tumor of metastatic non-small cell lung carcinoma: A rare case report. Int J Surg Case Rep 2024; 118:109621. [PMID: 38636161 PMCID: PMC11044029 DOI: 10.1016/j.ijscr.2024.109621] [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: 03/05/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE It is estimated that 1 out of 5 patients with cancer will experience bone metastasis. With non-small cell lung cancer by itself having 220.000 reported cases per year, but the prevalence of soft tissue metastasis from lung cancer is only 2.3 % making it commonly overlooked as a possible metastasis site. CASE PRESENTATION Male presents with a lump and pain on the right upper arm. A 8 cm × 8 cm mass was palpated under the biceps. CT-scan showed a lung lesion on the anterior segment. Shoulder MRI showed a dense, lobulated, and indefinitely demarcated soft tissue mass approximately 5.6 cm × 7.8 cm × 8.8 cm. The patient was treated with wide excision of the tumor. Core biopsy showed a metastatic adenosquamous carcinoma with suspected primary lesion from the respiratory tract. Treatment with targeted chemotherapy and radiotherapy were then done to the patient. The patient was discharged without any complications and is still at remission at the 6 months post-operative checkup. CLINICAL DISCUSSION Soft tissue metastasis of lung cancer cell is a rare but a very real phenomenon. In our case the diagnosis of the soft tissue mass as a metastasis from the lungs was decided on a clinical, physical, radiological, and histological basis without using immunohistochemistry. CONCLUSION MRI, biopsy, and immunohistochemistry are traditionally needed to confirm the diagnosis but in select cases, radiological and microscopic examinations along with clinical correlation are enough to ascertain the diagnosis. While it is rare, a soft tissue metastasis should always be suspected in lung cancer patients that have a palpable mass.
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Affiliation(s)
- Andriandi
- Department of Orthopaedic and Traumatology, Faculty of Medicine Unversitas Sumatera Utara - Adam Malik General Hospital, Medan, Indonesia
| | - C Tirta
- Department of Orthopaedic and Traumatology, Faculty of Medicine Unversitas Sumatera Utara - Adam Malik General Hospital, Medan, Indonesia.
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Tian M, Li J, Wu H, Wu Y. FOXM1 promotes the progression of non-small cell lung cancer by inhibiting miR-509-5p expression via binding to the miR-509-5p promoter region. Heliyon 2024; 10:e27147. [PMID: 38495135 PMCID: PMC10943339 DOI: 10.1016/j.heliyon.2024.e27147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 03/19/2024] Open
Abstract
Background Forkhead box M1 (FOXM1) functions as a transcription factor and is consistently overexpressed in various cancers, including non-small-cell lung-, breast-, cervical-, and colorectal cancer. Its overexpression is associated with poor prognosis in patients with non-small-cell lung cancer, although the detailed mechanisms by which FOXM1 promotes the development of non-small-cell lung cancer remain unclear. Objective The mechanism of FOXM1 in migration, invasion, apoptosis, and viability of lung cancer cells was investigated. Methods Transwell assay, scratch test, and flow cytometry were employed to study the effects of FOXM1 on migration, invasion, and apoptosis in A549 cells. A quantitative polymerase chain reaction was used to determine the impact of FOXM1 on miR-509-5p expression in A549 cells. Dual-luciferase reporter gene assay and chromatin immunoprecipitation were adopted to investigate the molecular mechanisms of FOXM1 on miR-509-5p expression. Results FDI-6 (a FOXM1 inhibitor) reduced the protein abundance of FOXM1, thereby increasing the expression of miR-509-5p in A549 cells. Moreover, FDI-6 treatment significantly reduced migration, invasion, and viability of A549 cells while promoting cell apoptosis. Furthermore, miR-509-5p inhibitor obviously alleviated the biological effects of FDI-6 on A549 cells, suggesting that FOXM1 primarily exerted its cancer promoting effect by regulating miR-509-5p. Mechanistically, FOXM1 directly bound to the miR-509-5p promoter to inhibit miR-509-5p expression. Conclusion FOXM1 directly binds to the promoter region of miR-509-5p to form a negative feedback loop, thereby inhibiting miR-509-5p expression and promoting the development of non-small-cell lung cancer. This study is expected to complement research on the pathogenesis of non-small-cell lung cancer and promote the development of novel therapeutic targets for this disease.
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Affiliation(s)
- Mengcha Tian
- Department of Clinical Laboratory, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Jiaming Li
- Department of Clinical Laboratory, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Huihui Wu
- Department of Clinical Laboratory, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Yuying Wu
- Department of General Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
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Liu LF, Deng JY, Lizaso A, Lin J, Sun S. Effective response to crizotinib of concurrent KIF5B-MET and MET- CDR2-rearranged non-small cell lung cancer: A case report. World J Clin Cases 2022; 10:2529-2536. [PMID: 35434049 PMCID: PMC8968612 DOI: 10.12998/wjcc.v10.i8.2529] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/12/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Due to the rarity of mesenchymal-epithelial transition factor (MET) fusions, the clinical efficacy of crizotinib has only been described in a few patients with MET fusions involving various fusion partners. Herein, we report the clinical response to crizotinib of a patient with advanced poorly differentiated non-small cell carcinoma (NSCLC) having concurrent MET fusions.
CASE SUMMARY A 46-year-old woman was diagnosed with poorly differentiated NSCLC (T4N3M1). With no classic driver mutations, she was treated with two cycles of gemcitabine and cisplatin without clinical benefit. Targeted sequencing revealed the detection of two concurrent MET fusions, KIF5B-MET and novel MET-CDR2. Crizotinib was initiated at a dose of 250 mg twice daily. Within 4 wk of crizotinib therapy, repeat computed chromatography revealed a dramatic reduction in primary and metastatic lesions, assessed as partial response. She continued to benefit from crizotinib for 3 mo until disease progression and died within 1 mo despite receiving nivolumab therapy.
CONCLUSION Crizotinib sensitivity was observed in an advanced poorly differentiated NSCLC patient with concurrent MET fusions KIF5B-MET and MET-CDR2. Crizotinib can serve as a therapeutic option for patients with MET fusions. In addition, our case also highlights the importance of comprehensive genomic profiling particularly in patients with no classic driver mutation for guiding alternative therapeutic decisions.
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Affiliation(s)
- Lian-Fang Liu
- Department of Oncology, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China
| | - Jia-Ying Deng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Analyn Lizaso
- Burning Rock Biotech, Guangzhou 510300, Guangdong Province, China
| | - Jing Lin
- Burning Rock Biotech, Guangzhou 510300, Guangdong Province, China
| | - Si Sun
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Kim C, Cho HH, Choi JY, Franks TJ, Han J, Choi Y, Lee SH, Park H, Lee KS. Pleomorphic carcinoma of the lung: Prognostic models of semantic, radiomics and combined features from CT and PET/CT in 85 patients. Eur J Radiol Open 2021; 8:100351. [PMID: 34041307 PMCID: PMC8141891 DOI: 10.1016/j.ejro.2021.100351] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction To demonstrate semantic, radiomics, and the combined risk models related to the prognoses of pulmonary pleomorphic carcinomas (PCs). Methods We included 85 patients (M:F = 71:14; age, 35–88 [mean, 63 years]) whose imaging features were divided into training (n = 60) and test (n = 25) sets. Nineteen semantic and 142 radiomics features related to tumors were computed. Semantic risk score (SRS) model was built using the Cox-least absolute shrinkage and selection operator (LASSO) approach. Radiomics risk score (RRS) from CT and PET features and combined risk score (CRS) adopting both semantic and radiomics features were also constructed. Risk groups were stratified by the median of the risk scores of the training set. Survival analysis was conducted with the Kaplan-Meier plots. Results Of 85 PCs, adenocarcinoma was the most common epithelial component found in 63 (73 %) tumors. In SRS model, four features were stratified into high- and low-risk groups (HR, 4.119; concordance index ([C-index], 0.664) in the test set. In RRS model, five features helped improve the stratification (HR, 3.716; C-index, 0.591) and in CRS model, three features helped perform the best stratification (HR, 4.795; C-index, 0.617). The two significant features of CRS models were the SUVmax and the histogram feature of energy ([CT Firstorder Energy]). Conclusion In PCs of the lungs, the combined model leveraging semantic and radiomics features provides a better prognosis compared to using semantic and radiomics features separately. The high SUVmax of solid portion (CT Firstorder Energy) of tumors is associated with poor prognosis in lung PCs.
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Key Words
- C-index, Concordance index
- CRS, Combined risk score
- DL, Deep learning
- GCLM, Gray-level co-occurrence matrix
- HR, Hazard ration
- ICC, Intra-class correlation
- ISZM, Intensity size zone matrix
- KRAS, Kirsten rat sarcoma viral oncogene homolog
- LASSO, Least absolute shrinkage and selection operator
- LDA, Low density area
- Lung
- MRI, Magnetic resonance imaging
- MTV, Metabolic tumor volume
- Non-small cell carcinoma
- PC, Pleomorphic carcinoma
- PET/CT, Positron emission tomography/Computed tomography
- Pleomorphic carcinoma
- Prognosis
- ROI, Region of interest
- RRS, Radiomics risk score
- Radiomics
- SRS, Semantic risk score
- SUVavg, Average standardized uptake value
- SUVmax, Maximum standardized uptake value
- TLG, Total lesion glycolysis
- VOI, Volume of interest
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Affiliation(s)
- Chohee Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Hwan-Ho Cho
- Department of Electronic and Computer Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Teri J Franks
- Department of Pulmonary and Mediastinal Pathology, Department of Defense, The Joint Pathology Center, Silver Spring, MD, USA
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Yeonu Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Hyunjin Park
- School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, South Korea.,Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
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Hanna K, Lele SM, McCormick G, McMahon A, Hill B, Boyle SL. Primary prostatic squamous cell carcinoma. Urol Case Rep 2020; 34:101478. [PMID: 33235827 PMCID: PMC7670195 DOI: 10.1016/j.eucr.2020.101478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/03/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 11/21/2022] Open
Abstract
Primary prostate squamous cell malignancies are rare and very aggressive. A 65-year-old man presented to our institution with clinical and radiographic findings concerning for advanced prostatic malignancy. Surgical pathology of the tumor revealed poorly differentiated carcinoma with squamous differentiation, and histopathological markers were positive for markers of squamous differentiation negative for all urothelial and prostatic markers.
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Affiliation(s)
- Kevin Hanna
- College of Medicine, University of Nebraska Medical Center, 985520 Nebraska Medical Center, Omaha, NE 68198-5520, United States
- Corresponding author
| | - Subodh M. Lele
- Department of Pathology, University of Nebraska Medical Center, 983135 Nebraska Medical Center, Omaha, NE 68198-3135, United States
| | - Grant McCormick
- College of Medicine, University of Nebraska Medical Center, 985520 Nebraska Medical Center, Omaha, NE 68198-5520, United States
| | - Amber McMahon
- College of Medicine, University of Nebraska Medical Center, 985520 Nebraska Medical Center, Omaha, NE 68198-5520, United States
| | - Brett Hill
- Department of Surgery, Division of Urologic Surgery, University of Nebraska Medical Center, 984110 Nebraska Medical Center, Omaha, NE 68198-4110, United States
| | - Shawna L. Boyle
- Department of Surgery, Division of Urologic Surgery, University of Nebraska Medical Center, 984110 Nebraska Medical Center, Omaha, NE 68198-4110, United States
- Corresponding author.
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Liu HE, Vuppalapaty M, Wilkerson C, Renier C, Chiu M, Lemaire C, Che J, Matsumoto M, Carroll J, Crouse S, Hanft VR, Jeffrey SS, Di Carlo D, Garon EB, Goldman J, Sollier E. Detection of EGFR Mutations in cfDNA and CTCs, and Comparison to Tumor Tissue in Non-Small-Cell-Lung-Cancer (NSCLC) Patients. Front Oncol 2020; 10:572895. [PMID: 33117705 PMCID: PMC7578230 DOI: 10.3389/fonc.2020.572895] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapies, based on the evaluation of EGFR mutations, have shown dramatic clinical benefits. EGFR mutation assays are mainly performed on tumor biopsies, which carry risks, are not always successful and give results relevant to the timepoint of the assay. To detect secondary EGFR mutations, which cause resistance to 1st and 2nd generation TKIs and lead to the administration of a 3rd generation drug, effective and non-invasive monitoring of EGFR mutation status is needed. Liquid biopsy analytes, such as circulating tumor cells (CTCs) and circulating tumor DNA (cfDNA), allow such monitoring over the course of the therapy. The aim of this study was to develop and optimize a workflow for the evaluation of cfDNA and CTCs in NSCLC patients all from one blood sample. Using Vortex technology and EntroGen ctEGFR assay, EGFR mutations were identified at 0.5 ng of DNA (∼83 cells), with a sensitivity ranging from 0.1 to 2.0% for a total DNA varying from 25 ng (∼4 CTCs among 4000 white blood cells, WBCs) to 1 ng (∼4 CTCs among 200 WBCs). The processing of plasma-depleted-blood provided comparable capture recovery as whole blood, confirming the possibility of a multimodality liquid biopsy analysis (cfDNA and CTC DNA) from a single tube of blood. Different anticoagulants were evaluated and compared in terms of respective performance. Blood samples from 24 NSCLC patients and 6 age-matched healthy donors were analyzed with this combined workflow to minimize blood volume needed and sample-to-sample bias, and the EGFR mutation profile detected from CTCs and cfDNA was compared to matched tumor tissues. Despite the limited size of the patient cohort, results from this non-invasive EGFR mutation analysis are encouraging and this combined workflow represents a valuable means for informing therapy selection and for monitoring treatment of patients with NSCLC.
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Affiliation(s)
- Haiyan E Liu
- Vortex Biosciences, Inc., Pleasanton, CA, United States
| | | | | | | | - Michael Chiu
- Vortex Biosciences, Inc., Pleasanton, CA, United States
| | | | - James Che
- Vortex Biosciences, Inc., Pleasanton, CA, United States
| | - Melissa Matsumoto
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - James Carroll
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Steve Crouse
- Vortex Biosciences, Inc., Pleasanton, CA, United States
| | - Violet R Hanft
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Stefanie S Jeffrey
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Dino Di Carlo
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States.,California NanoSystems Institute, Los Angeles, CA, United States.,UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States
| | - Edward B Garon
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States
| | - Jonathan Goldman
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States
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7
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Chang YC, Ding Y, Dong L, Zhu LJ, Jensen RV, Hsiao LL. Differential expression patterns of housekeeping genes increase diagnostic and prognostic value in lung cancer. PeerJ 2018; 6:e4719. [PMID: 29761043 PMCID: PMC5949062 DOI: 10.7717/peerj.4719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/08/2018] [Accepted: 04/16/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Using DNA microarrays, we previously identified 451 genes expressed in 19 different human tissues. Although ubiquitously expressed, the variable expression patterns of these "housekeeping genes" (HKGs) could separate one normal human tissue type from another. Current focus on identifying "specific disease markers" is problematic as single gene expression in a given sample represents the specific cellular states of the sample at the time of collection. In this study, we examine the diagnostic and prognostic potential of the variable expressions of HKGs in lung cancers. METHODS Microarray and RNA-seq data for normal lungs, lung adenocarcinomas (AD), squamous cell carcinomas of the lung (SQCLC), and small cell carcinomas of the lung (SCLC) were collected from online databases. Using 374 of 451 HKGs, differentially expressed genes between pairs of sample types were determined via two-sided, homoscedastic t-test. Principal component analysis and hierarchical clustering classified normal lung and lung cancers subtypes according to relative gene expression variations. We used uni- and multi-variate cox-regressions to identify significant predictors of overall survival in AD patients. Classifying genes were selected using a set of training samples and then validated using an independent test set. Gene Ontology was examined by PANTHER. RESULTS This study showed that the differential expression patterns of 242, 245, and 99 HKGs were able to distinguish normal lung from AD, SCLC, and SQCLC, respectively. From these, 70 HKGs were common across the three lung cancer subtypes. These HKGs have low expression variation compared to current lung cancer markers (e.g., EGFR, KRAS) and were involved in the most common biological processes (e.g., metabolism, stress response). In addition, the expression pattern of 106 HKGs alone was a significant classifier of AD versus SQCLC. We further highlighted that a panel of 13 HKGs was an independent predictor of overall survival and cumulative risk in AD patients. DISCUSSION Here we report HKG expression patterns may be an effective tool for evaluation of lung cancer states. For example, the differential expression pattern of 70 HKGs alone can separate normal lung tissue from various lung cancers while a panel of 106 HKGs was a capable class predictor of subtypes of non-small cell carcinomas. We also reported that HKGs have significantly lower variance compared to traditional cancer markers across samples, highlighting the robustness of a panel of genes over any one specific biomarker. Using RNA-seq data, we showed that the expression pattern of 13 HKGs is a significant, independent predictor of overall survival for AD patients. This reinforces the predictive power of a HKG panel across different gene expression measurement platforms. Thus, we propose the expression patterns of HKGs alone may be sufficient for the diagnosis and prognosis of individuals with lung cancer.
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Affiliation(s)
- Yu-Chun Chang
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Yan Ding
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lingsheng Dong
- Research Computing, Harvard Medical School, Boston, MA, United States of America
| | - Lang-Jing Zhu
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Nephrology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Roderick V. Jensen
- Department of Biological Sciences, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, United States of America
| | - Li-Li Hsiao
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
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Antoine M, Vieira T, Fallet V, Hamard C, Duruisseaux M, Cadranel J, Wislez M. [Pulmonary sarcomatoid carcinoma]. Ann Pathol. 2016;36:44-54. [PMID: 26778815 DOI: 10.1016/j.annpat.2015.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/08/2015] [Indexed: 02/06/2023]
Abstract
Pulmonary sarcomatoid carcinomas are a rare group of tumors accounting for about one percent of non-small cell lung carcinoma (NSCLC). In 2015, the World Health Organization classification united under this name all the carcinomas with sarcomatous-like component with spindle cell or giant cell appearance, or associated with a sarcomatous component sometimes heterologous. There are five subtypes: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma and pulmonary blastoma. Clinical characteristics are not specific from the other subtypes of NSCLC. Epithelial to mesenchymal transition pathway may play a key role. Patients, usually tobacco smokers, are frequently symptomatic. Tumors are voluminous more often peripherical than central, with strong fixation on FDG TEP CT. Distant metastases are frequent with atypical visceral locations. These tumors have poorer prognosis than the other NSCLC subtypes because of great aggressivity, and frequent chemoresistance. Here we present pathological description and a review of literature with molecular features in order to better describe these tumors and perhaps introduce new therapeutics.
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Rodriguez EF, Monaco SE. Recent advances in the pathology and molecular genetics of lung cancer: A practical review for cytopathologists. J Am Soc Cytopathol 2016; 5:252-265. [PMID: 31042502 DOI: 10.1016/j.jasc.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/21/2016] [Accepted: 02/23/2016] [Indexed: 11/17/2022]
Abstract
Lung cancer is one of the most common causes of cancer-related death worldwide. Better understanding of the molecular genetic characteristics of non-small cell lung carcinoma (NSCLC), particularly adenocarcinoma, has opened the opportunity for targeted therapies. With the different molecular abnormalities and the different responses to new targeted therapies based on the histological subtype of NSCLC, there came a need to further classify NSCLC into squamous cell carcinoma and adenocarcinoma, and to perform the appropriate molecular testing in these different subtypes to guide management decisions. Given that approximately 70% of lung cancer patients have only small biopsies or cytology specimens available, incorporating the testing of these specimens into the cytopathology laboratory has been crucial. Herein, we review current concepts and recommendations on NSCLC subtyping and molecular testing that are relevant for the cytopathology community.
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Affiliation(s)
- Erika F Rodriguez
- Department of Pathology, Johns Hopkins University, Carnegie 469-Pathology, 600 North Wolfe Street, Baltimore, Maryland.
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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10
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Abstract
Most clinically actionable alterations in lung adenocarcinomas are detected using molecular or cytogenetic techniques. However, many such alterations have a protein-level correlate that can be interrogated using immunohistochemistry. This review will summarize the therapeutic relevance of predictive biomarkers in lung adenocarcinoma including the oncogenes EGFR, MET, ALK, RET, and ROS1 and tumor suppressors PTEN and LKB1 with an emphasis on established and emerging protein immunohistochemistry reagents and their promise in clinical practice.
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Affiliation(s)
- Lynette M Sholl
- Department of Pathology, Brigham and Women׳s Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115.
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11
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Kishimoto M, Iwano S, Ito S, Kato K, Ito R, Naganawa S. Prognostic evaluations of small size lung cancers by 18F-FDG PET/CT and thin-section CT. Lung Cancer 2014; 86:180-4. [PMID: 25263854 DOI: 10.1016/j.lungcan.2014.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/08/2014] [Accepted: 09/07/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE Primary lung cancers have varying prognoses, even for tumors ≤3cm in diameter. Thus, a thorough evaluation is necessary for therapeutic planning. Two imaging biomarkers have been shown to be useful for predicting primary lung cancer prognosis: maximum standardized uptake values (SUVmax) on fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and the consolidation/tumor (C/T) ratio defined as the maximum diameter of consolidation within a tumor to the maximum tumor diameter on thin-section computed tomography (TSCT). We compared these biomarkers for predicting post-surgical recurrence in patients with small lung cancers. MATERIALS AND METHODS Clinical records, post-operative pathologic findings, and pre-operative PET/CT and TSCT images were reviewed. Solitary primary lung cancers of ≤3cm in diameter after surgical resection were selected for analysis. SUVmax and C/T ratios were recorded. Kaplan-Meier survival curves and Cox hazards ratios were used to identify independent predictors of lung cancer recurrence from among age, gender, surgical procedure, lesion size, C/T ratio, and SUVmax. RESULTS A total of 169 patients (114 males and 55 females; age range: 34-87 years) with solitary lung cancers were evaluated. The median post-operative follow-up period was 42 months. Twenty-eight patients had cancer recurrence with significantly higher SUVmax (p<0.001) and C/T ratios (p<0.001) than patients without recurrence. Disease-free survival was significantly reduced for SUVmax of ≥2.5 vs. SUVmax of <2.5 (p<0.001) or for a C/T ratio of ≥50% vs. a C/T ratio of <50% (p=0.030). For 19 patients with C/T ratios of <50%, none had a post-operative recurrence. A Cox hazards ratio model showed that only SUVmax was an independent predictor of recurrence (hazards ratio=1.324; p<0.001). CONCLUSION SUVmax on FDG-PET/CT was a significant imaging biomarker relevant to the prognosis of patients with lung cancers, and was superior to the C/T ratio on TSCT for predicting postoperative recurrence, particularly for solid type lung cancer.
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Tokito T, Shukuya T, Akamatsu H, Ono A, Taira T, Kenmotsu H, Naito T, Murakami H, Takahashi T, Endo M, Mori K, Yamamoto N. Toxicity and efficacy of chemotherapy for non-small cell lung cancer with cavitary lesions. Respir Investig 2014; 52:184-189. [PMID: 24853019 DOI: 10.1016/j.resinv.2013.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 10/04/2013] [Revised: 11/29/2013] [Accepted: 12/04/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Concurrent chemoradiation in stage III non-small cell lung cancer (NSCLC) patients with cavitary lesions is reported to cause serious lung complications and is a predictor of poor survival. However, the efficacy and toxicity associated with chemotherapy for advanced NSCLC patients with cavitary lesions is not clear. We investigated the toxicities, particularly hemoptysis and cavity infection, and efficacy associated with chemotherapy for NSCLC patients with cavitary lesions. METHODS We retrospectively reviewed consecutive patients who received first-line chemotherapy, including platinum-based chemotherapy, single-agent chemotherapy, or epidermal growth factor receptor-tyrosine kinase inhibitors, at our institution between January 2008 and December 2010. RESULTS We found tumor cavitation prior to treatment in 23 of 415 NSCLC patients (5.5%). The response rate of all the patients was 30%, and the median survival time (MST) was 8.9 months. The MST of the 15 patients treated with platinum-based chemotherapy was 11 months. Grade 1 bronchopulmonary hemorrhage occurred in 2 patients. Grade 3 cavitary infection occurred in 2 patients, resulting in the discontinuation of chemotherapy. CONCLUSIONS This study indicates that the toxicity of chemotherapy for NSCLC patients with cavitary lesions is tolerable; however, the development of cavitary infection should be carefully considered. In addition, this study suggests that the efficacy of chemotherapy for NSCLC patients with cavitary lesions is similar to the response rates reported in the literature; however, the survival of these patients may be worse than that for general NSCLC patients.
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Affiliation(s)
- Takaaki Tokito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Takehito Shukuya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan; Department of Respiratory Medicine, Juntendo University, Hongou Bunkyou-ku, Tokyo, Japan.
| | - Hiroaki Akamatsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Tetsuhiko Taira
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Keita Mori
- Division of Clinical Trial Center, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan.
| | - Nobuyuki Yamamoto
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Japan; Third Department of Internal Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan.
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Swati I, Zhang S, Tull J, Khurana KK. Accuracy of Cytology Specimen and Needle Core Biopsies for Detection of KRAS Mutation in Non-Small Cell Carcinoma: Comparison With Resection Specimen. World J Oncol 2011; 2:275-280. [PMID: 29147262 PMCID: PMC5649711 DOI: 10.4021/wjon416w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2011] [Indexed: 11/12/2022] Open
Abstract
Background Recent studies have shown that KRAS mutations are negative predictors of benefit from both adjuvant chemotherapy and anti-EGFR directed therapies for non-small cell lung carcinoma (NSCLC). Needle core biopsy, cytology specimen and resected tissue have all been used for KRAS mutational analysis of malignant lung tumors. However, studies validating the correlation between needle core biopsy/cytology specimen and resected tissue, histologic reference standard for KRAS mutational analysis are lacking. We retrospectively compared the KRAS mutation detection on cytology specimen or needle core biopsy with corresponding resected malignant neoplasm of lung, the histologic reference standard for mutational analysis. Method Twenty-seven samples including 8 cell blocks, 9 cytology smears and 10 needle core biopsies, and corresponding 22 resected malignant tumor of lung were correlated for KRAS mutational analysis. In cases where cell block material did not correspond with results on resected specimen, cytology smears of corresponding cases were microdissected for isolation of DNA. Results The needle core biopsy specimens and the corresponding surgical resections showed 100% concordant results for KRAS mutational analysis. KRAS mutation was detected in 4 out of 8 cell blocks, compared to 7 out of 8 corresponding surgical resections. Low cellularity (2 cases) and failure to retrieve DNA (1case) resulted in lack of correlation in 3 cases with cell blocks. However, cytology smears in these 3 cases confirmed the KRAS mutation noted in corresponding surgical resections. Overall concordance between cytology smears and corresponding surgical resections was 89% (8 of 9 cases). KRAS mutation was detected in 1 of the 9 cytology smears and was lacking in corresponding surgically resection. Conclusion Cytology specimen and needle core biopsies provide adequate material for KRAS mutational analysis. Excellent mutational analysis concordance between cytology specimen/needle core biopsies and resected tumor suggests that predictive marker based therapeutic decision need not shift to more invasive surgical procedures.
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Affiliation(s)
- Ismatun Swati
- Department of Pathology, State University of New York Syracuse, New York, 13210 USA
| | - Shengle Zhang
- Department of Pathology, State University of New York Syracuse, New York, 13210 USA
| | - Jamie Tull
- Department of Pathology, State University of New York Syracuse, New York, 13210 USA
| | - Kamal K Khurana
- Department of Pathology, State University of New York Syracuse, New York, 13210 USA
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