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Riddle N, Parkash V, Guo CC, Shen SS, Perincheri S, Ramirez AS, Auerbach A, Belchis D, Humphrey PA. Recent Advances in Genitourinary Tumors: Updates From the 5th Edition of the World Health Organization Blue Book Series. Arch Pathol Lab Med 2024; 148:952-964. [PMID: 38031818 DOI: 10.5858/arpa.2022-0509-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 12/01/2023]
Abstract
CONTEXT.— Urinary and Male Genital Tumours is the 8th volume of the World Health Organization Classification of Tumours series, 5th edition. Released in hard copy in September 2022, it presents an update to the classification of male genital and urinary tumors in the molecular age. Building upon previous volumes in this series, significant effort has been made to harmonize terminology across organ systems for biologically similar tumors (eg, neuroendocrine tumors). Genomic terminology has been standardized and genetic syndromes covered more comprehensively. This review presents a concise summary of this volume, highlighting new entities, notable modifications relative to the 4th edition, and elements of relevance to routine clinical practice. OBJECTIVE.— To provide a comprehensive update on the World Health Organization classification of urinary and male genital tumors, highlighting updated diagnostic criteria and terminology. DATA SOURCES.— The 4th and 5th editions of the World Health Organization Classification of Tumours: Urinary and Male Genital Tumours. CONCLUSIONS.— The World Health Organization has made several changes in the 5th edition of the update on urinary and male genital tumors that pathologists need to be aware of for up-to-date clinical practice.
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Auerbach A, Aguilera NS. The changing landscape of pediatric histiocytoses: Birth, life, and transdifferentiation of pediatric histiocytes. Semin Diagn Pathol 2023; 40:420-428. [PMID: 37258365 DOI: 10.1053/j.semdp.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
Histiocytic neoplasms in the children are very rare, and histiocytoses can occur in the perinatal period. The presumed origins and presentation of specific histiocytoses in the pediatric age group are described. Common and newly described histiocytoses are presented including Langerhans cell histiocytosis, Rosai-Dorfman disease, histiocytic sarcoma, ALK positive histiocytosis, and hemophagocytic lymphohistiocytosis. Molecular findings common to pediatric histiocytoses are also discussed.
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Auerbach A, Girton M, Aguilera N. Controversies in the Spleen: Histiocytic, Dendritic, and Stromal Cell Lesions. Surg Pathol Clin 2023; 16:385-400. [PMID: 37149364 DOI: 10.1016/j.path.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Histiocytic, dendritic, and stromal cell lesions that occur in the spleen are challenging diagnostically, not well studied due to their rarity, and therefore somewhat controversial. New techniques for obtaining tissue samples also create challenges as splenectomy is no longer common and needle biopsy does not afford the same opportunity for examination of tissue. Characteristic primary splenic histiocytic, dendritic, and stromal cell lesions are presented in this paper with new molecular genetic findings in some entities that help differentiate these lesions from those occurring in non-splenic sites, such as soft tissue, and identify possible molecular markers for diagnosis.
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Hyrcza MD, Lindenmuth TR, Auerbach A. Top Ten Lymphoproliferative Lesions Not to Miss When Evaluating Oral Ulcer Biopsies. Head Neck Pathol 2023; 17:99-118. [PMID: 36928739 PMCID: PMC10063747 DOI: 10.1007/s12105-023-01532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/12/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Oral ulcers represent a full thickness loss of the mucosal epithelium leading to exposure of the submucosal connective tissue. These are common and usually self-limited lesions, although they may sometimes result from neoplasms, most commonly squamous cell carcinoma. Lymphoproliferative disorders may be difficult to diagnose in apthous ulcers since they mimic reactive inflammation. METHODS This review presents ten rare oral lymphoid proliferations which should not be missed when assessing oral ulcer biopsies. RESULTS The ten lesions include several with diagnostic cells which look similar to the histiocytes of a reactive inflammatory ulcer, including Rosai-Dorfman disease, reticulohistiocytoma, Langerhans cell histiocytosis, and traumatic ulcerative granuloma. Other lesions, such as EBV-positive mucocutaneous ulcer, extranodal marginal zone lymphoma of mucosal-associated lymphoid tissue, and plasmablastic lymphoma have lymphoid and/or plasma cell differentiation that mimic the reactive lymphocytes and plasma cells found in reactive ulcers. Two dendritic cell lesions, follicular dendritic cell sarcoma and blastic plasmacytoid dendritic cell neoplasm, both have distinct phenotypes which are required to make an accurate diagnosis. CONCLUSION Each of these lesions are diagnosed by evaluating their histology, along with their phenotypic profile, which is sometimes enhanced by pertinent molecular findings.
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Klassen-Fischer MK, Nelson AM, Neafie RC, Neafie FA, Auerbach A, Baker TP, Burke AP, Datta AA, Franks TJ, Horkayne-Szakaly I, Lack EE, Lewin-Smith MR, Luiña Contreras A, Mattu RH, Rush WL, Shick PC, Zhang Y, Rentas FJ, Moncur JT. The Reemergence of Measles. Am J Clin Pathol 2023; 159:81-88. [PMID: 36315019 DOI: 10.1093/ajcp/aqac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/07/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Present-day pathologists may be unfamiliar with the histopathologic features of measles, which is a reemerging disease. Awareness of these features may enable early diagnosis of measles in unsuspected cases, including those with an atypical presentation. Using archived tissue samples from historic patients, a unique source of histopathologic information about measles and other reemerging infectious diseases, we performed a comprehensive analysis of the histopathologic features of measles seen in commonly infected tissues during prodrome, active, and late phases of the disease. METHODS Subspecialty pathologists analyzed H&E-stained slides of specimens from 89 patients accessioned from 1919 to 1998 and correlated the histopathologic findings with clinical data. RESULTS Measles caused acute and chronic histopathologic changes, especially in the respiratory, lymphoid (including appendix and tonsils), and central nervous systems. Bacterial infections in lung and other organs contributed significantly to adverse outcomes, especially in immunocompromised patients. CONCLUSIONS Certain histopathologic features, especially Warthin-Finkeldey cells and multinucleated giant cells without inclusions, allow pathologists to diagnose or suggest the diagnosis of measles in unsuspected cases.
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Kim N, Auerbach A, Manning MA. Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation. Radiographics 2022; 42:683-701. [PMID: 35302864 DOI: 10.1148/rg.210071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Splenic lesions are commonly discovered incidentally at imaging, without clinical signs or symptoms that may aid in diagnosis. As such, the differential diagnosis and subsequent management are based primarily on imaging characteristics. Much has been written about the myriad pathologic conditions that can occur in the spleen; however, there is little guidance on the approach to an incidental splenic mass. Applying an approach frequently used in imaging to the splenic mass-based on the number and consistency of lesions and refined by supplementary imaging features-allows formulation of a useful differential diagnosis. Solitary cystic masses include true cysts, pseudocysts, and parasitic cysts. When multiple cystic lesions are present, the differential diagnosis expands to include infectious lesions (abscess or microabscesses) and lymphangioma (a benign cystic neoplasm). Hemangioma is the most common solitary solid mass, although other vascular lesions (hamartoma, sclerosing angiomatoid nodular transformation) and nonvascular lesions (inflammatory pseudotumor, lymphoma) manifest as solitary and solid. When multiple solid masses are present, diffuse inflammatory disease (sarcoidosis), littoral cell angioma, and lymphoma should be considered. Malignancies, such as angiosarcoma or metastasis, can manifest as solitary or multiple and solid or cystic masses but are typically associated with symptoms or widespread primary malignancy. Careful assessment of the multimodality imaging characteristics of splenic lesions based on this approach aids the radiologist faced with the incidental splenic lesion. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Davis JW, Auerbach A, Crothers BA, Lewin E, Lynch DT, Teschan NJ, Schmieg JJ. Intravascular Large B-Cell Lymphoma. Arch Pathol Lab Med 2022; 146:1160-1167. [PMID: 34979566 DOI: 10.5858/arpa.2021-0165-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Intravascular large B-cell lymphoma (IVLBCL) is a rare hematopathologic entity, posing both a clinical and histologic challenge for diagnosis. Numerous pitfalls can hinder making the diagnosis. OBJECTIVE.— To summarize recent developments in literature pertaining to IVLBCL and point out key pitfalls pathologists should be prepared to encounter. DATA SOURCES.— Literature review via PubMed search and hospital (Darnall Medical Library) resources. CONCLUSIONS.— The 3 primary pitfalls of IVLBCL include masking of IVLBCL, mimicry by IVLBCL, and mimicry of IVLBCL. These scenarios illustrate the importance of histologic pattern recognition and subsequent usage of immunohistochemistry, especially in context of a clinical history that may be noncharacteristic.
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Schmieg JJ, Muir JM, Aguilera NS, Auerbach A. CD5-Negative, CD10-Negative Low-Grade B-Cell Lymphoproliferative Disorders of the Spleen. Curr Oncol 2021; 28:5124-5147. [PMID: 34940069 PMCID: PMC8700451 DOI: 10.3390/curroncol28060430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/18/2021] [Accepted: 11/27/2021] [Indexed: 01/20/2023] Open
Abstract
CD5-negative, CD10-negative low-grade B-cell lymphoproliferative disorders (CD5-CD10-LPD) of the spleen comprise a fascinating group of indolent, neoplastic, mature B-cell proliferations that are essential to accurately identify but can be difficult to diagnose. They comprise the majority of B-cell LPDs primary to the spleen, commonly presenting with splenomegaly and co-involvement of peripheral blood and bone marrow, but with little to no involvement of lymph nodes. Splenic marginal zone lymphoma is one of the prototypical, best studied, and most frequently encountered CD5-CD10-LPD of the spleen and typically involves white pulp. In contrast, hairy cell leukemia, another well-studied CD5-CD10-LPD of the spleen, involves red pulp, as do the two less common entities comprising so-called splenic B-cell lymphoma/leukemia unclassifiable: splenic diffuse red pulp small B-cell lymphoma and hairy cell leukemia variant. Although not always encountered in the spleen, lymphoplasmacytic lymphoma, a B-cell lymphoproliferative disorder consisting of a dual population of both clonal B-cells and plasma cells and the frequent presence of the MYD88 L265P mutation, is another CD5-CD10-LPD that can be seen in the spleen. Distinction of these different entities is possible through careful evaluation of morphologic, immunophenotypic, cytogenetic, and molecular features, as well as peripheral blood and bone marrow specimens. A firm understanding of this group of low-grade B-cell lymphoproliferative disorders is necessary for accurate diagnosis leading to optimal patient management.
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Gonzalez RS, Raza A, Propst R, Adeyi O, Bateman J, Sopha SC, Shaw J, Auerbach A. Recent Advances in Digestive Tract Tumors: Updates From the 5th Edition of the World Health Organization "Blue Book". Arch Pathol Lab Med 2021; 145:607-626. [PMID: 32886739 DOI: 10.5858/arpa.2020-0047-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The World Health Organization Classification of Tumours: Digestive System Tumors, 5th edition, was published in 2019 and shows several impactful changes as compared with the 4th edition published in 2010. Changes include a revised nomenclature of serrated lesions and revamping the classification of neuroendocrine neoplasms. Appendiceal goblet cell adenocarcinoma is heavily revised, and intrahepatic cholangiocarcinoma is split into 2 subtypes. New subtypes of colorectal carcinoma and hepatocellular carcinoma are described. Precursor lesions are emphasized with their own entries, and both dysplastic and invasive lesions are generally recommended to be graded using a 2-tier system. Hematolymphoid tumors, mesenchymal tumors, and genetic tumor syndromes each have their own sections in the 5th edition. New hematolymphoid lesions include monomorphic epitheliotropic intestinal T-cell lymphoma; duodenal-type follicular lymphoma; intestinal T-cell lymphoma, not otherwise specified; and indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. This paper will provide an in-depth look at the changes in the 5th edition as compared with the 4th edition. OBJECTIVE.— To provide a comprehensive, in-depth update on the World Health Organization classification of digestive tumors, including changes to nomenclature, updated diagnostic criteria, and newly described entities. DATA SOURCES.— The 5th edition of the World Health Organization Classification of Tumours: Digestive System Tumours, as well as the 4th edition. CONCLUSIONS.— The World Health Organization has made many key changes in its newest update on tumors of the digestive system. Pathologists should be aware of these changes and incorporate them into their practice as able or necessary.
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Auerbach A, Aguilera NS. Overview of Gastrointestinal Lymphoproliferative disorders ✰. Semin Diagn Pathol 2021; 38:1-5. [PMID: 33714627 DOI: 10.1053/j.semdp.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 11/11/2022]
Abstract
Lymphoproliferative processes which occur in the gastrointestinal tract range from benign reactive processes such as follicular hyperplasia (rectal tonsil) to high grade malignant lymphomas and histiocytic sarcoma. The WHO Classification of Tumors: Digestive System Tumors, 5th Edition was published in 2019 and shows several impactful changes as compared to the 4th Edition published in 2010. WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues 2017 also included detailed changes in hematopoietic neoplasms within the gastrointestinal tract. New entities or renamed hematolymphoid lesions include monomorphic epitheliotropic intestinal T-cell lymphoma, duodenal-type follicular lymphoma, intestinal T-cell lymphoma, NOS and indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. A brief overview of WHO classification of digestive tumors and WHO classification of tumors of hematopoietic and lymphoid tissue is discussed focusing on the changes in the most recent WHO texts. In depth discussions will be presented in other papers in this series.
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Auerbach A, Schmieg JJ, Aguilera NS. Pediatric Lymphoid and Histiocytic Lesions in the Head and Neck. Head Neck Pathol 2021; 15:41-58. [PMID: 33723759 PMCID: PMC7959275 DOI: 10.1007/s12105-020-01257-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/19/2020] [Indexed: 12/31/2022]
Abstract
Lymphoid and histiocytic lesions of the head and neck in pediatric patients is a fascinating topic as most of these lesions are benign, but that the neoplastic cases are essential to diagnose accurately for appropriate treatment. It is thought that 90% of children will have palpable lymph nodes between the ages of 4 to 8; most, but not all, are non-malignant and some resolve spontaneously without treatment. This paper will look at many of the benign and malignant lesions of both lymphocytic and histiocytic origin that present in the head and neck of children focusing on their diagnostic criteria. There is a very pertinent discussion of nonmalignant lymphoid proliferations, as infections and other reactive conditions dominate the pathology of pediatric lymphohistiocytic head and neck lesions. Discussion of those lymphomas which arise more frequently in the head and neck focuses on those seen in children and young adults such as classic Hodgkin lymphoma and Burkitt lymphoma, as well as new more controversial entities such as pediatric-type follicular lymphoma. Histiocytic lesions, both benign and malignant, are described and may be challenging to diagnose.
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Ramsey T, Athey A, Auerbach A, Turner R, Williams N, Jean-Louis G, Killgore WD, Wills CC, Grandner MA. 0226 Sleep Duration and Symptoms Associated with Race/Ethnicity in Elite Collegiate Athletes. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Previous studies have documented sleep disparities in the general population. Given the increased interest in sleep among athletes, and the degree to which demographics and schedules among athletes differ from the general population, this analysis aims to examine the relationship between race/ethnicity and sleep duration and symptoms among elite college athletes.
Methods
Data were obtained from N=189 Division-1 collegiate athletes across a wide range of sports played. Race/ethnicity was self-reported and categorized as Non-Hispanic White, Black/African-American, Hispanic/Latino, Asian, and American Indian/Alaskan Native. Outcomes of interest included self-reported typical sleep duration (in hours), CESD depression score, and frequency of sleep symptoms, assessed using items from the Sleep Disorders Symptom Check List (difficulty falling asleep, difficulty staying asleep, early morning awakenings, tiredness, sleepiness, loud snoring, choking/gasping, fragmentation, hypnogogic/pompic hallucinations, sleep paralysis, and nightmares). Sleep duration and depression were evaluated with linear regression, and symptoms were evaluated as ordinal. Covariates included age and sex.
Results
Compared to Non-Hispanic Whites, Blacks/African-Americans reported less sleep (B=-0.80, p<0.0005), more depression (B=2.85, p=0.046), more difficulty maintaining sleep (oOR=2.12, p=0.034), early morning awakenings (oOR=3.15, p=0.001), and sleepiness (oOR=2.11, p=0.048); Hispanic/Latinos reported more hypnogogic/pompic hallucinations (oOR=2.90, p=0.007), sleep paralysis (oOR=2.72, p=0.026), and nightmares (oOR=2.22, p=0.035); Asians reported more depression (B=4.46, p=0.028), sleepiness (oOR=5.06, p=0.003), loud snoring (oOR=4.71, p=0.018), and sleep paralysis (oOR=3.57, p=0.031); and American Indians/Alaskan Natives reported less sleep (B=-1.00, p=0.018).
Conclusion
Racial/ethnic differences in sleep duration and sleep symptoms were seen among athletes. Future studies will be needed to replicate and further explain these findings.
Support
The REST study was funded by an NCAA Innovations grant. Dr. Grandner is supported by R01MD011600
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Abdi H, Athey A, Auerbach A, Turner R, Killgore WD, Wills CC, Grandner MA. 0240 College Football Players Compared to Other Collegiate Athletes: Symptoms of Insufficient Sleep Duration, Insomnia, and Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
College athletes experience frequent sleep disturbances. Data from professional football players suggests high rates of sleep apnea symptoms. Little data is available on college football players, especially compared to other athletes.
Methods
Data were obtained from N=189 NCAA Division-I student athletes, including N=45 football players). Outcomes of interest came from the Sleep Disorders Symptom Check List (SDSCL) which rated symptoms on a frequency scale of 0: never and 4: >5 times/week. Symptoms evaluated were daytime tiredness, any snoring, loud snoring, breathing pauses during sleep, and waking up choking/gasping sleep apnea), as well as difficulty falling asleep, difficulty with nighttime awakenings, and early morning awakenings (insomnia). Other outcomes include self-reported sleep duration, Insomnia Severity Index, frequency of caffeine use, and frequency of use of medications to help with sleep. Linear and ordinal logistic regression analyses were adjusted for age, sex, year in school, socioeconomic status, and mood. Post-hoc analyses examined men only.
Results
Regarding sleep apnea symptoms, football players reported more snoring (oOR=3.14, p=0.01), loud snoring (oOR=4.38, p=0.008), breathing pauses (oOR=5.42, p=0.0499), and choking/gasping (oOR=8.51), but not daytime tiredness. Regarding insufficient sleep, football players reported no difference in sleep duration but decreased caffeine use (oOR=0.27, p=0.002). Regarding insomnia, football players showed no difference in ISI scores or insomnia symptoms, but increased likelihood of sleeping pill use (oOR=3.01, p=0.03). When analyses were restricted to men only, all of these relationships were maintained.
Conclusion
College football athletes may exhibit different sleep symptoms than other college athletes, as they exhibit more sleep apnea-related symptoms, without the increase in daytime symptoms, such as tiredness.
Support
The REST study was funded by an NCAA Innovations grant.
Dr. Grandner is supported by R01MD011600
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Clay MA, Athey A, Charest J, Auerbach A, Turner RW, Killgore WD, Wills CC, Grandner MA. 0236 Team-Based Athletes Sleep Less Than Individual Athletes, But Do Not Report More Insomnia or Fatigue. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Collegiate student-athletes face challenges balancing academics and athletics, and getting an adequate amount of sleep is one factor that can assist in sustaining an elite level of play. Team-based sports may present with systematically different sets of demands.
Methods
Data were obtained at the start of the academic semester from N=189 NCAA Division-1 athletes from a wide range of sports. The sample was 46% female. Individuals were classified as playing in a team sport (e.g., football, basketball, baseball, softball, volleyball) or an individual sport (e.g., swimming, track, golf). Sleep-related outcomes included self-reported sleep duration and sleep latency, frequency of sleeping pill use (Never, Rarely, Sometimes, Often), Insomnia Severity Index score, and Fatigue Severity Scale score. Regression analyses were adjusted for age and sex.
Results
In adjusted analyses, team-based athletes reported 22.4 minutes less sleep than individual athletes (95%CI -42.8,-1.9; p<0.05). They also reported 5.6 less minutes of sleep latency (95%CI -10.8,-0.3; p<0.05). More frequent sleeping pill use was also reported (oOR=0.96; 95%CI: 0.26,1.67; p=0.007). They did not report any differences in insomnia or daytime fatigue levels.
Conclusion
These results suggest that even though team-based athletes may not report more sleep complaints or daytime complaints, they may be at increased risk for less sleep and more sleep medication. Further work is needed to identify the sources of these differences to guide interventions.
Support
The REST study was funded by an NCAA Innovations grant.
Dr. Grandner is supported by R01MD011600
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Abstract
T-cell lymphoproliferative processes in the spleen are rare and it is important to study normal T cell subsets in the spleen to understand the splenic milieu in which they arise. True malignant T-cell processes including hepatosplenic T-cell lymphoma and T-cell large granular lymphocytic leukemia occur in the spleen, but other atypical reactive T-cell proliferations and those of uncertain significance also have been described. Proper distinction of florid T cell responses from malignant T-cell neoplasms has important therapeutic implications for the patient.
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Delaloge S, Cella D, Ye Y, Buyse M, Chan A, Barrios CH, Holmes FA, Mansi J, Iwata H, Ejlertsen B, Moy B, Chia SKL, Gnant M, Smichkoska S, Ciceniene A, Martinez N, Filipović S, Ben-Baruch NE, Joy AA, Langkjer ST, Senecal F, de Boer RH, Moran S, Yao B, Bryce R, Auerbach A, Fallowfield L, Martin M. Effects of neratinib on health-related quality of life in women with HER2-positive early-stage breast cancer: longitudinal analyses from the randomized phase III ExteNET trial. Ann Oncol 2019; 30:567-574. [PMID: 30689703 DOI: 10.1093/annonc/mdz016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We report longitudinal health-related quality-of-life (HRQoL) data from the international, randomized, double-blind, placebo-controlled phase III ExteNET study, which demonstrated an invasive disease-free survival benefit of extended adjuvant therapy with neratinib over placebo in human epidermal growth factor receptor-2-positive early-stage breast cancer. PATIENTS AND METHODS Women (N = 2840) with early-stage HER2-positive breast cancer who had completed trastuzumab-based adjuvant therapy were randomly assigned to neratinib 240 mg/day or placebo for 12 months. HRQoL was an exploratory end point. Patients completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) and EuroQol 5-Dimensions (EQ-5D) questionnaires at baseline and months 1, 3, 6, 9, and 12. Changes from baseline were compared using analysis of covariance with no imputation for missing values. Sensitivity analyses used alternative methods. Changes in HRQoL scores were regarded as clinically meaningful if they exceeded previously reported important differences (IDs). RESULTS Of the 2840 patients (intention-to-treat population), 2407 patients were evaluable for FACT-B (neratinib, N = 1171; placebo, N = 1236) and 2427 patients for EQ-5D (neratinib, N = 1186; placebo, N = 1241). Questionnaire completion rates exceeded 85%. Neratinib was associated with a decrease in global HRQoL scores at month 1 compared with placebo (adjusted mean differences: FACT-B total, -2.9 points; EQ-5D index, -0.02), after which between-group differences diminished at later time-points. Except for the FACT-B physical well-being (PWB) subscale at month 1; all between-group differences were less than reported IDs. The FACT-B breast cancer-specific subscale showed small improvements with neratinib at months 3-9, but all were less than IDs. Sensitivity analyses exploring missing data did not change the results. CONCLUSIONS Extended adjuvant neratinib was associated with a transient, reversible decrease in HRQoL during the first month of treatment, possibly linked to treatment-related diarrhea. With the exception of the PWB subscale at month 1, all neratinib-related HRQoL changes did not reach clinically meaningful thresholds. ClinicalTrials.gov: NCT00878709.
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Borch WR, Aguilera NS, Brissette MD, O'Malley DP, Auerbach A. Practical Applications in Immunohistochemistry: An Immunophenotypic Approach to the Spleen. Arch Pathol Lab Med 2019; 143:1093-1105. [PMID: 30917045 DOI: 10.5858/arpa.2018-0211-cp] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Even though immunohistochemistry is routinely used by pathologists, evaluation of immunohistochemistry in splenic lesions remains difficult for many. Classification of benign and splenic lesions often requires a combination of hematoxylin-eosin evaluation, immunophenotyping, and sometimes molecular testing. Immunohistochemical staining is essential in evaluating many splenic lesions, and requires an understanding of the normal compartments of the spleen. OBJECTIVE.— To address different immunohistochemical features used for identification and subclassification of different lesions of the spleen, as well as in the normal compartments of the spleen. DATA SOURCES.— The information outlined in this review article is based on our experiences with a variety of spleen cases, on the current World Health Organization classification of hematopoietic and lymphoid tumors, and on a review of English-language articles published during 2018. CONCLUSIONS.— Features for phenotyping normal spleen as well as a variety of splenic lesions, including littoral cell angioma and splenic marginal zone lymphoma, are discussed. Suggested immunopanels are provided to assist in the diagnosis of different lesions of the spleen.
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Aguilera NS, Auerbach A. Hamartoma, choristomas and malformation of the spleen and lymph node. Semin Diagn Pathol 2018; 36:16-23. [PMID: 30482418 DOI: 10.1053/j.semdp.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Auerbach A, Rogers S. IMPLEMENTING STEADI IN A HOSPITAL DISCHARGE SETTING: TRANSLATION IN A DIGITAL HEALTH ENVIRONMENT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sudhan DR, Schwarz LJ, Guerrero-Zotano AL, Nixon M, Formisano L, Croessmann S, Gonzalez Ericsson PI, Sanders ME, Balko JM, Avogadri-Connors F, Cutler RE, Lalani AS, Bryce R, Auerbach A, Arteaga CL. Abstract P1-13-08: Extended adjuvant neratinib/fulvestrant blocks ER/HER2 crosstalk and maintains complete responses of ER+/HER2+ tumors following treatment with chemotherapy and anti-HER2 therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neratinib is a potent, irreversible pan-HER tyrosine kinase inhibitor. The phase III trial ExteNET showed improved disease-free survival in patients (pts) with HER2+ breast cancer treated with neratinib vs placebo after trastuzumab-based adjuvant therapy. The benefit from neratinib appeared to be greater in pts with ER+ tumors. Thus, we sought to elucidate mechanisms that may explain the benefit from extended adjuvant therapy with neratinib in pts with ER+/HER2+ breast cancer using a human-in-mouse model that simulates the clinical outcomes seen in ExteNET.
Results: Mice with established ER+/HER2 amplified MDA-361 tumors were treated with trastuzumab (tz) + paclitaxel (pac) for 4 weeks, and then randomized to fulvestrant (fulv) ± neratinib for 4 weeks. All MDA-361 tumors exhibited a prompt and marked reduction in volume after tz/pac treatment; 10 mice achieved a complete response (CR) before receiving 'extended adjuvant' therapy with fulv (n=5) or neratinib/fulv (n=5). A CR was maintained with neratinib/fulv following tz/pac. However, mice treated with fulv alone, relapsed rapidly (p<0.05 at week 8) despite of a complete downregulation of tumor ER levels. In a second experiment, nude mice with established MDA-361 xenografts were treated with pertuzumab/tz/pac for 4 weeks. Following a CR, mice were randomized to neratinib/fulv vs. fulv. Again, mice treated with neratinib/fulv maintained a CR, while mice in the fulv alone arm exhibited tumor progressions within a week. In three ER+/HER2+ cell lines (MDA-361, BT474 and UACC893) but not in ER+/HER– MCF7 cells, treatment with neratinib induced ER reporter transcriptional activity whereas treatment with fulv resulted in an increase in HER2 phosphorylation, suggesting compensatory crosstalk between the ER and HER2 pathways. To further understand the molecular basis of this crosstalk, MDA-361 tumor-bearing mice were treated with either fulv, neratinib or the combination for 7 days, after which tumors were harvested and analyzed using a Nanostring breast cancer ER panel consisting of 196 ER-regulated genes. Compared to vehicle or fulv-treated tumors, tumors treated with neratinib alone and neratinib/fulv showed marked downregulation of cyclin D1 mRNA expression. Similarly, in MDA-361, BT474 and UACC893 cells but not in MCF7 cells, only neratinib/fulv downregulated cyclin D1, P-AKT and P-ERK. Finally, treatment with neratinib/fulv but not fulv alone reduced cyclin D1 transcriptional reporter activity and cyclin D1 protein levels, and induced cell cycle arrest, suggesting double blockade is required to overcome compensatory crosstalk between ER and amplified HER2.
Conclusions: Neratinib/fulv but not fulv alone maintained complete responses of ER+/HER+ tumors following treatment with tz/pac or pertuzumab/tz/pac, reminiscent of the results in ExteNET. Neratinib treatment promoted ER transcriptional activity whereas ER downregulation with fulv was associated with increased HER2 signaling. In ER+/HER2+ breast cancer cells and tumors, neratinib/fulv synergistically inhibited growth, cyclin D1 expression, and AKT and MAPK activation, thus providing a plausible mechanism to explain the results in the ExteNET trial.
Citation Format: Sudhan DR, Schwarz LJ, Guerrero-Zotano AL, Nixon M, Formisano L, Croessmann S, Gonzalez Ericsson PI, Sanders ME, Balko JM, Avogadri-Connors F, Cutler RE, Lalani AS, Bryce R, Auerbach A, Arteaga CL. Extended adjuvant neratinib/fulvestrant blocks ER/HER2 crosstalk and maintains complete responses of ER+/HER2+ tumors following treatment with chemotherapy and anti-HER2 therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-08.
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Aguilera N, Auerbach A. Epstein-Barr Virus (EBV) associated reactive and indeterminate lymphoid proliferations in the lymph node. Semin Diagn Pathol 2017; 35:54-60. [PMID: 29174725 DOI: 10.1053/j.semdp.2017.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kligerman SJ, Auerbach A, Franks TJ, Galvin JR. Castleman Disease of the Thorax: Clinical, Radiologic, and Pathologic Correlation: From the Radiologic Pathology Archives. Radiographics 2017; 36:1309-32. [PMID: 27618318 DOI: 10.1148/rg.2016160076] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Castleman disease is a complex lymphoproliferative disease pathologically divided into two subtypes, the hyaline vascular variant (HVV) and the plasma cell variant (PCV). The HVV is the most common, is thought to represent a benign neoplasm of lymph node stromal cells, and is treated with surgical resection. It is most commonly found in the mediastinum, where it classically appears as a unicentric, avidly enhancing mass at computed tomography (CT) and magnetic resonance imaging. This appearance can mimic other avidly enhancing mediastinal masses, and location, clinical history, laboratory data, and nuclear medicine single photon emission CT (SPECT) and positron emission tomography (PET) studies can help narrow the differential diagnosis. Multicentric Castleman disease (MCD), which in the majority of cases is composed of the PCV, is an aggressive lymphoproliferative disorder associated with human herpesvirus infection, interleukin 6 dysregulation, and other systemic disorders. While it can be difficult to differentiate MCD from lymphoma, the presence of avidly enhancing lymph nodes can suggest the diagnosis. The purpose of this article is to review the clinical, immunologic, and pathologic findings associated with both unicentric Castleman disease and MCD and discuss how the imaging findings correlate with the pathophysiology of the disease.
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Poran S, Nguyen-Duc T, Auerbach A, Dupuis N, Frydman A, Bourgeois O. Quantum criticality at the superconductor-insulator transition revealed by specific heat measurements. Nat Commun 2017; 8:14464. [PMID: 28224994 PMCID: PMC5322500 DOI: 10.1038/ncomms14464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/03/2017] [Indexed: 11/09/2022] Open
Abstract
The superconductor–insulator transition (SIT) is considered an excellent example of a quantum phase transition that is driven by quantum fluctuations at zero temperature. The quantum critical point is characterized by a diverging correlation length and a vanishing energy scale. Low-energy fluctuations near quantum criticality may be experimentally detected by specific heat, cp, measurements. Here we use a unique highly sensitive experiment to measure cp of two-dimensional granular Pb films through the SIT. The specific heat shows the usual jump at the mean field superconducting transition temperature marking the onset of Cooper pairs formation. As the film thickness is tuned towards the SIT, is relatively unchanged, while the magnitude of the jump and low-temperature specific heat increase significantly. This behaviour is taken as the thermodynamic fingerprint of quantum criticality in the vicinity of a quantum phase transition. To detect thermodynamic signatures of quantum fluctuations for quantum phase transitions is challenging. Here, Poran et al. report a significant increase in the specific heat when the thickness of granular Pb films approaches a superconductor-insulator transition.
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Aguilera N, Auerbach A. Extra-adrenal myelolipoma presenting in the spleen: A report of two cases. HUMAN PATHOLOGY: CASE REPORTS 2016. [DOI: 10.1016/j.ehpc.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Abstract
An overview of the pathology of extranodal lymphoma is presented. The emphasis of this presentation is on the classification system of extranodal lymphomas, including both B-cell and T-cell lymphomas, based on their morphology, phenotype, and molecular alterations.
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