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Kervarrec T, Westphal D, Pissaloux D, Legrand M, Tirode F, Neuhart A, Drouot F, Becker JC, Macagno N, Seris A, Jouary T, Beltzung F, Jullie ML, Harms PW, Cribier B, Mourah S, Jouenne F, Fromont G, Louveau B, Mancini M, Kazakov DV, de la Fouchardière A, Battistella M. Porocarcinomas with PAK1/2/3 fusions: a series of 12 cases. Histopathology 2024. [PMID: 38785043 DOI: 10.1111/his.15214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/16/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
AIMS Porocarcinoma is a malignant sweat gland tumour differentiated toward the upper part of the sweat duct and may arise from the transformation of a preexisting benign poroma. In 2019, Sekine et al. demonstrated the presence of YAP1::MAML2 and YAP1::NUTM1 fusions in most poromas and porocarcinomas. Recently, our group identified PAK2-fusions in a subset of benign poromas. Herein we report a series of 12 porocarcinoma cases harbouring PAK1/2/3 fusions. METHODS AND RESULTS Five patients were male and the median age was 79 years (ranges: 59-95). Tumours were located on the trunk (n = 7), on the thigh (n = 3), neck (n = 1), or groin area (n = 1). Four patients developed distant metastases. Microscopically, seven cases harboured a benign poroma component and a malignant invasive part. Ductal formations were observed in all, while infundibular/horn cysts and cells with vacuolated cytoplasm were detected in seven and six tumours, respectively. In three cases, the invasive component consisted of a proliferation of elongated cells, some of which formed pseudovascular spaces, whereas the others harboured a predominant solid or trabecular growth pattern. Immunohistochemical staining for CEA and EMA confirmed the presence of ducts. Focal androgen receptor expression was detected in three specimens. Whole RNA sequencing evidenced LAMTOR1::PAK1 (n = 2), ZDHHC5::PAK1 (n = 2), DLG1::PAK2, CTDSP1::PAK1, CTNND1::PAK1, SSR1::PAK3, CTNNA1::PAK2, RNF13::PAK2, ROBO1::PAK2, and CD47::PAK2. Activating mutation of HRAS (G13V, n = 3, G13R, n = 1, Q61L, n = 2) was present in six cases. CONCLUSION Our study suggests that PAK1/2/3 fusions is the oncogenic driver of a subset of porocarcinomas lacking YAP1 rearrangement.
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Affiliation(s)
- Thibault Kervarrec
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Université de Tours, Tours, France
- "Biologie des infections à polyomavirus" Team, UMR INRA ISP 1282, Université de Tours, Tours, France
- CARADERM Network
| | - Danna Westphal
- National Center for Tumour Diseases (NCT), Partner Site Dresden, Dresden, Germany
- Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Daniel Pissaloux
- Department of Biopathology, Center Léon Bérard, Lyon, France
- Cancer Research Center of Lyon, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Equipe Labellisée Ligue contre le Cancer, Lyon, France
| | - Mélanie Legrand
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Université de Tours, Tours, France
| | - Franck Tirode
- Department of Biopathology, Center Léon Bérard, Lyon, France
- Cancer Research Center of Lyon, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Equipe Labellisée Ligue contre le Cancer, Lyon, France
| | - Anne Neuhart
- Department of Biopathology, Center Léon Bérard, Lyon, France
- Cancer Research Center of Lyon, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Equipe Labellisée Ligue contre le Cancer, Lyon, France
| | | | - Jürgen C Becker
- Department of Translational Skin Cancer Research, University Hospital Essen, Essen, Germany
- Department of Dermatology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Pa German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicolas Macagno
- CARADERM Network
- Department of Pathology, Timone University Hospital, Marseille, France
| | - Alice Seris
- CARADERM Network
- Service de Dermatologie, Centre hospitalier de Pau, Pau, France
| | - Thomas Jouary
- CARADERM Network
- Service de Dermatologie, Centre hospitalier de Pau, Pau, France
| | - Fanny Beltzung
- Department of Pathology, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Marie-Laure Jullie
- CARADERM Network
- Department of Pathology, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Paul W Harms
- Department of Pathology, Michigan Medicine/University of Michigan, Ann Arbor, MI, USA
- Department of Dermatology, Michigan Medicine/University of Michigan, Ann Arbor, MI, USA
| | - Bernard Cribier
- Dermatology Clinic, Hopitaux Universitaires & Université de Strasbourg, Hopital Civil, Strasbourg, France
| | - Samia Mourah
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital, Paris University, AP-HP, Paris, France
| | - Fanélie Jouenne
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital, Paris University, AP-HP, Paris, France
| | - Gaelle Fromont
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Université de Tours, Tours, France
| | - Baptiste Louveau
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital, Paris University, AP-HP, Paris, France
| | - Maxence Mancini
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital, Paris University, AP-HP, Paris, France
| | - Dmitry V Kazakov
- IDP Dermatohistopathologie Institut, Pathologie Institut Enge, Zurich, Switzerland
| | - Arnaud de la Fouchardière
- CARADERM Network
- National Center for Tumour Diseases (NCT), Partner Site Dresden, Dresden, Germany
- Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Maxime Battistella
- CARADERM Network
- Department of Pathology, APHP Hôpital Saint Louis, INSERM U976, Université Paris Cité7, Paris, France
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Bertlich I, Bidier M, Schulz T, Kazakov DV, Schwaibold EMC, Hartschuh W. Unusual variant of scleromyxedema presenting with severe systemic involvement and atypical adnexal proliferations - A histological pitfall with the risk of unnecessary surgeries. J Dtsch Dermatol Ges 2024; 22:434-437. [PMID: 38200613 DOI: 10.1111/ddg.15306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/14/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Ines Bertlich
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Mona Bidier
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Tilman Schulz
- Institute of Pathology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Dmitry V Kazakov
- IDP Institute for Dermatohistopathology, Pathology Institute Enge, Zurich, Switzerland
| | - Eva M C Schwaibold
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Hartschuh
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Bertlich I, Bidier M, Schulz T, Kazakov DV, Schwaibold EMC, Hartschuh W. Ungewöhnliche Variante eines Skleromyxödems mit ausgeprägter Systembeteiligung und atypischen Adnexproliferaten - Ein histologischer Stolperstein mit dem Risiko unnötiger Operationen: Unusual variant of scleromyxedema presenting with severe systemic involvement and atypical adnexal proliferations - A histological pitfall with the risk of unnecessary surgeries. J Dtsch Dermatol Ges 2024; 22:434-437. [PMID: 38450836 DOI: 10.1111/ddg.15306_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/14/2023] [Indexed: 03/08/2024]
Affiliation(s)
- Ines Bertlich
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Mona Bidier
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Tilman Schulz
- Institut für Pathologie, Klinikum Bayreuth GmbH, Bayreuth, Deutschland
| | - Dmitry V Kazakov
- IDP Institut für Dermatohistopathologie, Pathologie Institut Enge, Zürich, Schweiz
| | - Eva M C Schwaibold
- Institut für Humangenetik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Donati M, Grossmann P, Mansour B, Kazakov DV. Melanocytic Neoplasm With KIT and APC Mutations: A New Subtype of Melanocytoma? Am J Dermatopathol 2024; 46:107-110. [PMID: 37982490 DOI: 10.1097/dad.0000000000002556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
ABSTRACT We report a very unusual case of melanocytic neoplasm appearing clinically as a 0.5-cm dome-shaped pigmented papule on the chest of a 63-year-old man. Microscopically, it was an asymmetric, entirely dermally based neoplasm characterized by a multinodular, vaguely plexiform architecture composed of moderately pleomorphic spindled melanocytes with ample, dusty pigmented cytoplasm and scattered multinucleated cells. The tumor cells were strongly positive for Melan-A, HMB45, S100, and PRAME, whereas p16 showed diffuse nuclear loss. β-catenin presented a strong and diffuse cytoplasmic staining, while nuclei were negative. Despite an increased cellularity, mitotic count was low (1/mm 2 ). Fluorescence in situ hybridization revealed no copy number alteration in melanoma-related genes ( CDKN2A, MYB, MYC, CCND1 and RREB1 ). DNA and RNA sequencing identified KIT c.2458G>T and APC c.6709C>T mutations. No further genetic alteration was detected including TERT-promoter (TERT-p ) hot-spot mutation. A re-excision was performed. A sentinel lymph node biopsy was negative. Clinical investigations revealed no extracutaneous involvement. The patient is disease-free after a follow-up period of 8 months. Given the peculiar morphologic and molecular findings, we hypothesize the lesion may represent a novel subtype of an intermediate grade melanocytic tumor (melanocytoma).
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Affiliation(s)
- Michele Donati
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Petr Grossmann
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | | | - Dmitry V Kazakov
- IDP Institut für Dermatohistopathologie, Pathologie Institut Enge, Zürich, Switzerland
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5
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Donati M, Kazakov DV. Beyond typical histology of BAP1-inactivated melanocytoma. Pathol Res Pract 2024:155162. [PMID: 38326181 DOI: 10.1016/j.prp.2024.155162] [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: 10/12/2023] [Revised: 01/05/2024] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
BAP1-inactivated melanocytoma (BIM) is a novel subgroup of melanocytic neoplasm listed in the 5th edition of WHO classification of skin tumor. BIM is characterized by two molecular alterations, including a mitogenic driver mutation (usually BRAF gene) and the loss of function of BAP1, a tumor suppressor gene located on chromosome 3p21, which encodes for BRCA1-associated protein (BAP1). The latter represents a nuclear-localized deubiquitinase involved in several cellular processes including cell cycle regulation, chromatin remodeling, DNA damage response, differentiation, senescence and cell death. BIMs are histologically characterized by a population of large epithelioid melanocytes with well-demarcated cytoplasmic borders and copious eosinophilic cytoplasm, demonstrating loss of BAP1 nuclear expression by immunohistochemistry. Recently, we have published a series of 50 cases, extending the morphological spectrum of the neoplasm and highlighting some new microscopic features. In the current article, we focus on some new histological features, attempting to explain and link them to certain mechanisms of tumor development, including senescence, endoreplication, endocycling, asymmetric cytokinesis, entosis and others. In light of the morphological and molecular findings observed in BIM, we postulated that this entity unmasks a fine mechanism of tumor in which both clonal/stochastic and hierarchical model can be unified.
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Affiliation(s)
- Michele Donati
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Department of Pathology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy.
| | - Dmitry V Kazakov
- IDP Dermatohistopathologie Institut, Pathologie Institut Enge, Zurich, Switzerland
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Donati M, Mansour B, Hagstrom M, Gerami P, Kazakov DV. Clinical, Morphological and Molecular Features of Spitz tumors. Cesk Patol 2024; 60:35-48. [PMID: 38697826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Spitz tumors represent a heterogeneous group of challenging melanocytic neoplasms, displaying a range of biological behaviors, spanning from benign lesions, Spitz nevi (SN) to Spitz melanomas (SM), with intermediate lesions in between known as atypical Spitz tumors (AST). They are histologically characterized by large epithelioid and/or spindled melanocytes arranged in fascicles or nests, often associated with characteristic epidermal hyperplasia and fibrovascular stromal changes. In the last decade, the detection of mutually exclusive structural rearrangements involving receptor tyrosine kinases ROS1, ALK, NTRK1, NTRK2, NTRK3, RET, MET, serine threonine kinases BRAF and MAP3K8, or HRAS mutation, led to a clinical, morphological and molecular based classification of Spitz tumors. The recognition of some reproducible histological features can help dermatopathologist in assessing these lesions and can provide clues to predict the underlying molecular driver. In this review, we will focus on clinical and morphological findings in molecular Spitz tumor subgroups.
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Plaza JA, Kastnerova L, Gru AA, Dulmage B, Sangueza MJ, Kazakov DV. Spiradenoma With Adenoid Cystic Carcinoma-like Changes: A Case Series of This Rare Variant With a Potential Diagnostic Pitfall. Am J Surg Pathol 2023; 47:1409-1416. [PMID: 37737683 DOI: 10.1097/pas.0000000000002123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Spiradenomas are benign cutaneous adnexal neoplasms with sweat gland differentiation that can manifest a broad spectrum of histomorphologic appearances. While they show a characteristic histopathologic phenotype and clinical management involves surgical excision with a low risk of recurrence, there have been unusual histopathologic variants of spiradenoma reported, including cases with adenoid cystic carcinoma (ACC)-like changes. Primary cutaneous ACC is a low-grade malignancy presenting as a subcutaneous mass with the potential for local invasion, perineural invasion, and high rates of local recurrence after excision. The diagnosis of spiradenomas with ACC-like features can be challenging, especially when only the ACC-like component is present for evaluation. A retrospective analysis of 21 cases of spiradenoma with ACC-like changes were obtained from large academic institutions, was performed, and summarized below. All cases showed background of conventional spiradenoma, and the ACC-like areas represented a component in all lesions. The percentage of ACC-like component ranged from 5% to 40% in all cases. The ACC-like component was multifocal and without pleomorphism, perineural and/or vascular invasion, necrosis, or increased mitotic activity. MYB translocation and protein expression was studied in 16 cases by fluorescence in situ hybridization, polymerase chain reaction, and immunohistochemistry. All studied cases were negative for MYB / NFIB , MYB L1, and MYB F by fluorescence in situ hybridization and polymerase chain reaction and 3 cases were positive for MYB expression by immunohistochemistry. Our study expands on spiradenomas with ACC-like features that ought to be considered in the differential diagnosis of cutaneous neoplasms such as primary cutaneous ACC. Our results indicate that a thorough histopathologic inspection and strict application of well-defined histologic criteria are necessary to support the diagnosis of this unusual histopathologic variant. These tumors can be difficult to diagnose, and awareness of their histomorphologic spectrum will facilitate definitive diagnosis and avoid misdiagnosis with other conditions.
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Affiliation(s)
- Jose A Plaza
- Departments of Pathology
- Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
| | - Liubov Kastnerova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague
| | - Alejandro A Gru
- Department of Dermatology, Columbia University, New York, NY
| | | | | | - Dmitry V Kazakov
- Pathology Department, Institute of Dermatopathology, Pathology Department, Zurich, Switzerland
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Mansour B, Rossi SM, Kazakov DV, Donati M. Glandular Schwannoma With Apocrine Decapitation Secretion: A True Divergent Differentiation or Entrapped Normal Tissue? Am J Dermatopathol 2023; 45:839-842. [PMID: 37982466 DOI: 10.1097/dad.0000000000002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
ABSTRACT We report an unusual case of schwannoma with glandular elements that demonstrated apocrine decapitation secretion. The glandular structures were embedded within the tumor, varied in shape and size, and were lined by a double-to-multilayered epithelium, with the inner layer composed of monomorphous cuboidal to columnar cells, focally with apocrine decapitation secretion, and the outer layer representing myoepithelial cells. A normal eccrine unit was observed near the lesion. Immunohistochemical studies showed that all luminal cells of the glandular structures stained positive for CK7, whereas myoepithelial cells expressed S100 and p63, and epithelial membrane antigen highlighted the luminal border. CK20 and neuroendocrine markers were negative in the glandular elements.Our findings suggest that the origin of the glandular elements in our case was represented by entrapped glands. Two theories may explain the epithelial hyperplasia observed in the present case as follows: the obstructive effect theory and the inductive ability of a mesenchymal proliferation to produce epidermal or adnexal changes. We suggest that, in a subset of cases, the origin of the glandular elements might represent entrapped glands, wherein their histomorphology/cytomorphology recapitulates the elements comprising the normal adjacent tissue. Further research is necessary to elucidate the histogenesis of glandular schwannoma.
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Affiliation(s)
| | - Silvia Maria Rossi
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; and
| | - Dmitry V Kazakov
- IDP Institut für Dermatohistopathologie, Pathologie Institut Enge, Zürich, Switzerland
| | - Michele Donati
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; and
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Donati M, Nosek D, Olivares S, Lemahieu J, Loontiens S, Mansour B, Gerami P, Kazakov DV. Spitz tumor with RAF1 fusion: A report of 3 cases. Ann Diagn Pathol 2023; 67:152215. [PMID: 37856952 DOI: 10.1016/j.anndiagpath.2023.152215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Spitz tumors are melanocytic neoplasms morphologically characterized by spindled and/or epithelioid cells and specific stromal and epidermal changes associated with mutually exclusive fusion kinases involving ALK, ROS1, NTRK1, NTRK2, NTRK3, MET and RET, BRAF and MAP3K8 genes or, less commonly, HRAS mutation. RAF1 fusions have been recently detected in cutaneous melanocytic neoplasms, including conventional melanoma, congenital nevus and BAP-1 inactivated tumors. We report herewith three Spitz neoplasms with a RAF1 fusion, including a previously reported CTDSPL::RAF1 fusion and two novel PPAP2B::RAF1 and ATP2B4::RAF1 fusions. Two cases were classified as Spitz nevus, while the remaining neoplasm was classified as Spitz melanoma at the time of the diagnosis, given 9p21 homozygous deletion and positive sentinel lymph node biopsy. We suggest that RAF1 fused melanocytic neoplasms can represent a novel subgroup of Spitz tumors, with a RAF1 fusion representing an oncogenic driver.
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Affiliation(s)
- Michele Donati
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Daniel Nosek
- Department of Pathology, Umeå University, Umeå, Sweden
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Siebe Loontiens
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium; Molecular Diagnostics Ghent University Hospital (MDG), Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent, Belgium
| | - Boulos Mansour
- Department of Pathology, Ospedale Israelitico di Roma, Rome, Italy
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dmitry V Kazakov
- IDP Institut für Dermatohistopathologie, Pathologie Institut Enge, Zürich, Switzerland
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Ismailov ZB, Belykh ES, Chernykh AA, Udoratina AM, Kazakov DV, Rybak AV, Kerimova SN, Velegzhaninov IO. Systematic review of comparative transcriptomic studies of cellular resistance to genotoxic stress. Mutat Res Rev Mutat Res 2023; 792:108467. [PMID: 37657754 DOI: 10.1016/j.mrrev.2023.108467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 08/19/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
The development of resistance by tumor cells to various types of therapy is a significant problem that decreases the effectiveness of oncology treatments. For more than two decades, comparative transcriptomic studies of tumor cells with different sensitivities to ionizing radiation and chemotherapeutic agents have been conducted in order to identify the causes and mechanisms underlying this phenomenon. However, the results of such studies have little in common and often contradict each other. We have assumed that a systematic analysis of a large number of such studies will provide new knowledge about the mechanisms of development of therapeutic resistance in tumor cells. Our comparison of 123 differentially expressed gene (DEG) lists published in 98 papers suggests a very low degree of consistency between the study results. Grouping the data by type of genotoxic agent and tumor type did not increase the similarity. The most frequently overexpressed genes were found to be those encoding the transport protein ABCB1 and the antiviral defense protein IFITM1. We put forward a hypothesis that the role played by the overexpression of the latter in the development of resistance may be associated not only with the stimulation of proliferation, but also with the limitation of exosomal communication and, as a result, with a decrease in the bystander effect. Among down regulated DEGs, BNIP3 was observed most frequently. The expression of BNIP3, together with BNIP3L, is often suppressed in cells resistant to non-platinum genotoxic chemotherapeutic agents, whereas it is increased in cells resistant to ionizing radiation. These observations are likely to be mediated by the binary effects of these gene products on survival, and regulation of apoptosis and autophagy. The combined data also show that even such obvious mechanisms as inhibition of apoptosis and increase of proliferation are not universal but show multidirectional changes.
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Affiliation(s)
- Z B Ismailov
- Institute of Biology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, 28b Kommunisticheskaya St., Syktyvkar 167982, Russia
| | - E S Belykh
- Institute of Biology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, 28b Kommunisticheskaya St., Syktyvkar 167982, Russia
| | - A A Chernykh
- Institute of Physiology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, 50 Pervomaiskaya St., Syktyvkar 167982, Russia
| | - A M Udoratina
- Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Avenue, Nizhny Novgorod 603022, Russia
| | - D V Kazakov
- Institute of Physics and Mathematics of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, 4 Oplesnina St., Syktyvkar 167982, Russia
| | - A V Rybak
- Institute of Biology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, 28b Kommunisticheskaya St., Syktyvkar 167982, Russia
| | - S N Kerimova
- State Medical Institution Komi Republican Oncology Center, 46 Nyuvchimskoe highway, Syktyvkar 167904, Russia
| | - I O Velegzhaninov
- Institute of Biology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, 28b Kommunisticheskaya St., Syktyvkar 167982, Russia.
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Kolm I, Konstantinova AM, Kutzner H, Barghorn A, Vanecek T, Mangana J, Kazakov DV. Cuticular Poroma: A Rare Poroma Variant Simulating a Malignant Neoplasm That Often Harbors YAP1::NUTM1 Fusions Similar to Their Conventional Counterparts. Am J Dermatopathol 2023; Publish Ahead of Print:00000372-990000000-00203. [PMID: 37335840 DOI: 10.1097/dad.0000000000002465] [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] [Indexed: 06/21/2023]
Abstract
ABSTRACT Cuticular poroma is a rare variant of poroma composed of exclusively or predominantly cuticular cells, namely of large cells with ample eosinophilic cytoplasm. We report 7 cases of this rare tumor identified among 426 neoplasms diagnosed as poroma or porocarcinoma. The patients were 4 males and 3 females, ranging in age from 18 to 88 years. All presented with a solitary asymptomatic nodule. The location included knee (2 cases), shoulder, thigh, shin, lower arm, and neck (each 1). All lesions were surgically removed. No evidence of disease was observed in 5 patients with available follow-up (range 12-124 months).Microscopically, all neoplasms were composed of variably sized, focally closed packed, or interconnecting nodules constituted mostly of cuticular cells. Small poroid cells were a focal feature in 5 tumors, whereas in the remaining 2 cases, poroid cells with conspicuous but still in minority. Five neoplasms were somewhat asymmetric, with irregular outlines. Ductal differentiation and intracytoplasmic vacuoles were seen in 6 tumors. Other features variably encountered were conspicuous intranuclear pseudoinclusions, cystic change, occasional multinucleated cells, increased mitoses, and stromal desmoplasia. Four of the 5 tumors analyzed with next-generation sequencing yielded YAP1::NUTM1 fusions. In addition, various mutations, mostly of unknown significance were identified in one neoplasm.
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Affiliation(s)
- Isabel Kolm
- Department of Dermatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Anastasia M Konstantinova
- Department of Pathology, Clinical Research and Practical Center for Specialized Oncological Care, Saint-Petersburg, Russia
- Department of Pathology, Saint-Petersburg Medico-Social Institute, Saint-Petersburg, Russia
| | - Heinz Kutzner
- Dermatopathology Laboratory, Friedrichshafen, Germany
| | | | - Tomas Vanecek
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; and
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Dmitry V Kazakov
- Department of Dermatology, University Hospital Zurich, University of Zurich, Switzerland
- IDP Institut für Dermatopathohistologie, Pathologie Institut Enge, Zürich, Switzerland
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Bianchi A, Baldi A, Farabini A, Nibid L, Roberti V, Pellacani G, Kazakov DV, Donati M. Dermatoscopic, Histological and Confocal Microscopic Analysis of a Kissing Nevus of the Penis. Dermatopathology (Basel) 2023; 10:147-152. [PMID: 37366797 DOI: 10.3390/dermatopathology10020022] [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: 03/29/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Kissing nevus is a congenital melanocytic neoplasm arising in those parts of the body that split at some point during embryological development (i.e., eyelid; penis), resulting in two adjacent melanocytic nevi. To date, 23 cases of kissing nevus of the penis have been described, and dermatoscopic and histological findings are available in 4/23 cases. We report a dermatoscopic, histological and confocal microscopic analysis in a new case of the kissing nevus of the penis in a 57 years old man. Dermatoscopic analysis showed large globules in the central area and a peripheral pigment network; the histological examination confirmed the presence of an intradermal melanocytic nevus with minimal junctional component and congenital features. Moreover, we reported, for the first time, confocal microscopy findings in the kissing nevus of the penis, revealing the presence of dendritic cells in correspondence with the epidermis and suggesting a state of cellular activity. Considering the clinicopathological features of the lesion, a conservative approach was adopted, and a clinical follow-up was planned after six months.
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Affiliation(s)
- Alexander Bianchi
- Fondazione Policlinico Tor Vergata, Tor Vergata University, 81-00133 Rome, Italy
| | - Alfonso Baldi
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "L. Vanvitelli", 43-81100 Caserta, Italy
| | - Andrea Farabini
- Istituto di Medicina e Scienza dello Sport "Antonio Venerando", 1-00197 Rome, Italy
| | - Lorenzo Nibid
- Anatomical Pathology Unit, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Vincenzo Roberti
- Dermatology Clinic, Sapienza University of Rome, 155-00161 Rome, Italy
| | | | - Dmitry V Kazakov
- IDP Institut für Dermatohistopathologie, Pathologie Institut Enge, Hardturmstrasse, 133-8005 Zurich, Switzerland
| | - Michele Donati
- Anatomical Pathology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Rome, Italy
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13
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Mansour B, Vanecek T, Kastnerova L, Nosek D, Kazakov DV, Donati M. Spitz Tumor With SQSTM1::NTRK2 Fusion: A Clinicopathological Study of 5 Cases. Am J Dermatopathol 2023; 45:306-310. [PMID: 36939120 DOI: 10.1097/dad.0000000000002410] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
ABSTRACT Spitz tumors are melanocytic neoplasms characterized by specific, mutually exclusive driver molecular events, namely genomic rearrangements involving the threonine kinase BRAF and the tyrosine kinase receptors ALK , NTRK1 , NTRK2 , NTRK3 , MET , RET , ROS1 , and MAP3K8 or less commonly, mutations in HRAS or MAP2K1 . We hereby report 5 Spitz tumors with a SQSTM1::NTRK2 fusion. All patients were woman with the ages at diagnosis ranging from 30 to 50 years. Locations included the lower extremity (n = 3), forearm, and back (one each). All the neoplasms were superficial melanocytic proliferation with a flat to dome-shaped silhouette, in which junctional spindled and polygonal dendritic melanocytes were mainly arranged as horizontal nests associated with conspicuous lentiginous involvement of the follicular epithelium. Only one case showed heavily pigmented, vertically oriented melanocytic nests resembling Reed nevus. A superficial intradermal component observed in 2 cases appeared as small nests with a back-to-back configuration. In all lesions, next-generation sequencing analysis identified a SQSTM1::NTRK2 fusion. A single case studied with fluorescence in situ hybridization for copy number changes in melanoma-related genes proved negative. No further molecular alterations were detected, including TERT-p hotspot mutations.
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Affiliation(s)
- Boulos Mansour
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Tomas Vanecek
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Liubov Kastnerova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Daniel Nosek
- Department of Pathology, Umeå University, Umeå, Sweden; and
| | - Dmitry V Kazakov
- IDP Institut für Dermatohistopathologie, Pathologie Institut Enge, Zürich, Switzerland
| | - Michele Donati
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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14
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Karpov AV, Kazakov DV, Punegov VI. Dynamical theory of X-ray diffraction by crystals with different surface relief profiles. Acta Crystallogr A Found Adv 2023; 79:171-179. [PMID: 36862042 DOI: 10.1107/s2053273322012062] [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: 06/09/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023] Open
Abstract
A dynamical theory is developed of X-ray diffraction on a crystal with surface relief for the case of high-resolution triple-crystal X-ray diffractometry. Crystals with trapezoidal, sinusoidal and parabolic bar profile models are investigated in detail. Numerical simulations of the X-ray diffraction problem for concrete experimental conditions are performed. A simple new method to resolve the crystal relief reconstruction problem is proposed.
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Affiliation(s)
- Andrey V Karpov
- Institute of Physics and Mathematics, Komi Science Center, UrB RAS, Syktyvkar, Komi Republic, 167982, Russian Federation
| | - Dmitry V Kazakov
- Institute of Physics and Mathematics, Komi Science Center, UrB RAS, Syktyvkar, Komi Republic, 167982, Russian Federation
| | - Vasily I Punegov
- Institute of Physics and Mathematics, Komi Science Center, UrB RAS, Syktyvkar, Komi Republic, 167982, Russian Federation
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15
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Donati M, Martinek P, Steiner P, Grossmann P, Vanecek T, Kastnerova L, Kolm I, Baneckova M, Donati P, Kletskaya I, Kalmykova A, Feit J, Blasch P, Szilagyi D, Baldi A, Persichetti P, Crescenzi A, Michal M, Kazakov DV. Novel insights into the BAP1-inactivated melanocytic tumor. Mod Pathol 2022; 35:664-675. [PMID: 34857909 DOI: 10.1038/s41379-021-00976-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
BAP1-inactivated melanocytic tumor (BIMT) is a group of melanocytic neoplasms with epithelioid cell morphology molecularly characterized by the loss of function of BAP1, a tumor suppressor gene located on chromosome 3p21, and a mutually exclusive mitogenic driver mutation, more commonly BRAF. BIMTs can occur as a sporadic lesion or, less commonly, in the setting of an autosomal dominant cancer susceptibility syndrome caused by a BAP1 germline inactivating mutation. Owing to the frequent identification of remnants of a conventional nevus, BIMTs are currently classified within the group of combined melanocytic nevi. "Pure" lesions can also be observed. We studied 50 BIMTs from 36 patients. Most lesions were composed of epithelioid melanocytes of varying size and shapes, resulting extreme cytomorphological heterogeneity. Several distinctive morphological variants of multinucleated/giant cells were identified. Some hitherto underrecognized microscopic features, especially regarding nuclear characteristics included nuclear blebbing, nuclear budding, micronuclei, shadow nuclei, peculiar cytoplasmic projections (ant-bear cells) often containing micronuclei and cell-in-cell structures (entosis). In addition, there were mixed nests of conventional and BAP1-inactivated melanocytes and squeezed remnants of the original nevus. Of the 26 lesions studied, 24 yielded a BRAF mutation, while in the remaining two cases there was a RAF1 fusion. BAP1 biallelic and singe allele mutations were found in 4/22 and 16/24 neoplasms, respectively. In five patients, there was a BAP1 germline mutation. Six novel, previously unreported BAP1 mutations have been identified. BAP1 heterozygous loss was detected in 11/22 lesions. Fluorescence in situ hybridization for copy number changes revealed a related amplification of both RREB1 and MYC genes in one tumor, whereas the remaining 20 lesions studied were negative; no TERT-p mutation was found in 14 studied neoplasms. Tetraploidy was identified in 5/21 BIMTs. Of the 21 patients with available follow-up, only one child had a locoregional lymph node metastasis. Our results support a progression of BIMTs from a conventional BRAF mutated in which the original nevus is gradually replaced by epithelioid BAP1-inactivated melanocytes. Some features suggest more complex underlying pathophysiological events that need to be elucidated.
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Affiliation(s)
- Michele Donati
- Department of Pathology, University Hospital Campus Bio-Medico, Rome, Italy.,Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | | | | | | | | | - Liubov Kastnerova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Bioptical Laboratory, Pilsen, Czech Republic
| | - Isabel Kolm
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Martina Baneckova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Bioptical Laboratory, Pilsen, Czech Republic
| | | | - Irina Kletskaya
- Russian Children's Clinical Hospital of Pirogov Russian National Research Medical University of the Ministry of Healthcare, Russian Federation, Moscow, Russia
| | | | - Josef Feit
- Institute of Pathology, University of Ostrava, Ostrava, Czech Republic
| | - Petr Blasch
- Department of Pathology, Regional Hospital, Hranice, Czech Republic
| | - Diana Szilagyi
- Department of Pathology, Emergency Clinical County Hospital "Pius Brinzeu", Timisoara, Romania
| | - Alfonso Baldi
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy
| | - Anna Crescenzi
- Department of Pathology, University Hospital Campus Bio-Medico, Rome, Italy
| | - Michal Michal
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Bioptical Laboratory, Pilsen, Czech Republic
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic. .,Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
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16
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Kolm I, Kastnerova L, Konstantinova AM, Michal M, Kazakov DV. Trichoblastoma: A Consecutive Series of 349 Sporadic Cases Analyzed by Ackerman Subtypes. Am J Dermatopathol 2021; 43:887-897. [PMID: 34797788 DOI: 10.1097/dad.0000000000001895] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Trichoblastoma (TB) is a benign biphasic follicular neoplasm with differentiation toward the germinative cells and a specific follicular mesenchyme. We subtyped 349 sporadic TB according to a classification proposed by Ackerman. Two hundred forty-six (246/349, 70.5%) neoplasms were comprised of mixed subtypes. TB composed exclusively of a single pattern was less common (103/349, 29.5%). The most common pure subtype was cribriform TB followed by small nodular TB. Twelve cases (12/349, 3.4%) had unique features and are reported herein as novel histopathologic subtypes of the neoplasm.
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Affiliation(s)
- Isabel Kolm
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Liubov Kastnerova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
| | - Anastasia M Konstantinova
- Department of Pathology, Clinical Research and Practical Center for Specialized Oncological Care, Saint-Petersburg, Russia
- Department of Pathology, Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russia ; and
- Department of Pathology, Saint-Petersburg Medico-Social Institute, Saint-Petersburg, Russia
| | - Michal Michal
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
| | - Dmitry V Kazakov
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
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17
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Ramirez-Fort MK, Meier-Schiesser B, Lachance K, Mahase SS, Church CD, Niaz MJ, Liu H, Navarro V, Nikolopoulou A, Kazakov DV, Contassot E, Nguyen DP, Sach J, Hadravsky L, Sheng Y, Tagawa ST, Wu X, Lange CS, French LE, Nghiem PT, Bander NH. Folate hydrolase-1 (FOLH1) is a novel target for antibody-based brachytherapy in Merkel cell carcinoma. Skin Health Dis 2021; 1. [PMID: 34541577 PMCID: PMC8447486 DOI: 10.1002/ski2.9] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Backgrounds Folate Hydrolase‐1 (FOLH1; PSMA) is a type II transmembrane protein, luminally expressed by solid tumour neo‐vasculature. Monoclonal antibody (mAb), J591, is a vehicle for mAb‐based brachytherapy in FOLH1+ cancers. Brachytherapy is a form of radiotherapy that involves placing a radioactive material a short distance from the target tissue (e.g., on the skin or internally); brachytherapy is commonly accomplished with the use of catheters, needles, metal seeds and antibody or small peptide conjugates. Herein, FOLH1 expression in primary (p) and metastatic (m) Merkel cell carcinoma (MCC) is characterized to determine its targeting potential for J591‐brachytherapy. Materials & Methods Paraffin sections from pMCC and mMCC were evaluated by immunohistochemistry for FOLH1. Monte Carlo simulation was performed using the physical properties of conjugated radioisotope lutetium‐177. Kaplan–Meier survival curves were calculated based on patient outcome data and FOLH1 expression. Results Eighty‐one MCC tumours were evaluated. 67% (54/81) of all cases, 77% (24/31) pMCC and 60% (30/50) mMCC tumours were FOLH1+. Monte Carlo simulation showed highly localized ionizing tracks of electrons emitted from the targeted neo‐vessel. 42% (34/81) of patients with FOLH1+/− MCC had available survival data for analysis. No significant differences in our limited data set were detected based on FOLH1 status (p = 0.4718; p = 0.6470), staining intensity score (p = 0.6966; p = 0.9841) or by grouping staining intensity scores (− and + vs. ++, +++, +++) (p = 0.8022; p = 0.8496) for MCC‐specific survival or recurrence free survival, respectively. Conclusions We report the first evidence of prevalent FOLH1 expression within MCC‐associated neo‐vessels, in 60‐77% of patients in a large MCC cohort. Given this data, and the need for alternatives to immune therapies it is appropriate to explore the safety and efficacy of FOLH1‐targeted brachytherapy for MCC. What's already known about this topic? We report the first evidence of prevalent folate hydrolase‐1 (FOLH1; also known as prostate‐specific membrane antigen) expression within MCC‐associated neovessels.
What does this study add? Herein, FOLH1 expression in Merkel cell carcinoma neovasculature is validated, and the therapeutic mechanism of specific, systemic targeting of disseminated disease with antibody‐based brachytherapy, is defined.
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Affiliation(s)
- M K Ramirez-Fort
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico, USA.,Department of Urology, Weill Cornell Medicine, New York, New York, USA.,Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - B Meier-Schiesser
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - K Lachance
- Department of Dermatology, University of Washington, Seattle, Washington, USA
| | - S S Mahase
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - C D Church
- Department of Dermatology, University of Washington, Seattle, Washington, USA
| | - M J Niaz
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - H Liu
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - V Navarro
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - A Nikolopoulou
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - D V Kazakov
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland.,Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - E Contassot
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - D P Nguyen
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - J Sach
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - L Hadravsky
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Y Sheng
- Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - S T Tagawa
- Department of Urology, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - X Wu
- Shanghai Proton and Heavy Ion Center, Shanghai, China.,Innovative Cancer Institute, Miami, Florida, USA
| | - C S Lange
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico, USA.,Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - L E French
- Department of Dermatology, Münich University Hospital, Münich, Germany
| | - P T Nghiem
- Department of Dermatology, University of Washington, Seattle, Washington, USA
| | - N H Bander
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
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18
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Belousova IE, Shpilyuk RG, Chepushtanova KO, Gorbunov YG, Kazakov DV. [Are multiple trichodiscomas/fibrofolliculomas the Birt-Hogg-Dubé syndrome?]. Arkh Patol 2021; 83:45-51. [PMID: 34041896 DOI: 10.17116/patol20218303145] [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: 11/18/2022]
Abstract
Birt-Hogg-Dubé syndrome is a rare autosomal dominant disease caused by a mutation in the FLCN gene and presents with a triad of multiple fibrofolliculomas, trichodiscomas, and masses that clinically resemble fibroepithelial polyps (acrochordones), accompanied by an increased risk of kidney tumors and lung cysts. The paper provides a literature review supplemented by clinical cases and the morphological pattern of skin lesions. It presents the clinical and morphological features of cutaneous manifestations of the syndrome and gives diagnostic criteria.
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Affiliation(s)
- I E Belousova
- Kirov Military Medical Academy, St. Petersburg, Russia
| | - R G Shpilyuk
- Kirov Military Medical Academy, St. Petersburg, Russia
| | | | - Yu G Gorbunov
- Kirov Military Medical Academy, St. Petersburg, Russia
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19
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Donati M, Nožička J, Kastnerova L, Hajkova V, Persichetti P, Michal M, Kazakov DV. Primary Cutaneous Desmoplastic Melanoma With Collagen Rosettes and Pseudoglandular Features. Am J Dermatopathol 2021; 43:221-224. [PMID: 33201013 DOI: 10.1097/dad.0000000000001809] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Primary cutaneous desmoplastic melanoma (DM) is a group of rare melanocytic tumors arising on severely sun-damaged skin, histologically characterized by the proliferation of spindled melanocytes in a prominent desmoplastic stroma, with a range of morphological presentations. In this article, we report a unique case of primary cutaneous DM composed of a nodular proliferation of highly pleomorphic spindled and epithelioid cells, pseudoglandular structures, clear cell change, and unusual collagen rosettes. Immunohistochemical analysis showed a strong and diffuse positivity for S-100 protein, SOX-10, nestin, p75 (nerve growth factor receptor), WT1, and p53. Molecular analysis detected a mutation in the NF1 gene [c.4084C > T, p.(Arg1362Ter)], 2 different pathogenic mutations in TP53 [c.742C > T, p.(Arg248Trp), AF:12%, COSM1640831 and c.528C > G, p.(Cys176Trp), AF:12%, COSM11114], and a mutation in GNAS [c.601C > T, p.(Arg201Cys), AF: 9%, COSM123397]. To the best of our knowledge, this is the first case reporting collagen rosettes and pseudoglandular features in primary cutaneous DM.
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Affiliation(s)
- Michele Donati
- Department of Pathology, University Hospital Campus Bio-Medico, Rome, Italy
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Jan Nožička
- Histological and Cytological Laboratory, Usti and Orlici, Czech Republic
| | - Liubov Kastnerova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic ; and
| | - Veronika Hajkova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic ; and
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy
| | - Michal Michal
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic ; and
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic ; and
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20
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Konstantinova AM, Kastnerova L, Michal M, Kolm I, Kazakov DV. Sebaceous Tumors of the Skin: A Study of 145 Lesions From 136 Patients Correlating Pathologic Features and DNA Mismatch Repair Staining Pattern. Am J Dermatopathol 2021; 43:174-181. [PMID: 33201015 DOI: 10.1097/dad.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sebaceous neoplasms occur sporadically or in the setting of Muir-Torre syndrome. The data regarding the correlation of pathologic features and DNA mismatch repair (MMR) staining pattern in sebaceous tumors of the skin are very scanty and based on relatively small series of patients. The goal of this study was to correlate MMR staining pattern with selected morphological features in a series of 145 sebaceous neoplasms (sebaceous adenoma, sebaceoma, and extraocular sebaceous carcinoma) from 136 patients. Cystic change, intratumoral mucin deposits, squamous metaplasia in the absence of keratoacanthoma-like changes, ulceration, intratumoral and peritumoral lymphocytes (in cases without epidermal ulceration), and intertumoral heterogeneity proved to be significantly associated with MMR deficiency. Identification of any of these changes, alone or in combination, should prompt further investigation of the patient to exclude Muir-Torre Syndrome. Our study also confirms the previously published observation that the diagnosis and tumor location are significantly associated with MMR deficiency.
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Affiliation(s)
- Anastasia M Konstantinova
- Department of Pathology, Clinical Research and Practical Center for Specialized Oncological Care, Saint-Petersburg, Russia
- Department of Pathology, Medical Faculty, Saint-Petersburg State University, Saint Petersburg, Russia
- Department of Pathology, Saint-Petersburg Medico-Social Institute, Saint Petersburg, Russia
| | - Liubov Kastnerova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Michal Michal
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic; and
| | - Isabel Kolm
- Department of Dermatology, University Hospital, Zurich, Switzerland
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic; and
- Department of Dermatology, University Hospital, Zurich, Switzerland
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21
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Kolm I, Buset C, Flury U, Nosek D, Kazakov DV, Kempf W. Lichen aureus with pseudolymphomatous infiltrate. J Cutan Pathol 2021; 48:669-673. [PMID: 33368548 DOI: 10.1111/cup.13948] [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] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/16/2022]
Abstract
Lichen aureus is a variant of pigmented purpuric dermatoses. The usual histopathology of lichen aureus is characterized by a subepidermal dense, band-like lymphocytic infiltrate, extravasated erythrocytes, and hemosiderin deposits. We report three patients with lichen aureus on the extremities with similar clinical, dermoscopic, and histopathological findings characterized by a dense band-like relatively deep dermal infiltrate accompanied by extravasation of erythrocytes and hemosiderin deposits occasioning a resemblance to a lymphoproliferative disorder.
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Affiliation(s)
- Isabel Kolm
- Department of Dermatology, University Hospital Zurich, Switzerland
| | - Caroline Buset
- Department of Dermatology, University Hospital Zurich, Switzerland.,Dermatology Service, Cantonal Hospital Frauenfeld, Switzerland
| | - Ursula Flury
- Division of Dermatology, Lucerne Cantonal Hospital and Cancer Center, Lucerne, Switzerland
| | - Daniel Nosek
- Department of Medical Biosciences/Pathology, Umeå University, Umeå, Sweden
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Werner Kempf
- Department of Dermatology, University Hospital Zurich, Switzerland.,Kempf & Pfaltz Histologische Diagnostik, Zurich, Switzerland
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22
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Baněčková M, Kazakov DV, Skálová A, Michal M. MAML2-Rearranged Tumors of the Breast: A Diagnostic Dilemma. Int J Surg Pathol 2020; 29:343-345. [PMID: 33325304 DOI: 10.1177/1066896920981634] [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: 11/16/2022]
Affiliation(s)
- Martina Baněčková
- 60569Charles University, Plzen, Czech Republic.,Bioptic Laboratory Ltd, Plzen, Czech Republic
| | - Dmitry V Kazakov
- 60569Charles University, Plzen, Czech Republic.,Bioptic Laboratory Ltd, Plzen, Czech Republic
| | - Alena Skálová
- 60569Charles University, Plzen, Czech Republic.,Bioptic Laboratory Ltd, Plzen, Czech Republic
| | - Michal Michal
- 60569Charles University, Plzen, Czech Republic.,Bioptic Laboratory Ltd, Plzen, Czech Republic
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Abstract
Extramammary Paget disease (EMPD) is a rare neoplasm with uncertain histogenesis, usually presenting in the anogenital area, most commonly in the vulva. The disease is characterized by slow grow and high recurrence rates. This article reviews the epidemiological, clinical, morphological, genetic and treatment features of EMPD of the vulva reported in recent years.
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Affiliation(s)
- Anastasia M Konstantinova
- Department of Pathology, Clinical Research and Practical Center for Specialized Oncological care, Saint-Petersburg, Russian Federation; Department of Pathology, Medical Faculty, Saint-Petersburg State University, Russian Federation; Department of Pathology, Saint-Petersburg Medico-Social Institute, St.-Petersburg, Russian Federation
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; Bioptical Laboratory, Pilsen, Czech Republic.
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24
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Kastnerova L, Martinek P, Grossmann P, Steiner P, Vanecek T, Kyclova J, Ferak I, Zalud R, Slehobr O, Svajdler P, Sulc M, Bradamante M, Banik M, Hadravsky L, Sticova E, Hajkova V, Ptakova N, Michal M, Kazakov DV. A Clinicopathological Study of 29 Spitzoid Melanocytic Lesions With ALK Fusions, Including Novel Fusion Variants, Accompanied by Fluorescence In Situ Hybridization Analysis for Chromosomal Copy Number Changes, and Both TERT Promoter and Next-Generation Sequencing Mutation Analysis. Am J Dermatopathol 2020; 42:578-592. [PMID: 32701692 DOI: 10.1097/dad.0000000000001632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ALK-fused spitzoid neoplasms represent a distinctive group of melanocytic lesions. To date, few studies addressed genetic and chromosomal alterations in these lesions beyond the ALK rearrangements. Our objective was to study genetic alterations, including ALK gene fusions, telomerase reverse transcriptase promoter (TERT-p) mutations, chromosomal copy number changes, and mutations in other genes. We investigated 29 cases of Spitz lesions (11 Spitz nevi and 18 atypical Spitz tumors), all of which were ALK immunopositive. There were 16 female and 13 male patients, with age ranging from 1 to 43 years (mean, 18.4 years). The most common location was the lower extremity. Microscopically, all neoplasms were polypoid or dome shaped with a plexiform, predominantly dermally located proliferation of fusiform to spindled melanocytes with mild to moderate pleomorphism. The break-apart test for ALK was positive in 17 of 19 studied cases. ALK fusions were detected in 23 of 26 analyzable cases by Archer FusionPlex Solid Tumor Kit. In addition to the previously described rearrangements, 3 novel fusions, namely, KANK1-ALK, MYO5A-ALK, and EEF2-ALK, were found. Fluorescence in situ hybridization for copy number changes yielded one case with the loss of RREB1 among 21 studied cases. TERT-p hotspot mutation was found in 1 of 23 lesions. The mutation analysis of 271 cancer-related genes using Human Comprehensive Cancer Panel was performed in 4 cases and identified in each case mutations in several genes with unknown significance, except for a pathogenic variant in the BLM gene. Our study confirms that most ALK fusion spitzoid neoplasms can be classified as atypical Spitz tumors, which occurs in young patients with acral predilection and extends the spectrum of ALK fusions in spitzoid lesions, including 3 hitherto unreported fusions. TERT-p mutations and chromosomal copy number changes involving 6p25 (RRB1), 11q13 (CCND1), 6p23 (MYB), 9p21 (CDKN2A), and 8q24 (MYC) are rare in these lesions. The significance of mutation in other genes remains unknown.
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Affiliation(s)
- Liubov Kastnerova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
| | - Petr Martinek
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
| | - Petr Grossmann
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
| | - Petr Steiner
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
| | - Tomas Vanecek
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
| | - Jitka Kyclova
- Department of Pathology, University Hospital, Brno, Czech Republic
| | - Ivan Ferak
- Agel Laboratory, Novy Jicin, Czech Republic
| | - Radim Zalud
- Department of Pathology, Regional Hospital, Kolin, Czech Republic
| | - Ondrej Slehobr
- Department of Pathology, Regional Hospital, Kolin, Czech Republic
| | - Peter Svajdler
- Department of Pathology, L. Pausteur University Hospital, Kosice, Czech Republic
| | - Miroslav Sulc
- Pathology Laboratory Chomutov, Chomutov, Czech Republic
| | | | - Martin Banik
- Department of Pathology, Regional Hospital, Karlovy Vary, Czech Republic
| | - Ladislav Hadravsky
- Department of Pathology, 1st Faculty of Medicine and General University Hospital, Charles University in Prague, Czech Republic; and
| | - Eva Sticova
- Clinical and Transplant Pathology Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | - Michal Michal
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic
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25
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Michal M, Rubin BP, Kazakov DV, Michalová K, Šteiner P, Grossmann P, Hájková V, Martínek P, Švajdler M, Agaimy A, Hadravský L, Kalmykova AV, Konishi E, Heidenreich F, Michal M. Inflammatory leiomyosarcoma shows frequent co-expression of smooth and skeletal muscle markers supporting a primitive myogenic phenotype: a report of 9 cases with a proposal for reclassification as low-grade inflammatory myogenic tumor. Virchows Arch 2020; 477:219-230. [PMID: 32078043 DOI: 10.1007/s00428-020-02774-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 11/12/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
Inflammatory leiomyosarcoma (ILMS) is a very rare soft tissue tumor that usually follows an indolent clinical course, but long-term follow-up studies are lacking. Recent publications primarily focused on its genetic profile characterized by a near haploid genome. One study also showed these tumors to have upregulation of genes known to be crucial for skeletal muscle differentiation. Nevertheless, immunohistochemical expression of skeletal muscle markers, as well as markers that would help to distinguish ILMS from a long list of relevant differential diagnostic entities, has not been extensively studied. Nine cases of ILMS were collected and stained by a broad IHC panel which, besides others, contained MyoD1, myogenin, and PAX-7. A subset of cases was also analyzed by 2 different NGS assays and by MDM2 fluorescence in situ hybridization. Five male and 4 female patients ranged in age from 25 to 54 years (mean, 36 years). The tumors showed a predilection for intramuscular sites of the lower limbs (n = 4) and back (n = 2), whereas the remaining 3 cases affected an unspecified skeletal muscle, lung, and omentum. Follow-up with an average length of 10.6 years (range 0.5-22) was available for 8 patients. The omental tumor spread locally within the abdominal cavity, but the patient has been free of disease 7 years after treatment. None of the 5 patients with somatic soft tissue tumors (and follow-up longer than 1.5 years) had either recurrence or metastasis. Immunohistochemical studies revealed a substantial expression of skeletal muscle markers in almost all cases. This phenotype coupled with a highly characteristic genotype and significantly more indolent clinical behavior as compared with conventional leiomyosarcoma of deep soft tissue offers a strong rationale to change the current nomenclature. Based on the clinicopathological features and gene expression profile, we propose the name low-grade inflammatory myogenic tumor.
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Affiliation(s)
- Michael Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic. .,Biomedical Center, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic. .,Bioptical Laboratory, Ltd., Plzen, Czech Republic.
| | - Brian P Rubin
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Dmitry V Kazakov
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic.,Bioptical Laboratory, Ltd., Plzen, Czech Republic
| | - Květoslava Michalová
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic.,Bioptical Laboratory, Ltd., Plzen, Czech Republic
| | - Petr Šteiner
- Bioptical Laboratory, Ltd., Plzen, Czech Republic
| | | | | | | | - Marian Švajdler
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic.,Bioptical Laboratory, Ltd., Plzen, Czech Republic
| | - Abbas Agaimy
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ladislav Hadravský
- Department of Pathology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Eiichi Konishi
- Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Filip Heidenreich
- Department of Radiology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic.,Bioptical Laboratory, Ltd., Plzen, Czech Republic
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26
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Michal M, Ptáková N, Martínek P, Gatalica Z, Kazakov DV, Michalová K, Stoláriková L, Švajdler M, Michal M. S100 and CD34 positive spindle cell tumor with prominent perivascular hyalinization and a novel NCOA4-RET fusion. Genes Chromosomes Cancer 2019; 58:680-685. [PMID: 30938880 DOI: 10.1002/gcc.22758] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 03/04/2019] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 01/01/2023] Open
Abstract
We report a case of a 35-year old male patient with a tumor located in the deep dermis on his forearm. The lesion was completely excised but recurred 4 years later. The patient showed no signs of neurofibromatosis type 1. The morphology and immunophenotype of the tumor corresponded to the recently characterized group of soft tissue spindle cell lesions defined by a relatively uniform cytomorphology, patternless architecture, conspicuous stromal and perivascular hyalinization, S100 and CD34 coexpression and recurrent fusions involving RAF1, BRAF, and NTRK1/2 genes. Using a 592-gene panel and massively parallel next-generation sequencing platform, we initially detected only NF1 gene mutation in our case. However, further molecular testing with Archer fusion assay revealed a novel NCOA4-RET gene fusion, adding it to the list of multiple kinase fusions originally reported in these tumors. Although break-apart FISH showed false negative result due to the presence of intrachromosomal rearrangement, RT-PCR confirmed the fusion transcript. Knowing the exact fusion is of great clinical importance especially for patients within the aggressive subset of these neoplasms that could be treated with selective kinase inhibitors. The presented case underscores the benefits of massively parallel sequencing as the types and number of gene fusions these tumors can potentially harbor render single-gene assays such as FISH impractical, and in this particular case, also insensitive.
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Affiliation(s)
- Michael Michal
- Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic.,Biomedical Center, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic.,Department of Pathology and Molecular Genetics, Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Nikola Ptáková
- Department of Pathology and Molecular Genetics, Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Petr Martínek
- Department of Pathology and Molecular Genetics, Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | | | - Dmitry V Kazakov
- Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic.,Department of Pathology and Molecular Genetics, Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Květoslava Michalová
- Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic.,Department of Pathology and Molecular Genetics, Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | | | - Marián Švajdler
- Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic.,Department of Pathology and Molecular Genetics, Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, Czech Republic.,Department of Pathology and Molecular Genetics, Bioptical Laboratory, Ltd., Pilsen, Czech Republic
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27
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Requena C, Requena L, Kazakov DV, Traves V, Nagore E, Llombart B, Serra C, Guillén C, Sanmartín O. Multiple facial plaque variant of trichoblastoma. J Cutan Pathol 2019; 46:285-289. [DOI: 10.1111/cup.13416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/07/2018] [Accepted: 12/23/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Celia Requena
- Departments of Dermatology and PathologyInstituto Valenciano de Oncología Valencia Spain
| | - Luis Requena
- Department of DermatologyFundación Jiménez Díaz Madrid Spain
| | - Dmitry V. Kazakov
- Sikl’s Department of Pathology, Medical Faculty in PilsenCharles University in Prague Pilsen Czech Republic
| | - Victor Traves
- Departments of Dermatology and PathologyInstituto Valenciano de Oncología Valencia Spain
| | - Eduardo Nagore
- Departments of Dermatology and PathologyInstituto Valenciano de Oncología Valencia Spain
| | - Beatriz Llombart
- Departments of Dermatology and PathologyInstituto Valenciano de Oncología Valencia Spain
| | - Carlos Serra
- Departments of Dermatology and PathologyInstituto Valenciano de Oncología Valencia Spain
| | - Carlos Guillén
- Departments of Dermatology and PathologyInstituto Valenciano de Oncología Valencia Spain
| | - Onofre Sanmartín
- Departments of Dermatology and PathologyInstituto Valenciano de Oncología Valencia Spain
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28
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Häfliger EM, Ramelyte E, Mangana J, Kunz M, Kazakov DV, Dummer R, Cheng PF. Metastatic acral lentiginous melanoma in a tertiary referral center in Switzerland: a systematic analysis. Melanoma Res 2018; 28:442-450. [PMID: 29847461 DOI: 10.1097/cmr.0000000000000465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Acral lentiginous melanoma (ALM) is a unique histopathological subtype of melanoma with a poorer prognosis than other cutaneous melanomas. This study aims to evaluate the clinicopathological characteristics, metastatic pattern, prognostic factors, response to systemic therapy, and overall survival (OS) of ALM in a White population. This is a retrospective study of patients who were diagnosed and/or treated for ALM at the Department of Dermatology of the University Hospital Zurich, Switzerland, from January 2005 to December 2015. Overall, 172 patients with histologically confirmed ALM were included in the study. In univariate Cox regression, Breslow thickness (P<0.001), age (P=0.003), status of sentinel lymph node (P=0.005), and ulceration (P=0.008) were identified as significant prognostic factors for OS in ALM. In multivariate analysis, only Breslow thickness (P=0.0003) showed statistical significance. The median OS (mOS) was 155.7 months in the entire cohort (n=172) and 11.2 months for stage IV patients (n=36), irrespective of treatment. When first treatment was considered (n=35), mOS for stage IV patients was 8.9, 16.6, 21.7, and 3.7 months, for patients who had received chemotherapy (ChT) (n=17), immunotherapy (n=9), targeted therapy (TT) (n=3), and no therapy (n=6), respectively. The overall response rate was 44% (7/16 patients) to ChT, 100% to TT (3/3), and 25% to ipilimumab (2/8). In our study, Breslow thickness represents the best prognostic factor for OS. In stage IV ALM patients treated with either immunotherapy or TT, there is a trend for extended mOS compared with ChT.
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Affiliation(s)
- Esther M Häfliger
- Department of Dermatology, University Hospital Zurich, Zurich
- Department of Internal Medicine, Zuger Kantonsspital, Baar, Switzerland
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Zurich
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich, Zurich
| | - Michael Kunz
- Department of Dermatology, University Hospital Zurich, Zurich
| | - Dmitry V Kazakov
- Department of Dermatology, University Hospital Zurich, Zurich
- Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich
| | - Phil F Cheng
- Department of Dermatology, University Hospital Zurich, Zurich
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29
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Baur V, Papadopoulos T, Kazakov DV, Agaimy A, Hartmann A, Isbary G, Wirtz RM, Schultz ES. A case of multiple familial trichoepitheliomas responding to treatment with the Hedgehog signaling pathway inhibitor vismodegib. Virchows Arch 2018; 473:241-246. [DOI: 10.1007/s00428-018-2397-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
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Ibrahim YL, Lambert S, Kazakov DV, Kaya G. An Unusual Morphological Presentation of Cutaneous Squamous Cell Carcinoma Mimicking Microcystic Adnexal Carcinoma: A Diagnostic Pitfall. Dermatopathology (Basel) 2018; 5:64-68. [PMID: 29998100 PMCID: PMC6031951 DOI: 10.1159/000488981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 11/19/2022] Open
Abstract
Cutaneous squamous cell carcinoma (SCC) exhibiting microcystic adnexal carcinoma-like differentiation is an extremely rare tumor that shows both squamous and ductal differentiation. This tumor is often misdiagnosed clinically and histologically and is confused with other malignant and benign cutaneous neoplasms. It usually occurs in middle-aged to older adults. Here, we report a case of SCC with microcystic adnexal carcinoma-like differentiation on the left chin of a 71-year-old male. The histopathological examination revealed a nodular tumor infiltrating the dermis, subcutaneous fat, and striated muscle tissue, consisting of both prominent atypical squamous differentiation and foci of duct-like structures.
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Affiliation(s)
- Yasmine L Ibrahim
- Department of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
| | - Stéphanie Lambert
- Department of Otorhinolaryngology, University Hospital of Geneva, Geneva, Switzerland
| | - Dmitry V Kazakov
- Department of Pathology, Medical Faculty Hospital, Charles University, Pilsen, Czech Republic
| | - Gürkan Kaya
- Department of Dermatology and Venereology, University Hospital of Geneva, Geneva, Switzerland
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31
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Michalova K, Michal M, Sedivcova M, Kazakov DV, Bacchi C, Antic T, Miesbauerova M, Hes O, Michal M. Solid pseudopapillary neoplasm (SPN) of the testis: Comprehensive mutational analysis of 6 testicular and 8 pancreatic SPNs. Ann Diagn Pathol 2018; 35:42-47. [PMID: 29705715 DOI: 10.1016/j.anndiagpath.2018.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recently, we came with the theory of a possible relationship between a group of testicular and pancreatic tumors. We used one case of a pancreatic analogue solid pseudopapillary neoplasm of the testis composed partially of areas reminiscent of solid pseudopapillary neoplasm (SPN) of the pancreas and partially of structures identical to primary signet ring stromal tumor of the testis (PSRSTT) as a connecting link between these two entities. After demonstrating that PSRSTT and pancreatic analogue SPN of the testis share the same immunoprofile and genetic features characteristic for pancreatic SPN, we came to the conclusion that pancreatic analogue SPN of the testis and PSRSTT represent a morphological spectrum of a single entity and that both are related to the pancreatic SPN. DESIGN The aim of this study is to present a series of 6 cases of testicular tumors, which lacked the signet ring cell component and were thus morphologically very similar to the SPN of the pancreas. The goal of this study is to compare the genetic background of these testicular tumors that are obviously related to the PSRSTT/pancreatic analogue SPN of the testis with the series of 8 pancreatic SPN. RESULTS The mutational analysis revealed an oncogenic somatic mutation in the exon 3 of the CTNNB1 (β-catenin) gene in all analyzable (5/6) testicular and all pancreatic (8/8) tumors. The immunoprofile (positivity with β-catenin, CD10, vimentin, NSE, CD56, and negativity with inhibin, calretinin, chromogranin) was identical in all testicular and pancreatic tumors. CONCLUSION This study expanded the morphological spectrum of the PSRSTT/pancreatic analogue SPN of the testis by adding 6 cases without the signet ring cell component. Considering the obvious analogy of PSRSTT/pancreatic analogue SPN of the testis/SPN of the testis and their relationship to the pancreatic SPN we propose the collective term "solid pseudopapillary neoplasm of the testis" for these tumors. The mutational profile of the SPN of the testis and pancreas was the same in both groups of tumors which we consider as a final proof that SPN of the testis is identical to the SPN of the pancreas.
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Affiliation(s)
- Kvetoslava Michalova
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic.
| | - Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | | | - Dmitry V Kazakov
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | | | - Tatjana Antic
- Department of Pathology, The University of Chicago, Chicago, USA
| | - Marketa Miesbauerova
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Ondrej Hes
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
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32
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Michal M, Kazakov DV, Michalova K, Michal M. Atypical multivacuolated lipoblasts and atypical mitoses are not compatible with the diagnosis of spindle cell/pleomorphic lipoma—reply. Hum Pathol 2018; 74:189. [DOI: 10.1016/j.humpath.2017.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
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34
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Belousova IE, Khairutdinov VR, Kazakov DV. Facial Follicular Cyst and Cicatricial Alopecia: Challenge. Am J Dermatopathol 2017; 40:e130-e131. [PMID: 28937440 DOI: 10.1097/dad.0000000000000998] [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: 11/25/2022]
Affiliation(s)
- Irena E Belousova
- Department of Dermatology, Medical Military Academy, Saint Petersburg, Russia
| | | | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
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35
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Toberer F, Rütten A, Requena L, Kazakov DV, Enk A, Hartschuh W, Haenssle HA. Eosinophil-rich trichoblastic carcinoma with aggressive clinical course in a young man. J Cutan Pathol 2017; 44:986-990. [DOI: 10.1111/cup.13031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/07/2017] [Accepted: 08/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ferdinand Toberer
- Department of Dermatology, Venerology and Allergology, University Medical Center; Ruprecht-Karls-University; Heidelberg Germany
| | - Arno Rütten
- Dermatopathology Friedrichshafen; Friedrichshafen Germany
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz; Universidad Autónoma; Madrid Spain
| | - Dmitry V. Kazakov
- The Sikl Department of Pathology; Charles University Medical Faculty Hospital; Pilsen Czech Republic
| | - Alexander Enk
- Department of Dermatology, Venerology and Allergology, University Medical Center; Ruprecht-Karls-University; Heidelberg Germany
| | - Wolfgang Hartschuh
- Department of Dermatology, Venerology and Allergology, University Medical Center; Ruprecht-Karls-University; Heidelberg Germany
| | - Holger A. Haenssle
- Department of Dermatology, Venerology and Allergology, University Medical Center; Ruprecht-Karls-University; Heidelberg Germany
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36
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Michalova K, Michal M, Kazakov DV, Sedivcova M, Hes O, Hadravsky L, Agaimy A, Tretiakova M, Bacchi C, Hartmann A, Kuroda N, Bulimbasic S, Coric M, Antic T, Michal M. Primary signet ring stromal tumor of the testis: a study of 13 cases indicating their phenotypic and genotypic analogy to pancreatic solid pseudopapillary neoplasm. Hum Pathol 2017; 67:85-93. [DOI: 10.1016/j.humpath.2017.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/11/2017] [Accepted: 07/04/2017] [Indexed: 11/25/2022]
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Pennacchia I, Kutzner H, Kazakov DV, Mentzel T. Fibroblastic connective tissue nevus: Clinicopathological and immunohistochemical study of 14 cases. J Cutan Pathol 2017. [DOI: 10.1111/cup.12993] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Ilaria Pennacchia
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | | | - Dmitry V. Kazakov
- Sikl's Department of Pathology; Medical Faculty in Pilsen, Charles University in Prague; Pilsen Czech Republic
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Konstantinova AM, Belousova IE, Kacerovska D, Michal M, Shelekhova KV, Kazakov DV. [Anogenital mammary-like glands and related diseases. Part 2. Malignant tumors of the anogenital glands]. Arkh Patol 2017. [PMID: 28631716 DOI: 10.17116/patol201779347-52] [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: 11/17/2022]
Abstract
Mammary-like glands are a normal anatomical component of the anogenital region and can give rise to many benign and malignant tumors that morphologically mimic the similar diseases of the breast. The literature review is complemented by a description of 199 cases of malignant tumors of mammary-like glands. The paper presents the clinical and morphological characteristics of various malignant tumors of mammary-like glands, including extramammary Paget's disease, ductal, tubulolobular, adenoid cystic adenocarcinoma, low-grade phyllodes tumor, etc.
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Affiliation(s)
- A M Konstantinova
- Pathology Department, Saint Petersburg Clinical Research and Practical Center for Specialized Care, Saint Petersburg, Russia; Department of Pathology, Medical Faculty, Saint Petersburg State University, Saint Petersburg, Russia; Department of Pathology, Saint Petersburg Sociomedical Institute, Saint Petersburg, Russia
| | - I E Belousova
- Pathology Department, Saint Petersburg Clinical Research and Practical Center for Specialized Care, Saint Petersburg, Russia; Department of Pathology, Saint Petersburg Sociomedical Institute, Saint Petersburg, Russia; Department of Skin and Venereal Diseases, Military Medical Academy, Saint Petersburg, Russia
| | - D Kacerovska
- Department of Pathology, Charles University, Plzen, Czech Republic
| | - M Michal
- Department of Pathology, Charles University, Plzen, Czech Republic
| | - K V Shelekhova
- Pathology Department, Saint Petersburg Clinical Research and Practical Center for Specialized Care, Saint Petersburg, Russia; Department of Pathology, Saint Petersburg Sociomedical Institute, Saint Petersburg, Russia
| | - D V Kazakov
- Department of Pathology, Charles University, Plzen, Czech Republic
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Michal M, Kazakov DV, Hadravsky L, Michalova K, Grossmann P, Steiner P, Vanecek T, Renda V, Suster S, Michal M. Lipoblasts in spindle cell and pleomorphic lipomas: a close scrutiny. Hum Pathol 2017; 65:140-146. [PMID: 28546131 DOI: 10.1016/j.humpath.2017.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/27/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
The presence and frequency of lipoblasts (LPB) in spindle cell lipomas (SCL) and pleomorphic lipomas (PL) has never been studied in detail on a histologically, immunohistochemically and molecular genetically validated set of tumors. The authors investigated this feature by reviewing 91 cases of SCL and 38 PL. When more than 3 unequivocal LPB were found, the case was regarded as positive for the presence of LPB. All positive cases were then stained with CD34 and retinoblastoma (Rb) protein antibodies and tested by fluorescence in situ hybridization for MDM2 and CDK4 amplifications and the FUS gene rearrangements. The patients with SCL and PL containing LPB were 14 women and 47 men, the rest were of unknown gender. The cases usually presented as superficial, well-circumscribed soft tissue masses and most commonly occurred in the upper back and neck. CD34 was expressed in all cases, while Rb protein was consistently absent in all. Molecular genetic results, when available, were in concordance with the morphological diagnosis of SCL/PL. LPB were found in 37 (41%) cases of SCL and 25 cases of PL (66%). While in many cases they are inconspicuous, in some others they constitute a very prominent component of the tumor. It is important to be aware of this fact in order to avoid misinterpretation as liposarcoma.
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Affiliation(s)
- Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic.
| | - Dmitry V Kazakov
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Ladislav Hadravsky
- Department of Pathology, Third Medical Faculty in Prague, Charles University, 100 34 Prague, Czech Republic
| | - Kvetoslava Michalova
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Petr Grossmann
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Petr Steiner
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Tomas Vanecek
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Valentina Renda
- Department of Pathology and MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA 53226-3522
| | - Saul Suster
- Department of Pathology and MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA 53226-3522
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
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Kacerovska D, Portelli F, Michal M, Kazakov DV. Acquired elastotic hemangioma-like changes and eccrine sweat duct squamous metaplasia in lichen simplex chronicus/prurigo nodularis-like lesions of the knee and elbow. J Cutan Pathol 2017; 44:605-611. [DOI: 10.1111/cup.12945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Denisa Kacerovska
- Sikl's Department of Pathology; Charles University in Prague, Medical Faculty in Pilsen; Pilsen Czech Republic
- Bioptical Laboratory; Pilsen Czech Republic
| | - Francesca Portelli
- Department for Health Promotion and Mother and Child's Care G. D'Alessandro, Section of Pathology; University of Palermo; Palermo Italy
| | - Michal Michal
- Sikl's Department of Pathology; Charles University in Prague, Medical Faculty in Pilsen; Pilsen Czech Republic
- Bioptical Laboratory; Pilsen Czech Republic
| | - Dmitry V. Kazakov
- Sikl's Department of Pathology; Charles University in Prague, Medical Faculty in Pilsen; Pilsen Czech Republic
- Bioptical Laboratory; Pilsen Czech Republic
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Michalova K, Michal M, Hes O, Kazakov DV, Michal M. Solid pseudopapillary tumor: a new tumor entity in the testis? Reply. Hum Pathol 2017; 62:243-245. [DOI: 10.1016/j.humpath.2016.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 11/25/2022]
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Michal M, Kazakov DV, Agaimy A, Hosova M, Michalova K, Grossmann P, Steiner P, Skenderi F, Vranic S, Michal M. Whorling cellular perineurioma: A previously undescribed variant closely mimicking monophasic fibrous synovial sarcoma. Ann Diagn Pathol 2017; 27:74-78. [PMID: 28325366 DOI: 10.1016/j.anndiagpath.2017.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/18/2022]
Abstract
The authors present a distinctive perineurioma (PN) variant which morphologically strongly resembles monophasic fibrous synovial sarcoma (MSS). The patients were 3 males and 1 female. The age ranged from 15 to 61years (mean: 44years). Locations included the sole, lower jaw, palm and foot. The tumor size ranged from 1.3cm to 2.5cm in the largest dimension (mean 1.8cm). Morphologically, all tumors had an identical, monotonous appearance. The perineurial cells were closely packed and created a confluent cellular whorls and/or sheets in a scarce stroma, with only focally discernible long, slender cytoplasmic processes typical for perineurial differentiation. The nuclei were rounded or slightly elongated to tapered, without nuclear atypia. Mitoses were rare to completely absent. Atypical mitoses, hemorrhage, necrosis or calcifications were not present. The proliferative index (Ki-67) was 1-3%. All analyzed tumors were positive for EMA, Claudin-1, GLUT-1 and negative with S100 protein, CD34, OSCAR, CK7 and TLE-1. Two cases were tested by fluorescence in situ hybridization and neither showed alterations of the SYT gene. One case studied by electron microscopy showed characteristic features of perineurial differentiation. Follow-up was available for two patients both of which showed no evidence of disease at 8years and 6months, respectively. Based on their bland morphology, perineurial features and presumably benign clinical outcome we propose the term "whorling cellular perineurioma" for these tumors, which may represent an extremely cellular variant of sclerosing PN. Awareness of this PN subtype and its distinction from MSS is of utmost clinical significance.
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Affiliation(s)
- Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic; Biomedical Center of the Faculty of Medicine in Pilsen, Alej Svobody 80, 304 60 Pilsen, Czech Republic.
| | - Dmitry V Kazakov
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital, Krankenhausstrasse 8-10, 910 54, Erlangen, Germany
| | - Marta Hosova
- Department of Pathology, Faculty Hospital, Budínova 67/2, 180 81 Prague, Czech Republic
| | - Kvetoslava Michalova
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Petr Grossmann
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Petr Steiner
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Faruk Skenderi
- Department of Pathology, Clinical Center, University of Sarajevo, Bolnička 25, 710 00 Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- Department of Pathology, Clinical Center, University of Sarajevo, Bolnička 25, 710 00 Sarajevo, Bosnia and Herzegovina; School of Medicine, Bolnička 25, 710 00 Sarajevo, Bosnia and Herzegovina
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
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Konstantinova AM, Belousova IE, Kacerovska D, Michal M, Shelekhova KV, Kazakov DV. [Anogenital mammary-like glands and related lesions. Part 1. Benign tumors and tumor-like disorders]. Arkh Patol 2017; 79:43-51. [PMID: 28295007 DOI: 10.17116/patol201779143-51] [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] [Indexed: 11/17/2022]
Abstract
Anogenital mammary-like glands represent a normal anatomic constituent of the anogenital area and may give rise to many benign and malignant tumors that morphologically mimic similar breast diseases. The literature review is complemented by a description of 286 cases of benign tumors and tumor-like processes in the mammary-like glands. The paper presents the clinical and morphological characteristics of papillary hidradenoma, fibroadenoma, benign phyllodes tumor, lactating adenoma, sclerosing adenosis, pseudoangiomatous stromal hyperplasia, etc.
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Affiliation(s)
- A M Konstantinova
- Pathology Department, Saint Petersburg Clinical Research and Practical Center for Specialized Types of Medical Care, Saint Petersburg, Russia; Pathology Department, Medical Faculty, Saint Petersburg State University, Saint Petersburg, Russia; Department of Pathology, Saint Petersburg Sociomedical Institute, Saint Petersburg, Russia
| | - I E Belousova
- Pathology Department, Saint Petersburg Clinical Research and Practical Center for Specialized Types of Medical Care, Saint Petersburg, Russia; Department of Pathology, Saint Petersburg Sociomedical Institute, Saint Petersburg, Russia; Department of Dermatology and Venerology, Medical Military Academy, Saint Petersburg, Russia
| | - D Kacerovska
- Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Pilsen, Czech Republic
| | - M Michal
- Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Pilsen, Czech Republic
| | - K V Shelekhova
- Pathology Department, Saint Petersburg Clinical Research and Practical Center for Specialized Types of Medical Care, Saint Petersburg, Russia; Department of Pathology, Saint Petersburg Sociomedical Institute, Saint Petersburg, Russia
| | - D V Kazakov
- Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Pilsen, Czech Republic
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Konstantinova AM, Vanecek T, Martinek P, Kyrpychova L, Spagnolo DV, Stewart CJR, Portelli F, Michal M, Kazakov DV. Molecular alterations in lesions of anogenital mammary-like glands and their mammary counterparts including hidradenoma papilliferum, intraductal papilloma, fibroadenoma and phyllodes tumor. Ann Diagn Pathol 2017. [PMID: 28648934 DOI: 10.1016/j.anndiagpath.2017.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/20/2022]
Abstract
Lesions affecting anogenital mammary-like glands (AGMLG) are histopathologically very similar to those seen in the breast but whether this morphological similarity is also reflected at the genetic level is unknown. To compare the underlying molecular mechanisms in lesions of AGMLG and their mammary counterparts, we analyzed the mutational profile of 16 anogenital neoplasms including 5 hidradenomas papilliferum (HP), 1 lesion with features of HP and fibroadenoma (FA), 7 FA, 3 phyllodes tumors (PhT)) and 18 analogous breast lesions (6 intraductal papillomas (IDP), 9 FA, and 3 PhT) by high-coverage next generation sequencing (NGS) using a panel comprising 50 cancer-related genes. Additionally, all cases were analyzed for the presence of a mutation in the MED12 gene. All detected mutations with allele frequencies over 20% were independently validated by Sanger sequencing (concordance: 100%). Mutations in PIK3CA, AKT1, MET, ABL1 and TP53 genes were found in lesions of AGMLG and also their mammary counterparts. The PI3K-AKT cascade plays a role in tumors arising at both sites. It appears that some histopathologically similar anogenital and breast lesions develop along similar molecular pathways.
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Affiliation(s)
- Anastasia M Konstantinova
- Department of Pathology, Clinical research and practical center for specialized oncological care, Saint-Petersburg, Russia; Department of Pathology, Medical Faculty, Saint-Petersburg State University, Russia; Department of Pathology, Medico-Social Institute, St.-Petersburg, Russia
| | - Tomas Vanecek
- Departments of Pathology, Charles University, Medical Faculty and Charles University Hospital, Pilsen, Czech Republic; Department of Molecular Genetics, Bioptical Laboratory Ltd., Pilsen, Czech Republiс
| | - Petr Martinek
- Departments of Pathology, Charles University, Medical Faculty and Charles University Hospital, Pilsen, Czech Republic; Department of Molecular Genetics, Bioptical Laboratory Ltd., Pilsen, Czech Republiс
| | - Liubov Kyrpychova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Dominic V Spagnolo
- PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia; University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, WA, Australia
| | - Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | | | - Michal Michal
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; Bioptical Laboratory, Pilsen, Czech Republic
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; Bioptical Laboratory, Pilsen, Czech Republic.
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Michalova K, Kazakov DV, Michal M, Hadravsky L, Kacerovska D, Rychly B, Miesbauerova M, Michal M. Differentiated squamous intraepithelial lesion (dSIL)-like changes in the epidermis overlying anogenital melanocytic nevi: A diagnostic pitfall. Ann Diagn Pathol 2017; 26:43-46. [PMID: 28038710 DOI: 10.1016/j.anndiagpath.2016.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Differentiated squamous intraepithelial lesion (dSIL) is morphologically and immunohistochemically analogous in the whole anogenital region. dSIL is a premalignant lesion frequently misinterpreted histopathologically as a benign dermatosis. The authors describe a peculiar change in the basal cell layer of the epidermis/epithelium overlying anogenital melanocytic nevi that may histopathologically imitate dSIL. The aim of this study is to familiarize the pathologists with this pitfall to avoid its possible overdiagnosis as dysplasia. Further, we tried to explore the biological characteristics of the dSIL-like changes and to focus on the differential diagnostic aspects. DESIGN Seventy cases of anogenital nevi were retrieved from our registry. All cases were stained with hematoxylin and eosin (H&E) and reviewed. Cases in which the epidermis overlying nevi featured atypical appearing basal keratinocytes in otherwise fully differentiated epithelium, variable degrees of acanthosis and parakeratosis were selected for additional investigation. RESULTS Thirty cases meeting the above described criteria were identified. The patients were 8 males and 22 females, with age at the time of diagnosis ranging from 4 to 68years. Follow-up data were available for 28 patients (range 0.5-19years, mean 5.1), and to date, no signs of epithelial malignancy have been recorded. Immunohistochemically (IHC), the epidermis overlying nevi showed insignificant positivity for p53 in all tested cases. Melanocytic markers (S-100 protein, SOX10, Melan A) and cytokeratin AE1/3 labeled melanocytes and keratinocytes, respectively, enabling their distinction, especially in nevi featuring a junctional component. CONCLUSIONS Differentiated squamous intraepithelial lesion-like changes seem to occur relatively often in the epidermis overlying anogenital melanocytic nevi. Since morphologically they are virtually identical to the "true" dSIL, their distinction largely depends on p53 expression in basal keratinocytes with normal p53 expression in dSIL-like changes and diffuse nuclear/p53-null immunostaining in the "true" dSIL serving as an essential differential diagnostic tool. dSIL-like alterations seem to have no malignant potential, as to date, none of the patients included in this study have shown any signs of epithelial malignancy.
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Affiliation(s)
- Kvetoslava Michalova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
| | - Dmitry V Kazakov
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Michael Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic; Biomedical Center, Faculty of Medicine in Plzen and Charles University Hospital Plzen, Czech Republic
| | - Ladislav Hadravsky
- Department of Pathology, Charles University, 3rd Medical Faculty and Charles University Hospital Royal Vineyards, Prague, Czech Republic
| | - Denisa Kacerovska
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | | | - Marketa Miesbauerova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
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Michal M, Kazakov DV, Michal M. Hybrid peripheral nerve sheath tumors: A review. Cesk Patol 2017; 53:81-88. [PMID: 28597668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hybrid peripheral nerve sheath tumors (HPNST) are relatively recently described tumors. With ongoing research, a considerable amount of important findings have been made, much of which has substantial clinical implications. However, a comprehensive review of the whole topic has not been published in the literature so far. In the presented manuscript, the various hybrid tumors are discussed separately with a special emphasis on the morphological and immunohistochemical findings as well as on their association with tumor syndromes.
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Michal M, Kazakov DV, Hadravský L, Michalová K, Rychlý B, Michal M. Multivacuolated mucin-filled cells: a unique cell characteristic of plexiform neurofibroma. A report of 11 cases. Hum Pathol 2016; 60:167-173. [PMID: 27816720 DOI: 10.1016/j.humpath.2016.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/15/2016] [Revised: 10/09/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
The authors present 11 cases of plexiform neurofibroma (PN) that featured a very characteristic type of cell appearing as multivacuolated mucin-filled cells (MMFC). The 11 cases were obtained after reviewing 109 cases of PN. Six out of 10 patients showed clinical features of neurofibromatosis type 1. The size of PN ranged from 0.8 cm to 11.5 cm in the largest dimension. The lesions represented classical PN in all cases with myxoid, hypocellular stroma. The MMFC were found within the most myxoid tumorous nodules and were haphazardly located, typically featuring a variably sized, multivacuolated cytoplasm divided by fine septa with a small polygonal nucleus on one side, which was often compressed or slightly indented by the cytoplasmic mucous substances. In many cases, the cells resembled a soccer ball or a jellyfish. In all tested cases (n = 9), the MMFC stained for CD34; six cases were also positive with GLUT-1 antibody, and two cases expressed Claudin-1, whereas S-100 protein was negative. For comparison, we have reviewed a series of randomly selected non-PN, malignant peripheral nerve sheath tumors (MPNST) and of cases featuring non-neoplastic nerve trunks in our files, in which no MMFC were encountered. MMFC seem to be unique to myxoid areas of PN, where they occur in about 10% of cases. Their exact histogenesis is unclear but they might represent an intermediate type of cell between perineurial cells and fibroblasts. The awareness of this cell type in PN is especially important in limited (small) biopsy specimens where their recognition may provide a clue for the correct diagnosis.
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Affiliation(s)
- Michael Michal
- Department of Pathology, Charles University, Biomedical Center, Faculty of Medicine in Plzen and Charles University Hospital Plzen, Alej Svobody 80, 304 60 Pilsen, Czech Republic.
| | - Dmitry V Kazakov
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Ladislav Hadravský
- Department of Pathology, Charles University, Third Medical Faculty and Charles University Hospital Kralovske Vinohrady, Šrobárova 50, 100 34 Prague, Czech Republic
| | - Květoslava Michalová
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Boris Rychlý
- Cytopathos, Limbová 5, 833 07, Bratislava 37, Slovakia
| | - Michal Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Alej Svobody 80, 304 60 Pilsen, Czech Republic
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Petersson F, Michal M, Kazakov DV, Grossmann P, Michal M. A New Hitherto Unreported Histopathologic Manifestation of Mammary Analogue Secretory Carcinoma: "Masked MASC" Associated With Low-grade Mucinous Adenocarcinoma and Low-grade In Situ Carcinoma Components. Appl Immunohistochem Mol Morphol 2016; 24:e80-e85. [PMID: 26808131 DOI: 10.1097/pai.0000000000000320] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a salivary gland tumor of the parotid gland in a 54-year-old woman, which contained a minor mammary analogue secretory carcinoma (MASC) component (20%) intermixed with a morphologically entirely different mucinous adenocarcinomatous component that comprised 80% of the tumor mass and a morphologically nondescript low-grade intraductal carcinoma (in situ) component. On fluorescence in situ hybridization, a break in the ETV6 gene was documented in the mucinous adenocarcinomatous, the conventional MASC, and the intraductal (in situ) components. RT-PCR failed to reveal an ETV6-NTRK3 fusion. The entire conventional MASC and only rare mucinous adenocarcinoma tumor cells were mammaglobin positive, whereas the low-grade intraductal carcinoma (in-situ) component was negative. S-100 protein stained only the MASC component.
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Affiliation(s)
- Fredrik Petersson
- *Department of Pathology, National University Health System, Singapore, Singapore †Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Plzen, Czech Republic
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Orlova MV, Kazakov DV. [NEW FINDINGS OF RARE SPECIES OF THE MITE GENUS SPINTURNIX VON HEYDEN, 1826 (MESOSTIGMATA: GAMASINA: SPINTURNICIDAE) IN RUSSIA AND TADJIKISTAN]. Parazitologiia 2016; 50:404-408. [PMID: 29211431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The article reports new findings of rare and poorly known mite species of the genus Spinturnix von Heyden, 1826 (Gamasina: Spinturnicidae) parasitizing bats of the genera Myotis and Barbastella in Russia and Tadjikistan.
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50
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Peckova K, Michal M, Hadravsky L, Suster S, Damjanov I, Miesbauerova M, Kazakov DV, Vernerova Z, Michal M. Littoral cell angioma of the spleen: a study of 25 cases with confirmation of frequent association with visceral malignancies. Histopathology 2016; 69:762-774. [PMID: 27374010 DOI: 10.1111/his.13026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 03/01/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022]
Abstract
AIMS Littoral cell angioma (LCA) is a rare primary splenic tumour that is frequently associated with internal malignancies. Immunohistochemistry can demonstrate a distinct hybrid endothelial-histiocytic phenotype of littoral cells, and is a helpful adjunct for making the correct diagnosis. The aims of this study were to present a series of 25 LCAs, with an emphasis on the frequent association of the neoplasm with visceral malignancies, and to provide a detailed immunohistochemical analysis by employing new markers. METHODS AND RESULTS All 25 cases with available tissue blocks were immunohistochemically stained for endothelial and histiocytic markers. Clinical and follow-up data were retrieved from the respective institutions. The tumours were obtained from 16 males and nine females, whose age ranged from 32 to 86 years (mean 56.2 years). Clinical information was available for 24 of 25 patients, and follow-up for 11 of 25 patients (range 2-19 years; mean 11.6 years). Immunohistochemically, all cases were positive for LYVE-1, factor VIII, FLI-1, vascular endothelial growth factor receptor (VEGFR)-2, VEGFR-3, claudin-5, ERG, LMO2, CD31, CD163, lysozyme, and CD4, but negative for D2-40, CD8, and factor XIIIa. Fifteen of 25 cases were associated with various malignancies, including epithelial, mesenchymal and haematological tumours. CONCLUSIONS The cohort of 25 patients is the largest series of LCAs published to date. By using antibodies against recently introduced endothelial markers, we have expanded the immunoprofile of LCA. We have further highlighted the clinical significance of LCA, as more than half of the patients in this study also harboured a coexisting visceral malignancy. Therefore, we conclude that the finding of splenic LCA mandates a thorough clinical evaluation for a concomitant malignancy.
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Affiliation(s)
- Kvetoslava Peckova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic.
| | - Michael Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Plzen and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Ladislav Hadravsky
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Saul Suster
- Department of Pathology and MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ivan Damjanov
- Department of Pathology and Laboratory Medicine, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Marketa Miesbauerova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Dmitry V Kazakov
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Zdenka Vernerova
- Department of Pathology, Charles University, Third Medical Faculty and Charles University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
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