11q13 alterations in two cases of hibernoma: large heterozygous deletions and rearrangement breakpoints near GARP in 11q13.5

Intraosseous Hibernoma: A Rare Entity in Orthopedics With Peculiar Radiological Features

Intraosseous hibernoma is a rare benign bone tumor derived from brown fat. It is typically found in the axial skeleton and is more commonly observed in women. It can manifest as a painful lesion or may be incidentally discovered. Intraosseous hibernoma often presents as a sclerotic lesion, although it can also manifest as a lytic lesion. Due to its varied radiographic appearance, it should be considered in the differential diagnosis of bone lesions as it can mimic metastatic lesions as well as other sclerotic and lytic bone lesions. Therefore, obtaining a biopsy of the lesion is crucial for an accurate diagnosis. In this report, we present the clinical, radiological, and histopathological findings of two cases of intraosseous hibernoma and provide a concise overview based on a review of the literature.

Analysis of the Relative Importance of Stand Structure and Site Conditions for the Productivity, Species Diversity, and Carbon Sequestration of Cunninghamia lanceolata and Phoebe bournei Mixed Forest

Forest stand structure (the characteristics and interrelationships of live trees) and site conditions (the physical and environmental characteristics of a specific location) have been linked to forest regeneration, nutrient cycling, wildlife habitat, and climate regulation. While the effects of stand structure (i.e., spatial and non-spatial) and site conditions on the single function of Cunninghamia lanceolata and Phoebe bournei (CLPB) mixed forest have been studied in previous studies, the relative importance of stand structure and site conditions in terms of productivity, species diversity, and carbon sequestration remains unresolved. In this study, a structural equation model (SEM) was adopted to analyze the relative importance of stand structure and site conditions for the forest productivity, species diversity, and carbon sequestration of CLPB mixed forest in Jindong Forestry in Hunan Province. Our research demonstrates that site conditions have a greater influence on forest functions than stand structure, and that non-spatial structures have a greater overall impact on forest functions than spatial structures. Specifically, the intensity of the influence of site conditions and non-spatial structure on functions is greatest for productivity, followed by carbon sequestration and species diversity. In contrast, the intensity of the influence of spatial structure on functions is greatest for carbon sequestration, followed by species diversity and productivity. These findings provide valuable insights for the management of CLPB mixed forest in Jindong Forestry and have significant reference value for the close-to-natural forest management (CTNFM) of pure Cunninghamia lanceolata forests.

Beyond the "3 Ps": A critical appraisal of the non-endocrine manifestations of multiple endocrine neoplasia type 1

Multiple endocrine neoplasia type 1 (MEN1), an autosomal-dominantly inherited tumor syndrome, is classically defined by tumors arising from the "3 Ps": Parathyroids, Pituitary, and the endocrine Pancreas. From its earliest descriptions, MEN1 has been associated with other endocrine and non-endocrine neoplastic manifestations. High quality evidence supports a direct association between pathogenic MEN1 variants and neoplasms of the skin (angiofibromas and collagenomas), adipose tissue (lipomas and hibernomas), and smooth muscle (leiomyomas). Although CNS tumors, melanoma, and, most recently, breast cancer have been reported as MEN1 clinical manifestations, the published evidence to date is not yet sufficient to establish causality. Well-designed, multicenter prospective studies will help us to understand better the relationship of these tumors to MEN1, in addition to verifying the true prevalence and penetrance of the well-documented neoplastic associations. Nevertheless, patients affected by MEN1 should be aware of these non-endocrine manifestations, and providers should be encouraged always to think beyond the "3 Ps" when treating an MEN1 patient.

CD10 (neprilysin) expression: a potential adjunct in the distinction of hibernoma from morphologic mimics

Although the morphologic diagnosis of hibernoma is usually straightforward, some hibernomas have atypical morphologic features, mimicking atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLs). In addition, the multivacuolated brown fat cells may be mistaken for lipoblasts by pathologists, especially those without significant soft tissue tumor exposure. Thus, we continue to receive in consultation cases of hibernoma sent for MDM2 fluorescence in situ hybridization testing to exclude ALT/WDL. Testing hibernomas for MDM2 amplification, however, adds cost and delays the final diagnosis. Recently, we have noted expression of neprilysin (CD10, CALLA), a zinc-dependent metalloproteinase involved in the inactivation of various peptide hormones, in brown fat cells, and wished to explore the potential utility of this widely available, inexpensive ancillary test in the differential diagnosis of hibernoma. Formalin-fixed, paraffin-embedded tissue sections from well-characterized cases of hibernoma (n = 48), brown fat (n = 21), ALTs/WDLs (n = 17), pleomorphic liposarcomas (PLPSs) (n = 6), lipomas (n = 5), and fat necrosis (n = 5) were immunostained for CD10, using a commercially available antibody and routine laboratory protocols. CD10 expression was evaluated in both adipocytes and in surrounding stromal cells. The hibernomas occurred in 28 men and 20 women, ranging from 11 to 76 years of age and involved the extremities (n = 25), pelvis (n = 7), abdomen/pelvis/retroperitoneum (n = 7), head and neck region (n = 6), back (n = 2), and chest (n = 1). All showed diffuse, strong CD10 expression in multivacuolated brown fat cells and in the majority of adjacent univacuolated fat cells. Brown adipose tissue from various anatomic structures showed an identical pattern of immunoreactivity. In contrast, CD10 expression was present in the adipocytes of only 3 of 17 (18%) ALTs/WDLs and was absent in lipomas and fat necrosis. Lipoblasts expressed CD10 in 3 PLPSs. Expression of CD10 by surrounding fibroblastic stromal cells was more widespread, present in 13 hibernomas, 10 ALTs/WDLs, 1 instance of fat necrosis, 6 PLPSs, and 4 examples of brown fat. We conclude that immunohistochemistry for CD10 may represent a useful, rapid and inexpensive ancillary test in the differential diagnosis of hibernoma from potential morphologic mimics, especially when morphologic features favor hibernoma. CD10 expression in adipocytes, however, should be rigorously distinguished from fibroblastic stromal cell CD10 expression, a nonspecific finding.

Immunoregulatory functions and the therapeutic implications of GARP-TGF-β in inflammation and cancer

GARP (glycoprotein-A repetitions predominant) is a type I transmembrane cell surface docking receptor for latent transforming growth factor-β (TGF-β) that is abundantly expressed on regulatory T lymphocytes and platelets. GARP regulates the availability of membrane-bound latent TGF-β and modulates its activation. For this reason, GARP expression on immune and non-immune cells is involved in maintaining peripheral tolerance. It plays an important role in preventing inflammatory diseases such as allergy and graft versus host disease (GvHD). GARP is also frequently hijacked by cancer cells to promote oncogenesis. This review summarizes the most important features of GARP biology described to date including gene regulation, protein expression and mechanism in activating latent TGF-β, and the function of GARP in regulatory T cell biology and peripheral tolerance, as well as GARP’s increasingly recognized roles in platelet-mediated cancer immune evasion. The promise for GARP-targeted strategy as a novel immunotherapy of cancer is also highlighted.

Transcription profiles of the responses of chicken bursae of Fabricius to IBDV in different timing phases

Background

Infectious bursal disease virus (IBDV) infection causes immunosuppression in chickens and increases their susceptibility to secondary infections. To explore the interaction between host and IBDV, RNA-Seq was applied to analyse the transcriptional profiles of the responses of chickens’ bursas of Fabricius in the early stage of IBDV infection.

Results

The results displayed that a total of 15546 genes were identified in the chicken bursa libraries. Among the annotated genes, there were 2006 and 4668 differentially expressed genes in the infection group compared with the mock group on day 1 and day 3 post inoculation (1 and 3 dpi), respectively. Moreover, there were 676 common up-regulated and 83 common down-regulated genes in the bursae taken from the chickens infected with IBDV on both 1 and 3 dpi. Meanwhile, there were also some characteristic differentially expressed genes on 1 and 3 dpi. On day 1 after inoculation with IBDV, host responses mainly displayed immune response processes, while metabolic pathways played an important role on day three post infection. Six genes were confirmed by quantitative reverse transcription-PCR.

Conclusions

In conclusion, the differential gene expression profile demonstrated with RNA-Seq might offer a better understanding of the molecular interactions between host and IBDV during the early stage of infection.

Electronic supplementary material

The online version of this article (doi:10.1186/s12985-017-0757-x) contains supplementary material, which is available to authorized users.

Well-Differentiated Liposarcoma With Hibernoma-Like Morphology

Well-differentiated liposarcoma (WDL) can show a morphologic spectrum, including lipoma-like, sclerosing and inflammatory subtypes. It does not metastasize but can dedifferentiate, acquiring metastatic potential. Hibernomas are benign neoplasms that show variable differentiation toward brown fat, and can sometimes occur in the abdomen or retroperitoneum. We illustrate a case of retroperitoneal WDL that showed extensive hibernoma-like morphology, with sheets of multivacuolated adipocytes of varying sizes, with abundant cytoplasm and numerous lipid vacuoles or granular eosinophilic cytoplasm. However, very focally there were fibrous septa containing spindle cells with enlarged, hyperchromatic, mildly pleomorphic nuclei. Further sampling showed areas of typical WDL, with lobules of mature fat intersected by fibrous septa containing atypical, enlarged spindle cells, as well as small foci of dedifferentiation. Immunohistochemistry for CDK4 and p16 showed strong and diffuse nuclear expression in the hibernoma-like areas, and fluorescence in situ hybridization showed MDM2 gene amplification, all in keeping with WDL. We highlight hibernoma-like morphology as part of the histologic spectrum of WDL, and recognition of this variant is important for correct treatment and prognostication.

Mammary Hibernoma: A Rare Entity

Hibernoma arising in the breast is rare and may present as an asymptomatic mass or may be detected by screening mammography. Four histologic types have been identified: typical, myxoid variant, spindle cell variant, and the lipoma-like variant. The most common "typical variant" is composed of pale to eosinophilic multivacuolated cells with interspersed univacuolar cells. Hibernomas are universally benign and are not known to recur or have an aggressive behavior, even in incompletely excised lesions. Hence, their clinical importance lies in distinguishing them from other benign and malignant breast neoplasms as well as inflammatory conditions that come into the histologic or radiologic differential. This review discusses the clinical features, radiologic and histopathologic characteristics, ancillary studies, suggested pathogenesis, differential diagnosis, and treatment of and prognosis for these uncommon lesions.

Mesenchymal stromal cells express GARP/LRRC32 on their surface: effects on their biology and immunomodulatory capacity

Mesenchymal stromal cells (MSCs) represent a promising tool for therapy in regenerative medicine, transplantation, and autoimmune disease due to their trophic and immunomodulatory activities. However, we are still far from understanding the mechanisms of action of MSCs in these processes. Transforming growth factor (TGF)-β1 is a pleiotropic cytokine involved in MSC migration, differentiation, and immunomodulation. Recently, glycoprotein A repetitions predominant (GARP) was shown to bind latency-associated peptide (LAP)/TGF-β1 to the cell surface of activated Foxp3⁺ regulatory T cells (Tregs) and megakaryocytes/platelets. In this manuscript, we show that human and mouse MSCs express GARP which presents LAP/TGF-β1 on their cell surface. Silencing GARP expression in MSCs increased their secretion and activation of TGF-β1 and reduced their proliferative capacity in a TGF-β1-independent manner. Importantly, we showed that GARP expression on MSCs contributed to their ability to inhibit T-cell responses in vitro. In summary, we have found that GARP is an essential molecule for MSC biology, regulating their immunomodulatory and proliferative activities. We envision GARP as a new target for improving the therapeutic efficacy of MSCs and also as a novel MSC marker. Stem Cells2015;33:183–195

Genomic copy number imbalances associated with bone and non-bone metastasis of early-stage breast cancer

The aim of this study is to identify and validate copy number aberrations in early-stage primary breast tumors associated with bone or non-bone metastasis. Whole-genome molecular inversion probe arrays were used to evaluate copy number imbalances (CNIs) in breast tumors from 960 early-stage patients with information about site of metastasis. The CoxBoost algorithm was used to select metastasis site-related CNIs and to fit a Cox proportional hazards model. Gains at 1q41 and 1q42.12 and losses at 1p13.3, 8p22, and Xp11.3 were significantly associated with bone metastasis. Gains at 2p11.2, 3q21.3-22.2, 3q27.1, 10q23.1, and 14q13.2-3 and loss at 7q21.11 were associated with non-bone metastasis. To examine the joint effect of CNIs and clinical predictors, patients were stratified into three risk groups (low, intermediate, and high) based on the sum of predicted linear hazard ratios. For bone metastasis, the hazard (95 % confidence interval) for the low-risk group was 0.32 (0.11-0.92) compared to the intermediate-risk group and 2.99 (1.74-5.11) for the high-risk group. For non-bone metastasis, the hazard for the low-risk group was 0.34 (0.17-0.66) and 2.33 (1.59-3.43) for the high-risk group. The prognostic value of loss at 8p22 for bone metastasis and gains at 10q23.1 for non-bone metastasis, and gain at 11q13.5 for both bone and non-bone metastases were externally validated in 335 breast tumors pooled from four independent cohorts. Distinct CNIs are independently associated with bone and non-bone metastasis for early-stage breast cancer patients across cohorts. These data warrant consideration for tailoring surveillance and management of metastasis risk.

Case of hibernoma in the right supraclavicular fossa

A patient with a supraclavicular mass originally diagnosed as a lipoma who was referred to a plastic surgeon for definitive treatment is presented. Gross intraoperative findings were inconsistent with lipoma, and subsequent pathological evaluation revealed the mass to be a hibernoma (a benign, brown adipose tumour). The incidence, etiology, presentation, pathology and imaging characteristics of this somewhat rare soft tissue tumour are reviewed.

Intrascrotal lipoblastoma in a ten year old: case report and review of literature

Lipoblastoma is a rare benign soft tissue tumor encountered almost exclusively in infancy and early childhood. The location of tumors varies, but most occur in the extremities, trunk, head and neck. Less frequently, lipoblastomas have been reported in the mediastinum, the retroperitoneum and the inguinal region. Only 7 cases of lipoblastoma in the scrotum have been reported so far in the English literature, with none of the patients older than 8. We report an intrascrotal lipoblastoma in a 10 year-old boy. The differential diagnosis is discussed with reference to the literature.

Contributions of cytogenetics and molecular cytogenetics to the diagnosis of adipocytic tumors

Over the last 20 years, a number of tumor-specific chromosomal translocations and associated fusion genes have been identified for mesenchymal neoplasms including adipocytic tumors. The addition of molecular cytogenetic techniques, especially fluorescence in situ hybridization (FISH), has further enhanced the sensitivity and accuracy of detecting nonrandom chromosomal translocations and/or other rearrangements in adipocytic tumors. Indeed, most resent molecular cytogenetic analysis has demonstrated a translocation t(11;16)(q13;p13) that produces a C11orf95-MKL2 fusion gene in chondroid lipoma. Additionally, it is well recognized that supernumerary ring and/or giant rod chromosomes are characteristic for atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma, and amplification of 12q13–15 involving the MDM2, CDK4, and CPM genes is shown by FISH in these tumors. Moreover, myxoid/round cell liposarcoma is characterized by a translocation t(12;16)(q13;p11) that fuses the DDIT3 and FUS genes. This paper provides an overview of the role of conventional cytogenetics and molecular cytogenetics in the diagnosis of adipocytic tumors.

Concomitant deletions of tumor suppressor genes MEN1 and AIP are essential for the pathogenesis of the brown fat tumor hibernoma

Hibernomas are benign tumors with morphological features resembling brown fat. They consistently display cytogenetic rearrangements, typically translocations, involving chromosome band 11q13. Here we demonstrate that these aberrations are associated with concomitant deletions of AIP and MEN1, tumor suppressor genes that are located 3 Mb apart and that underlie the hereditary syndromes pituitary adenoma predisposition and multiple endocrine neoplasia type I. MEN1 and AIP displayed a low expression in hibernomas whereas the expression of genes up-regulated in brown fat--PPARA, PPARG, PPARGC1A, and UCP1--was high. Thus, loss of MEN1 and AIP is likely to be pathogenetically essential for hibernoma development. Simultaneous loss of two tumor suppressor genes has not previously been shown to result from a neoplasia-associated translocation. Furthermore, in contrast to the prevailing assumption that benign tumors harbor relatively few genetic aberrations, the present analyses demonstrate that a considerable number of chromosome breaks are involved in the pathogenesis of hibernoma.

GARP (LRRC32) is essential for the surface expression of latent TGF-beta on platelets and activated FOXP3+ regulatory T cells

TGF-beta family members are highly pleiotropic cytokines with diverse regulatory functions. TGF-beta is normally found in the latent form associated with latency-associated peptide (LAP). This latent complex can associate with latent TGFbeta-binding protein (LTBP) to produce a large latent form. Latent TGF-beta is also found on the surface of activated FOXP3(+) regulatory T cells (Tregs), but it is unclear how it is anchored to the cell membrane. We show that GARP or LRRC32, a leucine-rich repeat molecule of unknown function, is critical for tethering TGF-beta to the cell surface. We demonstrate that platelets and activated Tregs co-express latent TGF-beta and GARP on their membranes. The knockdown of GARP mRNA with siRNA prevented surface latent TGF-beta expression on activated Tregs and recombinant latent TGF-beta1 is able to bind directly with GARP. Confocal microscopy and immunoprecipitation strongly support their interactions. The role of TGF-beta on Tregs appears to have dual functions, both for Treg-mediated suppression and infectious tolerance mechanism.

In vitro analysis of integrated global high-resolution DNA methylation profiling with genomic imbalance and gene expression in osteosarcoma

Genetic and epigenetic changes contribute to deregulation of gene expression and development of human cancer. Changes in DNA methylation are key epigenetic factors regulating gene expression and genomic stability. Recent progress in microarray technologies resulted in developments of high resolution platforms for profiling of genetic, epigenetic and gene expression changes. OS is a pediatric bone tumor with characteristically high level of numerical and structural chromosomal changes. Furthermore, little is known about DNA methylation changes in OS. Our objective was to develop an integrative approach for analysis of high-resolution epigenomic, genomic, and gene expression profiles in order to identify functional epi/genomic differences between OS cell lines and normal human osteoblasts. A combination of Affymetrix Promoter Tilling Arrays for DNA methylation, Agilent array-CGH platform for genomic imbalance and Affymetrix Gene 1.0 platform for gene expression analysis was used. As a result, an integrative high-resolution approach for interrogation of genome-wide tumour-specific changes in DNA methylation was developed. This approach was used to provide the first genomic DNA methylation maps, and to identify and validate genes with aberrant DNA methylation in OS cell lines. This first integrative analysis of global cancer-related changes in DNA methylation, genomic imbalance, and gene expression has provided comprehensive evidence of the cumulative roles of epigenetic and genetic mechanisms in deregulation of gene expression networks.

Complex rearrangement of chromosomes 19, 21, and 22 in Ewing sarcoma involving a novel reciprocal inversion-insertion mechanism of EWS-ERG fusion gene formation: a case analysis and literature review

EWS-ERG Ewing sarcoma (ES) gene fusions often result from complex chromosomal rearrangements. We report an unusually aggressive case of ES with an EWS-ERG fusion gene that appeared to be a result of a simple balanced and reciprocal translocation, t(19;22)(q13.2;q12.2). Subsequent molecular investigation of the primary tumor, the metastasis, and a cell line generated from this ES permitted reconstruction of each genomic step in the evolution of this complex EWS-ERG fusion. We elucidated a new mechanism of reciprocal insertion inversion between chromosome 21 and 22, involving cryptic alterations to both the ERG and EWS genes. Molecular cytogenetic investigation, using systematic analysis with locus-specific probes, identified the cognate genomic breakpoints within chromosome 21 and 22, mandatory for the excision and exchange of both 3'ERG and 3'EWS, resulting in the formation of the EWS-ERG fusion gene present on the der(22). Array comparative genomic hybridization and fluorescence in situ hybridization studies of the ES cell line derived from this tumor identified additional acquired chromosomal and genomic abnormalities, likely associated with establishment and adaptation to in vitro growth. Notably, the cell line had lost one copy of the RB1 gene within the 13q13.1 approximately q14.2 region, and also had a near-tetraploid karyotype. The significance of these findings and their relationship to other reports of variant and complex ES translocations involving the ERG gene are reviewed.

A (9;11)(q34;q13) translocation in a hibernoma

The diagnosis of hibernoma has historically been made by histopathologic examination and finding of characteristic brown fat cells with granular multivacuolated cytoplasm. The diagnosis of hibernoma may be complicated, however, because seemingly diagnostic cells could be mistakenly identified as lipoblasts, leading to the erroneous diagnosis of well-differentiated liposarcoma. Cytogenetic alterations in lipomatous tumors are well established and could be used for diagnostic purposes. Previous cytogenetic abnormalities reported in hibernomas have included alteration of 11q13 region. Here, we present a case of a hibernoma with a novel cytogenetic alteration involving a reciprocal translocation between 9q and 11q that was useful in establishing the final diagnosis.

Characterization of the myxoid variant of hibernoma

Hibernomas are rare benign neoplasms composed of brown adipose tissue. Although they were first mentioned in the literature almost a century ago, relatively few reports have documented their range of pathological features. Multivacuolated fat cells with small, central nuclei are typical features of hibernomas. Based on the nature of the stroma and the appearance of the multivacuolated cells, 4 categories of hibernomas are described: typical, lipoma-like, myxoid, and spindle cell. The myxoid variant is very rare. In this report, we present and characterize the spectrum of morphological features of the myxoid variant of hibernoma by describing the case of a 45-year-old white man who was referred to our hospital for treatment of an ovoid mass in the posterior segment of the right deltoid region. Histopathologic examination of the resected specimen revealed a multilobulated, tan-yellow, variegated tumor with a rubbery consistency that was separated by thick fibrous septa with interspersed collections of foamy histiocytes. The mass was initially diagnosed as schwannoma with degenerative changes, but workup revealed a myxoid variant of hibernoma. This report highlights recent advances that may help confirm the diagnosis and explain the differential diagnosis of this rare tumor. This is one of only a few cases of a myxoid variant of hibernoma reported in the literature.

Truncation and fusion of HMGA2 in lipomas with rearrangements of 5q32-->q33 and 12q14-->q15

Chromosome segment 12q13-->q15 recombines with many different chromosome bands in lipomas and at least ten recurrent translocations have been identified. The HMGA2 gene is often rearranged, but little is known about the molecular consequences at other breakpoints. Fusion genes between HMGA2 (12q14-->q15) and LPP (3q27-->q28), LHFP (13q12) and CMKOR1 (2q37) have been reported. In the present study, eight lipomas with rearrangements involving chromosome bands 12q14-->q15 and 5q32-->q33 were analyzed. In chromosome 5, five of the cases had a breakpoint in the 5' part of EBF in 5q33, while three cases had breakpoints located about 200 kb 3' of EBF. In chromosome 12, the breakpoints clustered to the region of HMGA2. Four cases had breaks within the gene and four had breaks 5' to HMGA2 where the gene BC058822 is located. Two versions of an HMGA2/EBF fusion transcript were detected in one case; one transcript was in frame and the other out of frame. Identical EBF/BC058822 fusion transcripts, seen in two cases, one of which also had the HMGA2/EBF transcript, were out of frame and resulted in truncation of EBF. Since EBF and HMGA2 have different orientations, the findings must be explained by complex aberrations including multiple breaks. The combined data indicate that the pathogenetically significant event is fusion, truncation or transcriptional activation of HMGA2, but it can not be excluded that EBF, which has been implicated in adipogenesis, contributes to the tumor development.

Recurrence and bleeding in hibernomas

Hibernomas are rare, benign, soft tissue tumors of brown fat. Despite being benign, we have experienced recurrent hibernomas and cases of significant bleeding at our institution. The current literature contains case reports of recurrence, and one large series that describes pathologic variants but contains little clinical data. We could not find data on bleeding. We hypothesized that recurrence is related to the resection type and/or the pathologic variant. We also postulated that atypical histologic findings correlate with excessive bleeding during excision. We sought to confirm that the MRI features of hibernomas could distinguish them from lipomas yet place them among lipomatous tumors. We retrospectively reviewed all hibernomas at our institution over 10 years. There were six hibernomas. Two were removed with a marginal excision and four with an intralesional excision. Two recurred after intralesional surgery. Histologic findings were typical for all patients. An MRI was available on only one patient and showed a fatty tumor that was distinguishable from a lipoma. Recurrences occurred after intralesional but not after marginal excisions. Histology could not predict recurrence. Hibernomas have the potential for significant bleeding during surgical excision, as seen in two of our cases.

LEVEL OF EVIDENCE

Prognostic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.