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Liu H, Yao J, Liu Y, Wu L, Tan Z, Hu J, Chen S, Zhang X, Cheng S. Diagnostic value of immune-related biomarker FAM83A in differentiating malignant from benign pleural effusion in lung adenocarcinoma. Discov Oncol 2024; 15:242. [PMID: 38914812 PMCID: PMC11196556 DOI: 10.1007/s12672-024-01109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) is frequently observed in patients with advanced lung adenocarcinoma (LUAD). Pleural fluid cytology is a less invasive procedure compared to pleural biopsy. Therefore, it is crucial to identify novel effective biomarkers for LUAD-associated pleural fluid cytology. METHODS The RNA sequencing (RNA-Seq) and clinical data of LUAD cases were downloaded from TCGA and OncoSG databases. Differential gene expression analysis, survival analysis and immune cell infiltration analysis were performed on the LUAD datasets. The expression levels of FAM83A, TFF-1, and NapsinA in 94 paired LUAD and adjacent normal tissues, and in the pleural effusion specimens of 40 LUAD and 21 non-neoplastic patients were evaluated by immunohistochemistry. RESULTS FAM83A expression levels were significantly different between the LUAD and normal tissue datasets, and correlated with overall or disease-free survival, and histological grade of the tumors. Furthermore, the in-situ expression of FAM83A was higher in 89/94 LUAD tissues compared to the paired normal tissues. FAM83A expression was significantly correlated with immune cell infiltration, and showed a positive association with macrophage infiltration. In addition, FAM83A staining was positive in 37 LUAD pleural effusion samples, and negative in 20 non-neoplastic pleural effusion samples. The expression pattern of FAM83A in the pleural effusion of LUAD patients was relatively consistent with that of TFF-1 and NapsinA, and even stronger in some specimens that were weakly positive or negative for TTF1/NapsinA. CONCLUSIONS FAM83A is a promising immune-related biomarker in LUAD biopsy specimens and pleural fluid, and can distinguish between malignant and benign pleural effusion.
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Affiliation(s)
- Hangfeng Liu
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, 610051, China
| | - Jia Yao
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610051, China
- Med-X Center for Informatics, Sichuan University, Chengdu, 610051, China
| | - Yulan Liu
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, 610051, China
| | - Liping Wu
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, 610051, China
| | - Zhiwei Tan
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, 610051, China
| | - Jie Hu
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, 610051, China
| | - Shigao Chen
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, 610051, China
| | - Xiaolin Zhang
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, 610051, China.
| | - Shuanghua Cheng
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, 610051, China.
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Saka M, Fujimoto M, Mizoguchi K, Tsujimura M, Saeki M, Hirata M, Shibuya S, Odani K, Sakurai T, Yuba Y, Moriyoshi K, Nakajima N, Sumiyoshi S, Kono F, Ono K, Shirase T, Watanabe C, Yoshizawa A, Haga H. Insulin-like Growth Factor II mRNA-binding Protein 3 is a Highly Sensitive Marker for Intravascular Large B-cell Lymphoma: Immunohistochemical Analysis of 152 Pathology Specimens From 88 Patients. Am J Surg Pathol 2024; 48:671-680. [PMID: 38497417 DOI: 10.1097/pas.0000000000002214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of aggressive extranodal large B-cell lymphoma characterized by the selective growth of lymphoma cells within the lumina of blood vessels, particularly capillaries. IVLBCL lacks mass formation, and its diagnosis can be challenging. We analyzed the utility of insulin-like growth factor II mRNA-binding protein 3 (IMP3) immunohistochemistry for IVLBCL diagnosis in various organs. Double staining with paired box 5 (PAX5) was performed for validation. Overall, 152 pathological specimens (111 positive and 41 negative for IVLBCL) obtained from 88 patients with a diagnosis of IVLBCL were stained for IMP3 and IMP3/PAX5. As negative controls, 40 pathology specimens from 38 patients with no history of IVLBCL or other B-cell lymphomas were stained for IMP3, which comprised 31 benign pathological specimens from 29 patients in whom malignancy was suspected, 7 cases of appendicitis with intravascular and/or intralymphatic lymphoid proliferations, and 2 cases of intravascular natural killer/T-cell lymphoma. All mononuclear cells with cytoplasmic staining were considered positive for IMP3 expression, but expression restricted to germinal center B cells was excluded from evaluation. All 111 IVLBCL pathological specimens were positive for IMP3 and IMP3/PAX5. In addition, 11 of the 41 specimens originally diagnosed as IVLBCL-negative showed IMP3/PAX5 double-positive cells, raising the suspicion of IVLBCL. However, of the 40 negative control samples, IMP3-positive non-germinal center B cells were detected in only 2 samples ( P = 0.0131) and no intravascular IMP3-positive B cells suspicious for IVLBCL were identified. Altogether, IMP3 immunohistochemistry is a highly sensitive marker of IVLBCL and can be a helpful adjunct for IVLBCL diagnosis.
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Affiliation(s)
- Manduwa Saka
- Department of Diagnostic Pathology, Kyoto University Hospital
| | | | - Kai Mizoguchi
- Department of Diagnostic Pathology, Kyoto University Hospital
| | | | - Miho Saeki
- Department of Diagnostic Pathology, Kyoto University Hospital
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital
| | | | - Kentaro Odani
- Department of Diagnostic Pathology, Osaka Red Cross Hospital
| | - Takaki Sakurai
- Department of Diagnostic Pathology, Osaka Red Cross Hospital
| | - Yoshiaki Yuba
- Department of Pathology, Medical Research Institute, Kitano Hospital
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, National Hospital Organization Kyoto Medical Center
| | - Naoki Nakajima
- Department of Diagnostic Pathology, Toyooka Hospital, Hyogo
| | | | - Fumihiko Kono
- Department of Diagnostic Pathology, Uji-Tokushukai Medical Center, Kyoto
| | - Kazuo Ono
- Department of Diagnostic Pathology, Japanese Red Cross Wakayama Medical Center, Wakayama
| | | | - Chihiro Watanabe
- Department of Diagnostic Pathology, Takatsuki Red Cross Hospital, Osaka
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital
- Department of Diagnostic Pathology, Nara Medical University, Nara
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital
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3
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Li P, Gao C, Wei Y, Zhao X, Sun D, Lin L, Yang Y, Shao Q, Lv H. A novel frameshift mutation of the endoglin(ENG) gene causes hereditary hemorrhagic telangiectasia in a Chinese family. Eur Arch Otorhinolaryngol 2024; 281:237-243. [PMID: 37603052 DOI: 10.1007/s00405-023-08186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE Hereditary hemorrhagic telangiectasia (HHT) is a dominantly inherited disorder that involves epistaxis, mucocutaneous telangiectases, and visceral arteriovenous malformations (AVMs). This study aims to investigate the genetic causes in a Chinese family with HHT. METHODS HHT was confirmed according to Curaçao's diagnostic criteria. Three patients diagnosed with HHT and healthy members were recruited. Whole-exome sequencing (WES) and sanger sequencing were performed to define the patient's genetically pathogenic factor. RESULTS The proband presented with recurrent epistaxis, hepatopulmonary arteriovenous malformation, and adenocarcinoma. A novel frameshift mutation (c.1376_1377delAC, p.H459Lfs*41) of the ENG gene was revealed in affected individuals by WES. There was no report of this variant and predicted to be highly damaging by causing truncation of the ENG protein. CONCLUSION We report a novel variant in the ENG gene in Chinese that extends the mutational and phenotypic spectra of the ENG gene, and also demonstrates the feasibility of WES in the application of genetic diagnosis of HHT.
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Affiliation(s)
- Peng Li
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Chunhai Gao
- Department of Laboratory Medicine, Linyi People's Hospital, Linyi, China
- Key Laboratory for Laboratory Medicine of Linyi City, Linyi People's Hospital, Linyi, China
| | - Yuda Wei
- Department of Laboratory Medicine, Linyi People's Hospital, Linyi, China
- Key Laboratory for Laboratory Medicine of Linyi City, Linyi People's Hospital, Linyi, China
| | - Xiangyu Zhao
- Department of Laboratory Medicine, Linyi People's Hospital, Linyi, China.
- Key Laboratory for Laboratory Medicine of Linyi City, Linyi People's Hospital, Linyi, China.
| | - Dezhong Sun
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China
| | - Liqiang Lin
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China
| | - Yangyang Yang
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China
| | - Qiang Shao
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China
| | - Huaiqing Lv
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China.
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4
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Chen L, Davelaar J, Gaddam S, Kosari K, Nissen N, Chaux G, Lee C, Vail E, Hendifar A, Gong J, Reckamp K, Osipov A. Early Application of Next-Generation Sequencing Identifies Pancreatic Mass as Metastasis From an EGFR-Mutated Lung Adenocarcinoma. J Natl Compr Canc Netw 2022; 21:6-11. [PMID: 36395704 DOI: 10.6004/jnccn.2022.7053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
Pancreatic metastasis of primary lung adenocarcinoma is a rare occurrence, accounting for <0.3% of all pancreatic malignancies. Given that the prognosis and treatment options for primary pancreatic cancer differ greatly from pancreatic metastases from a primary site, an accurate diagnosis is critical. This report presents a unique case of a 65-year-old man who was admitted with significant unintentional weight loss, fatigue, abdominal pain, and jaundice, and found to have a pancreatic mass initially thought to be primary pancreatic adenocarcinoma and subsequently diagnosed as an EGFR-mutated lung adenocarcinoma with metastases to the pancreas via early application of next-generation sequencing (NGS). The use of NGS early in the patient's clinical course not only changed the treatment strategy but also drastically altered the prognosis. Although metastatic pancreatic adenocarcinoma has a poor prognosis and survival rate, treatment of EGFR-mutated non-small cell lung cancer with EGFR tyrosine kinase inhibitors is associated with high response rates. Importantly, our case demonstrates that timely application of NGS very early in the disease course is paramount to the diagnosis, management, and prognosis of solid malignancies.
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Affiliation(s)
- Luxi Chen
- 1Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - John Davelaar
- 1Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Srinivas Gaddam
- 2Department of Medicine, Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kambiz Kosari
- 3Department of Hepatobiliary and Pancreatic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nicholas Nissen
- 3Department of Hepatobiliary and Pancreatic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - George Chaux
- 4Department of Medicine, Pulmonary and Lung Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - Christopher Lee
- 5Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric Vail
- 6Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Hendifar
- 1Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jun Gong
- 1Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Karen Reckamp
- 1Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Arsen Osipov
- 1Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
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5
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Liang J, Chen Z, Huang Y, Bi G, Bian Y, Jin X, Zhang H, Sui Q, Zhan C, Wang Q. Signatures of malignant cells and novel therapeutic targets revealed by single-cell sequencing in lung adenocarcinoma. Cancer Med 2022; 11:2244-2258. [PMID: 35102706 PMCID: PMC9160812 DOI: 10.1002/cam4.4547] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023] Open
Abstract
Background Single‐cell transcriptomics has been used to investigate various tumors to elucidate the molecular distinction of all cell type compositions of a complex mix. Aims This study aimed to investigate malignant‐cell‐specific genes to explore diagnostic and therapeutic biomarkers using single‐cell transcriptomic data of lung adenocarcinoma. Materials & Methods 10X single‐cell RNA‐seq data of fourteen patients with lung adenocarcinoma were analyzed. Genes that expressed differentially and those with higher confidence to distinguish tumor cells from normal cells were picked out using the ROC curves. The LASSO regression method was used to select most markedly correlated genes to predict the malignancy of every single cell within a model. We also conducted further experiments to determine their roles in lung cancer in vitro. Results Twenty two thousand four hundred and ninety one tumor and 181 666 normal single cells were analyzed where 369 genes were found to be specifically expressed in single malignant cells. Seventy of them, encoding secreted or membrane‐bound proteins, showed involvement in cell‐to‐cell communications in tumor biology. KRT18 and the other six genes were identified as predictors to distinguish single malignant cells and were integrated to construct an accurate (96.1%) predicting model. Notably, IRX2, SPINK13, and CAPN8 outperformed the other four genes. Further experiments confirmed the upregulation of them in lung adenocarcinoma at both tissue and cell levels. Proliferative capacities of lung adenocarcinoma cells were attenuated by knocking‐down of either of them. However, targeting CAPN8, IRX2, or SPINK13 hardly exerted a cytotoxic effect on these cells. Discussion Apart from the current model, similar tools were still warranted using single‐cell RNA‐seq data of more types of tumors. The three genes identified as potential therapeutic targets in the present study still need to be validated in more in lung cancer. Conclusion Our model can aid the analyses of single‐cell sequencing data. CAPN8, IRX2, and SPINK13 may serve as novel targets of targeted and immune‐based therapies in lung adenocarcinoma.
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Affiliation(s)
- Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhencong Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guoshu Bi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunyi Bian
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xing Jin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huan Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qihai Sui
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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6
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Simonsen AT, Utke A, Lade-Keller J, Thomsen LW, Steiniche T, Stougaard M. A targeted expression panel for classification, gene fusion detection and PD-L1 measurements - Can molecular profiling replace immunohistochemistry in non-small cell lung cancer? Exp Mol Pathol 2022; 125:104749. [PMID: 35093316 DOI: 10.1016/j.yexmp.2022.104749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/10/2021] [Accepted: 01/22/2022] [Indexed: 11/19/2022]
Abstract
The histological classification of non-small-cell lung cancer (NSCLC) and identification of possible therapeutic targets are important for disease management. However, as biopsies are often small, with a limited amount of tumor cells, it can be challenging to obtain enough tissue for the needed number of diagnostic immunohistochemical stains and molecular analyses. In this study, we combined a small custom designed targeted expression panel with a commercial fusion transcript assay by which we were able to perform both a histological classification (transcribing the expression of the genes encoding TTF1, Napsin A, CK5/6, and the truncated P63 isoform ΔNp63 (p40) into either adenocarcinoma or squamous cell carcinoma) and an identification of fusion genes involving ALK, RET, and ROS1. The expression panel also included the PD-L1 encoding gene, CD274, in order to evaluate the PD-L1 mRNA potential for identification of patients who will benefit from immune checkpoint inhibitor treatment. We evaluated the panel using 42 NSCLC patient samples. The molecular profiling agreed with the original immunohistochemistry (IHC)-based classification in 93% of the cases. For ten of the patients, being fusion gene positive, the fusion transcripts were detected in 100%. The molecular assessment of PD-L1 also showed agreement with the original assessment made by IHC. In conclusion, this study presents a small, targeted expression panel with the potential to perform both a molecularly based histological classification and a fusion gene identification in NSCLC patients as well as identifying PD-L1 status from a very limited amount of starting material.
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Affiliation(s)
| | - Amalie Utke
- Department of Clinical Medicine, Aarhus University, Denmark
| | | | | | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Magnus Stougaard
- Department of Pathology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
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7
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Gaydarov N, Martinelli-Kläy CP, Lombardi T. A study on the immunohistochemical expression of napsin A in oral squamous cell carcinomas, intraepithelial neoplasia, and normal oral mucosa. J Histotechnol 2021; 44:139-143. [PMID: 33876717 DOI: 10.1080/01478885.2021.1894391] [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: 10/21/2022]
Abstract
Napsin A is an aspartic proteinase expressed in some types of carcinomas, such as lung adenocarcinomas and renal cell carcinomas but rarely in squamous cell carcinomas. No specific studies have been carried out focusing on napsin A antibody expression in oral squamous cell carcinomas (OSCC). The aim of this study was to investigate the reactivity of this antibody in primary OSCC. This retrospective study included 70 OSCC cases of which 31 (44.3%) presented metastasis involvement. Patient data, including age, gender, tumor location, histological grade, regional and distant metastasis, were collected. OSCC edge epithelium with intraepithelial neoplasia and healthy oral mucosa (n = 10) were included in the analysis. Sections of lung adenocarcinomas (n = 2) were used as the positive control and an immunohistochemical assay for napsin A was performed on all cases. Napsin A expression was negative in all 70 cases of OSCC, as well as in the intraepithelial neoplasia adjacent to the carcinoma area and in healthy oral mucosa epithelium. Metastatic neck lymph nodes and distant organs were also negative for napsin A. This study shows that napsin A is consistently not expressed in oral squamous cell carcinoma, or in metastatic sites of primary OSCC, intraepithelial neoplasia, and healthy oral mucosa.
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Affiliation(s)
- Nicolay Gaydarov
- Laboratory of Oral & Maxillofacial Pathology, Oral Medicine and Oral and Maxillofacial Pathology Unit, Division of Oral Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Carla P Martinelli-Kläy
- Laboratory of Oral & Maxillofacial Pathology, Oral Medicine and Oral and Maxillofacial Pathology Unit, Division of Oral Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Tommaso Lombardi
- Laboratory of Oral & Maxillofacial Pathology, Oral Medicine and Oral and Maxillofacial Pathology Unit, Division of Oral Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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8
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Singh S, Ranjan R, Prashar M, Taur N, Lohia N, Sivasubramananian R, Sundaram V, Subramananiam A. Utility of Napsin-A in diagnosis of non-small cell lung carcinomas and its addition with thyroid transcription factor-1 (TTF-1) in small biopsies of lung: Does it help in morphologically challenging situations? MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_283_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Li Z, Qian Y, Li W, Liu L, Yu L, Liu X, Wu G, Wang Y, Luo W, Fang F, Liu Y, Song F, Cai Z, Chen W, Huang W. Human Lung Adenocarcinoma-Derived Organoid Models for Drug Screening. iScience 2020; 23:101411. [PMID: 32771979 PMCID: PMC7415928 DOI: 10.1016/j.isci.2020.101411] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
Lung cancer is an extremely heterogeneous disease, and its treatment remains one of the most challenging tasks in medicine. Few existing laboratory lung cancer models can faithfully recapitulate the diversity of the disease and predict therapy response. Here, we establish 12 patient-derived organoids from the most common lung cancer subtype, lung adenocarcinoma (LADC). Extensive gene and histopathology profiling show that the tumor organoids retain the histological architectures, genomic landscapes, and gene expression profiles of their parental tumors. Patient-derived lung cancer organoids are amenable for biomarker identification and high-throughput drug screening in vitro. This study should enable the generation of patient-derived lung cancer organoid lines, which can be used to further the understanding of lung cancer pathophysiology and to assess drug response in personalized medicine. Generation of a living biobank of patient-derived lung adenocarcinoma organoids Organoid biobank encompasses most of known subtypes of adenocarcinoma Organoids maintain the histological and mutational spectrum of original tumors Tumor organoids provide a tool for biomarker identification and drug testing
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Affiliation(s)
- Zhichao Li
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China; International Cancer Center, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China; Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen, Guangdong 518035, China
| | - Youhui Qian
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Wujiao Li
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China; International Cancer Center, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China; Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen, Guangdong 518035, China
| | - Lisa Liu
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China; International Cancer Center, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China; Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen, Guangdong 518035, China
| | - Lei Yu
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China; International Cancer Center, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China; Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen, Guangdong 518035, China
| | - Xia Liu
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Guodong Wu
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Youyu Wang
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Weibin Luo
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Fuyuan Fang
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Yuchen Liu
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China; International Cancer Center, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China; Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen, Guangdong 518035, China
| | - Fei Song
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China; International Cancer Center, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China; Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen, Guangdong 518035, China
| | - Zhiming Cai
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China; Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China; International Cancer Center, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China; The First Affiliated Hospital of Shantou University, Shantou, Guangdong 515041, China; Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen, Guangdong 518035, China
| | - Wei Chen
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China; International Cancer Center, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China; The First Affiliated Hospital of Shantou University, Shantou, Guangdong 515041, China; Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen, Guangdong 518035, China.
| | - Weiren Huang
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China; Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China; International Cancer Center, Shenzhen University School of Medicine, Shenzhen, Guangdong 518060, China; The First Affiliated Hospital of Shantou University, Shantou, Guangdong 515041, China; Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen, Guangdong 518035, China.
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10
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An Algorithmic Immunohistochemical Approach to Define Tumor Type and Assign Site of Origin. Adv Anat Pathol 2020; 27:114-163. [PMID: 32205473 DOI: 10.1097/pap.0000000000000256] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immunohistochemistry represents an indispensable complement to an epidemiology and morphology-driven approach to tumor diagnosis and site of origin assignment. This review reflects the state of my current practice, based on 15-years' experience in Pathology and a deep-dive into the literature, always striving to be better equipped to answer the age old questions, "What is it, and where is it from?" The tables and figures in this manuscript are the ones I "pull up on the computer" when I am teaching at the microscope and turn to myself when I am (frequently) stuck. This field is so exciting because I firmly believe that, through the application of next-generation immunohistochemistry, we can provide better answers than ever before. Specific topics covered in this review include (1) broad tumor classification and associated screening markers; (2) the role of cancer epidemiology in determining pretest probability; (3) broad-spectrum epithelial markers; (4) noncanonical expression of broad tumor class screening markers; (5) a morphologic pattern-based approach to poorly to undifferentiated malignant neoplasms; (6) a morphologic and immunohistochemical approach to define 4 main carcinoma types; (7) CK7/CK20 coordinate expression; (8) added value of semiquantitative immunohistochemical stain assessment; algorithmic immunohistochemical approaches to (9) "garden variety" adenocarcinomas presenting in the liver, (10) large polygonal cell adenocarcinomas, (11) the distinction of primary surface ovarian epithelial tumors with mucinous features from metastasis, (12) tumors presenting at alternative anatomic sites, (13) squamous cell carcinoma versus urothelial carcinoma, and neuroendocrine neoplasms, including (14) the distinction of pheochromocytoma/paraganglioma from well-differentiated neuroendocrine tumor, site of origin assignment in (15) well-differentiated neuroendocrine tumor and (16) poorly differentiated neuroendocrine carcinoma, and (17) the distinction of well-differentiated neuroendocrine tumor G3 from poorly differentiated neuroendocrine carcinoma; it concludes with (18) a discussion of diagnostic considerations in the broad-spectrum keratin/CD45/S-100-"triple-negative" neoplasm.
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11
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Guo R, Tian Y, Zhang N, Huang H, Huang Y, Yang J. Use of dual-marker staining to differentiate between lung squamous cell carcinoma and adenocarcinoma. J Int Med Res 2019; 48:300060519893867. [PMID: 31880186 PMCID: PMC7645362 DOI: 10.1177/0300060519893867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the value of dual-marker immunostaining for detecting p40 and napsin A, and cytokeratin 5/6 (CK5/6) and thyroid transcription factor 1 (TTF1) in single sections of lung cancer tissue, for differentiating between lung squamous cell carcinoma and adenocarcinoma. METHODS Lung cancer tissue sections from 58 patients were stained by dual-marker immunostaining using a mixtures of anti-p40 and anti-napsin A, and anti-CK5/6 and anti-TTF1 primary antibodies. Sections stained with single markers were used as controls. Nuclear or cytoplasmic staining was considered as indicating positive p40 or napsin A expression, respectively, and cytoplasmic or nuclear staining was considered as indicating positive CK5/6 or TTF1 expression, respectively. RESULTS p40/napsin A and CK5/6/TTF1 dual-marker staining showed high sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of squamous cell carcinoma and adenocarcinoma respectively. There were no differences in marker expression between dual-marker and single-marker staining. CONCLUSIONS Dual-marker immunostaining is a relatively easy, time- and cost-conserving staining method for detecting two markers in a single section using one procedure and one chromogen. p40 and napsin A, and CK5/6 and TTF1 dual-marker staining were suitable for the differential diagnosis of lung squamous cell carcinoma and adenocarcinoma.
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Affiliation(s)
- Rui Guo
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Yi Tian
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Na Zhang
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Hong Huang
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Ying Huang
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
| | - Jun Yang
- Department of Pathology, The Second Affiliated Hospital, Xi'an JiaoTong University, Xi'an, Shaan'xi Province, China
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Roberts EA, Morrison LE, Behman LJ, Draganova-Tacheva R, O'Neill R, Solomides CC. Chromogenic immunohistochemical quadruplex provides accurate diagnostic differentiation of non-small cell lung cancer. Ann Diagn Pathol 2019; 45:151454. [PMID: 31923744 DOI: 10.1016/j.anndiagpath.2019.151454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 12/21/2022]
Abstract
Lung cancer is the most common cancer worldwide and has the highest mortality rate. Carcinomas comprise 95% of all lung malignancies, the vast majority of which are non-small cell lung carcinomas (NSCLC). Increasingly, the diagnosis of lung cancer is established by examination of small tissue specimens obtained by minimally invasive techniques. It is critical to employ these tissues at maximum efficiency in order to render an accurate pathologic diagnosis and to perform theranostic studies, either genomic or by immunohistochemistry, to demonstrate genetic mutations that make patients eligible for molecularly targeted agents. Currently Thyroid Transcription Factor-1 (TTF-1) and Napsin A are the most commonly used immunohistochemical (IHC) stains to identify primary lung adenocarcinoma, and p40 and cytokeratin 5/6 (CK5/6) are used for squamous cell carcinoma. IHC stains for these markers, are performed either individually (IHC brown staining) or in combination as dual immunostains (i.e. TTF-1 + Napsin A and p40 + CK5/6, utilizing brown and red chromogens). Here we present a novel, truly multiplex immunohistochemical approach that combines staining with the above four antibodies on a single tissue section utilizing four different chromogens to accurately diagnose primary lung adenocarcinomas, squamous cell carcinomas, and combined adenosquamous carcinomas of the lung. Each marker is represented by a distinct color that can be read by a pathologist, using standard, bright field microscopy. We evaluated the ability of pathologists to differentiate NSCLCs using the multiplexed assay as compared to standard, single marker per slide diaminobenzidine (DAB)-based IHC. All cases in a cohort of 264 NSCLCs showed concordance of information (including positivity of stain, intensity of stain and coverage) between single IHC stains and the multiplex assay. This new multiplex IHC offers the capability to accurately diagnose and sub-classify primary lung NSCLCs, while conserving precious tissue for additional testing.
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Affiliation(s)
- Esteban A Roberts
- Ventana Medical Systems, Inc., 1910 Innovation Park Drive, Tucson, AZ 85755, United States of America.
| | - Larry E Morrison
- Ventana Medical Systems, Inc., 1910 Innovation Park Drive, Tucson, AZ 85755, United States of America.
| | - Lauren J Behman
- Ventana Medical Systems, Inc., 1910 Innovation Park Drive, Tucson, AZ 85755, United States of America.
| | - Rossitza Draganova-Tacheva
- Penn Medicine at Chester County Hospital, Department of Pathology and Laboratory Medicine, 701 East Marshall Street, West Chester, PA 19380, United States of America.
| | - Raymond O'Neill
- Thomas Jefferson University Hospital, Department of Pathology, Philadelphia, PA, United States of America.
| | - Charalambos C Solomides
- Thomas Jefferson University Hospital, Department of Pathology, Philadelphia, PA, United States of America.
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van Zyl A, Schubert PT, Koegelenberg CFN. The utility of TTF-1, napsin A, CK5 and p63 staining in the sub-classification of non-small cell carcinoma of the lung. Cytopathology 2019; 30:586-591. [PMID: 31206846 DOI: 10.1111/cyt.12741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/16/2019] [Accepted: 06/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The potentially curative and/or palliative therapy for non-resectable lung cancer has evolved significantly over the past 2 decades. With the availability of targeted therapies, the need for precise sub-typing of non-small cell lung carcinoma (NCSLC) has become paramount. OBJECTIVES As there are few data from South Africa, we aimed to determine utility of TTF-1, napsin A, p63 and CK5 immunostaining on fine needle aspiration (FNA) cell block and formalin-fixed paraffin-embedded tissue biopsy specimens in subtyping NSCLC as adenocarcinoma and squamous cell carcinomas. METHODS All cases of NSCLC diagnosed during a 3-year period were retrospectively identified. All FNA biopsy and formalin-fixed paraffin-embedded cases that were stained with TTF-1, napsin A, CK5 and p63 were collected. A lung cancer registry was used to access and correlate clinical and radiological data. RESULTS We included 271 cases with diagnoses of adenocarcinoma of the lung (n = 201), squamous cell carcinoma of the lung (n = 53), unspecified NSCLC (n = 8) and other carcinomas (n = 9). TTF-1 and napsin A had sensitivities of 99.0% and 91.9%, respectively, positive predictive values (PPVs) of 90.8% and 90.3%, respectively, and accuracies of 91.0% for adenocarcinoma of the lung. Napsin A had a higher specificity than TTF-1 (90.2% vs 62.8%). Both CK5 and P63 had high sensitivities (95.4% and 97.9%, respectively) and negative predictive values of 96.4% and 96.8%, respectively, for squamous cell carcinoma of the lung. CK5 had a higher specificity than p63 (84.4% and 61.2%, respectively), PPV (80.4% and 70.8%, respectively) and accuracy (88.8% and 79.2%, respectively) for squamous cell carcinoma. CONCLUSION All four immunostaining methods had high sensitivities. TTF-1 and napsin A both had high PPV and diagnostic accuracy for adenocarcinoma of the lung, whereas CK5 had an equally high PPV and accuracy for squamous cell carcinoma of the lung. The specificity of napsin A for adenocarcinoma was higher than that of TTF-1. The specificity of CK5 for squamous cell carcinoma was higher than p63.
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Affiliation(s)
- Adri van Zyl
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pawel T Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Vilayvong S, Hando K, Sekine M, Luangxay T, Arounlangsy P, Xaysomphet P, Xayaphet P, Thavisouk H, Soejima Y, Kitagawa M, Sawabe M. Useful Application of Immunostaining to Malignant Pleural Effusion among Lao People in Vientiane Capital, Lao PDR. Asian Pac J Cancer Prev 2019; 20:243-248. [PMID: 30678439 PMCID: PMC6485547 DOI: 10.31557/apjcp.2019.20.1.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Pathology and laboratory medicine (PALM) services are limited in low-resource countries, such as
Lao PDR. Patients with malignant pleural effusion (MPE) are not properly diagnosed and treated in these situations.
The purpose of this study is to confirm the usefulness of immunocytochemistry in MPE to identify the histological
type and probable primary site of cancer of MPE and to discuss its usefulness in low-resource countries, such as Laos.
Methods: We retrospectively reviewed glass slides of pleural effusion sent to the Department of Pathology at the
University of Health Sciences from the central hospitals for cytological screening from January 2012 to December
2016. The cytological review, cell transfer and immunocytochemical staining were performed at Tokyo Medical and
Dental University. Among 81 cases of MPE from Laos, 66 cases of malignant tumors that contained enough tumor
cells were included in this study, and the slides were screened with 14 primary antibodies to classify the histological
type and identify the probable primary site of carcinoma. Results: Among the 66 cases, 34 cases (52%) were of female
patients, and 32 cases (48%) were of male patients. The patients’ ages ranged from 28 to 88 years with an average of 58
years. The immunocytochemical study identified 32 cases (49%) of primary lung adenocarcinoma, two cases (3%) of
malignant mesothelioma, one case (1.5%) of breast/gynecological carcinoma, one case (1.5%) of T cell lymphoma, and
one case (1.5%) of B cell lymphoma. Twenty-nine cases (43.5%) were classified as carcinoma not otherwise specified.
Pulmonary small cell carcinoma/squamous cell carcinoma and metastatic colon, prostate, and liver carcinoma were not
identified among the cases. Conclusions: Immunocytochemistry is a useful ancillary method in MPE diagnostics. This
method could be applied in the pathological laboratories in low- or middle-resource countries, such as Laos.
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Affiliation(s)
- Soulideth Vilayvong
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
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Jin L, Liu Y, Wang X, Qi X. Immunohistochemical analysis and comparison of napsin A, TTF1, SPA and CK7 expression in primary lung adenocarcinoma. Biotech Histochem 2018; 93:364-372. [PMID: 29956575 DOI: 10.1080/10520295.2018.1444790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- L Jin
- Department of Pathology, Affiliated Hospital of Jiangnan University (The Fourth People’s Hospital of WuXi), PR China
| | - Y Liu
- Department of Pathology, Affiliated Hospital of Jiangnan University (The Fourth People’s Hospital of WuXi), PR China
| | - X Wang
- Department of Pathology, Affiliated Hospital of Jiangnan University (The Fourth People’s Hospital of WuXi), PR China
| | - X Qi
- Department of Pathology, Affiliated Hospital of Jiangnan University (The Fourth People’s Hospital of WuXi), PR China
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16
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Hutchings D, Maleki Z, Rodriguez EF. Pulmonary Non-Small Cell Carcinoma With Morphologic Features of Adenocarcinoma or "Non-Small Cell Carcinoma Favor Adenocarcinoma" in Cytologic Specimens Share Similar Clinical and Molecular Genetic Characteristics. Am J Clin Pathol 2018; 149:514-521. [PMID: 29635384 DOI: 10.1093/ajcp/aqy018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Define if the presence of morphologic features of adenocarcinoma (ACA) in non-small cell lung carcinoma (NSCLC) on cytology specimens correlates with clinical and biologic features. METHODS A total of 209 cases of NSCLC diagnosed on fine-needle aspiration in a 3-year period were included. RESULTS After morphologic review, the cases were classified as ACA (n = 115), NSCLC favor ACA (n = 43), and NSCLC-not otherwise specified (NOS) (n = 18). Squamous cell (SCC) (n = 14) and NSCLC favor SCC (n = 19) were excluded from further analysis. Patients with EGFR-mutated tumors had longer overall survival than those with EGFR wild-type tumors (P = .01). When comparing cases with morphologic features of ACA, NSCLC favor ACA, and NSCLC-NOS, there were no differences in the presence or absence of tested mutations, clinical stage, or survival. CONCLUSION Patients diagnosed with pulmonary ACA, NSCLC favor ACA, or NSCLC-NOS in cytology specimens have similar clinical stage, survival, and molecular alterations.
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Affiliation(s)
- Danielle Hutchings
- From the Department of Pathology, Division of Cytopathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Zahra Maleki
- From the Department of Pathology, Division of Cytopathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Erika F Rodriguez
- From the Department of Pathology, Division of Cytopathology, Johns Hopkins School of Medicine, Baltimore, MD
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Mito JK, Conner JR, Hornick JL, Cibas ES, Qian X. SOX10/keratin dual-color immunohistochemistry: An effective first-line test for the workup of epithelioid malignant neoplasms in FNA and small biopsy specimens. Cancer Cytopathol 2018; 126:179-189. [DOI: 10.1002/cncy.21960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/18/2017] [Accepted: 12/01/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Jeffrey K. Mito
- Department of Pathology; Brigham and Women's Hospital, and Harvard Medical School; Boston Massachusetts
| | - James R. Conner
- Department of Pathology; Brigham and Women's Hospital, and Harvard Medical School; Boston Massachusetts
| | - Jason L. Hornick
- Department of Pathology; Brigham and Women's Hospital, and Harvard Medical School; Boston Massachusetts
| | - Edmund S. Cibas
- Department of Pathology; Brigham and Women's Hospital, and Harvard Medical School; Boston Massachusetts
| | - Xiaohua Qian
- Department of Pathology; Brigham and Women's Hospital, and Harvard Medical School; Boston Massachusetts
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18
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Khosravi P, Kazemi E, Imielinski M, Elemento O, Hajirasouliha I. Deep Convolutional Neural Networks Enable Discrimination of Heterogeneous Digital Pathology Images. EBioMedicine 2018; 27:317-328. [PMID: 29292031 PMCID: PMC5828543 DOI: 10.1016/j.ebiom.2017.12.026] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022] Open
Abstract
Pathological evaluation of tumor tissue is pivotal for diagnosis in cancer patients and automated image analysis approaches have great potential to increase precision of diagnosis and help reduce human error. In this study, we utilize several computational methods based on convolutional neural networks (CNN) and build a stand-alone pipeline to effectively classify different histopathology images across different types of cancer. In particular, we demonstrate the utility of our pipeline to discriminate between two subtypes of lung cancer, four biomarkers of bladder cancer, and five biomarkers of breast cancer. In addition, we apply our pipeline to discriminate among four immunohistochemistry (IHC) staining scores of bladder and breast cancers. Our classification pipeline includes a basic CNN architecture, Google's Inceptions with three training strategies, and an ensemble of two state-of-the-art algorithms, Inception and ResNet. Training strategies include training the last layer of Google's Inceptions, training the network from scratch, and fine-tunning the parameters for our data using two pre-trained version of Google's Inception architectures, Inception-V1 and Inception-V3. We demonstrate the power of deep learning approaches for identifying cancer subtypes, and the robustness of Google's Inceptions even in presence of extensive tumor heterogeneity. On average, our pipeline achieved accuracies of 100%, 92%, 95%, and 69% for discrimination of various cancer tissues, subtypes, biomarkers, and scores, respectively. Our pipeline and related documentation is freely available at https://github.com/ih-_lab/CNN_Smoothie.
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Affiliation(s)
- Pegah Khosravi
- Institute for Computational Biomedicine, Weill Cornell Medical College, NY, USA; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Ehsan Kazemi
- Yale Institute for Network Science, Yale University, New Haven, CT, USA
| | - Marcin Imielinski
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medical College, NY, USA; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, NY, USA; The New York Genome Center, NY, USA; The Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Institute for Computational Biomedicine, Weill Cornell Medical College, NY, USA; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medical College, NY, USA; The Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Iman Hajirasouliha
- Institute for Computational Biomedicine, Weill Cornell Medical College, NY, USA; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medical College, NY, USA; The Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
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Osmani L, Askin F, Gabrielson E, Li QK. Current WHO guidelines and the critical role of immunohistochemical markers in the subclassification of non-small cell lung carcinoma (NSCLC): Moving from targeted therapy to immunotherapy. Semin Cancer Biol 2017; 52:103-109. [PMID: 29183778 DOI: 10.1016/j.semcancer.2017.11.019] [Citation(s) in RCA: 476] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/21/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022]
Abstract
Recent large scale genomic studies from the Clinical Lung Cancer Genome Project have identified different driver gene mutations in the subtypes of non-small cell lung carcinoma (NSCLC). These findings not only lead to remarkable progress in targeted therapies for lung cancer patients, but also provide fundamental knowledge for the subclassification of NSCLC. More recently, the advancement and clinical application of immunotherapy have reinforced the need for the accurate subclassification of NSCLC. In 2015, the World Health Organization (WHO) and the International Association for the Study of Lung Cancer (IASLC) updated their guidelines for the subclassification of lung cancers. These guidelines emphasize: (1) the subclassification of NSCLC, (2) the critical role of molecular characterization of tumors for targeted therapy, (3) the unique terminology for subclassifying NSCLC using small biopsy specimens, and (4) the utility of IHC biomarkers in the accurate diagnosis and subclassification of lung cancer. The guidelines have significant prognostic impact on oncologic practice and patient care. In this review, we summarize the current WHO guidelines for the classification of lung cancer, discuss advancements of targeted therapy and immunotherapy, and address the utility and limitation of immunomarkers in the subclassification of NSCLC, as well as the prospective future of the field.
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Affiliation(s)
- Lais Osmani
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States
| | - Frederic Askin
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States
| | - Edward Gabrielson
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States
| | - Qing Kay Li
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States.
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Woo JS, Reddy OL, Koo M, Xiong Y, Li F, Xu H. Application of Immunohistochemistry in the Diagnosis of Pulmonary and Pleural Neoplasms. Arch Pathol Lab Med 2017. [PMID: 28644685 DOI: 10.5858/arpa.2016-0550-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A vast majority of neoplasms arising from lung or pleura are initially diagnosed based on the histologic evaluation of small transbronchial, endobronchial, or needle core biopsies. Although most diagnoses can be determined by morphology alone, immunohistochemistry can be a valuable diagnostic tool in the workup of problematic cases. OBJECTIVE - To provide a practical approach in the interpretation and immunohistochemical selection of lung/pleura-based neoplasms obtained from small biopsy samples. DATA SOURCES - A literature review of previously published articles and the personal experience of the authors were used in this review article. CONCLUSION - Immunohistochemistry is a useful diagnostic tool in the workup of small biopsies from the lung and pleura sampled by small biopsy techniques.
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Beck J, Miller MA, Frank C, DuSold D, Ramos-Vara JA. Surfactant Protein A and Napsin A in the Immunohistochemical Characterization of Canine Pulmonary Carcinomas: Comparison With Thyroid Transcription Factor-1. Vet Pathol 2017; 54:767-774. [PMID: 28578631 DOI: 10.1177/0300985817712559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Thyroid transcription factor-1 (TTF-1) is a specific and sensitive marker for canine pulmonary tumors but is also expressed in thyroid carcinomas, which commonly metastasize to lung. Napsin A and surfactant protein A (SP-A) are used in the histologic diagnosis of non-small-cell lung cancer in humans but have not been thoroughly evaluated in neoplasms of dogs. The objective of this study was to compare the efficacy of immunohistochemistry for SP-A, napsin A, and TTF-1 in the diagnosis of canine pulmonary carcinomas. TTF-1, napsin A, and SP-A antibodies were applied to 67 formalin-fixed, paraffin-embedded canine pulmonary tumors. Although each marker had good sensitivity, only 3% (2/67) of lung tumors were negative for SP-A compared with 7% (5/67) and 9% (6/67) for napsin A and TTF-1, respectively. Each antigen was detected in a greater percentage of cells of tumors with acinar or papillary patterns compared with those with squamous differentiation. SP-A immunoreactivity was absent in all 113 nonpulmonary tumors tested. Of 108 normal tissues, SP-A was detected only in lung and in 1 of 6 adrenal, 1 of 3 endometrial, and 1 of 4 hepatic sections. Based on these findings, SP-A and napsin A are useful markers of canine lung epithelial neoplasia. Of these, SP-A is the most sensitive and specific (a possible pitfall is the need to distinguish entrapped normal pulmonary epithelial cells or alveolar macrophages from neoplastic cells) and can be used in combination with TTF-1 or napsin A to improve detection and differentiation of pulmonary carcinomas from metastatic tumors in the canine lung.
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Affiliation(s)
- Jessica Beck
- 1 Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, USA.,2 Laboratory of Human Carcinogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Margaret A Miller
- 1 Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, USA
| | - Chad Frank
- 3 Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Dee DuSold
- 1 Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, USA
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Hosny Mohammed K, Ewaz A, Cohen C, Siddiqui MT. Double staining: diagnostic utility in non-small cell lung carcinoma in the era of tissue conservation. J Am Soc Cytopathol 2017; 6:170-175. [PMID: 31043270 DOI: 10.1016/j.jasc.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In an era of precision medicine distinguishing pulmonary squamous cell carcinoma (SQCC) from adenocarcinoma (ADC) is vital for treatment. Immunohistochemical (IHC) staining for p40, p63 and Cytokeratin 5 (CK5) are useful for SQCC, while TTF-1 and Napsin-A can be used for confirming ADC. Fine needle aspiration (FNA) cell blocks (CB) have limited tissue, hence, double IHC staining is helpful for tissue conservation for molecular analysis. MATERIALS AND METHODS Thirty six confirmed lung SQCC and 45 ADC CB were selected for IHC. Double staining was performed with p40/CK5 and p63/CK5 on all SQCC, and with TTF-1/Napsin-A on all ADC. Results were positive if at least 5% of malignant cells were immunoreactive for the antigen. RESULTS P40/CK5 had (92%) sensitivity, (100%) specificity, (100%) positive predictive value (PPV), (91%) negative predictive value (NPV) and an overall diagnostic accuracy of (96%). By contrast, P63/CK5 double stains showed (92%) sensitivity, (80%) specificity, (85%) PPV, (89%) NPV and (86%) overall diagnostic accuracy, respectively. TTF-1/Napsin A staining for ADC showed a sensitivity of 80%, specificity of 96%, PPV of 97%, NPV of 71% and accuracy of 85%. CONCLUSION P40/CK5 double stain has higher specificity, PPV, NPV, and overall accuracy than P63/CK5 double stain in the diagnosis of lung SQCC. TTF-1/Napsin-A double staining is a valuable marker with high specificity, PPV, and diagnostic accuracy in diagnosing lung ADC. The usage of P40/CK5 and TTF-1/Napsin-A as a panel can be recommended for characterizing non-small cell carcinoma (NSCC) of the lung and for conserving tissue for molecular testing.
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Affiliation(s)
- Kareem Hosny Mohammed
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia.
| | - Abdulwahab Ewaz
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - Cynthia Cohen
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
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Takagaki M, Kinoshita M, Nishino K, Nakano M, Adachi H, Ueno M, Kitamura M, Fujimoto Y, Tashiro K, Tomita Y, Imamura F, Yoshimine T. Downregulation of EGFR in a metastatic brain lesion of EGFR-mutated non-small cell lung cancer using a tyrosine kinase inhibitor: A case report. Oncol Lett 2017; 13:2085-2088. [PMID: 28454365 PMCID: PMC5403179 DOI: 10.3892/ol.2017.5677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 11/25/2016] [Indexed: 12/17/2022] Open
Abstract
Brain metastasis is a common complication in patients with cancer, with lung cancer being the most frequent origin of brain metastases. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have begun to serve a pivotal role in lung cancer treatment and have been reported to demonstrate anticancer activity against brain metastases by penetrating the blood-brain barrier. The present study reports, to the best of our knowledge, the first case of EGFR-mutated non-small cell lung cancer (NSCLC) brain metastasis that was surgically resected while the lesion was responding to the EGFR-TKI erlotinib. The results of the present study demonstrated that EGFR-mutated NSCLC cells were able to evade the cytotoxic effect of EGFR-TKI by downregulating EGFR expression, without exhibiting the T790M EGFR mutation.
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Affiliation(s)
- Masatoshi Takagaki
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Masakazu Nakano
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto 606-8507, Japan
| | - Hiroko Adachi
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto 606-8507, Japan
| | - Morio Ueno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 606-8507, Japan
| | - Masanori Kitamura
- Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Yasunori Fujimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Kei Tashiro
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto 606-8507, Japan
| | - Yasuhiko Tomita
- Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Leiman G. Two decades of lung cancer through the pages of Cancer Cytopathology. Cancer Cytopathol 2016; 124:375-9. [PMID: 27294407 DOI: 10.1002/cncy.21737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Gladwyn Leiman
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont
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Nishino M, Hoang MP, Della Pelle P, Morales-Oyarvide V, Huynh TG, Mark EJ, Mino-Kenudson M. Napsin A/p40 antibody cocktail for subtyping non-small cell lung carcinoma on cytology and small biopsy specimens. Cancer Cytopathol 2016; 124:472-84. [PMID: 27412420 DOI: 10.1002/cncy.21707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/30/2016] [Accepted: 02/04/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Subtyping non-small cell lung carcinomas (NSCLC) into adenocarcinoma (ACA) or squamous cell carcinoma (SQCC) is important for treatment and specimen triage for molecular studies. To preserve tissue for molecular studies in cytology/small biopsy specimens, a 2-antibody cocktail for NSCLC subtyping was developed. METHODS Markers for lung ACA (thyroid transcription factor 1 and napsin A) and SQCC (cytokeratin 5/6 and p40) were evaluated on tissue microarrays (TMAs) with 143 ACA and 98 SQCC specimens. The napsin A/p40 combination was selected for NSCLC subtyping and validated on the TMA as well as on a cohort of cell block/small biopsy specimens from 80 poorly differentiated NSCLCs. RESULTS Using TMA analysis, the napsin A-positive (+)/p40± immunophenotype identified ACA with 94% sensitivity and 100% specificity, whereas the napsin A (negative)-/p40+ immunophenotype identified SQCC with 100% sensitivity and specificity. On the validation cohort of 80 cell block and small biopsy specimens, the napsin A/p40 cocktail accurately subtyped 63 of 70 NSCLC (90%) as ACA or SQCC using the subsequent surgical resection as reference histology. Of the remaining 17 cases, 15 were classified as NSCLC-not otherwise specified based on a napsin A-/p40- immunophenotype; their corresponding resections were diagnosed as ACA (7 cases), large cell carcinoma (7 cases), or pleomorphic carcinoma (1 case). Two additional large cell carcinoma cases showed a napsin A-/p40+ or napsin A+/p40+ profile in the preoperative cell block/small biopsy sample. CONCLUSIONS A napsin A/p40 cocktail can accurately subtype NSCLC into ACA and SQCC in most cell block/small biopsy specimens of poorly differentiated NSCLC. In the minority of cases in which the napsin A/p40 immunophenotype is indeterminate, additional stains may be necessary for precise classification. Cancer Cytopathol 2016;124:472-84. © 2016 American Cancer Society.
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Affiliation(s)
- Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mai P Hoang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Tiffany G Huynh
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eugene J Mark
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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Gupta N, Sekar A, Rajwanshi A. Role of FNAC, fluid specimens, and cell blocks for cytological diagnosis of lung cancer in the present era. J Cytol 2016; 32:217-22. [PMID: 26811567 PMCID: PMC4707781 DOI: 10.4103/0970-9371.171219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cytoblocks prepared from residual tissue fluids and fine-needle aspirations can be useful adjuncts to smears for establishing a more definitive cytopathologic diagnosis. These paraffin embedded cytoblocks have been popular since these can be handled like any other histologic specimen. Rapid on-site evaluation (ROSE) can help in attaining adequate material in the cytoblock, which is a major concern to the cytopathologists. Ancillary studies can be done using cytoblocks including IHC and various molecular techniques. The opportunities for cytopathologists to influence therapy, and uncover strategies in the complex field of lung cancer are exciting and limitless especially in the presence of an adequate cytoblock
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Affiliation(s)
- Nalini Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Aravind Sekar
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
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Rodriguez EF, Monaco SE. Recent advances in the pathology and molecular genetics of lung cancer: A practical review for cytopathologists. J Am Soc Cytopathol 2016; 5:252-265. [PMID: 31042502 DOI: 10.1016/j.jasc.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/21/2016] [Accepted: 02/23/2016] [Indexed: 11/17/2022]
Abstract
Lung cancer is one of the most common causes of cancer-related death worldwide. Better understanding of the molecular genetic characteristics of non-small cell lung carcinoma (NSCLC), particularly adenocarcinoma, has opened the opportunity for targeted therapies. With the different molecular abnormalities and the different responses to new targeted therapies based on the histological subtype of NSCLC, there came a need to further classify NSCLC into squamous cell carcinoma and adenocarcinoma, and to perform the appropriate molecular testing in these different subtypes to guide management decisions. Given that approximately 70% of lung cancer patients have only small biopsies or cytology specimens available, incorporating the testing of these specimens into the cytopathology laboratory has been crucial. Herein, we review current concepts and recommendations on NSCLC subtyping and molecular testing that are relevant for the cytopathology community.
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Affiliation(s)
- Erika F Rodriguez
- Department of Pathology, Johns Hopkins University, Carnegie 469-Pathology, 600 North Wolfe Street, Baltimore, Maryland.
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Kawai T, Tominaga S, Hiroi S, Kameda K, Ogata S, Nakashima H, Ozeki Y, Nakanishi K. Expressions of Thyroid Transcription Factor-1, Napsin A, p40, p63, CK5/6 and Desmocollin-3 in Non-Small Cell Lung Cancer, as Revealed by Imprint Cytology Using a Malinol-Based Cell-Transfer Technique. Acta Cytol 2015; 59:457-64. [PMID: 26696549 DOI: 10.1159/000442659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/23/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The introduction of new therapies has made it important to differentiate between adenocarcinoma and squamous cell carcinoma. To allow the use of various immunocytochemical stains on limited materials, we tried transferring cells from a given smear to multiple slides. Using touch-preparation samples of 215 surgically resected non-small cell lung carcinomas of confirmed histologic classification (adenocarcinoma,n = 101; squamous cell carcinoma,n = 114), we performed immunocytochemistry for thyroid transcription factor-1, napsin A, p40, p63, CK5/6 and desmocollin-3, and compared cytologic staining results with the corresponding resection. METHODS We examined: (a) the expressions of the above 6 antibodies on cells transferred from touch imprints of resected specimens, the extent of staining being considered positive if more than 5% of the area was stained, and (b) the sensitivity, specificity, positive predictive value and negative predictive value for each antibody. RESULTS The histologic corresponding rate with Papanicolaou staining was only 73%. Regarding the differentiation of adenocarcinoma from squamous cell carcinoma, the sensitivity and specificity for napsin A in adenocarcinoma were 80 and 97%, respectively, while those for p40 in squamous cell carcinoma were 84 and 98%, respectively. CONCLUSION The immunocytochemical expressions of napsin A and p40 in imprint cytology seem to be of great utility for the accurate histological differentiation of lung cancers.
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Affiliation(s)
- Toshiaki Kawai
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
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Bessho H, Wong B, Huang D, Tan J, Ong CK, Iwamura M, Hart S, Dangl M, Thomas M, Teh BT. Effect of Ang-2-VEGF-A Bispecific Antibody in Renal Cell Carcinoma. Cancer Invest 2015; 33:378-86. [PMID: 26115098 DOI: 10.3109/07357907.2015.1047505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The blockade of VEGF pathway has been clinically validated as an initial treatment for renal cell carcinoma (RCC). Angiopoietin-2 (Ang-2) has been indicated as a key regulator for angiogenesis escape. The effect of a novel bispecific antibody (A2V CrossMab) against both Ang-2 and VEGF was investigated in comparison with either factor. A2V CrossMab significantly reduced tumor volume, vessel density, and interstitial fluid pressure compared to either monotherapy of anti-VEGF or anti-Ang-2. Host-derived angiogenesis-related genes have been significantly down-regulated in A2V CrossMab group. These data demonstrate that A2V CrossMab has additive anti-tumor effect for the treatment of RCC.
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Affiliation(s)
- Hideharu Bessho
- a Laboratory of Cancer Epigenome , National Cancer Centre Singapore , Singapore.,b Program in Cancer and Stem Cell Biology , Duke-NUS Graduate Medical School , Singapore.,c Department of Urology , Kitasato University School of Medicine , Kanagawa , Japan
| | - Bernice Wong
- a Laboratory of Cancer Epigenome , National Cancer Centre Singapore , Singapore.,b Program in Cancer and Stem Cell Biology , Duke-NUS Graduate Medical School , Singapore
| | - Dachuan Huang
- a Laboratory of Cancer Epigenome , National Cancer Centre Singapore , Singapore.,b Program in Cancer and Stem Cell Biology , Duke-NUS Graduate Medical School , Singapore
| | - Jing Tan
- a Laboratory of Cancer Epigenome , National Cancer Centre Singapore , Singapore.,b Program in Cancer and Stem Cell Biology , Duke-NUS Graduate Medical School , Singapore
| | - Choon Kiat Ong
- a Laboratory of Cancer Epigenome , National Cancer Centre Singapore , Singapore.,b Program in Cancer and Stem Cell Biology , Duke-NUS Graduate Medical School , Singapore
| | - Masatsugu Iwamura
- c Department of Urology , Kitasato University School of Medicine , Kanagawa , Japan
| | - Stefan Hart
- d Roche Pharma Research & Early Development , Translational Medicine Hub , Singapore , Singapore
| | - Markus Dangl
- d Roche Pharma Research & Early Development , Translational Medicine Hub , Singapore , Singapore
| | | | - Bin Tean Teh
- a Laboratory of Cancer Epigenome , National Cancer Centre Singapore , Singapore.,b Program in Cancer and Stem Cell Biology , Duke-NUS Graduate Medical School , Singapore.,f Cancer Science Institute of Singapore , National University of Singapore , Singapore
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Gurda GT, Zhang L, Wang Y, Chen L, Geddes S, Cho WC, Askin F, Gabrielson E, Li QK. Utility of five commonly used immunohistochemical markers TTF-1, Napsin A, CK7, CK5/6 and P63 in primary and metastatic adenocarcinoma and squamous cell carcinoma of the lung: a retrospective study of 246 fine needle aspiration cases. Clin Transl Med 2015; 4:16. [PMID: 25977750 PMCID: PMC4417108 DOI: 10.1186/s40169-015-0057-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/30/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fine needle aspiration (FNA) biopsy plays a critical role in the diagnosis and staging of lung primary and metastatic lung carcinoma. Accurate subclassification of adenocarcinoma (ADC) and/or squamous cell carcinoma (SqCC) is crucial for the targeted therapy. However, the distinction between ADC and SqCC may be difficult in small FNA specimens. Here, we have retrospectively evaluated the utility of TTF-1, Napsin A, CK7, P63 and CK5/6 immunohistochemical (IHC) markers in the distinguishing and subclassification of ADC and SqCC. METHODS A total of 246 FNA cases were identified by a computer search over a two-year period, including 102 primary NSCLC and 144 primary NSCLC which had metastasized to other sites. The immunostaining patterns of TTF-1, Napsin A, CK7, P63 and CK5/6 were correlated with the histological diagnosis of the tumor. RESULTS In 72 primary ADCs, TTF-1, Napsin A and CK7 showed a sensitivity and specificity of 84.5%/96.4%, 92.0%/100%, and 93.8%/50.0%. In 30 primary SqCCs, CK5/6 and P63 showed a sensitivity and specificity of 100%/77.8% and 91.7%/78.3%. In 131 metastatic ADCs, Napsin A showed the highest specificity (100%), versus TTF-1 (87.5%) and CK7 (25%) but decreased sensitivity (67.8% versus 86.9% and 100%); whereas in 13 metastatic SqCCs, CK5/6 and P63 showed a sensitivity/specificity of 100%/84.6% and 100%/68.4%. Bootstrap analysis showed that the combination of TTF-1/CK7, TTF-1/Napsin A and TTF-1/CK7/Napsin A had a sensitivity/specificity of 0.960/0.732, 0.858/0.934, 0.972/0.733 for primary lung ADCs and 0.992/0.642, 0.878/0.881, 0.993/0.618 for metastatic lung ADCs. CONCLUSIONS Our study demonstrated that IHC markers had variable sensitivity and specificity in the subclassification of primary and metastatic ADC and SqCC. Based on morphological findings, an algorithm with the combination use of markers aided in the subclassification of NSCLCs in difficult cases.
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Affiliation(s)
- Grzegorz T Gurda
- />The Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Lei Zhang
- />The Department of Pathology and Division of Cytopathology, University of Chicago Hospitals, Chicago, IL 60637 USA
| | - Yuting Wang
- />The Department of Chemistry, Magdalen College,, University of Oxford, Oxford, OX1 4 AU UK
| | - Li Chen
- />The Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Susan Geddes
- />The Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
- />Department of Pathology, The Johns Hopkins Medical Institute, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224 USA
| | - William C Cho
- />The Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, SAR China
| | - Frederic Askin
- />The Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
- />Department of Pathology, The Johns Hopkins Medical Institute, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224 USA
| | - Edward Gabrielson
- />The Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
- />Department of Pathology, The Johns Hopkins Medical Institute, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224 USA
| | - Qing Kay Li
- />The Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
- />Department of Pathology, The Johns Hopkins Medical Institute, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224 USA
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Jain D, Mathur SR, Iyer VK. Cell blocks in cytopathology: a review of preparative methods, utility in diagnosis and role in ancillary studies. Cytopathology 2014; 25:356-71. [PMID: 25113785 DOI: 10.1111/cyt.12174] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 12/19/2022]
Abstract
The cell block (CB) is a routine procedure in cytopathology that has gained importance because of its pivotal role in diagnosis and ancillary studies. There is no precise review in the published literature that deals with the various methods of preparation of CB, its utility in diagnosis, immunocytochemistry (ICC) or molecular testing, and its drawbacks. An extensive literature search on CB in cytology using internet search engines was performed for this review employing the following keywords: cell block, cytoblock, cytology, cytopathology, methods, preparation, fixatives, diagnostic yield, ancillary and molecular studies. Ever since its introduction more than a century ago, the CB technique has undergone numerous modifications to improve the quality of the procedure; however, the overall principle remains the same in each method. CBs can be prepared from virtually all varieties of cytological samples. In today's era of personalized medicine, cytological specimens, including CBs, augment the utility of cytological samples in analysing the molecular alterations as effectively as surgical biopsies or resection specimens. With the availability of molecular targeted therapy for many cancers, a large number of recent studies have used cytological material or CBs for molecular characterization. The various techniques of CB preparation with different fixatives, their advantages and limitations, and issues of diagnostic yield are discussed in this review.
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Affiliation(s)
- D Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Heymann JJ, Hoda RS, Scognamiglio T. Polyclonal Napsin A Expression: A Potential Diagnostic Pitfall in Distinguishing Primary From Metastatic Mucinous Tumors in the Lung. Arch Pathol Lab Med 2014; 138:1067-71. [DOI: 10.5858/arpa.2013-0403-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Napsin A is a useful marker for distinguishing primary from metastatic lung tumors. Mucinous lung tumors may be difficult to distinguish from metastatic mucinous tumors.
Objectives.—To evaluate napsin A expression in lung and extrapulmonary mucinous tumors on both histology and cytology specimens and to determine napsin A's utility in differentiating primary from metastatic mucinous tumors.
Design.—Napsin A immunohistochemistry was performed using a rabbit polyclonal antibody on formalin-fixed, paraffin-embedded surgical and fine-needle aspiration biopsy–derived, paraffin-embedded cell block specimens. Positive expression was defined as coarse, granular, cytoplasmic staining in 10% or more of tumor cells.
Results.—Sixteen of 32 mucinous lung tumors (50%) and 16 of 33 extrapulmonary mucinous tumors (48%), including 15 of 18 of gastrointestinal origin (83%), expressed napsin A. Positivity was concordant between surgical and cell block specimens in 5 of 9 cases (56%). In 3 of 4 discordant cases, napsin A expression was detected on the surgical specimen but not the cell block. The cell block material in these cases was paucicellular.
Conclusions.—Napsin A shows decreased sensitivity and specificity for mucinous lung tumors and is unlikely to be reliable as a sole immunohistochemical marker of lung origin for such tumors (52% specificity in this study). The high frequency of napsin A expression in gastrointestinal mucinous tumors makes it particularly unreliable in distinguishing metastatic gastrointestinal from primary lung mucinous tumors. However, napsin A expression analysis may facilitate distinguishing mucinous tumors of pulmonary from those of nongastrointestinal origin. Interpretation of napsin A staining may be problematic in mucinous tumor specimens of low cellularity such as cell blocks.
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Affiliation(s)
- Jonas J. Heymann
- From the Department of Pathology & Laboratory Medicine, NewYork-Presbyterian Hospital–Weill Cornell Medical College, New York, New York
| | - Rana S. Hoda
- From the Department of Pathology & Laboratory Medicine, NewYork-Presbyterian Hospital–Weill Cornell Medical College, New York, New York
| | - Theresa Scognamiglio
- From the Department of Pathology & Laboratory Medicine, NewYork-Presbyterian Hospital–Weill Cornell Medical College, New York, New York
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The high diagnostic accuracy of combined test of thyroid transcription factor 1 and Napsin A to distinguish between lung adenocarcinoma and squamous cell carcinoma: a meta-analysis. PLoS One 2014; 9:e100837. [PMID: 25003505 PMCID: PMC4086931 DOI: 10.1371/journal.pone.0100837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/30/2014] [Indexed: 12/14/2022] Open
Abstract
Background Accurate classification of non-small cell lung cancer (NSCLC) using morphological features has several limitations. However, the use of thyroid transcription factor 1 (TTF-1) and Napsin A as markers for the identification of various subtypes of NSCLC has shown promise. This meta-analysis was designed to evaluate the diagnostic value of combined TTF-1 and Napsin A test to distinguish lung adenocarcinoma from squamous cell carcinoma. Methods The Medline, EMBASE and Web of Science databases were searched, along with the reference lists of relevant articles (up to May 4, 2014). Ten studies containing 1,446 subjects were identified. The sensitivity, specificity, diagnostic odds ratio (DOR) and area under the summary receiver operating characteristics curve (AUC) were calculated to estimate the combined diagnostic value of TTF-1 and Napsin A. Results The pooled sensitivity and specificity were 0.76 (95% CI: 0.69–0.83) and 1.00 (95% CI: 0.92–1.00), respectively. The positive and negative likelihood ratios were 877.60 (95% CI: 8.40–91533.40) and 0.24 (95% CI: 0.18–0.32). The DOR was 3719 (95% CI: 33–414884). The AUC was 0.92 (95%CI: 0.89–0.94). The patient's location was a source of heterogeneity for sensitivity. The patient's location, the study's sample size and the threshold used to determine positive staining were consistently found to be sources of heterogeneity for specificity in subgroup analyses and meta-regression. Conclusions The combined test of TTF-1 and Napsin A presents a promising alternative method, useful to distinguish between lung adenocarcinoma and squamous cell carcinoma.
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Ma Y, Fan M, Chen K. [Significance of immunohistochemical indicators in diagnosis and prognosis of
squamous cell carcinoma and adenocarcinoma of lung]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:506-10. [PMID: 24949694 PMCID: PMC6000096 DOI: 10.3779/j.issn.1009-3419.2014.06.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yunfan Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department I of Thoracic Surgery,
Peking University Cancer Hospital, Beijing 100142, China
| | - Mengying Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department I of Thoracic Surgery,
Peking University Cancer Hospital, Beijing 100142, China
| | - Keneng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department I of Thoracic Surgery,
Peking University Cancer Hospital, Beijing 100142, China
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Guresci S, Ozmen O, Ertugrul DT, Demirag F. Utility of on-site cytological examination and cell block preparation in thyroid fine needle aspiration biopsy of metastatic carcinoma: report of two cases. Cytopathology 2014; 26:57-9. [PMID: 24750365 DOI: 10.1111/cyt.12134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Guresci
- Department of Pathology, Kecioren Training and Research Hospital, Ankara, Turkey
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Kim MY, Go H, Koh J, Lee K, Min HS, Kim MA, Jeon YK, Lee HS, Moon KC, Park SY, Kim WH, Chung DH. Napsin A is a useful marker for metastatic adenocarcinomas of pulmonary origin. Histopathology 2014; 65:195-206. [DOI: 10.1111/his.12383] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Moon-Young Kim
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
| | - Heounjeong Go
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | - Jaemoon Koh
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
| | - Kyoungbun Lee
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
| | - Hye-Sook Min
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
| | - Min-A Kim
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
| | - Yoon Kyung Jeon
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
| | - Hye-Seung Lee
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
- Department of Pathology; Seoul National University Bundang Hospital; Seongnam Gyeonggi-do South Korea
| | - Kyung-Chul Moon
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
| | - So Yeon Park
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
- Department of Pathology; Seoul National University Bundang Hospital; Seongnam Gyeonggi-do South Korea
| | - Woo-Ho Kim
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
| | - Doo Hyun Chung
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
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Zhu B, Dalal S, Kamp DW, Lin X. Warranting investigation of primary lung adenocarcinoma in patients with an extrapulmonary malignancy and lung nodules due to high frequency. Am J Clin Pathol 2014; 141:429-36. [PMID: 24515772 DOI: 10.1309/ajcp97ftjxwpfjxy] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To distinguish primary lung adenocarcinoma (PLA) from metastatic adenocarcinoma/malignancy to optimize therapy. METHODS We investigated the utility of thyroid transcription factor 1 (TTF-1) and napsin A in distinguishing PLA from metastatic adenocarcinoma/malignancy and assessed the frequency of PLA in patients with extrapulmonary malignancy/adenocarcinoma (PLA-EPM/EPA). RESULTS TTF-1 and napsin A identified PLA in PLA-EPM/ EPA with a sensitivity of 89.4% and 93.3% and a specificity of 93.9% and 94.7%, respectively. PLA was confirmedin 47.4% of PLA-EPM and 40.2% of PLA-EPA. Overall, 38.5% of patients with PLA had EPM. The common organs for PLA-EPA were breast (35.8%), colon (13.2%), and others, whereas the common organs resulting in pulmonary metastasis were the colon (32.8%), breast (28.1%), and others. A patient with a smoking history and without EPM had a higher chance of having PLA. Multiple nodules are not a reliable indication of metastatic adenocarcinoma. CONCLUSIONS Our results firmly support the role of TTF-1 and napsin A in identifying PLA-EPM/EPA. We reason that all new lung nodules in patients with a history of EPM should be screened using these techniques due to the high frequency of PLA-EPM, which will affect treatment and prognosis of patients with EPM/EPA.
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Affiliation(s)
- Bing Zhu
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University, Chicago, IL
| | - Shavari Dalal
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University, Chicago, IL
| | - David W. Kamp
- Division of Pulmonary and Critical Care Medicine, Northwestern Memorial Hospital, Northwestern University, Chicago, IL
| | - Xiaoqi Lin
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University, Chicago, IL
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Ao MH, Zhang H, Sakowski L, Sharma R, Illei PB, Gabrielson E, Askin F, Li QK. The utility of a novel triple marker (combination of TTF1, napsin A, and p40) in the subclassification of non-small cell lung cancer. Hum Pathol 2014; 45:926-34. [PMID: 24746197 DOI: 10.1016/j.humpath.2014.01.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/09/2014] [Accepted: 01/10/2014] [Indexed: 01/15/2023]
Abstract
In lung cancer, targeted therapies depend on accurate histological subclassification of the tumor. The majority of lung cancers can be subclassified based on hematoxylin and eosin staining; however, classification may be difficult in small biopsies. In this study, we investigated the utility of a newly developed triple marker (combination of TTF1/Napsin A/p40) and compared the sensitivity and specificity of this novel marker with individual markers in the subclassification of non-small cell lung carcinomas. Lung cancer tissue microarrays were constructed using surgical resection material from the Johns Hopkins Hospital. They included 77 adenocarcinomas (ADCs), 77 squamous cell carcinomas (SqCCs), and 46 cases of metastatic lung ADCs. Immunostaining patterns of all markers were scored semi-quantitatively and compared. In ADCs, the sensitivity and specificity of the triple marker were 93.5% and 77.5%, respectively. The sensitivity and specificity of TTF1 and Napsin A were 85.7% and 75.0%, and 89.6% and 90.0%. In SqCCs, the sensitivity and specificity of the triple marker were 88.3% and 92.5%, while the p40, p63 and CK5/6 showed 80.5% and 90.0%; 93.5% and 80.0%; and 89.6% and 80.0%. In addition, the sensitivity and specificity of the triple marker in metastatic ADCs showed 71.7% and 73.5%, respectively. Our triple marker (combination of TTF1/Napsin A/p40) showed a similar sensitivity and specificity for the subclassification of NSCLC when compared to individual markers. Our study not only demonstrates a useful combination of immunomarkers but also optimally conserves tissue for molecular marker testing.
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Affiliation(s)
- Ming-Hui Ao
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Hui Zhang
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Lynne Sakowski
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Rajni Sharma
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Peter B Illei
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Edward Gabrielson
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Frederic Askin
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Qing Kay Li
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA.
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Kocas O, Selcukbiricik F, Bilici A, Kanıtez M, Yildiz S, Avci S, Tanik C. Primary signet ring cell carcinoma of the lung with cerebellar metastasis showing full response to Cisplatin and docetaxel therapy. Case Rep Oncol Med 2014; 2014:968723. [PMID: 24716057 PMCID: PMC3970380 DOI: 10.1155/2014/968723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022] Open
Abstract
Introduction. Primary signet ring cell carcinoma (SRCC) of the lung is a very rare disease. We describe a new case of primary SRCC of the lung with cerebellar metastasis, which responded well to the therapeutic approach with cisplatin and docetaxel. Case Report. A 41-year-old female patient (nonsmoker) was consulted to our oncology outpatient clinic after cerebellar metastasectomy. The histopathological diagnosis was SRCC metastasis. The primary tumor was unknown. The PET-CT imaging showed a hypermetabolic mass in the right middle lobe of the lung and hypermetabolic mediastinal lymph node stations. Oesophagogastroduodenoscopy and colonoscopy showed no evidence of gastrointestinal system tumor. The clinical diagnosis of primary SRCC of the lung was made and the administration of six rounds of cisplatin and docetaxel treatment was planned. After the chemotherapy the PET-CT scan to evaluate the therapy response showed full metabolic regression of the primary tumor and the mediastinal lymph nodes. There was no evidence of new metastasis. Conclusion. Primary SRCC of the lung is a very rare disease with poor prognosis. There are not many cases in literature and no standardized chemotherapy protocols. Cisplatin and docetaxel may be a good treatment option.
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Affiliation(s)
- Onur Kocas
- Division of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey
| | - Fatih Selcukbiricik
- Division of Medical Oncology, Department of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey
| | - Ahmet Bilici
- Division of Medical Oncology, Department of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey
| | - Metin Kanıtez
- Division of Medical Oncology, Department of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey
| | - Serdar Yildiz
- Division of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey
| | - Suna Avci
- Division of Internal Medicine, Sisli Education and Research Hospital, 34200 Istanbul, Turkey
| | - Canan Tanik
- Division of Pathology, Sisli Education and Research Hospital, 34200 Istanbul, Turkey
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Surfactant protein A compared to thyroid transcription factor-1 in identifying metastatic tumors of lung origin in cytopathology. J Am Soc Cytopathol 2014; 3:261-268. [PMID: 31051680 DOI: 10.1016/j.jasc.2014.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/26/2014] [Accepted: 04/29/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Differentiating primary tumors and metastases of lung origin from other neoplasms often cannot be done on cytomorphology alone. Immunocytochemistry using markers such as thyroid transcription factor-1 (TTF-1) is employed for this purpose. Surfactant protein A (SPA) is a glycoprotein with multiple functions in the lung. There have been limited immunohistochemical studies investigating the diagnostic role of SPA. This study aimed to determine the diagnostic utility of SPA compared with that of TTF-1 in identifying tumors of lung origin in cytology samples. MATERIALS AND METHODS A total of 155 consecutive cytology specimens procured outside of the lung were analyzed, in which SPA immunohistochemistry was reported. Cases were reviewed to document final diagnoses, immunostain results (including TTF-1), and histopathology follow-up when available. RESULTS Cytoplasmic SPA immunoreactivity was identified primarily in metastatic lung adenocarcinomas (ADC). SPA was also positive in 3 carcinomas of gynecologic/breast origin. SPA and TTF-1 specificity and positive predictive value were high (>90%) with relatively low sensitivity and negative predictive value for identifying metastatic ADC of lung origin. A panel of SPA and TTF-1 correctly identified most (79.7%) lung metastatic adenocarcinomas. CONCLUSIONS SPA is a useful cytoplasmic marker to confirm lung origin in metastatic nonmucinous ADC. However, SPA is limited by having low sensitivity and being negative in up to 35% of metastatic ADCs of lung origin, whereas TTF-1 exhibited better sensitivity. SPA may rarely demonstrate false immunoreactivity in a subset of gynecologic/breast carcinomas. Employing a panel of SPA and TTF-1 has better diagnostic utility than either stain alone.
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Abstract
The importance of cytologic techniques for investigation of respiratory conditions has been recognized since the earliest days of clinical cytology. Cytology is able to detect most of mycoses and parasitic and viral infections based on the morphologic recognition of these agents. The most relevant application of lung cytology today is in the diagnosis and management of lung cancer; approximately 70% of those cancers are diagnosed at a late stage and are unresectable. This article addresses the most common ancillary techniques, such as special stains, immunocytochemistry, and molecular testing, used to refine the cytologic diagnosis of lung cancer and to guide personalized therapy.
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Value of thyroid transcription factor-1 immunostaining in tumor diagnosis: a review and update. Appl Immunohistochem Mol Morphol 2013; 20:429-44. [PMID: 22531688 DOI: 10.1097/pai.0b013e31825439bc] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Thyroid transcription factor-1 (TTF-1) is a tissue-specific transcription factor that plays a critical role in the normal development of embryonic epithelial cells of the thyroid and lung. Because TTF-1 expression is highly restricted to epithelial tumors arising in these organs, it is, at present, one of the immunohistochemical markers most commonly used to assist in the differential diagnosis of carcinomas of the lung and thyroid. Recent studies, however, have reported that TTF-1 is not as specific for lung and thyroid carcinomas as was previously thought as it can be found to be expressed, although much less frequently, in some carcinomas arising in other organs, such as the ovaries, endometrium, colon, and breast, as well as in some tumors of the central nervous system. Even though this unexpected TTF-1 positivity has been reported more frequently with the recently available SPT24 anti-TTF-1 monoclonal antibody, it has also been shown to occur with the commonly used 8G7G3/1 clone, albeit in a lower percentage of cases. Despite these findings, TTF-1 remains a very useful immunohistochemical marker in diagnostic pathology.
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Tamura K, Furuse H, Sugiyama T, Kato T, Suzuki T, Kai F, Nagata M, Otsuka A, Takayama T, Ishii Y, Mugiya S, Ozono S. [Bilateral adrenal hemorrhage due to adrenal metastasis of lung cancer]. Nihon Hinyokika Gakkai Zasshi 2013; 104:17-21. [PMID: 23457929 DOI: 10.5980/jpnjurol.104.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 58-year-old man presented with nausea and left flank pain. The patient was referred to our hospital based on clear detection of anemia and computed tomography findings of bilateral adrenal tumors with hemorrhage and a mass in the apex of the left lung. Right adrenal artery embolization had no effect on enlargement of the right adrenal hematoma or advanced anemia. Right adrenalectomy was then performed in an attempt to control hemorrhaging and make a definitive diagnosis, and the patient's anemia improved following the operation. Histopathological diagnosis suggested adrenal metastasis of lung adenocarcinoma, which was subsequently diagnosed given similarities in transbronchial biopsy findings to those in the right adrenal gland. Adrenal hemorrhage due to metastasis of lung cancer is an extremely rare condition; indeed, to our knowledge, the present case is only the 26th reported worldwide. However, prognosis for this mortal condition may be improved should patients receive adrenalectomy followed by an appropriate treatment regimen.
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Affiliation(s)
- Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine
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Ordóñez NG. Thyroid Transcription Factor-1 Is Not Expressed in Squamous Cell Carcinomas of the Lung. Appl Immunohistochem Mol Morphol 2012; 20:525-30. [DOI: 10.1097/pai.0b013e318251d8c1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Powell M, Pfannl R, Nystrom JS. Looks like lung cancer acts like colon cancer. Clin Colorectal Cancer 2012; 12:140-4. [PMID: 23083633 DOI: 10.1016/j.clcc.2012.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/26/2012] [Accepted: 09/13/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Martha Powell
- Floating Hospital for Children, Department Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA 02111, USA
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Kim MJ, Shin HC, Shin KC, Ro JY. Best immunohistochemical panel in distinguishing adenocarcinoma from squamous cell carcinoma of lung: tissue microarray assay in resected lung cancer specimens. Ann Diagn Pathol 2012; 17:85-90. [PMID: 23040737 DOI: 10.1016/j.anndiagpath.2012.07.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 07/17/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
Abstract
The emergence of the targeted therapies for non-small cell lung carcinoma (NSCLC) has generated a need for accurate histologic subtyping of NSCLC. In this study, we assessed the utility of immunohistochemical markers that could be helpful in distinction between adenocarcinoma (ADC) and squamous cell carcinoma (SCC). We performed a battery of immunohistochemistry using tissue microarray for napsin-A, Thyroid transcription factor 1 (TTF-1), p63, cytokeratin (CK) 5/6, thrombomodulin (CD141), Epithelial-related antigen (MOC-31), carcinoembryonic antigen (CEA), Cyclooxygenase 2 (COX-2), high-molecular-weight CK (HMWCK), p27kip1 (p27), and Rb protein in 129 resected primary NSCLC with 81 ADCs and 48 SCCs and 10 metastatic ADC to the lung (primary in colon, 7 cases; stomach, 2 cases; vagina, 1 case). Cases of ADC and SCC were morphologically unequivocal and solid tumors with no definite squamous or glandular differentiation were excluded for this analysis. Napsin-A and TTF-1 were positive in 81% and 70% of ADC and in 0% and 2% of SCC, respectively, whereas P63 and CK5/6 were positive in 91% and 90% of SCC and in 9% and 4% of ADC, respectively (P < .001). CD141 stained significantly higher in SCC over ADC (positive in 2% of ADC and 46% of SCC. MOC-31, CEA, COX-2, HMWCK, p27, and Rb appeared to be not useful markers in distinction between ADC and SCC because of their low specificity. None of metastatic ADC to the lung showed positive for napsin-A and TTF-1. It was evident that combination of napsin-A, TTF-1, CK5/6, and p63 was the best immunohistochemical panel in differentiating ADC from SCC of the lung in this study. CD141 appeared to be a potential new marker for SCC with high specificity. Cyclooxygenase 2, MOC-31, CEA, HMWCK, p27, and Rb showed less specificity for differentiation ADC from SCC.
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Affiliation(s)
- Mi Jin Kim
- Department of Pathology, Yeungnam University College of Medicine, Nam-gu, Daegu, South Korea.
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Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Petersen I, Roggli V, Thunnissen E, Tsao M. Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med 2012; 137:668-84. [PMID: 22970842 DOI: 10.5858/arpa.2012-0263-ra] [Citation(s) in RCA: 286] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification provides, for the first time, standardized terminology for lung cancer diagnosis in small biopsies and cytology; this was not primarily addressed by previous World Health Organization classifications. Until recently there have been no therapeutic implications to further classification of NSCLC, so little attention has been given to the distinction of adenocarcinoma and squamous cell carcinoma in small tissue samples. This situation has changed dramatically in recent years with the discovery of several therapeutic options that are available only to patients with adenocarcinoma or NSCLC, not otherwise specified, rather than squamous cell carcinoma. This includes recommendation for use of special stains as an aid to diagnosis, particularly in the setting of poorly differentiated tumors that do not show clear differentiation by routine light microscopy. A limited diagnostic workup is recommended to preserve as much tissue for molecular testing as possible. Most tumors can be classified using a single adenocarcinoma marker (eg, thyroid transcription factor 1 or mucin) and a single squamous marker (eg, p40 or p63). Carcinomas lacking clear differentiation by morphology and special stains are classified as NSCLC, not otherwise specified. Not otherwise specified carcinomas that stain with adenocarcinoma markers are classified as NSCLC, favor adenocarcinoma, and tumors that stain only with squamous markers are classified as NSCLC, favor squamous cell carcinoma. The need for every institution to develop a multidisciplinary tissue management strategy to obtain these small specimens and process them, not only for diagnosis but also for molecular testing and evaluation of markers of resistance to therapy, is emphasized.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
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Collins BT. Endobronchial ultrasound fine-needle aspiration biopsy of pulmonary non-small cell carcinoma with subclassification by immunohistochemistry panel. Cancer Cytopathol 2012; 121:146-54. [DOI: 10.1002/cncy.21222] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/20/2012] [Accepted: 06/22/2012] [Indexed: 11/09/2022]
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Desmoglein-3 and Napsin A Double Stain, a Useful Immunohistochemical Marker for Differentiation of Lung Squamous Cell Carcinoma and Adenocarcinoma From Other Subtypes. Appl Immunohistochem Mol Morphol 2012; 20:350-5. [DOI: 10.1097/pai.0b013e318245c730] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sterlacci W, Savic S, Schmid T, Oberaigner W, Auberger J, Fiegl M, Tzankov A. Tissue-sparing application of the newly proposed IASLC/ATS/ERS classification of adenocarcinoma of the lung shows practical diagnostic and prognostic impact. Am J Clin Pathol 2012; 137:946-56. [PMID: 22586054 DOI: 10.1309/ajcp77kmkjxnmpms] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The histologic subtype of non-small cell lung cancer (NSCLC) determines treatment strategies and the need for genetic analyses. Since most NSCLC are diagnosed on small biopsy or cytologic specimens, an accurate but tissue-sparing approach is necessary. To date, consensus for a general diagnostic algorithm is lacking. To test the diagnostic and clinical relevance of the recently published multidisciplinary guidelines by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society, we examined 371 surgically resected NSCLCs brought into tissue microarray format. The antibody panel thyroid transcription factor-1 (TTF-1), p63, cytokeratin (CK)5/6, and CK7 is diagnostic for most cases (>94%). Faint/focal staining for CK7 is negligible for classificatory purposes. Grading adenocarcinomas according to histologic architecture is prognostically significant (median overall survival for well/moderate differentiation, 72.5 months; for poor differentiation, 38.5 months; P = .019). Double stains combining the aforementioned nuclear and membranous markers are highly diagnostic for NSCLC, conserving tumor tissue for subsequent analyses.
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