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Yin F, Wu ZH, Lai JP. New insights in diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms. World J Gastroenterol 2022; 28:1751-1767. [PMID: 35633912 PMCID: PMC9099195 DOI: 10.3748/wjg.v28.i17.1751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare epithelial neoplasms derived from pluripotent endocrine cells along the gastrointestinal tract and pancreas. GEP-NENs are classified into well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas. Despite overlapping morphological features, GEP-NENs vary in molecular biology, epigenetic, clinical behavior, treatment response, and prognosis features and remain an unmet clinical challenge. In this review, we introduce recent updates on the histopathologic classification, including the tumor grading and staging system, molecular genetics, and systemic evaluation of the diagnosis and treatment of GEP-NENs at different anatomic sites, together with some insights into the diagnosis of challenging and unusual cases. We also discuss the application of novel therapeutic approaches for GEP-NENs, including peptide receptor radionuclide therapy, targeted therapy, and immunotherapy with immune checkpoint inhibitors. These findings will help improve patient care with precise diagnosis and individualized treatment of patients with GEP-NENs.
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Affiliation(s)
- Feng Yin
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65212, United States
| | - Zi-Hao Wu
- Department of Surgery, University of Missouri, Columbia, MO 65212, United States
| | - Jin-Ping Lai
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA 95825, United States
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LIU ALEX, BORGES PAULAM, TAY YOUSHER, THOMPSON LESTERD, KONG MAXX, LAI JINPING. Thyroid Follicular Cell-derived Carcinomas in a Background of Multiple Adenomatous Nodules Leading to a Diagnosis of PTEN Hamartoma Tumor Syndrome in an Adult Patient With a Novel RECQL4 Mutation. Anticancer Res 2022; 42:1481-1485. [PMID: 35220242 DOI: 10.21873/anticanres.15619] [Citation(s) in RCA: 1] [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: 01/17/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/08/2023]
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Ghlichloo I, Jin Z, Fan R, Tong C, Starostik P, Chien JR, Lai J. Synchronous Basal Cell Carcinoma and Squamous Cell Carcinoma of Nasal Vestibule With Novel Unique Variants Identified by Whole-exome Sequencing. In Vivo 2022; 36:251-257. [PMID: 34972722 DOI: 10.21873/invivo.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/18/2021] [Accepted: 10/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM It is estimated that nonmelanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), affects more than 3 million Americans each year. Translation of next-generation sequencing (NGS) data into identification of new potential targets for therapeutic applications may be helpful. Whole-exome sequencing (WES) is a widely used NGS method that involves sequencing the protein-coding regions of the genome. CASE REPORT We report a case of a 65-year-old female smoker who was found to have two 6 mm lesions in her left nasal vestibule. Biopsies demonstrated synchronous BCC and SCC. The patient underwent surgical excision of both cancers with safe margins followed by plastic reconstruction. WES was performed on both cancers and 16 alterations including BRCA2 (p.P389S), FAM5C (S420L), KMT2A (P855L), and SMO (L412F), as unique for BCC, and 4 alterations including TP53 (p.H179Q) and CDKN2A (p.P114L), as unique for SCC, were identified. CONCLUSION We report the first documented case with unique genetic alterations in two distinct and synchronous skin BCC and SCC arising from the same nasal vestibule of a patient. This adds to the growing field of data regarding genetic variants in characterizing malignancies and potentially for targeted therapies.
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Affiliation(s)
- Ida Ghlichloo
- California Northstate University College of Medicine, Elk Grove, CA, U.S.A
| | - Zhongbo Jin
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Ruohao Fan
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Caili Tong
- Department of Biochemistry and Molecular Medicine, University of California Davis Health and School of Medicine, Sacramento, CA, U.S.A.,Department of Obstetrics and Gynecology, University of California Davis Health and School of Medicine, Sacramento, CA, U.S.A
| | - Petr Starostik
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Jeremy R Chien
- Department of Biochemistry and Molecular Medicine, University of California Davis Health and School of Medicine, Sacramento, CA, U.S.A.; .,Department of Obstetrics and Gynecology, University of California Davis Health and School of Medicine, Sacramento, CA, U.S.A
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A.; .,Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
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Yang H, Tan S, Qiao J, Xu Y, Gui Z, Meng Y, Dong B, Peng G, Ibhagui OY, Qian W, Lu J, Li Z, Wang G, Lai J, Yang L, Grossniklaus HE, Yang JJ. Non-invasive detection and complementary diagnosis of liver metastases via chemokine receptor 4 imaging. Cancer Gene Ther 2022; 29:1827-1839. [PMID: 35145271 PMCID: PMC9363530 DOI: 10.1038/s41417-022-00433-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/12/2021] [Accepted: 01/26/2022] [Indexed: 02/08/2023]
Abstract
Noninvasive detection of early-stage liver metastases from different primary cancers is a pressing unmet medical need. The lack of both molecular biomarkers and the sensitive imaging methodology makes the detection challenging. In this study, we observed the elevated expression of chemokine receptor 4 (CXCR4) in uveal melanoma (UM) patient liver tissues, and high CXCR4 expression in liver metastases of UM murine models, regardless of the expression levels in the primary tumors. Based on these findings, we identified CXCR4 as an imaging biomarker and exploited a CXCR4-targeted MRI contrast agent ProCA32.CXCR4 for molecular MRI imaging. ProCA32.CXCR4 has strong CXCR4 binding affinity, high metal selectivity, and r1 and r2 relaxivities, which enables the sensitive detection of liver micrometastases. The MRI imaging capacity for detecting liver metastases was demonstrated in three UM models and one ovarian cancer model. The imaging results were validated by histological and immunohistochemical analysis. ProCA32.CXCR4 has strong potential clinical application for non-invasive diagnosis of liver metastases.
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Affiliation(s)
- Hua Yang
- grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory University, Atlanta, GA 30322 USA
| | - Shanshan Tan
- grid.256304.60000 0004 1936 7400Department of Chemistry, Georgia State University, Atlanta, GA 30303 USA
| | - Jingjuan Qiao
- grid.256304.60000 0004 1936 7400Department of Chemistry, Georgia State University, Atlanta, GA 30303 USA
| | - Yiting Xu
- grid.256304.60000 0004 1936 7400Department of Chemistry, Georgia State University, Atlanta, GA 30303 USA
| | - Zongxiang Gui
- grid.256304.60000 0004 1936 7400Department of Chemistry, Georgia State University, Atlanta, GA 30303 USA
| | - Yuguang Meng
- grid.189967.80000 0001 0941 6502Yerkes National Primate Research Center, Atlanta, GA 30329 USA
| | - Bin Dong
- grid.256304.60000 0004 1936 7400Department of Chemistry, Georgia State University, Atlanta, GA 30303 USA
| | - Guangda Peng
- grid.256304.60000 0004 1936 7400Department of Biology, Georgia State University, Atlanta, GA 30303 USA
| | - Oluwatosin Y. Ibhagui
- grid.256304.60000 0004 1936 7400Department of Chemistry, Georgia State University, Atlanta, GA 30303 USA
| | - Weiping Qian
- grid.189967.80000 0001 0941 6502Department of Surgery, Emory University, Atlanta, GA 30322 USA
| | - Jimmy Lu
- grid.504342.4Codex BioSolutions Inc, Gaithersburg, MD USA
| | - Zezhong Li
- grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory University, Atlanta, GA 30322 USA
| | - Guimin Wang
- grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory University, Atlanta, GA 30322 USA ,Affiliated Eye Hospital of Shandong Traditional Chinese Medicine University, Jinan, China
| | - Jinping Lai
- grid.414896.6Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA 95825 USA
| | - Lily Yang
- grid.189967.80000 0001 0941 6502Department of Surgery, Emory University, Atlanta, GA 30322 USA
| | - Hans E. Grossniklaus
- grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory University, Atlanta, GA 30322 USA
| | - Jenny J. Yang
- grid.256304.60000 0004 1936 7400Department of Chemistry, Georgia State University, Atlanta, GA 30303 USA
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Abstract
CONTEXT.— Nonalcoholic fatty liver disease (NAFLD) encompasses steatosis and steatohepatitis. The cause may be multifactorial, and diagnosis requires correlation with clinical information and laboratory results. OBJECTIVE.— To provide an overview of the status of histology diagnosis of steatosis, steatohepatitis, and associated conditions. DATA SOURCES.— A literature search was performed using the PubMed search engine. The terms ''steatosis,'' ''steatohepatitis,'' ''nonalcoholic fatty liver disease (NAFLD),'' ''nonalcoholic steatohepatitis (NASH),'' "alcoholic steatohepatitis (ASH)," ''type 2 diabetes (T2DM),'' "cryptogenic cirrhosis," "drug-induced liver injury (DILI)," "immune checkpoint inhibitor therapy," and "COVID-19 and liver" were used. CONCLUSIONS.— Nonalcoholic fatty liver disease has become the most common chronic liver disease in the United States. NASH is the progressive form of nonalcoholic fatty liver disease. The hallmarks of steatohepatitis are steatosis, ballooned hepatocytes, and lobular inflammation. NASH and alcoholic steatohepatitis share similar histologic features, but some subtle differences may help their distinction. NASH is commonly seen in patients with metabolic dysfunction but can also be caused by other etiologies. Examples are medications including newly developed immune checkpoint inhibitors and viral infections such as coronavirus disease 2019 (COVID-19). NASH is also a common cause of cryptogenic cirrhosis but can be reversed. The results from recent clinical trials for NASH treatment are promising in reducing the severity of steatosis, ballooning, and fibrosis.
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Affiliation(s)
- Jinping Lai
- From the Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, California (Lai)
| | - Hanlin L Wang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (HL Wang)
| | - Xuchen Zhang
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Zhang)
| | - Huamin Wang
- Departments of Anatomic Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston (H Wang)
| | - Xiuli Liu
- The Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville (Liu)
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Nakamura I, Asumda FZ, Moser CD, Kang YNN, Lai JP, Roberts LR. Sulfatase-2 Regulates Liver Fibrosis through the TGF-β Signaling Pathway. Cancers (Basel) 2021; 13:5279. [PMID: 34771445 DOI: 10.3390/cancers13215279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 02/05/2023] Open
Abstract
Transforming growth factor-β (TGF-β) activates hepatic stellate cells (HSCs), which drive liver fibrosis via the production and deposition of extracellular matrix (ECM). We aimed to elucidate the mechanistic role of sulfatase-2 (SULF2) in liver fibrosis. To this end, we induced liver fibrosis in wild-type (WT) and SULF2 knockout (Sulf2-KO) mice (6-8 weeks-old) via bile duct ligation (BDL), intraperitoneal injection of carbon tetrachloride (CCl4) or thioacetamide (TAA). The levels of fibrosis in the liver sections were assessed via Sirius red and Masson's trichrome staining, immunohistochemistry and immunoblotting for α-smooth muscle actin (α-SMA) and hydroxyproline. To evaluate the interaction between TGF-β and SULF2, we transfected human HSCs with scrambled control shRNA and shRNA constructs targeting SULF2 and measured α-SMA expression following treatment with TGF-β1 ligand. We show here that knockout of SULF2 significantly decreases collagen content, as well as bands of bridging fibrosis, as demonstrated by Sirius red, Masson's trichrome and α-SMA staining after BDL, CCl4 and TAA injection in Sulf2-KO versus WT mice. In all three models of liver fibrosis, we observed significantly lower levels of hydroxyproline in the Sulf2-KO mice compared to the WT mice. HSCs with reduced levels of SULF2 failed to significantly express α-SMA and collagen type I following treatment with TGF-β1. Furthermore, SULF2 co-localizes with TGFBR3 and the in vitro knockdown of SULF2 in HSCs decreases the release of TGF-β1 from TGFBR3. Together, these data suggest that SULF2 regulates liver fibrosis via the TGF-β signaling pathway. Pharmacologic inhibition of SULF2 may represent a novel therapeutic approach to improve liver fibrosis.
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Lai J, Tong C, Chien JR. Ovarian Serous Carcinoma With a Novel HSP90AB1 Mutation in a Patient With Synchronous Primary Fallopian Tube Serous Carcinoma. Anticancer Res 2021; 41:4417-4422. [PMID: 34475063 DOI: 10.21873/anticanres.15248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM Ovarian carcinoma is the fifth leading cause of cancer-related deaths in women in the United States. Serous papillary carcinoma is the most common histological type of ovarian carcinoma that often goes undetected until it has spread within the pelvis and abdomen leading to poor prognosis. Translation of next-generation sequencing (NGS) technology into personalized medicine and identification of new potential targets for therapeutic applications may be helpful. CASE REPORT We report a case of a 59-year-old female who initially presented in the emergency department with increasing abdominal girth, and bloating. Computed tomography showed ascites and omental and pelvic masses. Fine needle biopsy of the omental mass showed high-grade papillary adenocarcinoma consistent with high-grade ovarian serous carcinoma. She was treated with chemotherapy followed by debulking surgery. Primary ovarian serous carcinoma and synchronous primary fallopian tube serous carcinoma with multiple leiomyomas were identified in the surgical specimen. Pleural biopsy was also positive for carcinoma. NGS and programmed death-ligand 1 (PD-L1) expression testing were performed in the ovarian serous carcinoma. The results showed mutations of breast cancer type 1 (BRCA1) and type 2 (BRCA2), tumor protein p53 (TP53) (c.524G>A at pR175H), and heat shock protein 90 alpha family class B member 1 (HSP90AB1) (p.R456C), as well as low RNA expression score of PD-L1. CONCLUSION Identification of these mutations and PD-L1 abnormality at the diagnosis of ovarian carcinoma may shed light for clinicians to provide targeted therapy with poly (ADP-ribose) polymerase (PARP) inhibitors and immune checkpoint inhibitors for ovarian serous carcinoma. This is the first documented case of ovarian serous carcinoma to have found a HSP90AB1 (p.R456C) mutation.
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Affiliation(s)
- Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.;
| | - Caili Tong
- Department of Biochemistry and Molecular Medicine, University of California Davis Health and School of Medicine, Sacramento, CA, U.S.A.,Department of Obstetrics and Gynecology, University of California Davis Health and School of Medicine, Sacramento, CA, U.S.A
| | - Jeremy R Chien
- Department of Biochemistry and Molecular Medicine, University of California Davis Health and School of Medicine, Sacramento, CA, U.S.A.,Department of Obstetrics and Gynecology, University of California Davis Health and School of Medicine, Sacramento, CA, U.S.A
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Abstract
Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum and characterized by a complex and variable clinical presentation. Cases of unexpected oral syphilis presenting as non-healing ulcers are uncommonly reported. We report 3 cases (one female and two males, aged 35, 35, and 56 years, respectively) in which patients presented with non-healing oral ulcers. Biopsies revealed surface ulceration and a significant neutrophilic infiltrate rather than the more conventional plasma cell infiltrate seen with most reported syphilis infections, potentially leading to an inaccurate diagnosis. Treponema pallidum immunohistochemistry highlighted spirochetes within the epithelium, with additional diagnostic confirmation by serum T. pallidum particle agglutination assay. Sexual history documentation by the clinician with nonspecific oral ulcers is paramount to aiding diagnosis and leading to proper management. Further, it is important to perform immunohistochemistry for T. pallidum in oral biopsies from non-healing ulcers, especially when clinical history raises the differential diagnosis or when other clinical manifestations may support this consideration.
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Affiliation(s)
- Frank Deng
- Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Lester D. R. Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, CA USA
| | - Jinping Lai
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave, 95825 Sacramento, CA USA
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Cao C, Poti SM, Ledgerwood LG, Lai J. Mixed HPV-related Neuroendocrine Carcinoma and HPV-related Squamous Cell Carcinoma of the Base of Tongue in a Patient With Incidental Identification of Synchronous Metastatic Papillary Thyroid Carcinoma. Anticancer Res 2021; 41:3639-3642. [PMID: 34230161 DOI: 10.21873/anticanres.15153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/04/2021] [Accepted: 06/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND While it is not uncommon in patients with head and neck cancer to present with multiple metachronous primary neoplasms, rarely do these present as a singular mass composed of intertwined, histologically distinct malignant tumors. Sometimes referred to as collision tumors, these entities are poorly understood and only appear in a handful of case studies in the literature. CASE REPORT Here we present a 58-year-old male diagnosed with a human papillomavirus-related collision tumor consisting of oropharyngeal squamous cell carcinoma and small-cell neuroendocrine carcinoma, as well as an incidentally discovered metastatic thyroid papillary carcinoma, despite an unremarkable thyroid gland. The patient underwent transoral robotic base-of-tongue resection and partial pharyngectomy with selective neck dissection followed by chemoradiotherapy. At the 18-month follow-up the patient was doing well. His thyroid was normal and no recurrent or metastatic carcinoma was identified on the computed tomography and positron-emission tomography/computed tomography imaging findings. CONCLUSION To the best of our knowledge, this is the first such case in English literature. This case demonstrates the importance of tumor morphology and immunohistochemical testing in HPV-related oropharyngeal carcinomas, despite the overall good prognosis of such tumors, due to the possibility of synchronous or colliding primary neoplasms.
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Affiliation(s)
- Can Cao
- The Warren Alpert Medical School, Brown University, Providence, RI, U.S.A
| | - Shannon M Poti
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Levi G Ledgerwood
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.
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Rengifo DA, Varadarajan VV, Lai J, Justice JM. Transformation from Sinonasal Seromucinous Hamartoma to Adenocarcinoma: A Case Report. ORL J Otorhinolaryngol Relat Spec 2021; 83:478-480. [PMID: 34237726 DOI: 10.1159/000514641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/21/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Sinonasal hamartomas are benign neoplasms composed of disorganized mature tissue elements. Epithelial variants include respiratory epithelial adenomatoid hamartoma (REAH) and seromucinous hamartoma (SMH). Malignant transformation of REAH is rarely reported; however, the malignant transformation of SMH to adenocarcinoma has not been described. We report the first case of a transformation from SMH to adenocarcinoma. METHODS The medical records of a patient presenting with sinonasal SMH with malignant transformation to adenocarcinoma were reviewed. The NCBI database was queried for the literature regarding SMH and malignant transformation of sinonasal hamartomas. RESULTS A 39-year-old man presented with a left nasal mass, nasal obstruction, and epistaxis. Computed tomography and magnetic resonance imaging demonstrated a nonaggressive and heterogeneous left nasal mass with involvement of the middle turbinate and posterior ethmoid sinuses. He underwent endoscopic sinus surgery with complete excision of the mass. Pathology revealed SMH with focal areas of transition to low-grade adenocarcinoma characterized by stromal invasion but no bony, perineural, or lymphovascular invasion. Adjuvant treatment was not recommended. Literature review revealed no reported cases of malignant transformation of SMH. CONCLUSION We report the first case of malignant transformation of SMH. Patients with SMH must be counseled that there is an extremely rare and potentially unrecognized risk of malignancy that may influence treatment and postoperative monitoring.
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Affiliation(s)
- David A Rengifo
- Department of Otolaryngology & Head and Neck Surgery, University of Florida-Shands, Gainesville, Florida, USA
| | - Varun V Varadarajan
- Department of Otolaryngology & Head and Neck Surgery, University of Florida-Shands, Gainesville, Florida, USA.,Department of Otolaryngology & Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Jinping Lai
- Department of Pathology, University of Florida-Shands, Gainesville, Florida, USA.,Department of Pathology, Kaiser Permanente Sacramento Medical Center, Sacramento, California, USA
| | - Jeb M Justice
- Department of Otolaryngology & Head and Neck Surgery, University of Florida-Shands, Gainesville, Florida, USA
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Lai J, Garvey KY, Li P, Azevedo RA. Primary Ovarian Melanoma Arising From a Mature Teratoma With Melanoma In Situ Present in the Ciliated Columnar and Squamous Epithelium in a Patient With Synchronous Skin Basal Cell Carcinoma. Int J Gynecol Pathol 2021; 40:383-390. [PMID: 33560745 DOI: 10.1097/pgp.0000000000000727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Primary ovarian melanoma arising from ovarian teratomas are rarely reported and difficult to accurately diagnose. Cases in the literature rely on a diagnosis of exclusion, and cases of primary ovarian melanoma with pathologic evidence of melanoma in situ are exceedingly rare. We report a case of a 66-yr-old female who presented to emergency department with abdominal pain and bloating. Computed tomography scan showed a 21 cm complex pelvic mass. An urgent laparoscopic bilateral salpingo-oophorectomy was performed. Pathologically the mass was identified as a mature teratoma. Within the cystic teratoma, there was an area showing a sheet arrangement of atypical cells. Those atypical cells were positive for Melan A, Sox10, HMB45, and c-KIT, and negative for PD-L1. Melanoma in situ was present in both the squamous and ciliated columnar epithelium. The melanoma was negative for PD-L1, and no BRAF (codon 600, exons 11, 14, and 15) or c-KIT (exons 2, 9, 10, 11, 13, 14, 15, 17, 18) mutations were identified, thus supporting the so-called triple negative malignant melanoma. A thorough dermatologic exam was conducted and only a 3 mm skin basal cell carcinoma was confirmed on biopsy. At 11 mo of follow-up, the patient is disease free and doing well and no metastatic melanoma has been identified. To the best of our knowledge, this is the first documented case of a primary ovarian melanoma arising in a mature teratoma with evidence of melanoma in situ present in both ciliated columnar and squamous epithelium in a patient with synchronous skin basal cell carcinoma. Our case is positive for c-KIT protein (CD117) by immunohistochemistry, but negative for KIT mutation. More case reports are needed to further characterize the disease.
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Dayton KA, Bril F, Barb D, Lai J, Kalavalapalli S, Cusi K. Severity of non-alcoholic steatohepatitis is not linked to testosterone concentration in patients with type 2 diabetes. PLoS One 2021; 16:e0251449. [PMID: 34077443 PMCID: PMC8172043 DOI: 10.1371/journal.pone.0251449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background Hypogonadism is reported to occur in non-alcoholic fatty liver disease (NAFLD), but earlier studies used low-sensitivity diagnostic techniques (CT, ultrasound), for NAFLD diagnosis. We hypothesized that if hypogonadism was due to NAFLD, and not solely attributable to underlying obesity/diabetes, it would be more severe in the presence of steatohepatitis (NASH). To examine the influence of liver disease on testosterone in males with type 2 diabetes mellitus (T2DM), we used gold-standard liver imaging with MR-spectroscopy (1H-MRS), and performed liver biopsies to grade/stage the NAFLD. Methods In this cross-sectional study, we measured in 175 males with T2DM total and free testosterone, markers of insulin resistance, and intrahepatic triglyceride content (IHTG) by 1H-MRS. Those with NAFLD on imaging underwent a liver biopsy. Results Total testosterone was higher in the group without NAFLD (“No-NAFLD”; n = 48) compared to isolated steatosis (IS; n = 62) or NASH (n = 65) (385 ± 116 vs. 339 ± 143 vs. 335 ± 127 ng/ml, ptrend 0.03). Testosterone was also lower in obese vs. non-obese subjects in both the No-NAFLD and IS groups (p = 0.06 and p = 0.11, respectively), but not in obese vs. non-obese patients with NASH (p = 0.81). IHTG was independently associated with total testosterone (ß = -4.8, p = 0.004). None of the liver histology characteristics were associated with lower testosterone. Conclusions NAFLD is linked to lower total testosterone in patients with T2DM, but likely given a common soil of insulin resistance/obesity and not from the severity of liver necroinflammation or fibrosis. Nevertheless, clinicians should consider screening patients with T2DM and NAFLD for hypogonadism.
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Affiliation(s)
- Kristin Alexandra Dayton
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Florida, Gainesville, Florida, United States of America
| | - Fernando Bril
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, United States of America
- Malcom Randall Veterans Administration Medical Center, Gainesville, Florida, United States of America
| | - Diana Barb
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, United States of America
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Srilaxmi Kalavalapalli
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, United States of America
| | - Kenneth Cusi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, United States of America
- Malcom Randall Veterans Administration Medical Center, Gainesville, Florida, United States of America
- * E-mail:
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13
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Abstract
NY-ESO-1 (CTAG 1B) is highly expressed in the majority of synovial sarcomas and myxoid/round cell liposarcomas as well as in a subset of melanomas, but only rarely in other mesenchymal tumors. This points to a potential for using NY-ESO-1 in the differential diagnosis of these lesions. Furthermore, promising results have been obtained in clinical trials testing NY-ESO-1-targeted immunotherapy in subsets of melanoma and synovial sarcoma patients.
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Affiliation(s)
- Jin-Ping Lai
- Laboratory of Pathology; National Cancer Institute; NIH; Bethesda, MD USA
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14
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Liu B, Shiraga S, Mortenson MM, Lai J. Small Cell Lung Carcinoma and Synchronous Rectal Adenocarcinoma and Jejunal Gastrointestinal Stromal Tumor Present in a Patient With History of Laryngeal Squamous Cell Carcinoma. Anticancer Res 2020; 40:7053-7056. [PMID: 33288602 DOI: 10.21873/anticanres.14732] [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: 10/27/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The synchronous diagnosis of two or more primary malignancies in a patient is overall rare. CASE REPORT We report such a case of a 67-year-old male smoker with a history of laryngeal squamous cell carcinoma. He was incidentally identified through follow up computed tomography to have three masses in the lung, rectum and jejunum, respectively. Biopsies were performed and demonstrated synchronous lung small cell carcinoma (pT1bN0) and rectal adenocarcinoma. The patient underwent fractionated stereotactic radiation (FSRT) to the pulmonary tumor and chemotherapy with cisplatin and etoposide followed by laparoscopic rectum low anterior resection and small bowel segmental resection. Final pathology diagnoses confirmed synchronous microsatellite stable (MMS) moderately differentiated adenocarcinoma of the rectum (pT3N1b) and jejunal gastrointestinal stromal tumor (GIST), spindle cell type (pT2N0). At 8 months follow up postsurgery, the patient was doing well and no tumor recurrences were identified. CONCLUSION To the best of our knowledge, this is the first documented case of synchronous primary small cell lung carcinoma, rectal adenocarcinoma, and GIST in the English literature. The rarity, diagnosis and treatment challenges of these entities are discussed.
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Affiliation(s)
- Bowei Liu
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.,School of Medicine St. George's University, Grenada, West Indies, U.S.A
| | - Sharon Shiraga
- Division of Surgical Oncology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Melinda M Mortenson
- Division of Surgical Oncology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.
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15
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Abstract
BACKGROUND Anaplastic thyroid carcinoma (ATC), a highly aggressive malignancy, has no effective treatment to date. Trophoblast cell-surface antigen 2 (TROP-2), a transmembrane glycoprotein, has been suggested to be a promising novel target for sacituzumab govitecan, an antibody-drug conjugate. 5-Hydroxymethylcytosine (5hmC) has a role in tumor suppression and promoting modification. Additionally, isocitrate dehydrogenase 1 (IDH1) mutations are strongly associated with increased overall survival in gliomas and worse prognosis in leukemias. This study attempts to evaluate the immunoexpression of TROP-2, 5hmC, and IDH1 in ATCs and to determine their potential impact in targeted therapy. METHODS Twenty-four ATCs were retrieved, with 9 cases that occurred de novo and 15 cases derived from either papillary thyroid carcinoma (PTC) or follicular thyroid carcinoma (FTC). Sections were immunostained with TROP-2, 5hmC, and IDH1 antibodies, and evaluated using the QuPath program. The t tests were performed using SPSS software. RESULTS TROP-2 was detected in 12 ATCs with 9 cases demonstrating a high expression and in all PTC components, and absent in all FTC components of secondary ATCs. 5hmC expression was moderately reduced in PTC and FTC components and markedly reduced in ATC. The entire cohort showed a total absence of IDH1. CONCLUSIONS Increased TROP-2 immunoexpression in some ATCs supports that these patients may potentially benefit from an antibody-drug conjugate therapy targeting TROP-2. Markedly reduced 5hmC expression suggests that 5hmC may be used as potential therapeutic targets for ATC. The total lack of IDH1 R132H mutation by immunostain indicates that it has no prognostic and therapeutic value in ATC.
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Affiliation(s)
- Jae Yeon Seok
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.,Department of Pathology & Laboratory Medicine, 548288Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kristine Astvatsaturyan
- Department of Pathology & Laboratory Medicine, 548288Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Jinping Lai
- 23542Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Xuemo Fan
- Department of Pathology & Laboratory Medicine, 548288Cedars-Sinai Medical Center, Los Angeles, CA, USA
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16
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Qian X, Zhang W, Shams A, Mohammed K, Befeler AS, Kang N, Lai J. Yes-associated protein-1 may serve as a diagnostic marker and therapeutic target for residual/recurrent hepatocellular carcinoma post-transarterial chemoembolization ☆. Liver Res 2020; 4:212-217. [PMID: 33520338 PMCID: PMC7842263 DOI: 10.1016/j.livres.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM The transcriptional co-activator Yes-associated protein-1 (YAP1) has been implicated as an oncogene and is overexpressed in different kinds of human cancers, especially hepatocellular carcinoma (HCC). However, the role of YAP1 has not been reported in residual/recurrent HCC after transarterial chemoembolization (TACE). Our aim is to determine whether YAP1 is overexpressed in the residual/recurrent HCC after TACE. METHODS A total of 105 tumor tissues from 71 patients including 30 cases of primary HCC without prior treatment, 35 cases of residual/recurrent HCC post TACE, and 6 cases of hepatoblastoma were included in the immunohistochemical study. YAP1 immunoreactivity was blindly scored as 0, 1+, 2+ or 3+ in density and percentages of positive cells. RESULTS About 33.3% (10/30) of primary HCC without prior treatment showed 2+ of YAP1 immunoreactivity. While 82.8% (29/35) of residual/recurrent HCCs after TACE treatment displayed 2-3+ of YAP1 immunoreactivity, which was significantly higher compared to primary HCC without prior treatment (P = 0.0002). YAP1 immunoreactivity was moderately to strongly positive (2-3+) in 100% of the hepatoblastoma, particularly in the embryonal components (3+ in 100% cases). CONCLUSIONS YAP1 is significantly upregulated in the residual/recurrent HCCs post TACE treatment, suggesting that YAP1 may serve as a sensitive diagnostic marker and a treatment target for residual/recurrent HCC post TACE.
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Affiliation(s)
- Xia Qian
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Wei Zhang
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, FL, USA,Corresponding author. Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, FL, USA. (W. Zhang)
| | - Alireza Shams
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Kahee Mohammed
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Alex S. Befeler
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Ningling Kang
- The Hormel Institute, University of Minnesota and Mayo Clinic, Austin, MN, USA
| | - Jinping Lai
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, USA,Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA,Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA,Corresponding author. Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA. (J. Lai)
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17
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Yin F, Saad M, Lin J, Jackson CR, Ren B, Lawson C, Karamchandani DM, Bernabeu BQ, Jiang W, Dhir T, Zheng R, Schultz CW, Zhang D, Thomas CL, Zhang X, Lai J, Schild M, Zhang X, Xie H, Liu X. Splenic-vasculature involvement is associated with poor prognosis in resected distal pancreatic cancer. Gastroenterol Rep (Oxf) 2020; 9:139-145. [PMID: 34026221 PMCID: PMC8128010 DOI: 10.1093/gastro/goaa084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/09/2020] [Accepted: 03/13/2020] [Indexed: 02/05/2023] Open
Abstract
Background Distal pancreatic carcinoma is one of the most lethal cancers largely due to its high incidence of distant metastasis. This study aims to assess the prognostic value of splenic-vasculature involvement in resected distal pancreatic carcinoma. Methods In this retrospective study, we collected the clinicopathologic information of 454 patients with pancreatic cancer and performed univariate and multivariate analyses to identify factors associated with progression-free survival (PFS) and overall survival (OS), with an emphasis on the prognostic value of splenic-artery and -vein involvement. Results Univariate analysis revealed that larger tumor size, non-intraductal papillary mucinous neoplasm (non-IPMN)-associated adenocarcinoma, poor differentiation, stage pT3, nodal metastasis, lymphovascular invasion, perineural invasion, and pathologic and radiographic evidence of splenic-vein invasion were significantly associated with shorter PFS and OS (all P < 0.05). Multivariate analysis confirmed non-IPMN-associated adenocarcinoma, stage pT3, stage pN1–2, and post-operative adjuvant chemotherapy as independent risk factors for both PFS and OS, and larger tumor size and radiographic evidence of splenic-artery invasion as predictors of PFS only. Conclusion Guidelines should be developed for a uniform approach with regard to the examination and reporting of the status of the splenic vasculature when dealing with distal-pancreatic-cancer specimens.
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Affiliation(s)
- Feng Yin
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA
| | - Mohammed Saad
- Department of Pathology, Indiana University, Indianapolis, IN, USA
| | - Jingmei Lin
- Department of Pathology, Indiana University, Indianapolis, IN, USA
| | | | - Bing Ren
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Cynthia Lawson
- Department of Pathology, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Dipti M Karamchandani
- Department of Pathology, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Wei Jiang
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Teena Dhir
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Richard Zheng
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher W Schultz
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Xuchen Zhang
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Michael Schild
- Department of Pathology, Duke University, Durham, NC, USA
| | - Xuefeng Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Hao Xie
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Xiuli Liu
- Department of Pathology, Immunology and Lab Medicine, University of Florida, Gainesville, FL, USA
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Chen L, Himmelfarb EA, Sun M, Choi EK, Fan L, Lai J, Kim CJ, Xu H, Wang HL. Immunostaining Patterns of Posttransplant Liver Biopsies Using 2 Anti-C4d Antibodies. Appl Immunohistochem Mol Morphol 2020; 28:146-53. [PMID: 32044883 DOI: 10.1097/PAI.0000000000000723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Histopathologic diagnosis of antibody-mediated rejection in posttransplant liver biopsies is challenging. The recently proposed diagnostic criteria by the Banff Working Group on Liver Allograft Pathology require positive C4d immunohistochemical staining to establish the diagnosis. However, the reported C4d staining patterns vary widely in different studies. One potential explanation may be due to different antibody preparations used by different investigators. In this study, posttransplant liver biopsies from 69 patients histopathologically diagnosed with acute cellular rejection, chronic rejection, or recurrent hepatitis C were immunohistochemically stained using 2 polyclonal anti-C4d antibodies. On the basis of the distribution of C4d immunoreactivity, 5 different staining patterns were observed: portal vein and capillary, hepatic artery, portal stroma, central vein, and sinusoids. The frequency, extent, and intensity of positive C4d staining with the 2 antibody preparations differed significantly for portal veins/capillaries and central veins, but not for hepatic arteries and portal stroma. Positive sinusoidal staining was seen in only 1 case. There were no significant differences in the frequency, extent, and intensity of positive C4d staining among the acute cellular rejection, chronic rejection, and recurrent hepatitis C groups with the 2 anti-C4d antibodies. These data show that different anti-C4d antibodies can show different staining patterns, which may lead to different interpretation. Caution is thus needed when selecting C4d antibodies for clinical use to aid in the diagnosis of antibody-mediated rejection.
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19
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Xanthakos SA, Lavine JE, Yates KP, Schwimmer JB, Molleston JP, Rosenthal P, Murray KF, Vos MB, Jain AK, Scheimann AO, Miloh T, Fishbein M, Behling CA, Brunt EM, Sanyal AJ, Tonascia J. Progression of Fatty Liver Disease in Children Receiving Standard of Care Lifestyle Advice. Gastroenterology 2020; 159:1731-1751.e10. [PMID: 32712103 PMCID: PMC7680281 DOI: 10.1053/j.gastro.2020.07.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/19/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Nonalcoholic fatty liver disease (NAFLD) is the most common pediatric chronic liver disease. Little is known about outcomes in recognized youth. METHODS We compared paired liver biopsies from 122 of 139 children with NAFLD (74% male; 64% white; 71% Hispanic; mean age, 13 ± 3 years; age range, 8-17 years) who received placebo and standard of care lifestyle advice in 2 double-blind, randomized clinical trials within the nonalcoholic steatohepatitis (NASH) clinical research network from 2005 through 2015. We analyzed histologic changes with respect to baseline and longitudinal change in clinical variables using regression analysis. RESULTS At enrollment, 31% of the children had definite NASH, 34% had borderline zone 1 NASH, 13% had borderline zone 3 NASH, and 21% had fatty liver but not NASH. Over a mean period of 1.6 ± 0.4 years, borderline or definite NASH resolved in 29% of the children, whereas 18% of the children with fatty liver or borderline NASH developed definite NASH. Fibrosis improved in 34% of the children but worsened in 23%. Any progression to definite NASH and/or in fibrosis was associated with adolescent age, and higher waist circumference, levels of alanine or aspartate aminotransferase, total and low-density lipoprotein cholesterol at baseline (<0.05), and over follow-up time, with increasing level of alanine aminotransferase, hemoglobin A1C (P<.05), gamma-glutamyl transferase and development of type 2 diabetes (P<.01). Increasing level of gamma-glutamyl transferase was also associated with reduced odds of any improvement (P = .003). CONCLUSIONS One-third of children with NAFLD enrolled in placebo groups of clinical trials had histologic features of progression within 2 years, in association with increasing obesity and serum levels of aminotransferases and loss of glucose homeostasis.
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Affiliation(s)
- Stavra A. Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joel E. Lavine
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California
| | - Jean P. Molleston
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, Indiana
| | - Philip Rosenthal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, Benioff Children’s Hospital, San Francisco, California
| | - Karen F. Murray
- Pediatrics Institute, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Miriam B. Vos
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Ajay K. Jain
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, St. Louis University, St. Louis, Missouri
| | | | - Tamir Miloh
- Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Mark Fishbein
- Department of Pediatrics, Feinberg Medical School of Northwestern University, Chicago, Illinois
| | - Cynthia A. Behling
- Department of Pathology, Sharp Memorial Hospital; Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, California
| | - Elizabeth M. Brunt
- Department of Pathology and Immunology, Washington University, St. Louis, Missouri
| | - Arun J. Sanyal
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - James Tonascia
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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20
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Yin F, Xie H, Lai J, Chen Y, Dong J, Zhang X, Liu X. Double Negativity for Expression of YAP1 and CDX2 Defines an Aggressive Type of Colitis-associated Cancer. Anticancer Res 2020; 40:5411-5416. [PMID: 32988861 DOI: 10.21873/anticanres.14550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease have markedly increased risk for developing colitis-associated colorectal adenocarcinoma (CAC). There is no established prognostic biomarker for CAC. MATERIALS AND METHODS A retrospective study was performed on a cohort of 57 CACs. Expression of caudal type homeobox transcription factor 2 (CDX2) and YES-associated protein 1 (YAP1) expression was correlated with clinicodemographic and histopathological features. RESULTS Neither YAP1 nor CDX2 expression alone was significantly associated with tumor invasion beyond the muscularis propria or lymph node status. However, a subgroup of CAC with double negativity for expression of YAP1 and CDX2 was more frequently found in younger patients, and more frequently associated with higher pathological tumor stage and nodal metastasis. Furthermore, a positive correlation between CDX2 and YAP1 expression was identified in CAC and sporadic colorectal adenocarcinoma. CONCLUSION Our study demonstrates that double negativity for expression of YAP1 and CDX2 defines a subgroup of CAC with early onset and aggressive clinical features.
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Affiliation(s)
- Feng Yin
- Department of Pathology and Anatomic Sciences, University of Missouri, Columbia, MO, U.S.A.
| | - Hao Xie
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, U.S.A
| | - Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Yuanhong Chen
- Eppley Institute for Research in Cancer and Allied Diseases, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Jixin Dong
- Eppley Institute for Research in Cancer and Allied Diseases, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Xuefeng Zhang
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, U.S.A
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, U.S.A.
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21
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Loomba R, Neuschwander-Tetri BA, Sanyal A, Chalasani N, Diehl AM, Terrault N, Kowdley K, Dasarathy S, Kleiner D, Behling C, Lavine J, Van Natta M, Middleton M, Tonascia J, Sirlin C, Allende D, Dasarathy S, McCullough AJ, Penumatsa R, Dasarathy J, Lavine JE, Abdelmalek MF, Bashir M, Buie S, Diehl AM, Guy C, Kigongo C, Kopping M, Malik D, Piercy D, Chalasani N, Cummings OW, Gawrieh S, Ragozzino L, Sandrasegaran K, Vuppalanchi R, Brunt EM, Cattoor T, Carpenter D, Freebersyser J, King D, Lai J, Neuschwander‐Tetri BA, Siegner J, Stewart S, Torretta S, Wriston K, Gonzalez MC, Davila J, Jhaveri M, Kowdley KV, Mukhtar N, Ness E, Poitevin M, Quist B, Soo S, Ang B, Behling C, Bhatt A, Loomba R, Middleton MS, Sirlin C, Akhter MF, Bass NM, Brandman D, Gill R, Hameed B, Maher J, Terrault N, Ungermann A, Yeh M, Boyett S, Contos MJ, Kirwin S, Luketic VA, Puri P, Sanyal AJ, Schlosser J, Siddiqui MS, Yost‐Schomer L, Brunt EM, Fowler K, Kleiner DE, Doo EC, Hall S, Hoofnagle JH, Robuck PR, Sherker AH, Torrance R, Belt P, Clark JM, Dodge J, Donithan M, Isaacson M, Lazo M, Meinert J, Miriel L, Sharkey EP, Smith J, Smith M, Sternberg A, Tonascia J, Van Natta ML, Wagoner A, Wilson LA, Yamada G, Yates K, Covarrubias Y, Gamst A, Hamilton G, Henderson W, Hooker J, Lavine JE, Loomba R, Middleton MS, Schlein A, Schwimmer JB, Shen W, Sirlin C, Wolfson T. Multicenter Validation of Association Between Decline in MRI-PDFF and Histologic Response in NASH. Hepatology 2020; 72:1219-1229. [PMID: 31965579 PMCID: PMC8055244 DOI: 10.1002/hep.31121] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [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: 10/11/2019] [Accepted: 12/23/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Emerging data from a single-center study suggests that a 30% relative reduction in liver fat content as assessed by magnetic resonance imaging-proton density fat fraction (MRI-PDFF) from baseline may be associated with histologic improvement in nonalcoholic steatohepatitis (NASH). There are limited multicenter data comparing an active drug versus placebo on the association between the quantity of liver fat reduction assessed by MRI-PDFF and histologic response in NASH. This study aims to examine the association between 30% relative reduction in MRI-PDFF and histologic response in obeticholic acid (OCA) versus placebo-treated patients in the FLINT (farnesoid X receptor ligand obeticholic acid in NASH trial). APPROACH AND RESULTS This is a secondary analysis of the FLINT trial including 78 patients with MRI-PDFF measured before and after treatment along with paired liver histology assessment. Histologic response was defined as a 2-point improvement in nonalcoholic fatty liver disease activity score without worsening of fibrosis. OCA (25 mg orally once daily) was better than placebo in improving MRI-PDFF by an absolute difference of -3.4% (95% confidence interval [CI], -6.5 to -0.2%, P value = 0.04) and relative difference of -17% (95% CI, -34 to 0%, P value = 0.05). The optimal cutoff point for relative decline in MRI-PDFF for histologic response was 30% (using Youden's index). The rate of histologic response in those who achieved less than 30% decline in MRI-PDFF versus those who achieved a 30% or greater decline in MRI-PDFF (MRI-PDFF responders) relative to baseline was 19% versus 50%, respectively. Compared with MRI-PDFF nonresponders, MRI-PDFF responders demonstrated both a statistically and clinically significant higher odds 4.86 (95% CI, 1.4-12.8, P value < 0.009) of histologic response, including significant improvements in both steatosis and ballooning. CONCLUSION OCA was better than placebo in reducing liver fat. This multicenter trial provides data regarding the association between 30% decline in MRI-PDFF relative to baseline and histologic response in NASH.
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Affiliation(s)
- Rohit Loomba
- University of California San Diego, La Jolla, CA, USA
| | | | - Arun Sanyal
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Norah Terrault
- University of California San Francisco, San Francisco, CA USA
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Peng H, Ning H, Wang Q, Lai J, Wei L, Stumpo DJ, Blackshear PJ, Fu M, Hou R, Hoft DF, Liu J. Tristetraprolin Regulates T H17 Cell Function and Ameliorates DSS-Induced Colitis in Mice. Front Immunol 2020; 11:1952. [PMID: 32922402 PMCID: PMC7457025 DOI: 10.3389/fimmu.2020.01952] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/20/2020] [Indexed: 02/05/2023] Open
Abstract
TH17 cells have been extensively investigated in inflammation, autoimmune diseases, and cancer. The precise molecular mechanisms for TH17 cell regulation, however, remain elusive, especially regulation at the post-transcriptional level. Tristetraprolin (TTP) is an RNA-binding protein important for degradation of the mRNAs encoding several proinflammatory cytokines. With newly generated T cell-specific TTP conditional knockout mice (CD4CreTTPf/f), we found that aging CD4CreTTPf/f mice displayed an increase of IL-17A in serum and spontaneously developed chronic skin inflammation along with increased effector TH17 cells in the affected skin. TTP inhibited TH17 cell development and function by promoting IL-17A mRNA degradation. In a DSS-induced colitis model, CD4CreTTPf/f mice displayed severe colitis and had more TH17 cells and serum IL-17A compared with wild-type mice. Furthermore, neutralization of IL-17A reduced the severity of colitis. Our results reveal a new mechanism for regulating TH17 function and TH17-mediated inflammation post-transcriptionally by TTP, suggests that TTP might be a novel therapeutic target for the treatment of TH17-mediated diseases.
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Affiliation(s)
- Hui Peng
- Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Huan Ning
- Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Qinghong Wang
- Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Jinping Lai
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Lin Wei
- Department of Immunology, School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Deborah J Stumpo
- National Institute of Environmental Health Sciences, Research Triangle, NC, United States
| | - Perry J Blackshear
- National Institute of Environmental Health Sciences, Research Triangle, NC, United States
| | - Mingui Fu
- Shock/Trauma Research Center and Department of Basic Medical Science, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Rong Hou
- Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Daniel F Hoft
- Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Jianguo Liu
- Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis University, St. Louis, MO, United States
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Cao C, Kong MX, Kapali M, Moezardalan K, Shi Q, Azarm A, Lai J. EGFR Mutated Lung Adenocarcinoma Metastasis to the Pancreas Mimicking Primary Pancreatic Ductal Carcinoma. Anticancer Res 2020; 40:4401-4404. [PMID: 32727769 DOI: 10.21873/anticanres.14444] [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: 06/13/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The occurrence of lung adenocarcinoma metastasizing to the pancreas is overall rare and can histologically imitate primary pancreatic ductal carcinoma (PDAC). CASE REPORT This is a case report of a 70-year-old female with a history of surgically resected right lung adenocarcinoma presenting for routine follow up without symptoms. CT scans revealed a pancreatic cystic mass with ductal dilatation that was sampled via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and thought to be a primary pancreatic mucinous neoplasm with high grade dysplasia suspicious for carcinoma based on smear cytology. On repeat EUS-FNA and biopsy (FNB) with additional immunohistochemical testing for lung adenocarcinoma markers thyroid transcription factor (TTF1) and Napsin A and molecular testing, the lesion was identified as a metastasis of lung adenocarcinoma with an epidermal growth factor receptor (EGFR L858R) mutation; subsequently, the patient underwent targeted therapy that yielded an almost complete response. CONCLUSION To the best of our knowledge, this is the first documented case in English literature of a lung adenocarcinoma metastasis to the pancreas mimicking a pancreatic primary neoplasm and highlights the potential pitfalls of EUS-FNA for the diagnosis of certain metastases to the pancreas.
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Affiliation(s)
- Can Cao
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.,The Warren Alpert Medical School, Brown University, Providence, RI, U.S.A
| | - Max X Kong
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Malathy Kapali
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Koorosh Moezardalan
- Division of Gastroenterology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Qiuying Shi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, U.S.A
| | - Ali Azarm
- Division of Gastroenterology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.
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Cao C, Parikh P, Moezardalan K, Anantharaman A, Azarm A, Lai J. Synchronous Primary Pancreatic Ductal Carcinoma and Colonic Adenocarcinoma Present in a Patient With History of Skin Squamous Cell Carcinoma. Anticancer Res 2020; 40:4029-4032. [PMID: 32620648 DOI: 10.21873/anticanres.14398] [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: 05/09/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 02/08/2023]
Abstract
The synchronous diagnosis of two or more primary malignancies in a patient is overall rare. This is a case report of a 70-year-old female with a history of skin squamous cell carcinoma presenting with occult hematochezia. Colonoscopy and biopsy results confirmed a microsatellite stable (MMS) adenocarcinoma in the ascending colon, and subsequent computed tomography (CT) scans identified a 3.2 cm right colonic mass and a 5.0 cm mass in the pancreatic body. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) confirmed the presence of pancreatic ductal adenocarcinoma (PDAC). The patient underwent neo-adjuvant FOLFIRINOX (folinic acid, fluorouracil, irinotecan and oxaliplatin) chemotherapy prior to the simultaneous distal pancreatectomy and right hemicolectomy for both pancreatic and colonic tumors. The pathology diagnoses included moderately differentiated pancreatic ductal carcinoma (PDAC) with histiocyte-like features (tumor stage: ypT3N1M0) and moderately differentiated colonic adenocarcinoma, intestinal type (tumor stage: ypT3N0M0). To the best of our knowledge, this is the first documented case of synchronous primary colonic adenocarcinoma and PDAC in the English literature.
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Affiliation(s)
- Can Cao
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.,The Warren Alpert Medical School, Brown University, Providence, RI, U.S.A
| | - Purvi Parikh
- Division of Surgical Oncology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Koorosh Moezardalan
- Division of Gastroenterology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Archana Anantharaman
- Division of Medical Oncology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Ali Azarm
- Division of Gastroenterology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.
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25
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Tang Y, Li P, Cua D, Lai J. Laryngeal Diffuse Large B-Cell Lymphoma Presenting as Laryngeal Stenosis. In Vivo 2020; 34:255-260. [PMID: 31882486 DOI: 10.21873/invivo.11768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/05/2019] [Accepted: 10/10/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laryngeal stenosis is challenging for treatment due to uncertain etiology. Primary laryngeal lymphoma as the initial clinical manifestation of laryngeal stenosis has been rarely reported. Primary diffuse large B-cell lymphoma as an underlying etiology has not been reported. CASE REPORT A 79-year-old male presented with dyspnea, stridor and dysphonia of 6 months' duration. Computed tomography scans and flexible laryngoscopic examination revealed vocal cord mobility with bilaterally limited abduction and a subglottic stenosis up to 50%. The laryngeal mucosa was smooth. Laryngeal biopsy showed atypical lymphoid infiltrates, predominantly large sized B-cells, in the submucosa with crush/cauterized artifacts. The tumor cells were positive for B-lymphocyte antigen CD20, paired-box 5 (PAX5), B-cell lymphoma 2 (BCL2), BCL6 and multiple myeloma oncogene 1 (MUM1). They were negative for CD10, CD30, cyclin D1 (CCND1), SRY-box 11 (SOX11), activin-receptor like kinase 1 (ALK1), CD138 and c-MYC, and negative for kappa/lambda light chain and Epstein-Barr virus-encoded small RNA by in situ hybridization. The pathologic diagnosis was diffuse large B-cell lymphoma. Fluorescent in situ hybridization (FISH) for MYC was negative. Next-generation sequencing using a 175-gene panel was performed and no pathologic mutations were identified. No lymphadenopathy elsewhere was identified. The patient was treated with chemotherapy and was doing well at the 5-month follow-up. CONCLUSION To the best of our knowledge, this is the first documented case of primary laryngeal diffuse large B-cell lymphoma presenting as increasing laryngeal stenosis. The rarity, diagnosis and treatment of this entity are discussed.
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Affiliation(s)
- Yaoyun Tang
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A. .,Department of Otolaryngology-Head and Neck Surgery, Xiangya School of Medicine, Central South University, Changsha, P.R. China
| | - Peng Li
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A.,Department of Pathology, University of Utah, ARUP Laboratories, Inc., Salt Lake City, UT, U.S.A
| | - David Cua
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A. .,Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
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26
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Liu LI, Ahn E, Studeman K, Campbell K, Lai J. Primary Hepatic Carcinosarcoma Composed of Hepatocellular Carcinoma, Cholangiocarcinoma, Osteosarcoma and Rhabdomyosarcoma With Poor Prognosis. Anticancer Res 2020; 40:2225-2229. [PMID: 32234918 DOI: 10.21873/anticanres.14184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Primary hepatic carcinosarcoma is a rare subtype of liver malignancy, with only a small number of cases described in the English literature. CASE REPORT We report the case of a 72-year-old man with a history of hepatitis C, who presented with complaints of abdominal pain. The patient's alpha fetoprotein (AFP) level was highly elevated at 7,406 ng/ml. His albumin, total bilirubin, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase levels were within normal ranges. Computer tomographic scans discovered a 12×9×8 cm mass in the left lobe of the liver, extending to the anterior gastric wall. A partial hepatectomy of segments 2 and 3 with en bloc distal gastrectomy and omentectomy, a Roux-en-Y gastrojejunostomy, and a cholecystectomy were performed. Pathology revealed the mass to be a hepatic carcinosarcoma composed of collision tumor of four malignant components: hepatocellular carcinoma, cholangiocarcinoma, osteosarcoma and rhabdomyosarcoma. One and half month post-surgery, the patient was found to have a mass confirmed by biopsy as hepatocellular carcinoma in the right lobe, nodules in his lung and bone, and his AFP level elevated to 51,027.6 ng/ml. He died after two months during hospice care. CONCLUSION To the best of our knowledge, this is the first documented case of primary hepatic carcinosarcoma with collision tumor of four malignant entities (hepatocellular carcinoma, cholangiocarcinoma, osteosarcoma and rhabdomyosarcoma). The pathogenesis, diagnosis, treatment and prognosis of this disease are discussed.
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Affiliation(s)
- L I Liu
- Department of Pathology, Mercy Medical Center, Baltimore, MD, U.S.A.
| | - Elise Ahn
- University of Maryland, College Park, MD, U.S.A
| | | | - Kurtis Campbell
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, U.S.A
| | - Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.
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27
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Liao X, Liu X, Fan X, Lai J, Zhang D. Perianal Paget's disease: a clinicopathological and immunohistochemical study of 13 cases. Diagn Pathol 2020; 15:29. [PMID: 32209119 PMCID: PMC7093992 DOI: 10.1186/s13000-020-00952-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/21/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Perianal Paget's disease (PPD) is rare and mostly described in clinical literature as case reports or small series. METHODS We investigated the clinicopathologic and immunohistochemical features of PPD in a total of 13 cases retrieved from multiple academic institutions. RESULTS The median age at diagnosis was 75 (range 50-86) years. Males were predominant with a male to female ratio of 2.25:1. Four (30.8%) cases were classified as primary PPD due to lack of synchronous or metachronous underlying malignancies, while nine (69.2%) were classified as secondary PPD with concurrent invasive adenocarcinoma (n = 8) or tubular adenoma with high-grade dysplasia (n = 1). Immunohistochemically, there is no differential expression of CK7 or CK20 in Paget's cells between primary and secondary PPD; however, GCDFP-15 was only positive in primary PPD (3/3 vs. 0/6, P = 0.012), while CDX2 was only positive in secondary PPD (0/3 vs. 7/7, P = 0.008), suggesting different cell origin. All patients received local surgical resection with or without adjuvant therapy. After a median follow-up of 47 months, one patient with secondary PPD (7.7%) died of disease progression from underlying adenocarcinoma. CONCLUSIONS PPD occurs in elderly patients with male predominance and is frequently associated with underlying malignancies. Differential expression of CDX2 and GCDFP-15 may help distinguishing primary vs. secondary PPD, which is important for management as the presence of an underlying malignancy impacts clinical course and prognosis. Surgical excision remains the major treatment strategy for PPD. Long-term follow-up is required to monitor the disease recurrence and metastasis.
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Affiliation(s)
- Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Xuemo Fan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jinping Lai
- Department of Pathology and Laboratory of Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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28
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Alotaiby F, Islam MN, Bhattacharyya I, Cohen DM, Drew PA, Lai J. Carcinosarcoma Arising from Inverted Papilloma in a Patient with History of Radiotherapy for Sinonasal Squamous Cell Carcinoma. Am J Case Rep 2020; 21:e921827. [PMID: 32200390 PMCID: PMC7117858 DOI: 10.12659/ajcr.921827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patient: Male, 72-year-old Final Diagnosis: Sarcomatoid carcinoma arising from inverted papilloma Symptoms: Nasal mass • nasal obstruction Medication: — Clinical Procedure: Excsion Specialty: Pathology
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Affiliation(s)
- Faraj Alotaiby
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry Qassim University, Qassim, Saudi Arabia
| | - Mohammed N Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Donald M Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Peter A Drew
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jinping Lai
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
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29
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Eudy BJ, McDermott CE, Fernandez G, Mathews CE, Lai J, da Silva RP. Disruption of hepatic one-carbon metabolism impairs mitochondrial function and enhances macrophage activity in methionine-choline-deficient mice. J Nutr Biochem 2020; 81:108381. [PMID: 32422424 DOI: 10.1016/j.jnutbio.2020.108381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/24/2020] [Accepted: 03/13/2020] [Indexed: 02/05/2023]
Abstract
One-carbon metabolism is a collection of metabolic cycles that supports methylation and provides one-carbon bound folates for the de novo synthesis of purine and thymidine nucleotides. The methylation of phosphatidylethanolamine to form choline has been extensively studied in the context of fatty liver disease. However, the role of one-carbon metabolism in supporting nucleotide synthesis during liver damage has not been addressed. The objective of this study is to determine how the disruption of one-carbon metabolism influences nucleotide metabolism in the liver after dietary methionine and choline restriction. Mice (n=8) were fed a methionine-choline-deficient or control diet for 3 weeks. We treated mice with the compound alloxazine (0.5 mg/kg), a known adenosine receptor antagonist, every second day during the final week of feeding to probe the function of adenosine signaling during liver damage. We found that concentrations of several hepatic nucleotides were significantly lower in methionine- and choline-deficient mice vs. controls (adenine: 13.9±0.7 vs. 10.1±0.6, guanine: 1.8±0.1 vs. 1.4±0.1, thymidine: 0.0122±0.0027 vs. 0.0059±0.0027 nmol/mg dry tissue). Treatment of alloxazine caused a specific decrease in thymidine nucleotides, decrease in mitochondrial content in the liver and exacerbation of steatohepatitis as shown by the increased hepatic lipid content and altered macrophage morphology. This study demonstrates a role for one-carbon metabolism in supporting de novo nucleotide synthesis and mitochondrial function during liver damage.
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Affiliation(s)
- Brandon J Eudy
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL.
| | - Caitlin E McDermott
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL.
| | - Gabriel Fernandez
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL.
| | - Clayton E Mathews
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL.
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL; Department of Pathology and Laboratory Medicine, Kaiser Permanente, Sacramento, CA.
| | - Robin P da Silva
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL.
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30
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Bril F, Barb D, Lomonaco R, Lai J, Cusi K. Change in hepatic fat content measured by MRI does not predict treatment-induced histological improvement of steatohepatitis. J Hepatol 2020; 72:401-410. [PMID: 31589891 DOI: 10.1016/j.jhep.2019.09.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Proof-of-concept studies frequently assess changes in intrahepatic triglyceride (IHTG) content by magnetic resonance-based techniques as a surrogate marker of histology. The aim of this study was to establish how reliable this strategy is to predict changes in liver histology in patients with non-alcoholic steatohepatitis (NASH). METHODS Patients with NASH who had participated in our prior randomized controlled trials of pioglitazone with complete paired data for IHTG content by magnetic resonance spectroscopy and liver histology were included in the study. RESULTS A total of 121 patients were included. Changes in IHTG were assessed in several ways: as a continuous variable (correlations), as categorical groups (IHTG change ≥0%; or IHTG reduction of 1-30%; 31-50%; 51-70%; or >70%), and in a binomial way as steatosis resolution or not (defined as achieving IHTG <5.56%). Changes in IHTG correlated with steatosis on histology (r = 0.54; p <0.01). However, the magnitude of IHTG reduction was not associated with the rate of response of the primary histological outcome (2-point improvement in the NAFLD activity score from 2 different parameters, without worsening of fibrosis) or resolution of NASH without worsening of fibrosis, neither in patients receiving pioglitazone nor placebo. Changes in lobular inflammation, hepatocyte ballooning, or liver fibrosis were also independent of changes in IHTG, irrespective of treatment arm. Steatosis resolution was not associated with better histological outcomes either. CONCLUSIONS Changes in IHTG predict changes in steatosis but not of other liver histological parameters. This implies that IHTG response to treatment should be interpreted with caution, as it may not be as reliable as previously believed to predict a treatment's overall clinical efficacy in patients with NASH. LAY SUMMARY Quantification of liver fat by magnetic resonance imaging (MRI) is currently used to assess treatment responses in patients with fatty liver, with the assumption that improvements in liver fat translate into less inflammation, necrosis, and fibrosis in the liver. However, in this article, we showed that changes in liver fat do not necessarily translate into changes in these parameters. This means that MRI may not be as useful to assess treatment response in patients with fatty liver as previously believed.
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Affiliation(s)
- Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA; Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Diana Barb
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Romina Lomonaco
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA; Division of Endocrinology, Diabetes and Metabolism, Malcom Randall VA Medical Center, Gainesville, FL, USA.
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31
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Jiang P, Lai J. Merkel Cell Carcinoma Clinically Mimicking a Traumatic Suture Scar in the Nasal Vestibule: Earlier Diagnosis for Better Prognosis. Anticancer Res 2020; 40:1123-1126. [PMID: 32014963 DOI: 10.21873/anticanres.14052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive form of skin cancer that is often found in sun-exposed regions of the skin in older or immunocompromised individuals. To date there have only been four cases reported of MCC found in the nasal vestibule. CASE REPORT We document an unusual case of MCC in the nasal vestibule of a 66-year-old female which was clinically believed to be an inflammatory reaction to a previous suture scar. The patient also had a history of dermatitis treated with UV light. The lesion was less than 5 mm in the greatest dimension and biopsied. There was small blue cell infiltrate in the dermis and the tumor cells were positive for synaptophysin, chromogranin and cytokeratin 20. They were negative for S100 proteins, melan A, human melanoma black 45 (HMB45) and lymphocyte common antigen CD45. For Ki-67, staining was positive in 90% of the tumor cells and tumor protein 53 immunoreactivity showed a wild type staining pattern. The pathological diagnosis was MCC and the patient underwent Mohs surgery with no tumor recurrence or metastasis identified at 2.5 years of follow-up. CONCLUSION To the best of our knowledge, cases of MCC arising in the nasal vestibule with clinical features mimicking a suture scar have not been reported. The importance of early diagnosis and treatment of MCC to improve patient prognosis are discussed.
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Affiliation(s)
- Peter Jiang
- University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A.
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32
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Dong D, Wang Y, Li C, Zhang H, Zhao Y, Lai J. Fibro-osseous Lesions of Paranasal Sinus and Craniofacial Region: A Retrospective Study of 282 Cases. Laryngoscope 2020; 131:E1-E7. [PMID: 32057109 DOI: 10.1002/lary.28529] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the clinical characteristics of osteoma, ossifying fibroma (OF) and fibrous dysplasia (FD) in the paranasal sinus and craniofacial regions. METHODS Totally 282 patients (112 males, 170 females) with osteoma (161), OF (44), and FD (77) involving the paranasal sinus, skull base and orbit treated surgically from January 2012 to August 2018 were analyzed retrospectively. RESULTS For osteoma, OF and FD, the onset ages were 40.3 (6-75), 24.5 (5-62), and 15 (1-63) years, and the most common locations were ethmoid sinus (49.7%), maxilla (36.4%) and maxilla (49.4%), respectively. There were significant differences of the preoperative serum alkaline phosphatase (ALP) levels between patients with osteoma (65 [25,184] U/L), OF (85.5 [41,474] U/L), and FD (104 [39,362] U/L) (Z = 44.9, P < .05). The ALP levels of OF and FD patients were comparable between monostotic and polyostotic lesions (P > .05). The recurrent rates of osteoma, OF, and FD were 0%, 13.6%, and 15.6%, respectively. The recurrent OF cases had significantly higher ALP level than the primary ones (283.5 [108,474] U/L vs. 76 [41,348] U/L, U = 14, P < .05). CONCLUSION There are differences in the onset age, location, and recurrence rate among osteoma, OF and FD involving the paranasal sinus and craniofacial region. Osteoma most commonly occurs in the ethmoid sinus, while OF and FD involve the maxilla most and are more likely to involve the orbit and the skull base, respectively. Endoscopic surgery is currently the main method for treatment, but individualized treatment regimen should be developed for patients. LEVEL OF EVIDENCE IV Laryngoscope, 131:E1-E7, 2021.
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Affiliation(s)
- Dong Dong
- Department of Rhinology, the ENT Hospital, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yue Wang
- Department of Rhinology, the ENT Hospital, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chang Li
- Department of Rhinology, the ENT Hospital, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongyan Zhang
- Department of Pathology, Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yulin Zhao
- Department of Rhinology, the ENT Hospital, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinping Lai
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, U.S.A.,Department of Pathology and Laboratory Medicine, Kaiser Permanente, Permanente Medicine, KP Sacramento Medical Center, Sacramento, California, U.S.A
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33
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Bril F, McPhaul MJ, Caulfield MP, Clark VC, Soldevilla-Pico C, Firpi-Morell RJ, Lai J, Shiffman D, Rowland CM, Cusi K. Performance of Plasma Biomarkers and Diagnostic Panels for Nonalcoholic Steatohepatitis and Advanced Fibrosis in Patients With Type 2 Diabetes. Diabetes Care 2020; 43:290-297. [PMID: 31604692 DOI: 10.2337/dc19-1071] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The 2019 Standards of Medical Care in Diabetes suggested that patients with nonalcoholic fatty liver disease (NAFLD) should be evaluated for liver fibrosis. However, the performance of noninvasive clinical models/scores and plasma biomarkers for the diagnosis of nonalcoholic steatohepatitis (NASH) and advanced fibrosis has not been carefully assessed in patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS In this cross-sectional study, patients (n = 213) had a liver MRS, and those with a diagnosis of NAFLD underwent a percutaneous liver biopsy. Several noninvasive clinical models/scores and plasma biomarkers were measured to identify NASH and advanced fibrosis (NASH: ALT, cytokeratin-18, NashTest 2, HAIR, BARD, and OWLiver; advanced fibrosis: AST, fragments of propeptide of type III procollagen [PRO-C3], FIB-4, APRI, NAFLD fibrosis score, and FibroTest). RESULTS None of the noninvasive tools assessed for the diagnosis of NASH in patients with T2DM had an optimum performance (all areas under the curve [AUCs] <0.80). Of note, none of the panels or biomarkers was able to outperform plasma ALT (AUC 0.78 [95% CI 0.71-0.84]). Performance was better to diagnose advanced fibrosis, in which plasma PRO-C3, AST, and APRI showed better results than the other approaches (AUC 0.90 [0.85-0.95], 0.85 [0.80-0.91], and 0.86 [0.80-0.91], respectively). Again, none of the approaches did significantly better than plasma AST. Sequential use of plasma AST and other noninvasive tests may help in limiting the number of liver biopsies required to identify patients with advanced fibrosis. CONCLUSIONS Performance of noninvasive clinical models/scores and plasma biomarkers for the diagnosis of NASH or advanced fibrosis was suboptimal in patients with T2DM. Combination of multiple tests may provide an alternative to minimize the need for liver biopsies to detect fibrosis in these patients.
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Affiliation(s)
- Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL.,Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | | | | | - Virginia C Clark
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL
| | | | - Roberto J Firpi-Morell
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL
| | - Dov Shiffman
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA
| | | | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL .,Division of Endocrinology, Diabetes and Metabolism, Malcom Randall VA Medical Center, Gainesville, FL
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Abstract
Significant progress has been made in our understanding of the role of epigenetic modifiers in many types of human cancer. Here, we review currently available studies on the unique histone methyltransferase, SETD2, which is responsible for H3 lysine 36 tri-methylation (H3K36me3). SETD2 plays pivotal roles in RNA alternative splicing regulation, DNA damage repair, and cytoskeleton protein methylation; inactivation of SETD2 and resultant dysregulation of these functions may lead to tumorigenesis. Despite being a newly discovered tumor suppressor, SETD2 has been found to be mutated in multiple types of cancer, including gastrointestinal tumor. Some tumors can acquire a selective growth advantage after SETD2 inactivation, which could happen in different stages in tumor progression. Decreased level of H3K36me3 caused by SETD2 inactivation has been shown to associate with higher tumor grade, tumor stage, metastasis risk, and shorter survival. Some studies also suggest that SETD2 mutation is associated with therapy resistance, therefore these SETD2-deficient tumors may need different therapeutic strategies.
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Affiliation(s)
- Ming Hu
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Mu Hu
- Department of Orthopaedics, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qin Zhang
- Department of Pathology, Third Central Hospital of Nankai University, Tianjin, China
| | - Jinping Lai
- Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA,
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Zhang D, Gonzalez RS, Feely M, Umrau K, Lee H, Allende DS, Karamchandani DM, Zaleski M, Lin J, Westerhoff M, Zhang X, Alpert L, Liao X, Lai J, Liu X. Clinicopathologic features of Buschke-Löwenstein tumor: a multi-institutional analysis of 38 cases. Virchows Arch 2019; 476:543-550. [PMID: 31728626 DOI: 10.1007/s00428-019-02680-z] [Citation(s) in RCA: 7] [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] [Received: 06/22/2019] [Revised: 09/11/2019] [Accepted: 09/25/2019] [Indexed: 02/08/2023]
Abstract
Buschke-Löwenstein tumor (BLT) is a rare sexually transmitted disease, mostly described in clinical literature as case reports or small series. Here, we investigated the clinicopathologic features of BLT in a total of 38 cases retrieved from multiple academic institutions. The average age was 47.6 ± 12.8 (mean ± SD) years old at diagnosis. The male to female ratio was 4.4:1. Common presenting symptoms were pain/discomfort, bleeding, mass lesion, and discharge. It was frequently linked to smoking and positive human immunodeficiency virus status. The tumor size and thickness were 8.5 ± 6.6 cm and 1.5 ± 1.3 cm, respectively. Histologically, 19 (50%) cases had an invasive squamous cell carcinoma component and were associated with high-risk human papillomavirus infection. There was no lymphovascular or perineural invasion, or nodal metastasis at initial diagnosis. BLTs with invasion had higher frequency of dyskeratosis, neutrophilic microabscesses, and abnormal mitoses, but lower frequency of pushing border compared with BLTs without invasion. All patients underwent wide excision, and some also received chemoradiation therapy. After a median follow-up of 23 months (range 1-207), the recurrence rate was 23.7% and disease-specific mortality was 2.6%. In summary, we presented the largest case series of BLT to date to characterize its unique clinicopathologic features. Our study indicated that certain histologic features such as dyskeratosis, neutrophilic microabscess, and abnormal mitosis in the non-invasive portion may be important clues on lesional biopsy to predict the presence of underlying invasive carcinoma.
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Affiliation(s)
- Dongwei Zhang
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA. .,Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Feely
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kavita Umrau
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Hwajeong Lee
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | | | - Dipti M Karamchandani
- Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Michael Zaleski
- Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Lindsay Alpert
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jinping Lai
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Xiuli Liu
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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Gawrieh S, Guo X, Tan J, Lauzon M, Taylor KD, Loomba R, Cummings OW, Pillai S, Bhatnagar P, Kowdley KV, Yates K, Wilson LA, Chen YDI, Rotter JI, Chalasani N. A Pilot Genome-Wide Analysis Study Identifies Loci Associated With Response to Obeticholic Acid in Patients With NASH. Hepatol Commun 2019; 3:1571-1584. [PMID: 31832568 PMCID: PMC6887685 DOI: 10.1002/hep4.1439] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
A significantly higher proportion of patients with nonalcoholic steatohepatitis (NASH) who received obeticholic acid (OCA) had histological improvement relative to placebo in the FLINT (farnesoid X nuclear receptor ligand obeticholic acid for noncirrhotic, NASH treatment) trial. However, genetic predictors of response to OCA are unknown. We conducted a genome‐wide association study (GWAS) in FLINT participants to identify variants associated with NASH resolution and fibrosis improvement. Genotyping was performed using the Omni2.5 content GWAS chip. To avoid false positives introduced by population stratification, we focused our GWAS on white participants. Six regions on chromosomes 1, 4, 6, 7, 15, and 17 had multiple single nucleotide polymorphisms (SNPs) with suggestive association (P < 1 × 10-4) with NASH resolution. A sentinel SNP, rs75508464, near CELA3B on chromosome 1 was associated with NASH resolution, improvement in the nonalcoholic fatty liver disease activity score, portal inflammation, and fibrosis. Among individuals carrying this allele, 83% achieved NASH resolution with OCA compared with only 33% with placebo. Eight regions on chromosomes 1, 2, 3, 11, 13, and 18 had multiple SNPs associated with fibrosis improvement; of these, rs12130403 near TDRD10 on chromosome 1 was also associated with improvement in NASH and portal inflammation, and rs4073431 near ANO3 on chromosome 11 was associated with NASH resolution and improvement in steatosis. Multiple SNPs on chromosome 11 had suggestive association with pruritus, with rs1379650 near ANO5 being the top SNP. Conclusion: We identified several variants that may be associated with histological improvement and pruritus in individuals with NASH receiving OCA. The rs75508464 variant near CELA3B may have the most significant effect on NASH resolution in those receiving OCA.
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Affiliation(s)
- Samer Gawrieh
- Division of Gastroenterology and Hepatology Department of Medicine Indiana University Indianapolis IN
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Science and Department of Pediatrics Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance CA
| | - Jingyi Tan
- The Institute for Translational Genomics and Population Science and Department of Pediatrics Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance CA
| | - Marie Lauzon
- The Institute for Translational Genomics and Population Science and Department of Pediatrics Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance CA
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Science and Department of Pediatrics Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance CA
| | - Rohit Loomba
- Division of Gastroenterology and Hepatology Department of Medicine University of California San Diego San Diego CA
| | | | | | | | - Kris V Kowdley
- Liver Care Network and Organ Care Research Swedish Medical Center Seattle WA
| | - Katherine Yates
- Department of Epidemiology Bloomberg School of Public Health Johns Hopkins University Baltimore MD
| | - Laura A Wilson
- Department of Epidemiology Bloomberg School of Public Health Johns Hopkins University Baltimore MD
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Science and Department of Pediatrics Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance CA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Science and Department of Pediatrics Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance CA
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology Department of Medicine Indiana University Indianapolis IN
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Zhang D, Hart J, Ding X, Zhang X, Feely M, Yassan L, Alpert L, Soldevila-Pico C, Zhang X, Liu X, Lai J. Histologic patterns of liver injury induced by anti-PD-1 therapy. Gastroenterol Rep (Oxf) 2019; 8:50-55. [PMID: 32467761 PMCID: PMC7244961 DOI: 10.1093/gastro/goz044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/16/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023] Open
Abstract
Background Nivolumab and pembrolizumab—two monoclonal antibodies that block human programmed cell death-1 (PD-1)—have been successfully used to treat patients with multiple advanced malignancies. The histologic patterns of hepatic toxicity induced by anti-PD-1 treatment have not been well studied and the aim of this study was to explore them. Methods Eight patients with advanced malignancies who were treated with either nivolumab or pembrolizumab were identified from five institutions. These patients had no history of underlying liver disease and a viral hepatitis panel was negative in all patients. Results Seven of eight patients exhibited mild to moderate gastrointestinal symptoms such as abdominal pain, fatigue, nausea, vomiting, and jaundice after anti-PD-1 treatment. Significant elevations in liver-chemistry tests were detected in all patients. Six cases (6/8) demonstrated an acute lobular hepatitis pattern of histologic injury. The remaining two cases showed different histologic patterns of injury: steatohepatitis with mild cholestasis (1/8) and pure acute cholestatic injury (1/8). No case showed typical features of autoimmune hepatitis. The liver function recovered in all eight cases after cessation of anti-PD-1 agents and with immunosuppressive therapy. Conclusions Our study suggests that screening patients for abnormal liver-function tests prior to anti-PD-1 therapy as well as periodic monitoring of liver-function tests are necessary to prevent severe liver injury. Rather than causing classical autoimmune hepatitis, PD-1 inhibitors appear to produce an immune-mediated nonspecific acute hepatitis. Drug cessation, without steroid therapy, may therefore be sufficient in some patients.
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Affiliation(s)
- Dongwei Zhang
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - John Hart
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Xianzhong Ding
- Department of Pathology and Laboratory of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Michael Feely
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Lindsay Yassan
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Lindsay Alpert
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | | | - Xuefeng Zhang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Pathology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
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Bril F, Biernacki DM, Kalavalapalli S, Lomonaco R, Subbarayan SK, Lai J, Tio F, Suman A, Orsak BK, Hecht J, Cusi K. Role of Vitamin E for Nonalcoholic Steatohepatitis in Patients With Type 2 Diabetes: A Randomized Controlled Trial. Diabetes Care 2019; 42:1481-1488. [PMID: 31332029 DOI: 10.2337/dc19-0167] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/25/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE While vitamin E has shown to improve nonalcoholic steatohepatitis (NASH) in patients without diabetes, information on patients with type 2 diabetes mellitus (T2DM) is lacking. The aim of this study was to determine whether vitamin E, alone or combined with pioglitazone, improves histology in patients with T2DM and NASH. RESEARCH DESIGN AND METHODS This was a proof-of-concept, randomized, double-blind, placebo-controlled trial conducted from 2010 to 2016. Patients with T2DM and biopsy-proven NASH (n = 105) were randomized to vitamin E 400 IU b.i.d., vitamin E 400 IU b.i.d. plus pioglitazone 45 mg/day, or placebo. Eighty-six patients completed the 18-month study. The primary end point was a two-point reduction in the nonalcoholic fatty liver disease activity score from two different parameters, without worsening of fibrosis. Secondary outcomes were resolution of NASH without worsening of fibrosis, individual histological scores, and metabolic parameters. RESULTS More patients on combination therapy achieved the primary outcome versus placebo (54% vs. 19%, P = 0.003) but not with vitamin E alone (31% vs. 19%, P = 0.26). Both groups showed improvements in resolution of NASH compared with placebo (combination group: 43% vs. 12%, P = 0.005; vitamin E alone: 33% vs. 12%, P = 0.04). While steatosis assessed by histology improved with combination therapy (P < 0.001) and vitamin E alone (P = 0.018), inflammation (P = 0.018) and ballooning (P = 0.022) only improved with combination therapy. No improvement in fibrosis was observed in any group. CONCLUSIONS In this proof-of-concept study, combination therapy was better than placebo in improving liver histology in patients with NASH and T2DM. Vitamin E alone did not significantly change the primary histological outcome.
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Affiliation(s)
- Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Diane M Biernacki
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Srilaxmi Kalavalapalli
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Romina Lomonaco
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Sreevidya K Subbarayan
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Jinping Lai
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL
| | - Fermin Tio
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Amitabh Suman
- Division of Gastroenterology, Hepatology, and Nutrition, Malcom Randall VA Medical Center, Gainesville, FL
| | - Beverly K Orsak
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Joan Hecht
- Division of Diabetes, Audie L. Murphy Memorial VA Hospital, San Antonio, TX
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL .,Division of Endocrinology, Diabetes and Metabolism, Malcom Randall VA Medical Center, Gainesville, FL
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Siddiqui MS, Yamada G, Vuppalanchi R, Van Natta M, Loomba R, Guy C, Brandman D, Tonascia J, Chalasani N, Neuschwander-Tetri B, Sanyal AJ; NASH Clinical Research Network. Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage. Clin Gastroenterol Hepatol 2019; 17:1877-1885.e5. [PMID: 30616027 DOI: 10.1016/j.cgh.2018.12.031] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/03/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Noninvasive methods are needed to determine disease stage in patients with nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic performance of several widely available fibrosis models for the assessment of hepatic fibrosis in patients with NAFLD. METHODS We performed a retrospective analysis of data from individuals enrolled in the NIDDK NASH Clinical Research Network, from 2004 through 2018. Using biopsy as the reference standard, we determined the diagnostic performance of the aspartate aminotransferase (AST):platelet ratio (APRI), FIB-4, ratio of AST:alanine aminotransferase (ALT) and the NAFLD fibrosis score (NFS) in a cross-sectional study of 1904 subjects. The ability of these models to detect changes in fibrosis stage was assessed in a longitudinal data set of 292 subjects with 2 biopsies and accompanying laboratory data. Outcomes were detection of fibrosis of any stage (stages 0-4), detection of moderate fibrosis (stages 0-1 vs 2-4), and detection of advanced fibrosis (stages 0-2 vs 3-4). Diagnostic performance was evaluated using the C-statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) analyses. RESULTS In the cross-sectional study, FIB-4 and NFS outperformed other non-invasive models for detecting advanced fibrosis; the C-statistics were 0.80 for FIB-4 and 0.78 for NFS. In the longitudinal study, 216 patients had non-advanced fibrosis at baseline and 35 patients progressed to advanced fibrosis after median follow up of 2.6 years. After we adjusted for fibrosis stage and model score at initial biopsy, change in APRI, FIB-4, and NFS were significantly associated with change in fibrosis. A unit change in APRI, FIB-4, or NFS was associated with changes in fibrosis stage of 0.33 (95% CI, 0.20-0.45; P < .001), 0.26 (95% CI, 0.15-0.37; P < .001), and 0.19 (95% CI, 0.07-0.31; P = .002), respectively. The cross-validated C-statistic for detecting progression to advanced fibrosis for APRI was 0.82 (95% CI, 0.74-0.89), for FIB-4 was 0.81 (95% CI, 0.73-0.81), and for NFS was 0.80 (95% CI, 0.71-0.88). CONCLUSIONS In a combined analysis of data from 2 large studies, we found that FIB-4, APRI, and NFS can detect advanced fibrosis and fibrosis progression in patients with NAFLD.
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Liu Y, Feng X, Lai J, Yi W, Yang J, Du T, Long X, Zhang Y, Xiao Y. A novel role of kynureninase in the growth control of breast cancer cells and its relationships with breast cancer. J Cell Mol Med 2019; 23:6700-6707. [PMID: 31332944 PMCID: PMC6787497 DOI: 10.1111/jcmm.14547] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/17/2019] [Accepted: 05/17/2019] [Indexed: 02/05/2023] Open
Abstract
Breast cancer is the most common malignancy among women worldwide. Kynureninase (KYNU) located in 2q22.2, which was associated with tryptophan utilization and metabolic diseases including cardiac, renal and limb defects syndrome 2. However, the role of KYNU in breast cancer (BC) development remains unclear. The expression of KYNU was examined by immunohistochemistry (IHC) in 137 primary BC tissues, and the correlation of KYNU expression with clinical pathological characteristics and the biomarkers (ER, PR, HER2, E-cad and Ki-67) was analysed. The role of KYNU in cancer cell proliferation, tumour growth and development was evaluated by MTT assay, soft agar colony formation assay and xenograft mouse models. Among 137 primary BC tissues, 46.7% (64/137) had high KYNU expression (IHC scores >4) while 53.3% (73/137) had low KYNU expression (IHC scores ≤4). The expression of KYNU was positively correlated with the expressions of ER (P = .002), PR (P = .007) and E-cad (P = .03), while negatively associated with tumour grade (P = .008), tumour stage (P < .001) and the expressions of HER2 (P = .04) and Ki-67 (P = .019). Overexpression of KYNU significantly inhibited cell proliferation in cell culture, colony formation in soft agar and xenograft BC development in NOD/SCID mice. Kynureninase suppresses BC cell proliferation, tumour growth and development. Kynureninase may function as a tumour suppressor in BC.
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Affiliation(s)
- Yingzhe Liu
- Xiangya International Medical Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xueping Feng
- Department of Oncology and Institute of Medical Sciences, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jinping Lai
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Wenjun Yi
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiu Yang
- Department of Oncology and Institute of Medical Sciences, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tao Du
- Department of Oncology and Institute of Medical Sciences, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xueying Long
- Department of Oncology and Institute of Medical Sciences, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ye Zhang
- Department of Oncology and Institute of Medical Sciences, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yongzhi Xiao
- Department of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, China
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Lai J, Kresak JL, Cao D, Zhang D, Zhang S, Leon ME, Shenoy A, Liu W, Trevino J, Starostik P, Gonzalo DH, Wang H, Liu X, Fan X. Gastric Plexiform Fibromyxoma: A Great Mimic of Gastrointestinal Stromal Tumor (GIST) and Diagnostic Pitfalls. J Surg Res 2019; 239:76-82. [PMID: 30822694 DOI: 10.1016/j.jss.2019.01.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/24/2018] [Revised: 01/10/2019] [Accepted: 01/25/2019] [Indexed: 02/05/2023]
Abstract
Through a multicenter study, we collected seven cases of gastric plexiform fibromyxoma including four females and three males, 21 to 79 y old (46.1 ± 10.1). All cases showed a unilocular lesion measuring 0.3 to 17 cm (5.3 ± 2.4), arising from antrum (5/7) or body (2/7). Six of the seven cases had intraoperative frozen sections and/or endoscopic ultrasound fine needle aspiration (EUS-FNA), and all of them were preoperatively or intraoperatively diagnosed as gastrointestinal stromal tumor (GIST). EUS-FNA material showed markedly elongated spindle cells with streaming oval to elongated nuclei with rounded ends. Histologically, the tumors exhibited a plexiform growth pattern and were composed of a rich myxoid stroma and cytologically bland uniform spindle cells without mitotic figures, with the exception of one case which displayed nuclear pleomorphism and increased mitosis. Immunostains showed the tumor cells to be focally positive for SMA (6/6), focally and weakly positive for desmin (3/6) and caldesmon (2/3), negative for CD117 (0/7), CD34 (0/7), DOG1 (0/4), and S100 (0/5). No mutations were identified on Next-Generation Sequencing test, and no loss of SDHB immunoreactivity was identified in the tumor with nuclear pleomorphism. One case was treated with Gleevec because of the initial diagnosis of GIST. All patients had a follow-up for up to 11 y, with no tumor recurrence or metastasis reported. Our results suggest that gastric plexiform fibromyxoma is rare and may be underrecognized and misinterpreted as GIST during intraoperative frozen section or preoperative EUS-FNA diagnosis without immunostains leading to inappropriate treatment.
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Affiliation(s)
- Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Jesse L Kresak
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, Missouri
| | - Dongwei Zhang
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Sharon Zhang
- Department of Pathology and Laboratory Medicine, University of California in Los Angeles (UCLA), California
| | - Marino E Leon
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Archana Shenoy
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida; Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, Missouri
| | - Weidong Liu
- Department of Surgery, Xiangya Hospital, XiangYa School of Medicine, Central South University, Changsha, China
| | - Jose Trevino
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Petr Starostik
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - David Hernandez Gonzalo
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Hanlin Wang
- Department of Pathology and Laboratory Medicine, University of California in Los Angeles (UCLA), California
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Xuemo Fan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Bril F, Leeming DJ, Karsdal MA, Kalavalapalli S, Barb D, Lai J, Rabe M, Cusi K. Use of Plasma Fragments of Propeptides of Type III, V, and VI Procollagen for the Detection of Liver Fibrosis in Type 2 Diabetes. Diabetes Care 2019; 42:1348-1351. [PMID: 31221701 DOI: 10.2337/dc18-2578] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/19/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study assessed the utility of plasma fragments of propeptides of type III (PRO-C3), V (PRO-C5), and VI (PRO-C6) procollagen for the detection of liver fibrosis in patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Patients with T2DM (n = 191) underwent an oral glucose tolerance test, a liver 1H-MRS, and a liver biopsy when indicated. PRO-C3, PRO-C5, and PRO-C6 were blindly assessed. RESULTS PRO-C3 performed well for the diagnosis of moderate-to-advanced (area under the receiver operating characteristic curve [AUROC] 0.81 [95% CI 0.74-0.88]) and advanced (AUROC 0.88 [0.80-0.95]) fibrosis in T2DM patients. Its performance was similar to that of AST to platelet ratio index (APRI) (AUROC 0.83 and 0.87, respectively) and Fibrosis-4 (FIB-4) (AUROCs 0.83 and 0.86, respectively) scores. Use of PRO-C5 and PRO-C6 did not improve the accuracy to detect liver fibrosis. After 18 months, PRO-C3 changes were associated with changes in fibrosis stages. CONCLUSIONS PRO-C3 performed well for the detection of fibrosis in T2DM patients and showed promising results for prediction of histological changes in fibrosis stage with treatment.
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Affiliation(s)
- Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL.,Malcom Randall Veterans Administration Medical Center, Gainesville, FL
| | | | | | - Srilaxmi Kalavalapalli
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Diana Barb
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL
| | - Matthew Rabe
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL .,Malcom Randall Veterans Administration Medical Center, Gainesville, FL
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Hu M, Tang Y, Long G, Zhang D, Kresak JL, Lai J. Primary Extracranial Meningioma of Mastoid in a Patient With History of Skin Squamous Cell Carcinoma, Lung Adenocarcinoma and Prostatic Carcinoma. Anticancer Res 2019; 39:3197-3201. [PMID: 31177167 DOI: 10.21873/anticanres.13458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/07/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Meningiomas are the most common benign intracranial tumors and frequently develop in the parasagittal region, but can also present extracranially. Rarely, meningiomas may involve the middle ear and mastoid, resulting from contiguous spread of adjacent intracranial tumor, or extremely rarely, as an isolated primary tumor, which is frequently misdiagnosed and unrecognized, resulting in inappropriate clinical management. CASE REPORT Herein we report such a case of an 80-year-old man with history of multiple cancer who presented with ear pain, vertigo and hearing loss. Audiometry demonstrated bilateral sensorineural hearing loss. Contrast-enhanced temporal bone computed tomography revealed a soft-tissue mass in the right epitympanum without bone erosion or any intracranial involvement. Radiological and operative findings were suspicious for cholesteatoma. Histological examination showed an epithelial neoplasm arranged in nests and whorls with intranuclear inclusions. No psammoma bodies, mitotic figures, or tumor necrosis were identified. The tumor cells were positive for epithelial membrane antigen, vimentin, progesterone receptor and CD56; and negative for synaptophysin, chromogranin, pancytokeratin (AE1/AE3), cytokeratin 7, prostate-specific antigen, inhibin, S100, P63, and P40. Ki67 highlighted about 2% of the tumor cells. Based on the morphological features and immunohistochemical profile, the tumor was diagnosed as primary extracranial meningioma of the mastoid, meningothelial subtype, World Health Organization grade 1. CONCLUSION To the best of our knowledge, primary mastoid meningioma clinically mimicking a cholesteatoma presenting in a patient with a history of multiple primary carcinomas has not been previously reported. The pathogenesis, diagnosis and treatment of this entity are discussed.
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Affiliation(s)
- Ming Hu
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Yaoyun Tang
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Guanghui Long
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, U.S.A
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Jesse L Kresak
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Jinping Lai
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A. .,Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, U.S.A
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ZHANG DONGWEI, LIAO XIAOYAN, TANG YAOYUN, MEYER REIDG, VAN DYKE DANIELL, LIU XIULI, ISLAM MOHAMMEDN, LAI JINPING. Warthin-like Mucoepidermoid Carcinoma of the Parotid Gland: Unusual Morphology and Diagnostic Pitfalls. Anticancer Res 2019; 39:3213-3217. [PMID: 31177170 DOI: 10.21873/anticanres.13461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 02/08/2023]
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Dinarvand P, Davaro EP, Doan JV, Ising ME, Evans NR, Phillips NJ, Lai J, Guzman MA. Familial Adenomatous Polyposis Syndrome: An Update and Review of Extraintestinal Manifestations. Arch Pathol Lab Med 2019; 143:1382-1398. [PMID: 31070935 DOI: 10.5858/arpa.2018-0570-ra] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Familial adenomatous polyposis (FAP) is a rare genetic disorder with autosomal dominant inheritance, defined by numerous adenomatous polyps, which inevitably progress to colorectal carcinoma unless detected and managed early. Greater than 70% of patients with this syndrome also develop extraintestinal manifestations, such as multiple osteomas, dental abnormalities, and a variety of other lesions located throughout the body. These manifestations have historically been subcategorized as Gardner syndrome, Turcot syndrome, or gastric adenocarcinoma and proximal polyposis of the stomach. Recent studies, however, correlate the severity of gastrointestinal disease and the prominence of extraintestinal findings to specific mutations within the adenomatous polyposis coli gene (APC), supporting a spectrum of disease as opposed to subcategorization. Advances in immunohistochemical and molecular techniques shed new light on the origin, classification, and progression risk of different entities associated with FAP. OBJECTIVE.— To provide a comprehensive clinicopathologic review of neoplastic and nonneoplastic entities associated with FAP syndrome, with emphasis on recent developments in immunohistochemical and molecular profiles of extraintestinal manifestations in the thyroid, skin, soft tissue, bone, central nervous system, liver, and pancreas, and the subsequent changes in classification schemes and risk stratification. DATA SOURCES.— This review will be based on peer-reviewed literature and the authors' experiences. CONCLUSIONS.— In this review we will provide an update on the clinicopathologic manifestations, immunohistochemical profiles, molecular features, and prognosis of entities seen in FAP, with a focus on routine recognition and appropriate workup of extraintestinal manifestations.
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Affiliation(s)
- Peyman Dinarvand
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Elizabeth P Davaro
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - James V Doan
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Mary E Ising
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Neil R Evans
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Nancy J Phillips
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Jinping Lai
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Miguel A Guzman
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
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Upadhyaya JD, Fitzpatrick SG, Cohen DM, Bilodeau EA, Bhattacharyya I, Lewis JS, Lai J, Wright JM, Bishop JA, Leon ME, Islam MN, Seethala R, Padilla RJ, Carlos R, Müller S, Thompson LDR. Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia: Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study. Head Neck Pathol 2019; 14:156-165. [PMID: 30972634 PMCID: PMC7021885 DOI: 10.1007/s12105-019-01035-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/12/2019] [Accepted: 04/01/2019] [Indexed: 02/08/2023]
Abstract
The use of diverse terminology may lead to inconsistent diagnosis and subsequent mistreatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objectives of this study were: (a) to measure inter-observer variability between a variety of pathologists diagnosing PVL lesions; and (b) to evaluate the impact of diverse terminologies on understanding, interpretation, and subsequent treatment planning by oral and maxillofacial surgeons (OMFS). Six oral pathologists (OP) and six head and neck pathologists (HNP) reviewed 40 digitally scanned slides of PVL-type lesions. Inter-observer agreement on diagnoses was evaluated by Fleiss' kappa analysis. The most commonly used diagnostic terminologies were sent to ten OMFS to evaluate their resulting interpretations and potential follow-up treatment approaches. The overall means of the surgeons' responses were compared by Student t test. There was poor inter-observer agreement between pathologists on the diagnosis of PVL lesions (κ = 0.270), although there was good agreement (κ = 0.650) when diagnosing frankly malignant lesions. The lowest agreement was in diagnosing verrucous hyperplasia (VH) with/without dysplasia, atypical epithelial proliferation (AEP), and verrucous carcinoma (VC). The OMFS showed the lowest agreement on identical categories of non-malignant diagnoses, specifically VH and AEP. This study demonstrates a lack of standardized terminology and diagnostic criteria for the spectrum of PVL lesions. We recommend adopting standardized criteria and terminology, proposed and established by an expert panel white paper, to assist pathologists and clinicians in uniformly diagnosing and managing PVL spectrum lesions.
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Affiliation(s)
- Jasbir D. Upadhyaya
- Section of Diagnostic Sciences, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, 2800 College Avenue, Alton, IL 62002 USA
| | - Sarah G. Fitzpatrick
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Donald M. Cohen
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Elizabeth A. Bilodeau
- grid.21925.3d0000 0004 1936 9000Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA USA
| | - Indraneel Bhattacharyya
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - James S. Lewis
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Jinping Lai
- grid.15276.370000 0004 1936 8091Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL USA
| | - John M. Wright
- grid.264763.20000 0001 2112 019XDepartment of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, TX USA
| | - Justin A. Bishop
- grid.267313.20000 0000 9482 7121Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Marino E. Leon
- grid.15276.370000 0004 1936 8091Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL USA
| | - Mohammed N. Islam
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Raja Seethala
- grid.21925.3d0000 0004 1936 9000Department of Pathology, University of Pittsburgh, Pittsburgh, PA USA
| | - Ricardo J. Padilla
- grid.10698.360000000122483208Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Roman Carlos
- Pathology Division, Centro Clínico de Cabeza y Cuello, Guatemala City, Guatemala
| | - Susan Müller
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta Oral Pathology, Decatur, GA USA
| | - Lester D. R. Thompson
- grid.417224.60000 0004 0445 0789Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA USA
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Zhang D, Glover SC, Liu W, Liu X, Lai J. Small Bowel Pyogenic Granuloma With Cytomegalovirus Infection in a Patient With Crohn's Disease (Report of a Case and Review of the Literature). In Vivo 2019; 33:251-254. [PMID: 30587632 DOI: 10.21873/invivo.11468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 02/08/2023]
Abstract
Pyogenic granuloma (PG) represents a lobular capillary proliferation commonly seen in the skin or oral mucosa. They are rarely reported in the gastrointestinal tract. The mechanism underlying PG pathogenesis is not well understood. Only one case of cutaneous PG associated with cytomegalovirus (CMV) infection has been reported in the English literature. Here, we report such a unique case of PG arising from the small bowel. A 67-year-old male, status post ileocolic resection, presented for follow-up colonoscopy because of Crohn's disease of the terminal ileum and the colon. Colonoscopy revealed inflammation at the ileocolic anastomosis as well as an 8-mm pedunculated lesion with an irregular surface in the neo-terminal ileum. Histological studies of the small bowel mucosa revealed chronic active ileitis with pyloric gland metaplasia, consistent with his clinical history of Crohn's disease. The lesion demonstrated a lobular architecture consisting of clusters of small capillaries of various sizes lined by a single layer of cytologically bland endothelial cells, and accompanied by acute and chronic inflammatory infiltrates and surface erosion/ulceration. The histological features supported the diagnosis of PG. Scattered viral inclusions with positive CMV immunoreactivity were present in the endothelial cells and glandular cells of pyloric gland metaplasia within the PG. To the best of our knowledge, this is the first documented case of PG with local CMV infection in patients with inflammatory bowel disease.
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Affiliation(s)
- Dongwei Zhang
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A.,Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Sarah C Glover
- Division of Gastroenterology, Hematology and Nutrition, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Weidong Liu
- Department of Surgery, Xiangya Hospital, XiangYa School of Medicine, Central South University, Changsha, P.R. China
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A.
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Yang C, Sun L, Zhang L, Zhou L, Zhao M, Peng Y, Niu D, Li Z, Huang X, Kang Q, Jia L, Lai J, Cao D. Diagnostic Utility of SATB2 in Metastatic Krukenberg Tumors of the Ovary: An Immunohistochemical Study of 70 Cases With Comparison to CDX2, CK7, CK20, Chromogranin, and Synaptophysin. Am J Surg Pathol 2018; 42:160-71. [PMID: 28914716 DOI: 10.1097/PAS.0000000000000951] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
SATB2 is a sensitive marker for colorectal adenocarcinomas. No study has investigated its diagnostic utility in metastatic Krukenberg tumors (MKTs) of the ovary. Here we performed immunohistochemical staining SATB2 in 70 MKTs of various origins (stomach 27, colorectum 13, appendix 20 including 19 metastatic adenocarcinomas ex goblet cell carcinoids [AdexGCC] and 1 conventional poorly differentiated carcinoma with signet ring cells, breast 5, bladder 3, lung 2) to assess its diagnostic utility. We also compared SATB2 with CDX2, CK7, CK20, chromogranin, and synaptophysin in MKTs of gastric origin (MKTs-stomach), those of colorectal origin (MKTs-colorectum) and those due to appendiceal AdexGCCs (MKT-AdexGCCs) for their sensitivity and specificity to distinguish these tumors. SATB2 staining was seen in 1/27 (4%) MKTs-stomach (40% cells), 7/13 (54%) MKTs-colorectum (mean: 17% cells, median: 7%, range: 2% to 60%), and 19/19 (100%) of MKT-AdexGCCs (mean: 97% cells, median: 100%, range: 80% to 100%) (P<0.01 between any two). SATB2 staining was seen in 1/1 metastatic appendiceal poorly differentiated carcinoma with signet ring cells (5% cells), 1/3 MKTs of bladder origin (60% cells), 0/2 MKTs of pulmonary origin, and 1/5 MKTs of breast origin (10% cells). SATB2 staining was diffuse strong in MKT-AdexGCCs whereas in other MKTs it was focal and weak in the signet ring and nonsignet ring nonglandular cells and from focal weak to diffuse strong in well-formed glands. MKTs-stomach, MKTs-colorectum, and MKT-AdexGCCs showed no significant staining difference in CDX2 (100%, 100%, 100% cases, respectively; P=1.0), CK20 (96%, 100%, 100%, respectively; P=1.0), chromogranin (59%, 31%, 63%, respectively; P>0.05) or synaptophysin (59%, 63%, 84%, respectively; P>0.05) but they had significant difference in CK7 staining (93%, 8%, 42%, respectively; P<0.05). Among these 6 markers, SATB2 is the best one to distinguish MKT-AdexGCCs from MKTs-stomach (100% sensitivity, 96% specificity) and MKTs-colorectum (100% sensitivity and 100% specificity if staining more than 75% tumor cells as the cutoff). In distinguishing MKTs-stomach from MKTs-colorectum, SATB2 is not as good as CK7 which is the best marker. Our results indicate that SATB2 is a highly sensitive marker (100% sensitivity) for metastatic MKT-AdexGCCs with high specificity (100% specificity when showing strong staining in at least 75% cells) among MKTs. SATB2 is a useful marker for determining the primary sites of MKTs of the ovary.
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Desai A, Sandhu S, Lai JP, Sandhu DS. Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review. World J Hepatol 2019; 11:1-18. [PMID: 30705715 PMCID: PMC6354117 DOI: 10.4254/wjh.v11.i1.1] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/22/2018] [Accepted: 01/01/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which in turns accounts for the sixth most common cancer worldwide. Despite being the 6th most common cancer it is the second leading cause of cancer related deaths. HCC typically arises in the background of cirrhosis, however, about 20% of cases can develop in a non-cirrhotic liver. This particular subgroup of HCC generally presents at an advanced stage as surveillance is not performed in a non-cirrhotic liver. HCC in non-cirrhotic patients is clinically silent in its early stages because of lack of symptoms and surveillance imaging; and higher hepatic reserve in this population. Interestingly, F3 fibrosis in non-alcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infections are associated with high risk of developing HCC. Even though considerable progress has been made in the management of this entity, there is a dire need for implementation of surveillance strategies in the patient population at risk, to decrease the disease burden at presentation and improve the prognosis of these patients. This comprehensive review details the epidemiology, risk factors, clinical features, diagnosis and management of HCC in non-cirrhotic patients and provides future directions for research.
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Affiliation(s)
- Aakash Desai
- Department of Internal Medicine, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH 44109, United States
| | - Sonia Sandhu
- Department of Hematology and Oncology, Cleveland Clinic/Akron General Medical Center, Akron, OH 44307, United States
| | - Jin-Ping Lai
- Department of Pathology, University of Florida, Gainsville, FL 32611, United States
| | - Dalbir Singh Sandhu
- Division of Gastroenterology and Hepatology, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH 44109, the United States
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50
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Zhang D, Williams WD, Lai J. An Unusual Case of Cecal Mesenteric Dedifferentiated Liposarcoma Involving the Ileocolic Artery Resected by Right Hemicolectomy. Anticancer Res 2018; 39:487-490. [PMID: 30591499 DOI: 10.21873/anticanres.13138] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colonic mesenteric dedifferentiated liposarcoma is a rare entity. CASE REPORT A 65-year-old male developed a 6 cm diameter right-side intra-abdominal mesenteric mass. A biopsy of the mass was performed and the pathology diagnosis was a spindle cell neoplasm most consistent with low-grade sarcoma. The mass was found to involve the ileocolic vessels in the mesentery on the right side of the abdomen, and therefore the patient received right hemicolectomy with mesenteric mass resection. Pathology confirmed a dedifferentiated liposarcoma (DDLPS) arising in a well-differentiated liposarcoma/atypical lipomatous tumor with myxoid changes. The tumor cells were positive for MDM2 amplification by fluorescence in situ hybridization. After 6 months of follow-up, our patient showed no sign of recurrence. CONCLUSION We report an unusual cecal mesenteric DDLPS which was successfully resected by right hemicolectomy. The results suggest that DDLPS should be considered in the differential diagnosis of patients presenting with a spindle cell neoplasm in the mesentery.
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Affiliation(s)
- Dongwei Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, U.S.A.,Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - William D Williams
- Department of Pathology and Laboratory Medicine, Broward Health North, Deerfield Beach, FL, U.S.A
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A.
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