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Duan S, Sawyer TW, Witten BL, Song H, Else T, Merchant JL. Spatial profiling reveals tissue-specific neuro-immune interactions in gastroenteropancreatic neuroendocrine tumors. J Pathol 2024; 262:362-376. [PMID: 38229586 PMCID: PMC10869639 DOI: 10.1002/path.6241] [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: 07/12/2023] [Revised: 10/14/2023] [Accepted: 11/24/2023] [Indexed: 01/18/2024]
Abstract
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are heterogeneous malignancies that arise from complex cellular interactions within the tissue microenvironment. Here, we sought to decipher tumor-derived signals from the surrounding microenvironment by applying digital spatial profiling (DSP) to hormone-secreting and non-functional GEP-NETs. By combining this approach with in vitro studies of human-derived organoids, we demonstrated the convergence of cell autonomous immune and pro-inflammatory proteins that suggests their role in neuroendocrine differentiation and tumorigenesis. DSP was used to evaluate the expression of 40 neural- and immune-related proteins in surgically resected duodenal and pancreatic NETs (n = 20) primarily consisting of gastrinomas (18/20). A total of 279 regions of interest were examined between tumors, adjacent normal and abnormal-appearing epithelium, and the surrounding stroma. The results were stratified by tissue type and multiple endocrine neoplasia I (MEN1) status, whereas protein expression was validated by immunohistochemistry (IHC). A tumor immune cell autonomous inflammatory signature was further evaluated by IHC and RNAscope, while functional pro-inflammatory signaling was confirmed using patient-derived duodenal organoids. Gastrin-secreting and non-functional pancreatic NETs showed a higher abundance of immune cell markers and immune infiltrate compared with duodenal gastrinomas. Compared with non-MEN1 tumors, MEN1 gastrinomas and preneoplastic lesions showed strong immune exclusion and upregulated expression of neuropathological proteins. Despite a paucity of immune cells, duodenal gastrinomas expressed the pro-inflammatory and pro-neural factor IL-17B. Treatment of human duodenal organoids with IL-17B activated NF-κB and STAT3 signaling and induced the expression of neuroendocrine markers. In conclusion, multiplexed spatial protein analysis identified tissue-specific neuro-immune signatures in GEP-NETs. Duodenal gastrinomas are characterized by an immunologically cold microenvironment that permits cellular reprogramming and neoplastic transformation of the preneoplastic epithelium. Moreover, duodenal gastrinomas cell autonomously express immune and pro-inflammatory factors, including tumor-derived IL-17B, that stimulate the neuroendocrine phenotype. © 2024 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Suzann Duan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Travis W. Sawyer
- Department of Optical Sciences, University of Arizona Wyant College of Optical Sciences, Tucson, AZ, USA
| | - Brandon L. Witten
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Heyu Song
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Tobias Else
- Department of Internal Medicine, Endocrinology, University of Michigan, Ann Harbor, Michigan, USA
| | - Juanita L. Merchant
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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Guerini C, Furlan D, Ferrario G, Grillo F, Libera L, Arpa G, Klersy C, Lenti MV, Riboni R, Solcia E, Fassan M, Mastracci L, Ardizzone S, Moens A, De Hertogh G, Ferrante M, Graham RP, Sessa F, Paulli M, Di Sabatino A, Vanoli A. IDH1-mutated Crohn's disease-associated small bowel adenocarcinomas: Distinctive pathological features and association with MGMT methylation and serrated-type dysplasia. Histopathology 2024; 84:515-524. [PMID: 37988281 DOI: 10.1111/his.15095] [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: 08/21/2023] [Revised: 10/04/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023]
Abstract
AIMS Patients with Crohn's disease (CrD) have an elevated risk for the development of small bowel adenocarcinomas (SBAs). Actionable isocitrate dehydrogenase 1 (IDH1) mutations have been reported to be more frequent in CrD-SBAs than in sporadic SBAs. The present study aimed to investigate the clinicopathological and immunophenotypical features, as well as methylation profiles, of IDH1-mutated CrD-SBAs. METHODS AND RESULTS An international multicentre series of surgically resected CrD-SBAs was tested for IDH1 mutation. Clinicopathological features, immunophenotypical marker expression and O6-methylguanine-DNA methyltransferase (MGMT) and long interspersed nuclear element-1 (LINE-1) methylation were compared between IDH1-mutated and IDH1 wild-type CrD-SBAs. Ten (20%) of the 49 CrD-SBAs examined harboured an IDH1 mutation and all the mutated cancers harboured the R132C variant. Compared to IDH1 wild-type cases, IDH1-mutated CrD-SBAs showed significantly lower rates of cytokeratin 7 expression (P = 0.005) and higher rates of p53 overexpression (P = 0.012) and MGMT methylation (P = 0.012). All three dysplastic growths associated with IDH1-mutated SBAs harboured the same IDH1 variant (R132C) of the corresponding invasive cancer, and all were of non-conventional subtype (two serrated dysplastic lesions and one goblet cell-deficient dysplasia). In particular, non-conventional serrated dysplasia was significantly associated with IDH1-mutated CrD-SBAs (P = 0.029). No significant cancer-specific survival difference between IDH1-mutated CrD-SBA patients and IDH1 wild-type CrD-SBA patients was found (hazard ratio = 0.55, 95% confidence interval = 0.16-1.89; P = 0.313). CONCLUSIONS IDH1-mutated CrD-SBAs, which represent approximately one-fifth of total cases, are characterised by distinctive immunophenotypical features and methylation profiles, with potential therapeutic implications. Moreover, IDH1-mutated non-conventional, serrated dysplasia is likely to represent a precursor lesion to such CrD-SBAs.
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Affiliation(s)
- Camilla Guerini
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Daniela Furlan
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Giuseppina Ferrario
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Federica Grillo
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino University Hospital, Genoa, Italy
| | - Laura Libera
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Giovanni Arpa
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco V Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Roberta Riboni
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Enrico Solcia
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
| | - Matteo Fassan
- Surgical Pathology and Cytopathology Unit, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Luca Mastracci
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino University Hospital, Genoa, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Annick Moens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, KU Leuven University Hospitals, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Fausto Sessa
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Marco Paulli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Alessandro Vanoli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
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Miyakura Y, Yamaguchi T, Lefor AK, Tamaki S, Takao A, Takao M, Mori Y, Chikatani K, Ishida H, Kono M, Takeuchi Y, Ishikawa H, Nagasaki T, Sasaki K, Matsubara T, Hirata K, Taniguchi F, Tanakaya K, Tomita N, Ajioka Y. Clinical features and distribution of the APC variant in duodenal and ampullary polyps in patients with familial adenomatous polyposis: a multicenter retrospective cohort study in Japan. Int J Clin Oncol 2024; 29:169-178. [PMID: 38142452 DOI: 10.1007/s10147-023-02442-7] [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: 08/11/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Management of duodenal or ampullary adenomas in patients with familial adenomatous polyposis (FAP) is a major challenge for clinicians. Insufficient data are available to evaluate the clinical manifestations and distribution of adenomatous polyposis coli (APC) variants in these patients. METHODS We enrolled 451 patients with data regarding duodenal or ampullary polyps from 632 patients with FAP retrospectively registered in a nationwide Japanese multicenter study. Clinicopathological features and distribution of APC variants were compared between patients with and without duodenal or ampullary polyps. RESULTS Duodenal and ampullary polyps were found in 59% and 18% of patients with FAP, respectively. The incidence of duodenal cancer was 4.7% in patients with duodenal polyps, and that of ampullary cancer was 18% in patients with ampullary polyps. Duodenal polyps were significantly associated with the presence of ampullary polyps and jejunal/ileal polyps. Duodenal polyps progressed in 35% of patients with a median follow-up of 776 days, mostly in those with early Spigelman stage lesions. Ampullary polyps progressed in 50% of patients with a follow-up of 1484 days. However, only one patient developed a malignancy. The proportion of patients with duodenal polyps was significantly higher among those with intermediate- or profuse-type APC variants than attenuated-type APC variants. The presence of duodenal polyps was significantly associated with ampullary and jejunal/ileal polyps in patients with intermediate- or profuse-type APC variants. CONCLUSIONS Periodic endoscopic surveillance of the papilla of Vater and small intestine should be planned for patients with FAP with duodenal polyps.
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Affiliation(s)
- Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama-Shi, Saitama-Ken, 330-8503, Japan.
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.
| | - Tatsuro Yamaguchi
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Clinical Genetics, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | | | - Sawako Tamaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama-Shi, Saitama-Ken, 330-8503, Japan
| | - Akinari Takao
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Misato Takao
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yoshiko Mori
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kenichi Chikatani
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hideyuki Ishida
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology, Osaka International Cancer Center, Osaka, Japan
| | - Yoji Takeuchi
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Gastrointestinal Oncology, Osaka International Cancer Center, Osaka, Japan
| | | | - Toshiya Nagasaki
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuhito Sasaki
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takaaki Matsubara
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Keiji Hirata
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Fumitaka Taniguchi
- Department of Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Kohji Tanakaya
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Department of Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Naohiro Tomita
- The Committee of Hereditary Colorectal Cancer of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
- Cancer Treatment Center, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Yoichi Ajioka
- Japanese Society for Cancer of Colon and Rectum, Tokyo, Japan
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Haas S, Strassburg CP, Nattermann J, Hueneburg R. [Results of Endoscopic Screening and Therapy of the Duodenum in MUTYH-associated Polyposis]. Zentralbl Chir 2023; 148:502-507. [PMID: 37995714 DOI: 10.1055/a-2194-0901] [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] [Indexed: 11/25/2023]
Abstract
MUTYH-associated polyposis (MAP) is a very rare autosomal recessive polyposis syndrome. It is caused by a homozygous or compound heterozygous germline mutation in the MUTYH gene. MAP is characterised by numerous colorectal adenomas; furthermore there is an increased risk for colorectal cancer (CRC). However, the phenotype can be highly variable; for example, affected individuals also have an increased risk of polyps of the upper gastrointestinal tract and development of duodenal carcinomas.This study included 15 patients with evidence of a pathogenic MUTYH variant, who were screened at the National Center for Hereditary Tumor Syndromes. Oesophagogastroduodenoscopy (EGD) results were prospectively recorded in a database from 2012 to 2023.At least one EGD (median 4, range 1-15) was performed in 15 patients, seven of whom carried a homozygous and 8 a compound heterozygous pathogenic MUTYH variant. The median surveillance period was 115 months (range, 3-215 months). The median age at baseline was 44 (range 17-65) years. A total of 72 EGDs were performed (median 4; range 1-15). Five patients had duodenal adenomas; histology showed tubular adenomas with low grade intraepithelial dysplasia (LGIEN) in all of these cases. The total number of duodenal adenomas detected was 48, and the median number was 3 (range, 1-37). Neither high grade intraepithelial neoplasia (HGIEN) nor duodenal cancer was detected during the surveillance period.Patients with MUTYH-associated polyposis should be managed in a multidisciplinary centre for hereditary tumour disease. Our cohort showed more patients with duodenal adenomas than in previously published data. However, no progression to HGIEN or duodenal carcinomas was observed as a result of the endoscopic therapy performed.
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Affiliation(s)
- Sonja Haas
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn, Deutschland
- Nationales Zentrum für erbliche Tumorerkrankungen, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Christian P Strassburg
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn, Deutschland
- Nationales Zentrum für erbliche Tumorerkrankungen, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Jacob Nattermann
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn, Deutschland
- Nationales Zentrum für erbliche Tumorerkrankungen, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Robert Hueneburg
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn, Deutschland
- Nationales Zentrum für erbliche Tumorerkrankungen, Universitätsklinikum Bonn, Bonn, Deutschland
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Akbulut S, Küçükakçalı Z, Çolak C. Predicting Duodenal Cancer Risk in Patients with Familial Adenomatous Polyposis Using Machine Learning Model. Turk J Gastroenterol 2023; 34:1025-1034. [PMID: 37565794 PMCID: PMC10645292 DOI: 10.5152/tjg.2023.22346] [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] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/29/2022] [Indexed: 08/12/2023]
Abstract
BACKGROUND/AIMS The aim of this study was to both classify data of familial adenomatous polyposis patients with and without duode- nal cancer and to identify important genes that may be related to duodenal cancer by XGboost model. MATERIALS AND METHODS The current study was performed using expression profile data from a series of duodenal samples from familial adenomatous polyposis patients to explore variations in the familial adenomatous polyposis duodenal adenoma-carcinoma sequence. The expression profiles obtained from cancerous, adenomatous, and normal tissues of 12 familial adenomatous polyposis patients with duodenal cancer and the tissues of 12 familial adenomatous polyposis patients without duodenal cancer were compared. The ElasticNet approach was utilized for the feature selection. Using 5-fold cross-validation, one of the machine learning approaches, XGboost, was utilized to classify duodenal cancer. Accuracy, balanced accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score performance metrics were assessed for model performance. RESULTS According to the variable importance obtained from the modeling, ADH1C, DEFA5, CPS1, SPP1, DMBT1, VCAN-AS1, APOB genes (cancer vs. adenoma); LOC399753, APOA4, MIR548X, and ADH1C genes (adenoma vs. adenoma); SNORD123, CEACAM6, SNORD78, ANXA10, SPINK1, and CPS1 (normal vs. adenoma) genes can be used as predictive biomarkers. CONCLUSIONS The proposed model used in this study shows that the aforementioned genes can forecast the risk of duodenal cancer in patients with familial adenomatous polyposis. More comprehensive analyses should be performed in the future to assess the reliability of the genes determined.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery, İnönü University Faculty of Medicine, Malatya, Turkey
- Department of Public Health, İnönü University Faculty of Medicine, Malatya, Turkey
- Department of Biostatistics and Medical Informatics, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Zeynep Küçükakçalı
- Department of Biostatistics and Medical Informatics, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Cemil Çolak
- Department of Biostatistics and Medical Informatics, İnönü University Faculty of Medicine, Malatya, Turkey
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Aso N, Ohtsuka K, Shibahara J, Koda H, Morikawa T, Abe N, Watanabe T, Ohnishi H. Microsatellite instability in the high-grade dysplasia component of duodenal adenoma is associated with progression to adenocarcinoma. Surg Today 2023; 53:252-260. [PMID: 35871406 DOI: 10.1007/s00595-022-02558-9] [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: 03/23/2022] [Accepted: 06/26/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE We examined the microsatellite instability of duodenal tumors to evaluate their molecular features associated with the adenoma-carcinoma sequence. METHODS Fifty-two non-ampullary duodenal epithelial tumors collected by endoscopic mucosal resection or surgical resection were studied. When a tumor had two or more dysplasia grades, the highest grade was considered. Representative areas were macro-dissected and subjected to a microsatellite instability analysis and immunohistochemical staining. RESULTS The 52 tumors were classified as either adenoma with low-grade dysplasia (n = 18), adenoma with high-grade dysplasia (n = 20), or adenocarcinomas (n = 14). Among these, 3 adenocarcinoma cases showed microsatellite instability and the remaining 49 tumors showed microsatellite stability. Of the 14 adenocarcinoma cases, 3 contained both high-grade dysplasia and adenocarcinoma components, and 11 contained only the adenocarcinoma component. Interestingly, all three adenocarcinoma + high-grade dysplasia cases were microsatellite instability-high in both the adenocarcinoma and high-grade dysplasia components. Immunohistochemical staining of mismatch repair proteins showed mismatch repair deficiency in three microsatellite instability-high adenocarcinoma + high-grade dysplasia cases. CONCLUSIONS Only adenocarcinoma cases with high-grade dysplasia components were microsatellite instability-high (in both the adenocarcinoma and high-grade dysplasia components). This suggests that microsatellite instability in the high-grade dysplasia component of duodenal adenoma is associated with progression to adenocarcinoma.
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Affiliation(s)
- Nobuyoshi Aso
- Department of Gastroenterological and General Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Kouki Ohtsuka
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Junji Shibahara
- Department of Pathology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hirotomo Koda
- Department of Pathology, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Teppei Morikawa
- Department of Pathology, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Nobutsugu Abe
- Department of Gastroenterological and General Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Takashi Watanabe
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hiroaki Ohnishi
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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Fukusada S, Shimura T, Iwasaki H, Okuda Y, Katano T, Ozeki T, Kitagawa M, Nishie H, Tanaka M, Ozeki K, Kubota E, Tanida S, Kataoka H. Relationship between gene mutations and clinicopathological features in nonampullary duodenal epithelial tumors. Dig Liver Dis 2022; 54:905-910. [PMID: 34961702 DOI: 10.1016/j.dld.2021.12.004] [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: 07/01/2021] [Revised: 08/27/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Molecular features of nonampullary duodenal epithelial tumors (NADETs) remain unclear. AIM The aim of this study is to determine the association between the genetic features and clinicopathological findings of NADETs. METHODS In total, 75 NADETs were enrolled in this study, and was performed targeted DNA sequencing of the GNAS, KRAS, TP53, and APC genes. Histological grade was classified as category 3 or category 4/5 according to the Vienna classification, and the immunophenotype was categorized as the gastric phenotype (G type), gastrointestinal phenotype (GI type), or the intestinal phenotype (I type). RESULTS The prevalence of GNAS and KRAS mutations was significantly higher in the G type than in the GI/I type (GNAS, P = 0.027; KRAS, P = 0.005). In contrast, the frequency of TP53 mutations was significantly higher in the GI/I type than in the G type (P = 0.049). Notably, APC mutations, excluding c.4479 G>A which was synonymous mutation, were more frequently identified in category 4/5 tumors than in category 3 tumors (50% vs. 24.5%; P = 0.039). CONCLUSION G-type NADETs harbored frequent GNAS and KRAS mutations, whereas TP53 mutations are common in NADETs with intestinal features. APC mutations were significantly associated with high-grade neoplasia and invasive carcinoma.
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Affiliation(s)
- Shigeki Fukusada
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
| | - Hiroyasu Iwasaki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yusuke Okuda
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takahito Katano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takanori Ozeki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Mika Kitagawa
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Hirotada Nishie
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Mamoru Tanaka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Keiji Ozeki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Eiji Kubota
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Satoshi Tanida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Hackeng WM, van Beek DJ, Kok ASM, van Emst M, Morsink FHM, van Treijen MJC, Borel Rinkes IHM, Dreijerink KMA, Offerhaus GJA, Valk GD, Vriens MR, Brosens LAA. Metastatic Patterns of Duodenopancreatic Neuroendocrine Tumors in Patients With Multiple Endocrine Neoplasia Type 1. Am J Surg Pathol 2022; 46:159-168. [PMID: 34560682 DOI: 10.1097/pas.0000000000001811] [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] [Indexed: 11/26/2022]
Abstract
Patients with multiple endocrine neoplasia 1 syndrome (MEN1) often develop multifocal duodenopancreatic neuroendocrine tumors (dpNETs). Nonfunctional pancreatic neuroendocrine tumors (PanNETs) and duodenal gastrinomas are the most frequent origins of metastasis. Current guidelines recommend surgery based on tumor functionality, size ≥2 cm, grade or presence of lymph node metastases. However, in case of multiple primary tumors it is often unknown which specific tumor metastasized. This study aims to unravel the relationship between primary dpNETs and metastases in patients with MEN1 by studying endocrine differentiation. First, it was shown that expression of the endocrine differentiation markers ARX and PDX1 was concordant in 18 unifocal sporadic neuroendocrine tumors (NETs) and matched metastases. Thereafter, ARX, PDX1, Ki67 and gastrin expression, and the presence of alternative lengthening of telomeres were determined in 137 microscopic and macroscopic dpNETs and 36 matched metastases in 10 patients with MEN1. ARX and PDX1 H-score clustering was performed to infer relatedness. For patients with multiple metastases, similar intrametastases transcription factor expression suggests that most metastases (29/32) originated from a single NET of origin, while few patients may have multiple metastatic primary NETs. In 6 patients with MEN1 and hypergastrinemia, periduodenopancreatic lymph node metastases expressed gastrin, and clustered with minute duodenal gastrinomas, not with larger PanNETs. PanNET metastases often clustered with high grade or alternative lengthening of telomeres-positive primary tumors. In conclusion, for patients with MEN1-related hypergastrinemia and PanNETs, a duodenal origin of periduodenopancreatic lymph node metastases should be considered, even when current conventional and functional imaging studies do not reveal duodenal tumors preoperatively.
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Affiliation(s)
- Wenzel M Hackeng
- Department of Pathology, University Medical Center Utrecht, Utrecht University
| | - Dirk-Jan van Beek
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht
| | - Aranxa S M Kok
- Department of Pathology, University Medical Center Utrecht, Utrecht University
| | - Madelon van Emst
- Department of Pathology, University Medical Center Utrecht, Utrecht University
| | - Folkert H M Morsink
- Department of Pathology, University Medical Center Utrecht, Utrecht University
| | - Mark J C van Treijen
- Department of Endocrine Oncology, University Medical Center Utrecht Cancer Center, Utrecht
| | | | - Koen M A Dreijerink
- Department of Endocrinology and Internal Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - G Johan A Offerhaus
- Department of Pathology, University Medical Center Utrecht, Utrecht University
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht Cancer Center, Utrecht
| | - Menno R Vriens
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht
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Sree UD, Prayaga AK, R Reddy VV, Rukmanghadha N, Chowhan AK, Phaneendra BV. Differential expression of CK7, CK20, CDX2 in intestinal and pancreatobiliary types of preriampullary carcinoma. INDIAN J PATHOL MICR 2022; 65:42-48. [PMID: 35074964 DOI: 10.4103/ijpm.ijpm_1440_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
CONTEXT Incidence of periampullary carcinoma is low, approximately 0.5-2% of all gastrointestinal malignancies. Histologic subtyping has a prognostic bearing. The purpose of this study is to differentiate periampullary carcinomas based on immunohistochemistry (IHC) by using cytokeratin 7 (CK7), cytokeratin 20 (CK20), caudal type homeobox 2 (CDX2). AIMS To analyze the usefulness of IHC as single/panel of markers that included CK7, CK20, and CDX2. SETTINGS AND DESIGN This was a prospective study done from January 2017 to September 2018. SUBJECTS AND METHODS A total 50 pancreaticoduodenectomy specimens were evaluated and classified as intestinal (INT) and pancreaticobiliary (PB) types based on their morphological and immunohistochemical features, respectively. The morphologic subtypes, expression of IHC markers were correlated with different histologic parameters. STATISTICAL ANALYSIS Chi-square test was used to study the association between different IHC markers with histologic parameters. Probability (P) values <0.05 were regarded as statistically significant. RESULTS The expression of CK7, CK20, CDX2 were studied in 50 cases to classify them as INT and pancreatobiliary subtypes. CK7 has high sensitivity (88.2%), CDX2 has high specificity (96.4%), CK20+/CDX2+ has both high sensitivity (94.2 percent) and specificity (89.2 percent) in differentiating INT from pancreatobiliary subtypes. The morphologic subtypes showed correlation with two variables (tumor grade, pathologic T stage). CK20 and CK20/CDX2 expression showed a positive correlation with tumor grade, pathologic T staging, and lymphovascular invasion. CONCLUSIONS In conclusion, morphological classification can significantly discriminate histologic types, IHC plays a moderate role. However, the combined expression of CK20 and CDX2 is helpful in subtyping.
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Affiliation(s)
- Udayagiri D Sree
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Aruna K Prayaga
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Venkat R Reddy
- Department of Gastroenterology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - N Rukmanghadha
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amit K Chowhan
- Department of Pathology and Lab Medicine, AIIMS, Raipur, Chhattishgarh, India
| | - B V Phaneendra
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Mohammed N, Rabinovitch PS, Wang D, Kővári BP, Mattis AN, Lauwers GY, Choi WT. Nonampullary Duodenal Adenomas in Familial Adenomatous Polyposis and Sporadic Patients Lack the DNA Content Abnormality That Is Characteristic of the Adenoma-Carcinoma Sequence Involved in the Development of Other Gastrointestinal Malignancies. Am J Surg Pathol 2021; 45:1694-1702. [PMID: 34138799 DOI: 10.1097/pas.0000000000001754] [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] [Indexed: 10/21/2022]
Abstract
Nonampullary duodenal adenomas (NADAs) develop sporadically or in the setting of a hereditary syndrome such as familial adenomatous polyposis (FAP). Although they are thought to progress into duodenal adenocarcinomas via an adenoma to carcinoma sequence similar to colorectal cancer, limited data suggested that they may be biologically dissimilar to colorectal adenomas. The clinicopathologic features of 71 patients diagnosed with NADAs (37 FAP and 34 sporadic) were analyzed. From the 71 patients, 89 NADA biopsies (42 FAP and 47 sporadic) were evaluated by DNA flow cytometry. Eighty-two samples showed low-grade dysplasia, and 7 demonstrated high-grade dysplasia (HGD). Twenty-one low-grade adenomas of the ileal pouch (n=19) and jejunum (n=2) from 15 FAP patients who underwent total proctocolectomy were also analyzed by DNA flow cytometry. The FAP patients were more likely to be younger (mean: 28 y) and have multifocal disease (92%) than the sporadic patients (66 y and 24%, respectively) (P<0.001). Most NADAs presented as polypoid lesions (87%) in the duodenal bulb and/or second portion of the duodenum (94%). Sporadic NADAs (mean: 2.4 cm) were significantly larger than FAP-related NADAs (1.3 cm) (P=0.005). Three (4%) patients (2 sporadic and 1 FAP) had high-grade NADAs at the first endoscopy, while the remaining 68 (96%) patients had low-grade dysplasia. Two additional sporadic and 1 FAP patients developed HGD on follow-up. Although the overall detection rate of advanced neoplasia (either HGD or adenocarcinoma) was similar between the FAP (n=5; 14%) and sporadic groups (n=4; 12%) (P=1.000), 3 FAP patients (all with Spigelman stage III to IV) developed adenocarcinoma in the duodenum (n=2) or in the ileal pouch (n=1) within a mean follow-up time of 76 months, while no adenocarcinoma was found in the sporadic group. Of the 37 FAP patients, 29 (78%) had a history of total proctocolectomy, and 15 (52%) developed low-grade adenomas in the ileal pouch with (n=2) or without (n=13) jejunal involvement (vs. 0% in the sporadic patients, P<0.001). All 15 patients had ≥Spigelman stage II. Aneuploidy was detected in only 1 (1%) sporadic NADA with HGD, whereas the remaining 109 duodenal, ileal pouch, and jejunal adenomas showed normal DNA content. The overall 3-, 9-, and 15-year detection rates of adenocarcinoma (in the duodenum and ileal pouch) in all NADA patients were 1.4%, 7.2%, and 18.8%, respectively. Three-, 9-, and 15-year detection rates of adenocarcinoma in the FAP patients were 2.7%, 9.7%, and 22.6%, respectively, while these rates remained at 0% in the sporadic patients. In conclusion, FAP-related NADAs have distinct clinicopathologic features compared with their sporadic counterpart. However, the vast majority of both FAP-related and sporadic NADAs (99%) lack the DNA content abnormality that is characteristic of the typical adenoma-carcinoma sequence involved in other gastrointestinal carcinogenesis. Although adenocarcinoma is more likely to develop in FAP patients with a high adenoma burden, probably due to the higher likelihood that some advanced lesions are missed endoscopically, FAP-related and sporadic NADAs may have a comparable risk of developing advanced neoplasia on a per-adenoma basis.
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Affiliation(s)
- Nebil Mohammed
- Department of Pathology, University of California at San Francisco, San Francisco, CA
| | | | - Dongliang Wang
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Bence P Kővári
- Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Aras N Mattis
- Department of Pathology, University of California at San Francisco, San Francisco, CA
| | | | - Won-Tak Choi
- Department of Pathology, University of California at San Francisco, San Francisco, CA
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11
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Kinugasa H, Kanzaki H, Tanaka T, Yamamoto S, Yamasaki Y, Nouso K, Ichimura K, Nakagawa M, Mitsuhashi T, Okada H. The Impact of KRAS Mutation in Patients With Sporadic Nonampullary Duodenal Epithelial Tumors. Clin Transl Gastroenterol 2021; 12:e00424. [PMID: 34797780 PMCID: PMC8604005 DOI: 10.14309/ctg.0000000000000424] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/23/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The genomic characterization of primary nonampullary duodenal adenocarcinoma indicates a genetic resemblance to gastric and colorectal cancers. However, a correlation between the clinical and molecular characteristics of these cancers has not been established. This study aimed to elucidate the clinicopathological features of sporadic nonampullary duodenal epithelial tumors, including their molecular characteristics and prognostic factors. METHODS One hundred forty-eight patients with sporadic nonampullary duodenal epithelial tumors were examined in this study. Patient sex, age, TNM stage, tumor location, treatment methods, histology, KRAS mutation, BRAF mutation, Fusobacterium nucleatum, mucin phenotype, and programmed death-ligand 1 (PD-L1) status were evaluated. KRAS and BRAF mutations, Fusobacterium nucleatum, mucin phenotype, and PD-L1 status were analyzed by direct sequencing, quantitative polymerase chain reaction, and immunochemical staining. RESULTS The median follow-up duration was 119.4 months. There were no deaths from duodenal adenoma (the primary disease). Kaplan-Meier analysis for duodenal adenocarcinoma showed a significant effect of TNM stage (P < 0.01). In univariate analysis of primary deaths from duodenal adenocarcinoma, TNM stage II or higher, undifferentiated, KRAS mutations, gastric phenotype, intestinal phenotype, and PD-L1 status were significant factors. In multivariate analysis, TNM stage II or higher (hazard ratio: 1.63 × 1010, 95% confidence interval: 18.66-6.69 × 1036) and KRAS mutation (hazard ratio: 3.49, confidence interval: 1.52-7.91) were significant factors. DISCUSSION Only KRAS mutation was a significant prognostic factor in primary sporadic nonampullary duodenal adenocarcinoma in cases in which TNM stage was considered.
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Affiliation(s)
- Hideaki Kinugasa
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Shumpei Yamamoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Yasushi Yamasaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Kazuhiro Nouso
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Kouichi Ichimura
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Naka-ku, Hirosima, Japan
| | - Masahiro Nakagawa
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Naka-ku, Hirosima, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
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Matsueda K, Kanzaki H, Takenaka R, Nakagawa M, Matsueda K, Iwamuro M, Kawano S, Kawahara Y, Toji T, Tanaka T, Yagi T, Fujiwara T, Okada H. Clinical and phenotypical characteristics of submucosal invasive carcinoma in non-ampullary duodenal cancer. PLoS One 2021; 16:e0256797. [PMID: 34449813 PMCID: PMC8396771 DOI: 10.1371/journal.pone.0256797] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/16/2021] [Indexed: 12/05/2022] Open
Abstract
Objective The rare incidence of submucosal invasive non-ampullary duodenal carcinoma has led to scant information in literature; therefore, we compared the clinicopathological features between submucosal invasive carcinoma (SM-Ca), mucosal carcinoma (M-Ca), and advanced carcinoma (Ad-Ca). Materials We retrospectively analyzed 165 patients with sporadic non-ampullary duodenal carcinomas (SNADCs) from four institutions between January 2003 and December 2018. The SNADCs were divided to three groups according to histological diagnosis: SM-Ca, M-Ca, and Ad-Ca. The clinicopathological characteristics and mucin phenotypes were compared between groups. Results Among the 165 SNADCs, 11 (7%) were classified as SM-Ca, 70 (42%) as M-Ca, and 84 (51%) as Ad-Ca. We found that all SM-Ca (P = 0.013) and most Ad-Ca (P = 0.020) lesions were located on the oral-Vater; however, an almost equal distribution of M-Ca lesions was found between the oral- and anal-Vater. No significant difference was observed between the tumor diameter of M-Ca and SM-Ca; however, 45% (5/11) of SM-Ca were ≤10 mm. A total of 73% (8/11) of SM-Ca were classified as gastric phenotype and no lesions were classified as intestinal phenotype; whereas most M-Ca were classified as intestinal phenotype (67%, 8/12). Conclusions SM-Ca lesions were all located on the oral-Vater and were highly associated with the gastric mucin phenotype, which were different from the features of most M-Ca.
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Affiliation(s)
- Katsunori Matsueda
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-Ku, Okayama, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-Ku, Okayama, Japan
- * E-mail:
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama, Okayama, Japan
| | - Masahiro Nakagawa
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Naka-Ku, Hiroshima, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-Ku, Okayama, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-Ku, Okayama, Japan
| | - Yoshiro Kawahara
- Department of Practical Gastrointestinal Endoscopy, Okayama University Hospital, Kita-Ku, Okayama, Japan
| | - Tomohiro Toji
- Department of Diagnostic Pathology, Okayama University Hospital, Kita-Ku, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-Ku, Okayama, Japan
| | - Takahito Yagi
- Department of Hepato-Biliary-Pancreatic Surgery, Okayama University Hospital, Kita-Ku, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-Ku, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-Ku, Okayama, Japan
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Niitsu H, Lu Y, Huh WJ, Love AM, Franklin JL, Coffey RJ. Cell-Autonomous Role of EGFR in Spontaneous Duodenal Tumors in LRIG1 Null Mice. Cell Mol Gastroenterol Hepatol 2021; 12:1159-1162.e4. [PMID: 33989815 PMCID: PMC8413138 DOI: 10.1016/j.jcmgh.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 12/10/2022]
Affiliation(s)
- H Niitsu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Y Lu
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - W J Huh
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - A M Love
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - J L Franklin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee
| | - R J Coffey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee.
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Gurzu S, Jung I, Borz C, Patrichi A, Yamada H, Sugimura H. Sporadic Multifocal Gastrinoma Mimicking a Duodenal GIST, in a Patient with MEN1 Gene Polymorphism D418D: an Unusual Case Report. J Gastrointest Cancer 2021; 52:351-354. [PMID: 32705580 DOI: 10.1007/s12029-020-00461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Simona Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, George Emil Palade, 38 Ghe Marinescu Street, 540139, Targu-Mures, Romania.
- Department of Pathology, Clinical County Emergency Hospital, George Emil Palade, Targu-Mures, Romania.
- Department of Pathology, Research Center of the University of Medicine, Pharmacy, Sciences and Technology, George Emil Palade, Targu-Mures, Romania.
| | - Ioan Jung
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, George Emil Palade, 38 Ghe Marinescu Street, 540139, Targu-Mures, Romania
| | - Cristian Borz
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, George Emil Palade, Targu-Mures, Romania
| | - Andrei Patrichi
- Department of Pathology, Clinical County Emergency Hospital, George Emil Palade, Targu-Mures, Romania
| | - Hidetaka Yamada
- Department of Tumor Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Haruhiko Sugimura
- Department of Tumor Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Demiryas S, Caliskan R, Saribas S, Akkus S, Gareayaghi N, Kirmusaoglu S, Kepil N, Dinc H, Dag H, Dagdeviren E, Tokman HB, Kalayci F, Demirci M, Tasci I, Erzin Y, Bal K, Kocazeybek B. The association between cagL and cagA, vacAs-m, babA genes in patients with gastric cancer, duodenal ulcer, and non-ulcer dyspepsia related to Helicobacter pylori. Acta Gastroenterol Belg 2020; 83:385-392. [PMID: 33094584] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION As a component of the cag T4SS, the cagL gene is involved in the translocation of CagA into host cells and is essential for the formation of cag PAI-associated pili between H. pylori and gastric epithelial cells. AIM We aimed to investigate the clinical association of the cagL gene with other virulence factors (VacA, CagA, EPIYA-C, and BabA protein) of H. pylori strains isolated from GC, duodenal ulcer (DU), and non-ulcer dyspepsia (NUD) cases. METHODS The patient group (PG), including 47 patients (22 GC and 25 DU) and a 25 control group (CG= NUD) were included. Amplification of the H. pylori cagL, cagA, vacA, and babA2 genes and typing of EPIYA motifs were performed by PCR methods. RESULTS Sixty-one (84.7%) H. pylori strains were detected with cagL (93.6% in SG, 68% in CG). We detected a significant difference between SG and CG for the presence of cagL (p=0.012) but no statistical comparison was done for (≥2) EPIYA-C repeats In the comparison of H. pylori strains with cagA/vacAs1m1 and cagA/ vacAs1m2 and babA2 for the presence of cagL, we could not detect a significant difference (p=1). CONCLUSION We detected a significant difference between groups for the presence of cagL genotype (p=0.012). The vacAs1m1 (OR: 2.829), genotypes increased the GC and DU risk by 2.8 times, while multiple (≥2) EPIYA-C repeats incresed the GC and DU risk by 3.524 times. Gender (to be female) (OR: 0.454) decreased the GC and DU risk by inversly decreased in the multivariate analysis.
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Affiliation(s)
- S Demiryas
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul, Turkey
| | - R Caliskan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - S Saribas
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - S Akkus
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - N Gareayaghi
- Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Blood Center, University of Health Sciences, Istanbul, Turkey
| | - S Kirmusaoglu
- T.C. Haliç University, Faculty of Arts and Sciences, Department of Molecular Biology and Genetics, Istanbul, Turkey
| | - N Kepil
- Istanbul University- Cerrahpasa, Cerrahpasa Medical Faculty, Department of Pathology, Istanbul, Turkey
| | - H Dinc
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - H Dag
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - E Dagdeviren
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - H B Tokman
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - F Kalayci
- Istanbul Yeni Yuzyil University, Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - M Demirci
- Beykent University Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - I Tasci
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul, Turkey
| | - Y Erzin
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Gastroenterology, Istanbul, Turkey
| | - K Bal
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Gastroenterology, Istanbul, Turkey
| | - B Kocazeybek
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
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Graur F, Nechita VI, Bolboaca SD, Dragota M, Cosma AM, Hajjar NA. EPCephalic duodenopancreatectomy for neurofibromatosis associated with gastrointestinal stromal tumor. A case report. Ann Ital Chir 2019; 8:S2239253X19030482. [PMID: 31203268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Neurofibromatosis is a genetic autosomal dominant disease characterized by multiple skin nodules and hyperpigmentation. This condition is frequently associated with a large variety of neoplasia, including gastrointestinal stromal tumors (GIST) in about 6% of cases. We present a case of neurofibromatosis associated GIST. CASE REPORT A 57 year-old male patient with Von Recklinghausen disease was referred into our service after he was discovered with a 7 mm nodular formation in contact with the pancreatic head, during a routine abdominal ultrasonography. Ultrasound examination performed into our service reveals a nodular formation with hypoechoic circumference, central translucency, with central necrosis, contrast medium uptake and dimensions at about 78/49/77 mm, without peritoneal fluid content. Trans-gastric biopsy specimen shows mesenchymal proliferation with spindle cells and elongated nuclei and c-kit intensely positive. The diagnosis was gastrointestinal stromal tumor. Delimitation towards pancreatic head was unclear. A cephalic duodenopacreatectomy was performed. Morphopathology confirmed a multifocal GIST of low grade G1, in the second stage. CONCLUSION A rare case of neurofibromatosis associated GIST with multifocal localization was successfully treated by cephalic duodenopancreatectomy. KEY WORDS Neurofibromatosis type 1 (NF1), Retroperitoneal Gastrointestinal Stromal Tumor (GIST).
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17
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Stretch C, Aubin JM, Mickiewicz B, Leugner D, Al-manasra T, Tobola E, Salazar S, Sutherland FR, Ball CG, Dixon E, Vogel HJ, Damaraju S, Baracos VE, Bathe OF. Sarcopenia and myosteatosis are accompanied by distinct biological profiles in patients with pancreatic and periampullary adenocarcinomas. PLoS One 2018; 13:e0196235. [PMID: 29723245 PMCID: PMC5933771 DOI: 10.1371/journal.pone.0196235] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/09/2018] [Indexed: 01/06/2023] Open
Abstract
Introduction Pancreatic and periampullary adenocarcinomas are associated with abnormal body composition visible on CT scans, including low muscle mass (sarcopenia) and low muscle radiodensity due to fat infiltration in muscle (myosteatosis). The biological and clinical correlates to these features are poorly understood. Methods Clinical characteristics and outcomes were studied in 123 patients who underwent pancreaticoduodenectomy for pancreatic or non-pancreatic periampullary adenocarcinoma and who had available preoperative CT scans. In a subgroup of patients with pancreatic cancer (n = 29), rectus abdominus muscle mRNA expression was determined by cDNA microarray and in another subgroup (n = 29) 1H-NMR spectroscopy and gas chromatography-mass spectrometry were used to characterize the serum metabolome. Results Muscle mass and radiodensity were not significantly correlated. Distinct groups were identified: sarcopenia (40.7%), myosteatosis (25.2%), both (11.4%). Fat distribution differed in these groups; sarcopenia associated with lower subcutaneous adipose tissue (P<0.0001) and myosteatosis associated with greater visceral adipose tissue (P<0.0001). Sarcopenia, myosteatosis and their combined presence associated with shorter survival, Log Rank P = 0.005, P = 0.06, and P = 0.002, respectively. In muscle, transcriptomic analysis suggested increased inflammation and decreased growth in sarcopenia and disrupted oxidative phosphorylation and lipid accumulation in myosteatosis. In the circulating metabolome, metabolites consistent with muscle catabolism associated with sarcopenia. Metabolites consistent with disordered carbohydrate metabolism were identified in both sarcopenia and myosteatosis. Discussion Muscle phenotypes differ clinically and biologically. Because these muscle phenotypes are linked to poor survival, it will be imperative to delineate their pathophysiologic mechanisms, including whether they are driven by variable tumor biology or host response.
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Affiliation(s)
- Cynthia Stretch
- Department of Oncology, University of Calgary, Calgary, Canada
| | | | - Beata Mickiewicz
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Derek Leugner
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Tariq Al-manasra
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | | | | | | | - Chad G. Ball
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Elijah Dixon
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Hans J. Vogel
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Sambasivario Damaraju
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
- Department of Oncology, University of Alberta, Edmonton, Canada
| | | | - Oliver F. Bathe
- Department of Oncology, University of Calgary, Calgary, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
- * E-mail:
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18
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Bettini AC, Beretta GD, Sironi P, Mosconi S, Labianca R. Chemotherapy in Small Bowel Adenocarcinoma Associated with Celiac Disease: A Report of Three Cases. Tumori 2018; 89:193-5. [PMID: 12841670 DOI: 10.1177/030089160308900217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tumors of the small intestine are rare and usually occur in association with genetic disease and chronic intestinal inflammation. We report three cases of small bowel adenocarcinoma in patients affected by celiac disease who received a safe chemotherapy regimen (FOLFOX IV or LV5FU2) after tumor resection.
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Delker DA, Wood AC, Snow AK, Samadder NJ, Samowitz WS, Affolter KE, Boucher KM, Pappas LM, Stijleman IJ, Kanth P, Byrne KR, Burt RW, Bernard PS, Neklason DW. Chemoprevention with Cyclooxygenase and Epidermal Growth Factor Receptor Inhibitors in Familial Adenomatous Polyposis Patients: mRNA Signatures of Duodenal Neoplasia. Cancer Prev Res (Phila) 2018; 11:4-15. [PMID: 29109117 PMCID: PMC5754246 DOI: 10.1158/1940-6207.capr-17-0130] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/31/2017] [Accepted: 10/02/2017] [Indexed: 12/20/2022]
Abstract
To identify gene expression biomarkers and pathways targeted by sulindac and erlotinib given in a chemoprevention trial with a significant decrease in duodenal polyp burden at 6 months (P < 0.001) in familial adenomatous polyposis (FAP) patients, we biopsied normal and polyp duodenal tissues from patients on drug versus placebo and analyzed the RNA expression. RNA sequencing was performed on biopsies from the duodenum of FAP patients obtained at baseline and 6-month endpoint endoscopy. Ten FAP patients on placebo and 10 on sulindac and erlotinib were selected for analysis. Purity of biopsied polyp tissue was calculated from RNA expression data. RNAs differentially expressed between endpoint polyp and paired baseline normal were determined for each group and mapped to biological pathways. Key genes in candidate pathways were further validated by quantitative RT-PCR. RNA expression analyses of endpoint polyp compared with paired baseline normal for patients on placebo and drug show that pathways activated in polyp growth and proliferation are blocked by this drug combination. Directly comparing polyp gene expression between patients on drug and placebo also identified innate immune response genes (IL12 and IFNγ) preferentially expressed in patients on drug. Gene expression analyses from tissue obtained at endpoint of the trial demonstrated inhibition of the cancer pathways COX2/PGE2, EGFR, and WNT. These findings provide molecular evidence that the drug combination of sulindac and erlotinib reached the intended tissue and was on target for the predicted pathways. Furthermore, activation of innate immune pathways from patients on drug may have contributed to polyp regression. Cancer Prev Res; 11(1); 4-15. ©2017 AACRSee related editorial by Shureiqi, p. 1.
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Affiliation(s)
- Don A Delker
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Austin C Wood
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Angela K Snow
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - N Jewel Samadder
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Wade S Samowitz
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Kajsa E Affolter
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Kenneth M Boucher
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Lisa M Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Inge J Stijleman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Priyanka Kanth
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Kathryn R Byrne
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Randall W Burt
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Philip S Bernard
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Deborah W Neklason
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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20
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Sundaresan S, Meininger CA, Kang AJ, Photenhauer AL, Hayes MM, Sahoo N, Grembecka J, Cierpicki T, Ding L, Giordano TJ, Else T, Madrigal DJ, Low MJ, Campbell F, Baker AM, Xu H, Wright NA, Merchant JL. Gastrin Induces Nuclear Export and Proteasome Degradation of Menin in Enteric Glial Cells. Gastroenterology 2017; 153:1555-1567.e15. [PMID: 28859856 PMCID: PMC5705278 DOI: 10.1053/j.gastro.2017.08.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 02/23/2017] [Revised: 07/31/2017] [Accepted: 08/13/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS The multiple endocrine neoplasia, type 1 (MEN1) locus encodes the nuclear protein and tumor suppressor menin. MEN1 mutations frequently cause neuroendocrine tumors such as gastrinomas, characterized by their predominant duodenal location and local metastasis at time of diagnosis. Diffuse gastrin cell hyperplasia precedes the appearance of MEN1 gastrinomas, which develop within submucosal Brunner's glands. We investigated how menin regulates expression of the gastrin gene and induces generation of submucosal gastrin-expressing cell hyperplasia. METHODS Primary enteric glial cultures were generated from the VillinCre:Men1FL/FL:Sst-/- mice or C57BL/6 mice (controls), with or without inhibition of gastric acid by omeprazole. Primary enteric glial cells from C57BL/6 mice were incubated with gastrin and separated into nuclear and cytoplasmic fractions. Cells were incubated with forskolin and H89 to activate or inhibit protein kinase A (a family of enzymes whose activity depends on cellular levels of cyclic AMP). Gastrin was measured in blood, tissue, and cell cultures using an ELISA. Immunoprecipitation with menin or ubiquitin was used to demonstrate post-translational modification of menin. Primary glial cells were incubated with leptomycin b and MG132 to block nuclear export and proteasome activity, respectively. We obtained human duodenal, lymph node, and pancreatic gastrinoma samples, collected from patients who underwent surgery from 1996 through 2007 in the United States or the United Kingdom. RESULTS Enteric glial cells that stained positive for glial fibrillary acidic protein (GFAP+) expressed gastrin de novo through a mechanism that required PKA. Gastrin-induced nuclear export of menin via cholecystokinin B receptor (CCKBR)-mediated activation of PKA. Once exported from the nucleus, menin was ubiquitinated and degraded by the proteasome. GFAP and other markers of enteric glial cells (eg, p75 and S100B), colocalized with gastrin in human duodenal gastrinomas. CONCLUSIONS MEN1-associated gastrinomas, which develop in the submucosa, might arise from enteric glial cells through hormone-dependent PKA signaling. This pathway disrupts nuclear menin function, leading to hypergastrinemia and associated sequelae.
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Affiliation(s)
- Sinju Sundaresan
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Cameron A Meininger
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Anthony J Kang
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Amanda L Photenhauer
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Michael M Hayes
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Nirakar Sahoo
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan
| | - Jolanta Grembecka
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Tomasz Cierpicki
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Lin Ding
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Thomas J Giordano
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Tobias Else
- Division of Metabolism Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan
| | - David J Madrigal
- Endocrine Oncology Program, University of Michigan, Ann Arbor, Michigan
| | - Malcolm J Low
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Fiona Campbell
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Ann-Marie Baker
- Center for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Haoxing Xu
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan
| | - Nicholas A Wright
- Center for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Juanita L Merchant
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan.
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Schrock AB, Devoe CE, McWilliams R, Sun J, Aparicio T, Stephens PJ, Ross JS, Wilson R, Miller VA, Ali SM, Overman MJ. Genomic Profiling of Small-Bowel Adenocarcinoma. JAMA Oncol 2017; 3:1546-1553. [PMID: 28617917 PMCID: PMC5710195 DOI: 10.1001/jamaoncol.2017.1051] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [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: 01/12/2017] [Accepted: 03/21/2017] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Small-bowel adenocarcinomas (SBAs) are rare cancers with a significantly lower incidence, later stage at diagnosis, and worse overall survival than other intestinal-derived cancers. To date, comprehensive genomic analysis of SBA is lacking. OBJECTIVE To perform in-depth genomic characterization of a large series of SBAs and other gastrointestinal tumors to draw comparisons and identify potentially clinically actionable alterations. DESIGN, SETTING, AND PARTICIPANTS Prospective analysis was performed of clinical samples from patients with SBA (n = 317), colorectal cancer (n = 6353), and gastric carcinoma (n = 889) collected between August 24, 2012, and February 3, 2016, using hybrid-capture-based genomic profiling, at the request of the individual treating physicians in the course of clinical care for the purpose of making therapy decisions. RESULTS Of the 7559 patients included in analysis, 4138 (54.7%) were male; the median age was 56 (range, 12-101) years. The frequency of genomic alterations seen in SBA demonstrated distinct differences in comparison with either colorectal cancer (APC: 26.8% [85 of 317] vs 75.9% [4823 of 6353], P < .001; and CDKN2A: 14.5% [46 of 317] vs 2.6% [165 of 6353], P < .001) or gastric carcinoma (KRAS: 53.6% [170 of 317] vs 14.2% [126 of 889], P < .001; APC: 26.8% [85 of 317] vs 7.8% [69 of 889], P < .001; and SMAD4: 17.4% [55 of 317] vs 5.2% [46 of 889], P < .001). BRAF was mutated in 7.6% (484 of 6353) of colorectal cancer and 9.1% (29 of 317) of SBA samples, but V600E mutations were much less common in SBA, representing only 10.3% (3 of 29) of BRAF-mutated cases. The ERBB2/HER2 point mutations (8.2% [26 of 317]), microsatellite instability (7.6% [13 of 170]), and high tumor mutational burden (9.5% [30 of 317]) were all enriched in SBA. Significant differences were noted in the molecular profile of unspecified SBA compared with duodenal adenocarcinoma, as well as in inflammatory bowel disease-associated SBAs. Targetable alterations in several additional genes, including PIK3CA and MEK1, and receptor tyrosine kinase fusions, were also identified in all 3 series. CONCLUSIONS AND RELEVANCE This study presents to our knowledge the first large-scale genomic comparison of SBA with colorectal cancer and gastric carcinoma. The distinct genomic differences establish SBA as a molecularly unique intestinal cancer. In addition, genomic profiling can identify potentially targetable genomic alterations in the majority of SBA cases (91%), and the higher incidence of microsatellite instability and tumor mutational burden in SBA suggests a potential role for immunotherapy.
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Affiliation(s)
| | - Craig E. Devoe
- Northwell Health, The Monter Cancer Center, Lake Success, New York
| | | | - James Sun
- Foundation Medicine, Inc, Cambridge, Massachusetts
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology, Centre Hospitalo-Universitaire Avicenne, Assistance Publique Hôpitaux de Paris, University Paris 13, Bobigny, France
| | | | - Jeffrey S. Ross
- Foundation Medicine, Inc, Cambridge, Massachusetts
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York
| | - Richard Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Northern Ireland
| | | | - Siraj M. Ali
- Foundation Medicine, Inc, Cambridge, Massachusetts
| | - Michael J. Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
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22
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Zheng L, Bai J, Zhang JL, Meng X, Hao YN. Heat Shock Protein 90 Alpha, Lass B Member 1: a Key Regulative Gene of Monitoring Duodenal Tumor for Obesity Induced by High-Fat Diet. Clin Lab 2017; 63:1357-1364. [PMID: 28879710 DOI: 10.7754/clin.lab.2017.170214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Effective methods of preventing and treating duodenal carcinoma, especially cancer induced by obesity (resulting from a high-fat diet) remains a longstanding challenge in medicine. METHODS With regard to the objective, key genes were explored in the evolutional process in a group of normal, obese (high-fat diet), and duodenal tumor mice. Here, 23 genes were selected by the bioinformatics method. In order to correct the result, verification experiments were performed twice through online analysis. RESULTS Finally, heat shock protein 90 alpha class B member 1, enriched in inflammation, tumors and steroid hormones-related pathways, was the statistically different gene in the evolutional process. CONCLUSIONS This work provided a new perspective to understand the evolutional process in a group of normal, obese (high-fat diet), and duodenal tumor mice and a potential target gene for monitoring duodenal tumors for normal individuals especially for obesity induced by high-fat diet.
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Elston MS, Sehgal S, Dray M, Phillips E, Conaglen JV, Clifton-Bligh RJ, Gill AJ. A Duodenal SDH-Deficient Gastrointestinal Stromal Tumor in a Patient With a Germline SDHB Mutation. J Clin Endocrinol Metab 2017; 102:1447-1450. [PMID: 28324028 DOI: 10.1210/jc.2017-00165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/09/2017] [Indexed: 02/13/2023]
Abstract
CONTEXT Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract arising from the interstitial cells of Cajal. Succinate dehydrogenase (SDH)-deficient GISTs are a unique class of GIST defined by loss of immunohistochemical expression of SDHB, indicating dysfunction of the mitochondrial complex 2; lack of driver mutations in KIT and PDGFRA; and distinctive morphologic features and natural history. To date, all reported SDH-deficient GISTs have arisen in the stomach. We report an SDH-deficient GIST arising in the gastrointestinal tract outside the stomach. CASE DESCRIPTION A 29-year-old man with a germline SDHB mutation (p.Arg90*) presented with acute upper gastrointestinal hemorrhage. Endoscopy identified a lesion in the second part of the duodenum, close to the distal common bile duct, consistent with a GIST. Endoscopic ultrasonography and magnetic resonance imaging did not demonstrate metastatic or nodal disease. Open transduodenal excision was performed to remove the tumor. Histologic evaluation confirmed the clinical diagnosis of a GIST, with positive staining for DOG1 and KIT. The mitotic count was low (1 per 50 high-power fields). Immunohistochemistry for SDHB was negative in the presence of an internal control. SDHA expression was retained. No somatic mutations were identified in KIT (exons 9, 11, 13, and 17) or PDGFRA (exons 12, 14, and 18). The germline SDHB mutation and loss of heterozygosity were confirmed on molecular testing of the tumor. CONCLUSION We describe an SDH-deficient GIST occurring outside of the stomach. This case indicates that SDH-deficient GISTs may also arise in the small intestine.
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Affiliation(s)
- Marianne S Elston
- Department of Endocrinology, Waikato Hospital, Hamilton 3240, New Zealand
- Waikato Clinical Campus, University of Auckland, Hamilton 3240, New Zealand
| | - Shekhar Sehgal
- Department of Endocrinology, Waikato Hospital, Hamilton 3240, New Zealand
| | - Michael Dray
- Department of Anatomical Pathology, Waikato Hospital, Hamilton 3240, New Zealand
| | - Elizabeth Phillips
- Department of Gastroenterology, Waikato Hospital, Hamilton 3240, New Zealand
| | - John V Conaglen
- Waikato Clinical Campus, University of Auckland, Hamilton 3240, New Zealand
| | - Roderick J Clifton-Bligh
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards 2065, Australia
- Department of Medicine, University of Sydney, Sydney 2006, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards 2065, Australia
- Sydney Medical School, University of Sydney, Sydney 2006, Australia
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Abstract
Small bowel adenocarcinomas (SBAs) are rare tumors, but their incidence is increasing. The most common primary location is the duodenum. Even though SBAs are more often sporadic, some diseases are risk factors. Early diagnosis of small bowel adenocarcinoma remains difficult, despite significant radiologic and endoscopic progress. After R0 surgical resection, the main prognostic factor is lymph node invasion. An international randomized trial (BALLAD [Benefit of Adjuvant Chemotherapy For Small Bowel Adenocarcinoma] study) will evaluate the benefit of adjuvant chemotherapy. For metastatic disease, retrospectives studies suggest that platinum-based chemotherapy is the most effective treatment. Phase II studies are ongoing to evaluate targeted therapy in metastatic SBA.
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Affiliation(s)
- Thomas Aparicio
- Gastroenterology and Digestive Oncology Unit, Avicenne Hospital, HUPSSD, APHP, Université Paris 13, Sorbonne Paris Cité, 125 rue de Stalingrad, Bobigny 93000, France.
| | - Aziz Zaanan
- Gastroenterology and Digestive Oncology Unit, Georges Pompidou Hospital, APHP, Paris Descartes University, 20 Rue Leblanc, Paris 75015, France
| | - Florence Mary
- Gastroenterology and Digestive Oncology Unit, Avicenne Hospital, HUPSSD, APHP, Université Paris 13, Sorbonne Paris Cité, 125 rue de Stalingrad, Bobigny 93000, France
| | - Pauline Afchain
- Oncology Unit, Saint Antoine Hospital, APHP, 184 Rue du Faubourg Saint-Antoine, Paris 75012, France
| | - Sylvain Manfredi
- Hepato-Gastroenterology Unit, Dijon Hospital, 14 rue Paul Gaffarel, Dijon 21079, France
| | - Thomas Ronald Jeffry Evans
- Translational Cancer Therapeutics department, The Beatson West of Scotland Cancer Centre, University of Glasgow, 1053 Great Western Road, Glasgow G12 0YN, UK
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Zhuang Z, Yang C, Ryska A, Ji Y, Hou Y, Graybill SD, Bullova P, Lubensky IA, Klöppel G, Pacak K. HIF2A gain-of-function mutations detected in duodenal gangliocytic paraganglioma. Endocr Relat Cancer 2016; 23:L13-6. [PMID: 27130043 PMCID: PMC4899235 DOI: 10.1530/erc-16-0148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/18/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Zhengping Zhuang
- Surgical Neurology BranchNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Chunzhang Yang
- Neuro-Oncology BranchNational Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ales Ryska
- The Fingerland Department of PathologyCharles University Medical Faculty Hospital, Hradec Kralove, Czech Republic
| | - Yuan Ji
- Department of PathologyZhongshan Hospital, Fudan University, Shanghai, China
| | - Yingyong Hou
- Department of PathologyZhongshan Hospital, Fudan University, Shanghai, China
| | - Sky D Graybill
- San Antonio Military Medical CenterFort Sam Houston, Texas, USA
| | - Petra Bullova
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA Department of Molecular Medicine Institute of Virology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Irina A Lubensky
- Cancer Diagnosis ProgramDivision of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Günter Klöppel
- Consultation Center for Pancreas and Neuroendocrine TumorsDepartment of Pathology, Technical University Munich, Munich, Germany
| | - Karel Pacak
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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Samadder NJ, Neklason DW, Boucher KM, Byrne KR, Kanth P, Samowitz W, Jones D, Tavtigian SV, Done MW, Berry T, Jasperson K, Pappas L, Smith L, Sample D, Davis R, Topham MK, Lynch P, Strait E, McKinnon W, Burt RW, Kuwada SK. Effect of Sulindac and Erlotinib vs Placebo on Duodenal Neoplasia in Familial Adenomatous Polyposis: A Randomized Clinical Trial. JAMA 2016; 315:1266-75. [PMID: 27002448 PMCID: PMC5003411 DOI: 10.1001/jama.2016.2522] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Patients with familial adenomatous polyposis (FAP) are at markedly increased risk for duodenal polyps and cancer. Surgical and endoscopic management of duodenal neoplasia is difficult and chemoprevention has not been successful. OBJECTIVE To evaluate the effect of a combination of sulindac and erlotinib on duodenal adenoma regression in patients with FAP. DESIGN, SETTING, AND PARTICIPANTS Double-blind, randomized, placebo-controlled trial, enrolling 92 participants with FAP, conducted from July 2010 through June 2014 at Huntsman Cancer Institute in Salt Lake City, Utah. INTERVENTIONS Participants with FAP were randomized to sulindac (150 mg) twice daily and erlotinib (75 mg) daily (n = 46) vs placebo (n = 46) for 6 months. MAIN OUTCOMES AND MEASURES The total number and diameter of polyps in the proximal duodenum were mapped at baseline and 6 months. The primary outcome was change in total polyp burden at 6 months. Polyp burden was calculated as the sum of the diameters of polyps. The secondary outcomes were change in total duodenal polyp count, change in duodenal polyp burden or count stratified by genotype and initial polyp burden, and percentage of change from baseline in duodenal polyp burden. RESULTS Ninety-two participants (mean age, 41 years [range, 24-55]; women, 56 [61%]) were randomized when the trial was stopped by the external data and safety monitoring board because the second preplanned interim analysis met the prespecified stopping rule for superiority. Grade 1 and 2 adverse events were more common in the sulindac-erlotinib group, with an acne-like rash observed in 87% of participants receiving treatment and 20% of participants receiving placebo (P < .001). Only 2 participants experienced grade 3 adverse events. [table: see text]. CONCLUSIONS AND RELEVANCE Among participants with FAP, the use of sulindac and erlotinib compared with placebo resulted in a lower duodenal polyp burden after 6 months. Adverse events may limit the use of these medications at the doses used in this study. Further research is necessary to evaluate these preliminary findings in a larger study population with longer follow-up to determine whether the observed effects will result in improved clinical outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT 01187901.
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Affiliation(s)
- N Jewel Samadder
- Huntsman Cancer Institute, University of Utah, Salt Lake City2Department of Medicine (Gastroenterology), University of Utah, Salt Lake City
| | - Deborah W Neklason
- Huntsman Cancer Institute, University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City4Department of Medicine (Genetic Epidemiology), University of Utah, Salt Lake City
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City5Department of Medicine (Epidemiology), University of Utah, Salt Lake City
| | - Kathryn R Byrne
- Department of Medicine (Gastroenterology), University of Utah, Salt Lake City
| | - Priyanka Kanth
- Department of Medicine (Gastroenterology), University of Utah, Salt Lake City
| | - Wade Samowitz
- Huntsman Cancer Institute, University of Utah, Salt Lake City6Department of Pathology, University of Utah, Salt Lake City
| | - David Jones
- Huntsman Cancer Institute, University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City
| | - Sean V Tavtigian
- Huntsman Cancer Institute, University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City
| | - Michelle W Done
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Therese Berry
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Kory Jasperson
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Lisa Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Laurel Smith
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Danielle Sample
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Rian Davis
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Matthew K Topham
- Huntsman Cancer Institute, University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City7Department of Medicine (Pulmonary), University of Utah, Salt Lake City
| | - Patrick Lynch
- Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Randall W Burt
- Huntsman Cancer Institute, University of Utah, Salt Lake City2Department of Medicine (Gastroenterology), University of Utah, Salt Lake City3Department of Oncological Sciences, University of Utah, Salt Lake City
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Gingras MC, Covington KR, Chang DK, Donehower LA, Gill AJ, Ittmann MM, Creighton CJ, Johns AL, Shinbrot E, Dewal N, Fisher WE, Pilarsky C, Grützmann R, Overman MJ, Jamieson NB, Van Buren G, Drummond J, Walker K, Hampton OA, Xi L, Muzny DM, Doddapaneni H, Lee SL, Bellair M, Hu J, Han Y, Dinh HH, Dahdouli M, Samra JS, Bailey P, Waddell N, Pearson JV, Harliwong I, Wang H, Aust D, Oien KA, Hruban RH, Hodges SE, McElhany A, Saengboonmee C, Duthie FR, Grimmond SM, Biankin AV, Wheeler DA, Gibbs RA. Ampullary Cancers Harbor ELF3 Tumor Suppressor Gene Mutations and Exhibit Frequent WNT Dysregulation. Cell Rep 2016; 14:907-919. [PMID: 26804919 PMCID: PMC4982376 DOI: 10.1016/j.celrep.2015.12.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [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: 04/14/2015] [Revised: 10/30/2015] [Accepted: 11/19/2015] [Indexed: 02/08/2023] Open
Abstract
The ampulla of Vater is a complex cellular environment from which adenocarcinomas arise to form a group of histopathologically heterogenous tumors. To evaluate the molecular features of these tumors, 98 ampullary adenocarcinomas were evaluated and compared to 44 distal bile duct and 18 duodenal adenocarcinomas. Genomic analyses revealed mutations in the WNT signaling pathway among half of the patients and in all three adenocarcinomas irrespective of their origin and histological morphology. These tumors were characterized by a high frequency of inactivating mutations of ELF3, a high rate of microsatellite instability, and common focal deletions and amplifications, suggesting common attributes in the molecular pathogenesis are at play in these tumors. The high frequency of WNT pathway activating mutation, coupled with small-molecule inhibitors of β-catenin in clinical trials, suggests future treatment decisions for these patients may be guided by genomic analysis.
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Affiliation(s)
- Marie-Claude Gingras
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Michael DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Kyle R Covington
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - David K Chang
- Wolfson Wohl Cancer Research Centre, Institute for Cancer Sciences, University of Glasgow, Garscube Estate, Bearsden, Glasgow G61 1BD, UK; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK; The Kinghorn Cancer Centre and the Cancer Research Program Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW 2010, Australia; South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, NSW 2170, Australia
| | - Lawrence A Donehower
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Anthony J Gill
- The Kinghorn Cancer Centre and the Cancer Research Program Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW 2010, Australia; Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia; Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Michael M Ittmann
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA; Michael E. DeBakey Department of Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Chad J Creighton
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Amber L Johns
- The Kinghorn Cancer Centre and the Cancer Research Program Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW 2010, Australia
| | - Eve Shinbrot
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ninad Dewal
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - William E Fisher
- Michael DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA; The Elkins Pancreas Center at Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Robert Grützmann
- Department of Surgery, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nigel B Jamieson
- Wolfson Wohl Cancer Research Centre, Institute for Cancer Sciences, University of Glasgow, Garscube Estate, Bearsden, Glasgow G61 1BD, UK; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK; Academic Unit of Surgery, Institute of Cancer Sciences, Glasgow Royal Infirmary, Level 2, New Lister Building, University of Glasgow, Glasgow G31 2ER, UK
| | - George Van Buren
- Michael DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA; The Elkins Pancreas Center at Baylor College of Medicine, Houston, TX 77030, USA
| | - Jennifer Drummond
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kimberly Walker
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Oliver A Hampton
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Liu Xi
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Donna M Muzny
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Harsha Doddapaneni
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sandra L Lee
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michelle Bellair
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jianhong Hu
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yi Han
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Huyen H Dinh
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mike Dahdouli
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jaswinder S Samra
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; Department of Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Peter Bailey
- Wolfson Wohl Cancer Research Centre, Institute for Cancer Sciences, University of Glasgow, Garscube Estate, Bearsden, Glasgow G61 1BD, UK
| | - Nicola Waddell
- Queensland Centre for Medical Genomics, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia; QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD 4006, Australia
| | - John V Pearson
- Queensland Centre for Medical Genomics, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia; QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD 4006, Australia
| | - Ivon Harliwong
- Queensland Centre for Medical Genomics, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Huamin Wang
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Daniela Aust
- Department of Pathology, TU Dresden, 01307 Dresden, Germany
| | - Karin A Oien
- Wolfson Wohl Cancer Research Centre, Institute for Cancer Sciences, University of Glasgow, Garscube Estate, Bearsden, Glasgow G61 1BD, UK; Department of Pathology, Southern General Hospital, Greater Glasgow and Clyde NHS, Glasgow G51 4TF, UK
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, the Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Sally E Hodges
- Michael DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; The Elkins Pancreas Center at Baylor College of Medicine, Houston, TX 77030, USA
| | - Amy McElhany
- Michael DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; The Elkins Pancreas Center at Baylor College of Medicine, Houston, TX 77030, USA
| | - Charupong Saengboonmee
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Biochemistry and Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Fraser R Duthie
- Wolfson Wohl Cancer Research Centre, Institute for Cancer Sciences, University of Glasgow, Garscube Estate, Bearsden, Glasgow G61 1BD, UK; Department of Pathology, Southern General Hospital, Greater Glasgow and Clyde NHS, Glasgow G51 4TF, UK
| | - Sean M Grimmond
- Wolfson Wohl Cancer Research Centre, Institute for Cancer Sciences, University of Glasgow, Garscube Estate, Bearsden, Glasgow G61 1BD, UK; Queensland Centre for Medical Genomics, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Andrew V Biankin
- Wolfson Wohl Cancer Research Centre, Institute for Cancer Sciences, University of Glasgow, Garscube Estate, Bearsden, Glasgow G61 1BD, UK; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK; The Kinghorn Cancer Centre and the Cancer Research Program Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW 2010, Australia; South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, NSW 2170, Australia
| | - David A Wheeler
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
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Barzola-Navarro EJ, Flores-García JÁ, López-Guerra D, Tejera-Pérez C, Rodríguez-Díez N, Gómez-Durán A, Rubio-Fernández A, Blanco-Fernández G. Duodenal Ewing´s sarcoma: Unusual location and atypical EWRS-1 translocation. Rev Esp Enferm Dig 2015; 107:109-110. [PMID: 25659392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Thompson CM, Seiter J, Chappell MA, Tappero RV, Proctor DM, Suh M, Wolf JC, Haws LC, Vitale R, Mittal L, Kirman CR, Hays SM, Harris MA. Synchrotron-based imaging of chromium and γ-H2AX immunostaining in the duodenum following repeated exposure to Cr(VI) in drinking water. Toxicol Sci 2015; 143:16-25. [PMID: 25352572 PMCID: PMC4274380 DOI: 10.1093/toxsci/kfu206] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Current drinking water standards for chromium are for the combined total of both hexavalent and trivalent chromium (Cr(VI) and Cr(III)). However, recent studies have shown that Cr(III) is not carcinogenic to rodents, whereas mice chronically exposed to high levels of Cr(VI) developed duodenal tumors. These findings may suggest the need for environmental standards specific for Cr(VI). Whether the intestinal tumors arose through a mutagenic or non-mutagenic mode of action (MOA) greatly impacts how drinking water standards for Cr(VI) are derived. Herein, X-ray fluorescence (spectro)microscopy (µ-XRF) was used to image the Cr content in the villus and crypt regions of duodena from B6C3F1 mice exposed to 180 mg/l Cr(VI) in drinking water for 13 weeks. DNA damage was also assessed by γ-H2AX immunostaining. Exposure to Cr(VI) induced villus blunting and crypt hyperplasia in the duodenum--the latter evidenced by lengthening of the crypt compartment by ∼2-fold with a concomitant 1.5-fold increase in the number of crypt enterocytes. γ-H2AX immunostaining was elevated in villi, but not in the crypt compartment. µ-XRF maps revealed mean Cr levels >30 times higher in duodenal villi than crypt regions; mean Cr levels in crypt regions were only slightly above background signal. Despite the presence of Cr and elevated γ-H2AX immunoreactivity in villi, no aberrant foci indicative of transformation were evident. These findings do not support a MOA for intestinal carcinogenesis involving direct Cr-DNA interaction in intestinal stem cells, but rather support a non-mutagenic MOA involving chronic wounding of intestinal villi and crypt cell hyperplasia.
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Affiliation(s)
- Chad M Thompson
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Jennifer Seiter
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Mark A Chappell
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Ryan V Tappero
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Deborah M Proctor
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Mina Suh
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Jeffrey C Wolf
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Laurie C Haws
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510 ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Rock Vitale
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510 ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510 ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Liz Mittal
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Christopher R Kirman
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510 ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510 ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510 ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc
| | - Sean M Hays
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
| | - Mark A Harris
- ToxStrategies, Inc., Katy, Texas 77494, U.S. Army Engineer Research and Development Center, Vicksburg, Mississippi 39180, Photon Sciences Department, Brookhaven National Laboratory, Upton, New York 11973, ToxStrategies, Inc., Mission Viejo, California 92692, Experimental Pathology Laboratories, Sterling, Virginia 20166, ToxStrategies, Inc., Austin, Texas 78731, Environmental Standards, Inc., Valley Forge, Pennsylvania 19482, Summit Toxicology, LLP, Orange Village, Ohio 44022 and Summit Toxicology, LLP, Allenspark, Colorado 80510
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Amjad AI, Singhi AD, Balaban EP, Dudley B, Brand RE, Bahary N. First reported case of a squamous cell carcinoma arising in the duodenum in a patient with Lynch syndrome. Int J Clin Exp Pathol 2014; 7:8988-8995. [PMID: 25674277 PMCID: PMC4313961] [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] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 06/04/2023]
Abstract
A 58 y/o male with Lynch syndrome, who was diagnosed with a squamous cell carcinoma (SCC) arising in the duodenum, is described. Previous malignancies included two metachronous colorectal adenocarcinomas, and a known family history of Lynch syndrome associated with deletion of exons 8-15 of the MSH2 gene. Analysis of his small bowel SCC revealed loss of MSH2 and MSH6 protein expression, suggesting a pathogenic role of the germ-line deletion. While small bowel adenocarcinomas have previously been reported in Lynch syndrome, to our knowledge this is the first report of Lynch syndrome-associated squamous histology. As patients with Lynch syndrome live longer with early detection and treatment of their cancers, unusual sites and histology of previously unreported cancers may emerge. It is also important to recognize variant histologies that otherwise might not prompt pursuing a diagnosis of Lynch syndrome in the appropriate clinical setting.
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Affiliation(s)
- Ali I Amjad
- Division of Hematology Oncology, Department of Medicine, University of PittsburghPA, USA
| | - Aatur D Singhi
- Department of Pathology, University of PittsburghPA, USA
| | | | - Beth Dudley
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of PittsburghPA, USA
| | - Randall E Brand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of PittsburghPA, USA
| | - Nathan Bahary
- Division of Hematology Oncology, Department of Medicine, University of PittsburghPA, USA
- Department of Molecular Genetics and Developmental Biology, University of Pittsburgh School of MedicinePittsburgh, PA, USA
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Fisher SB, Kim SC, Kooby DA, Cardona K, Russell MC, Delman KA, Staley CA, Maithel SK. Gastrointestinal stromal tumors: a single institution experience of 176 surgical patients. Am Surg 2013; 79:657-665. [PMID: 23815996] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Large single-institution series of patients undergoing resection for gastrointestinal stromal tumors (GIST) are lacking. Clinicopathologic characteristics and postoperative outcomes were retrospectively collected and analyzed from patients undergoing resection for GIST from 2002 to 2011. One hundred seventy-six patients were identified; 156 underwent resection of primary nonmetastatic disease. KIT mutations were identified in 131 patients (84.0%). Of the 156 patients with primary disease, the most common site was the stomach (75.6%). Tumors were categorized as very low (24.4%), low (35.9%), intermediate (12.2%), high (24.4%), or unknown (3.2%) risk. Symptomatic patients more often had high risk (35.6 vs 9.8%; P < 0.0001) and larger tumors (7.3 vs 3.0 cm; P < 0.0001). Forty-seven patients (30.1%) underwent laparoscopic resection (LR). Compared with open surgery, LR was performed for smaller tumors (3.8 vs 6.2 cm; P = 0.002). Positive margin rates were similar (4.3% LR vs 10.2% open; P = 0.346). Median follow-up for the 156 patients with primary tumors was 32.9 months; mean overall survival was 120.9 months (median not reached). Of the 20 patients with metastatic GIST (excluded from above analysis), five patients (25.0%) died of disease with a median follow-up of 15.9 months. Most patients with resectable primary GIST have a favorable prognosis. The presence of symptoms directly related to GIST may be associated with a poor prognosis and is likely related to increased tumor size. Laparoscopic resection is well tolerated and does not appear to compromise outcomes in well-selected patients. Highly selected patients with metastatic disease may benefit from resection.
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Affiliation(s)
- Sarah B Fisher
- Department of Surgery, Division of Surgical Oncology, Emory University, Atlanta, Georgia, USA
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Overman MJ, Zhang J, Kopetz S, Davies M, Jiang ZQ, Zhi-Qin J, Stemke-Hale K, Rümmele P, Pilarsky C, Grützmann R, Hamilton S, Hwang R, Abbruzzese JL, Varadhachary G, Broom B, Wang H. Gene expression profiling of ampullary carcinomas classifies ampullary carcinomas into biliary-like and intestinal-like subtypes that are prognostic of outcome. PLoS One 2013; 8:e65144. [PMID: 23776447 PMCID: PMC3679143 DOI: 10.1371/journal.pone.0065144] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 01/09/2013] [Accepted: 04/22/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Adenocarcinomas of the ampulla of Vater are classified as biliary cancers, though the exact epithelium of origin for these cancers is not known. We sought to molecularly classify ampullary adenocarcinomas in comparison to known adenocarcinomas of the pancreas, bile duct, and duodenum by gene expression analysis. METHODS We analyzed 32 fresh-frozen resected, untreated periampullary adenocarcinomas (8 pancreatic, 2 extrahepatic biliary, 8 duodenal, and 14 ampullary) using the Affymetrix U133 Plus 2.0 genome array. Unsupervised and supervised hierarchical clustering identified two subtypes of ampullary carcinomas that were molecularly and histologically characterized. RESULTS Hierarchical clustering of periampullary carcinomas segregated ampullary carcinomas into two subgroups, which were distinctly different from pancreatic carcinomas. Non-pancreatic periampullary adenocarcinomas were segregated into two subgroups with differing prognoses: 5 year RFS (77% vs. 0%, p = 0.007) and 5 year OS (100% vs. 35%, p = 0.005). Unsupervised clustering analysis of the 14 ampullary samples also identified two subgroups: a good prognosis intestinal-like subgroup and a poor prognosis biliary-like subgroup with 5 year OS of 70% vs. 28%, P = 0.09. Expression of CK7+/CK20- but not CDX-2 correlated with these two subgroups. Activation of the AKT and MAPK pathways were both increased in the poor prognostic biliary-like subgroup. In an independent 80 patient ampullary validation dataset only histological subtype (intestinal vs. pancreaticobiliary) was significantly associated with OS in both univariate (p = 0.006) and multivariate analysis (P = 0.04). CONCLUSIONS Gene expression analysis discriminated pancreatic adenocarcinomas from other periampullary carcinomas and identified two prognostically relevant subgroups of ampullary adenocarcinomas. Histological subtype was an independent prognostic factor in ampullary adenocarcinomas.
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Affiliation(s)
- Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, United States of America.
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Mori M, Kobayashi Y, Maeshima AM, Gotoda T, Oda I, Kagami Y, Bennett S, Nomoto J, Azuma T, Yokoyama H, Maruyama D, Kim SW, Watanabe T, Matsuno Y, Tobinai K. The indolent course and high incidence of t(14;18) in primary duodenal follicular lymphoma. Ann Oncol 2009; 21:1500-1505. [PMID: 20022910 DOI: 10.1093/annonc/mdp557] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Information on the clinical behavior of the recently proposed primary duodenal follicular lymphoma (DFL) is limited. PATIENTS AND METHODS Demographic data, signs, symptoms, disease stage, and treatment of the patients diagnosed in National Cancer Center Hospital from 1999 to 2007 were collected and analyzed. RESULTS Twenty-seven patients were studied. Nineteen patients were asymptomatic at the time of diagnosis. Twenty patients had stage I disease. The histological grade was 1 or 2 in 26 patients. IgH/BCL2 fusion was shown in 20 of the examined 24 cases (83%). Fourteen patients received therapy upon diagnosis (local radiotherapy in 2 patients and chemotherapy in 12 including rituximab therapy), their response rate was 85%, and the estimated progression-free survival (PFS) rate at 3 years was 70%. One patient developed histological transformation. The other 13 patients were followed up; their estimated PFS rate at 3 years was 74%. Five among six cases responded to treatment even after progressive disease. All 27 patients have survived with a median follow-up time of 47.9 months. CONCLUSIONS The majority of primary DFL patients have a localized tumor of low-grade histology and are positive for t(14;18). Watchful waiting might be an alternative approach for its indolent course; however, further studies are warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 18/genetics
- Cytogenetic Analysis
- Disease Progression
- Duodenal Neoplasms/genetics
- Duodenal Neoplasms/pathology
- Duodenal Neoplasms/therapy
- Female
- Humans
- Incidence
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasm Staging
- Radiotherapy Dosage
- Retrospective Studies
- Survival Rate
- Translocation, Genetic/genetics
- Treatment Outcome
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Affiliation(s)
- M Mori
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Y Kobayashi
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan.
| | - A M Maeshima
- Division of Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - T Gotoda
- Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - I Oda
- Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Y Kagami
- Division of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - S Bennett
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - J Nomoto
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - T Azuma
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - H Yokoyama
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - D Maruyama
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - S-W Kim
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - T Watanabe
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Y Matsuno
- Division of Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - K Tobinai
- Division of Hematology, National Cancer Center Hospital, Tokyo, Japan
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35
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Company Campins MM, Morales R, Dolz C, Garcia-Bonafe M, Vilella A, Huguet P. Primary monophasic synovial sarcoma of the duodenum confirmed by cytogenetic analysis with demonstration of t(X;18): a case report. J Gastrointestin Liver Dis 2009; 18:89-93. [PMID: 19337641] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Synovial sarcoma (SS) is an uncommon malignant neoplasm of the soft tissues. It mainly affects the periarticular tissues of the extremities in young adults, but has been described at nearly all sites; nevertheless, the gastrointestinal tract is an exceptional location. We report a case of a primary synovial sarcoma of the duodenum in a 69-year-old woman. Histological study showed a monophasic pattern. The tumor cells demonstrated diffuse vimentin and Bcl-2 expression, partial EMA expression and focal AE1/3 positivity. The differential diagnosis includes gastrointestinal stromal tumors. Cytogenetic analysis confirmed the diagnosis, with detection of the X;18 translocation. The patient presented postoperative complications and died one month following the intervention.
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MESH Headings
- Adolescent
- Adult
- Aged
- Biopsy
- Chromosomes, Human, Pair 18
- Chromosomes, Human, X
- Duodenal Neoplasms/diagnosis
- Duodenal Neoplasms/genetics
- Duodenal Neoplasms/pathology
- Duodenal Neoplasms/therapy
- Fatal Outcome
- Female
- Genetic Testing/methods
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Male
- Middle Aged
- Pancreaticoduodenectomy/adverse effects
- Radiotherapy, Adjuvant
- Sarcoma, Synovial/diagnosis
- Sarcoma, Synovial/genetics
- Sarcoma, Synovial/pathology
- Sarcoma, Synovial/therapy
- Tomography, X-Ray Computed
- Translocation, Genetic
- Treatment Failure
- Young Adult
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Chetty R, Vajpeyi R. Vasculopathic changes, a somatostatin-producing neuroendocrine carcinoma and a jejunal gastrointestinal stromal tumor in a patient with type 1 neurofibromatosis. Endocr Pathol 2009; 20:177-81. [PMID: 19488862 DOI: 10.1007/s12022-009-9083-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 36-year-old male with neurofibromatosis type 1 (NF-1) presented with symptoms of obstructive jaundice. Imaging showed a periampullary mass, which on endoscopic retrograde cholangiopancreatography biopsy proved to be a somatostatinoma. A Whipple's procedure was performed and a somatostatinoma of the duodenum was confirmed. In addition, the patient had a gastrointestinal stromal tumor (GIST) of the jejunum with accompanying hyperplasia of interstitial cells of Cajal. The somatostatinoma was histologically characteristic with pseudoglandular and solid patterns together with psammoma bodies and lymphovascular invasion. The GIST did not display mutations in c-kit or platelet-derived growth factor receptor genes. The novel finding in this case was the presence of several vessels in the submucosa and muscularis propria of the duodenum displaying prominent intimal hyperplasia and in keeping with so-called neurofibromatosis-associated vasculopathy. These abnormal vessels were within and close to the somatostatinoma only and were not found away from the tumor. It is thought that the vasculopathy is related to NF-1 with abnormal neurofibromin possibly playing a role.
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Affiliation(s)
- Runjan Chetty
- Department of Pathology, University Health Network/University of Toronto, Toronto, Ontario, Canada.
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37
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Anlauf M, Perren A, Klöppel G. Endocrine precursor lesions and microadenomas of the duodenum and pancreas with and without MEN1: criteria, molecular concepts and clinical significance. Pathobiology 2007; 74:279-84. [PMID: 17890894 DOI: 10.1159/000105810] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [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: 11/22/2006] [Accepted: 01/30/2007] [Indexed: 01/09/2023] Open
Abstract
Proliferative changes in the neuroendocrine cells that precede neoplasia are of interest for the understanding of tumorigenesis and the early recognition of neuroendocrine tumors. This review focuses on precursor lesions of duodenal and pancreatic neuroendocrine tumors in multiple endocrine neoplasia type 1 (MEN1) and also discusses 2 new disease entities of pancreatic microadenomatosis. The gastrinomas observed in MEN1 are almost exclusively localized in the duodenum and are multicentric. It has been shown that, in contrast to sporadic duodenal gastrinomas, they are associated with hyperplastic gastrin cell lesions and tiny gastrin-producing microtumors less than 500 microm in diameter. In the pancreas, microadenomatosis (multiple tumors up to 5 mm in diameter) is a feature of MEN1. These microadenomas predominantly express glucagon and pancreatic polypeptide, but do not cause a hormonal syndrome. Approximately 50% of MEN1 minigastrinomas in the duodenum and almost all microadenomas in the pancreas show allelic deletion of the MEN1 gene and therefore may represent 'initial' neoplasms. In contrast, endocrine cell precursor lesions retain heterozygosity. Pancreatic microadenomatosis was also found unassociated with hereditary syndromes and 2 monohormonal types were identified: (1) glucagon-producing microadenomatosis and (2) insulin-producing microadenomatosis, both associated with macrotumors. Whether these types of microadenomatosis represent novel disease entities and how to diagnose and treat these patients remains to be clarified by further studies.
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Affiliation(s)
- Martin Anlauf
- Department of Pathology, University of Kiel, Kiel, Germany.
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Berkhout M, Nagtegaal ID, Cornelissen SJB, Dekkers MMG, van de Molengraft FJJM, Peters WHM, Nagengast FM, van Krieken JHJM, Jeuken JWM. Chromosomal and methylation alterations in sporadic and familial adenomatous polyposis-related duodenal carcinomas. Mod Pathol 2007; 20:1253-62. [PMID: 17873900 DOI: 10.1038/modpathol.3800952] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Primary carcinomas of the small intestine are rare and the mechanism of their pathogenesis is poorly understood. Patients with familial adenomatous polyposis (FAP) have a high risk of developing duodenal carcinomas. The aim of this study is to gain more insight into the development of duodenal carcinomas. Therefore, five FAP-related duodenal carcinomas were characterized for chromosomal and methylation alterations, which were compared to those observed in sporadic duodenal carcinomas. Comparative genomic hybridization (CGH) and methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) was performed in 10 primary sporadic and five primary FAP-related duodenal carcinomas. In the FAP-related carcinomas, frequent gains were observed on chromosomes 8, 17 and 19, whereas in sporadic carcinomas they occurred on chromosomes 8, 12, 13 and 20. In 60% of the sporadic carcinomas, gains in the regions of chromosome 12 were observed which were absent in the FAP-related carcinomas (P=0.04). Hypermethylation was observed in the immunoglobulin superfamily genes member 4 (IGSF4), TIMP metallopeptidase inhibitor 3 (TIMP3), Estrogen receptor 1 (ESR1), adenomatous polyposis coli (APC), H-cadherin (CDH13) and paired box gene 6 (PAX6) genes. Hypermethylation of PAX6 was only observed in FAP-related carcinomas (3/5) and not in sporadic carcinomas (P=0.02). In conclusion, in contrast to sporadic duodenal carcinomas, gains on chromosome 12 were not observed in duodenal carcinomas of patients with FAP. Identification of the genes in these regions of chromosome 12 could lead to a better understanding of the carcinogenesis pathways leading to sporadic and FAP-related duodenal carcinomas. Furthermore, hypermethylation seems to be a general feature of both FAP-related duodenal carcinomas as well as sporadic duodenal carcinomas with the exception of the PAX6 gene, which is methylated only in FAP-related carcinomas.
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Affiliation(s)
- Marloes Berkhout
- Department of Gastroenterology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Park JG, Kim DW, Hong CW, Nam BH, Shin YK, Hong SH, Kim IJ, Lim SB, Aronson M, Bisgaard ML, Brown GJ, Burn J, Chow E, Conrad P, Douglas F, Dunlop M, Ford J, Greenblatt MS, Heikki J, Heinimann K, Lynch EL, Macrae F, McKinnon WC, Möeslein G, Rossi BM, Rozen P, Schofield L, Vaccaro C, Vasen H, Velthuizen M, Viel A, Wijnen J. Germ line mutations of mismatch repair genes in hereditary nonpolyposis colorectal cancer patients with small bowel cancer: International Society for Gastrointestinal Hereditary Tumours Collaborative Study. Clin Cancer Res 2007; 12:3389-93. [PMID: 16740762 DOI: 10.1158/1078-0432.ccr-05-2452] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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: 11/16/2022]
Abstract
PURPOSE The aim of study was to determine the clinical characteristics and mutational profiles of the mismatch repair genes in hereditary nonpolyposis colorectal cancer (HNPCC) patients with small bowel cancer (SBC). EXPERIMENTAL DESIGN A questionnaire was mailed to 55 members of the International Society for Gastrointestinal Hereditary Tumours, requesting information regarding patients with HNPCC-associated SBC and germ line mismatch repair gene mutations. RESULTS The study population consisted of 85 HNPCC patients with identified mismatch repair gene mutations and SBCs. SBC was the first HNPCC-associated malignancy in 14 of 41 (34.1%) patients for whom a personal history of HNPCC-associated cancers was available. The study population harbored 69 different germ line mismatch repair gene mutations, including 31 mutations in MLH1, 34 in MSH2, 3 in MSH6, and 1 in PMS2. We compared the distribution of the mismatch repair mutations in our study population with that in a control group, including all pathogenic mismatch repair mutations of the International Society for Gastrointestinal Hereditary Tumours database (excluding those in our study population). In patients with MSH2 mutations, patients with HNPCC-associated SBCs had fewer mutations in the MutL homologue interaction domain (2.9% versus 19.9%, P = 0.019) but an increased frequency of mutations in codons 626 to 733, a domain that has not previously been associated with a known function, versus the control group (26.5% versus 2.8%, P < 0.001). CONCLUSIONS In HNPCC patients, SBC can be the first and only cancer and may develop as soon as the early teens. The distribution of MSH2 mutations found in patients with HNPCC-associated SBCs significantly differed from that found in the control group (P < 0.001).
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Affiliation(s)
- Jae-Gahb Park
- Korean Hereditary Tumor Registry, Laboratory of Cell Biology, Cancer Research Institute and Cancer Research Center, Seoul National University College of Medicine, Korea.
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Graham J, Debiec-Rychter M, Corless CL, Reid R, Davidson R, White JD. Imatinib in the management of multiple gastrointestinal stromal tumors associated with a germline KIT K642E mutation. Arch Pathol Lab Med 2007; 131:1393-6. [PMID: 17824795 DOI: 10.5858/2007-131-1393-iitmom] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2007] [Indexed: 11/06/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gut and are distinguished by expression of CD117 (c-Kit). Oncogenic mutations in the KIT or PDGFRA gene are detected in approximately 85% of sporadic GISTs. In recent years, examples of familial GIST have been reported in which germline mutations of KIT or PDGFRA result in multiple GISTs, skin disorders, and other abnormalities. The most common germline mutations are in KIT exon 11, mutations in exons 8 and 17 have also been described, and there are 2 families with germline PDGFRA mutations. We present a case in which a germline KIT exon 13 mutation (K642E) was discovered in a patient with multiple GISTs of rectum, small intestine, and esophagus, as well as diffuse hyperplasia of the interstitial cells of Cajal. To our knowledge, this is only the second germline example of this particular mutation. The patient's esophageal tumors were stabilized with imatinib.
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Affiliation(s)
- Janet Graham
- Beatson Oncology Centre, Glasgow, United Kingdom
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41
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Sato Y, Ichimura K, Tanaka T, Takata K, Morito T, Sato H, Kondo E, Yanai H, Ohara N, Oka T, Yoshino T. Duodenal follicular lymphomas share common characteristics with mucosa-associated lymphoid tissue lymphomas. J Clin Pathol 2007; 61:377-81. [PMID: 17601964 DOI: 10.1136/jcp.2007.049825] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Follicular lymphomas occasionally arise in the extra-nodal organs and are frequently found in the duodenum. They are often localised tumours with multiple polyps around the ampulla of Vater. AIMS To examine a IgH/bcl-2 hybrid gene and VH gene to investigate the nature of the lymphoma cells and how they differ from nodal follicular lymphomas and MALT lymphomas. METHODS Of 40 patients reported previously, 35 with duodenal follicular lymphoma were studied in detail with respect to clinicopathological characteristics. RESULTS 37/40 patients were in clinical stage I (n = 30) or stage II (n = 7). Clonal immunoglobulin gene rearrangement was detected in 53.3% of examined cases, and rearrangement of IgH/bcl-2 gene at the major break point was detected in 27% of cases. Three of 8 examined cases were VH4 (38%); 2 out of them were VH4-34. As VH4 deviation is one of the common characteristics of MALT lymphomas and 2/3 were identical, duodenal follicular lymphomas have a similar aetiology to MALT lymphomas. Clinical course was also similar to that of MALT lymphomas. CONCLUSIONS Results suggest that duodenal follicular lymphomas have intermediate characteristics of MALT lymphomas and nodal follicular lymphomas.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Blotting, Southern
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Duodenal Neoplasms/genetics
- Duodenal Neoplasms/pathology
- Female
- Gene Rearrangement
- Genes, Immunoglobulin
- Genes, bcl-2
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Immunophenotyping
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Sequence Analysis, DNA
- Translocation, Genetic
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Affiliation(s)
- Y Sato
- Department of Pathology, Okayama University Graduate School of Medical, Dentistry and Pharmaceutical Sciencies, Okayama, Japan
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Schreiber-Facklam H, Bode-Lesniewska B, Frigerio S, Flury R. Primary monophasic synovial sarcoma of the duodenum with SYT/SSX2 type of translocation. Hum Pathol 2007; 38:946-9. [PMID: 17509396 DOI: 10.1016/j.humpath.2007.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 12/04/2006] [Accepted: 01/11/2007] [Indexed: 01/09/2023]
Abstract
Recent findings on the molecular background of synovial sarcoma with the description of the specific translocation t(X;18) led to the incorporation of this particular genetic aberration into the definition of this tumor type. Synovial sarcomas with proven diagnostic translocation are being described with increasing frequency in unsuspected locations not related to joints, such as lung, pleura, heart, or pharynx. The gastrointestinal tract has been rarely reported as a primary site of synovial sarcomas with rare cases in the esophagus and stomach. We report a case of a primary synovial sarcoma of the distal duodenum with SYT/SSX2 type of the t(X;18) translocation. Primary spindle cell neoplasms of the duodenum are rare and consist mostly of gastrointestinal stromal tumors, which are amenable to the therapy with Gleevec. Synovial sarcoma widens the differential diagnosis of mesenchymal tumors of the intestine.
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Anlauf M, Perren A, Henopp T, Rudolf T, Garbrecht N, Schmitt A, Raffel A, Gimm O, Weihe E, Knoefel WT, Dralle H, Heitz PU, Komminoth P, Klöppel G. Allelic deletion of the MEN1 gene in duodenal gastrin and somatostatin cell neoplasms and their precursor lesions. Gut 2007; 56:637-44. [PMID: 17135306 PMCID: PMC1942169 DOI: 10.1136/gut.2006.108910] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/19/2006] [Accepted: 10/25/2006] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with a multiple endocrine neoplasia type 1 (MEN1)-associated Zollinger-Ellison syndrome (ZES) show multifocal duodenal gastrinomas and precursor lesions. AIMS To test these lesions for loss of heterozygosity (LOH) of the MEN1 gene locus on chromosome 11q13, and to investigate whether the MEN1-related endocrine cell changes also involved somatostatin cells. MATERIAL AND METHODS Tissue specimens from six patients with MEN1 and ZES were analysed by immunohistochemistry and immunofluorescence. LOH analysis was performed by fluorescence in situ hybridisation (FISH), using probes containing the MEN1 gene locus and the centromere 11 (C11) region. For simultaneous analysis of hormones and allelic deletions, a combined FISH/immunofluorescence protocol was established. RESULTS 28 of a total of 33 duodenal neuroendocrine tumours (NETs) were gastrin-producing tumours; 13/28 (46.4%) revealed LOH on 11q13 and/or C11. Five of the NETs were somatostatin-expressing tumours, two revealing LOH. Allelic loss was detected in tumours as small as 300 microm (gastrin) and 400 microm (somatostatin) in diameter. The gastrin-producing tumours showed different deletion/retention patterns. Hyperplastic somatostatin cell lesions, similar to those of the gastrin cells, were present in all patients. The hyperplastic lesions of both cell lines consistently retained both 11q13 alleles. CONCLUSIONS Allelic deletion of the MEN1 gene may reflect a pivotal event in the development of multifocal gastrin and somatostatin cell neoplasms in the duodenum of patients with MEN1. The observation of distinct deletion patterns in small synchronous tumours supports the concept that each gastrin-producing tumour in an individual MEN1 patient arises from an independent cell clone.
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Affiliation(s)
- M Anlauf
- Department of Pathology W, University of Kiel, Michaelisstr 11, 24105 Kiel, Germany.
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44
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Abstract
Deletion of the second allele of the tumour suppressor gene MEN1 is assoiated with development of duodenal gastrin‐secreting microtumours in MEN1
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Affiliation(s)
- D M Pritchard
- Division of Gastroenterology, School of Clinical Sciences, University of Liverpool, The Henry Wellcome Laboratory, Nuffield Building, Crown Street, Liverpool L69 3GE, UK.
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Tsujioka T, Wada H, Yata KI, Kondo T, Suemori S, Tokunaga H, Ohmori K, Kubo Y, Nakanishi H, Mikami M, Haruma K, Sadahira Y, Sugihara T. [Clinical analysis of eight patients with primary follicular lymphoma in the duodenum]. Rinsho Ketsueki 2007; 48:134-9. [PMID: 17370641] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We performed a clinical analysis on 8 patients with primary follicular lymphoma in the duodenum taken from among 26 cases of primary gastrointestinal malignant lymphoma treated in our division. The median age was 60 years (range 48 to 82 yr). The ratio of males to females was 4:4. The chief complaints were no symptoms in 4 cases, heartburn in 2 cases, lower abdominal pain in 1 case, and back pain in 1 case. All patients were in clinical stage I EA. Gastroendoscopic findings showed multiple whitish granules around the ampulla of Vater in all patients. Involvement of the site in 6 cases was only located at the second portion; lesions in the other 2 cases were located at the second portion, and at the third portion or fourth portion, respectively. A histological study showed follicular lymphoma grade 1, and an immunohistological study demonstrated that the lymphoma cells were positive for CD79a, CD10, CD20, and bcl-2. Five patients were positive for the FISH analysis fusion signal of IgH/bcl-2 genes. Rituximab with CHOP therapy was performed for 7 patients. Seven patients are currently alive, and one died of uterine cancer. At the medium-term 39 month-follow-up, 7 patients were in complete remission, and 1 patient was in partial remission. Rituximab with CHOP (CVP) therapy is a possible treatment for primary follicular lymphoma in the duodenum. Further consideration of appropriate therapy for this disease might be necessary.
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Affiliation(s)
- Takayuki Tsujioka
- Division of Hematology, Department of Medicine, Kawasaki Medical School
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Will O, Carvajal-Carmona LG, Gorman P, Howarth KM, Jones AM, Polanco-Echeverry GM, Chinaleong JA, Günther T, Silver A, Clark SK, Tomlinson I. Homozygous PMS2 deletion causes a severe colorectal cancer and multiple adenoma phenotype without extraintestinal cancer. Gastroenterology 2007; 132:527-30. [PMID: 17258725 DOI: 10.1053/j.gastro.2006.11.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 10/26/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS We report a patient of Indian descent with parental consanguinity, who developed 10 carcinomas and 35 adenomatous polyps at age 23 and duodenal adenocarcinoma at age 25. He also had dysmorphic features, mental retardation, and café-au-lait spots but no brain tumor. We aimed to establish his molecular diagnosis. METHODS Germ-line screening for APC and MYH/MUTYH mutations was normal as was immunohistochemistry for MLH1 and MSH2 proteins. Investigation by array-comparative genomic hybridization revealed deletion of a small region on chromosome 7. Using polymerase chain reaction, this region was refined to a 400-kilobase deletion, which included exons 9-15 of the PMS2 gene, and all coding regions of oncomodulin, TRIAD3, and FSCN1. RESULTS The deletion was confirmed as homozygous, and both parents were carriers. Immunohistochemistry showed absent PMS2 expression in all tumors and normal tissue. Most tumors showed microsatellite instability, more marked at dinucleotide than mononucleotide repeats. The tumors harbored no somatic mutations in APC, BRAF, AXIN2, or beta-catenin, but KRAS2 and TGFBR2 mutations were found. CONCLUSIONS Our patient represents a novel phenotype for homozygous PMS2 mutation and perhaps the most severe colorectal cancer phenotype-in terms of numbers of malignancies at an early age-described to date. PMS2 mutations-and perhaps other homozygous mismatch repair mutations-should be considered in any patient presenting with multiple gastrointestinal tumors, since our patient could not be distinguished clinically from cases with attenuated familial adenomatous polyposis or MUTYH-associated polyposis.
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Affiliation(s)
- Olivia Will
- Molecular and Population Genetics Laboratory, London Research Institute, Cancer Research, London, UK
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47
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Anlauf M, Perren A, Klöppel G. [Gastrin cell hyperplasia associated with duodenal MEN1-related gastrinomas: histopathology and genetics]. Verh Dtsch Ges Pathol 2007; 91:320-329. [PMID: 18314630] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIMS The identification of precursor lesions has a great impact on our understanding of tumorigenesis. In this study we investigated whether preneoplastic lesions can be identified in sporadic gastrinomas and in gastrinomas in multiple endocrine neoplasia type 1 (MEN1) patients. These lesions were tested for loss of heterozygosity (LOH) of the MEN1 gene locus on chromosome 11q13. MATERIAL AND METHODS Tissue specimens from 25 patients with Zollinger-Ellison syndrome (ZES) were analyzed. The MEN1 status was assessed clinically and by mutational analysis. For simultaneous analysis of hormones and allelic deletions a combined FISH fluorescence in situ hybridization/immunofluorescence protocol was established. RESULTS Hyperplastic gastrin cell lesions were present in the nontumorous mucosa of all MEN1 patients, but not in 12 patients with sporadic duodenal gastrinomas. The hyperplastic gastrin cells retained both 11q13 alleles. 11q13 LOH was, however, detected in duodenal gastrinomas, some as small as 300 microm in diameter, in 13 patients with MEN1. CONCLUSIONS MEN1-associated duodenal gastrinomas, but not sporadic gastrinomas, are associated with gastrin cell hyperplasia. It is therefore likely that hyperplastic gastrin cell lesions precede the development of MEN1-associated duodenal gastrinomas. Allelic deletion of the MEN1 gene locus may reflect a decisive initial event in the development of multifocal MEN1-associated gastrinomas from hyperplastic gastrin cell lesions.
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Affiliation(s)
- M Anlauf
- Institut für Pathologie, Universitätsklinikum S-H, Campus Kiel
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48
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Abstract
This review focuses on precursor lesions of gastrointestinal and pancreatic neuroendocrine tumors (GEP-NETs). There are three conditions that are associated with hyperplastic changes in endocrine cells preceding GEP-NETs: autoimmune chronic atrophic gastritis or multiple endocrine neoplasia type 1 (MEN1) with gastric enterochromaffin-like (ECL) cell hyperplasia; MEN1 with gastrin and somatostatin cell hyperplasia in the duodenum and glucagon cell hyperplasia in the islets of the pancreas; and inflammatory bowel disease with endocrine cell hyperplasia in the colon. In gastric ECL cell hyperplasia, it is assumed that hypergastrinemia promotes the growth of the ECL cells of the corpus mucosa and leads to hyperplasia and neoplasia. In the duodenum and the pancreas, the MEN1-associated germline mutation of the menin gene obviously causes hyperplasia of the gastrin and somatostatin cells (duodenum) and the glucagon cells (pancreas), resulting in multifocal development of tumors. These tumors show allelic deletion of the MEN1 gene, whereas the precursor lesions retain their heterozygosity. The endocrine cell hyperplasia in the colon described in inflammatory bowel disease has neither a genetic nor a definite hormonal background.
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Affiliation(s)
- Günter Klöppel
- Department of Pathology, University of Kiel, Michaelisstr. 11, 24105, Kiel, Germany.
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Karlin L, Itti E, Pautas C, Rachid M, Bories D, Cordonnier C, Maury S. PET-imaging as a useful tool for early detection of the relapse site in the management of primary myeloid sarcoma. Haematologica 2006; 91:ECR54. [PMID: 17194660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Bone Marrow Transplantation
- Combined Modality Therapy
- Cytarabine/administration & dosage
- Duodenal Neoplasms/diagnostic imaging
- Duodenal Neoplasms/drug therapy
- Duodenal Neoplasms/genetics
- Duodenal Neoplasms/surgery
- Early Diagnosis
- Humans
- Leukemic Infiltration/drug therapy
- Male
- Meninges/pathology
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/drug therapy
- Oncogene Proteins, Fusion/analysis
- Oncogene Proteins, Fusion/genetics
- Positron-Emission Tomography
- Remission Induction
- Sarcoma, Myeloid/diagnostic imaging
- Sarcoma, Myeloid/drug therapy
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/surgery
- Transplantation, Homologous
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Affiliation(s)
- Lionel Karlin
- Department of Hematology, Hôpital Henri Mondor, 94010 Créteil cedex, France
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50
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Anlauf M, Garbrecht N, Henopp T, Schmitt A, Schlenger R, Raffel A, Krausch M, Gimm O, Eisenberger CF, Knoefel WT, Dralle H, Komminoth P, Heitz PU, Perren A, Klöppel G. Sporadic versus hereditary gastrinomas of the duodenum and pancreas: Distinct clinico-pathological and epidemiological features. World J Gastroenterol 2006; 12:5440-6. [PMID: 17006979 PMCID: PMC4088224 DOI: 10.3748/wjg.v12.i34.5440] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastrinomas are defined as gastrin secreting tumors that are associated with Zollinger-Ellison syndrome (ZES). ZES is characterized by elevated fasting gastrin serum levels, positive secretin stimulation test and clinical symptoms such as recurrent peptic ulcer disease, gastroesophageal reflux disease and occasional diarrhea. Genetically, nonhereditary (sporadic) gastrinomas are distinguished from hereditary gastrinomas, which are associated with multiple endocrine neoplasia type 1 (MEN1) syndrome. In general, duodenal gastrinomas are small and solitary if they are sporadic and multiple as well as hereditary. The sporadic gastrinomas occur in the duodenum or in the pancreas while the hereditary gastrinomas almost all occur in the duodenum. Our series of 77 sporadic duodenal neuroendocrine tumors (NETs) includes 18 patients (23.4%) with gastrinomas and ZES. Of 535 sporadic NETs in the pancreas collected from the NET archives of the departments of pathology in Zürich, Switzerland, and Kiel, Germany, 24 patients (4.5%) suffered from sporadic pancreatic gastrinomas and ZES. These NETs have to be distinguished from tumors with immunohistochemical positivity for gastrin but without evidence of ZES. An additional 19 patients suffered from MEN1 and ZES. These patients showed exclusively duodenal gastrinomas, but not pancreatic gastrinomas. The prognosis of sporadic and MEN1-associated duodenal gastrinomas is better than that of pancreatic gastrinomas, since they progress slowly to liver metastasis. In summary, sporadic and MEN1-associated gastrinomas in the duodenum and pancreas show different clinico-pathological and genetic features. The incidence of sporadic duodenal gastrin-producing tumors is increasing, possibly due to optimized diagnostic procedures. In contrast, pancreatic MEN1-associated gastrinomas seem to be extremely rare. A considerable subset of tumors with immunohistochemical expression of gastrin but without evidence of ZES should be designated as functionally inactive NETs expressing gastrin, but not as gastrinomas.
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Affiliation(s)
- Martin Anlauf
- Department of Pathology, University of Kiel, Michaelisstrasse 11, 24105 Kiel, Germany.
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