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Orozco JIJ, Valdez BJ, Matsuba C, Simanonok MP, Ensenyat-Mendez M, Ramiscal JAB, Salomon MP, Takasumi Y, Grumley JG. Biological effects of intraoperative radiation therapy: histopathological changes and immunomodulation in breast cancer patients. Front Immunol 2024; 15:1373497. [PMID: 38720889 PMCID: PMC11076837 DOI: 10.3389/fimmu.2024.1373497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Intraoperative radiation therapy (IORT) delivers a single accelerated radiation dose to the breast tumor bed during breast-conserving surgery (BCS). The synergistic biologic effects of simultaneous surgery and radiation remain unclear. This study explores the cellular and molecular changes induced by IORT in the tumor microenvironment and its impact on the immune response modulation. Methods Patients with hormone receptor (HR)-positive/HER2-negative, ductal carcinoma in situ (DCIS), or early-stage invasive breast carcinoma undergoing BCS with margin re-excision were included. Histopathological evaluation and RNA-sequencing in the re-excision tissue were compared between patients with IORT (n=11) vs. non-IORT (n=11). Results Squamous metaplasia with atypia was exclusively identified in IORT specimens (63.6%, p=0.004), mimicking DCIS. We then identified 1,662 differentially expressed genes (875 upregulated and 787 downregulated) between IORT and non-IORT samples. Gene ontology analyses showed that IORT was associated with the enrichment of several immune response pathways, such as inflammatory response, granulocyte activation, and T-cell activation (p<0.001). When only considering normal tissue from both cohorts, IORT was associated with intrinsic apoptotic signaling, response to gamma radiation, and positive regulation of programmed cell death (p<0.001). Using the xCell algorithm, we inferred a higher abundance of γδ T-cells, dendritic cells, and monocytes in the IORT samples. Conclusion IORT induces histological changes, including squamous metaplasia with atypia, and elicits molecular alterations associated with immune response and intrinsic apoptotic pathways. The increased abundance of immune-related components in breast tissue exposed to IORT suggests a potential shift towards active immunogenicity, particularly immune-desert tumors like HR-positive/HER2-negative breast cancer.
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Affiliation(s)
- Javier I. J. Orozco
- Saint John’s Cancer Institute, Providence Saint John’s Health Center, Santa Monica, CA, United States
| | - Betsy J. Valdez
- Saint John’s Cancer Institute, Providence Saint John’s Health Center, Santa Monica, CA, United States
| | - Chikako Matsuba
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michael P. Simanonok
- Center for Cardiovascular Analytics, Research and Data Science, Providence Research Network, Portland, OR, United States
| | - Miquel Ensenyat-Mendez
- Cancer Epigenetics Laboratory at the Cancer Cell Biology Group, Institut d’Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
| | - Judi Anne B. Ramiscal
- Department of Surgical Oncology, Arrowhead Regional Medical Center & California University of Science and Medicine, Colton, CA, United States
| | - Matthew P. Salomon
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Yuki Takasumi
- Department of Pathology, Providence Saint John’s Health Center, Santa Monica, CA, United States
| | - Janie G. Grumley
- Saint John’s Cancer Institute, Providence Saint John’s Health Center, Santa Monica, CA, United States
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Humphries C, Petty DR, Li W. Complex Fibroadenoma with Pronounced Squamous Metaplasia: A Rare Case Report, Differential Diagnostic Considerations, and Associated Breast Cancer Risk. Int J Surg Pathol 2021; 30:227-231. [PMID: 34516324 DOI: 10.1177/10668969211035842] [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: 11/17/2022]
Abstract
Squamous metaplasia of the breast is a rare and unusual finding. A number of benign and malignant differential entities exist when squamous cells are present in a breast lesion. Our patient was found to have pronounced squamous metaplasia and keratin cysts arising in a complex fibroadenoma. The rare nature of squamous metaplasia arising in such a lesion poses some diagnostic challenges, as squamous epithelium and squamous metaplasia in the breast may raise suspicion for malignancy. Herein we present a unique case and discussion of benign and malignant differential entities. We also retrospectively reviewed a series of complex fibroadenomas in our institution, including the demographic and histologic features, and more importantly the associated breast cancer risk.
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Affiliation(s)
| | | | - Wencheng Li
- 12280Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
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Ginter PS, Ng J, Zhuo R, Swistel AJ, D'Alfonso TM. Exuberant Squamous Metaplasia with Calcification Following Intraoperative Radiotherapy for Breast Carcinoma: Report of an Unusual Case and Retrospective Review of Cases from a Single Institution. Breast J 2016; 23:267-274. [PMID: 27900811 DOI: 10.1111/tbj.12733] [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: 11/30/2022]
Abstract
Intraoperative radiotherapy (IORT) is a novel and increasingly utilized radiation technique in the treatment of breast carcinoma. There are few reports on the histologic changes seen in breast tissue from patients who have undergone IORT. We sought to evaluate the histologic changes observed in specimens received following IORT, as well as report an unusual case which prompted our study. A retrospective review of patients who received IORT and subsequently had breast tissue histologically evaluated at our institution was performed. Fifteen post-IORT specimens from 12 patients, including the patient from the reported case, were studied. We report a case of a 77-year-old woman found to have mammographic microcalcifications at the lumpectomy site 6 months following lumpectomy and IORT for ductal carcinoma in situ (DCIS). A stereotactic biopsy showed abundant desquamated anucleate squamous cells with calcification and keratin material associated with squamous metaplasia of ducts. Carcinoma was not present. The predominant findings in the post-IORT specimens were fat necrosis and scar (n = 5), recurrent invasive carcinoma (n = 5), surgical site changes (n = 3), abscess (n = 1), and exuberant squamous metaplasia with calcification (n = 1). Five of fifteen (33%) post-IORT specimens showed squamous metaplasia, all of which were collected within 6 months of IORT delivery. The morphologic changes observed after IORT are similar to those seen after external beam radiotherapy. Exuberant squamous metaplasia is an uncommon consequence of IORT; however, pathologists should be aware of this phenomenon and review a history of prior intraoperative radiation before raising concern for malignancy.
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Affiliation(s)
- Paula S Ginter
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - John Ng
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Rebecca Zhuo
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | | | - Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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Chai SM, Kavangh S, Ooi SS, Sterrett GF, Cull G, Plunkett M, Spagnolo D, Amanuel B, Joske D, Leslie C, Barham T, Frost F. Anaplastic large-cell lymphoma associated with breast implants: A unique entity within the spectrum of peri-implant effusions. Diagn Cytopathol 2014; 42:929-38. [DOI: 10.1002/dc.23152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 03/09/2014] [Accepted: 03/13/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Siaw Ming Chai
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Simon Kavangh
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Sin Sin Ooi
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Gregory F. Sterrett
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - Gavin Cull
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Myfanwy Plunkett
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Dominic Spagnolo
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - Benhur Amanuel
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - David Joske
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - Connull Leslie
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Tony Barham
- Perth Medical Laboratories; Fremantle Western Australia Australia
| | - Felicity Frost
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
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Lui PCW, Tse GMK, Tan PH, Jayaram G, Putti TC, Chaiwun B, Chan NHL, Lau PPL, Mak KL, Khin AT. Fine-needle aspiration cytology of metaplastic carcinoma of the breast. J Clin Pathol 2006; 60:529-33. [PMID: 16798932 PMCID: PMC1994547 DOI: 10.1136/jcp.2006.039412] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Metaplastic carcinoma of the breast encompasses a heterogeneous group of tumours with variable components of sarcomatoid, squamous or poorly differentiated carcinomas. AIM To review a series of 19 cytological preparations of metaplastic carcinomas to assess diagnostic cytological features. METHODS 17 cases of fine-needle aspirates of histologically proven metaplastic carcinomas (4 monophasic spindle cell carcinomas, 4 squamous cell carcinomas and 11 biphasic tumours) were reviewed, with an emphasis on the presence of poorly differentiated carcinoma, squamous cell carcinoma, atypical spindle cells, benign stromal fragments and necrosis. RESULTS All cases were diagnosed as malignant, with 68% of cases showing moderate to high cellularity, and 47% showing necrosis. If the tumours were analysed according to the constituting components histologically, 7, 15 and 8 cases, respectively, possess poorly differentiated carcinoma cells, sarcomatoid malignant cells and squamous carcinoma cells, whereas these components were cytologically identified in 11, 10 and 7 cases, respectively. Dual tumour populations were identified in only 5 of the 11 biphasic carcinomas in the cytological preparations; and the stromal material was cytologically identified in the only case with chondroid stroma. CONCLUSIONS Identification of metaplastic carcinoma in cytology remains problematic. There seems to be morphological overlap between various components. The identification of dual components, unequivocal squamous carcinoma cells and chondroid stroma is helpful for diagnosis, but it is uncommon. The presence of poorly differentiated carcinoma cells with a suggestion of focal spindle morphology is another clue to the suggestion of metaplastic carcinoma.
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Affiliation(s)
- Philip C W Lui
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Imaoka T, Okamoto M, Nishimura M, Nishimura Y, Ootawara M, Kakinuma S, Tokairin Y, Shimada Y. Mammary tumorigenesis in ApcMin/+ mice is enhanced by X irradiation with a characteristic age dependence. Radiat Res 2006; 165:165-73. [PMID: 16435915 DOI: 10.1667/rr3502.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The Apc(Min/+) (Min) mouse is genetically predisposed to both intestinal and mammary tumorigenesis. We investigated age-related changes in the susceptibility of mice (before, during and after puberty) to radiation-induced mammary tumorigenesis using this model. Female Min and wild-type mice having the C57BL/6J background were irradiated with 2 Gy of X rays at 2, 5, 7 and 10 weeks and killed humanely at 18 weeks of age. Min mice irradiated at 7-10 weeks of age (after puberty) developed mammary tumors with squamous metaplasia, whereas their wild-type littermates did not. Interestingly, irradiation of Min mice at 2-5 weeks (before and during puberty, respectively) did not induce mammary tumors but rather cystic nodules with metaplasia. The mammary tumors exhibited increased nuclear beta-catenin protein and loss of the wild-type Apc allele. Our results show that susceptibility to radiation-induced mammary tumorigenesis increases after puberty in Min mice, suggesting that the tumorigenic effect of ionizing radiation targets the lobular-alveolar progenitor cells, which increase in number with age and are controlled by beta-catenin signaling.
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Affiliation(s)
- Tatsuhiko Imaoka
- Low Dose Radiation Effects Research Project, Research Center for Radiation Safety, National Institute of Radiological Sciences, Chiba, Japan.
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Abstract
Fine needle aspiration biopsy is a widely used technique for the initial diagnosis of mammary lesions. The majority of patients undergoing fine needle aspiration biopsy of a breast lesion will have a benign disease of the breast. This article provides a review of the cytomorphologic features in a variety of benign breast lesions,and discusses the commonly encountered differential diagnoses on aspiration biopsy. Topics discussed include inflammatory and reactive conditions, treatment-induced changes, pregnancy-related changes, benign proliferative lesions, and benign neoplasms of the breast.
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Affiliation(s)
- Pascale Hummel Levine
- Department of Pathology, New York University School of Medicine, New York, NY 10016, USA
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