Tip Lesion Most Frequent FSGS Variant Related to COVID-19 Vaccine: Two Case Reports and Literature Review

Large-scale COVID-19 vaccination has been one of the most effective strategies to control the spread of the SARS-CoV-2 virus. However, several cases of glomerular injury related to the COVID-19 vaccine have been described in the literature. We report two cases of a tip lesion variant of focal segmental glomerulosclerosis (FSGS), which presented with significant proteinuria and improved after immunosuppression. In our literature review, the tip lesion variant of FSGS is currently the most frequent variant associated with vaccination against COVID-19. Prognosis is favorable and without significant alterations in the tubulointerstitial or vascular compartments. Adverse effects of vaccines need to be recognized early and will help us to understand the immune and pathological mechanisms of kidney damage.

What is the Role of SNORA42 in Carcinogenesis? A Systematic Review

OBJECTIVE

Perform a systematic literature review on SNORA42 in carcinogenesis in order to elucidate its importance, its potential use as a biomarker and as a therapeutic target.

METHODS

Using PubMed, SciELO and Science Direct databases as search means, articles that are in line with the scope of the study, written in English, that were published between 2012 and 2022, were selected using the following keywords: "small nucleolar RNA 42", "snoRNA 42" and "SNORA42", as well as searches for the synonyms of this snoRNA (SNORA80E, box H/ACA 42 and ACA42).

RESULT

From a total of 131 studies, seven were selected, in which it was possible to identify that SNORA42 interferes in several biological processes, such as proliferation, migration, invasion, metastasis, apoptosis, and signaling pathways. Among the signaling pathways, the p53 and NF-KappaB pathways stand out. Moreover, it is a potential biomarker for diagnosis, prognosis, and treatment of cancer.

CONCLUSION

The summary of the main information about SNORA42 in the process of carcinogenesis and cancer progression shows that the use of this snoRNA is ideal for future applications in the field of oncology, in which it can be used as a biomarker and therapeutic target. Thus, it is of fundamental importance to carry out new studies to consolidate the applicability of this molecule.

A comprehensive analysis of penile cancer in the region with the highest worldwide incidence reveals new insights into the disease

BACKGROUND

Although penile cancer (PC) is uncommon in developed countries, it is widespread in developing countries. The state of Maranhão (Northeast, Brazil) has the highest global incidence recorded for PC, and, despite its socioeconomic vulnerability, it has been attributed to human papillomavirus (HPV) infection. This study aimed to determine the histopathological features, the prevalence of HPV infection, and the immunohistochemical profile of PC in Maranhão.

METHODS

A retrospective cohort of 200 PC cases were evaluated. HPV detection was performed using nested-PCR followed by direct sequencing for genotyping. Immunohistochemistry (IHC) was performed using monoclonal antibodies anti-p16^INK4a, p53, and ki-67.

RESULTS

Our data revealed a delay of 17 months in diagnosis, a high rate of penile amputation (96.5%), and HPV infection (80.5%) in patients from Maranhão (Molecular detection). We demonstrated the high rate of HPV in PC also by histopathological and IHC analysis. Most patients presented koilocytosis (75.5%), which was associated with those reporting more than 10 different sexual partners during their lifetime (p = 0.001). IHC revealed frequent p16^INK4a overexpression (26.0%) associated with basaloid (p < 0.001) and high-grade tumors (p = 0.008). Interestingly, p16 appears not to be a better prognostic factor in our disease-free survival analysis, as previously reported. We also demonstrated high ki-67 and p53 expression in a subset of cases, which was related to worse prognostic factors such as high-grade tumors, angiolymphatic and perineural invasion, and lymph node metastasis. We found a significant impact of high ki-67 (p = 0.002, log-rank) and p53 (p = 0.032, log-rank) expression on decreasing patients' survival, as well as grade, pT, stage, pattern, and depth of invasion (p < 0.05, log-rank).

CONCLUSIONS

Our data reaffirmed the high incidence of HPV infection in PC cases from Maranhão and offer new insights into potential factors that may contribute to the high PC incidence in the region. We highlighted the possible association of HPV with worse clinical prognosis factors, differently from what was observed in other regions. Furthermore, our IHC analysis reinforces p16, ki-67, and p53 expression as important diagnosis and/or prognosis biomarkers, potentially used in the clinical setting in emerging countries such as Brazil.

Primary Leiomyosarcoma of the Glans

Penile leiomyosarcoma isz an extremely uncommon entity that rarely occurs in the glans. Due to the limited number of cases described in literature, guidelines regarding non-surgical treatment, prognosis, and management remain equivocal. Among the mesenchymal tumors of the penis, leiomyosarcoma has the highest propensity for recurrence. It originates in the smooth muscle cells from two distinct locations: superficial and deep. The deep subtype is the most aggressive and has the highest potential for metastasis. Surgical treatment should be implemented early and must be locally aggressive. Herein, we present a rare case of a 54-year-old patient with deep localized leiomyosarcoma of the glans, albeit with superficial characteristics. A review of the main histopathological, clinical, immunohistochemical, and therapeutic aspects of this unusual entity is presented.

Downregulation of miR-145 is associated with perineural invasion in penile carcinoma

Background

Human papillomavirus (HPV) infection is a risk factor for penile cancer (PC). The miR-145 expression has been correlated to this virus genomic amplification. In this context, this work aims to determine the expression level of miR-145 in penile tumors infected by high-risk HPV and correlate it with the clinicopathological characteristics of the tumor and protein expression of p53.

Methods

Formalin-fixed paraffin-embedded from 52 patients with PC, at diagnosis and prior to any cancer treatment, were obtained. HPV identification was performed by nested type PCR, and miR-145 expression was obtained by qRT-PCR. Immunohistochemical analysis of p53 and Ki-67 was performed.

Results

Tumoral miR-145 expression was significantly lower compared to adjacent tissue. Additionally, there was a significant reduction of miR-145 expression in invasion perineural, histological associated HPV, and absence of p53 expression in positive HPV cases. HPV infection was detected in 86.5%, the most frequent HPV16. Reduced disease-free survival was observed in patients with low expression of miR-145.

Conclusions

Our data suggest that the underexpression of miR-145 may be triggered by HPV action, decreasing protein expression of p53, and being correlated with perineural invasion. Therefore, the deregulation of miR-145 provides clues as to the potential role in penile carcinogenesis and is also a potential candidate for validation in noninvasive samples.

Brazilian Consortium for the Study on Renal Diseases Associated With COVID-19: A Multicentric Effort to Understand SARS-CoV-2-Related Nephropathy

Kidney involvement appears to be frequent in coronavirus disease 2019 (COVID-19). Despite this, information concerning renal involvement in COVID-19 is still scarce. Several mechanisms appear to be involved in the complex relationship between the virus and the kidney. Also, different morphological patterns have been described in the kidneys of patients with COVID-19. For some authors, however, this association may be just a coincidence. To investigate this issue, we propose assessing renal morphology associated with COVID-19 at the renal pathology reference center of federal university hospitals in Brazil. Data will come from a consortium involving 17 federal university hospitals belonging to Empresa Brasileira de Serviços Hospitalares (EBSERH) network, as well as some state hospitals and an autopsy center. All biopsies will be sent to the referral center for renal pathology of the EBSERH network. The data will include patients who had coronavirus disease, both alive and deceased, with or without pre-existing kidney disease. Kidney biopsies will be analyzed by light, fluorescence, and electron microscopy. Furthermore, immunohistochemical (IHC) staining for various inflammatory cells (i.e., cells expressing CD3, CD20, CD4, CD8, CD138, CD68, and CD57) as well as angiotensin-converting enzyme 2 (ACE2) will be performed on paraffinized tissue sections. In addition to ultrastructural assays, in situ hybridization (ISH), IHC and reverse transcription-polymerase chain reaction (RT-PCR) will be used to detect Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in renal tissue. For the patients diagnosed with Collapsing Glomerulopathy, peripheral blood will be collected for apolipoprotein L-1 (APOL1) genotyping. For patients with thrombotic microangiopathy, thrombospondin type 1 motif, member 13 (ADAMTS13), antiphospholipid, and complement panel will be performed. The setting of this study is Brazil, which is second behind the United States in highest confirmed cases and deaths. With this complete approach, we hope to help define the spectrum and impact, whether immediate or long-term, of kidney injury caused by SARS-CoV-2.

MIR-107, MIR-223-3P and MIR-21-5P Reveals Potential Biomarkers in Penile Cancer

BACKGROUND

Inguinal lymph node involvement is the main prognostic factor in patients with penile cancer. However, there is a lack of marker/s for lymph node metastasis. microRNAs have been investigated as potential markers for prognosis of various types of cancer. Taking this into consideration, our main goal was to determine the association of miR-223-3p, miR-107, and miR-21-5p expression with clinicopathological characteristics, as well as presence of lymph node metastasis in patients with penile cancer.

METHODS

Formalin-fixed paraffin-embedded penile squamous cell carcinoma specimens from 50 patients, at diagnosis and prior to any cancer treatment, were obtained. Tissue samples comprising at least 70% malignant cells and adjacent non-tumor tissues were evaluated by using qRT-PCR for expression level of miR-223-3p, miR-107 and miR-21-5p. Additionally, molecular identification of HPV was performed by PCR, and the expression levels of PTEN were analyzed by immunohistochemistry.

RESULTS

Penile squamous cell carcinoma primary tumors presented higher expression of miR-223-3p, miR-107, and miR-21-5p when compared to non-tumor adjacent tissues. Upregulation of miR-223-3p was associated lymph node metastasis. Higher expression of miR-107 was associated with worsening of prognosis (as observed by histological grade II and III, tumors bigger than 2.0 cm, stage III and IV, and lower disease-free survival). In addition, higher expression of miR-107 and miR-21-5p was correlated to the absence of PTEN protein expression.

CONCLUSIONS

Our data demonstrate that higher expression of miR-223-3p, miR-107, and miR-21-5p is correlated with poor prognosis in penile cancer. The upregulation of these microRNAs potentially affect critical cancer pathways and may be important for the prognosis and response to therapy in penile cancer.

P16INK4a expression in patients with penile cancer

BACKGROUND

Infection with human papillomavirus (HPV) is reported to be present in 30-50% of penile cancer cases. The immunohistochemical test for p16INK4a is used as an indicator of the presence of HPV and as a prognostic marker for squamous cell carcinomas in various sites. However, the role of this marker in penile carcinoma has not yet been completely elucidated. The aim of this study was to analyze whether the expression of p16INK4a is associated with the presence of HPV, histological parameters, and survival in penile cancer.

METHODS

A study was conducted from 2014 to 2016 that included 55 patients with penile carcinoma. HPV DNA was detected through PCR using fresh tumor tissue, and immunohistochemistry was performed for analysis of p16INK4a protein using paraffin-embedded tissue. Evaluation of histological parameters was performed following complete embedding of the tumor tissue in paraffin.

RESULTS

HPV DNA (low-risk and high-risk genotypes) was found in 49 (89.1%) cases, and 46/49 (93.9%) showed high-oncogenic risk HPV (HR-HPV). Of the 22 cases positive for p16INK4a, HR-HPV DNA was present in 21 (95.5%) (p = 0.032). Regarding histological parameters, p16INK4a and HR-HPV were significantly associated only with tumor subtype (p = 0.036 and p = 0.032, respectively); all carcinomas with basaloid characteristics were positive for p16INK4a. Although HPV+ patients had a higher disease-free survival (p <0.001), p16INK4a expression was not associated with patient survival.

CONCLUSIONS

Our study, using fresh tissue samples, showed the highest incidence of HPV compared to that observed in the literature. Expression of the p16INK4a protein was significantly associated with the presence of HR-HPV and this expression may serve as a marker for the presence of the virus. The p16INK4a protein was not associated with the histological prognostic parameters, with the exception of tumor subtype, nor with patient survival. In the results, we showed that the objective of the present study was reached.

Abstract B15: Copy number and mRNA expression alterations of the PI3K/AKT and inflammatory pathways in penile cancer patients

Penile cancer (PeCa) is a rare neoplasm in developed countries; however, its incidence is high in developing countries. In Brazil, the North and Northeast regions present the highest incidence of cases; in the state of Maranhão, in particular, about four penectomy procedures are conducted weekly in patients with advanced PeCa. Several risk factors have been attributed to the development of PeCa, including infection with human papillomavirus (HPV) and/or chronic inflammation. However, the genetic pathways that are involved in the malignant transformation impacted by these factors are not completely known. Gene alterations affecting the PI3K/AKT signaling pathway are commonly observed in many human cancers. Mutations in the PI3KCA gene and overexpression of EGFR are described in PeCa; however, their prognostic value and/or association with HPV and inflammatory markers are not well known. Therefore, in this study our objectives were to investigate copy number alterations (CNAs) in specific genes involved in the PI3K/AKT pathway (PIK3CA, AKT2 and PTEN) and the expression of the inflammatory associated markers COX2 and EGFR and their association with HPV infection and histopathologic parameters from the patients.

Formalin-fixed, paraffin-embedded (FFPE) tissue specimens from 37 patients with penile cancer were obtained from Instituto Maranhense de Oncologia Aldenora Belo (IMOAB) and Hospital Universitário Presidente Dutra (HU-UFMA), São Luis, Maranhão. The samples were obtained at the time of the surgery; 78.9% and 21.1% of the patients underwent partial and total penectomy, respectively. Lymphadenectomy was conducted in 76.7% of the patients. The average age of the patients was 59.9+18.3 years and the average tumor size was 4.44+2.39 mm. Most of the cases were of the spinocellular carcinoma histology (48.6%), followed by epidermoid (40.5%) and squamous cell carcinoma (10.8%). Tumor grade II was observed in 62.2% of the patients, and grades I and III in 19% each. Lymphatic and perineural invasion was observed in 33.3% and 42% of the patients, respectively.

DNA and RNA were isolated from the tumor tissue samples using AllPrep DNA/RNA FFPE Kit. Nested PCR genotyping assay was carried out to determine HPV subtypes of the patients. Copy number of the PIK3CA, AKT 2, and PTEN genes were accessed by TaqMan copy number assays and mRNA expression of the inflammatory associated genes EGFR and COX2 by qRT-PCR analysis.

HPV infection was detected in 91.9% of the patients for 14 subtypes of HPV (6, 16, 30, 35, 44, 51, 52, 53, 56, 59, 66, 70, 73, and 74), 23.5% of whom presented with multiple HPV infection. The most frequent subtypes observed, affecting 34.4% of the patients, were the subytpes 16 and 18. Deletion of copy number was observed for all three genes analyzed in almost all the patients (90%); PIK3CA presented the highest frequency of homozygous deletion (56.3%), followed by PTEN (39.4%) and AKT2 (36.4%). No gains and/or amplifications on these genes were observed in any of the cases analyzed. EGFR and COX2 genes were observed to be overexpressed in 87% and 40% of the tumors, respectively. No association was observed between copy number and gene expression alterations of the genes analyzed and HPV infection, and the clinical-histopathologic parameters analyzed. However, patients infected with the HPV subtypes 16 and 18 presented tumors of more advanced grade (grade III).

Homozygous deletion of the PIK3CA, PTEN, and AKT2 as well as overexpression of COX2 and EGFR genes were observed in the group of PeCa patients from the state of Maranhão. Although a remarkably high level of patients presented with HPV infection (92%), these genomic alterations occurred independently of this infection and of the other prognostic parameters evaluated. These findings support the involvement of alterations in the PI3K/AKT and inflammatory pathways in the etiology of PeCa, and open up opportunities of using the available or novel therapeutic strategies targeting these pathways for PeCa patients.

Citation Format: Silma Regina Ferreira Pereira, Juliana Melo Macedo, Marta Regina de Castro Belfort, Elis Vanessa de Lima Silva, Leudivan Ribeiro Nogueira, José Ribamar Calixto, Ronald Coelho, Antonio Augusto Lima Teixeira Júnior, Jaqueline Diniz Pinho, André Salim Khayat, Gyl Eanes Barros Silva, Luciane Regina Cavalli. Copy number and mRNA expression alterations of the PI3K/AKT and inflammatory pathways in penile cancer patients [abstract]. In: Proceedings of the AACR International Conference held in cooperation with the Latin American Cooperative Oncology Group (LACOG) on Translational Cancer Medicine; May 4-6, 2017; São Paulo, Brazil. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(1_Suppl):Abstract nr B15.