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Jain D, Khandakar B, Ni P, Kenney B, Qin L, Deshpande V, Fiel MI. von Meyenburg complexes are more frequently associated with cholangiocarcinoma. J Clin Pathol 2024:jcp-2024-209572. [PMID: 38729770 DOI: 10.1136/jcp-2024-209572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
AIM There is some evidence that von Meyenburg complexes (VMCs) can progress to cholangiocarcinoma (CC). This study aimed to evaluate the prevalence of VMCs in CC cases. METHODS All hepatic resections and explants with intra-hepatic CC (I-CC) and hilar-CC (H-CC) from 1985 to 2020 were studied. Hepatic resections (n=68) for benign lesions or metastatic colonic carcinoma and 15 cases with cirrhosis without any cancer were used as controls. RESULTS A total of 118 cases of CC (88 I-CC, 30 H-CC) were identified. Of these, 61 (52%) patients had no known background liver disease, and 20 (17%) had cirrhosis. Associated liver disorders included metabolic dysfunction-associated steatohepatitis (23), chronic viral hepatitis B or C (13), biliary disease (primary or secondary sclerosing cholangitis) (8), polycystic kidney disease (6), cryptogenic cirrhosis (5) and others miscellaneous disorders (7). VMCs were present in 34 (39%) of 88 I-CC cases and 7 (23%) of 30 H-CC cases. VMCs were present within the tumour (20 cases), outside the cancer (21 cases) or at both locations (10 cases). VMCs with dysplasia/carcinoma in situ were seen in 19 of 41 (46%) cases with CC and VMCs. In addition, bile duct adenomas were identified in 6 (5%) of CC. 7% of controls showed the presence of VMCs compared with 35% of CC cases (p<0.05). CONCLUSIONS VMCs are seen far more frequently in patients with CC than in the control group. The findings support the hypothesis that VMCs could represent a precursor of CC or a marker for a higher risk of developing CC.
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Affiliation(s)
- Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Binny Khandakar
- Department of Pathology and Laboratory Medicine, Donald Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Pu Ni
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Barton Kenney
- Department of Pathology, Middlesex Health, Middletown, Connecticut, USA
| | - Lihui Qin
- Department of Pathology, Weill Cornell Medical College, New York City, New York, USA
| | - Vikram Deshpande
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Isabel Fiel
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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2
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Chauhan A, Chan K, Halfdanarson TR, Bellizzi AM, Rindi G, O'Toole D, Ge PS, Jain D, Dasari A, Anaya DA, Bergsland E, Mittra E, Wei AC, Hope TA, Kendi AT, Thomas SM, Flem S, Brierley J, Asare EA, Washington K, Shi C. Critical updates in neuroendocrine tumors: Version 9 American Joint Committee on Cancer staging system for gastroenteropancreatic neuroendocrine tumors. CA Cancer J Clin 2024. [PMID: 38685134 DOI: 10.3322/caac.21840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/05/2024] [Indexed: 05/02/2024] Open
Abstract
The American Joint Committee on Cancer (AJCC) staging system for all cancer sites, including gastroenteropancreatic neuroendocrine tumors (GEP-NETs), is meant to be dynamic, requiring periodic updates to optimize AJCC staging definitions. This entails the collaboration of experts charged with evaluating new evidence that supports changes to each staging system. GEP-NETs are the second most prevalent neoplasm of gastrointestinal origin after colorectal cancer. Since publication of the AJCC eighth edition, the World Health Organization has updated the classification and separates grade 3 GEP-NETs from poorly differentiated neuroendocrine carcinoma. In addition, because of major advancements in diagnostic and therapeutic technologies for GEP-NETs, AJCC version 9 advocates against the use of serum chromogranin A for the diagnosis and monitoring of GEP-NETs. Furthermore, AJCC version 9 recognizes the increasing role of endoscopy and endoscopic resection in the diagnosis and management of NETs, particularly in the stomach, duodenum, and colorectum. Finally, T1NXM0 has been added to stage I in these disease sites as well as in the appendix.
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Affiliation(s)
- Aman Chauhan
- Department of Medicine, Neuroendocrine Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Kelley Chan
- Department of Surgery, Loyola University Medical Center, Chicago, Illinois, USA
| | | | - Andrew M Bellizzi
- Department of Pathology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - Guido Rindi
- Department of Life Sciences, Section of Anatomic Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health Sciences and Public Health, Anatomic Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS and Roma-Gemelli European Neuroendocrine Tumor Society Center of Excellence, Rome, Italy
| | - Dermot O'Toole
- National Center for Neuroendocrine Tumors, European Neuroendocrine Tumor Society Center of Excellence (St Vincent's University Hospital) and St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel A Anaya
- Department of Gastrointestinal Oncology-Surgery, Moffitt Cancer Center, Tampa, Florida, USA
| | - Emily Bergsland
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Erik Mittra
- Department of Diagnostic Radiology, Molecular Imaging and Therapy, Oregon Health and Science University, Portland, Oregon, USA
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Thomas A Hope
- Department of Radiology, University of California San Francisco, San Francisco, California, USA
| | - Ayse T Kendi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Samantha M Thomas
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sherlonda Flem
- Tumor Registrar, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James Brierley
- Radiation Medicine Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Elliot A Asare
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kay Washington
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chanjuan Shi
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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3
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Elliott EI, Smith D, Lipscomb J, Banini B, Meurer L, Vanderford TH, Johnson JA, Jain D, Achhra A. Acute Hepatitis due to Primary Human Immunodeficiency Virus Infection. Open Forum Infect Dis 2024; 11:ofae170. [PMID: 38585186 PMCID: PMC10996125 DOI: 10.1093/ofid/ofae170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
The acute retroviral syndrome may present with diverse systemic manifestations and laboratory abnormalities. Here we present a rare case of primary human immunodeficiency virus (HIV) infection causing severe acute hepatitis. Liver histopathology demonstrated a pattern of lymphocytic inflammation consistent with acute hepatitis, high levels of HIV proviral DNA were detected within liver tissue, and immunofluorescence showed HIV p24 antigen within immune and parenchymal cells including hepatocytes. We review the literature pertaining to HIV infection of cell compartments within the liver and discuss the implications for HIV-associated acute liver disease.
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Affiliation(s)
- Eric I Elliott
- Section of Infectious Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daisy Smith
- The DESA Group, Inc., Columbia, South Carolina, USA
| | - Jonathan Lipscomb
- HIV Laboratory Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bubu Banini
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lindsay Meurer
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas H Vanderford
- HIV Laboratory, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey A Johnson
- HIV Laboratory, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Amit Achhra
- Section of Infectious Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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4
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Gu SX, Siddon AJ, Huntington SF, Jain D. Helicobacter pylori-negative mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach: A clinicopathologic analysis. Am J Clin Pathol 2023; 160:612-619. [PMID: 37556379 PMCID: PMC10691190 DOI: 10.1093/ajcp/aqad088] [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: 04/11/2023] [Accepted: 06/29/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is historically associated with Helicobacter pylori (HP) infections in more than 80% of patients. However, the incidence of HP-negative MALT lymphoma has been increasing. The clinicopathologic features have not been well studied, and optimal management strategies remain unclear. METHODS The pathology database was searched for primary gastric MALT lymphomas diagnosed from 2000 to 2017. The clinical data and the slides were reviewed. The cases were divided for analysis into those with a background of chronic gastritis with HP, chronic gastritis without HP, and without either a background of chronic gastritis or HP. RESULTS Of 70 gastric MALT lymphoma cases identified, 26 (37% of total) had chronic gastritis and were positive for HP histologically (n = 23) or were HP positive by additional laboratory testing (n = 3). The remaining 44 (63% of total) cases were HP negative by histology. Within the HP-negative cases, 5 (11% of HP-negative cases) showed histologic gastritis while 39 (89% of HP-negative cases) did not have sufficient evidence of gastritis through review of slides (n = 18) or based on available pathology reports (n = 21). The HP-negative cases without gastritis had higher propensities to show a mass lesion on endoscopy compared with HP-positive cases (37.5% vs 11.1%, P = .02) at the initial diagnosis. The immunophenotype and rate of positive B-cell gene rearrangement were not significantly different between the 2 groups. While all HP-positive patients received antibiotics for HP eradication, treatment in the HP-negative group varied among antibiotics, radiation, rituximab, or chemotherapy. Among HP-negative patients with available follow-up, 13 (39%) showed disease recurrence, similar to the recurrence rate in HP-positive patients; however, no individual from either group has died of the disease thus far. CONCLUSIONS The incidence of HP-negative MALT lymphoma is increasing, and in our practice, it is currently more common than HP-associated MALT lymphomas. The pathophysiology of HP-negative MALT lymphoma without chronic gastritis remains unclear. Follow-up data in our study suggest that the prognosis of these cases is excellent despite varied management modalities.
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Affiliation(s)
- Sean X Gu
- Department of Laboratory Medicine, Yale School of Medicine, Yale University, New Haven, CT, US
| | - Alexa J Siddon
- Department of Laboratory Medicine, Yale School of Medicine, Yale University, New Haven, CT, US
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, CT, US
| | - Scott F Huntington
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, US
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, CT, US
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5
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Umetsu SE, Joseph NM, Cho SJ, Morotti R, Deshpande V, Jain D, Kakar S. Focal nodular hyperplasia-like nodules arising in the setting of hepatic vascular disorders with portosystemic shunting show β-catenin activation. Hum Pathol 2023; 142:20-26. [PMID: 37806391 DOI: 10.1016/j.humpath.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023]
Abstract
Hepatocellular nodules can develop in the setting of chronic hepatic vascular disorders including those characterized by portosystemic shunts such as Abernethy malformation and post-Fontan procedure. The nodules can range from benign lesions such as regenerative nodules, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA) to malignant neoplasms such as hepatocellular carcinoma (HCC). In many instances, these nodules are difficult to place into well-defined categories based on radiologic or histologic features. Nodular lesions that resemble FNH are common in this context and have been described as FNH-like nodules, the nature of which is not well-established. This study examines 6 liver resections from patients with vascular disease characterized by portosystemic shunts. A wide range of nodules were present in these cases, including regenerative nodules (n = 2), FNH and FNH-like (n = 30), HCA (n = 10), HCA-like (n = 13), and HCC (n = 2). Six nodules from 3 patients were categorized as FNH-like due to one or more features such as nodular architecture, fibrous septa, and ductular reaction, but lack of typical map-like glutamine synthetase (GS) staining. Further characterization of these 6 FNH-like nodules showed diffuse GS staining in all nodules (3 diffuse homogeneous, 3 diffuse heterogeneous). Targeted next-generation sequencing identified CTNNB1 alterations in all tested FNH-like nodules (n = 4). These results indicate that FNH-like nodules in the setting of chronic hepatic vascular disorders can be neoplastic. Since the presence of β-catenin activation portends a potential risk for malignant progression, GS and β-catenin immunohistochemistry should be obtained in all cases showing FNH-like morphology, with molecular analysis performed in cases with indeterminate staining pattern.
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Affiliation(s)
- Sarah E Umetsu
- Department of Pathology, University of California, San Francisco, San Francisco, CA, 94143, USA.
| | - Nancy M Joseph
- Department of Pathology, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Soo-Jin Cho
- Department of Pathology, University of California, San Francisco, San Francisco, CA, 94143, USA
| | | | - Vikram Deshpande
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University, New Haven, CT, 06520, USA
| | - Sanjay Kakar
- Department of Pathology, University of California, San Francisco, San Francisco, CA, 94143, USA
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6
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Sun T, Gilani S, Jain D, Cai G. Cytomorphologic, immunophenotypical and molecular features of pancreatic acinar cell carcinoma. Diagn Cytopathol 2023; 51:674-683. [PMID: 37469257 DOI: 10.1002/dc.25196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/14/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES As a rare tumor in pancreas, pancreatic acinar cell carcinoma (PACC) possesses a distinct molecular feature from pancreatic ductal carcinoma (PDAC). Though the diagnosis of PACC is often established based on cytology specimens, its cytologic diagnosis can be challenging. Furthermore, the correlation between PACC cytomorphology and its unique different molecular alterations have not been fully explored. METHODS Cytology features were analyzed in 8 histologically proven PACC and cytohistological correlation was performed. Immunocytochemistry for trypsin, chymotrypsin, BCL10, synaptophysin, chromogranin A, INSM1, β-catenin, and Ki-67 was assessed. Comprehensive molecular profiling and additional targetable treatment biomarker assessment were also performed. RESULTS The cohort included 4 mixed acinar-neuroendocrine carcinomas, 3 pure PACCs, and 1 mixed acinar-ductal carcinoma. Immunophenotypical features are consistent with diagnoses of PACC or PACC with neuroendocrine features. Identified genetic alterations included somatic mutations of CTNNB1, TP53, MAP2K1, PTEN, RAC1, germline mutations of NBN and BRAC2, and gene fusion of CCDC6-RET. CONCLUSIONS The current study is the first attempt to explore the correlation between the cytomorphology characteristics and molecular features of PACC and a few intriguing findings were observed. Further validation in larger cohorts is warranted.
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Affiliation(s)
- Tong Sun
- Departments of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Syed Gilani
- Departments of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dhanpat Jain
- Departments of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Guoping Cai
- Departments of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
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7
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Dwivedi AND, Varshney A, Jain D, Singh G. CT coronary angiography as an alternative imaging method to ascertain cardiac output and its correlation with echocardiography. Clin Radiol 2023; 78:e831-e838. [PMID: 37626004 DOI: 10.1016/j.crad.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
AIM To assess the feasibility and accuracy of cardiac output (CO) obtained using a test bolus in patients scanned with single-source prospective-gated cardiac computed tomography (CT), and comparing it with CO obtained from unenhanced two-dimensional (2D) echocardiography using biplane Simpson's method. MATERIALS AND METHODS In the present study, 100 patients with a mean age of 55 ± 12 years who underwent coronary CT angiography with prospective electrocardiogram (ECG)-gated CT in which the scan delay was evaluated using a test bolus. The time-attenuation curves obtained from the test bolus were used to calculate the CO of the patients. The CO obtained was then compared with that obtained after follow-up 2D echocardiography using biplane modified Simpson method. RESULTS Linear regression was calculated between the CO and contrast enhancement: CO = -0.16(HUmax) + 7.65. The study showed good correlation between the two methods with r=0.77, p<0.001. On Bland-Altman analysis, no significant difference was noted between the two methods. CONCLUSION This less researched method for CO estimation appears feasible; however, the clinical usefulness of this parameter is uncertain in absence of further clinical and reference standard validation.
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Affiliation(s)
- A N D Dwivedi
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, India.
| | - A Varshney
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, India
| | - D Jain
- Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, India
| | - G Singh
- Centre of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, India
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8
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Soon GST, Yasir S, Jain D, Kakar S, Wu TT, Yeh MM, Torbenson MS, Chen ZE. CRP Versus SAA for Identification of Inflammatory Hepatic Adenomas. Appl Immunohistochem Mol Morphol 2023; 31:590-595. [PMID: 37698958 DOI: 10.1097/pai.0000000000001155] [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] [Received: 12/07/2022] [Accepted: 08/04/2023] [Indexed: 09/14/2023]
Abstract
Subtyping hepatic adenomas is important for patient management due to differing complication risks. Immunohistochemical staining with C-reactive protein (CRP) and serum amyloid-A (SAA) is widely accepted as a surrogate for molecular classification to identify inflammatory hepatocellular adenomas. Limited data, however, has been published on how these 2 stains compare for sensitivity. We conducted a large, multicenter, retrospective study to examine the sensitivity and staining characteristics of CRP and SAA in inflammatory hepatic adenomas, with focal nodular hyperplasia (FNHs) as a control group. Inflammatory adenomas were identified in 133 patients (average age 37 years, 109 were female). In all, 69.9% of cases were resection specimens and 90.2% of all cases showed positive staining for both CRP and SAA; 10 (7.5%) were positive for CRP only and 3 (2.3%) were positive for SAA only. CRP was more sensitive than SAA (97.74% vs. 92.48%, P -value = 0.0961) and showed more extensive and intense staining, with a significantly higher modified H-score ( P <0.001). Focal nodular hyperplasia can also show positive CRP and SAA staining but with a lower modified H-score ( P <0.0001). Based on beta-catenin and glutamine synthetase staining, 26 of inflammatory adenomas also had beta-catenin activation (19.5%). All 3 cases with positive SAA and negative CRP staining were beta-catenin activated. In contrast, the proportion of cases that were CRP positive and SAA negative was similar regardless of beta-catenin activation. The data affirms the strategy of using both CRP and SAA immunostains for hepatic adenoma subtyping and raises the awareness of the highly variable nature of SAA staining characteristics.
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Affiliation(s)
- Gwyneth S T Soon
- Department of Pathology, National University Hospital, Singapore
| | - Saba Yasir
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Dhanpat Jain
- Department of Pathology, Yale University Medical Center, New Haven, CT
| | - Sanjay Kakar
- Department of Anatomic Pathology, University of California San Francisco Medical Center, San Francisco, CA
| | - Tsung-Teh Wu
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Matthew M Yeh
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
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9
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González IA, Torbenson M, Sharifai N, Byrnes K, Chatterjee D, Kakar S, Yeh MM, Wu TT, Zhang X, Jain D. Clinicopathologic characterization of hepatocellular adenomas in men: a multicenter experience. Hum Pathol 2023; 138:24-33. [PMID: 37245629 DOI: 10.1016/j.humpath.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
Hepatocellular adenomas (HCAs) are benign liver neoplasms which most commonly present in women in their reproductive age. In men, they are rare and have a higher risk of malignant transformation to hepatocellular carcinoma (HCC). Here we present our multicenter experience with HCA in men in the United States. A total of 27 HCA cases were included, with a mean age of presentation of 37 years (range, 9-69 years) and a mean size of 6.8 cm (range, 0.9-18.5 cm). Based on the 2019 World Health Organization classification, the most common subtype identified was inflammatory HCA (IHCA; 10 cases, 37.0%) followed by unclassified HCA (UHCA; 7 cases, 25.9%), HNF1A-inactivated HCA (H-HCA; 6 cases, 22.2%), β-catenin-activated IHCA (b-IHCA; 3 cases, 11.1%), and β-catenin-activated HCA (b-HCA; 1 case, 3.7%). Six additional cases diagnosed as hepatocellular neoplasm of uncertain malignant potential (HUMP) were also included in the study. These cases presented in a mean age of 46 years (range, 17-64 years) and a size of 10.8 cm (range, 4.2-16.5 cm). We evaluated the significance of androgen receptor (AR) expression by immunohistochemistry (IHC); of the 16 cases with materials available, 8 were considered positive using the Allred score system (2 IHCA, 2 H-HCA, 1 UHCA, and 3 HUMP). Of the total cases, 12 were diagnosed on biopsies, for which follow-up information is available for 7, and none of them show evidence of malignant transformation. Of the 21 resection cases, a concomitant well-differentiated HCC within the same lesion was identified in 5 cases (23.8%), which were diagnosed as HCA (n = 4) or HUMP (n = 1). Overall, 15% of cases in our entire cohort of HCA and HUMP showed concomitant HCC, while none of the 7 biopsy cases showed any malignant transformation on follow-up (range, 22-160 months; mean, 61.8 months).
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Affiliation(s)
- Iván A González
- Department of Pathology, Yale University, New Haven, CT, 06520, USA
| | - Michael Torbenson
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, 55901, USA
| | - Nima Sharifai
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Kathleen Byrnes
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Deyali Chatterjee
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Sanjay Kakar
- Department of Pathology, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Matthew M Yeh
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Tsung-Teh Wu
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, 55901, USA
| | - Xuchen Zhang
- Department of Pathology, Yale University, New Haven, CT, 06520, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University, New Haven, CT, 06520, USA.
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10
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Lee S, Ahmed M, Taddei T, Jain D. The role of routine biopsy of the background liver in the management of hepatocellular carcinoma. Hum Pathol 2023; 138:18-23. [PMID: 37236406 DOI: 10.1016/j.humpath.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 05/28/2023]
Abstract
We sought to determine the influence of background liver biopsies on hepatocellular carcinoma (HCC) management. The pathology database at a large university hospital was searched between 2013 and 2018 for all instances of when a separate biopsy of the nontumoral liver was performed within 6 months of an HCC biopsy. Patients were evaluated for baseline demographic and clinical characteristics, treatment proposed prior to biopsy, and impact of biopsy results on management. Among the 104 identified cases of paired liver biopsies, 22% were women; the median age was 64 years; and most were of earlier HCC stages at diagnosis (Barcelona Clinic Liver Cancer stages 0-A: 70%). Four patients among 10 in whom cirrhosis status was clinically unclear were confirmed to have cirrhosis on biopsy, and 4 patients did not have cirrhosis despite clinical suspicion. Treatment was altered by the background parenchymal findings for 5 patients (5%): management was less aggressive for 4 patients and more aggressive for 1 patient. A background liver biopsy can significantly impact the management of a small subset of HCC patients, especially those with early disease, and should be considered concurrently with the biopsy of the mass.
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Affiliation(s)
- Seohyuk Lee
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06520, USA
| | - Muhammad Ahmed
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Tamar Taddei
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06520, USA
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA.
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Liang Y, Hao Y, Xiong Y, Zhong M, Jain D. MYC overexpression in inflammatory bowel disease-associated conventional dysplasia and association of subsequent low-grade dysplasia in follow-up biopsies. Pathol Res Pract 2023; 248:154642. [PMID: 37379711 DOI: 10.1016/j.prp.2023.154642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Diagnosis of inflammatory bowel disease (IBD)-associated dysplastic lesions can be challenging. This study aims to evaluate MYC immunohistochemistry (IHC) as a potential biomarker for IBD-associated dysplasia and compare its effectiveness with p53 IHC. METHODS The study cohort included resections from 12 IBD patients with carcinoma and concurrent conventional low-grade dysplasia (LGD), as well as biopsies from 21 patients with visible conventional LGD, which were followed up for 2 years with subsequent endoscopic examination. MYC and p53 IHC and MYC-FISH analysis were performed. RESULTS Sensitivity for LGD detection was 67% (8/12) and 50% (6/12) for MYC and p53, respectively, but the difference was not statistically significant (p = 0.2207). MYC and p53 overexpression were not always mutually exclusive, nor were they always present simultaneously. Patients who presented dysplasia in subsequent biopsies (7/21) were found to be more likely present with multiple LGD polyps and MYC-overexpressed LGD in the initial biopsies, compared to those without subsequent dysplasia (p < 0.05). These dysplastic lesions were commonly associated with chronic colitis (p = 0.0614). The distribution of LGD sites did not show a significant difference between patients with and without subsequent LGD. In MYC overexpressed cases, homogeneously strong nuclear expression was not identified in all dysplastic epithelial cells, and no MYC amplification was found in these cases by FISH. CONCLUSION MYC IHC can complement p53 IHC as an adjunct biomarker for diagnosing IBD-associated conventional LGD and can be used for the prediction of subsequent LGD in the follow-up biopsies combined with endoscopic features.
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Affiliation(s)
- Yuanxin Liang
- Department of Pathology, Yale University, New Haven, CT, USA.
| | - Yansheng Hao
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Yiqin Xiong
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - Minghao Zhong
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University, New Haven, CT, USA
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12
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Jiao J, Finberg KE, Jain D, Morotti R. Hepatocellular Adenoma: Report of 2 Cases That Highlight the Relevance of Phenotype-Genotype Correlation in the Pediatric Population. Pediatr Dev Pathol 2023; 26:394-403. [PMID: 37334553 DOI: 10.1177/10935266231175426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) in the pediatric population is very rare and there are only limited studies, especially with molecular characterization of the tumors. Main HCA subtypes recognized in the current WHO classification include HNF1A-inactivated HCA (H-HCA), inflammatory HCA (IHCA), β-catenin-activated HCA (b-HCA), and β-catenin-activated IHCA (b-IHCA) and sonic hedgehog HCA (shHCA) is reported as an emerging subtype. METHODS Clinical history, pathological information, and molecular studies for a series of 2 cases of pediatric HCA were reviewed. RESULTS Case 1 was a b-HCA characterized by somatic CTNNB1 S45 mutation in a 11-year-old male with Abernethy malformation. Case 2 was a H-HCA characterized by germline HNF1A variant (c.526+1G>A) in a 15-year-old male associated with maturity-onset diabetes of the young type 3 (MODY3). CONCLUSION Our findings highlight the rarity of these 2 cases associated with adenomatosis, and the contribution of molecular/genetic analysis for proper sub-typing, prognosis and family surveillance.
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Affiliation(s)
- Jingjing Jiao
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Karin E Finberg
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Raffaella Morotti
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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13
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Verma S, Chitikela S, Singh V, Khurana S, Pushpam D, Jain D, Kumar S, Gupta Y, Malik PS. A phase II study of metformin plus pemetrexed and carboplatin in patients with non-squamous non-small cell lung cancer (METALUNG). Med Oncol 2023; 40:192. [PMID: 37261532 DOI: 10.1007/s12032-023-02057-y] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
Immune checkpoint inhibitors (ICIs) ± chemotherapy is the standard treatment for driver mutation-negative non-small cell lung cancer (NSCLC). However, accessibility to ICIs in LMICs is limited due to high cost, and platinum-based chemotherapy remains the mainstay of treatment. Metformin has anticancer properties, and studies suggest synergism between metformin and pemetrexed. Based on preclinical evidence, this combination may be more beneficial for STK11-mutated NSCLC, a subgroup, inherently resistant to ICIs. In this Simon two-stage, single-arm phase 2 trial, we investigated metformin with pemetrexed-carboplatin (PC) in patients with treatment-naive stage IV non-squamous NSCLC. The primary outcome was 6-month progression-free survival (PFS) rate. Secondary outcomes were safety, overall survival (OS), overall response rate (ORR), proportion of STK11 mutation, and effect of STK11 mutation on 6-month PFS rate. The study was terminated for futility after interim analysis. The median follow-up was 34.1 months. The 6-month PFS rate was 28% (95% CI 12.4-0.46). The median PFS and OS were 4.5 (95% CI 2.2-6.1) and 7.4 months (95% CI 5.3-15.3), respectively. The ORR was 72%. Gastrointestinal toxicities were the most common. No grade 4/5 toxicities were reported. Targeted sequencing was possible in nine cases. Two patients had STK11 mutation and a poor outcome (PFS < 12 weeks). We could not demonstrate the benefit of metformin with CP in terms of improvement in 6-month PFS rate; however, the combination was safe (CTRI/2019/02/017815).
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Affiliation(s)
- S Verma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Chitikela
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - V Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S Khurana
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - D Pushpam
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - D Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Y Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - P S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.
- Department of Medical Oncology, Dr.B.R.A.I.R.C.H., All India Institute of Medical Sciences, Room 245, New Delhi, India.
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14
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Gamit P, Saikia J, Malik P, Kumar S, Jain D, Madan K, Bharati S, Deo S, Kumar S. PP01.23 Outcomes of Stage IIIA Disease in NSCLC, Treated with Surgery - A Single Institution Experience. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.049] [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: 01/30/2023]
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15
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Sacirbegovic F, Günther M, Greco A, Zhao D, Wang X, Zhou M, Rosenberger S, Oberbarnscheidt MH, Held W, McNiff J, Jain D, Höfer T, Shlomchik WD. Graft-versus-host disease is locally maintained in target tissues by resident progenitor-like T cells. Immunity 2023; 56:369-385.e6. [PMID: 36720219 PMCID: PMC10182785 DOI: 10.1016/j.immuni.2023.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 09/07/2021] [Revised: 11/06/2022] [Accepted: 01/05/2023] [Indexed: 02/02/2023]
Abstract
In allogeneic hematopoietic stem cell transplantation, donor αβ T cells attack recipient tissues, causing graft-versus-host disease (GVHD), a major cause of morbidity and mortality. A central question has been how GVHD is sustained despite T cell exhaustion from chronic antigen stimulation. The current model for GVHD holds that disease is maintained through the continued recruitment of alloreactive effectors from blood into affected tissues. Here, we show, using multiple approaches including parabiosis of mice with GVHD, that GVHD is instead primarily maintained locally within diseased tissues. By tracking 1,203 alloreactive T cell clones, we fitted a mathematical model predicting that within each tissue a small number of progenitor T cells maintain a larger effector pool. Consistent with this, we identified a tissue-resident TCF-1+ subpopulation that preferentially engrafted, expanded, and differentiated into effectors upon adoptive transfer. These results suggest that therapies targeting affected tissues and progenitor T cells within them would be effective.
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Affiliation(s)
- Faruk Sacirbegovic
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthias Günther
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany; BioQuant Center, University of Heidelberg, Heidelberg, Germany
| | - Alessandro Greco
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany; BioQuant Center, University of Heidelberg, Heidelberg, Germany
| | - Daqiang Zhao
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xi Wang
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany; BioQuant Center, University of Heidelberg, Heidelberg, Germany
| | - Meng Zhou
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Rosenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martin H Oberbarnscheidt
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Werner Held
- Department of Oncology, University of Lausanne, Lausanne, Switzerland
| | - Jennifer McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Thomas Höfer
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany; BioQuant Center, University of Heidelberg, Heidelberg, Germany.
| | - Warren D Shlomchik
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
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16
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Abstract
Autoimmune hepatitis (AIH) is an immune-mediated chronic inflammatory liver disease, characterized by hypergammaglobulinemia, the presence of specific autoantibodies, and typical abnormalities in liver histology. Prompt diagnosis and initiation of immunosuppressive treatment are necessary for both chronic and acute onset AIH to prevent progression to end-stage liver disease or fatal liver failure. However, the diagnosis of AIH is challenging mainly because of its heterogeneous clinical, serological and pathological features. Although portal lymphoplasmacytosis and interface hepatitis are the most typical histological features of AIH, many other histological features can be observed in AIH, including emperipolesis, hepatocyte rosettes, and Kupffer cell hyaline globules. Recent studies have questioned emperipolesis and hepatocyte rosette formation as typical features of AIH, and atypical clinical and histological presentations have also been recognized. This led an international working group to propose the modified AIH diagnostic criteria. However, it is well recognized that there are no pathognomonic characteristics that can be used to diagnose AIH and careful clinicopathological correlation is required to arrive at the correct diagnosis. The aim of this review is to summarize the histological features of AIH, its varied histopathologic spectrum, recent updates and major differential diagnoses in routine clinical practice.
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Affiliation(s)
- Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, CT, 06520, United States.
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, CT, 06520, United States.
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17
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Mirza H, Besse W, Somlo S, Weinreb J, Kenney B, Jain D. An update on ductal plate malformations and fibropolycystic diseases of the liver. Hum Pathol 2023; 132:102-113. [PMID: 35777701 DOI: 10.1016/j.humpath.2022.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023]
Abstract
A variety of cystic and fibrocystic lesions can occur in the liver, which may be single or multiple and etiologically can be acquired or have genetic underpinnings. Although the morphology of ductal plate development and various associated malformations has been well described, the genetic etiologies of many of these disorders are still poorly understood. Multiple clinical phenotypes in the liver are proposed to originate from ductal plate malformations: congenital hepatic fibrosis, Caroli's disease, Von Meyenburg complex, and the liver cysts of autosomal dominant polycystic kidney and liver diseases. Although many of the patients with these disorders, particularly with isolated liver involvement remain asymptomatic, some develop portal hypertension or symptoms from cyst enlargement. Development of hepatocellular malignancy is a risk in a small subset. Recent advances have made it now possible for some of these phenotypes to be genetically defined, and intriguingly animal models of adult polycystic liver disease suggest that abnormal organ development is not required. This review describes the current understanding, genetic underpinning, and key clinicopathologic and imaging features of these fibropolycystic liver diseases.
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Affiliation(s)
- Haris Mirza
- Department of Pathology, Yale School of Medicine, New Haven CT 06520, USA
| | - Whitney Besse
- Department of Internal Medicine (Section of Nephrology), Yale School of Medicine, New Haven CT 06520, USA
| | - Stefan Somlo
- Department of Internal Medicine (Section of Nephrology), Yale School of Medicine, New Haven CT 06520, USA; Department of Genetics, Yale School of Medicine, New Haven CT 06520, USA
| | - Jeffrey Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven CT 06520, USA
| | - Barton Kenney
- Department of Pathology, Middlesex Health, Middletown CT 06457, USA
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven CT 06520, USA.
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18
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Wang JD, Sebastian C, Walther Z, Suresh T, Lacy J, Zhang X, Jain D. An Appraisal of Immunohistochemical Stain Use in Hepatic Metastasis Highlights the Effectiveness of the Individualized, Case-Based Approach: Analysis of Data From a Tertiary Care Medical Center. Arch Pathol Lab Med 2023; 147:185-192. [PMID: 35512224 DOI: 10.5858/arpa.2021-0457-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Liver biopsy plays an important role in the clinical management of metastases and often requires workup using immunohistochemical (IHC) markers, but the approach varies among institutions. OBJECTIVE.— To evaluate the utility of a morphologic pattern-based, individualized approach in the workup of hepatic metastases. DESIGN.— All liver biopsies with metastasis between 2015 and 2018 were identified from our institutional database and were reviewed. The morphologic pattern of the metastasis and IHC markers used in each case were recorded. The final identification of primary site of the tumor was assessed based on all the available clinicopathologic data. The academic ranking and practice pattern of the pathologist signing out the case were also recorded. RESULTS.— A total of 406 liver biopsies with metastasis were identified, and the cases were classified as adenocarcinoma (253 of 406; 62%), carcinoma not otherwise specified (12 of 406; 3%), neuroendocrine neoplasm (54 of 406; 13%), poorly differentiated carcinoma (43 of 406; 11%), nonepithelial tumor (24 of 406; 6%), and squamous cell carcinoma (20 of 406; 5%). The primary site was unknown in 39% (158 of 406) at the time of liver biopsy. A primary site was determined in 97% (395 of 406) of all cases, and only 3% (11 of 406) remained true carcinoma of unknown primary. The average number of IHC markers/case in patients with known primary was 2.6, compared with 5.9 with an initial unknown primary and 9.5 in cases of true carcinoma of unknown primary. CONCLUSIONS.— An individualized, case-based approach seems to be highly cost-effective and uses fewer IHC markers compared with preset panels that often comprise 10 or more IHC markers.
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Affiliation(s)
- Jeff D Wang
- From the Department of Pathology (Wang, Sebastian, Walther, Zhang, Jain), Yale University School of Medicine, New Haven, Connecticut
| | - Christopher Sebastian
- From the Department of Pathology (Wang, Sebastian, Walther, Zhang, Jain), Yale University School of Medicine, New Haven, Connecticut
| | - Zenta Walther
- From the Department of Pathology (Wang, Sebastian, Walther, Zhang, Jain), Yale University School of Medicine, New Haven, Connecticut
| | - Tejas Suresh
- From the Section of Medical Oncology (Suresh, Lacy), Yale University School of Medicine, New Haven, Connecticut
| | - Jill Lacy
- From the Section of Medical Oncology (Suresh, Lacy), Yale University School of Medicine, New Haven, Connecticut
| | - Xuchen Zhang
- From the Department of Pathology (Wang, Sebastian, Walther, Zhang, Jain), Yale University School of Medicine, New Haven, Connecticut
| | - Dhanpat Jain
- From the Department of Pathology (Wang, Sebastian, Walther, Zhang, Jain), Yale University School of Medicine, New Haven, Connecticut.,Authors Zhang and Jain contributed equally
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19
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Yasir S, Thompson S, Chen ZE, Knudson R, Knutson D, Kloft-Nelson S, Graham RP, Jain D, Simon SM, Wu TT, Torbenson M. Alternative lengthening of telomeres in primary hepatic neoplasms. Hum Pathol 2023; 131:79-86. [PMID: 36370823 PMCID: PMC10756352 DOI: 10.1016/j.humpath.2022.11.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
The alternative lengthening of telomeres (ALT) phenotype is characterized by ultra-bright telomeres on fluorescence in situ hybridization (FISH) and is a marker of a unique mechanism of telomere maintenance in tumors. ALT does not occur in normal tissues. ALT has been described in hepatocellular carcinoma (5-10%) and in primary hepatic angiosarcomas (75%). To study the frequency of ALT in other primary hepatic tumors, a wide range of primary hepatic neoplasms were retrieved. The tumors included the following: intrahepatic and hilar cholangiocarcinomas (N = 110), hepatic adenomas (N = 35), hepatocellular carcinomas (N = 30), fibrolamellar carcinomas (n = 11), combined cholangiocarcinoma-hepatocellular carcinomas (N = 8), carcinosarcoma (N = 10), hepatoblastomas (N = 5), hemangiomas (N = 4), angiosarcomas (N = 8), epithelioid hemangioendotheliomas (N = 10), calcified nested stromal epithelial tumor (N = 2), embryonal sarcoma (N = 2), rhabdoid tumor (N = 1), bile duct adenoma (N = 1), and angiomyolipoma (N = 1). For epithelial tumors, ALT-FISH was positive in one carcinosarcoma (10% of cases), one cholangiocarcinoma (1% of cases), and one combined hepatocellular carcinoma-cholangiocarcinoma (13% of cases). In the hepatocellular carcinoma component of both the carcinosarcoma and the combined hepatocellular carcinoma-cholangiocarcinoma, the tumor cells showed patchy marked nuclear pleomorphism akin to that described previously for chromophobe hepatocellular carcinoma, which are typically ALT FISH positive. The ALT-positive cholangiocarcinoma also showed patchy, striking nuclear pleomorphism. For soft tissue tumors, ALT was positive in two angiosarcomas (N = 2; 25% of cases). In summary, this study shows that ALT-FISH is positive in rare carcinosarcomas, cholangiocarcinomas, and combined cholangiocarcinoma-hepatocellular carcinoma. ALT is not a significant mechanism of telomere maintenance in hepatocellular adenomas or fibrolamellar carcinomas and was negative in all other tested primary hepatic neoplasms. ALT-FISH is also positive in a subset of primary hepatic angiosarcomas.
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Affiliation(s)
- Saba Yasir
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, 55905, USA
| | - Scott Thompson
- Department of Radiology, Mayo Clinic Rochester, MN, 55905, USA
| | - Zongming Eric Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, 55905, USA
| | - Ryan Knudson
- Medical Genome Facility, Cytogenetics Core Laboratory, Mayo Clinic Rochester, MN, 55905, USA
| | - Darlene Knutson
- Medical Genome Facility, Cytogenetics Core Laboratory, Mayo Clinic Rochester, MN, 55905, USA
| | - Sara Kloft-Nelson
- Medical Genome Facility, Cytogenetics Core Laboratory, Mayo Clinic Rochester, MN, 55905, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, 55905, USA
| | | | - Sanford M Simon
- Laboratory of Cellular Biophysics, The Rockefeller University, 1230 York Avenue, NY, NY, 10065, USA
| | - Tsung-Teh Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, 55905, USA
| | - Michael Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, 55905, USA.
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20
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Rottmann BG, Patel N, Ahmed M, Deng Y, Ciarleglio M, Vyas M, Jain D, Zhang X. Clinicopathological significance of neutrophil-rich colorectal carcinoma. J Clin Pathol 2023; 76:34-39. [PMID: 34312298 PMCID: PMC10910606 DOI: 10.1136/jclinpath-2021-207702] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/15/2021] [Accepted: 07/08/2021] [Indexed: 02/05/2023]
Abstract
AIMS The importance of the interaction between tumour cells and neutrophils has recently begun to emerge. However, the significance of tumour-infiltrating neutrophil (TIN) in colorectal carcinomas (CRCs) remains unclear. The aim of this study was to investigate the prognostic significance of TIN in CRCs. METHODS CRCs were evaluated for TIN and were classified as neutrophil-rich (NR), neutrophil-intermediate (NI) and neutrophil-poor (NP) based on the presence of >15, 5-15 and <5 TIN per 100 tumour cells, respectively. Various clinicopathological parameters were recorded in each case including age, gender, histological grade, tumour, node, metastasis (TNM) stage, tumour location and DNA mismatch repair (MMR) status. RESULTS Among the 348 CRC cases reviewed, 38 cases were NR, 43 cases were NI and 267 cases were NP. High TIN was associated with higher histological grade (p=0.0222), right-sided tumour location (p=0.0025), advanced TNM stage (p=0.0346) and higher rate of MMR-deficient CRCs (p=0.0027). Patients with NR CRCs had significantly poorer 5-year recurrence-free survival comparing to patients with NI or NP CRCs on Kaplan-Meier analysis (p=0.0001) and high TIN remained an independent risk factor with multivariate analysis (p=0.0137; HR: 1.930, 95% CI: 1.144 to 3.255). NR CRCs are more commonly seen in MMR-deficient than in MMR-proficient CRCs (p=0.0006). Patients with MMR-deficient NR CRCs showed similar 5-year recurrence-free survival compared with MMR-proficient NR CRCs. CONCLUSIONS Our findings reveal that high TIN confers poorer patient prognosis in both MMR-proficient and MMR-deficient CRCs.
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Affiliation(s)
- Bruce G Rottmann
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Natalie Patel
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Muhammad Ahmed
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maria Ciarleglio
- Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Monika Vyas
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xuchen Zhang
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
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21
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Lennerz JK, Pantanowitz L, Amin MB, Eltoum IE, Hameed MR, Kalof AN, Khanafshar E, Kunju LP, Lazenby AJ, Montone KT, Otis CN, Reid MD, Staats PN, Whitney-Miller CL, Abendroth CS, Aron M, Birdsong GG, Bleiweiss IJ, Bronner MP, Chapman J, Cipriani NA, de la Roza G, Esposito MJ, Fadare O, Ferrer K, Fletcher CD, Frishberg DP, Garcia FU, Geldenhuys L, Gill RM, Gui D, Halat S, Hameed O, Hornick JL, Huber AR, Jain D, Jhala N, Jorda M, Jorns JM, Kaplan J, Khalifa MA, Khan A, Kim GE, Lee EY, LiVolsi VA, Longacre T, Magi-Galluzzi C, McCall SJ, McPhaul L, Mehta V, Merzianu M, Miller SB, Molberg KH, Moreira AL, Naini BV, Nosé V, O'Toole K, Picken M, Prieto VG, Pullman JM, Quick CM, Reynolds JP, Rosenberg AE, Schnitt SJ, Schwartz MR, Sekosan M, Smith MT, Sohani A, Stowman A, Vanguri VK, Wang B, Watts JC, Wei S, Whitney K, Younes M, Zee S, Bracamonte ER. Ensuring remote diagnostics for pathologists: an open letter to the US Congress. Nat Med 2022; 28:2453-2455. [PMID: 36266514 DOI: 10.1038/s41591-022-02040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Jochen K Lennerz
- Massachusetts General Hospital/Harvard Medical School, Department of Pathology, Center for Integrated Diagnostics, Boston, MA, USA.
| | - Liron Pantanowitz
- University of Michigan Health, Department of Pathology, Anatomic Pathology, Ann Arbor, MI, USA
| | - Mitual B Amin
- Oakland University William Beaumont School of Medicine, Department of Pathology and Laboratory Medicine, Anatomical Pathology, Royal Oaks, MI, USA
| | - Isam-Eldin Eltoum
- University of Alabama at Birmingham, Department of Pathology, Section of Cytopathology, Birmingham, AL, USA
| | - Meera R Hameed
- Memorial Sloan Kettering Cancer Center, Department of Pathology, Surgical Pathology Service, New York, NY, USA
| | - Alexana N Kalof
- The University of Vermont Medical Center, Department of Pathology & Laboratory Medicine, Surgical Pathology, Burlington, VT, USA
| | - Elham Khanafshar
- University of California San Francisco, Department of Pathology, Cytopathology, San Francisco, CA, USA
| | - Lakshmi P Kunju
- University of Michigan Health, Department of Pathology, Genitourinary Pathology, Surgical Pathology, Histology Laboratory, and Image Analysis, Ann Arbor, MI, USA
| | - Audrey J Lazenby
- University of Nebraska Medical Center, College of Medicine, Department of Pathology, Anatomic Pathology, Omaha, NE, USA
| | - Kathleen T Montone
- Hospital of the University of Pennsylvania, Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology, Philadelphia, PA, USA
| | - Christopher N Otis
- Pathology at UMass Chan Medical School, Baystate Health Medical Center, Department of Pathology, Springfield, MA, USA
| | - Michelle D Reid
- Emory University School of Medicine, Winship Cancer Institute, Department of Pathology and Laboratory Medicine, Cytopathology and Anatomic Pathology/Cytopathology, Atlanta, GA, USA
| | - Paul N Staats
- University of Maryland School of Medicine, Department of Pathology, Anatomic Pathology Laboratory Operations, Baltimore, MD, USA
| | - Christa L Whitney-Miller
- University of Rochester Medical Center, School of Medicine & Dentistry, Vice Chair, Department of Pathology and Laboratory Medicine, Anatomic Pathology, Rochester, NY, USA
| | - Catherine S Abendroth
- Penn State Health Hershey Medical Center, Department of Pathology, Anatomic Pathology and Cytopathology, Hershey, PA, USA
| | - Manju Aron
- Keck School of Medicine of University of Southern California, Clinical Pathology, Los Angeles, CA, USA
| | - George G Birdsong
- Emory University School of Medicine, Department of Pathology & Laboratory Services, Atlanta, GA, USA.,Grady Memorial Hospital, Anatomic Pathology, Atlanta, GA, USA
| | - Ira J Bleiweiss
- University of Pennsylvania, Perelman School of Medicine, Department of Pathology, Breast Pathology, Philadelphia, PA, USA
| | - Mary P Bronner
- University of Utah, Department of Pathology, Anatomic Pathology, Salt Lake City, UT, USA
| | - Jennifer Chapman
- University of Miami Health System, Department of Pathology, Division of Hematopathology, Miami, FL, USA
| | - Nicole A Cipriani
- The University of Chicago, Department of Pathology, Anatomic Pathology Informatics, Chicago, IL, USA
| | - Gustavo de la Roza
- State University of New York-Upstate Medical University, Upstate University Hospital, Department of Pathology, Anatomic Pathology, Syracuse, NY, USA
| | - Michael J Esposito
- Northwell Health, North Shore University Hospital and Long Island Jewish Medical Center, Department of Pathology, Anatomic Pathology, Greenvale, NY, USA
| | - Oluwole Fadare
- University of California San Diego Health, Department of Pathology, Anatomic Pathology, San Diego, CA, USA
| | - Karen Ferrer
- Stroger Hospital of Cook County Health, Pathology & Laboratory Medicine, Surgical Pathology, Chicago, IL, USA
| | - Christopher D Fletcher
- Brigham & Women's Hospital/Harvard Medical School, Department of Pathology, Anatomic Pathology, Boston, MA, USA.,of Onco-Pathology, Dana Farber Cancer Institute, Boston, MA, USA
| | - David P Frishberg
- Cedars Sinai Medical Center, Department of Pathology and Laboratory Medicine, Los Angeles, CA, USA
| | - Fernando U Garcia
- Tower Health, Department of Pathology and Laboratory Medicine, West Reading, PA, USA
| | | | - Ryan M Gill
- University of California San Francisco, Moffitt-Long Hospital, Department of Pathology, Surgical Pathology, San Francisco, CA, USA
| | - Dorina Gui
- University of California Davis Health, Department of Pathology, Surgical Pathology, Davis, CA, USA
| | - Shams Halat
- Tulane University School of Medicine, Lakeside Hospital Laboratory, Department of Pathology, Surgical Pathology, New Orleans, LA, USA
| | - Omar Hameed
- Hospital Corporation of America, Pathology and Lab Services, Kansas City, MO, USA
| | - Jason L Hornick
- Brigham and Women's Hospital/Harvard Medical School, Department of Pathology, Boston, MA, USA
| | - Aaron R Huber
- University of Rochester Medical Center, School of Medicine and Dentistry, Department of Pathology and Laboratory Medicine, Rochester, NY, USA
| | - Dhanpat Jain
- Yale University School of Medicine, Department of Pathology, New Haven, CT, USA
| | - Nirag Jhala
- Temple University Hospital/Lewis Katz School of Medicine, Department of Pathology and Laboratory Medicine, Anatomic Pathology/Cytology, Philadelphia, PA, USA
| | - Merce Jorda
- University of Miami Miller School of Medicine, Department of Pathology & Laboratory Medicine, Miami, FL, USA
| | - Julie M Jorns
- Medical College of Wisconsin, Department of Pathology and Laboratory Medicine, Breast & Women's Health, Milwaukee, WI, USA
| | - Jeffrey Kaplan
- University of Colorado School of Medicine, Department of Pathology, Surgical Pathology and Anatomic Pathology Quality Management, Aurora, CO, USA
| | - Mahmoud A Khalifa
- University of Minnesota, Department of Laboratory Medicine and Pathology, Surgical Pathology, Minneapolis, MI, USA
| | - Ashraf Khan
- Pathology at UMass Chan Medical School, Baystate Health Medical Center, Department of Pathology, Springfield, MA, USA
| | - Grace E Kim
- University of California San Francisco, Department of Pathology and Laboratory Medicine, San Francisco, CA, USA
| | - Eun Y Lee
- University of Kentucky, Department of Pathology and Laboratory Medicine, Lexington, KY, USA
| | - Virginia A LiVolsi
- University of Pennsylvania, Perelman School of Medicine, Pathology and Laboratory Medicine, Surgical Pathology, Philadelphia, PA, USA
| | - Teri Longacre
- Stanford Medicine/Stanford Health Care/Stanford Medicine Children's Health, Surgical Pathology, Stanford, CA, USA
| | - Cristina Magi-Galluzzi
- The University of Alabama at Birmingham, Heersink School of Medicine, Department of Pathology Anatomic Pathology, Birmingham, AL, USA
| | - Shannon J McCall
- Duke University, Department of Pathology, Translational Research, Durham, NC, USA
| | - Laron McPhaul
- Harbor-UCLA Medical Center, Department of Pathology, Anatomic Pathology & Molecular Pathology, Torrance, CA, USA
| | - Vikas Mehta
- University of Illinois Health at Chicago, Department of Pathology, Surgical Pathology, Chicago, IL, USA
| | - Mihai Merzianu
- Roswell Park Comprehensive Cancer Center, Department of Pathology & Laboratory Medicine, Surgical Pathology, Buffalo, NY, USA
| | - Stacey B Miller
- Allegheny Health Network (AHN), Allegheny General Hospital (Primary), AHN Wexford Hospital, Allegheny Pathology Associates, Pathology and Laboratory Medicine, Surgical Pathology, Pittsburgh, PA, USA
| | - Kyle H Molberg
- UT Southwestern Medical Center, Department of Pathology, Dallas, TX, USA
| | - Andre L Moreira
- New York University (NYU) Grossman School of Medicine, NYU Langone Health, Department of Pathology, New York, NY, USA
| | - Bita V Naini
- University of California Los Angeles (UCLA) Health, David Geffen School of Medicine at UCLA, Clinical and Laboratory Pathology, Anatomic Pathology, Los Angeles, CA, USA
| | - Vania Nosé
- Massachusetts General Hospital/Harvard Medical School, Department of Pathology, Anatomic and Molecular Pathology, Boston, MA, USA
| | - Kathleen O'Toole
- Columbia University Irving Medical Center, Department of Pathology and Cell Biology, Anatomic Pathology, New York, NY, USA
| | - Maria Picken
- Loyola University Medical Center, Pathology and Laboratory Medicine, Surgical Pathology, Maywood, IL, USA
| | - Victor G Prieto
- The University of Texas, MD Anderson Cancer Center, Department of Pathology, Pathology-Lab Medicine, Houston, TX, USA
| | - James M Pullman
- Albert Einstein College of Medicine, Montefiore Medical Center, Anatomic Pathology, Bronx, NY, USA
| | - Charles M Quick
- University of Arkansas for Medical Sciences, College of Medicine, Department of Pathology, Anatomic Pathology, Little Rock, AR, USA
| | - Jordan P Reynolds
- Mayo Clinic, Department of Pathology, Cytopathology, Jacksonville, FL, USA
| | - Andrew E Rosenberg
- University of Miami, Miller School of Medicine, Department of Pathology and Laboratory Medicine, Anatomic Pathology, Miami, FL, USA
| | - Stuart J Schnitt
- Brigham and Women's Hospital/Harvard Medical School, Department of Pathology, Boston, MA, USA.,Dana-Farber Cancer Institute, Breast Oncologic Pathology, Boston, MA, USA
| | - Mary R Schwartz
- Baylor College of Medicine, Houston Methodist Hospital, Anatomic Pathology, Houston, TX, USA
| | - Marin Sekosan
- Stroger Hospital of Cook County Health, Pathology & Laboratory Medicine, Surgical Pathology, Chicago, IL, USA
| | - Michael T Smith
- Medical University of South Carolina, College of Medicine, Pathology and Laboratory Medicine, Anatomic Pathology, Charleston, SC, USA
| | - Aliyah Sohani
- Massachusetts General Hospital/Harvard Medical School, Department of Pathology, Surgical Pathology and Clinical Affairs, Boston, MA, USA
| | - Anne Stowman
- The University of Vermont Medical Center, Department of Pathology & Laboratory Medicine, Surgical Pathology, Burlington, VT, USA
| | - Vijay K Vanguri
- UMass Memorial Health, UMass Chan Medical School, Department of Pathology, Surgical Pathology, Worcester, MA, USA
| | - Beverly Wang
- University of California Irvine Medical Center, Department of Pathology, Anatomic Pathology, Orange, CA, USA
| | - John C Watts
- Beaumont Health, Surgical Pathology, Royal Oak, MI, USA
| | - Shi Wei
- University of Kansas Medical Center, Department of Pathology and Laboratory Medicine, Kansas City, KS, USA
| | - Kathleen Whitney
- Albert Einstein College of Medicine, Montefiore Medical Center, Anatomic Pathology, Bronx, NY, USA
| | - Mamoun Younes
- The George Washington University School of Medicine and Health Sciences, Department of Pathology, Surgical Pathology, Washington, DC, USA
| | - Sui Zee
- New York University (NYU) Grossman School of Medicine, NYU Langone Health, Department of Pathology, New York, NY, USA
| | - Erika R Bracamonte
- University of Arizona College of Medicine-Tucson, Department of Pathology, Anatomic Pathology, Tucson, AZ, USA
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22
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Panda S, Sehrawat A, Kayal S, Sundriyal D, Khanna M, Philips A, Jain D, Moharana L, Tiwari K, Kaaviya D, Cyriac S, Jose A, Saju S, Rathnam K, Ganesan P. 56P Clinico-pathological profile of adolescent and young adult colorectal cancer patients: Multicentre collaborative registry data from India. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.088] [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: 12/05/2022] Open
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23
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Rastogi J, Ho J, Rastogi J, Lazari J, Jageer P, Davis S, Kirresh A, Yiu J, Jain D, Ahmad M, Providencia R, Bray J. QTc interval in anorexia nervosa: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with anorexia nervosa (AN) are at higher risk of sudden cardiac death. Although the underlying aetiology for this association remains unclear. It may be related to prolongation of the QT interval, which can degenerate into fatal ventricular arrhythmias. However, the presence of prolonged heart rate-corrected QT interval (QTc) in AN remains controversial, and two previous meta-analyses on AN and QTc showed contradictory findings [1,2].
Purpose
In this systematic review and meta-analysis, we aimed to evaluate if AN was associated with changes in the QTc interval and dispersion.
Methods
MEDLINE, EMBASE and COCHRANE databases were systematically searched from inception to January 2021. Random-effects meta-analysis and meta-regression were used. The inclusion criteria were (i) confirmed diagnosis of AN, (ii) measurement of QTc on electrocardiogram and (iii) peer-reviewed articles. The primary endpoint of the study was the duration of the QTc interval calculated using the Bazett (QTcB), Hodges (QTcH), Fridericia (QTcF) and Framingham (QTcFr) formulae. The secondary endpoints were QT dispersion (QTd) and QTc dispersion (QTcd).
Results
The 25 eligible studies included 5687 patients (1862 AN, 3825 control) (Figure 1: PRISMA diagram). The majority of patients were female (96.3%) with a mean age between 14.3 to 31.0 years and mean duration of disease ranging from 9.1 to 129.6 months. The mean BMI ranged from 13.7 to 18.5 kg/m2. Pooled analysis did not show significant prolongation between AN versus control in QTcB (mean difference (MD) MD 4.9ms, 95% CI −3.2, 13.1ms, p=0.23; I2=95%; n=24/25 studies; Figure 2A), QTcH (MD 1.3ms, 95% CI −8.5, 11.2ms, p=0.79; I2=71%; n=3/25 studies), and QTcF (MD 3.1ms, 95% CI −21.6, 27.7ms, p=0.81; I2=97%; n=3/25 studies). Only two studies reporting QTcFr showed a significant prolongation between AN and control (MD 15.9ms, 95% CI 0.0, 31.8ms, p=0.05, I2=65%; n=2/25 studies; Figure 2B). However, QTd and QTcd were significantly greater in AN than control (MD 21.3ms, 95% CI 10.4, 32.3ms, p=0.0001, I2=94%; Figure 2C and MD 16.9ms, 95% CI 4.5, 29.3ms, p=0.007 I2=93%; Figure 2D, respectively).
Conclusion
To the best of our knowledge, this is the largest meta-analysis of QTc in AN and the first meta-analysis exploring the significance of QTd and QTcd in AN. AN was not found to be associated with prolongation of QTc calculated using the Bazett, Fridericia and Hodges formulae. However, an association of AN with prolonged QTc was observed in the studies using the Framingham formula. More pronounced dispersion (QTd and QTcd) was also observed in patients with AN.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Rastogi
- University College London, Medical School , London , United Kingdom
| | - J Ho
- Royal Free London NHS Foundation Trust , London , United Kingdom
| | - J Rastogi
- King's College London, Medical School , London , United Kingdom
| | - J Lazari
- Surrey and Sussex Healthcare NHS Trust , Redhill , United Kingdom
| | - P Jageer
- University College London, Medical School , London , United Kingdom
| | - S Davis
- Royal Free London NHS Foundation Trust , London , United Kingdom
| | - A Kirresh
- Royal Free London NHS Foundation Trust , London , United Kingdom
| | - J Yiu
- University College London, Medical School , London , United Kingdom
| | - D Jain
- Kent and Medway NHS and Social Care Partnership Trust , Kent , United Kingdom
| | - M Ahmad
- Royal Free London NHS Foundation Trust , London , United Kingdom
| | | | - J Bray
- Morriston Hospital , Swansea , United Kingdom
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24
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Madoff DC, Abi-Jaoudeh N, Braxton D, Goyal L, Jain D, Odisio BC, Salem R, Schattner M, Sheth R, Li D. An Expert, Multidisciplinary Perspective on Best Practices in Biomarker Testing in Intrahepatic Cholangiocarcinoma. Oncologist 2022; 27:884-891. [PMID: 35925597 PMCID: PMC9526481 DOI: 10.1093/oncolo/oyac139] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/01/2022] [Indexed: 11/20/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive malignancy that arises from the intrahepatic biliary tree and is associated with a poor prognosis. Until recently, the treatment landscape of advanced/metastatic iCCA has been limited primarily to chemotherapy. In recent years, the advent of biomarker testing has identified actionable genetic alterations in 40%-50% of patients with iCCA, heralding an era of precision medicine for these patients. Biomarker testing using next-generation sequencing (NGS) has since become increasingly relevant in iCCA; however, several challenges and gaps in standard image-guided liver biopsy and processing have been identified. These include variability in tissue acquisition relating to the imaging modality used for biopsy guidance, the biopsy method used, number of passes, needle choice, specimen preparation methods, the desmoplastic nature of the tumor, as well as the lack of communication among the multidisciplinary team. Recognizing these challenges and the lack of evidence-based guidelines for biomarker testing in iCCA, a multidisciplinary team of experts including interventional oncologists, a gastroenterologist, medical oncologists, and pathologists suggest best practices for optimizing tissue collection and biomarker testing in iCCA.
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Affiliation(s)
- David C Madoff
- Corresponding author: David C. Madoff, MD, FSIR, FACR, FCIRSE, Yale School of Medicine, 330 Cedar Street, TE-2, New Haven, CT 06520, USA. Tel: +1 203 785 5102; Fax: +1 203 737 1241;
| | | | - David Braxton
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | | | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Bruno C Odisio
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Riad Salem
- Northwestern University, Chicago, IL, USA
| | - Mark Schattner
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rahul Sheth
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Lam R, Tarangelo N, Wang R, Horibe M, Grimshaw AA, Jain D, Haffar S, Bazerbachi F, Kunz PL, Li DK. Microangiopathic Hemolytic Anemia Is a Late and Fatal Complication of Gastric Signet Ring Cell Carcinoma: A Systematic Review and Case-Control Study. Oncologist 2022; 27:751-759. [PMID: 35589098 PMCID: PMC9438916 DOI: 10.1093/oncolo/oyac093] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Microangiopathic hemolytic anemia (MAHA) is a rare paraneoplastic syndrome that has been reported in patients with gastric signet ring cell carcinoma (SRCC). Clinical and prognostic features of MAHA in this setting have been poorly described. MATERIALS AND METHODS We conducted a systematic review in 8 databases of gastric SRCC complicated by MAHA and performed a case-control study assessing factors associated with survival in patients with gastric SRCC and MAHA in our pooled cohort compared with age-, sex-, and stage-matched cases of gastric SRCC from the Surveillance, Epidemiology, and End Results (SEER) database. Descriptive analyses were performed and multivariable Cox-proportional hazards regression modeling was used to determine factors associated with overall survival. RESULTS All identified patients (n = 47) were symptomatic at index presentation, commonly with back/bone pain, and dyspnea. Microangiopathic hemolytic anemia was the first manifestation of gastric SRCC in 94% of patients. Laboratory studies were notable for anemia (median 7.7 g/dL), thrombocytopenia (median 45.5 × 103/μL), and hyperbilirubinemia (median 2.3 mg/dL). All patients with MAHA had metastatic disease at presentation, most often to the bone, bone marrow, and lymph nodes. Median survival in patients with gastric SRCC and MAHA was significantly shorter than a matched SEER-derived cohort with metastatic gastric SRCC (7 weeks vs 28 weeks, P < .01). In multivariate analysis, patients with MAHA were at significantly increased risk of mortality (HR 3.28, 95% CI 2.11-5.12). CONCLUSION Microangiopathic hemolytic anemia is a rare, late-stage complication of metastatic gastric SRCC and is associated with significantly decreased survival compared with metastatic gastric SRCC alone.
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Affiliation(s)
- Robert Lam
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Nicholas Tarangelo
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Alyssa A Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, CT, USA
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Samir Haffar
- Gastroenterology Department, Syrian Specialty Hospital, Damascus, Syrian Arab Republic
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, Saint Cloud Hospital, St. Cloud, MN, USA
| | - Pamela L Kunz
- Section of Medical Oncology, Department of Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Darrick K Li
- Corresponding author: Darrick K. Li, MD, PhD, P.O. Box 208019, New Haven, CT 06520-8019, USA. Tel: +1 203 785 7312; Fax: +1 203 785 7273;
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26
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thunnissen E, Borczuk A, Beasly M, Tsao M, Kerr K, Dacic S, Minami Y, Nicholson A, Lissenberg-Witte B, Roden A, Papotti M, Poleri C, Travis B, Jain D, Pelosi G, Chung J, Botling J, Bubendorf L, Mino-Kenudson M, Motoi N, Lantuejoul S, Cooper W, Hwang D, Moreira A, Noguchi M. MA12.07 Defining Morphologic Features of Invasion in Pulmonarynon-Mucinousadenocarcinoma with Lepidic Growth. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.146] [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: 11/26/2022]
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27
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Nambirajan A, Jangra K, Khurana S, Malik P, Mohan A, Jain D. EP03.01-005 Clinicopathological Features of ROS1-rearranged Adenocarcinomas: A Single Institutional Experience Spanning Four Years From India. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.400] [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: 11/30/2022]
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28
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Rathor A, Malik P, Tanwar P, Khurana S, Kumar S, Mohan A, Nambirajan A, Jain D. EP11.01-011 Clinical Application of Liquid Biopsy for Assessing Early EGFR Mutation Detection in Non-Small Cell Lung Carcinoma. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.908] [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: 10/14/2022]
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29
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Verma S, Malik P, Kalra K, Singh V, Kumar S, Khurana S, Pushpam D, Jain D, Gupta Y. P2.02-03 A Phase II Study of Metformin with Pemetrexed/Carboplatin in Patients with Metastatic Non-Squamous Non-Small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.218] [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: 10/14/2022]
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30
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Yasir S, Eric Chen Z, Jain D, Kakar S, Wu TT, Yeh MM, Torbenson MS. Hepatic Adenomas in Patients 60 and Older Are Enriched for HNF1A Inactivation and Malignant Transformation. Am J Surg Pathol 2022; 46:786-792. [PMID: 35383587 PMCID: PMC9469468 DOI: 10.1097/pas.0000000000001892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hepatic adenomas occur most commonly in women between the ages of 20 and 40 years, but rarely they occur in older aged persons, including those 60 years of age or older. This group of adenomas, however, has not been systemically examined. Twenty-six hepatic adenomas in persons 60 years of age or older were studied, along with a control group of 50 hepatic adenomas in persons aged 30 to 39. Hepatic adenomas in persons 60 or more years of age were found in 21 women and 5 men, while the control group had 44 women and 6 men. Subtyping the adenomas in persons 60 years or older showed the following results: 18 HNF1A-inactivated adenomas (69%), 4 inflammatory adenomas (15%), and 4 unclassified adenomas (15%). In contrast, the control group showed a significantly different pattern (P=0.003), with a greater percentage of inflammatory adenomas (28, 56%), fewer HNF1A-inactivated adenomas (8, 16%), and more unclassified adenomas (14, 28%). Atypia and malignant transformation within the hepatic adenomas was studied next. Of the hepatic adenomas in persons age 60 or greater, 3 (12%) showed atypical histologic features, and 6 (23%) had a malignant transformation. In contrast, for hepatic adenomas in the control group, only 4 (8%) adenomas showed atypical histologic features, and 3 (6%) had undergone malignant transformation. In addition, the hepatic adenomas that were atypical or showed early malignant transformation were less likely to have beta-catenin activation in patients over 60 (2/9 cases) compared with those between 30 and 39 years (5/7 cases). Myxoid change and heavy lipofuscin deposition were also more common in adenomas in older aged persons. In conclusion, hepatic adenomas in persons 60 years of age or older are enriched for HNF1A-inactivated adenomas and have a higher frequency of malignant transformation. Malignant transformation, however, is less likely to develop through activation of the beta-catenin pathway.
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Affiliation(s)
- Saba Yasir
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Dhanpat Jain
- Department of Pathology, Yale University Medical Center, New Haven, CT, USA
| | - Sanjay Kakar
- Department of Anatomic Pathology, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Tsung-Teh Wu
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Matthew M. Yeh
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
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31
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Lerch JM, Pai RK, Brown I, Gill AJ, Jain D, Kővári B, Kushima R, Sheahan K, Slavik T, Srivastava A, Lauwers GY, Langner C. Interobserver agreement of estimating the extent of intestinal metaplasia in patients with chronic atrophic gastritis. Virchows Arch 2022; 480:1277-1281. [PMID: 34904185 PMCID: PMC9184363 DOI: 10.1007/s00428-021-03245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
Abstract
The extent of gastric intestinal metaplasia (GIM) can be used to determine the risk of gastric cancer. Eleven international gastrointestinal expert pathologists estimated the extent of GIM on haematoxylin and eosin (H&E)- and Alcian blue-Periodic acid Schiff (AB-PAS)-stained slides of 46 antrum biopsies in 5% increments. Interobserver agreement was tested with the intraclass correlation coefficient (ICC). Correlation between standard deviation and extent of GIM was evaluated with the Spearman correlation. The interobserver agreement was very good (ICC = 0.983, 95% confidence interval (CI) 0.975-0.990). The use of AB-PAS did not increase the agreement (ICC = 0.975, 95% CI 0.961-0.985). Cases with a higher amount of metaplastic epithelium demonstrated a higher standard deviation (rs = 0.644; p < 0.01), suggesting lower diagnostic accuracy in cases with extensive GIM. In conclusion, estimating the extent of GIM on H&E-stained slides in patients with chronic atrophic gastritis can be achieved satisfactorily with high interobserver agreement, at least among international expert gastrointestinal pathologists.
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Affiliation(s)
- Julia M Lerch
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Ian Brown
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- New South Wales Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Bence Kővári
- Department of Pathology, University of Szeged, Szeged, Hungary
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Ryoji Kushima
- Department of Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Kieran Sheahan
- Department of Pathology & Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Tomas Slavik
- Ampath Pathology Laboratories, Pretoria, South Africa
- Department of Anatomical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | | | - Cord Langner
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria.
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Lohse AW, Sebode M, Bhathal PS, Clouston AD, Dienes HP, Jain D, Gouw ASH, Guindi M, Kakar S, Kleiner DE, Krech T, Lackner C, Longerich T, Saxena R, Terracciano L, Washington K, Weidemann S, Hübscher SG, Tiniakos D. Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH Pathology Group: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology. Liver Int 2022; 42:1058-1069. [PMID: 35230735 DOI: 10.1111/liv.15217] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/23/2021] [Accepted: 01/18/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Diagnostic histological criteria for autoimmune hepatitis (AIH) have not been clearly established. Previously published criteria focused mainly on chronic AIH, in which inflammatory changes mainly occur in portal/periportal regions and may not be applicable to acute presentation of AIH, in which inflammatory changes are typically predominantly lobular in location. International consensus criteria for the diagnosis and assessment of disease severity in both acute and chronic AIH are thus urgently needed. METHODS Seventeen expert liver pathologists convened at an international workshop and subsequently used a modified Delphi panel approach to establish consensus criteria for the histopathological diagnosis of AIH. RESULTS The consensus view is that liver biopsy should remain standard for diagnosing AIH. AIH is considered likely, if there is a predominantly portal lymphoplasmacytic hepatitis with more than mild interface activity and/or more than mild lobular hepatitis in the absence of histological features suggestive of another liver disease. AIH is also considered likely if there is predominantly lobular hepatitis with or without centrilobular necroinflammation and at least one of the following features: portal lymphoplasmacytic hepatitis, interface hepatitis or portal-based fibrosis, in the absence of histological features suggestive of another liver disease. Emperipolesis and hepatocellular rosettes are not regarded as being specific for AIH. CONCLUSIONS The criteria proposed in this consensus statement provide a uniform approach to the histological diagnosis of AIH, which is relevant for patients with an acute as well as a chronic presentation and to more accurately reflect the current understanding of liver pathology in AIH.
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Affiliation(s)
- Ansgar W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Marcial Sebode
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Prithi S Bhathal
- Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew D Clouston
- Molecular and Cellular Pathology, The University of Queensland and Envoi Specialist Pathologists, Brisbane, Queensland, Australia
| | - Hans P Dienes
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Dhanpat Jain
- Department of Anatomic Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Annette S H Gouw
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maha Guindi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sanjay Kakar
- Department of Pathology, University of California, San Francisco, California, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Till Krech
- Department of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Lackner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Thomas Longerich
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Romil Saxena
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Luigi Terracciano
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Kay Washington
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sören Weidemann
- Department of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan G Hübscher
- Department of Cellular Pathology, Queen Elizabeth Hospital, Birmingham, UK.,Institute for Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Dina Tiniakos
- Department of Pathology, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
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Pradhan NN, Paradkar MS, Kagal A, Valvi C, Kinikar A, Khwaja S, Dhage R, Chandane J, Ithape M, Bendre M, Madewar R, Nadgeri V, Nijampurkar A, Jain D, Gupte N, Gupta A, Mave V, Dooley KE, Thakur KT. Performance of Xpert ® MTB/RIF and Xpert ® Ultra for the diagnosis of tuberculous meningitis in children. Int J Tuberc Lung Dis 2022; 26:317-325. [PMID: 35351236 PMCID: PMC9592112 DOI: 10.5588/ijtld.21.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE: To assess Xpert® MTB/RIF (Xpert) and Xpert® MTB/RIF Ultra (Ultra) performance in diagnosing pediatric tuberculous meningitis (TBM).METHODS: We conducted a study among children with suspected meningoencephalitis in Pune, India. Clinical, radiological, laboratory, and treatment data were analyzed to classify disease as definite, probable, possible or no TBM, using microbiologic or composite reference standards. We tested cerebrospinal fluid (CSF) either using Xpert or Ultra and estimated test performance characteristics.RESULTS: Of 341 participants, 149 (43.7%) were tested using Ultra and 192 (56.3%) with Xpert. Ultra had higher sensitivity (50% vs. 18%), lower specificity (91% vs. 99%), poor positive predictive value (PPV) (13% vs. 75%), and higher negative predictive value (NPV) (99% vs. 93%) than Xpert using the composite reference standard, with similar results by the microbiologic reference standard. Of 10 participants with trace positivity on Ultra, none met clinical TBM definitions.CONCLUSION: This is the first study to report on diagnostic performance of Ultra in pediatric TBM, which showed higher sensitivity and NPV than Xpert. For children presenting with nonspecific clinical features, Ultra is a promising diagnostic test. Further studies are required to define its optimal clinical use, including interpretation of trace positive results.
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Affiliation(s)
- N. N. Pradhan
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins India, Pune, India
| | - M. S. Paradkar
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins India, Pune, India
| | - A. Kagal
- BJ Government Medical College and Sassoon General Hospitals, Pune, India
| | - C. Valvi
- BJ Government Medical College and Sassoon General Hospitals, Pune, India
| | - A. Kinikar
- BJ Government Medical College and Sassoon General Hospitals, Pune, India
| | - S. Khwaja
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - R. Dhage
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - J. Chandane
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - M. Ithape
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - M. Bendre
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - R. Madewar
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - V. Nadgeri
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - A. Nijampurkar
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins India, Pune, India
| | - D. Jain
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India
| | - N. Gupte
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A. Gupta
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V. Mave
- BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India;,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K. E. Dooley
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K. T. Thakur
- Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
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Bhat N, Esteghamat F, Chaube BK, Gunawardhana K, Mani M, Thames C, Jain D, Ginsberg HN, Fernandes-Hernando C, Mani A. TCF7L2 transcriptionally regulates Fgf15 to maintain bile acid and lipid homeostasis through gut-liver crosstalk. FASEB J 2022; 36:e22185. [PMID: 35133032 PMCID: PMC9624374 DOI: 10.1096/fj.202101607r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 12/13/2022]
Abstract
FGF19/FGF15 is an endocrine regulator of hepatic bile salt and lipid metabolism, which has shown promising effects in the treatment of NASH in clinical trials. FGF19/15 is transcribed and released from enterocytes of the small intestine into enterohepatic circulation in response to bile-induced FXR activation. Previously, the TSS of FGF19 was identified to bind Wnt-regulated TCF7L2/encoded transcription factor TCF4 in colorectal cancer cells. Impaired Wnt signaling and specifical loss of function of its coreceptor LRP6 have been associated with NASH. We, therefore, examined if TCF7L2/TCF4 upregulates Fgf19 in the small intestine and restrains NASH through gut-liver crosstalk. We examined the mice globally overexpressing, haploinsufficient, and conditional knockout models of TCF7L2 in the intestinal epithelium. The TCF7L2+/- mice exhibited increased plasma bile salts and lipids and developed diet-induced fatty liver disease while mice globally overexpressing TCF7L2 were protected against these traits. Comprehensive in vivo analysis revealed that TCF7L2 transcriptionally upregulates FGF15 in the gut, leading to reduced bile synthesis and diminished intestinal lipid uptake. Accordingly, VilinCreert2 ; Tcf7L2fl/fl mice showed reduced Fgf19 in the ileum, and increased plasma bile. The global overexpression of TCF7L2 in mice with metabolic syndrome-linked LRP6R611C substitution rescued the fatty liver and fibrosis in the latter. Strikingly, the hepatic levels of TCF4 were reduced and CYP7a1 was increased in human NASH, indicating the relevance of TCF4-dependent regulation of bile synthesis to human disease. These studies identify the critical role of TCF4 as an upstream regulator of the FGF15-mediated gut-liver crosstalk that maintains bile and liver triglyceride homeostasis.
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Affiliation(s)
- Neha Bhat
- Department of Internal Medicine, Cardiovascular Research Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Fatemehsadat Esteghamat
- Department of Internal Medicine, Cardiovascular Research Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bal Krishna Chaube
- Department of Comparative Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kushan Gunawardhana
- Department of Internal Medicine, Cardiovascular Research Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mitra Mani
- New York Medical College, Valhalla, New York, USA,Department of Internal Medicine, Columbia University College of Physicians and Surgeon, New York, New York, USA
| | - Clay Thames
- Department of Internal Medicine, Cardiovascular Research Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Henry N. Ginsberg
- Department of Internal Medicine, Columbia University College of Physicians and Surgeon, New York, New York, USA
| | | | - Arya Mani
- Department of Internal Medicine, Cardiovascular Research Center, Yale University School of Medicine, New Haven, Connecticut, USA,Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
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35
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Jain A, Mazer B, Deng Y, Ciarleglio M, Jain D, Taddei T, Zhang X. Hepatocellular Carcinoma: Does the Background Liver With or Without Cirrhosis Matter? Am J Clin Pathol 2022; 157:305-313. [PMID: 34542582 DOI: 10.1093/ajcp/aqab125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The pathologic differences between hepatocellular carcinoma (HCC) arising in noncirrhotic and cirrhotic livers have not been well studied. METHODS We performed a retrospective analysis of 378 HCC cases (95 in noncirrhotic, 283 in cirrhotic livers) from pathology archives (2010-2017). RESULTS Patients without cirrhosis were more likely to have hepatitis B (13.68% vs 2.83%, P < .001) or no known liver disease (30.53% vs 4.24%, P < .001), while hepatitis C was more common in patients with cirrhosis (65.72% vs 30.53%, P < .001). HCCs in noncirrhotic livers were larger in size (P < .001); were more likely to have a macrotrabecular histologic pattern (13.68% vs 4.95%, P < .01); were more likely to have fibrolamellar (3.16% vs 0%, P = .02), macrotrabecular-massive (13.68% vs 6.01%, P = .03), and clear cell (16.84% vs 6.71%, P < .01) subtypes; have a higher histologic grade (P < .01); be anaplastic tumor cells (P < .001); have a higher rate of vascular invasion (P < .01); and have a higher tumor stage (P = .04). CONCLUSIONS The findings indicate that HCCs in noncirrhotic livers demonstrate a larger tumor size; have a more macrotrabecular histologic pattern; have fibrolamellar, macrotrabecular-massive, and clear cell subtypes; have a higher tumor grade and stage; have a higher rate of vascular invasion; and have more anaplastic tumor cells compared with cirrhotic livers. Further studies to explore different pathways that promote oncogenesis in noncirrhotic livers are needed to better understand the pathogenesis of HCC.
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Affiliation(s)
| | | | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, CT, USA
| | | | | | - Tamar Taddei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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36
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Bhat N, Narayanan A, Fathzadeh M, Kahn M, Zhang D, Goedeke L, Neogi A, Cardone RL, Kibbey RG, Fernandez-Hernando C, Ginsberg HN, Jain D, Shulman GI, Mani A. Dyrk1b promotes hepatic lipogenesis by bypassing canonical insulin signaling and directly activating mTORC2 in mice. J Clin Invest 2022; 132:e153724. [PMID: 34855620 PMCID: PMC8803348 DOI: 10.1172/jci153724] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 08/02/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
Mutations in Dyrk1b are associated with metabolic syndrome and nonalcoholic fatty liver disease in humans. Our investigations showed that DYRK1B levels are increased in the liver of patients with nonalcoholic steatohepatitis (NASH) and in mice fed with a high-fat, high-sucrose diet. Increasing Dyrk1b levels in the mouse liver enhanced de novo lipogenesis (DNL), fatty acid uptake, and triacylglycerol secretion and caused NASH and hyperlipidemia. Conversely, knockdown of Dyrk1b was protective against high-calorie-induced hepatic steatosis and fibrosis and hyperlipidemia. Mechanistically, Dyrk1b increased DNL by activating mTORC2 in a kinase-independent fashion. Accordingly, the Dyrk1b-induced NASH was fully rescued when mTORC2 was genetically disrupted. The elevated DNL was associated with increased plasma membrane sn-1,2-diacylglyerol levels and increased PKCε-mediated IRKT1150 phosphorylation, which resulted in impaired activation of hepatic insulin signaling and reduced hepatic glycogen storage. These findings provide insights into the mechanisms that underlie Dyrk1b-induced hepatic lipogenesis and hepatic insulin resistance and identify Dyrk1b as a therapeutic target for NASH and insulin resistance in the liver.
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Affiliation(s)
- Neha Bhat
- Cardiovascular Research Center, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anand Narayanan
- Cardiovascular Research Center, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mohsen Fathzadeh
- Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Mario Kahn
- Yale Diabetes Research Center, Departments of Internal Medicine and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dongyan Zhang
- Yale Diabetes Research Center, Departments of Internal Medicine and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Leigh Goedeke
- Yale Diabetes Research Center, Departments of Internal Medicine and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arpita Neogi
- Cardiovascular Research Center, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rebecca L. Cardone
- Yale Diabetes Research Center, Departments of Internal Medicine and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard G. Kibbey
- Yale Diabetes Research Center, Departments of Internal Medicine and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Henry N. Ginsberg
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Gerald I. Shulman
- Yale Diabetes Research Center, Departments of Internal Medicine and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arya Mani
- Cardiovascular Research Center, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
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Ugwu N, Atzmony L, Ellis KT, Panse G, Jain D, Ko CJ, Nassiri N, Choate KA. Erratum: Cutaneous and hepatic vascular lesions due to a recurrent somatic GJA4 mutation reveal a pathway for vascular malformation. HGG Adv 2022; 3:100061. [PMID: 35047851 DOI: 10.1016/j.xhgg.2021.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.xhgg.2021.100028.].
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38
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Saffo S, Jain D, Sanchez H, Garcia-Tsao G. Invasive Fungal Infections Are Underdiagnosed in Hospitalized Patients With Decompensated Cirrhosis: An Autopsy Study. Gastro Hep Adv 2022; 1:803-806. [PMID: 36160304 PMCID: PMC9497452 DOI: 10.1016/j.gastha.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- S Saffo
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut
| | - D Jain
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - H Sanchez
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - G Garcia-Tsao
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut.,Section of Digestive Diseases, VA Connecticut Healthcare System, West Haven, Connecticut
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39
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Pacheco MC, Torbenson MS, Wu TT, Kakar S, Jain D, Yeh MM. Pediatric Hepatocellular Adenomas: The Influence of Age and Syndrome on Subtype. Am J Surg Pathol 2021; 45:1641-1647. [PMID: 34148984 PMCID: PMC8608351 DOI: 10.1097/pas.0000000000001763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
Hepatocellular adenomas are rare in children. A large study focused on pediatric patients has not been undertaken. A natural language search was performed at 5 institutions for hepatocellular adenomas in patients younger than 21 years old. Clinical characteristics as well as immunohistochemical staining profile was reviewed and adenomas subtyped per standard classification. Patients were divided into prepubescent and postpubescent age group. Thirty-one patients were included. Eleven (35%) were male and 10 (32%) were prepubescent. Fifteen (54%) of 28 patients with known clinical histories had adenomas associated with a syndrome. The percentage of the different adenoma subtypes was: 16% β-catenin activated, 10% combined inflammatory and β-catenin activated, 29% HFN1α-inactivated, 35% inflammatory, and 10% unclassified subtype by immunohistochemical staining. Interestingly 53% of patients with syndromes were male, while 85% of patients in the nonsyndromic group were female. The total number of β-catenin activated tumors was greater in the syndromic group (5/15, 33%) and prepubescent group (5/10, 50%) than in the nonsyndromic group (2/13, 16%) and postpubescent group (3/21, 14%), P=0.4 and 0.07, respectively. Inflammatory type adenoma was more frequent in the postpubescent (10/21, 48%) than in the prepubescent group (1/10, 10%), P=0.06, trending toward significance. Pediatric patients with hepatocellular adenomas frequently have syndromes, especially in the prepubescent group. In patients with syndromes a greater percentage of adenomas were β-catenin activated. In patients without a known syndrome the distribution of hepatocellular adenoma subtypes appears similar to adults.
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Affiliation(s)
- M. Cristina Pacheco
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | | | - Tsung-Teh Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Sanjay Kakar
- Department of Pathology, University of California San Francisco Medical Center, San Francisco, CA
| | - Dhanpat Jain
- Department of Pathology, Yale University Medical Center, New Haven, CT
| | - Matthew M. Yeh
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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40
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Li H, Zhang X, Finberg KE, Walther Z, Jain D, Gibson J. Pathogenic BRCA2 germline variants in combined hepatocellular-cholangiocarcinoma. Pathol Int 2021; 72:138-140. [PMID: 34808016 DOI: 10.1111/pin.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Hongjie Li
- Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xuchen Zhang
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Karin E Finberg
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zenta Walther
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Joanna Gibson
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
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41
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Kumar S, Ashok V, Jain D, Arora A, Singh A, Sikka P. Validation of an obstetric quality of recovery scoring tool (ObsQoR-11) after elective caesarean delivery in a developing country: a prospective observational study. Int J Obstet Anesth 2021; 49:103235. [PMID: 34810053 DOI: 10.1016/j.ijoa.2021.103235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The obstetric quality of recovery scoring tool (ObsQoR-11) was developed and validated in the United Kingdom for use after elective and emergency caesarean delivery. Quality of recovery scoring tools validated in one country may not be valid in other countries with significant cultural, socio-economic and linguistic variations. The aim of the current study was to validate a Hindi version of the ObsQoR-11. METHODS In this prospective observational study, 100 parturients who underwent elective caesarean delivery in a tertiary care obstetric referral university hospital in North India were asked to complete a Hindi version of the ObsQoR-11 scoring tool 24 h after surgery. The performance of the Hindi version of ObsQoR-11 was assessed using measures of validity, reliability, and feasibility. RESULTS The Hindi version of ObsQoR-11 correlated moderately with the global health visual analogue scale (r=0.45, 95% CI 0.27 to 0.59; P <0.0001) and discriminated well between good and poor recovery (mean (SD) score 84.6 (9.4) vs 75.0 (11.2); P <0.0001). The reliability and internal consistency were moderate (Cronbach's alpha=0.66; Spearman-Brown Prophesy Reliability estimate=0.57) with good repeatability (intraclass correlation coefficient 0.85, 95% CI 0.69 to 0.93; P <0.0001) and no floor or ceiling effects. All parturients completed the questionnaire (median (IQR) time of completion of 3 (1.5 - 5.5) min). CONCLUSION The Hindi version of the ObsQoR-11 questionnaire is a promising scoring tool to evaluate quality of recovery after elective caesarean delivery. Further research is needed to evaluate the Hindi tool in other institutions in India, as well as in other languages.
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Affiliation(s)
- S Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - V Ashok
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India.
| | - D Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Arora
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Singh
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - P Sikka
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
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42
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Haque W, Verma V, Teh B, Butler E, Hatch S, Desai M, Arentz S, Jain D, Schwartz M, Chevli N, Farach A. Postmastectomy Radiation Therapy Following Pathologic Complete Nodal Response to Neoadjuvant Chemotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.707] [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: 11/15/2022]
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Jain D, Sreenivasan P, Inayat I, Deng Y, Ciarleglio MM, Garcia-Tsao G. Thick Fibrous Septa on Liver Biopsy Specimens Predict the Development of Decompensation in Patients With Compensated Cirrhosis. Am J Clin Pathol 2021; 156:802-809. [PMID: 33940622 DOI: 10.1093/ajcp/aqab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In compensated cirrhosis, thick fibrous septa and small nodules on liver biopsy specimens correlate with the presence of clinically significant portal hypertension (CSPH). In turn, CSPH is the strongest predictor of cirrhosis decompensation. The aim of the study was to correlate liver biopsy specimen characteristics with the development of decompensation in patients with compensated cirrhosis. METHODS Patients with compensated cirrhosis and a concurrent liver biopsy specimen were reviewed. Semiquantitative grading of septal thickness and nodule size was performed. Primary end point was development of clinical decompensation. In total, 168 patients (median age, 49 years; 76% men) were included in the study; the most common etiology was viral. RESULTS In a median follow-up of 50 months, 43 (26%) patients developed clinical decompensation (60% ascites, 16% encephalopathy, 12% variceal hemorrhage, 7% jaundice, and 5% mixed). On univariate analysis, septal width was significantly associated with decompensation, but nodule size was not. On multivariate analysis including model for end-stage liver disease score, serum albumin, and septal width, albumin and septal width were independent predictors of decompensation. CONCLUSIONS Histologic cirrhosis in compensated patients can be subclassified by severity based on septal thickness, with thick septa denoting worse prognosis.
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Affiliation(s)
- Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Prithvi Sreenivasan
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
- Section of Digestive Diseases, VA-CT Healthcare System, West Haven, CT, USA
| | - Irteza Inayat
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
- Section of Digestive Diseases, VA-CT Healthcare System, West Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Maria M Ciarleglio
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
- Section of Digestive Diseases, VA-CT Healthcare System, West Haven, CT, USA
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Durand R, Balfe C, Jain D, McKearney E, Ward D, Crinion D. The role of ILR monitoring in patients with a family history of SADS, a view from real clinical practice. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Implantable Loop Recorder (ILR) device monitoring is an established method for long term heart rhythm monitoring in patients with inherited cardiac conditions. Many present with a family history of Sudden Arrhythmic Death Syndrome (SADS). The value of ILR findings in the investigation of SADS relatives has not been well documented.
Purpose
We aimed to evaluate the impact of ILR monitoring on the management plans of patients with a family history of SADS.
Methods
We performed a retrospective analysis of the ILR reports and electronic patient records of all patients at the inherited cardiac disease clinic with a family history of SADS and an ILR implanted. Patient demographics, ILR implant indication and specific changes to management plans were recorded and analysed using descriptive statistics.
Results
All 135 patients with ILR monitoring at the inherited cardiac disease clinic were screened and 87 patients (57.6% female, 41.7±14.0 years) with SADS relatives were included in the study. The mean follow up period was 657.9±392.3 days from ILR implant. Indications for ILR implantation included syncope (n=31, 15.7%), presyncope (45, 22.7%), palpitations (44, 22.2%), chest pain (9, 4.5%), short term heart rhythm monitor findings (6, 3.0%), ECG findings (6, 3.0%), asymptomatic indications (10, (5.1%) including patients with more than one relative with SADS, a family history of conduction disease or family history of long QT syndrome), and atypical symptoms (2 (1%) including seizures and sleep paralysis). Some patients had more than one indication for ILR at the time of implant. As a direct result of ILR monitoring, 43 (49.4%) patients had a change to their management plan. 6 specific definitions for management changes were used: Permanent pacemaker implantation (2, 2.3%), subsequent electrophysiology study (3, 3.5%), medication change (7, 8.1%), arrhythmia excluded as a cause for patient symptoms (26, 29.9%), prompted ILR implant in first degree relative (11, 12.6%) and ILR re-implant for further monitoring for premature conduction disease (1, 1.2%). Patients whose indication for ILR implant was palpitations had the highest likelihood for change of management with 27 changes associated with this indication, of which exclusion of arrhythmia as a cause for symptoms (15) was the most frequent outcome. The indications, syncope and presyncope both yield 21 management changes each.
Conclusion
The use of ILR devices in family relatives of patients with SADS provides information that may directly impact on patient management, with syncope providing the highest yield and reassurance the most common outcome in our cohort. ILR monitoring helped guide a wide range of other management strategies which included changes to medications and the need for further cardiac procedures. This data represented clinical practice in a niche patient cohort who are at risk for inherited cardiac conditions and associated arrhythmias.
Funding Acknowledgement
Type of funding sources: None. Indication for ILR vs management changeIndications for ILR implant
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Affiliation(s)
- R Durand
- Tallaght University Hospital, Dublin, Ireland
| | - C Balfe
- Tallaght University Hospital, Dublin, Ireland
| | - D Jain
- Tallaght University Hospital, Dublin, Ireland
| | - E McKearney
- Tallaght University Hospital, Dublin, Ireland
| | - D Ward
- Tallaght University Hospital, Dublin, Ireland
| | - D Crinion
- Tallaght University Hospital, Dublin, Ireland
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Balfe C, Durand R, Jain D, McKearney E, Sheahan R, Crinion D, Ward D. The utility of the implantable loop recorder in patients with a diagnosis or family history of long QT syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is limited published data on the use of implantable loop recorders (ILRs) in patients with long QT syndrome (LQTS).
Purpose
We sought to evaluate the utility of the ILR in patients who had a diagnosis of LQTS or who had a family history of LQTS.
Methods
We carried out a retrospective analysis of patients attending an Inherited Cardiac Conditions Clinic who had an active ILR and who had a diagnosis or family history of LQTS. Patient demographics, indications for ILR implantation and clinical outcomes were compiled.
Results
Nine patients with a diagnosis of LQTS and an active ILR were identified with an average age of 37 years. Genetic results were available for seven patients. Four patients had a confirmed pathogenic mutation (one KCNQ1 and three KCNH2), one patient had a variant of uncertain significance in SCN5A and two patients had negative genetic testing. Indications for implantation were syncope (n=4), recurrent altered consciousness episodes (n=1), assessment of occult arrhythmia or beta blocker complications (n=2), palpitations and dizziness (n=1) and nocturnal dyspnoea and palpitations (n=1). Mean follow-up was 706 days and average age at ILR implant was 35 years. The ILR for three patients was a second device, implanted after end of battery life of the initial ILR. ILR recordings led to a change in management in three patients: finding of paroxysmal atrial fibrillation (n=1), finding of nocturnal QTc of 511ms with a change in medications (n=1) and a pause leading to cessation of beta blocker (n=1).
Eleven patients with a family history of LQTS and active ILR were identified. Nine patients were female, and the average age was 44.4 years. Genetic test results were available for five patients. Three patients had a pathogenic mutation in SCN5A, and two patients had negative genetic testing for common LQTS genes. Indications for implantation included syncope (n=5), lightheaded episodes (n=3) and risk assessment in gene carriers (n=3). The mean duration of ILR follow-up was 680 days and average age at ILR implant was 42.5 years. Five patients had no arrhythmia detected during ILR recording, two patients had supraventricular tachycardia identified, in two patients ILR data outruled a sinister cause for a symptomatic episode, one patient had documentation of SVT and brief NSVT which led to referral for electrophysiology study and one patient had no recurrence of symptoms and a second ILR was implanted.
Conclusion
ILRs were inserted in selected patients with a diagnosis of LQTS or in patients with a family history of LQTS or who were gene carriers. Rationale for ILR implantation included risk stratification, monitoring for occult arrhythmia and rhythm-symptom correlation in symptomatic patients. The ILR impacted management in almost 50% of patients and is considered an important tool in selected patients attending Inherited Cardiac Condition Clinics.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- C Balfe
- Tallaght University Hospital, Dublin, Ireland
| | - R Durand
- Tallaght University Hospital, Dublin, Ireland
| | - D Jain
- Tallaght University Hospital, Dublin, Ireland
| | - E McKearney
- Tallaght University Hospital, Dublin, Ireland
| | | | - D Crinion
- Tallaght University Hospital, Dublin, Ireland
| | - D Ward
- Tallaght University Hospital, Dublin, Ireland
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Saikia J, Malik P, Kumar S, Jain D, Madan K, Bharati S, Deo S, Kumar S. 7P Predictive and prognostic value of cell-free DNA in plasma and pleural lavage among surgically treated adenocarcinomas of the lung (ADCL). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2003] [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: 11/28/2022] Open
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Nambirajan A, Singh V, Rana D, Malik P, Mohan A, Jain D. P59.27 Complementary Utility of Combined ALK/ROS1 FISH with Immunohistochemistry for ALK/ROS1 Rearrangement Testing in Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.616] [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: 10/20/2022]
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Yan K, Hung A, Parmer C, Yang H, Jain D, Lim B, Goodman AL, Garcia-Tsao G. Obeticholic Acid Decreases Intestinal Content of Enterococcus in Rats With Cirrhosis and Ascites. Hepatol Commun 2021; 5:1507-1517. [PMID: 34510838 PMCID: PMC8435275 DOI: 10.1002/hep4.1740] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/04/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023] Open
Abstract
The intestinal microbiome and bacterial translocation (BT), the passage of microorganisms from the gut lumen to mesenteric lymph nodes and other extra-intestinal sites, are main mechanisms implicated in liver injury and further decompensation in patients with cirrhosis. We hypothesized that obeticholic acid (OCA), a semisynthetic bile acid, would change the microbiome composition and reduce bacterial translocation in experimental cirrhosis. Rats with cirrhosis induced by carbon tetrachloride inhalation (a nonseptic model) with ascites present for at least 7 days were randomized to receive a 14-day course of OCA at a dose of 5 mg/kg/day (n = 34) or placebo (n = 34). Stool was collected at days 1 (randomization), 8, and 14 (sacrifice) for analysis of intestinal microbiome using the V4 hypervariable region of the bacterial 16S gene amplified by polymerase chain reaction. Bacteriological cultures of mesenteric lymph nodes, blood, and ascites were performed at end of study. Twenty-four animals in each group reached the end of study. Compared with placebo, rats treated with OCA had decreased relative abundance of Enterococcus in both ileum content (P = 0.02) and in stool (P < 0.001). BT from pathogenic bacteria was not different between groups. At end of treatment, rats on OCA had a significantly lower aspartate aminotransferase (AST) (266 vs. 369 IU/L; P < 0.01) and higher serum albumin (0.9 vs. 0.7 g/dL; P < 0.01) than rats on placebo. Conclusion: Although OCA did not appear to reduce BT by pathogenic bacteria, the reduction in intestinal content of Enterococcus, which has been associated with hepatocyte death, in OCA-treated animals is consistent with our observed improvements in AST and in liver function, as evidenced by higher serum albumin.
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Affiliation(s)
- Kathleen Yan
- Digestive Diseases SectionYale UniversityNew HavenCTUSA.,VA-Connecticut Healthcare SystemWest HavenCTUSA
| | - Adelina Hung
- Digestive Diseases SectionYale UniversityNew HavenCTUSA.,VA-Connecticut Healthcare SystemWest HavenCTUSA
| | - Caitlin Parmer
- Digestive Diseases SectionYale UniversityNew HavenCTUSA.,VA-Connecticut Healthcare SystemWest HavenCTUSA
| | - Hui Yang
- Digestive Diseases SectionYale UniversityNew HavenCTUSA.,VA-Connecticut Healthcare SystemWest HavenCTUSA
| | - Dhanpat Jain
- Department of Surgical PathologyYale UniversityNew HavenCTUSA
| | - Bentley Lim
- Department of Microbial Pathogenesis and Microbial Sciences InstituteYale UniversityNew HavenCTUSA
| | - Andrew L Goodman
- Department of Microbial Pathogenesis and Microbial Sciences InstituteYale UniversityNew HavenCTUSA
| | - Guadalupe Garcia-Tsao
- Digestive Diseases SectionYale UniversityNew HavenCTUSA.,VA-Connecticut Healthcare SystemWest HavenCTUSA
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Mittal A, Malik PS, Kumar S, Saikia J, Chitikela S, Khurana S, Bharti S, Jain D, Pathy S, Thulkar S, Kumar R, Madan K, Mohan A. Dose-dense Paclitaxel and Carboplatin as Neoadjuvant Chemotherapy for Stage IIB/IIIA Non-small Cell Lung Cancer - A Phase II trial. Clin Oncol (R Coll Radiol) 2021; 33:e553-e560. [PMID: 34340919 DOI: 10.1016/j.clon.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/26/2021] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 12/25/2022]
Abstract
AIMS The approach to potentially resectable non-small cell lung cancer (NSCLC) remains controversial. There is a benefit of neoadjuvant chemotherapy (NACT), but the ideal regimen is unknown. We evaluated the efficacy and safety of dose-dense NACT in potentially resectable NSCLC in this phase II trial. MATERIALS AND METHODS Paclitaxel at 80 mg/m2 on days 1, 8 and 15 with AUC-6 carboplatin on day 1, 3 weekly for four cycles was evaluated as NACT. Patients with Eastern Cooperative Oncology Group performance status 0-2, stage IIB and IIIA (with only non-bulky N2 nodes) were included. The primary end point was the objective response rate. Secondary end points included toxicity, progression-free survival, recurrence-free survival, complete resection rate and overall survival. The relative dose intensity (RDI) was calculated to define tolerability (CTRI/2016/05/006916). RESULTS In total, 37 patients were enrolled (median age 55 years). Most (78.8%) were smokers. Most patients had adenocarcinoma (57.6%) and stage IIIA disease (81.0%) according to the seventh American Joint Committee on Cancer staging system. Seventy-eight per cent of patients completed four cycles. The objective response rate was 75.6% with a complete response in 10.8%. The mean RDI of paclitaxel was 88.61%, with 68.0% of patients able to maintain an RDI ≥85.0%. In total, 187 toxicity events were recorded (120 grade 1, 64 grade 2 and three grade 3 events). Common toxicities were peripheral neuropathy (20.3%), myalgia (19.8%), nausea (15.7%) and neutropenia (10.2%). There were no treatment-related deaths. Seventeen patients underwent surgery (lobectomy 82.4%). After a median follow-up of 47 months (95% confidence interval 27-50.7 months), the median progression-free survival was 9.6 months (7.4-17.4) and overall survival was 29.2 months (16.0-37.2). CONCLUSION Dose-dense paclitaxel-carboplatin is feasible, safe and efficacious and should be evaluated further in potentially resectable NSCLC.
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Affiliation(s)
- A Mittal
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - P S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - S Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - J Saikia
- Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Chitikela
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Khurana
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Bharti
- Department of Oncoanaesthesia and Palliative Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - D Jain
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Pathy
- Department of Radiation Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Thulkar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - R Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Wen KW, Joseph NM, Srivastava A, Saunders TA, Jain D, Rank J, Feely M, Zarrinpar A, Al Diffalha S, Shyn PB, Graham RP, Drage MG, Kakar S. Inhibin-positive hepatic carcinoma: proposal for a solid-tubulocystic variant of intrahepatic cholangiocarcinoma. Hum Pathol 2021; 116:82-93. [PMID: 34298064 DOI: 10.1016/j.humpath.2021.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/02/2021] [Accepted: 07/10/2021] [Indexed: 01/13/2023]
Abstract
Inhibin-positive hepatic carcinoma is a rare primary liver neoplasm that resembles sex cord-stromal tumor and thyroid follicular tumors. The term "cholangioblastic variant of intrahepatic cholangiocarcinoma" has been proposed. This study describes the clinicopathologic, immunophenotypic, and molecular features of a small series (n = 6) of this rare tumor. Albumin in situ hybridization (ISH) and capture-based next-generation sequencing (NGS) were also performed. All tumors occurred in young women (mean age 32.5 years, range 19-44 years) as a solitary large mass (mean 15.8 cm, range 6.9-23.5 cm). All tumors showed a highly distinctive morphology with sheets and large nests of tumor cells alternating with tubular and cystic areas imparting a sex cord-like or thyroid follicle-like morphology. Cytologic atypia was mild, and mitotic activity was low. All cases were positive for inhibin, as well as pancytokeratin, CK7, CK19, and albumin ISH. Synaptophysin and chromogranin showed focal or patchy staining, whereas INSM1 was negative. Markers for hepatocellular differentiation, thyroid origin, and sex cord-stromal tumor were negative. There were no recurrent genomic changes based on capture-based NGS of ∼500 cancer genes. Recurrence and/or metastasis was seen in three (50%) cases (follow-up time range for all cases: 5 months to 2 years). In conclusion, this series describes the distinctive morphology, immunophenotypic features, and diffuse albumin staining in six cases of a rare inhibin-positive primary liver carcinoma that runs an aggressive course similar to intrahepatic cholangiocarcinoma. Genomic changes typical of cholangiocarcinoma or hepatocellular carcinoma were not identified, and there were no recurrent genetic abnormalities. We propose the term "solid-tubulocystic variant of intrahepatic cholangiocarcinoma" to reflect the spectrum of morphologic patterns observed in this tumor.
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Affiliation(s)
- Kwun Wah Wen
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | - Nancy M Joseph
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | - Amitabh Srivastava
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Tara A Saunders
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | - Dhanpat Jain
- Department of Pathology, Yale University, New Haven, CT 06520, United States
| | - Joseph Rank
- Cellnetix Pathology & Laboratories, Seattle, WA 98104, United States
| | - Michael Feely
- Department of Pathology, University of Florida, Gainesville, FL 32610, United States
| | - Ali Zarrinpar
- Department of Surgery, University of Florida, Gainesville, FL 32610, United States
| | - Sameer Al Diffalha
- Department of Pathology, University of Alabama, Birmingham, AL 35294, United States
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Rondell P Graham
- Department of Pathology, Mayo Medical Laboratories, Rochester, MN 55901, United States
| | - Michael G Drage
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY 14642, United States
| | - Sanjay Kakar
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States.
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