Management of Symptomatic Hemorrhage From a Developmental Venous Anomaly

Developmental venous anomalies (DVAs) are clinically benign, low-flow vascular malformations that classically hemorrhage only when associated with a cerebral cavernous malformation. It is very rare for an isolated DVA to hemorrhage. Resection of the DVA is generally contraindicated because of the high risk of venous infarct. We present the case of a large symptomatic hemorrhage stemming from an isolated DVA. The hematoma was evacuated and the hemorrhagic portion of the DVA was resected. This case demonstrates that in rare circumstances, careful resection can successfully treat hemorrhagic DVAs.

Targeted Next-Generation Sequencing Reveals Divergent Clonal Evolution in Components of Composite Pleomorphic Xanthoastrocytoma-Ganglioglioma

Composite pleomorphic xanthoastrocytoma-ganglioglioma (PXA-GG) is an extremely rare central nervous system neoplasm with 2 distinct but intermingled components. Whether this tumor represents a "collision tumor" of separate neoplasms or a monoclonal neoplasm with divergent evolution is poorly understood. Clinicopathologic studies and capture-based next generation sequencing were performed on extracted DNA from all available PXA-GG at 2 medical centers. Five PXA-GG were diagnosed in 1 male and 4 female patients ranging from 13 to 25 years in age. Four arose within the cerebral hemispheres; 1 presented in the cerebellar vermis. DNA was sufficient for analysis in 4 PXA components and 3 GG components. Four paired PXA and GG components harbored BRAF p.V600E hotspot mutations. The 4 sequenced PXA components demonstrated CDKN2A homozygous deletion by sequencing with loss of p16 (protein product of CDKN2A) expression by immunohistochemistry, which was intact in all assessed GG components. The PXA components also demonstrated more frequent copy number alterations relative to paired GG components. In one PXA-GG, shared chromosomal copy number alterations were identified in both components. Our findings support divergent evolution of the PXA and GG components from a common BRAF p.V600E-mutant precursor lesion, with additional acquisition of CDKN2A homozygous deletion in the PXA component as is typically seen in conventional PXA.

Developmentally anomalous cerebellar encephalocele arising within the cerebellopontine angle and extending into the adjacent skull base in a pediatric patient

Lesions of the cerebellopontine angle (CPA) in young children are rare, with the most common being arachnoid cysts and epidermoid inclusion cysts. The authors report a case of an encephalocele containing heterotopic cerebellar tissue arising from the right middle cerebellar peduncle and filling the right internal acoustic canal in a 2-year-old female patient. Her initial presentation included a focal left 6th nerve palsy. Magnetic resonance imaging was suggestive of a high-grade tumor of the right CPA. The lesion was removed via a retrosigmoid approach, and histopathologic analysis revealed heterotopic atrophic cerebellar tissue. This report is the first description of a heterotopic cerebellar encephalocele within the CPA and temporal skull base of a pediatric patient.

Accuracy of Suction Rectal Biopsy for Diagnosis of Hirschsprung's Disease in Neonates

INTRODUCTION

 Recent publications have questioned the sensitivity of suction rectal biopsy (SRB) for diagnosis of Hirschsprung's disease (HD) in newborns. A recent European survey reported that 39% of pediatric surgeons performed full-thickness transanal biopsies due to concerns about the accuracy of SRB. We sought to examine our contemporary SRB experience in infants.

MATERIALS AND METHODS

 A review was performed (2007-2016) of patients under 6 months of age who had a SRB at our children's hospital. The cohort was subdivided by postmenstrual age at time of SRB: preterm (< 40 weeks, A), term neonate (40-44 weeks, B), and infant (> 44 weeks, C). The pathology reports from endorectal pull-through were used as gold standard confirmation. One-year follow-up of patients with negative SRB was used to confirm accurate diagnosis.

RESULTS

 A total of 153 patients met the criteria and a total of 159 SRBs (< 2,500 g; n = 26) were performed (A = 60, B = 58, C = 35). Forty-three patients were diagnosed with HD (A = 25, B = 15, C = 3). A second SRB was performed in 6 (3.9%) patients due to inadequate tissue (A = 2, B = 2, C = 2) with HD diagnosed in 5. No complications occurred. Sensitivity and specificity of SRB was 100% in all age groups. Half of the patients with a negative SRB had at least 1 year follow-up, with none subsequently diagnosed with HD.

CONCLUSION

 SRB results in adequate tissue for evaluation of HD in nearly all patients less than 6 months of age on the first attempt and is highly accurate in the preterm and newborn infants. No complications occurred, even among infants less than 2,500 g.

Neonatal cholestasis and hepatosplenomegaly caused by congenital dyserythropoietic anemia type 1: A case report

BACKGROUND

Congenital dyserythropoietic anemia type 1 (CDA1) is an autosomal recessive disorder of ineffective erythropoiesis, resulting in increased iron storage. CDA1 is usually diagnosed in children and adolescents but can rarely present in the neonatal period with severe anemia at birth. There are no prior reports of neonatal liver histologic findings of CDA1. We report a case of CDA1 in a newborn presenting with severe anemia, cholestasis and liver failure, where liver biopsy helped confirm the diagnosis.

CASE SUMMARY

A term infant, born via emergency Cesarean section, presented with cholestasis, hepatosplenomegaly, multiorgan failure and severe anemia at birth. A prior pregnancy was significant for fetal demise at 35 wk without autopsy or known etiology for the fetal demise. Parents are both healthy and there is no history of consanguinity. On further evaluation, the patient was found to have severe ferritin elevation and pulmonary hypertension. An extensive infectious and metabolic work-up was negative. Salivary gland biopsy was negative for iron deposition. At 2 wk of age, a liver biopsy showed findings consistent with CDA1. A genome rapid sequencing panel revealed novel variants in the CDAN1 gene. The patient’s liver dysfunction, cholestasis and organomegaly resolved, however she remains transfusion-dependent.

CONCLUSION

We report liver pathology findings of CDA1 with a novel genetic mutation for the first time in a newborn.

C/EBPβ-1 promotes transformation and chemoresistance in Ewing sarcoma cells

CEBPB copy number gain in Ewing sarcoma was previously shown to be associated with worse clinical outcome compared to tumors with normal CEBPB copy number, although the mechanism was not characterized. We employed gene knockdown and rescue assays to explore the consequences of altered CEBPB gene expression in Ewing sarcoma cell lines. Knockdown of EWS-FLI1 expression led to a decrease in expression of all three C/EBPβ isoforms while re-expression of EWS-FLI1 rescued C/EBPβ expression. Overexpression of C/EBPβ-1, the largest of the three C/EBPβ isoforms, led to a significant increase in colony formation when cells were grown in soft agar compared to empty vector transduced cells. In addition, depletion of C/EBPβ decreased colony formation, and re-expression of either C/EBPβ-1 or C/EBPβ-2 rescued the phenotype. We identified the cancer stem cell marker ALDH1A1 as a target of C/EBPβ in Ewing sarcoma. Furthermore, increased expression of C/EBPβ led to resistance to chemotherapeutic agents. In summary, we have identified CEBPB as an oncogene in Ewing sarcoma. Overexpression of C/EBPβ-1 increases transformation, upregulates expression of the cancer stem cell marker ALDH1A1, and leads to chemoresistance.

Abstract 483: Functional validation of CEBPB as an oncogenic target of EWS-FLI1 in Ewing sarcoma

We previously identified increased copies of CEBPB in a subset of Ewing sarcoma (ES) tumors, and this gain was associated with worse clinical outcome. Due to CEBPB's role in cell growth and differentiation, as well as the gene's ability to transform normal mammary epithelial cells, we hypothesized that CEBPB acts as an oncogene in ES by increasing cell proliferation and transformation. To address this hypothesis, we altered gene expression using viral gene delivery systems in ES cell lines. First, we tested if CEBPB is a target of the EWS-FLI1 fusion protein using a FLI1 shRNA to knockdown EWS-FLI1 in an ES cell line (A673), followed by re-expression of the fusion gene. We then measured expression of the three C/EBPβ (protein) isoforms by western blot. Knockdown of EWS-FLI1 expression led to decreased protein expression of all three C/EBPβ isoforms. Re-expression of EWS-FLI1 rescued C/EBPβ protein expression, suggesting that C/EBPβ is a target of EWS-FLI1. To explore the functional consequence of altered expression of CEBPB, we transduced ES cell lines to knockdown, overexpress, and rescue C/EBPβ. Changes in protein expression were confirmed by western blot. Following transduction and antibiotic selection, cell proliferation and colony formation were measured by quantification of cellular ATP (Cell Titer Glo, Promega). Overexpression of C/EBPβ-1, the largest of the three C/EBPβ isoforms, led to a significant (p&lt;0.005) increase in colony formation when cells were grown in soft agar compared to empty vector transduced cells. In addition, knockdown of C/EBPβ decreased colony formation (p&lt;0.05), and re-expression of either C/EBPβ-1 (p&lt;0.0001) or C/EBPβ-2 (p&lt;0.005) rescued the phenotype. To identify downstream targets of C/EBPβ we measured changes in protein expression by western blot of potential CEBPB targets in cells with overexpression of each C/EBPβ isoform. Overexpression of C/EBPβ-1 and CEBPβ-2 led to increased protein expression of ALDH1A1. In addition, overexpression of C/EBPβ-1 and C/EBPβ-2 led to resistance to chemotherapeutic agents similar to previous reports of chemoresistance for ES cells that overexpressed ALDH. In conclusion, the increased transformation potential of ES cells that overexpress either C/EBPβ-1 or C/EBPβ-2 indicates that CEBPB is an oncogenic target of EWS-FLI1. Poor outcome for patients with CEBPB amplifications may result from chemoresistance mediated by increased expression of ALDH1A1. In addition, increased expression of ALDH may suggest that overexpression of C/EBPβ in ES tumors induces a stem cell like state. Patients with CEBPB amplifications may benefit from pretreatment with ALDH inhibitors prior to chemotherapy.

Citation Format: Lisa M. Abegglen, Jamie D. Gardiner, Clinton C. Mason, Bryce E. Carter, Elizabeth A. Schackmann, Marcus Stucki, Angelica R. Putnam, R Lor Randall, Heinrich Kovar, Stephen L. Lessnick, Joshua D. Schiffman. Functional validation of CEBPB as an oncogenic target of EWS-FLI1 in Ewing sarcoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 483. doi:10.1158/1538-7445.AM2015-483

Secondary osteosarcoma: is there a predilection for the chondroblastic subtype?

Osteosarcoma is the most common form of primary bone cancer in the adolescent and young adult patient population. Outcomes in patients with secondary osteosarcoma are inferior compared with outcomes in patients with primary osteosarcoma. The goal of this study was to investigate whether there is a predilection for the chondroblastic histologic subtype in secondary osteosarcoma. A retrospective chart review was performed to identify cases of secondary osteosarcoma treated at 1 institution from 1991 to 2012. Histologic subtypes were evaluated by a pathologist, and a review of the literature was also performed to identify the histologic subclassification of additional series of secondary osteosarcomas. Of a total of 131 cases of osteosarcoma, 9 (6.9%) were identified as a secondary malignancy. Only 2 cases (22%) were identified as chondroblastic variants, although 6 (67%) showed some degree of chondroid differentiation. Of the 3 cases meeting the criteria for postradiation osteosarcoma, 2 (67%) were identified as chondroblastic variants and all 3 showed some degree of chondroid differentiation. Five other studies evaluating histologic subtypes in postradiation osteosarcoma showed a cumulative frequency of 20% for the chondroblastic variant. Although the study results did not support the hypothesis of an association between secondary osteosarcoma and the chondroblastic subtype, the high proportion of cases of postradiation osteosarcoma with the chondroblastic subtype and the even higher proportion showing some degree of chondroid differentiation are noteworthy features of this disease.

Hirschsprung disease in the premature newborn: a population based study and 40-year single center experience

BACKGROUND/PURPOSE

Understanding of Hirschsprung disease (HD) in premature newborns (PHD) is anecdotal. We have sought in this study to identify the demographic and clinical features of PHD.

METHODS

All patients with HD 1970-2011 treated at our tertiary care children's hospital were identified. Patients with biopsy confirmed HD and EGA <37weeks were selected for further review. Prenatal and birth data, demographics, clinical signs, radiologic and pathologic data, and operative interventions were examined. The occurrence of PHD was observed using data from the Utah Department of Health database 1997-2011.

RESULTS

404 patients with HD from 1970 to 2011 were treated. Twenty-seven (6.7%) had PHD. Mean birth weight in PHD was 2196grams and mean gestational age 34 (range 29-36)weeks. Seven patients had Down syndrome. Nonchromosomal anomalies occurred in 25%. Median time from birth to biopsy diagnosis was 42days (range 2-316days). The most common presenting signs were abdominal distension and bilious emesis. The HD incidence in Utah for all births was 1/4322 (0.023%) and for premature infants 1/3885 (0.027%).

CONCLUSIONS

PHD are similar to term infants with HD. Diagnosis of HD is often delayed in premature newborns, and associated anomalies are more common.

Rye residues contribute weed suppression in no-tillage cropping systems

The use of allelopathic cover crops in reduced tillage cropping systems may provide an ecologically sound and environmentally safe management strategy for weed control. Growers often plant winter rye (Secale cereale L.) for increased soil organic matter and soil protection. Spring-planted living rye reduced weed biomass by 93% over plots without rye. Residues of fall-planted/spring-killed rye reduced total weed biomass over bare-ground controls. Rye residues also reduced total weed biomass by 63% when poplar excelsior was used as a control for the mulch effect, suggesting that allelopathy, in addition to the physical effects of the mulch, did contribute to weed control in these systems. In greenhouse studies, rye root leachates reduced tomato dry weight by 25-30%, which is additional evidence that rye is allelopathic to other plant species.

Isolation and characterization of phytotoxic compounds from asparagus (Asparagus officinalis L.) roots

Potential allelochemicals from aqueous extracts of dried asparagus (Asparagus officinalis L.) roots were isolated and characterized. Active fractions separated by HPLC included ferulic, isoferulic, malic, citric, and fumaric acids. Soxhlet extraction of the residues also produced phytotoxic caffeic acid. Although none of these compounds, when applied singly, was active enough to account for the phytotoxicity of asparagus extracts, their combined effect might be additive or synergistic. An extract from lyophilized fresh root tissues contained a fraction that was one order of magnitude more toxic than any compound obtained from the dried roots. The most active component was isolated by TLC and characterized by [(1)H]NMR as methylenedioxycinnamic acid (MDCA). This compound provided severe inhibition of curly cress (Lepidium sativum L.) root and shoot growth at concentrations of 25 ppm or above.

Molecular inversion probe analysis detects novel copy number alterations in Ewing sarcoma

Ewing sarcoma (ES) is the second most common bone tumor in children and young adults, with dismal outcomes for metastatic and relapsed disease. To better understand the molecular pathogenesis of ES and to identify new prognostic markers, we used molecular inversion probes (MIPs) to evaluate copy number alterations (CNAs) and loss of heterozygosity (LOH) in formalin-fixed paraffin-embedded (FFPE) samples, which included 40 ES primary tumors and 12 ES metastatic lesions. CNAs were correlated with clinical features and outcome, and validated by immunohistochemistry (IHC). We identified previously reported CNAs, in addition to SMARCB1 (INI1/SNF5) homozygous loss and copy neutral LOH. IHC confirmed SMARCB1 protein loss in 7-10% of clinically diagnosed ES tumors in three separate cohorts (University of Utah [N = 40], Children's Oncology Group [N = 31], and University of Michigan [N = 55]). A multifactor copy number (MCN)-index was highly predictive of overall survival (39% vs. 100%, P < 0.001). We also identified RELN gene deletions unique to 25% of ES metastatic samples. In summary, we identified both known and novel CNAs using MIP technology for the first time in FFPE samples from patients with ES. CNAs detected by microarray correlate with outcome and may be useful for risk stratification in future clinical trials.

Premature closure of the foramen ovale secondary to congenital aortic valvular stenosis in a stillborn

Premature closure of the foramen ovale is a rare and deleterious condition that can occur as an isolated defect or in association with other congenital and cardiovascular anomalies. We report on the pathologic findings in a 22-week stillborn male fetus with premature closure of the foramen ovale, severe aortic valve stenosis, cardiomegaly, intact atrial and ventricular septa, hypoplasia of the ascending aorta, and hypoplastic aortic arch with a preductal coarctation ridge. To the best of our knowledge, this is only the second report on this rare constellation of complex congenital cardiac defects.

Unilateral sclerocornea and tracheal stenosis: unusual findings in a patient with Goldenhar anomaly

The Goldenhar anomaly (GA) is a heterogeneous field defect of uncertain cause and wide variability of expression, characterized by facial phenotypes, usually asymmetric and unilateral, accompanied by various combinations and gradations of cardiac, skeletal, renal, and central nervous system defects. We report the pathologic findings in a 5-month-old boy with GA, tracheal stenosis, and left unilateral sclerocornea. To the best of our knowledge this is the first description of sclerocornea in a patient with GA.

Mortality and pathological findings in C (Opitz trigonocephaly) syndrome

Even as a rare multiple congenital anomalies/mental retardation syndrome, the C-syndrome (CS, or Opitz C-trigonoecephaly syndrome) is, at long last, beginning to attract attention because of its developmental and causal complexity. Also, the possibility that the apparently balanced translocation recently described in an affected Japanese boy may soon provide a molecular/causal insight into this disorder. The manifestations recorded in the previously published patients, those autopsied within recent years, and the unpublished instances in our files suggest that the CS is a heterogeneous genetic disorder, predominantly sporadic but with sufficient familial cases (at times with consanguinity) to allow postulation of an entity due to autosomal dominant mutations with a high rate of germinal mosaicism, or due to both autosomal dominant mutations and an autosomal recessive genocopy. In any event, elucidation of cause and pathogenesis of CS will, in due time, shed light on its developmental pleiotropy, rarity in liveborn infants, prevalence in stillborn fetuses, recurrence risk in humans, and occurrence in other animals (e.g., mice) to further understanding of pathogenesis.

Prenatal death in Fraser syndrome

Cryptophthalmos may be partial or complete, unilateral or bilateral, apparently nonsyndromal or syndromal. A recent study of 2 stillborn infants at the University of Utah prompted an analysis of the developmental aspects of the syndromal form (Fraser syndrome). We conclude that, per se, cryptophthalmos is a developmental field defect on the basis of heterogeneity (autosomal dominant and recessive forms) and phylogeneity (occurrence also in the pheasant, rabbit, pigeon, dog, and mouse). In humans this autosomal recessive disorder maps to 4q21, is homologous to the bleb (bl/bl) mouse, and is due to mutations in the FRAS1 gene that codes for a 4007 amino acid protein 85% identical to the Fras1 gene of the bleb mouse. Commonest anomalies in humans are cryptophthalmos, cutaneous syndactyly of digits, abnormal ears and genitalia, renal agenesis, and congenital heart defects. Almost half of affected infants are stillborn or die in infancy, and mental retardation is common. The pathogenesis evidently involves abnormal epithelial integrity during prenatal life. Older (mostly German) publications, some dating to the 19th century, provide a fascinating historical insight into the process of syndrome delineation.

Modeling a submicrometer electrostatic motor

Numerical models are developed for a recently proposed submicrometer device that uses the electric field energy of a biased parallel-plate semiconducting capacitor to propel a piston through the open capacitor gap. Through variation of design parameters or applied external bias, actuator forces on the order of hundreds of piconewtons are developed for device size scales ranging from 10(-7) m to 10(-4) m per side. A rotary configuration of the device is also presented.

Antifungal anthracycline antibiotics, spartanamicins A and B from Micromonospora spp

Spartanamicins A and B, two antifungal antibiotics, were produced by a culture of Micromonospora spp. strain No. MSU-43097 (ATCC 53803), isolated from a potted soil containing asparagus (Asparagus officinalis L.) plants. The antibiotics were isolated from the mycelial cake using organic solvents. The structures of spartanamicins A and B were determined by spectral and chemical means. Spartanamicin B is more active as an antifungal compound than it's analogue, A. The minimum inhibitory concentration for spartanamicin B on Candida albicans and Aspergillus, Cladosporium, Cryptococcus, Rhodotorula and Staphylococcus spp. ranged from 0.2 to 1 microgram/ml. It was not active against Staphylococcus aureus, Escherichia coli and Citrobacter spp. but some strains of S. aureus were sensitive.

In vitro antibacterial activity of faeriefungin, a new broad-spectrum polyene macrolide antibiotic

The in vitro activity of faeriefungin, a new pentaene macrolide lactone antibiotic produced by Streptomyces griseus var. autotrophicus, against 263 clinical bacterial isolates was examined. In contrast to the related fungicidal antibiotics nystatin and amphotericin B, which show no activity against bacteria, faeriefungin showed bactericidal activity against all species of gram-positive bacteria examined. MICs for these species ranged from 8 to 64 micrograms/ml, and the MIC for 90% of the isolates tested was 32 micrograms/ml. Isolates of some fastidious gram-negative species, including Neisseria gonorrhoeae, N. meningitidis, and Haemophilus influenzae, were slightly susceptible to faeriefungin, with MICs ranging from 16 to 128 micrograms/ml, but all members of the families Enterobacteriaceae and Pseudomonadaceae, with the exception of Pseudomonas cepacia, were completely resistant to faeriefungin at the concentrations tested. Faeriefungin is also active against fungi, nematodes, and mosquito larvae. The mode of action of faeriefungin against both bacteria and fungi is under investigation.

Herbicidal effects of geldanamycin and nigericin, antibiotics from Streptomyces hygroscopicus

Geldanamycin (2) and nigericin (1) (primarily the Na+ salt) are responsible for the phytotoxicity of a Streptomyces hygroscopicus strain found to be highly active in our screens for producers of herbicidal antibiotics. After extraction from the cells, the compounds were purified with column and thin layer layer chromatography on silica gel, bioassayed for inhibition of garden cress (Lepidium sativum L.) radicle elongation, and identified with ms, ir, nmr, and co-chromatography with authentic standards. Both caused 50% reduction in garden cress radicle growth at concentrations of 1-2 ppm and nearly complete inhibitions at 3-4 ppm. Symptoms of toxicity differed markedly for the two compounds. Geldanamycin at high concentrations caused radicles to turn brown and disintegrate, whereas, nigericin did not cause visible necrosis. Geldanamycin is structurally similar to the herbimycins, which are also produced by S. hygroscopicus and have been reported to have herbicidal activity. The phytotoxicity of geldanamycin and nigericin has stimulated investigation of their potential for use as natural product herbicides.

Quantification of allelopathic potential of sorghum residues by novel indexing of richards' function fitted to cumulative cress seed germination curves

The inhibitory activity of aqueous extracts of field-grown sorghum (Sorghum bicolor cv. Bird-a-boo) herbage and roots was quantitatively indexed by three aspects of cumulative cress (Lepidium sativum cv. Curlycress) seed germination: the germination onset; weighted mean rate; and final germination percentage. Extract potency was greatest for herbage collected four weeks after planting but declined sharply thereafter as the plants matured. About 91% of the inhibitory activity obtained from four-week-old herbage was in a low molecular weight fraction. Differential effects of herbage and root extracts on cress seed germination suggest that the nature and/or proportion of biologically active substances extractable from these plant parts is dissimilar.

Biological Suppression of Weeds: Evidence for Allelopathy in Accessions of Cucumber

Cucumber (Cucumis sativus L.) accessions from 41 nations were grown with two indicator species in a search for superior competitors. Of the plant introductions tested, one inhibited indicator plant growth by 87 percent and 25 inhibited growth by 50 percent or more. The toxicity of leachates from pots containing inhibitory cucumbers to indicator plants germinated in separate containers suggested allelopathy. Incorporation of an allelopathic character into a crop cultivar could provide the plant with a means of gaining a competitive advantage over certain weeds.