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Mansour MSI, Huseinzade A, Seidal T, Hejny K, Maty A, Taheri-Eilagh F, Mager U, Dejmek A, Dobra K, Brunnström H. Comparison of immunohistochemical mesothelial biomarkers in paired biopsies and effusion cytology cell blocks from pleural mesothelioma. Cytopathology 2023; 34:456-465. [PMID: 37337638 DOI: 10.1111/cyt.13265] [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: 03/30/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Traditionally, the diagnosis of pleural mesothelioma is based on histological material. Minimally invasive effusion cytology specimens are an alternative that, like biopsies, require ancillary analyses. Validation of immunohistochemical (IHC) analyses on cytology, including the surrogate markers for molecular alterations BAP1 and MTAP, is of interest. METHODS IHC for eight different markers was performed on 59 paired formalin-fixed, paraffin-embedded pleural biopsies and pleural effusion cell blocks with mesothelioma. Immunoreactivity in ≥10% of tumour cells was considered positive/preserved. The concordance between histological and cytological materials was assessed. RESULTS The overall percentage of agreement between the histological epithelioid component in 58 biopsies and paired cell blocks was 93% for calretinin, 98% for CK5, 97% for podoplanin, 90% for WT1, 86% for EMA, 100% for desmin, 91% for BAP1, and 72% for MTAP. For 11 cases with biphasic or sarcomatoid histology, the concordance between cytology and the histological sarcomatoid component was low for calretinin, CK5, and WT1 (all ≤45%). For the whole cohort, loss of both BAP1 and MTAP was seen in 40% while both markers were preserved in 11% of the biopsies for epithelioid histology. The corresponding numbers were 54% and 8%, respectively, for the paired cell blocks. CONCLUSIONS Generally, a high concordance for IHC staining was seen between paired biopsies and pleural effusion cell blocks from mesotheliomas, but the somewhat lower agreement for WT1, EMA, and especially MTAP calls for further investigation and local quality assurance. The lower concordance for the sarcomatoid subtype for some markers may indicate biological differences.
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Affiliation(s)
- Mohammed S I Mansour
- Department of Pathology and Cytology, Halland Hospital Halmstad, Sweden
- Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden
| | - Adela Huseinzade
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Tomas Seidal
- Department of Pathology and Cytology, Halland Hospital Halmstad, Sweden
| | - Kim Hejny
- Department of Pathology and Cytology, Halland Hospital Halmstad, Sweden
| | - Athar Maty
- Division of Medical Cancer Diagnostics Huddinge (MCDH), Pathology Core Facility Karolinska (PCFK), Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Fereshteh Taheri-Eilagh
- Division of Medical Cancer Diagnostics Huddinge (MCDH), Pathology Core Facility Karolinska (PCFK), Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ulrich Mager
- Division of Respiratory and Internal Medicine, Department of Clinical Medicine, Halland Hospital Halmstad, Halmstad, Sweden
| | - Annika Dejmek
- Department of Translational Medicine in Malmö, Lund University, Malmö, Sweden
| | - Katalin Dobra
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Hans Brunnström
- Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden
- Department of Genetics and Pathology, Laboratory medicine Region Skåne, Lund, Sweden
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Mansour MSI, Lindquist KE, Seidal T, Mager U, Mohlin R, Tran L, Hejny K, Holmgren B, Violidaki D, Dobra K, Dejmek A, Planck M, Brunnström H. PD-L1 Testing in Cytological Non-Small Cell Lung Cancer Specimens: A Comparison with Biopsies and Review of the Literature. Acta Cytol 2021; 65:501-509. [PMID: 34233336 DOI: 10.1159/000517078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/18/2021] [Accepted: 04/19/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Programmed death-ligand 1 (PD-L1) expression is used for treatment prediction in non-small cell lung cancer (NSCLC). While cytology may be the only available material in the routine clinical setting, testing in clinical trials has mainly been based on biopsies. METHODS We included 2 retrospective cohorts of paired, concurrently sampled, cytological specimens and biopsies. Also, the literature on PD-L1 in paired cytological/histological samples was reviewed. Focus was on the cutoff levels ≥1 and ≥50% positive tumor cells. RESULTS Using a 3-tier scale, PD-L1 was concordant in 40/47 (85%) and 66/97 (68%) of the paired NSCLC cases in the 2 cohorts, with kappa 0.77 and 0.49, respectively. In the former cohort, all discordant cases had lower score in cytology. In both cohorts, concordance was lower in samples from different sites (e.g., biopsy from primary tumor and cytology from pleural effusion). Based on 25 published studies including about 1,700 paired cytology/histology cases, the median (range) concordance was 81-85% (62-100%) at cutoff 1% for a positive PD-L1 staining and 89% (67-100%) at cutoff 50%. CONCLUSIONS The overall concordance of PD-L1 between cytology and biopsies is rather good but with significant variation between laboratories, which calls for local quality assurance.
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Affiliation(s)
- Mohammed S I Mansour
- Department of Pathology and Cytology, Halland Hospital Halmstad, Halmstad, Sweden
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Tomas Seidal
- Department of Pathology and Cytology, Halland Hospital Halmstad, Halmstad, Sweden
| | - Ulrich Mager
- Division of Respiratory and Internal Medicine, Department of Clinical Medicine, Halland Hospital Halmstad, Halmstad, Sweden
| | - Rikard Mohlin
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, Lund, Sweden
| | - Lena Tran
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Kim Hejny
- Department of Pathology and Cytology, Halland Hospital Halmstad, Halmstad, Sweden
| | - Benjamin Holmgren
- Department of Pathology and Cytology, Halland Hospital Halmstad, Halmstad, Sweden
| | - Despoina Violidaki
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, Lund, Sweden
| | - Katalin Dobra
- Division of Clinical Pathology/Cytology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Annika Dejmek
- Department of Translational Medicine in Malmö, Lund University, Malmö, Sweden
| | - Maria Planck
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
| | - Hans Brunnström
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, Lund, Sweden
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Mansour MSI, Seidal T, Mager U, Dobra K, Brunnström H, Dejmek A. Higher concordance of PD-L1 expression between biopsies and effusions in epithelioid than in nonepithelioid pleural mesothelioma. Cancer Cytopathol 2021; 129:468-478. [PMID: 33493383 PMCID: PMC8248121 DOI: 10.1002/cncy.22401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malignant mesothelioma (MM) is a therapy-resistant tumor, often causing an effusion. Drugs targeting the programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway have shown promising results, but assessment of PD-L1 expression to select patients for therapy has mainly been performed on histologic tissue samples. In a previous study, we showed that MM effusions are suitable for PD-L1 assessment with results comparable to those reported in histologic studies, but no studies have compared PD-L1 expression in histologic and cytologic samples. METHODS PD-L1 expression was determined immunohistochemically (clone 28-8) in 61 paired samples of effusions and biopsies from patients with pleural MM, obtained at the time of diagnosis. Only cases with >100 tumor cells were included. Membranous staining in tumor cells was considered positive at ≥1%, >5%, >10%, and >50% cutoff levels. RESULTS Of 61 histologic samples, PD-L1 expression was found in 28 and 7 samples at ≥1% and >50% cutoffs, respectively; the corresponding figures for cytology were 21 and 5, respectively. The overall percentage agreement between histology and cytology was 69% and 84%, with a kappa (κ) of 0.36 and 0.08 at ≥1% and >50% cutoffs, respectively. The concordance between cytology and histology tended to be higher for epithelioid MM versus nonepithelioid MM at a ≥1% cutoff. PD-L1 positivity in biopsies, but not in effusions, correlated with the histologic subtype at a ≥1% cutoff. CONCLUSIONS A moderate concordance of PD-L1 expression between biopsies and effusions from pleural MM, especially for the epithelioid subtype, indicates biological differences between the 2 types of specimens. Cytology and histology may be complementary.
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Affiliation(s)
- Mohammed S. I. Mansour
- Department of Pathology and CytologyHalland Hospital HalmstadHalmstadSweden
- Division of PathologyDepartment of Clinical Sciences LundLund UniversityLundSweden
| | - Tomas Seidal
- Department of Pathology and CytologyHalland Hospital HalmstadHalmstadSweden
| | - Ulrich Mager
- Division of Respiratory and Internal MedicineDepartment of Clinical MedicineHalland Hospital HalmstadHalmstadSweden
| | - Katalin Dobra
- Division of Clinical Pathology/CytologyDepartment of Laboratory MedicineKarolinska InstituteKarolinska University Hospital HuddingeHuddingeSweden
| | - Hans Brunnström
- Division of PathologyDepartment of Clinical Sciences LundLund UniversityLundSweden
- Department of Genetics and PathologyLaboratory Medicine Region SkåneLundSweden
| | - Annika Dejmek
- Department of Translational Medicine in MalmöLund UniversityMalmöSweden
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Mansour M, Seidal T, Mager U, Baigi A, Dobra K, Dejmek A. P1.09-010 PD-L1 Reactivity of Tumor Cells Can Successfully Be Determined in Malignant Mesothelioma Effusions. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mansour MSI, Seidal T, Mager U, Baigi A, Dobra K, Dejmek A. Determination of PD-L1 expression in effusions from mesothelioma by immuno-cytochemical staining. Cancer Cytopathol 2017; 125:908-917. [PMID: 28922567 DOI: 10.1002/cncy.21917] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/10/2017] [Accepted: 08/21/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Malignant mesothelioma (MM) is an aggressive, fatal tumor. Current therapeutic options only marginally improve survival. Programmed cell death ligand 1 (PD-L1) is a dominant mediator of immunosuppression, binding to programmed cell death 1 (PD-1). PD-L1 is up-regulated in cancer cells, and the PD-1/PD-L1 pathway plays a critical role in tumor immune evasion, thus providing a target for antitumor therapy. Further, a correlation between PD-L1 expression and prognosis has been reported. Studies performed on histological material have revealed expression of PD-L1 in MM, but no study has been performed on MM effusions thus far. METHODS PD-L1 expression was determined by a commercially available antibody (clone 28-8) in 74 formalin-fixed, paraffin-embedded cell blocks from body effusions obtained at diagnosis from patients with MM. The presence of MM cells was confirmed with CK5/6, calretinin, and EMA and the admixture of macrophages was assessed with CD68. Only cases containing more than 100 tumor cells were assessed. Membranous staining in tumor cells was considered positive. Survival time was calculated from the appearance of the first malignant effusion until death. RESULTS Reactivity was observed in 23 of 61 (38%) of cases and was classified as ≥1%-5% (n = 9 cases), >5%-10% (n = 4 cases), >10%-50% (n = 4 cases), and >50% (n = 6 cases) positive cells. Survival times did not differ significantly between patients with PD-L1-positive and PD-L1-negative tumors. CONCLUSION MM effusions are suitable for immune-cytochemical assessment of PD-L1 expression in malignant cells and the results are similar to those reported for histological specimens. Cancer Cytopathol 2017;125:908-17. © 2017 American Cancer Society.
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Affiliation(s)
- Mohammed S I Mansour
- Department of Pathology and Cytology, Halland Hospital Halmstad, Halmstad, Sweden
| | - Tomas Seidal
- Department of Pathology and Cytology, Halland Hospital Halmstad, Halmstad, Sweden
| | - Ulrich Mager
- Division of Lung and Allergy, Department of Clinical Medicine, Halland Hospital Halmstad, Halmstad, Sweden
| | - Amir Baigi
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Katalin Dobra
- Division of Clinical Pathology/Cytology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Huddinge, Sweden
| | - Annika Dejmek
- Department of Translational Medicine in Malmö, Lund University, Lund, Sweden
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Hjerpe A, Ascoli V, Bedrossian CWM, Boon ME, Creaney J, Davidson B, Dejmek A, Dobra K, Fassina A, Field A, Firat P, Kamei T, Kobayashi T, Michael CW, Önder S, Segal A, Vielh P. Guidelines for the Cytopathologic Diagnosis of Epithelioid and Mixed-Type Malignant Mesothelioma: a secondary publication. Cytopathology 2016; 26:142-56. [PMID: 26052757 DOI: 10.1111/cyt.12250] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To provide practical guidelines for the cytopathologic diagnosis of malignant mesothelioma. DATA SOURCES Cytopathologists with an interest in the field involved in the International Mesothelioma Interest Group (IMIG) and the International Academy of Cytology (IAC) contributed to this update. Reference material includes peer-reviewed publications and textbooks. RATIONALE This article is the result of discussions during and after the IMIG 2012 conference in Boston, followed by thorough discussions during the 2013 IAC meeting in Paris. Additional contributions have been obtained from cytopathologists and scientists who could not attend these meetings, with final discussions and input during the IMIG 2014 conference in Cape Town.
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Affiliation(s)
- A Hjerpe
- Division of Clinical Pathology/Cytology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Huddinge, Sweden
| | - V Ascoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | | | - M E Boon
- Leiden Cytology and Pathology Laboratory, Lieveren, The Netherlands
| | - J Creaney
- National Centre for Asbestos Related Disease, School of Medicine and Pharmacology, University of Western Australia, QEII Medical Centre, Perth, WA, Australia
| | - B Davidson
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - A Dejmek
- Department of Laboratory Medicine in Malmö, Lund University, Malmö University Hospital, Malmö, Sweden
| | - K Dobra
- Division of Clinical Pathology/Cytology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Huddinge, Sweden
| | - A Fassina
- Department of Medicine, University of Padova, Padova, Italy
| | - A Field
- Department of Anatomical Pathology, St Vincents Hospital, Sydney, NSW, Australia
| | - P Firat
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - T Kamei
- Division of Pathology, Yamaguchi Grand Medical Center, Hofu, Japan
| | - T Kobayashi
- Cancer Education and Research Center, Osaka University Graduate School of Medicine, Osaka, Japan
| | - C W Michael
- Department of Pathology, Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH, USA
| | - S Önder
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - A Segal
- Department of Tissue Pathology, PathWest Laboratory Medicine WA, QE2 Medical Centre, Perth, WA, Australia
| | - P Vielh
- Department of Biopathology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
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Hjerpe A, Ascoli V, Bedrossian CWM, Boon ME, Creaney J, Davidson B, Dejmek A, Dobra K, Fassina A, Field A, Firat P, Kamei T, Kobayashi T, Michael CW, Önder S, Segal A, Vielh P. Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma: Complementary Statement from the International Mesothelioma Interest Group, Also Endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology. Diagn Cytopathol 2016; 43:563-76. [PMID: 26100969 DOI: 10.1002/dc.23271] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide practical guidelines for the cytopathologic diagnosis of malignant mesothelioma. DATA SOURCES Cytopathologists with an interest in the field involved in the International Mesothelioma Interest Group (IMIG) and the International Academy of Cytology (IAC) contributed to this update. Reference material includes peer-reviewed publications and textbooks. RATIONALE This article is the result of discussions during and after the IMIG 2012 conference in Boston, followed by thorough discussions during the 2013 IAC meeting in Paris. Additional contributions have been obtained from cytopathologists and scientists who could not attend these meetings, with final discussions and input during the IMIG 2014 conference in Cape Town.
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Affiliation(s)
- Anders Hjerpe
- Division of Clinical Pathology/Cytology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Huddinge, Sweden
| | - Valeria Ascoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | | | - Mathilde E Boon
- Leiden Cytology and Pathology Laboratory, Lieveren, The Netherlands
| | - Jenette Creaney
- National Centre for Asbestos Related Disease, School of Medicine and Pharmacology, University of Western Australia, QEII Medical Centre, Perth, W.A, Australia
| | - Ben Davidson
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Annika Dejmek
- Department of Laboratory Medicine in Malmö, Lund University, Malmö University Hospital, Malmö, Sweden
| | - Katalin Dobra
- Division of Clinical Pathology/Cytology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Huddinge, Sweden
| | | | - Andrew Field
- Department of Anatomical Pathology, St Vincents Hospital, Sydney, N.S.W, Australia
| | - Pinar Firat
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Toshiaki Kamei
- Division of Pathology, Yamaguchi Grand Medical Center, Hofu
| | - Tadao Kobayashi
- Cancer Education and Research Center, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Claire W Michael
- Case Western Reserve University/University Hospitals Case Medical Center, Department of Pathology, Cleveland, Ohio, USA
| | - Sevgen Önder
- Hacettepe University, Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Amanda Segal
- Department of Tissue Pathology, PathWest Laboratory Medicine WA, QE2 Medical Centre, Perth, W.A, Australia
| | - Philippe Vielh
- Department of Biopathology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
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Lindgren I, Bååth M, Uvebrant K, Dejmek A, Kjaer L, Henic E, Bungum M, Bungum L, Cilio C, Leijonhufvud I, Skouby S, Andersen CY, Giwercman YL. Combined assessment of polymorphisms in the LHCGR and FSHR genes predict chance of pregnancy after in vitro fertilization. Hum Reprod 2016; 31:672-83. [PMID: 26769719 DOI: 10.1093/humrep/dev342] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/17/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Can gonadotrophin receptor variants separately or in combination, be used for the prediction of pregnancy chances in in vitro fertilization (IVF) trials? SUMMARY ANSWER The luteinizing hormone/human chorionic gonadotrophin receptor (LHCGR) variant N312S and the follicle-stimulating hormone receptor (FSHR) variant N680S can be utilized for the prediction of pregnancy chances in women undergoing IVF. WHAT IS KNOWN ALREADY The FSHR N680S polymorphism has been shown to affect the ovarian response in response to gonadotrophin treatment, while no information is currently available regarding variants of the LHCGR in this context. STUDY DESIGN, SIZE, DURATION Cross-sectional study, duration from September 2010 to February 2015. Women undergoing IVF were consecutively enrolled and genetic variants compared between those who became pregnant and those who did not. The study was subsequently replicated in an independent sample. Granulosa cells from a subset of women were investigated regarding functionality of the genetic variants. PARTICIPANTS/MATERIALS, SETTING, METHODS Women undergoing IVF (n = 384) were enrolled in the study and genotyped. Clinical variables were retrieved from medical records. For replication, an additional group of n = 233 women was utilized. Granulosa cells from n = 135 women were isolated by flow cytometry, stimulated with Follitropin alpha or Menotropin, and the downstream targets 3',5'-cyclic adenosine monophosphate (cAMP) and inositol 1,4,5-trisphosphate (IP3) measured with enzyme-linked immunosorbent assay. MAIN RESULTS AND THE ROLE OF CHANCE Women homozygous for serine (S) in both polymorphisms displayed higher pregnancy rates than women homozygous asparagine (N) (OR = 14.4, 95% CI: [1.65, 126], P = 0.016). Higher pregnancy rates were also evident for women carrying LHCGR S312, regardless of FSHR variant (OR = 1.61, 95% CI: [1.13, 2.29], P = 0.008). These women required higher doses of FSH for follicle recruitment than women homozygous N (161 versus 148 IU, P = 0.030). When combining the study cohort with the replication cohort (n = 606), even stronger associations with pregnancy rates were noted for the combined genotypes (OR = 11.5, 95% CI: [1.86, 71.0], P = 0.009) and for women carrying LHCGR S312 (OR = 1.49, 95% CI: [1.14, 1.96], P = 0.004). A linear significant trend with pregnancy rate and increasing number of G alleles was also evident in the merged study population (OR = 1.34, 95% CI: [1.10, 1.64], P = 0.004). A lower cAMP response in granulosa cells was noted following Follitropin alpha stimulation for women homozygous N in both polymorphisms, compared with women with other genotypes (0.901 pmol cAMP/mg total protein versus 2.19 pmol cAMP/mg total protein, P = 0.035). LIMITATIONS, REASONS FOR CAUTION Due to racial differences in LHCGR genotype distribution, these results may not be applicable for all populations. WIDER IMPLICATIONS OF THE FINDINGS Despite that >250 000 cycles of gonadotrophin stimulations are performed annually worldwide prior to IVF, it has not been possible to predict neither the pregnancy outcome, nor the response to the hormone with accuracy. If LHCGR and FSHR variants are recognized as biomarkers for chance of pregnancy, more individualized and thereby more efficient treatment modalities can be developed. STUDY FUNDING, COMPETING INTERESTS This work was supported by Interreg IV A, EU (grant 167158) and ALF governments grant (F2014/354). Merck-Serono (Darmstadt, Germany) supported the enrollment of the subjects. The authors declare no conflict of interest.
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Affiliation(s)
- I Lindgren
- Department of Translational Medicine, Molecular Genetic Reproductive Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 91, Plan 10, SE 20502 Malmö, Sweden
| | - M Bååth
- Department of Translational Medicine, Molecular Genetic Reproductive Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 91, Plan 10, SE 20502 Malmö, Sweden
| | - K Uvebrant
- Department of Clinical Sciences, Cellular Autoimmunity Unit, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 91, Plan 10, SE 20502 Malmö, Sweden
| | - A Dejmek
- Department of Clinical Pathology, University and Regional Laboratories, Skåne University Hospital, Jan Waldenströms gata 59, SE 20502 Malmö, Sweden
| | - L Kjaer
- Department of Translational Medicine, Molecular Genetic Reproductive Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 91, Plan 10, SE 20502 Malmö, Sweden
| | - E Henic
- Reproductive Medicine Centre, Skåne University Hospital, Jan Waldenströms gata 47, Plan 3, SE 20502 Malmö, Sweden
| | - M Bungum
- Reproductive Medicine Centre, Skåne University Hospital, Jan Waldenströms gata 47, Plan 3, SE 20502 Malmö, Sweden
| | - L Bungum
- Department of Obstetrics and Gynecology, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - C Cilio
- Department of Clinical Sciences, Cellular Autoimmunity Unit, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 91, Plan 10, SE 20502 Malmö, Sweden
| | - I Leijonhufvud
- Reproductive Medicine Centre, Skåne University Hospital, Jan Waldenströms gata 47, Plan 3, SE 20502 Malmö, Sweden
| | - S Skouby
- Department of Obstetrics and Gynecology, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - C Yding Andersen
- Laboratory of Reproductive Biology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Y Lundberg Giwercman
- Department of Translational Medicine, Molecular Genetic Reproductive Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 91, Plan 10, SE 20502 Malmö, Sweden
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Hjerpe A, Ascoli V, Bedrossian C, Boon M, Creaney J, Davidson B, Dejmek A, Dobra K, Fassina A, Field A, Firat P, Kamei T, Kobayashi T, Michael CW, Önder S, Segal A, Vielh P. Guidelines for cytopathologic diagnosis of epithelioid and mixed type malignant mesothelioma. Complementary statement from the International Mesothelioma Interest Group, also endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology. Cytojournal 2015; 12:26. [PMID: 26681974 PMCID: PMC4678521 DOI: 10.4103/1742-6413.170726] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 12/12/2022] Open
Abstract
To provide practical guidelines for the cytopathologic diagnosis of malignant mesothelioma (MM). Cytopathologists involved in the International Mesothelioma Interest Group (IMIG) and the International Academy of Cytology (IAC), who have an interest in the field contributed to this update. Reference material includes peer-reviewed publications and textbooks. This article is the result of discussions during and after the IMIG 2012 conference in Boston, followed by thorough discussions during the 2013 IAC meeting in Paris. Additional contributions have been obtained from cytopathologists and scientists, who could not attend these meetings, with final discussions and input during the IMIG 2014 conference in cape town. During the previous IMIG biennial meetings, thorough discussions have resulted in published guidelines for the pathologic diagnosis of MM. However, previous recommendations have stated that the diagnosis of MM should be based on histological material only.[12] Accumulating evidence now indicates that the cytological diagnosis of MM supported by ancillary techniques is as reliable as that based on histopathology, although the sensitivity with cytology may be somewhat lower.[345] Recognizing that noninvasive diagnostic modalities benefit both the patient and the health system, future recommendations should include cytology as an accepted method for the diagnosis of this malignancy.[67] The article describes the consensus of opinions of the authors on how cytology together with ancillary testing can be used to establish a reliable diagnosis of MM.
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Affiliation(s)
- Anders Hjerpe
- Address: Department of Laboratory Medicine, Division of Clinical Pathology/Cytology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-14186 Huddinge, Sweden
| | - Valeria Ascoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Carlos Bedrossian
- Department of Pathology, Rush University Medical College, Chicago, Illinois, USA
| | - Mathilde Boon
- Leiden Cytology and Pathology Laboratory, Leiden, Netherlands
| | - Jenette Creaney
- National Centre for Asbestos Related Disease, School of Medicine and Pharmacology, University of Western Australia, QEII Medical Centre, WA 6009, Sydney
| | - Ben Davidson
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, N-0310 Oslo, Norway
| | - Annika Dejmek
- Department of Laboratory Medicine, Lund University, Malmö University Hospital, SE-205 02 Malmö, Sweden
| | - Katalin Dobra
- Address: Department of Laboratory Medicine, Division of Clinical Pathology/Cytology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-14186 Huddinge, Sweden
| | - Ambrogio Fassina
- Department of Medicine, University of Padova, 35121 Padova, Italy
| | - Andrew Field
- Department of Anatomical Pathology, St. Vincents Hospital, Sydney
| | - Pinar Firat
- Department of Pathology, İstanbul University, İstanbul Faculty of Medicine, Capa, Fatih 34093, Istanbul, Turkey
| | - Toshiaki Kamei
- Department of Pathology, Yamaguchi Grand Medical Center, Hofu City, Yamaguchi Pref, 747-8511, Osaka, Japan
| | - Tadao Kobayashi
- Cancer Education and Research Center, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Claire W Michael
- Department of Pathology, Case Western Reserve University, University Hospitals Case Medical Center, MSPTH 5077, Cleveland, OH 44106, USA
| | - Sevgen Önder
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Amanda Segal
- Department of Tissue Pathology, Pathwest Laboratory Medicine WA, QE2 Medical Centre, Western Australia 6009, Australia
| | - Philippe Vielh
- Department of Biopathology, Gustave Roussy Comprehensive Cancer Center, 94805 Vilejuif Cedex, France
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Hjerpe A, Ascoli V, Bedrossian CWM, Boon ME, Creaney J, Davidson B, Dejmek A, Dobra K, Fassina A, Field A, Firat P, Kamei T, Kobayashi T, Michael CW, Önder S, Segal A, Vielh P. Guidelines for the cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma. Complementary statement from the International Mesothelioma Interest Group, also endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology. Acta Cytol 2015; 59:2-16. [PMID: 25824655 DOI: 10.1159/000377697] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To provide practical guidelines for the cytopathologic diagnosis of malignant mesothelioma. DATA SOURCES Cytopathologists with an interest in the field involved in the International Mesothelioma Interest Group (IMIG) and the International Academy of Cytology (IAC) contributed to this update. Reference material includes peer-reviewed publications and textbooks. RATIONALE This article is the result of discussions during and after the IMIG 2012 conference in Boston, followed by thorough discussions during the 2013 IAC meeting in Paris. Additional contributions have been obtained from cytopathologists and scientists who could not attend these meetings, with final discussions and input during the IMIG 2014 conference in Cape Town.
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Adell E, Dejmek A. Telomerase activity analyzed with TRAP in situ provides additional information in effusions remaining equivocal after immunocytochemistry and hyaluronan analysis. Diagn Cytopathol 2014; 42:1051-7. [DOI: 10.1002/dc.23165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 02/03/2014] [Accepted: 03/18/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Elisabet Adell
- Clinical Pathology; University and Regional Laboratories, Region Skåne; SUS Malmö Sweden
| | - Annika Dejmek
- Clinical Pathology; University and Regional Laboratories, Region Skåne; SUS Malmö Sweden
- Department of Laboratory Medicine; Lund University; Malmö Sweden
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Zendehrokh N, Olejnicka B, Westman A, Dejmek A. Liquid-based cytology using cytorich Red/Tripath is diagnostically equivalent to conventional smears for bronchial washings and brushings and reduces the cost. Diagn Cytopathol 2013; 41:876-84. [DOI: 10.1002/dc.22981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/08/2012] [Accepted: 02/07/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Nooreldin Zendehrokh
- University and Regional Laboratories, Region Skåne; Clinical Pathology, SUS Malmö; Sweden
| | | | - Agneta Westman
- University and Regional Laboratories, Region Skåne; Clinical Pathology, SUS Malmö; Sweden
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Dejmek A, Zendehrokh N, Tomaszewska M, Edsjö A. Preparation of DNA from cytological material: effects of fixation, staining, and mounting medium on DNA yield and quality. Cancer Cytopathol 2013; 121:344-53. [PMID: 23408720 DOI: 10.1002/cncy.21276] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/14/2012] [Accepted: 12/04/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Personalized oncology requires molecular analysis of tumor cells. Several studies have demonstrated that cytological material is suitable for DNA analysis, but to the authors' knowledge there are no systematic studies comparing how the yield and quality of extracted DNA is affected by the various techniques used for the preparation of cytological material. METHODS DNA yield and quality were compared using cultured human lung cancer cells subjected to different preparation techniques used in routine cytology, including fixation, mounting medium, and staining. The results were compared with the outcome of epidermal growth factor receptor (EGFR) genotyping of 66 clinical cytological samples using the same DNA preparation protocol. RESULTS All tested protocol combinations resulted in fragment lengths of at least 388 base pairs. The mounting agent EcoMount resulted in higher yields than traditional xylene-based medium. Spray and ethanol fixation resulted in both a higher yield and better DNA quality than air drying. In liquid-based cytology (LBC) methods, CytoLyt solution resulted in a 5-fold higher yield than CytoRich Red. Papanicolaou staining provided twice the yield of hematoxylin and eosin staining in both liquid-based preparations. Genotyping outcome and quality control values from the clinical EGFR genotyping demonstrated a sufficient amount and amplifiability of DNA in both spray-fixed and air-dried cytological samples. CONCLUSIONS Reliable clinical genotyping can be performed using all tested methods. However, in the cell line experiments, spray- or ethanol-fixed, Papanicolaou-stained slides provided the best results in terms of yield and fragment length. In LBC, the DNA recovery efficiency of the preserving medium may differ considerably, which should be taken into consideration when introducing LBC. Cancer (Cancer Cytopathol) 2013;121:344-353. © 2013 American Cancer Society.
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Affiliation(s)
- Annika Dejmek
- Department of Clinical Pathology, University and Regional Laboratories Region Skåne, Malmo, Sweden
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Hernroth B, Farahani F, Brunborg G, Dupont S, Dejmek A, Sköld HN. Possibility of mixed progenitor cells in sea star arm regeneration. J Exp Zool B Mol Dev Evol 2010; 314:457-68. [PMID: 20700890 DOI: 10.1002/jez.b.21352] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In contrast to most vertebrates, invertebrate deuterostome echinoderms, such as the sea star Asterias rubens, undergo regeneration of lost body parts. The current hypothesis suggests that differentiated cells are the main source for regenerating arm in sea stars, but there is little information regarding the origin and identity of these cells. Here, we show that several organs distant to the regenerating arm responded by proliferation, most significantly in the coelomic epithelium and larger cells of the pyloric caeca. Analyzing markers for proliferating cells and parameters indicating cell ageing, such as levels of DNA damage, pigment, and lipofuscin contents as well as telomere length and telomerase activity, we suggest that cells contributing to the new arm likely originate from progenitors rather than differentiated cells. This is the first study showing that cells of mixed origin may be recruited from more distant sources of stem/progenitor cells in a sea star, and the first described indication of a role for pyloric caeca in arm regeneration. Data on growth rate during arm regeneration further indicate that regeneration is at the expense of whole animal growth. We propose a new working hypothesis for arm regeneration in sea stars involving four phases: wound healing by coelomocytes, migration of distant progenitor cells of mixed origin including from pyloric caeca, proliferation in these organs to compensate for cell loss, and finally, local proliferation in the regenerating arm.
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Affiliation(s)
- Bodil Hernroth
- The Royal Swedish Academy of Sciences, Kristineberg, Fiskebäckskil, Sweden
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Hanna A, Pang Y, Bedrossian CWM, Dejmek A, Michael CW. Podoplanin is a useful marker for identifying mesothelioma in malignant effusions. Diagn Cytopathol 2010; 38:264-9. [PMID: 20146302 DOI: 10.1002/dc.21340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The diagnosis of malignant mesothelioma in serosal effusions continues to be a major challenge because some of its cytomorphological features closely resemble adenocarcinomas. Immunohistochemistry is a valuable tool in the differentiation of epithelioid mesothelioma from metastatic adenocarcinomas. However, no single antibody has demonstrated absolute sensitivity or specificity. In this study, we evaluated the value of immunostaining pattern for podoplanin to differentiate mesothelioma from adenocarcinomas of various origins.Cell blocks from previously collected paraffin-embedded cell blocks of 86 effusions (18 mesothelioma, 35 reactive mesothelium, 9 breast adenocarcinoma, 14 ovarian adenocarcinoma, and 10 lung adenocarcinoma) were retrieved from the file of the Department of Pathology at University of Michigan and Lund University in Sweden and were used for the study. Slides prepared from the cell blocks were stained for podoplanin. The percentage of immunostained cells was recorded as follows: 1+ (5-25%), 2+ (26-50%), and 3+ (>50%). A stain result involving <5% of cells was considered negative. The intensity of positive results was evaluated as strong, moderate, or weak.Podoplanin is expressed in 94% of malignant mesothelioma cases (17/18), 97% (30/31) of cases of reactive mesothelial, 0% of lung adenocarcinoma cases (0/9), 0% of breast adenocarcinoma (0/9), and 7% of ovarian adenocarcinoma (1/14). All positive cases of malignant mesothelioma and reactive mesothelium showed strong membranous reactivity to podoplanin. The one positive case of ovarian adenocarcinoma showed a weak membranous podoplanin immunostaining.On the basis of our results and published data, we believe that membranous podoplanin immunoreactivity, in conjunction with calretinin, would be more specific than CK5/6 and WT-1 in differentiating epithelioid malignant mesothelioma from adenocarcinoma of the lung, breast, and ovary.
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Affiliation(s)
- Atef Hanna
- Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109-0054, USA
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Losell K, Zendehrokh N, Solding I, Dejmek A. Comparison of liquid-based cytology and conventional filter preparations in urine: a possible serious pitfall. Acta Cytol 2010; 54:114-7. [PMID: 20307005 DOI: 10.1159/000324984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hansson M, Zendehrokh N, Ohyashiki J, Ohyashiki K, Westman UB, Roos G, Dejmek A. Telomerase activity in effusions: a comparison between telomere repeat amplification protocol in situ and conventional telomere repeat amplification protocol assay. Arch Pathol Lab Med 2008; 132:1896-902. [PMID: 19061286 DOI: 10.5858/132.12.1896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT We previously found telomere repeat amplification protocol (TRAP) in situ helpful in the diagnosis of malignancy in effusions, whereas varying sensitivities and specificities for malignancy were reported by investigators using extract-based TRAP. OBJECTIVE To compare the 2 methods and to elucidate the discrepancies between them. DESIGN Twenty-three effusions were analyzed. Telomerase activity of whole cell lysate was measured with a Telo TAGGG telomerase polymerase chain reaction ELISA PLUS kit with modifications to exclude polymerase chain reaction inhibitors. TRAP in situ was performed on cytospins. An estimate of total TRAP activity in the specimen was made based on the amount of positive cells, their fluorescence intensity, and the proportion of different cell types in the specimen. The estimate was compared with the level of telomerase activity in cell lysate-based TRAP. RESULTS TRAP in situ: Thirteen of 14 malignant cases and 2 of 2 equivocal cases showed moderate/strong reactivity. Five of 7 benign effusions were negative; in 2 of 7, mesothelial cells showed weak reactivity. Cell lysate-based TRAP assay: In 4 cases no internal standard was detected, indicating the presence of polymerase chain reaction inhibitors. The relative telomerase activities were 33.1 to 72.7 with a considerable overlap between malignant (48 +/- 9, mean +/- SD) and benign (43 +/- 9) cases. CONCLUSIONS The TRAP in situ results correlated to final diagnoses, whereas the cell lysate-based TRAP assay did not differentiate between malignant and benign cases. The varying proportions of positive cells and the variation in fluorescence intensity in the TRAP in situ slides explained some of the discrepancies. The problems encountered with TRAP performed on cell lysates are partly overcome using TRAP in situ.
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Affiliation(s)
- Maire Hansson
- Department of Laboratory Medicine, Lund University, Malmö, Sweden
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Abstract
OBJECTIVE To test the performance of CK5/6 for the differentiation between mesothelioma, adenocarcinoma and benign mesothelia/proliferations in effusion cytology. STUDY DESIGN CKS/6 immunocytochemistry was applied to ethanol-fixed cytospin preparations from 74 benign and malignant effusions. RESULTS Reactivity was seen in 7 of 8 mesotheliomas and in 9 of 11 benign mesothelial proliferations but also in 11 of l7 pulmonary adenocarcinomas and in 12 of 31 adenocarcinomas of nonpulmonary origin. Reactivity was also found in 3 of 5 non-small cell lung carcinomas and 1 of 1 squamous carcinoma. CONCLUSION CK5/6 reactivity was found in a considerable proportion of metastatic adenocarcinomas of pulmonary and nonpulmonary origin. The high reactivity rate in pulmonary adenocarcinomas disagrees with the results obtained with histologic sections from solid tumor tissue, and CK5/6 seems to be of very limited value as an additional marker in effusion cytology.
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Affiliation(s)
- Annika Dejmek
- Department of Laboratory Medicine, Malmö University Hospital, Lund University, Malmö, Sweden.
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Zendehrokh N, Rehnberg J, Dejmek A. Comparison of NCL-hTERT antibody reactivity and telomere repeat amplification protocol in situ in effusions. Acta Cytol 2007; 51:886-92. [PMID: 18077981 DOI: 10.1159/000325865] [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: 11/19/2022]
Abstract
OBJECTIVE To compare the performances of 2 methods, telomerase repeat amplification protocol (TRAP) in situ and antibodies to the hTERT protein, in assessing telomerase activity. STUDY DESIGN TRAP in situ and immunohistochemistry with a commercial antibody (NCL-hTERT) was performed on 54 body cavity effusions. The results were compared and correlated to diagnosis. RESULTS Thirty-four effusions from patients with verified malignant disease contained cytologically malignant cells. Both methods were positive in 33 of the cases, whereas only hTERT was positive in 1 case. Twenty effusions, all containing mesothelial cells, came from patients with benign conditions. In 2 fluids atypical, hyperplastic mesothelial cells were both TRAP in situ and hTERT positive. All remaining 18 fluids were TRAP in situ negative, whereas 12 of 18 were hTERT positive. Thus the results of TRAP in situ and hTERT immunohistochemistry disagreed in 1 of 34 (3%) malignant and 12 of 20 (60%) benign cases. CONCLUSION The sensitivities for malignancy were similar for TRAP in situ and hTERT immunohistochemistry. The specificity of the applied hTERT antibody was significantly lower, due to hTERT reactivity in mesothelial cells.
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Lundstig A, Dejmek A, Eklund C, Filinic I, Dillner J. No detection of SV40 DNA in mesothelioma tissues from a high incidence area in Sweden. Anticancer Res 2007; 27:4159-4161. [PMID: 18225586] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Simian virus 40 (SV40), a polyoma virus of the rhesus macaque was discovered in 1960 as a contaminant of human polio vaccines produced in monkey cells. A number of studies have reported the detection of SV40 nucleotide sequences in human tumors, mainly mesotheliomas, but the reports have not been consistent. The presence of SV40 in 26 consecutive cases of malignant mesothelioma of biphasic type was investigated using a SV40 quantitative real time polymerase chain reaction (PCR) with a sensitivity of 10 copies of viral DNA per sample. All the samples were also tested for amplifiability using a real-time PCR for the beta-globin gene. Eighteen tumors were amplifiable, but none contained SV40 DNA. The results do not support an association between mesothelioma and SV40.
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Affiliation(s)
- Annika Lundstig
- Department of Medical Microbiology, Malmö University Hospital, Lund University, 20502 Malmö, Sweden.
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Dejmek A, Naucler P, Smedjeback A, Kato H, Maeda M, Yashima K, Maeda J, Hirano T. Napsin A (TA02) is a useful alternative to thyroid transcription factor-1 (TTF-1) for the identification of pulmonary adenocarcinoma cells in pleural effusions. Diagn Cytopathol 2007; 35:493-7. [PMID: 17636482 DOI: 10.1002/dc.20667] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [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: 12/30/2022]
Abstract
The purpose of this study was to test napsin A as a diagnostic marker of metastatic lung adenocarcinoma in pleural effusions, and to compare its performance with TTF-1. Napsin A and TTF-1 reactivities were determined immunohistochemically on formalin-fixed paraffin embedded cell blocks from 50 pleural effusion (5 mesotheliomas, 10 mesothelial proliferations, 12 pulmonary, and 23 nonpulmonary metastases). The results were evaluated separately, and correlated to the final diagnoses. Concordant results were obtained in 48/50 cases. TTF-1 and Napsin A were positive in 8/12 and 10/12 pulmonary adenocarcinomas, respectively. Both markers were negative in 42 cases, including two lung carcinomas. Napsin reactivity was found in more than 75% of the tumor cells in 9/10 positive cases, whereas TTF-1 reactivity was seen in more than 75% of the tumor cells in 2/8 positive cases only (P < 0.05). This makes napsin A an alternative to TTF-1 in cytological diagnosis of effusions in which tumor cells may be scanty.
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Affiliation(s)
- Annika Dejmek
- Department of Laboratory Medicine, Malmö, Lund University, Sweden.
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Rehnberg J, Zendehrokh N, Dejmek A. Lower proliferation rate in metastatic effusion mesothelial cells than in benign effusions. Anal Quant Cytol Histol 2007; 29:217-20. [PMID: 17879629] [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: 05/17/2023]
Abstract
OBJECTIVE To determine the proliferation rates of mesothelial cells in metastatic and benign effusions. STUDY DESIGN Immunohistochemistry was performed on formalin-fixed pellets from 16 malignant and 9 benign clinical effusions. Dual staining with antibodies against Ki-67 (MIB-1) and desmin was applied to all effusions to differentiate between benign mesothelial cells and malignant cells, and the proportions of desmin+/Ki-67+ and desmin+/Ki-67- cells were calculated. RESULTS In 7 malignant effusions no proliferating mesothelial cells were found, whereas some rate of proliferation could always be demonstrated in mesothelial cells in the benign effusions. Further, the median proportions of proliferating cells, malignant 2% vs. benign 11%, differed significantly. CONCLUSIONS To our knowledge this finding has not been previously described, and it may have implications for both cytologic diagnosis and the understanding of tumor biology and the interaction between tumor cells and mesothelial cells.
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Affiliation(s)
- Johanna Rehnberg
- Department of Laboratory Medicine, Section of Pathology, Malmö University Hospital, Lund University, Malmö, Sweden
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Zendehrokh N, Franzen L, Dejmek A. Weak telomerase activity in malignant cells in metastatic serous effusions: correlation to short survival time. Acta Cytol 2007; 51:412-6. [PMID: 17536544 DOI: 10.1159/000325756] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether the intensity of telomerase activity measured on the cellular level in effusions correlates to survival time in cases of metastatic spread to the serous cavities. STUDY DESIGN Telomere repeat amplification protocol (TRAP) in situ was applied to 46 effusions containing metastatic cancer cells. RESULTS Weak telomerase activity in tumor cells was seen in 7 cases, and moderate or strong activity in 39 cases. The intensity of the enzyme activity correlated significantly to survival (Kaplan-Meier survival analysis), the median survival time being 18 days for patients with weakly positive tumors and 100 days for patients with moderately or strongly positive tumors (Kruskal-Wallis test, p = 0.021). CONCLUSION The strong relationship between telomerase activity in tumor cells in effusions and survival time has never been described before. Determination of telomerase activity on the cellular level provides a way to identify a subgroup of patients with a high probability of short survival.
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MESH Headings
- Adenocarcinoma/metabolism
- Adenocarcinoma/mortality
- Adenocarcinoma/secondary
- Biomarkers, Tumor/metabolism
- Carcinoma, Small Cell/metabolism
- Carcinoma, Small Cell/mortality
- Carcinoma, Small Cell/secondary
- Colonic Neoplasms/metabolism
- Colonic Neoplasms/mortality
- Colonic Neoplasms/pathology
- Female
- Genital Neoplasms, Female/metabolism
- Genital Neoplasms, Female/mortality
- Genital Neoplasms, Female/pathology
- Humans
- Lung Neoplasms/metabolism
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Pancreatic Neoplasms/metabolism
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/pathology
- Pleural Effusion, Malignant/metabolism
- Pleural Effusion, Malignant/mortality
- Pleural Effusion, Malignant/pathology
- Predictive Value of Tests
- Telomerase/metabolism
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
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Affiliation(s)
- Nooreldin Zendehrokh
- Department of Laboratory Medicine, Section of Pathology, Malmö University Hospital, Lund University, Malmö, Sweden
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Dejmek JS, Dejmek A. The reactivity to CK5/6 antibody in tumor cells from non-small cell lung cancers shed into pleural effusions predicts survival. Oncol Rep 2006; 15:583-7. [PMID: 16465416] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Lung cancer, especially adenocarcinoma and large cell carcinoma, tends to spread to the pleural cavities. Once an effusion develops, the prognosis is generally dismal. Immunocytochemistry is frequently applied to effusions for diagnostic purposes, but the prognostic value of markers in malignant effusions have thus far attracted less attention. Dakopatts CK 5/6 antibody was applied to ethanol-fixed fresh cytospin preparations from malignant pleural effusions originating from 18 patients (11 men and 7 women) with a previously or later verified non-small cell lung carcinoma (NSCLC). In three cases, CK5/6 reactivity was found in part of the malignant population, whereas 10 cases showed reactivity in most tumor cells. The lack of reactivity in malignant cells was only seen in five effusions. Females showed significantly lower reactivity rates, with all negative effusions coming from female patients, whereas 9/10 effusions with reactivity in most malignant cells originated from males. CK5/6 reactivity was significantly correlated to survival, with a median survival time of 18 days for patients with CK5/6-negative tumors, and 212 days for those with positive tumors. The strong relationship between CK5/6 reactivity and survival, and the observed gender difference, warrants larger studies aimed at the clinical utility of CK5/6 as a prognostic marker in metastatic NSCLC, the possible functional role of CK5/6 in cell adhesion in advanced NSCLC and its possible hormonal control.
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Dejmek J, Dejmek A. The reactivity to CK5/6 antibody in tumor cells from non-small cell lung cancers shed into pleural effusions predicts survival. Oncol Rep 2006. [DOI: 10.3892/or.15.3.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Dejmek J, Dejmek A, Säfholm A, Sjölander A, Andersson T. Wnt-5a protein expression in primary dukes B colon cancers identifies a subgroup of patients with good prognosis. Cancer Res 2005; 65:9142-6. [PMID: 16230369 DOI: 10.1158/0008-5472.can-05-1710] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oncogenic Wnt/beta-catenin signaling occurs in a majority of colorectal cancers. In contrast, very little is known about the role of the nontransforming Wnt protein family member Wnt-5a in those tumors. In the most common of the three colon cancer stages, Dukes B or lymph node-negative, the outcome is the hardest to predict. We searched for a predictive marker in this group and observed loss of or reduced Wnt-5a expression in 50% of Dukes B tumors. Such Wnt-5a negativity was a strong predictor of adverse outcome, with a relative risk of death of 3.007 (95% confidence interval, 1.336-6.769; P = 0.008) after 5 years in Wnt-5a-negative patients. Furthermore, the median survival time after diagnosis was 109.1 months for patients with Wnt-5a-positive primary tumors but only 58 months for those with Wnt-5a-negative primary tumors. To find a possible biological explanation for these results, we studied the invasive and poorly differentiated human colon cancer cell line, SW480, which does not express Wnt-5a protein and the Wnt-5a-expressing and moderately differentiated Caco2 colon cancer cell line. We found that the addition of recombinant/purified Wnt-5a significantly reduced the migratory capacity of SW480 cells. By comparison, equivalent treatment did not significantly alter migration in the Wnt-5a-expressing Caco2 colon cancer cell line. These findings indicate that the expression of Wnt-5a in primary Dukes B colon cancer tissue constitutes a good prognostic marker for longer survival, which can be explained by the ability of Wnt-5a to impair tumor cell migration and thus reduce invasiveness and metastasis.
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Affiliation(s)
- Janna Dejmek
- Experimental Pathology and Pathology, Department of Laboratory Medicine, Lund University, Malmö University Hospital, Malmö, Sweden.
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Dejmek A, Hjerpe A. The combination of CEA, EMA, and BerEp4 and hyaluronan analysis specifically identifies 79% of all histologically verified mesotheliomas causing an effusion. Diagn Cytopathol 2005; 32:160-6. [PMID: 15690331 DOI: 10.1002/dc.20202] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A previously tested antibody panel identified three criteria of major importance for distinguishing between mesothelioma and adenocarcinoma (ACA): carcinoembryonic antigen (CEA), BerEp4, and epithelial membrane antigen (EMA) accentuated at the cell membrane. An extended panel, consisting of CEA, BerEp4, EMA, vimentin, mesothelioma antibody (HBME-1), thrombomodulin, Ca125, and sialyl-Tn was applied to effusions from 86 ACAs and 21 mesotheliomas. The specificities and sensitivities of the previously identified reactivity patterns were tested on the new material and the effect of the added antibodies was evaluated. Further, hyaluronan analysis was added as a parameter. The previously selected criteria remained fully predictive for mesothelioma and ACA, respectively, also in the extended material (in all, 139 ACAs and 57 mesotheliomas). With the addition of the hyaluronan value, 79% of the cases was identified with 100% specificity. Among the new antibodies sialyl-Tn seemed the most promising because it specifically identified ACAs not expressing CEA.
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Affiliation(s)
- Annika Dejmek
- Department of Pathology and Cytology, Malmö University Hospital, Lund University, Sweden.
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Zendehrokh N, Dejmek A. Telomere repeat amplification protocol (TRAP) in situ reveals telomerase activity in three cell types in effusions: malignant cells, proliferative mesothelial cells, and lymphocytes. Mod Pathol 2005; 18:189-96. [PMID: 15389260 DOI: 10.1038/modpathol.3800278] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 12/16/2022]
Abstract
Telomerase Repeat Amplification Protocol (TRAP) in situ was performed on cytospin preparations from 65 effusions from the serous cavities (45 pleural and 19 ascitic fluids and one pericardial fluid) submitted for routine diagnosis and the results were correlated to cytological morphology. Three types of cells with nuclear fluorescence were identified: malignant cells, hyperplastic mesothelial cell and lymphocytes. Of 38 cytologically malignant effusions, 12 showed strong reactivity in all malignant cells, three strong reactivity in part of the malignant population, whereas 12 showed moderate reactivity in the whole and five in part of the malignant population, respectively. In five malignant effusions weak reactivity was found in all (one case) and in scattered (four cases) malignant cells. Two effusions contained telomerase-negative malignant cells. Two pleural and two ascitic fluids contained proliferative mesothelial cells with weak or, in one case, moderate reactivity. Lymphocytes usually showed weak telomerase activity. Telomerase was expressed in almost all malignant tumours metastatic to serous cavities. Heterogeneity in tumour populations was demonstrated, which may have diagnostic implications, especially in cytology. Weak or moderate reactivity was found in lymphocytes and in some mesothelial proliferations and may explain the low specificity for malignancy sometimes obtained with the TRAP extract method. The weak reactivity found in lymphocytes may reduce the specificity when the extract method is used but causes no diagnostic problem with the TRAP in situ method.
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Affiliation(s)
- Nooreldin Zendehrokh
- Department of Clinical Pathology and Cytology, Malmö University Hospital, Lund University, S-205 02 Malmö, Sweden
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29
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Abstract
BACKGROUND Fine needle aspiration is a valuable tool in the diagnosis of ovarian cysts, especially in the young and when a nonneoplastic cyst is suspected. High cellularity, epitheliallike clusters and cellular atypia in aspirates from functional cysts are known features that may lead to an erroneous diagnosis of malignancy. Granulosa cells in ovarian cystic fluids may originate in follicular cysts or cystic granulosa cell tumors. In luteinized follicular cysts the cells usually have ample cytoplasm and tend to form clusters. This report draws attention to a case where abundant, dispersed cells lacking cytoplasm led to the incorrect diagnosis of a granulosa cell tumor. CASE In an ovarian cystic aspirate from a 34-year-old woman, the fluid was highly cellular, with a striking predominance of cells interpreted as granulosa cells. Granulosa cells are often found in aspirates from functional cysts, but striking cellularity, prominent nuclear grooves and lack of luteinization made us consider a granulosa cell tumor rather than a follicle-derived cyst. Surgery was performed, and histology revealed a benign serous cystadenoma but also numerous maturing follicles and follicular cysts with thick layers of granulosa cells. The aspirate obviously did not represent the cystadenoma but one of the prominent follicular cysts. CONCLUSION An understanding of the cytologic features of functional ovarian cysts, including the pitfalls, is necessary to avoid a false diagnoses of a neoplastic lesion. For a correct interpretation of the cytologic findings, close communication with the clinician and with the radiologist performing the aspiration is of vital importance.
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Affiliation(s)
- Annika Dejmek
- Department of Clinical Pathology and Cytology, Lund University, Malmö University Hospital, S-205 02 Malmö, Sweden
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30
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Abstract
Telomerase activity in 16 pleural effusions was studied using an in situ telomerase repeat amplification protocol (TRAP) assay on cytospin preparations. Six of nine cytologically malignant specimens contained telomerase-positive cells (67%), and in two further specimens, suspicious positive cells were seen. Two of four atypical specimens contained telomerase-positive cells, whereas two benign cases were telomerase-negative. No mesothelial cells showed telomerase reactivity. Thus, telomerase activity was specific for malignancy and it was always found only in malignant cells. The results suggest that telomerase activity measured with this in situ method can be a valuable complement in the assessment of malignancy in pleural effusions.
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Affiliation(s)
- A Dejmek
- Department of Clinical Cytology and Pathology, Malmö University Hospital, Malmö, Sweden.
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31
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Brockstedt U, Gulyas M, Dobra K, Dejmek A, Hjerpe A. An optimized battery of eight antibodies that can distinguish most cases of epithelial mesothelioma from adenocarcinoma. Am J Clin Pathol 2000; 114:203-9. [PMID: 10941335 DOI: 10.1309/qhca-8594-ta7p-0dvq] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [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: 10/26/2022] Open
Abstract
An immunocytochemical battery comprising 9 antibodies specifically distinguishes 80% of the epithelial malignant mesotheliomas from adenocarcinomas. The discriminatory power of antibodies to calretinin was tested together with this battery to determine whether the performance thereby could be improved. The study comprises 119 mesotheliomas of epithelial or mixed phenotype and 57 adenocarcinoma metastases in the pleural cavity. The differences between the 2 groups were highly significant for all recorded parameters, but typical reactivity for all parameters was seen in only 6 (5.0%) of the 119 mesotheliomas. An algorithm based on stepwise logistic regression was used to interpret divergent reaction patterns. Most diagnostic information was obtained with 8 of the parameters studied. The resulting algorithm identified almost 90% of the mesotheliomas with high specificity. The battery can be performed in 2 steps: several adenocarcinomas first are diagnosed with a few antibodies, applying the rest of the battery on the remaining unresolved cases.
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Affiliation(s)
- U Brockstedt
- Department of Immunology, Microbiology, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
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32
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Abstract
BACKGROUND Telomerase is a ribonucleoprotein that compensates for the erosion of telomeres (chromosomal termini). Telomerase activity is detected in more than 85% of cancerous lesions and is therefore considered a novel marker of cancer. The authors compared cytologic morphology and telomerase activity at the cellular level to obtain further insight into their association. METHODS The authors used bronchial washing and brushing materials obtained from 18 patients with lung carcinomas (6 squamous cell, 8 adenocarcinoma, 2 large cell, 1 small cell, and 1 metastasis from colon carcinoma) and 20 patients with nonmalignant disease. An in situ telomeric repeat amplification protocol (TRAP) assay was performed, and routine Papanicolaou-stained slides using the same sample were assessed. RESULTS Nuclear fluorescent signals at the nuclear area, corresponding to telomerase activity, shown by the in situ TRAP assay were only detected in samples containing morphologically malignant cells. No nuclear fluorescence was seen in the keratinizing component of well-differentiated squamous cell carcinoma. Nuclear staining was not seen in metaplastic or basal hyperplastic cells. Cytoplasmic fluorescence was only found in macrophages and polymorphonuclear leukocytes. CONCLUSIONS Nuclear fluorescence corresponding to telomerase activity was not demonstrated in metaplastic or basal hyperplastic cells, thus indicating that detection of telomerase activity is closely associated with the presence of malignant cells, but not premalignant lesions, in lung carcinoma patients. Moreover, in some samples with cancer, cells failed to show telomerase activity, suggesting the limitation of this method for the detection of malignant cells in certain lung carcinoma patients.
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Affiliation(s)
- A Dejmek
- Department of Clinical Cytology and Pathology, Malmö University Hospital, Sweden
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33
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Abstract
Anti-CEA, anti-vimentin, CAM5.2, BerEp4, Leu-M1 and anti-EMA were applied to effusions from 36 mesotheliomas, 53 adenocarcinomas and 24 reactive mesothelial proliferations. Stepwise logistic regression analysis selected three criteria of major importance for distinguishing between adenocarcinoma and mesothelioma: BerEp4, CEA and EMA accentuated at the cell membrane (mEMA), these three being of similar diagnostic value. The pattern BerEp4-, CEA- and mEMA+ was fully predictive for mesothelioma (sensitivity 47%), whereas the opposite pattern was fully predictive for adenocarcinoma (sensitivity 80%). Only EMA seemed to distinguish between mesotheliosis and mesothelioma. Comparison of reactivity in cytological and histological material from the same mesotheliomas showed similar staining frequencies for CEA and CAM5.2, with some random variation for Leu-M1 and EMA, whereas vimentin and BerEp4 reactivity was more frequent in cytological specimens.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/immunology
- Antibodies, Monoclonal/immunology
- Antibodies, Neoplasm/immunology
- Antibody Specificity
- Antigens, Neoplasm
- Antigens, Surface/analysis
- Antigens, Surface/immunology
- Biomarkers
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/immunology
- Carcinoembryonic Antigen/analysis
- Carcinoembryonic Antigen/immunology
- Diagnosis, Differential
- Epithelium/immunology
- Humans
- Hyperplasia
- Immunoenzyme Techniques
- Keratins/analysis
- Keratins/immunology
- Lewis X Antigen
- Logistic Models
- Lung Neoplasms/diagnosis
- Lung Neoplasms/immunology
- Mesothelioma/diagnosis
- Mesothelioma/immunology
- Mucin-1/analysis
- Mucin-1/immunology
- Neoplasm Proteins/analysis
- Neoplasm Proteins/immunology
- Pleural Effusion, Malignant/diagnosis
- Pleural Effusion, Malignant/immunology
- Sensitivity and Specificity
- Vimentin/analysis
- Vimentin/immunology
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Affiliation(s)
- A Dejmek
- Department of Clinical Cytology and Pathology, Lund University, Malmö Academic Hospital, Sweden
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Abstract
We compared the performance of Papnet to manual screening with respect to detection of dysplastic/atypical epithelial cells, endocervical cells, and inflammatory changes/infectious agents. One thousand consecutive manually screened smears were retrieved from the cytological files and subjected to Papnet analysis. Five slides had to be excluded for technical reasons. Of the remaining 995 cases, manual and Papnet diagnosis showed agreement in 986 cases, 950 benign or within normal limits, and 36 with epithelial abnormalities. Papnet detected 4 cases missed by manual screening, but failed to detect 5 manually diagnosed cases. In 293/749 smears, existing endocervical cells were not selected by Papnet (40%) and inflammatory changes/infectious agents were diagnosed in 49 cases, compared to 87 cases by manual screening (56%). Papnet equaled manual screening for dysplasias and epithelial atypias, but its poor performance regarding endocervical cells and inflammation would be a drawback in primary screening. Diagn. Cytopathol. 1999;21:296-299.
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Affiliation(s)
- K Losell
- Department of Clinical Cytology and Pathology, Malmö University Hospital, Malmö, Sweden
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35
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Abstract
Malignant mesotheliomas show a highly variable aggressiveness, but it is difficult to predict the outcome in the individual case at the time of diagnosis. Glutathione S-transferases are detoxification enzymes that have been correlated with the prognosis in some tumours. We have therefore assessed the value of GST expression as a prognostic parameter in mesotheliomas. The reactivities to GST-pi, -alpha and -mu antibodies were studied in histological sections from altogether 88 cases. Most of them showed distinct cytoplasmic reactivity to one or more of the GST antibodies tested. This high prevalence is in good agreement with the low responsiveness of mesotheliomas to chemotherapy. However, there was no prognostic value in detecting GST immunoreactivity, and it gave no information of value for distinguishing between neoplastic and reactive mesothelium.
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Affiliation(s)
- A Dejmek
- Department of Clinical Cytology and Pathology, Malmö General Hospital, Lund University, Sweden
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36
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Dejmek A, Brockstedt U, Hjerpe A. Optimization of a battery using nine immunocytochemical variables for distinguishing between epithelial mesothelioma and adenocarcinoma. APMIS 1997; 105:889-94. [PMID: 9393561 DOI: 10.1111/j.1699-0463.1997.tb05099.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 02/05/2023]
Abstract
A battery of immunocytochemical analyses, previously established to distinguish between malignant mesothelioma and metastatic adenocarcinoma, was extended by analysing the same cases with three other commercially available antibodies. Altogether, 11 antibodies were studied in mesotheliomas diagnosed by other means, using 14 different immunocytochemical parameters. Logistic regression analysis indicated that the following parameters were of importance for this diagnostic problem: vimentin reactivity in epithelial cells (1), cytokeratin (CAM 5.2) reactivity in spindle-shaped (fibrous) cells (2), cell membrane-associated reactivity of EMA (3), HBME-1 (4) and thrombomodulin (5), and absence of reactivity to CEA (6), CD15 (7), BerEp4 (8) and Sialyl-TN (9). The analysis gave an algorithm with which a specific diagnosis of mesothelioma could be made in 80% of the cases-i.e., some improvement compared to the 55% sensitivity using the previous battery.
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Affiliation(s)
- A Dejmek
- Department of Clinical Cytology and Pathology, Lund University, Malmö University Hospital, Sweden
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37
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Affiliation(s)
- A Dejmek
- Department of Clinical Cytology and Pathology, Malmö University Hospital, Sweden
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38
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Abstract
A case of bilateral isolated adrenal coccidioidomycosis in a previously healthy and immunocompetent 43-year-old Caucasian male is presented. He had never travelled to a coccidioidomycosis endemic area. Subclinical adrenal dysfunction was found with elevated plasma ACTH and mineralocorticosteroid and androgen pathway abnormalities. The implement of the fungal infection on adrenal function, and the diagnosis and management of adrenal coccidioidomycosis are discussed.
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Abstract
Abstract
A previously described HPLC method for determining hyaluronate in effusions was used to analyze a consecutive series of effusions from 1039 patients with pleural fluids and from 571 patients with peritoneal fluids. A mesothelioma was verified histologically in 50 of the cases. The results were used to estimate the clinical utility of the analysis. With a cutoff of 75 mg/L for hyaluronate-derived uronic acid, assay specificity for a malignant mesothelioma was 100% and the sensitivity 56%. Only 20% of the effusions from the mesothelioma patients showed no evidence of increased production of hyaluronate. Cytological smears from the associated cell pellets were evaluated as malignant or suspicious for malignancy in only 28% or in a further 46% of the mesothelioma cases, respectively, leaving 30% of the pellets as cytologically false-negative. We also analyzed effusions from selected cases submitted from other hospitals, 154 of which had been diagnosed histologically as mesotheliomas. Concentrations of hyaluronate were increased in these cases too, but a considerable proportion of the samples showed evidence of losses of hyaluronate; consequently, the sensitivity of the assay in these samples was lower.
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Affiliation(s)
- M Nurminen
- Department of Pathology, Huddinge University Hospital, Sweden
| | - A Dejmek
- Department of Pathology, Huddinge University Hospital, Sweden
| | - G Mårtensson
- Department of Pathology, Huddinge University Hospital, Sweden
| | - A Thylen
- Department of Pathology, Huddinge University Hospital, Sweden
| | - A Hjerpe
- Department of Pathology, Huddinge University Hospital, Sweden
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40
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Nurminen M, Dejmek A, Mårtensson G, Thylen A, Hjerpe A. Clinical utility of liquid-chromatographic analysis of effusions for hyaluronate content. Clin Chem 1994; 40:777-80. [PMID: 8174251] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A previously described HPLC method for determining hyaluronate in effusions was used to analyze a consecutive series of effusions from 1039 patients with pleural fluids and from 571 patients with peritoneal fluids. A mesothelioma was verified histologically in 50 of the cases. The results were used to estimate the clinical utility of the analysis. With a cutoff of 75 mg/L for hyaluronate-derived uronic acid, assay specificity for a malignant mesothelioma was 100% and the sensitivity 56%. Only 20% of the effusions from the mesothelioma patients showed no evidence of increased production of hyaluronate. Cytological smears from the associated cell pellets were evaluated as malignant or suspicious for malignancy in only 28% or in a further 46% of the mesothelioma cases, respectively, leaving 30% of the pellets as cytologically false-negative. We also analyzed effusions from selected cases submitted from other hospitals, 154 of which had been diagnosed histologically as mesotheliomas. Concentrations of hyaluronate were increased in these cases too, but a considerable proportion of the samples showed evidence of losses of hyaluronate; consequently, the sensitivity of the assay in these samples was lower.
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Affiliation(s)
- M Nurminen
- Department of Pathology, Huddinge University Hospital, Sweden
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41
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Abstract
Histological sections from 103 malignant mesotheliomas and 43 adenocarcinoma metastases in pleural biopsies were investigated for reactivity against a panel of 11 different antibodies. The size of the material allowed the evaluation by stepwise logistic regression analysis, which selected five parameters of major importance: vimentin reactivity in epithelial cells, reactivity to low-molecular-weight keratins in fibrous cells, strong membrane accentuation of EMA reactivity, and lack of reactivity to LeuM1 and BerEp4. Three of these criteria were sufficient to identify a mesothelioma with high specificity and with a sensitivity of approximately 70%. Whilst the monoclonal anti-CEA tested was the most valuable single parameter, it did not add any diagnostic information to the combination of criteria selected by the stepwise logistic regression analysis. However, this antibody can be used to exclude most of the adenocarcinomas from further analysis with the more extensive panel.
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Affiliation(s)
- A Dejmek
- Department of Clinical Cytology and Pathology, Lund University, Malmö General Hospital, Sweden
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42
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Abstract
BACKGROUND Immunohistochemical reactivity to carcinoembryonic antigen (CEA) is often used to exclude the diagnosis of malignant mesothelioma. METHODS In a study comprising 61 malignant mesotheliomas and 20 adenocarcinomas, the reactivity against one polyclonal and five different monoclonal anti-CEA antibodies was tested. RESULTS Thirteen of the mesotheliomas showed distinct reactivity to the polyclonal antiserum, even after absorption with spleen powder. Of the monoclonal preparations, those staining granulocytes and macrophages also showed varying reactivity to some of these 13 mesotheliomas. Only one monoclonal antibody showed no such reactivity and labeled no mesothelioma case, while its capacity to stain adenocarcinomas remained. CONCLUSIONS Mesotheliomas may contain substances that share epitopes with the CEA molecule. Only one of the tested monoclonal antibodies seemed sufficiently specific to be used diagnostically as a single immunohistochemical parameter to exclude malignant mesothelioma.
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Affiliation(s)
- A Dejmek
- Department of Clinical Cytology and Pathology, University of Lund, Malmö General Hospital, Sweden
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43
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Dejmek A, Strömberg C, Wikström B, Hjerpe A. Prognostic importance of the DNA ploidy pattern in malignant mesothelioma of the pleura. Anal Quant Cytol Histol 1992; 14:217-21. [PMID: 1418271] [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: 12/26/2022]
Abstract
Malignant mesotheliomas often raise a difficult diagnostic problem: once the diagnosis is made, the possibilities of predicting the biologic activity and prognosis of the tumor are limited. DNA ploidy patterns have been used as a prognostic instrument for other tumors, and this pattern was therefore studied in 37 cases of verified mesothelioma. The measurements were made on Feulgen-stained smears from pleural effusions using a Leica Miamed computer microscope. When a highly aneuploid tumor was defined as a condition with greater than 5% of the cells within defined intervals outside the ranges of the stem-line and the peaks representing polyploidization thereof, a near-diploid/polyploid pattern was obtained in 41% of the cases, while the remaining 59% were classified as highly aneuploid. The prognosis was significantly better among the near-diploid/polyploid cases. This estimate of the outcome could not be improved by using alternative algorithms for high-grade aneuploidy.
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Affiliation(s)
- A Dejmek
- Department of Pathology II, Karolinska Institute, Huddinge University Hospital, Sweden
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44
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Domanski H, Dejmek A, Ljung R. Gaucher's disease in an infant diagnosed by fine needle aspiration of the liver and spleen. A case report. Acta Cytol 1992; 36:410-2. [PMID: 1580127] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A case of Gaucher's disease diagnosed by means of fine needle aspiration of the liver and spleen in a 12-month-old boy with hepatosplenomegaly is presented. The diagnosis was based on the finding of large, macrophagelike cells with abundant, pale, fibrillary cytoplasm and small nuclei. The patient had no family history of Gaucher's disease, and the diagnosis was not suspected clinically.
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Affiliation(s)
- H Domanski
- Department of Clinical Cytology and Pathology, Malmö General Hospital, Sweden
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45
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46
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Dejmek A, Lindholm K. Frequency of cytologic features in fine needle aspirates from histologically and cytologically diagnosed fibroadenomas. Acta Cytol 1991; 35:695-9. [PMID: 1950317] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Identification of key cytologic criteria for various lesions by means of stepwise logistic regression is common today and is often claimed to facilitate cytologic diagnosis. As can be expected, there usually is good agreement between the selected criteria and those given in the cytologic literature. In a study by Bottles et al based on 64 fibroadenomas, stroma, antler horn clusters and honeycomb sheets differentiated fibroadenoma from ductal carcinoma. We applied Bottles's criteria to our fibroadenoma material in order to test their value in clinical cytologic practice. In fine needle aspirates from histologically (cytologically) diagnosed fibroadenomas, stroma was found in 41 (57%), antler horn clusters in 59 (90%) and honeycomb sheets in 62 (81%), which reduced the clinical value of the criteria.
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Affiliation(s)
- A Dejmek
- Department of Clinical Pathology and Cytology, Malmö General Hospital, Sweden
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47
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Dejmek A, Lindholm K. Fine needle aspiration biopsy of cystic lesions of the head and neck, excluding the thyroid. Acta Cytol 1990; 34:443-8. [PMID: 2343703] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The occurrence of cystic lesions of the head and neck region (excluding the thyroid gland) and their diagnosis by fine needle aspiration (FNA) biopsy were reviewed for a two-year period. Of the 967 total aspirates of the region, 98 were cystic. The frequency of cysts was thus 10% in the total material, including 23% in parotid gland aspirates and 3% in lymph node aspirates. Salivary gland cysts occurred more often on the right side. The overall malignancy rate was the same for cysts and solid lesions (16%); however, 81% of cystic lymph node lesions were malignant. There was no difference in the frequency of nondiagnostic FNA material between solid and cystic lesions. A histologically correct diagnosis of benign or malignant was rendered by cytology in 85% of the cystic cases, with 4% false negatives and 2% false positives. This diagnostic accuracy was similar to that of the solid lesions. The FNA diagnostic problems were concentrated in the salivary gland lesions, with the false diagnoses illustrating the difficulties of interpreting atypical oxyphilic epithelium. The results suggest that a true neoplastic lesion should be seriously considered when a single population of oxyphilic epithelium is identified, even at the risk of overdiagnosing benign lesions.
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Affiliation(s)
- A Dejmek
- Department of Clinical Cytology, Malmö General Hospital, Sweden
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48
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Abstract
A 7-year-old boy with recurrent pneumonia of the right lower lobe is described. At bronchoscopy a small tumour almost totally obliterating the right lower lobe was detected. Surgical treatment was undertaken. Histopathologic studies showed findings consistent with those of a muco-epidermoid tumour. The case emphasizes bronchoscopy as an important investigation in children with recurrent pneumonia. It also shows the importance of performing the bronchoscopy during a prolonged course of antibiotic prophylaxis in order to ensure a minimum of infected mucus within the bronchi. This report is completed with a short review of the literature on muco-epidermoid tumours of the bronchus in children. Their favourable prognosis and very low malignant potential is underlined.
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