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Jamjoum G, Alrefaei M, Alhamed W, Alsefri J, Abuzinadah A. Co-existence of malignant phylloid tumor and metaplastic malignant spindle cell carcinoma: case report. J Surg Case Rep 2024; 2024:rjae465. [PMID: 39056023 PMCID: PMC11272168 DOI: 10.1093/jscr/rjae465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Phyllodes tumors (PTs) and Metaplastic Malignant Spindle Cell Carcinoma (MMSCC) are rare and challenging breast malignancies. MMSCC is even rarer and highly aggressive. Surgical excision is the mainstay of treatment for both, but MMSCC generally carries a poorer prognosis. A 46-year-old woman with a history of breast augmentation 4 years ago presented with a rapidly progressing right breast mass. Imaging and core biopsy suggested a malignant PT. A right mastectomy with latissimus dorsi flap reconstruction was done. Initially diagnosed as a malignant PT, the post-operative pathology revealed a co-existence of malignant PT and MMSCC, an extremely rare finding. This case reports the unique challenge of a patient harboring both malignant PT and MMSCC within the same breast tissue. This exceedingly rare co-existence emphasizes the diagnostic complexities associated with uncommon breast malignancies. Our case highlights the challenges of diagnosing and managing uncommon and aggressive breast malignancies.
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Affiliation(s)
- Ghader Jamjoum
- Gastrointestinal Oncology Unit, King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia
| | - Mariya Alrefaei
- King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia
| | - Wasan Alhamed
- King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia
| | - Joud Alsefri
- Fakeeh College for Medical Sciences, Jeddah 21461, Saudi Arabia
| | - Ahmed Abuzinadah
- Biomedical Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Sun H, Ding Q, Sahin AA. Immunohistochemistry in the Diagnosis and Classification of Breast Tumors. Arch Pathol Lab Med 2023; 147:1119-1132. [PMID: 37490413 DOI: 10.5858/arpa.2022-0464-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 07/27/2023]
Abstract
CONTEXT.— In the clinical practice of breast pathology, immunohistochemistry (IHC) of different markers is widely used for the diagnosis and classification of breast lesions. OBJECTIVE.— To provide an overview of currently used and recently identified IHC stains that have been implemented in the field of diagnostic breast pathology. DATA SOURCES.— Data were obtained from literature review and clinical experience of the authors as breast pathologists. CONCLUSIONS.— In the current review, we summarize the common uses of IHC stains for diagnosing different types of breast lesions, especially invasive and noninvasive breast lesions, and benign and malignant spindle cell lesions. In addition, the cutting-edge knowledge of diagnostic carcinoma markers will lead us to further understand the different types of breast carcinoma and differentiate breast carcinomas from other carcinomas of similar morphology. Knowing the strengths and limitations of these markers is essential to the clinical practice of breast pathology.
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Affiliation(s)
- Hongxia Sun
- From the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Qingqing Ding
- From the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Aysegul A Sahin
- From the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
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Zhang X, Liang J, Du Z, Xie Q, Li T, Tang F. Comparison of nomogram with random survival forest for prediction of survival in patients with spindle cell carcinoma. J Cancer Res Ther 2022; 18:2006-2012. [PMID: 36647963 DOI: 10.4103/jcrt.jcrt_2375_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose Spindle cell carcinoma (SpCC) is a relatively rare tumor with an unfavorable prognosis. This study aimed to develop and validate a prediction model for the individual survival of patients with SpCC using Cox regression and the random survival forest (RSF) model. Methods Patients diagnosed with SpCC between 2004 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database, and randomly divided into training and validating cohorts. Cox regression and RSF were used to identify prognostic predictors and build prediction models. A nomogram based on Cox regression was constructed to predict the 1-, 3-, and 5-year survival of patients with SpCC. Internal validation was conducted using the bootstrapping method. We evaluated the discrimination accuracy and calibration of the model using Harrell's C-index and calibration plot, respectively. Results Two hundred and fifty patients diagnosed with SpCC with required information were enrolled in this study. Multivariate Cox regression and RSF identified age, primary site, grade, SEER stage, tumor size, and treatment as significant prognostic predictors of SpCC. The bootstrapped and validated C-indices were 0.812 and 0.783 for nomogram, and 0.790 and 0.768 for RSF, respectively. Calibration plot of the nomogram showed an agreement between the prediction and actual observation. Conclusions The nomogram developed in this study is a promising tool with a simplified presentation that can easily be used and interpreted by clinicians for evaluating the survival of each patient with SpCC; its performance was comparable to that of RSF. Application of such models are needed to help oncologists identify the high-risk patients and improve clinical decision making of SpCC treatment.
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Affiliation(s)
- Xiaoshuai Zhang
- Department of Data Science, School of Statistics, Shandong University of Finance and Economics, Jinan, China
| | - Jing Liang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhaohui Du
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Qi Xie
- Medical Research Center, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Ting Li
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Fang Tang
- Center for Data Science in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University; Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Yoon E, Ding Q, Hunt K, Sahin A. High-Grade Spindle Cell Lesions of the Breast: Key Pathologic and Clinical Updates. Surg Pathol Clin 2022; 15:77-93. [PMID: 35236635 DOI: 10.1016/j.path.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Most of the high-grade spindle cell lesions of the breast are malignant phyllodes tumors (MPTs), spindle cell carcinomas (SpCCs), and matrix-producing metaplastic breast carcinomas (MP-MBCs). MPTs have neoplastic spindle stromal cells and a classic leaf-like architecture with subepithelial stromal condensation. MPTs are often positive for CD34, CD117, and bcl-2 and are associated with MED12, TERT, and RARA mutations. SpCCs and MP-MBCs are high-grade metaplastic carcinomas, whereas neoplastic epithelial cells become spindled or show heterologous mesenchymal differentiation, respectively. The expression of epithelial markers must be evaluated to make a diagnosis. SAS, or rare metastatic spindle cell tumors, are seen in the breast, and clinical history is the best supporting evidence. Surgical resection is the standard of care.
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Affiliation(s)
- Esther Yoon
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA.
| | - Qingqing Ding
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 85, Room G1.3565C, Houston, TX 77030-4009, USA
| | - Aysegul Sahin
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA
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Ishizuka Y, Horimoto Y, Yanagisawa N, Arakawa A, Nakai K, Saito M. Clinicopathological Examination of Metaplastic Spindle Cell Carcinoma of the Breast: Case Series. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:11782234211039433. [PMID: 34413650 PMCID: PMC8369969 DOI: 10.1177/11782234211039433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022]
Abstract
Background: Spindle cell carcinoma (SpCC) of the breast is a rare histological type, a subtype of metaplastic carcinoma characterized by atypical spindle cell and epithelial carcinoma. The proportions of the spindle cell and epithelial components vary among tumours. Due to its rarity, biological characteristics of this disease have been poorly studied. Methods: In total, 10 patients with SpCC were surgically treated at our institution from January 2007 to December 2018. We retrospectively investigated these SpCC cases, focusing on the differences between spindle cell and epithelial components. Microsatellite status was also examined. Results: Nine cases were triple-negative breast cancer (TNBC). The rates of high tumour grade were 70% in spindle cell components and 56% in epithelial components (P = .65), while the mean Ki67 labelling index were 63% and 58%, respectively (P = .71). Mean programmed death ligand 1 (PD-L1) expression in these components was 11% and 1%, respectively (P = .20). All 10 tumours were microsatellite stable. Patient outcomes of triple-negative SpCC did not differ from those of propensity-matched patients with conventional TNBC. Conclusions: Spindle cell components showed higher values in factors examined, although there was no statistically significant difference. Our data reveal that these 2 components of SpCC may be of different biological nature.
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Affiliation(s)
- Yumiko Ishizuka
- Department of Breast Oncology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Yoshiya Horimoto
- Department of Breast Oncology, Juntendo University, School of Medicine, Tokyo, Japan.,Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan
| | | | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Katsuya Nakai
- Department of Breast Oncology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University, School of Medicine, Tokyo, Japan
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Chao X, Tan W, Tsang JY, Tse GM, Hu J, Li P, Hou J, Li M, He J, Sun P. Clinicopathologic and genetic features of metaplastic breast cancer with osseous differentiation: a series of 6 cases. Breast Cancer 2021; 28:1100-1111. [PMID: 33942253 DOI: 10.1007/s12282-021-01246-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/01/2021] [Indexed: 01/12/2023]
Abstract
AIMS Metaplastic breast cancer (MBC) comprises a heterogeneous group of tumors, of which MBC with osseous differentiation (MBC-OD) is extremely rare that only few cases have been reported. This study aimed to present the clinicopathologic and molecular features of MBC-OD. METHODS We collected 6 cases of MBC-OD from five different centers and described its clinicopathologic and molecular characteristics based on the next-generation sequencing. Another 11 cases from the literature were also reviewed to better characterize the tumor. RESULTS The tumor primarily showed an osteosarcoma-like appearance, which composed of high cellularity with spindle cells and osteoblast-like cells producing coarse lace-like neoplastic bone (4/6) or osteoid matrix (6/6). 55 somatic mutations including 39 missenses (70.9%), 9 frameshifts (16.4%), 3 splice sites (5.5%), 3 in-frame InDels (5.5%) and 1 nonsense (1.8%) were identified. TP53 was the most frequently mutated genes (5/6, 83.3%), followed by RB1 (3/6, 50.0%), BCOR (2/6, 33.3%), MED12 (2/6, 33.3%), PIK3CA (2/6, 33.3%), and TET2 (2/6, 33.3%). Genetic alterations suggesting therapies with clinical benefit, including mTOR inhibitors, tyrosine kinase inhibitors (TKI), and poly-ADP ribose polymerase inhibitor (PARPi), were observed in five cases. The median follow-up was 21 months (range, 3-80 months). Local recurrence was observed in two cases and three patients displayed distant metastasis. Two patients died of the disease at 3 months and 7 months, respectively. CONCLUSIONS Based on this series, MBC-OD is a highly aggressive breast tumor with osteosarcoma-like morphology and a high incidence of recurrent disease showing specific genetic profiles.
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Affiliation(s)
- Xue Chao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, 510080, Guangzhou, People's Republic of China
| | - Wanlin Tan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, 510080, Guangzhou, People's Republic of China
| | - Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jintao Hu
- Department of Pathology, The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, China
| | - Ping Li
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Jinghui Hou
- Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mei Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, 510080, Guangzhou, People's Republic of China
| | - Jiehua He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Department of Pathology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, 510080, Guangzhou, People's Republic of China.
| | - Peng Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Department of Pathology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, 510080, Guangzhou, People's Republic of China.
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Sprissler R, Perkins B, Johnstone L, Babiker HM, Chalasani P, Lau B, Hammer M, Mahadevan D. Rare Tumor-Normal Matched Whole Exome Sequencing Identifies Novel Genomic Pathogenic Germline and Somatic Aberrations. Cancers (Basel) 2020; 12:E1618. [PMID: 32570879 PMCID: PMC7352311 DOI: 10.3390/cancers12061618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/26/2022] Open
Abstract
Whole exome sequencing (WES) of matched tumor-normal pairs in rare tumors has the potential to identify genome-wide mutations and copy number alterations (CNAs). We evaluated 27 rare cancer patients with tumor-normal matching by WES and tumor-only next generation sequencing (NGS) as a comparator. Our goal was to: 1) identify known and novel variants and CNAs in rare cancers with comparison to common cancers; 2) examine differences between germline and somatic variants and how that functionally impacts rare tumors; 3) detect and characterize alleles in biologically relevant genes-pathways that may be of clinical importance but not represented in classical cancer genes. We identified 3343 germline single nucleotide variants (SNVs) and small indel variants-1670 in oncogenes and 1673 in tumor suppressor genes-generating an average of 124 germline variants/case. The number of somatic SNVs and small indels detected in all cases was 523:306 in oncogenes and 217 in tumor suppressor genes. Of the germline variants, six were identified to be pathogenic or likely pathogenic. In the 27 analyzed rare cancer cases, CNAs are variable depending on tumor type, germline pathogenic variants are more common. Cell fate pathway mutations (e.g., Hippo, Notch, Wnt) dominate pathogenesis and double hit (mutation + CNV) represent ~18% cases.
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Affiliation(s)
- Ryan Sprissler
- Department of Health Sciences, Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson, AZ 85721, USA;
- Arizona Research Labs, University of Arizona Genetics Core, University of Arizona, Tucson, AZ 85721, USA; (L.J.); (B.L.)
| | - Bryce Perkins
- Department of Medicine, Division of Hematology and Oncology, University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA; (B.P.); (H.M.B.); (P.C.)
| | - Laurel Johnstone
- Arizona Research Labs, University of Arizona Genetics Core, University of Arizona, Tucson, AZ 85721, USA; (L.J.); (B.L.)
| | - Hani M. Babiker
- Department of Medicine, Division of Hematology and Oncology, University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA; (B.P.); (H.M.B.); (P.C.)
- Department of Medicine—Hematology/Oncology, University of Texas Health San Antonio, Mays Cancer Center, San Antonio, TX 78229, USA
| | - Pavani Chalasani
- Department of Medicine, Division of Hematology and Oncology, University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA; (B.P.); (H.M.B.); (P.C.)
- Department of Medicine—Hematology/Oncology, University of Texas Health San Antonio, Mays Cancer Center, San Antonio, TX 78229, USA
| | - Branden Lau
- Arizona Research Labs, University of Arizona Genetics Core, University of Arizona, Tucson, AZ 85721, USA; (L.J.); (B.L.)
| | - Michael Hammer
- Department of Health Sciences, Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson, AZ 85721, USA;
- Arizona Research Labs, University of Arizona Genetics Core, University of Arizona, Tucson, AZ 85721, USA; (L.J.); (B.L.)
- Department of Medicine, Division of Hematology and Oncology, University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA; (B.P.); (H.M.B.); (P.C.)
| | - Daruka Mahadevan
- Department of Medicine—Hematology/Oncology, University of Texas Health San Antonio, Mays Cancer Center, San Antonio, TX 78229, USA
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Nozoe E, Nozoe T, Tanaka J, Ohga T, Fujita A, Sueishi K. Spindle cell carcinoma of the breast - A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 67:365-367. [PMID: 33148918 DOI: 10.2152/jmi.67.365] [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: 11/14/2022]
Abstract
Spindle cell carcinoma (SpCC) of the breast is quite a rare modality classified to the metaplastic carcinoma of the breast. Regarding its biological behavior and the prognosis of the patients with this rare tumor, it has been remaining controversial. We herein report an 88 year-old woman who had a huge bleeding tumor on the right breast. She was a high-aged woman with low activities of daily life, even with some suspicion of distant organ metastasis. While the tumor proved to drastically bleed due to the tumor disintegration, a right simple mastectomy was performed. According to the histopathologic examinations, sarcomatoid spindle cells with severe atypia were observed. By an immunohistochemical examination, the tumor had proved to express neither estrogen receptor, progesterone receptor nor HER2 receptor. Moreover an immunohistochemical expression of AE1/3 and CAM5.2, defining an epithelial neoplasm were observed in addition to an expression of vimentin. From these findings, this bleeding tumor was diagnosed as spindle cell carcinoma of the breast. J. Med. Invest. 67 : 365-367, August, 2020.
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Affiliation(s)
- Emiko Nozoe
- Department of Breast Surgery , Fukuoka Higashi Medical Center, Fukuoka, Japan
| | - Tadahiro Nozoe
- Department of Breast Surgery , Fukuoka Higashi Medical Center, Fukuoka, Japan
| | - Junko Tanaka
- Saiseikai Fukuoka General Hospital, Tanaka Junko Breast Clinic , Fukuoka Higashi Medical Center, Fukuoka, Japan
| | - Takefumi Ohga
- Department of Surgery , Fukuoka Higashi Medical Center, Fukuoka, Japan
| | - Aya Fujita
- Pathology , Fukuoka Higashi Medical Center, Fukuoka, Japan
| | - Katsuo Sueishi
- Pathology , Fukuoka Higashi Medical Center, Fukuoka, Japan
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Li Y, Zhang N, Zhang H, Yang Q. Comparative prognostic analysis for triple-negative breast cancer with metaplastic and invasive ductal carcinoma. J Clin Pathol 2019; 72:418-424. [PMID: 30872384 DOI: 10.1136/jclinpath-2018-205544] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/19/2019] [Accepted: 02/23/2019] [Indexed: 01/01/2023]
Abstract
AIMS Triple-negative breast cancer comprises different histological subtypes, including metaplastic breast cancer (MBC) and ductal carcinomas (IDCs). The purpose of this study was to compare triple-negative MBC (TN-MBC) with triple-negative IDC (TN-IDC) in terms of survival and predictive factors. METHODS With access to the Surveillance, Epidemiology and End Result (SEER) database, a total of 19 383 patients met the eligibility criteria. Clinicopathological characteristics were compared between groups using the χ2 test. Univariate and multivariate analyses were applied to evaluate the disease-specific survival (DSS) and overall survival (OS). Subgroup analyses summarised the hazard ratios of TN-MBC versus TN-IDC using a forest plot. RESULTS A total of 586 patients with TN-MBC and 18 797 with TN-IDC were included in this study. Patients with TN-MBC were older and presented with larger tumour sizes, relatively rare lymph node positive disease, and had received more chemotherapy. Compared with TN-IDC, the TN-MBC group showed a significantly poorer prognosis before and after the 1:3 matched case-control analysis. Further subgroup analysis indicated that patients with TN-MBC were older, were from specific races, and those with distant metastasis and not receiving radiotherapy had worse prognosis than patients with TN-IDC in terms of DFS and OS. CONCLUSION Our results showed that patients with TN-MBC had unique clinicopathological characteristics and poorer prognostic subtype compared with TN-IDC. This improves our understanding of the clinicopathological and prognostic features of this rare entity but also provides more convincing therapeutic guidelines for TN-MBC in patients with breast cancer.
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Affiliation(s)
- Yaming Li
- Department of Breast Surgery, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China
| | - Ning Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China
| | - Hanwen Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China
| | - Qifeng Yang
- Pathology Tissue Bank, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Abstract
Spindle cell carcinoma of the breast is a rare malignancy. If diagnosed and treated in a timely manner, it is generally associated with a good prognosis. Herein, we have presented an interesting case of metastatic spindle cell carcinoma of breast origin, with extensive metastasis and an unusually aggressive disease course. We also discussed refractory hypoglycemia as a fatal complication of highly metabolically active malignancy. Lastly, we briefly explored the importance of seeking medical attention for early detection and treatment and the need to address psychosocial barriers that influence breast cancer screening.
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Affiliation(s)
| | - Hamza Hashmi
- Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, USA
| | - Samuel B Reynolds
- Internal Medicine, University of Louisville School of Medicine, Louisville, USA
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TiHo-0906: a new feline mammary cancer cell line with molecular, morphological, and immunocytological characteristics of epithelial to mesenchymal transition. Sci Rep 2018; 8:13231. [PMID: 30185896 PMCID: PMC6125410 DOI: 10.1038/s41598-018-31682-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
Feline mammary carcinomas (FMCs) with anaplastic and malignant spindle cells histologically resemble the human metaplastic breast carcinoma (hMBC), spindle-cell subtype. hMBCs display epithelial-to-mesenchymal transition (EMT) characteristics. Herein we report the establishment and characterization of a cell line (TiHoCMglAdcar0906; TiHo-0906) exhibiting EMT-like properties derived from an FMC with anaplastic and malignant spindle cells. Copy-number variations (CNVs) by next-generation sequencing and immunohistochemical characteristics of the cell line and the tumour were compared. The absolute qPCR expression of EMT-related markers HMGA2 and CD44 was determined. The growth, migration, and sensitivity to doxorubicin were assessed. TiHo-0906 CNVs affect several genomic regions harbouring known EMT-, breast cancer-, and hMBCs-associated genes as AKT1, GATA3, CCND2, CDK4, ZEB1, KRAS, HMGA2, ESRP1, MTDH, YWHAZ, and MYC. Most of them were located in amplified regions of feline chromosomes (FCAs) B4 and F2. TiHo-0906 cells displayed an epithelial/mesenchymal phenotype, and high HMGA2 and CD44 expression. Growth and migration remained comparable during subculturing. Low-passaged cells were two-fold more resistant to doxorubicin than high-passaged cells (IC50: 99.97 nM, and 41.22 nM, respectively). The TiHo-0906 cell line was derived from a poorly differentiated cellular subpopulation of the tumour consistently displaying EMT traits. The cell line presents excellent opportunities for studying EMT on FMCs.
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Feng L, Cai D, Muhetaer A, Yang YL, Ren F, Yishake M, Zhang H, Fang Y, Wushou A. Spindle cell carcinoma: the general demographics, basic clinico-pathologic characteristics, treatment, outcome and prognostic factors. Oncotarget 2018; 8:43228-43236. [PMID: 28591732 PMCID: PMC5522141 DOI: 10.18632/oncotarget.18017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/17/2017] [Indexed: 12/21/2022] Open
Abstract
Background Owing to the rarity, the general demographics, basic clinico-pathologic features, management, outcome and prognostic factors of spindle cell carcinoma (SpCC) were unexplored. Methods A SEER analysis was performed with 2336 cases (1973-2016). Results A peak incidence occurred at 70~80 years without any gender predominance and 83.13% occurred in white people. The respiratory system was mostly affected tumor site (35%). Significant overall survival (OS) and disease specific survival (DSS) were found differentiated in gender, age, marital status, primary tumor location, AJCC stage, T stage, N stage, M stage, pathologic grade and treatment modality. In the multivariate Cox model, the age > 69 years (Hazard ratio [HR] = 1.427 for OS, P = 0.01 and HR = 1.491 for DSS, P = 0.003; Reference [Ref] age ≤ 69 years), tumor location in respiratory system (HR = 1.550 for OS, P = 0.041 and HR = 1.561 for DSS, P = 0.04; Ref: digestive system), N2 stage (HR = 1.962 for OS, P = 0.006 and HR = 1.982 for DSS, P = 0.004; Ref: N0 stage) and AJCC stage IV (HR = 4.601 for OS, P = 0.000 and HR = 5.107 for DSS, P = 0.000; Ref: stage I) were independently associated with worse OS and DSS. Conclusions SpCC mostly occurred in white people at 70~80 years old without predominance in any gender. The respiratory system was mostly affected site. The patient's age, primary tumor location, AJCC stage were independent prognostic indicators for both DSS and OS of SpCC.
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Affiliation(s)
- Lei Feng
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, China
| | - Deng Cai
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Alanuer Muhetaer
- Department of Gynaecology, Zhongshan Hospital, Fudan University, Shanghai 200000, China
| | - Yin-Long Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Fei Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Mumingjiang Yishake
- Department of Orthopedics Surgery, Zhongshan Hospital, Fudan University, Shanghai 200000, China
| | - Hao Zhang
- Department of Epidemiology and Biostatistics, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, China
| | - Yuan Fang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200000, China
| | - Alimujiang Wushou
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, China
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Li K, Kang H, Wang Y, Hai T, Wang B. Development of ipsilateral chest wall spindle cell carcinoma in a patient with invasive ductal breast carcinoma during postoperative adjuvant therapy: A case report. Medicine (Baltimore) 2018; 97:e0739. [PMID: 29742739 PMCID: PMC5959442 DOI: 10.1097/md.0000000000010739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Metaplastic breast carcinoma (MBC) is rare subtype of breast carcinoma and is regarded as ductal carcinoma that undergoes metaplasia into a glandular growth pattern. Spindle cell carcinoma (SPC) is a subtype of MBC with a predominant spindle cell component. PATIENT CONCERNS The patient was a 52-year-old female with invasive ductal breast carcinoma who underwent a modified radical mastectomy and an axillary node dissection. A new lump was observed underneath the surgical site between the pectoralis major and pectoralis minor muscles 45 days after the patient underwent sequential postoperative chemotherapy and radiotherapy. DIAGNOSES It was speculated that the new lesion had developed during postoperative adjuvant therapy. And the new lesion was regarded as a recurrence. INTERVENTIONS We performed a wide dissection of the tumor with negative margins. The pathology of the tumor indicated SPC. Then, the patient received chemotherapy and demonstrated a poor response. OUTCOMES Local recurrence and pulmonary metastasis developed shortly afterwards, and the patient succumbed to the disease within 5 months. LESSONS Local recurrence with metaplastic SPC transformed from invasive ductal breast carcinoma during postoperative chemotherapy and radiotherapy is rare. The failure of subsequent chemotherapy and the progression of disease indicate the aggressive nature of SPC and its decreased sensitivity to chemotherapy and radiotherapy. Further studies must be performed to improve the prognosis of these patients.
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MESH Headings
- Breast Neoplasms/surgery
- Breast Neoplasms/therapy
- Carcinoma/diagnosis
- Carcinoma/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/therapy
- Chemotherapy, Adjuvant
- Fatal Outcome
- Female
- Humans
- Lung Neoplasms/secondary
- Lymph Node Excision
- Mastectomy, Modified Radical
- Middle Aged
- Neoplasm Recurrence, Local
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/pathology
- Radiotherapy, Adjuvant
- Thoracic Neoplasms/diagnosis
- Thoracic Neoplasms/pathology
- Thoracic Wall/pathology
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Alaoui M'hamdi H, Abbad F, Rais H, Asmouki H, Soumani A, Khouchani M, Belbaraka R. Rare variant of metaplastic carcinoma of the breast: a case report and review of the literature. J Med Case Rep 2018; 12:43. [PMID: 29463294 PMCID: PMC5820794 DOI: 10.1186/s13256-017-1553-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 12/23/2017] [Indexed: 01/03/2023] Open
Abstract
Background Metaplastic carcinoma encompasses a group of neoplasms characterized by differentiation of the neoplastic epithelium into squamous cells and/or mesenchymal-looking elements. Spindle cell carcinoma is a rare variant of this special histological type. Its prognosis remains poor, with a high rate of local recurrence and distant metastasis. To date, only a small number of cases have been described. There is no clear agreement on this histological subtype. Case presentation We report a case of a 53-year-old Moroccan woman who consulted our institution following palpation of a nodule of the left breast. Mammography in combination with breast ultrasonography revealed a lesion classified as Breast Imaging Reporting and Data System 4 with microcalcification. The patient was diagnosed with spindle cell carcinoma of the breast. The diagnosis was based primarily on histological and immunohistochemical studies of the breast biopsy and secondarily on the surgical specimen. No local or distant metastasis was found. The treatment used was total surgical excision followed by radiotherapy. Conclusions We describe the features (epidemiological, clinical, histological, immunohistochemical, and therapeutic outcomes) of our patient’s case and compare them with literature data.
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Affiliation(s)
- H Alaoui M'hamdi
- Department of Medical Oncology of Marrakech, University Hospital of Marrakech, Marrakech, Morocco.
| | - F Abbad
- Department of Pathology, University Hospital of Marrakech, Marrakech, Morocco
| | - H Rais
- Department of Pathology, University Hospital of Marrakech, Marrakech, Morocco
| | - H Asmouki
- Department of Gynecology and Obstetrics, University Hospital of Marrakech, Marrakech, Morocco
| | - A Soumani
- Department of Gynecology and Obstetrics, University Hospital of Marrakech, Marrakech, Morocco
| | - M Khouchani
- Department of Radiotherapy of Marrakech, University Hospital of Marrakech, Marrakech, Morocco
| | - R Belbaraka
- Department of Medical Oncology of Marrakech, University Hospital of Marrakech, Marrakech, Morocco
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Zhou S, Sun X, Yu L, Zhou R, Li A, Li M, Yang W. Differential expression and clinical significance of epithelial-mesenchymal transition markers among different histological types of triple-negative breast cancer. J Cancer 2018; 9:604-613. [PMID: 29483966 PMCID: PMC5820928 DOI: 10.7150/jca.19190] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 08/20/2017] [Indexed: 01/08/2023] Open
Abstract
Background: Triple-negative breast cancer (TNBC) is a heterogeneous disease closely associated with epithelial-to-mesenchymal transition (EMT). This study aimed to investigate the role of EMT in metaplastic carcinoma. Methods: E-cadherin, Slug, Twist and Vimentin levels were detected by immunohistochemistry in 167 TNBC tumors, including 145 invasive carcinomas of no special type (ICONSTs), 14 spindle cell carcinomas (SpCCs) and 8 matrix-producing carcinomas (MPCs). Results: Nuclear Slug and Twist were more frequently detected in SpCC and MPC tumors than that in ICONST tumors (p<0.001). The rate of E-cadherin loss was much lower in the ICONST tumors than that in the SpCC and MPC tumors (p<0.001). Vimentin was expressed in all SpCC and MPC tumors. Furthermore, nuclear expression of Slug and Twist was positively associated with the cytoplasmic localization of Vimentin (p<0.001) and was inversely associated with membranous staining of E-cadherin (p<0.001). These trends were more apparent in the SpCC and MPC tumors than in the ICONST tumors. Follow-up data were available for 151 patients. The follow-up times ranged from 1 month to 11 years (mean: 74 m; median: 21 m). The median progression-free survival and overall survival times were 24 months (mean: 32 months) and 22 months (mean: 35 months), respectively. Tumor size, TNM stage and E-cadherin were found to be independent prognostic factors of TNBC. Conclusions: EMT may play an important role in TNBC, especially in MPC and SpCC. Further researches are needed to confirm this finding. The results of this study may facilitate the future development of targeted therapies based on alterations in the EMT and stem cell markers.
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Affiliation(s)
- Shuling Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Xiangjie Sun
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Ruoji Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Anqi Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Ming Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
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Rajakylä K, Krishnan R, Tojkander S. Analysis of Contractility and Invasion Potential of Two Canine Mammary Tumor Cell Lines. Front Vet Sci 2017; 4:149. [PMID: 28955712 PMCID: PMC5600937 DOI: 10.3389/fvets.2017.00149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/28/2017] [Indexed: 01/30/2023] Open
Abstract
Cancer cells are surrounded by a mechanically and biochemically distinct microenvironment that undergoes dynamic changes throughout the neoplastic progression. During this progression, some cancer cells acquire abnormal characteristics that potentiate their escape from the primary tumor site, to establish secondary tumors in distant organs. Recent studies with several human cancer cell lines have shown that the altered physical properties of tumor cells, such as their ability to apply high traction forces to the surroundings, are directly linked with their potential to invade and metastasize. To test the hypothetical interconnection between actomyosin-mediated traction forces and invasion potential within 3D-microenvironment, we utilized two canine mammary tumor cell lines with different contractile properties. These cell lines, canine mammary tumor (CMT)-U27 and CMT-U309, were found to have distinct expression patterns of lineage-specific markers and organization of actin-based structures. In particular, CMT-U309 carcinoma cells were typified by thick contractile actomyosin bundles that exerted high forces to their environment, as measured by traction force microscopy. These high contractile forces also correlated with the prominent invasiveness of the CMT-U309 cell line. Furthermore, we found high contractility and 3D-invasion potential to be dependent on the activity of 5′AMP-activated protein kinase (AMPK), as blocking AMPK signaling was found to reverse both of these features. Taken together, our findings implicate that actomyosin forces correlate with the invasion potential of the studied cell lines.
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Affiliation(s)
- Kaisa Rajakylä
- Faculty of Veterinary Medicine, Department of Veterinary Biosciences, Section of Pathology, University of Helsinki, Helsinki, Finland
| | - Ramaswamy Krishnan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Sari Tojkander
- Faculty of Veterinary Medicine, Department of Veterinary Biosciences, Section of Pathology, University of Helsinki, Helsinki, Finland
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Raj SD, Sweetwood K, Kapoor MM, Raj KM, Nagi C, Sepulveda KA, Sedgwick EL. Spindle cell lesions of the breast: Multimodality imaging and clinical differentiation of pathologically similar neoplasms. Eur J Radiol 2017; 90:60-72. [DOI: 10.1016/j.ejrad.2017.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 01/11/2017] [Accepted: 02/13/2017] [Indexed: 01/13/2023]
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Zhang B, Xiao Q, Yang D, Li X, Hu J, Wang Y, Wang W. Spindle cell carcinoma of the esophagus: A multicenter analysis in comparison with typical squamous cell carcinoma. Medicine (Baltimore) 2016; 95:e4768. [PMID: 27631227 PMCID: PMC5402570 DOI: 10.1097/md.0000000000004768] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This study conducted a retrospective multicenter analysis to investigate the clinicopathological features, optimal therapeutic strategy, and prognosis of spindle cell carcinoma (SpCC) of the esophagus.A total of 71 patients with esophageal SpCC from 3 large cancer centers in China were systematically analyzed. All patients received curative resection, 13 patients received adjuvant radiotherapy and 15 patients received adjuvant combination chemotherapy. Additionally, a total of 1852 patients with typical esophageal SCC (SCC) were selected as controls in this study.SpCC mostly presented as a polypoid appearance (66.2%), and the surrounding mucosa showed high-grade hyperplasia or superficial SCC in 31 cases (43.7%). Two patients even had extensive carcinoma in situ that spread to the resection margins. Patients in the SpCC group were more likely to present with stage I lesions compared with those in the typical SCC group (33.8% vs 8.0%, P < 0.001). Although the percentage of T1/2 lesions was higher in the SpCC group than in the typical SCC group (67.6% vs 29.7%, P < 0.001), both groups had similar rates of locoregional lymphatic metastases (45.1% vs 48.4%, P = 0.578). The median survival time and 5-year overall survival of the SpCC group was 43 months and 44.8%, respectively, higher than 37.5 months and 38.3%, respectively, for the typical SCC group (P = 0.044). In univariate analysis, the macroscopical type and pathological T, N, and TNM stages had a statistically significant impact on the prognosis of SpCC after curative resection. However, only the TNM stage (hazard ratio, 2.708; 95% confidence interval, 1.786-4.105, P < 0.001) was identified as an independent prognostic factor in multivariate analysis. The 5-year OS of SpCC in stages I (79.8%) and II (39.7%) were significantly longer than that of stages III/IV (16.2%) (P < 0.001 and P = 0.012). As those SpCC cases that received chemoradiotherapy were in more advanced stages, their prognosis was still worse than SpCC patients who did not receive chemoradiotherapy even after such treatment (P = 0.042, 0.010, respectively).SpCC shows a highly aggressive tendency of lymphatic spread, although it does not tend to infiltrate deeply into the esophageal wall. Compared with typical SCC that also underwent esophagectomy with extended lymphadenectomy, SpCC may achieve a better survival rate. Further investigation is warranted to examine the effect of postoperative chemoradiotherapy on the prognosis of SpCC.
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Affiliation(s)
| | - Qin Xiao
- The Department of Thoracic Radiotherapy
| | | | - Xu Li
- The 2nd Department of Thoracic Surgery
| | - Jun Hu
- The Department of Pathology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, CSU, Changsha, Hunan Province
| | - Yonggang Wang
- Department of Thoracic Surgery, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, BeijingThe People's Republic of China
- Correspondence: Yonggang Wang, Department of Thoracic Surgery, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Chaoyang District, Beijing, The People's Republic of China (e-mail: ); Wenxiang Wang, The 2nd Department of thoracic surgery, Hunan Cancer Hospital, Yuelu District, Changsha, China (e-mail: )
| | - Wenxiang Wang
- The 2nd Department of Thoracic Surgery
- Correspondence: Yonggang Wang, Department of Thoracic Surgery, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Chaoyang District, Beijing, The People's Republic of China (e-mail: ); Wenxiang Wang, The 2nd Department of thoracic surgery, Hunan Cancer Hospital, Yuelu District, Changsha, China (e-mail: )
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