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Pelosi G, Travis WD. Head-to-head: Should Ki67 proliferation index be included in the formal classification of pulmonary neuroendocrine neoplasms? Histopathology 2024; 85:535-548. [PMID: 38728050 DOI: 10.1111/his.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 08/31/2024]
Abstract
The reporting of lung neuroendocrine neoplasms (NENs) according to the 2021 World Health Organisation (WHO) is based on mitotic count per 2 mm2, necrosis assessment and a constellation of cytological and immunohistochemical details. Accordingly, typical carcinoid and atypical carcinoid are low- to intermediate-grade neuroendocrine tumours (NETs), while large-cell neuroendocrine carcinoma (NEC) and small-cell lung carcinoma are high-grade NECs. In small-sized diagnostic material (cytology and biopsy), the noncommittal term of carcinoid tumour/NET not otherwise specified (NOS) and metastatic carcinoid NOS have been introduced with regard to primary and metastatic diagnostic settings, respectively. Ki-67 antigen, a well-known marker of cell proliferation, has been included in the WHO classification as a non-essential but desirable criterion, especially to distinguish NETs from high-grade NECs and to delineate the provisional category of carcinoid tumours/NETs with elevated mitotic counts (> 10 mitoses per mm2) and/or Ki-67 proliferation index (≥ 30%). However, a wider use of this marker in the spectrum of lung NENs continues to be highly reported and debated, thus witnessing a never-subsided attention. Therefore, the arguments for and against incorporating Ki-67 in the classification and clinical practice of these neoplasms are discussed herein in detail.
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Affiliation(s)
- Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Inter-Hospital Pathology Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA
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2
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Roca E, Aujayeb A, Astoul P. Diagnosis of Pleural Mesothelioma: Is Everything Solved at the Present Time? Curr Oncol 2024; 31:4968-4983. [PMID: 39329996 DOI: 10.3390/curroncol31090368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/22/2024] [Accepted: 08/24/2024] [Indexed: 09/28/2024] Open
Abstract
Ranked high in worldwide growing health issues, pleural diseases affect approximately one million people globally per year and are often correlated with a poor prognosis. Among these pleural diseases, malignant pleural mesothelioma (PM), a neoplastic disease mainly due to asbestos exposure, still remains a diagnostic challenge. Timely diagnosis is imperative to define the most suitable therapeutic approach for the patient, but the choice of diagnostic modalities depends on operator experience and local facilities while bearing in mind the yield of each diagnostic procedure. Since the analysis of pleural fluid cytology is not sufficient in differentiating historical features in PM, histopathological and morphological features obtained via tissue biopsies are fundamental. The quality of biopsy samples is crucial and often requires highly qualified expertise. Since adequate tissue biopsy is essential, medical or video-assisted thoracoscopy (MT or VATS) is proposed as the most suitable approach, with the former being a physician-led procedure. Indeed, MT is the diagnostic gold standard for malignant pleural pathologies. Moreover, this medical or surgical approach can allow diagnostic and therapeutic procedures: it provides the possibility of video-assisted biopsies, the drainage of high volumes of pleural fluid and the administration of sterile calibrated talcum powder under visual control in order to achieve pleurodesis, placement of indwelling pleural catheters if required and in a near future potential intrapleural therapy. In this context, dedicated diagnostic pathways remain a crucial need, especially to quickly and properly diagnose PM. Lastly, the interdisciplinary approach and multidisciplinary collaboration should always be implemented in order to direct the patient to the best customised diagnostic and therapeutic pathway. At the present time, the diagnosis of PM remains an unsolved problem despite MDT (multidisciplinary team) meetings, mainly because of the lack of standardised diagnostic work-up. This review aims to provide an overview of diagnostic procedures in order to propose a clear strategy.
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Affiliation(s)
- Elisa Roca
- Thoracic Oncology, Lung Unit, P. Pederzoli Hospital, Peschiera Del Garda, VR, Italy
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Health Care NHS Foundation Trust, Care of Gail Hewitt, Newcastle NE23 6NZ, UK
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North Hospital, Aix-Marseille University, Chemin des Bourrely, 13005 Marseille, France
- La Timone Campus, Aix-Marseille University, 13005 Marseille, France
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3
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Yang SR, Jayakumaran G, Benhamida J, Febres-Aldana CA, Fanaroff R, Chang J, Gedvilaite E, Villafania LB, Sauter JL, Offin M, Zauderer MG, Ladanyi M. Diffuse Pleural Mesotheliomas with Genomic Near-Haploidization: A Newly Recognized Subset with Distinct Clinical, Histologic, and Molecular Features. Clin Cancer Res 2024; 30:2780-2789. [PMID: 38630790 PMCID: PMC11216861 DOI: 10.1158/1078-0432.ccr-24-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/13/2024] [Accepted: 04/16/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Diffuse pleural mesotheliomas (DPM) with genomic near-haploidization (GNH) represent a novel subtype first recognized by The Cancer Genome Atlas project; however, its clinicopathologic and molecular features remain poorly defined. EXPERIMENTAL DESIGN We analyzed clinical genomic profiling data from 290 patients with DPM using the Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) assay. Allele-specific copy number analysis was performed using the Fraction and Allele-Specific Copy Number Estimates from Tumor Sequencing (FACETS) algorithm. RESULTS A total of 210 patients were evaluable for loss of heterozygosity (LOH) analysis using FACETS from MSK-IMPACT tumor:normal sequencing data. In this cohort, GNH, defined as LOH across >80% of the genome, was detected in 10 cases (4.8%). Compared with non-GNH tumors, GNH DPMs were associated with younger age and less frequent self-reported history of occupational asbestos exposure. Histologically, GNH DPMs were enriched in biphasic subtype (80% vs. 14.5%) and showed abundant tumor-infiltrating lymphocytes (TILs). Genomic analysis revealed a higher frequency of TP53 alterations, whereas SETDB1 mutations were present in nearly all and only in this subset. The clinicopathologic and molecular findings were further validated in a separate cohort. Despite the younger age, patients with GNH DPMs had a shorter overall survival (10.9 vs. 25.4 months, P = 0.004); the poor prognostic impact of GNH remained significant after controlling for biphasic histology. Of three patients with GNH DPMs who received immune checkpoint blockade, two achieved a clinician-assessed partial response. CONCLUSIONS GNH defines an aggressive subtype of mainly biphasic DPMs in younger patients with recurrent alterations in SETDB1 and TP53. The enrichment in biphasic histology and TILs, together with our preliminary immune checkpoint blockade response data and anecdotal clinical trial data, suggests that further evaluation of immunotherapy may be warranted in this subset.
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Affiliation(s)
- Soo-Ryum Yang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gowtham Jayakumaran
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamal Benhamida
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Rachel Fanaroff
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason Chang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erika Gedvilaite
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liliana B. Villafania
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer L. Sauter
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Offin
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Marjorie G. Zauderer
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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4
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Sonobe H, Omote R, Habara T, Washio K, Yamazoe N, Matsumoto S, Nabeshima K, Toda H. A Rare Case of Pleural Epithelioid Mesothelioma With a Prominent Myxoid Stroma Reported With Morphology, Fluorescent In Situ Hybridization, and Ultrastructural Findings. Cureus 2024; 16:e62212. [PMID: 39006698 PMCID: PMC11244714 DOI: 10.7759/cureus.62212] [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] [Accepted: 06/08/2024] [Indexed: 07/16/2024] Open
Abstract
Herein, we report a rare case of pleural epithelioid malignant mesothelioma with a prominent myxoid stroma. To date, detailed morphological or molecular pathological findings have not been reported for this type of tumor. Hence, we aimed to describe the cytological, histological, immuno-cytohistological, electron-microscopic, and molecular pathological findings using fluorescence in situ hybridization (FISH) in such a case. The patient was a male in his mid-sixties with a history of asbestos exposure and had originally visited the hospital with a persistent cough and fever. Chest radiography revealed left pleural effusion, and laboratory examination revealed a high titer for hyaluronic acid in the effusion. Additionally, computed tomography revealed diffuse multinodular or cystic lesions in the left parietal pleura, and pleural effusion cytology revealed large epithelioid cells with mild nuclear atypia, which were considered reactive mesothelial cells. Cytologically, Giemsa staining revealed that these cells harbored variously sized intracytoplasmic vacuoles that were Alcian-blue-positive, suggesting hyaluronan production. Biopsy revealed large epithelioid cells that loosely proliferated against a prominent myxoid background. These cells were immuno-positive for calretinin, Wilms' tumor 1, D2-40, vimentin, and cytokeratin AE1/AE3 but not for carcinoembryonic antigen, Ber-EP4, or desmin. BRCA 1 associated protein 1 immunostaining showed nuclear loss, and FISH showed homozygous deletion of cyclin-dependent kinase inhibitor 2A (p16) on chromosome 9p21. Based on these findings, the lesion was diagnosed as an epithelioid mesothelioma with a prominent myxoid stroma. Electron-microscopy demonstrated a dense microvillus pattern on the surface of the tumor cells, indicating a mesothelial cell origin, and variously sized vacuoles in the cytoplasm, confirming the presence of intracytoplasmic vacuoles demonstrated on cytology. The tumor tissues obtained during surgery harbored prominent myxoid stroma, which proved that the present tumor was consistent with this type of mesothelioma. After informed consent was obtained, the patient and family wished for total resection of the tumor and postoperative chemotherapy, and the patient eventually died eight months after surgery.
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Affiliation(s)
- Hiroshi Sonobe
- Department of Diagnostic Pathology, National Hospital Organization Fukuyama Medical Center, Fukuyama, JPN
| | - Rika Omote
- Department of Diagnostic Pathology, National Hospital Organization Fukuyama Medical Center, Fukuyama, JPN
| | - Toshiyuki Habara
- Department of Clinical Laboratory, Chugoku Central Hospital of the Mutual Aid Associations of Public School Teachers, Fukuyama, JPN
| | - Kazuhiro Washio
- Department of Surgery, Chugoku Central Hospital of the Mutual Aid Associations of Public School Teachers, Fukuyama, JPN
| | | | - Shinji Matsumoto
- Department of Pathology, Fukuoka University Hospital, Fukuoka, JPN
| | - Kazuki Nabeshima
- Department of Diagnostic Pathology, Pathological Diagnosis Center, Fukuoka Tokushukai Hospital, Fukuoka, JPN
| | - Hiroko Toda
- Department of Diagnostic Pathology, Chugoku Central Hospital of the Mutual Aid Associations of Public School Teachers, Fukuyama, JPN
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Galeano B, Smith CJ, Yi ES, Roden AC, Jenkins S, Capelle J, Kittle-Francis M, Mansfield AS, Aubry MC. Ki-67 Proliferation Index Is Associated With Tumor Grade and Survival in Pleural Epithelioid Mesotheliomas. Am J Surg Pathol 2024; 48:615-622. [PMID: 38369761 PMCID: PMC11019975 DOI: 10.1097/pas.0000000000002196] [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: 02/20/2024]
Abstract
Pleural epithelioid mesothelioma (PEM) is divided into low and high grades based on nuclear atypia, mitoses, and necrosis in the tumor. Assessing mitoses and nuclear atypia tend to be labor-intensive with limited reproducibility. Ki-67 proliferation index was shown to be a prognostic factor in PEM, but its performance has not been directly correlated with tumor grade or mitotic score. This study evaluated the potential of Ki-67 index as a surrogate of tumor grade. We also compared the predictability of mitoses and Ki-67 index for overall survival (OS). Ninety-six PEM samples from 85 patients were identified from the surgical pathology file during 2000-2021 at our institution, and all glass slides were reviewed by 2 pulmonary pathologists to confirm the diagnosis and assign the tumor grade. Digital image analysis (DIA) was done for Ki-67 index. The agreement on tumor grading between 2 reviewers was moderate (kappa value = 0.47). The correlation between mitotic count (average count by 2 reviewers) and Ki-67 index was 0.65. The areas under the curve for predicting tumor grade by mitotic score and Ki-67 index were 0.84 and 0.74 (reviewer 1) and 0.85 and 0.81 (reviewer 2), respectively. High Ki-67 index and mitoses were significantly associated with poor OS ( P =0.03 and 0.0005, using 30% and 10/2 mm 2 as cutoffs, respectively). In conclusion, Ki-67 index by DIA was associated with tumor grade as well as mitotic count, and its predictability for OS was comparable to that of mitotic score, thus being a potential surrogate for tumor grade.
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Affiliation(s)
| | - Caleb J. Smith
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Eunhee S. Yi
- Departments of Laboratory Medicine and Pathology
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6
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Schulte JJ, Husain AN. Updates on grading mesothelioma. Histopathology 2024; 84:153-162. [PMID: 37872123 DOI: 10.1111/his.15065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/25/2023]
Abstract
Mesothelioma is a rare disease with an historically poor prognosis. Over the past decade, a grading system has been developed that is a powerful prognostic tool in epithelioid mesothelioma. Grading of epithelioid mesothelioma is now required or strongly recommended by expert consensus, the College of American Pathologists, the World Health Organization, and the International Mesothelioma Interest Group. The original nuclear grading system for epithelioid mesothelioma, developed in the United States, split epithelioid mesotheliomas into three prognostic groups with marked differences in survival. Now, this three-tiered nuclear grading system has been combined with the presence or absence of necrosis to form the currently recommended two-tiered grading system of low- and high-grade epithelioid mesothelioma. This review will focus on the development of this grading system in mesothelioma, the grading system's shortcomings, and the application of the grading system to cytology specimens and other extra-pleural sites. Lastly, this review will briefly discuss alternative grading systems and future considerations.
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7
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Chen-Yost HIH, Tjota MY, Gao G, Mitchell O, Kindler H, Segal J, Husain AN, Mueller J, Schulte JJ. Characterizing the distribution of alterations in mesothelioma and their correlation to morphology. Am J Clin Pathol 2023; 160:238-246. [PMID: 37141416 DOI: 10.1093/ajcp/aqad041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/16/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES Mesothelioma is a lethal disease that arises from the serosal lining of organ cavities. Several recurrent alterations have been observed in pleural and peritoneal -mesotheliomas, including in BAP1, NF2, and CDKN2A. Although specific histopathologic parameters have been correlated with prognosis, it is not as well known whether genetic alterations correlate with histologic findings. METHODS We reviewed 131 mesotheliomas that had undergone next-generation sequencing (NGS) at our institutions after pathologic diagnosis. There were 109 epithelioid mesotheliomas, 18 biphasic mesotheliomas, and 4 sarcomatoid mesotheliomas. All our biphasic and sarcomatoid cases arose in the pleura. Of the epithelioid mesotheliomas, 73 were from the pleura and 36 were from the peritoneum. On average, patients were 66 years of age (range, 26-90 years) and predominantly male (92 men, 39 women). RESULTS The most common alterations identified were in BAP1, CDKN2A, NF2, and TP53. Twelve mesotheliomas did not show a pathogenic alteration on NGS. For epithelioid mesotheliomas in the pleura, the presence of an alteration in BAP1 correlated with low nuclear grade (P = .04), but no correlation was found in the peritoneum (P = .62). Similarly, there was no correlation between the amount of solid architecture in epithelioid mesotheliomas and any alterations in the pleura (P = .55) or peritoneum (P = .13). For biphasic mesotheliomas, cases with either no alteration detected or with an alteration in BAP1 were more likely to be epithelioid predominant (>50% of the tumor, P = .0001), and biphasic mesotheliomas with other alterations detected and no alteration in BAP1 were more likely to be sarcomatoid predominant (>50% of the tumor, P = .0001). CONCLUSIONS This study demonstrates a significant association between morphologic features associated with a better prognosis and an alteration in BAP1.
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Affiliation(s)
| | - Melissa Y Tjota
- Department of Pathology, The University of Chicago Hospitals, Chicago, IL, US
| | - Guimin Gao
- Department of Public Health Sciences, Biostatistics Laboratory & Research Computing Group, The University of Chicago Hospitals, Chicago, IL, US
| | - Owen Mitchell
- Department of Medicine, The University of Chicago Hospitals, Chicago, IL, US
| | - Hedy Kindler
- Department of Medicine, The University of Chicago Hospitals, Chicago, IL, US
| | - Jeremy Segal
- Department of Pathology, The University of Chicago Hospitals, Chicago, IL, US
| | - Aliya N Husain
- Department of Pathology, The University of Chicago Hospitals, Chicago, IL, US
| | - Jeffrey Mueller
- Department of Pathology, The University of Chicago Hospitals, Chicago, IL, US
| | - Jefree J Schulte
- Department of Pathology and Laboratory Medicine, The University of Wisconsin School of Medicine and Public Health, Madison, WI, US
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8
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Li Y, Salama AM, Baine MK, Bodd FM, Offin MD, Rekhtman N, Zauderer MG, Travis WD, Adusumilli PS, Sauter JL. Reliability of assessing morphologic features with prognostic significance in cytology specimens of epithelioid diffuse pleural mesothelioma and implications for cytopathology reporting. Cancer Cytopathol 2023; 131:495-506. [PMID: 37127928 PMCID: PMC11037265 DOI: 10.1002/cncy.22705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The World Health Organization incorporates morphologic features with prognostic significance in the 2021 classification of epithelioid diffuse pleural mesothelioma (E-DPM). Although cytology specimens are often the first and occasionally the only specimen available for patients with DPM, these features have not yet been investigated in cytology. METHODS Nuclear atypia, pleomorphic features, necrosis, and architectural patterns were retrospectively assessed in 35 paired cytology and concurrent/consecutive surgical pathology specimens of E-DPM. Agreement between pairs was determined via unweighted κ scores. Discordant cases were re-reviewed to determine the reasons for disagreement. RESULTS Interpretation of nuclear atypia in cytology was concordant with histology in all cases (κ = 1.000; p < .001). The presence of pleomorphic features and necrosis was concordant in 97.1% (κ = 0.842; p < .001) and 85.7% (κ = 0.481; p = .001) of paired cases, respectively. Assessment of architectural patterns in cytology showed only slight agreement with histology (κ = 0.127; p = .037). In cytology cases (n = 23) with cell block material available, assessment of nuclear atypia and the presence of pleomorphic features showed perfect agreement (κ = 1.000; p < .001, each), the presence of necrosis showed moderate agreement (κ = 0.465; p = .008), and assessment of architectural patterns showed slight agreement (κ = 0.162; p = .15) in paired specimens. Most disagreements were due to sampling differences between cytology and histology specimens. CONCLUSIONS Although complete nuclear grading of E-DPM is not possible given the unreliability of mitotic counts in cytology, assessment of nuclear atypia in cytology specimens is shown to be reliable. Identification of pleomorphic features and necrosis is also reliable despite occasional sampling issues. Assessment of architectural patterns is more limited in cytology.
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Affiliation(s)
- Yan Li
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Hubei, People’s Republic of China
| | - Abeer M. Salama
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Marina K Baine
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Francis M. Bodd
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Michael D. Offin
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, and Department of Medicine, Weill Cornell Medical College, New York, New York, 10065, USA
| | - Natasha Rekhtman
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Marjorie G. Zauderer
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, and Department of Medicine, Weill Cornell Medical College, New York, New York, 10065, USA
| | - William D. Travis
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
| | - Jennifer L. Sauter
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
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9
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Aksoy Y, Chou A, Mahjoub M, Sheen A, Sioson L, Ahadi MS, Gill AJ, Fuchs TL. A novel prognostic nomogram for predicting survival in diffuse pleural mesothelioma. Pathology 2023; 55:449-455. [PMID: 36842876 DOI: 10.1016/j.pathol.2022.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/29/2022] [Accepted: 11/20/2022] [Indexed: 02/09/2023]
Abstract
Recent advances in the management of diffuse pleural mesothelioma (DPM) have increased interest in prognostication and risk stratification on the basis that maximum benefit of combination immunotherapy appears to be seen in patients who otherwise would have the worst prognosis. Various grading schemes have been proposed, including the recently published Mesothelioma Weighted Grading Scheme (MWGS). However, predictive modelling using deep learning algorithms is increasingly regarded as the gold standard in prognostication. We therefore sought to develop and validate a prognostic nomogram for DPM. Data from 369 consecutive patients with DPM were used as independent training and validation cohorts to develop a prognostic tool that included the following variables: age, sex, histological type, nuclear atypia, mitotic count, necrosis, and BAP1 immunohistochemistry. Patients were stratified into four risk groups to assess model discrimination and calibration. To assess discrimination, the area-under-the-curve (AUC) of a receiver-operator-curve (ROC), concordance-index (C-index), and dissimilarity index (D-index) were calculated. Based on the 5-year ROC analysis, the AUC for our model was 0.75. Our model had a C-index of 0.67 (95% CI 0.53-0.79) and a D-index of 2.40 (95% CI 1.69-3.43). Our prognostic nomogram for DPM is the first of its kind, incorporates well established prognostic markers, and demonstrates excellent predictive capability. As these factors are routinely assessed in most pathology laboratories, it is hoped that this model will help inform prognostication and difficult management decisions, such as patient selection for novel therapies. This nomogram is now freely available online at: https://nomograms.shinyapps.io/Meso_Cox_ML/.
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Affiliation(s)
- Yagiz Aksoy
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Angela Chou
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Mahiar Mahjoub
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Amy Sheen
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Loretta Sioson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Mahsa S Ahadi
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Talia L Fuchs
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.
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10
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New Insights in Pleural Mesothelioma Classification Update: Diagnostic Traps and Prognostic Implications. Diagnostics (Basel) 2022; 12:diagnostics12122905. [PMID: 36552912 PMCID: PMC9776784 DOI: 10.3390/diagnostics12122905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/05/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
The 2021 WHO Classification of Tumors of the Pleura has introduced significant changes in mesothelioma codification beyond the three current histological subtypes-epithelioid, sarcomatoid and biphasic. Major advances since the 2015 WHO classification include nuclear grading and the introduction of architectural patterns, cytological and stromal features for epithelioid diffuse mesothelioma. Mesothelioma in situ has been recognized as a diagnostic category. Demonstration of loss of BAP1 or MTAP by immunohistochemistry, or CDKN2A homozygous deletion by FISH, is valuable in establishing the diagnosis of epithelioid mesothelioma. Recent emerging data proved that grading and histological subtypes have prognostic implications and may be helpful to patient risk stratification and clinical management. Nevertheless, the latest mesothelioma classification increases the already non-negligible diagnostic pitfalls, especially concerning differential diagnosis of pre-invasive tumors. In this review, recent changes in histologic classification of mesothelioma and advances in molecular markers are presented and their relation to diagnostic challenges and prognostic implications is discussed.
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Holzknecht A, Illini O, Hochmair MJ, Krenbek D, Setinek U, Huemer F, Bitterlich E, Kaindl C, Getman V, Akan A, Weber M, Leobacher G, Valipour A, Mueller MR, Watzka SB. Multimodal Treatment of Malignant Pleural Mesothelioma: Real-World Experience with 112 Patients. Cancers (Basel) 2022; 14:cancers14092245. [PMID: 35565374 PMCID: PMC9104590 DOI: 10.3390/cancers14092245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare pleural cancer associated with asbestos exposure. According to current evidence, the combination of chemotherapy, surgery and radiotherapy improves patients’ survival. However, the optimal sequence and weighting of the respective treatment modalities is unclear. In anticipation of the upcoming results of the MARS-2 trial, we sought to determine the relative impact of the respective treatment modalities on complications and overall survival in our own consecutive institutional series of 112 patients. Fifty-seven patients (51%) underwent multimodality therapy with curative intent, while 55 patients (49%) were treated with palliative intent. The median overall survival (OS) of the entire cohort was 16.9 months (95% CI: 13.4−20.4) after diagnosis; 5-year survival was 29% for patients who underwent lung-preserving surgery. In univariate analysis, surgical treatment (p < 0.001), multimodality therapy (p < 0.001), epithelioid subtype (p < 0.001), early tumor stage (p = 0.02) and the absence of arterial hypertension (p = 0.034) were found to be prognostic factors for OS. In multivariate analysis, epithelioid subtype was associated with a survival benefit, whereas the occurrence of complications was associated with worse OS. Multimodality therapy including surgery significantly prolonged the OS of MPM patients compared with multimodal therapy without surgery.
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Affiliation(s)
- Arnulf Holzknecht
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Oliver Illini
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, 1210 Vienna, Austria; (O.I.); (M.J.H.); (A.V.)
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, 1210 Vienna, Austria; (O.I.); (M.J.H.); (A.V.)
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Dagmar Krenbek
- Institute for Pathology, Klinik Floridsdorf, 1210 Vienna, Austria;
| | - Ulrike Setinek
- Institute for Pathology and Microbiology, Klinik Ottakring, 1160 Vienna, Austria;
| | - Florian Huemer
- Division of Pulmonology, Klinik Penzing, 1140 Vienna, Austria;
| | - Erwin Bitterlich
- Division of Pulmonology, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria;
| | - Christoph Kaindl
- Division of Surgery, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria;
| | - Vladyslav Getman
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Ahmet Akan
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Michael Weber
- Department of Medical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Gunther Leobacher
- Institute of Mathematics and Scientific Computing, University of Graz, 8010 Graz, Austria;
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, 1210 Vienna, Austria; (O.I.); (M.J.H.); (A.V.)
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Michael R. Mueller
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
- Division of Thoracic Surgery, Sigmund Freud University, 1020 Vienna, Austria
| | - Stefan B. Watzka
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
- Division of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +431-27700-74213
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12
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Pleural mesothelioma classification-update and challenges. Mod Pathol 2022; 35:51-56. [PMID: 34465883 DOI: 10.1038/s41379-021-00895-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022]
Abstract
Mesothelial tumors are classified into benign or preinvasive tumors, and mesotheliomas. The benign or preinvasive group includes adenomatoid tumors, well-differentiated papillary mesothelial tumors, and mesothelioma in situ. Malignant tumors are mesotheliomas and can be localized or diffuse. Histological classification of invasive mesotheliomas into three major subtypes-epithelioid, sarcomatoid, and biphasic is prognostically important. It also plays a significant role in the treatment decisions of patients diagnosed with this deadly disease. Grading and subtyping of epithelioid mesotheliomas have been one of the major changes in the recent WHO classification of pleural tumors. Mesothelioma in situ has emerged as a precisely defined clinico-pathologic entity that for diagnosis requires demonstration of loss of BAP1 or MTAP by immunohistochemistry, or CDKN2A homozygous deletion by FISH. The use of these two biomarkers improves the diagnostic sensitivity of effusion specimens and limited tissue samples and is valuable in establishing the diagnosis of epithelioid mesothelioma. In this review, recent changes in the histologic classification of pleural mesothelioma, importance of ancillary diagnostic studies, and molecular characteristics of mesotheliomas are discussed.
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13
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A Critical Assessment of Current Grading Schemes for Diffuse Pleural Mesothelioma With a Proposal for a Novel Mesothelioma Weighted Grading Scheme (MWGS). Am J Surg Pathol 2021; 46:774-785. [PMID: 34907994 DOI: 10.1097/pas.0000000000001854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although there is early support for schemes based on nuclear grade, necrosis and mitotic rate, there is currently no widely implemented grading system for diffuse pleural mesothelioma (DPM). We investigated current systems and propose a novel Mesothelioma Weighted Grading Scheme (MWGS). The MWGS assigns weighted scores from 0 to 10 based on age (≤74, >74 yrs: 0,1); histologic type (epithelioid, biphasic, sarcomatoid: 0,1,2); necrosis (absent, present: 0,2); mitotic count per 2 mm2 (≤1, 2 to 4, ≥5: 0,1,2); nuclear atypia (mild, moderate, severe: 0,1,2); and BRCA1-associated protein 1 (BAP1) expression (lost, retained: 0,1). A score of 0 to 3 is low grade, 4 to 6 intermediate grade, and 7 to 10 high grade. In 369 consecutive DPMs, median survival was 17.1, 10.1, and 4.1 months for low, intermediate, and high grades (P<0.0001). A progressive increase in score correlated with worsening overall survival (P<0.0001). Interobserver concordance was substantial (κ=0.588), with assessment of nuclear grade being the most subjective parameter (κ=0.195). We compared the MWGS to the 2-tiered system discussed in the World Health Organization (WHO) fifth edition. The WHO system predicted median survival in epithelioid (median 18.0 vs. 11.3 mo, P=0.003) and biphasic (16.2 vs. 4.2 mo, P=0.002), but not sarcomatoid DPM (5.4 vs. 4.7 mo, P=0.407). Interestingly, the WHO grading system was prognostic in cases with BAP1 loss (median survival 18.7 vs. 10.4 mo, P<0.0001), but not retained BAP1 expression (8.9 vs. 6.2 mo, P=0.061). In conclusion, the WHO scheme has merit in epithelioid/biphasic and BAP1-deficient DPM, however, the MWGS can be used for risk stratification of all DPMs, regardless of histologic subtype and BAP1 status.
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14
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Schulte JJ, Chapel DB, Attanoos R, Brcic L, Burn J, Butnor KJ, Chang N, Chen H, Dacic S, De Perrot M, Fukuoka J, Galateau-Salle F, Godschachner T, Hiroshima K, Klebe S, Krausz T, Litzky L, Marchevsky AM, Mueller J, Nabeshima K, Nicholson AG, Pal P, Roden AC, Rorvig S, Santoni-Rugiu E, Tazelaar H, Tsao MS, Walts AE, Weynand B, Zaizen Y, Zhang YZ, Husain AN. Comparison of Nuclear Grade, Necrosis, and Histologic Subtype Between Biopsy and Resection in Pleural Malignant Mesothelioma: An International Multi-Institutional Analysis. Am J Clin Pathol 2021; 156:989-999. [PMID: 33978147 DOI: 10.1093/ajcp/aqab054] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Numerous studies on malignant mesothelioma (MM) highlight the prognostic importance of histologic subtype, nuclear grade, and necrosis. This study compares these parameters in paired biopsy and resection specimens of pleural MM. METHODS Histologic subtype, percentage of epithelioid morphology, nuclear grade, and the presence or absence of necrosis were compared in 429 paired biopsies and resection specimens of pleural MM from 19 institutions. RESULTS Histologic subtype was concordant in 81% of cases (κ = 0.58). When compared with resection specimens, epithelioid morphology at biopsy had a positive predictive value (PPV) of 78.9% and a negative predictive value (NPV) of 93.5%; sarcomatoid morphology showed high PPV (92.9%) and NPV (99.3%), and biphasic morphology PPV was 89.7% and NPV was 79.7%. Agreement of the percentage of epithelioid morphology was fair (κ = 0.27). Nuclear grade and necrosis were concordant in 75% (κ = 0.59) and 81% (κ = 0.53) of cases, respectively. Nuclear grade showed moderate (κ = 0.53) and substantial (κ = 0.67) agreement from patients with and without neoadjuvant therapy, respectively, and necrosis showed moderate (κ = 0.47 and κ = 0.60) agreement, respectively, in the same subsets of paired specimens. CONCLUSIONS Paired biopsy-resection specimens from pleural MM show overall moderate agreement in pathologic parameters. These findings may help guide postbiopsy management and triage of patients with MM.
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Affiliation(s)
- Jefree J Schulte
- Department of Pathology, University of Chicago, Chicago, IL, USA
- Department of Pathology and Lab Medicine, University of Wisconsin, Madison, WI, USA
| | - David B Chapel
- Department of Pathology, University of Chicago, Chicago, IL, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Richard Attanoos
- Department of Cellular Pathology, University Hospital of Wales and School of Medicine, Cardiff University, Cardiff, UK
| | - Luka Brcic
- Diagnostics and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Juliet Burn
- Douglass Hanly Moir Pathology, Sydney, Australia
| | - Kelly J Butnor
- Department of Pathology, University of Vermont Medical Center, Burlington, VT, USA
| | - Nina Chang
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Canada
| | - Heather Chen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Marc De Perrot
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Canada
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Theresa Godschachner
- Diagnostics and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Kenzo Hiroshima
- Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Sonja Klebe
- Department of Anatomical Pathology, SA Pathology, Flinders University, Adelaide, Australia
| | - Thomas Krausz
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Leslie Litzky
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alberto M Marchevsky
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey Mueller
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University Hospital, Fukuoka, Japan
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, UK
| | - Prodipto Pal
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Canada
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology; Mayo Clinic, Rochester, MN, USA
| | - Sara Rorvig
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eric Santoni-Rugiu
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henry Tazelaar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Ming-Sound Tsao
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Canada
| | - Ann E Walts
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Birgit Weynand
- Department of Pathology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Yoshiaki Zaizen
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yu Zhi Zhang
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, UK
| | - Aliya N Husain
- Department of Pathology, University of Chicago, Chicago, IL, USA
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15
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Bulloni M, Pattini L, Pelosi G. Intratumor Distribution of Ki-67 Antigen Beyond Labeling Index for Clinical Decision-Making: A New Way of Counting. JTO Clin Res Rep 2021; 2:100207. [PMID: 34734194 PMCID: PMC8486920 DOI: 10.1016/j.jtocrr.2021.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Matteo Bulloni
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Linda Pattini
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Inter-Hospital Pathology Division, IRCCS MultiMedica, Milan, Italy
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16
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Belderbos RA, Aerts JGV. In Response to "Intratumor Distribution of Ki-67 Antigen Beyond Labeling Index for Clinical Decision Making: A New Way of Counting". JTO Clin Res Rep 2021; 2:100215. [PMID: 34734195 PMCID: PMC8486919 DOI: 10.1016/j.jtocrr.2021.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Robert A. Belderbos
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joachim G.J. V. Aerts
- Address correspondence to: Joachim G. J. V. Aerts, MD, PhD, Department of Pulmonary Medicine, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
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17
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Pezzuto F, Vimercati L, Fortarezza F, Marzullo A, Pennella A, Cavone D, Punzi A, Caporusso C, d'Amati A, Lettini T, Serio G. Evaluation of prognostic histological parameters proposed for pleural mesothelioma in diffuse malignant peritoneal mesothelioma. A short report. Diagn Pathol 2021; 16:64. [PMID: 34294087 PMCID: PMC8296535 DOI: 10.1186/s13000-021-01125-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 07/06/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Diffuse malignant peritoneal mesothelioma (DMPM) is a rare malignant neoplasm with poor survival that shares some similarities with the best-known pleural variant, pleural mesothelioma. The recent European Reference Network on Rare Adult Cancers (EURACAN)/International Association for the Study of Lung Cancer (IASLC) proposals attempted to improve the histological diagnosis and patient risk stratification. Herein, we investigated whether the pathology recommendations and suggestions of the pleural proposals were applicable to diffuse malignant peritoneal mesothelioma. Methods Fifty multiple laparoscopic biopsies of DMPM were consecutively collected at the Pathology Unit of the University of Bari. A two-tier system, i.e., low, and high grade, was used to categorize 34 epithelioid DMPMs. Architectural patterns, cytological features and stromal changes were also reported. Immunohistochemistry was performed for BRCA1-associated protein 1 (BAP1), programmed death-ligand 1 (PD-L1), and Ki67, while fluorescence in situ hybridization (FISH) was performed for p16/cyclin-dependent kinase inhibitor 2A (CDKN2A). Results High-grade epithelioid mesothelioma, high Ki67, and p16/CDKN2A deletion were significantly associated with short survival (p = 0.004, p < 0.0001, and p = 0.002, respectively). BAP1 loss and PD-L1 negativity were the most common findings. Multivariate analysis revealed that the nuclear grading system and p16 deletion significantly correlated with survival (p = 0.003 each). Conclusions The present study examined the prognostic significance of several factors proposed for pleural mesothelioma in an extra pleural site. Notably, the introduction of a grading system may provide better risk stratification in epithelioid DMPM. Ki67, BAP1 and p16/CDKN2A should also be measured whenever possible. A detailed report with all supportive data would allow us to collect sufficient information for use in further studies on larger case series.
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Affiliation(s)
- Federica Pezzuto
- Pathology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, via A. Gabelli 61, 35121, Padova, Italy.
| | - Luigi Vimercati
- Department of Interdisciplinary Medicine, Occupational Health Division, University of Bari, 1 Umberto I Sq., 70121, Bari, Italy
| | - Francesco Fortarezza
- Pathology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, via A. Gabelli 61, 35121, Padova, Italy
| | - Andrea Marzullo
- Pathology Unit, Department of Emergency and Organ Transplantation - DETO, University of Bari, 1 Umberto I Sq., 70121, Bari, Italy
| | - Antonio Pennella
- Pathology Unit, Department of Surgery, University of Foggia, 121 Napoli St, 71122, Foggia, Italy
| | - Domenica Cavone
- Department of Interdisciplinary Medicine, Occupational Health Division, University of Bari, 1 Umberto I Sq., 70121, Bari, Italy
| | - Alessandra Punzi
- Pathology Unit, IRCCS National Cancer Institute "Giovanni Paolo II", 65 Orazio Flacco St, 70124, Bari, Italy
| | - Concetta Caporusso
- Pathology Unit, Department of Emergency and Organ Transplantation - DETO, University of Bari, 1 Umberto I Sq., 70121, Bari, Italy
| | - Antonio d'Amati
- Pathology Unit, Department of Emergency and Organ Transplantation - DETO, University of Bari, 1 Umberto I Sq., 70121, Bari, Italy
| | - Teresa Lettini
- Pathology Unit, Department of Emergency and Organ Transplantation - DETO, University of Bari, 1 Umberto I Sq., 70121, Bari, Italy
| | - Gabriella Serio
- Pathology Unit, Department of Emergency and Organ Transplantation - DETO, University of Bari, 1 Umberto I Sq., 70121, Bari, Italy
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18
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Prall OW. Malignant Pleural Mesothelioma-Does Ki67 Make the Grade? JTO Clin Res Rep 2021; 2:100170. [PMID: 34590021 PMCID: PMC8474261 DOI: 10.1016/j.jtocrr.2021.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Owen W.J. Prall
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
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19
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Abstract
Despite multiple diagnostic toolkits, the diagnosis of diffuse malignant pleural mesothelioma relies primarily on proper histologic assessment. The definitive diagnosis of diffuse malignant pleural mesothelioma is based on the pathologic assessment of tumor tissue, which can be obtained from core biopsy sampling, pleurectomy, or other more extensive resections, such as extrapleural pneumonectomy. Given its rarity and overlapping microscopic features with other conditions, the histologic diagnosis of diffuse malignant pleural mesothelioma is challenging. This review discusses the pathologic features and the differential diagnosis of diffuse malignant pleural mesothelioma, including select diagnostic pitfalls.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Lucian R Chirieac
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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20
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Beasley MB, Galateau-Salle F, Dacic S. Pleural mesothelioma classification update. Virchows Arch 2021; 478:59-72. [PMID: 33475835 DOI: 10.1007/s00428-021-03031-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 12/17/2022]
Abstract
The 2015 WHO classification of pleural mesotheliomas includes three major histologic subtypes-epithelioid, sarcomatoid, and biphasic. Recent genomic data has supported the need for a more granular and clinically valid classification beyond the three current subtypes. Because of tumor rarity and overlapping histologic features with other tumor types, diagnostic immunohistochemical work up is essential component in establishing the final diagnosis of mesothelioma. The use of BAP1 and CDKN2A/MTAP improves the diagnostic sensitivity of effusion specimens and are valuable in establishing the diagnosis of epithelioid mesothelioma. The major change in the forthcoming WHO classification is the inclusion of mesothelioma in situ as a diagnostic category. In this review, we discuss recently proposed changes in the histologic classification of pleural mesothelioma, differential diagnosis, and importance of ancillary diagnostic studies.
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Affiliation(s)
- Mary Beth Beasley
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
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21
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AXL Inactivation Inhibits Mesothelioma Growth and Migration via Regulation of p53 Expression. Cancers (Basel) 2020; 12:cancers12102757. [PMID: 32992696 PMCID: PMC7601862 DOI: 10.3390/cancers12102757] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Malignant mesothelioma is a locally aggressive and highly lethal neoplasm. Dysregulation and activation of Gas6/AXL tyrosine kinase signaling are associated with mesothelioma progression, but the mechanisms of these AXL tumorigenic roles are poorly understood. p53 mutants in lung carcinoma upregulate AXL expression by binding and acetylating the AXL promoter. Although TP53 mutations are uncommon in mesothelioma, we hypothesized that these tumors might have alternative feedback mechanisms between AXL and p53. In the current report, we investigated AXL regulation of TP53 transcription, expression, and biological function in mesothelioma. AXL expression was stronger in mesothelioma than most of the other tumor types from the TCGA gene expression profile dataset. AXL knockdown by shRNA induced wild-type and mutant p53 expression in mesothelioma cell lines, suggesting that AXL pro-tumorigenic roles result in part from the suppression of p53 function. Likewise, induced AXL inhibited expression of wild type p53 in COS-7 cells and 293T cells. Immunofluorescence staining showed nuclear colocalization of AXL and p53; however, association of AXL and p53 was not demonstrated in immunoprecipitation complexes. The AXL effects on p53 expression resulted from the inhibition of TP53 transcription, as demonstrated by qRT-PCR after AXL silencing and TP53 promotor dual luciferase activity assays. Chromatin immunoprecipitation-qPCR and sequencing showed that AXL bound to the initial 600 bp sequence at the 5' end of the TP53 promoter. AXL inhibition (shRNA or R428) reduced mesothelioma cell viability, migration, and invasion, whereas TP53 shRNA knockdown attenuated antiproliferative, migration, and invasive effects of AXL silencing or AXL inactivation in these cells. These studies demonstrate a novel feedback regulation loop between AXL and p53, and provide a rationale for mesothelioma therapies targeting AXL/p53 signaling.
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22
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Astoul P. Rethought histologic classification of pleural mesothelioma to better treat: go forward from looking back. Transl Lung Cancer Res 2020; 9:1613-1616. [PMID: 32953534 PMCID: PMC7481632 DOI: 10.21037/tlcr-20-592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Aix-Marseille University, Marseille, France
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23
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Bilecz A, Stockhammer P, Theegarten D, Kern I, Jakopovic M, Samarzija M, Klikovits T, Hoda MA, Döme B, Oberndorfer F, Muellauer L, Fillinger J, Kovács I, Pirker C, Schuler M, Plönes T, Aigner C, Klepetko W, Berger W, Brcic L, Laszlo V, Hegedus B. Comparative analysis of prognostic histopathologic parameters in subtypes of epithelioid pleural mesothelioma. Histopathology 2020; 77:55-66. [PMID: 32170970 DOI: 10.1111/his.14105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/25/2022]
Abstract
AIMS Malignant pleural mesothelioma (MPM) is a rare malignancy with a dismal prognosis. While the epithelioid type is associated with a more favourable outcome, additional factors are needed to further stratify prognosis and to identify patients who can benefit from multimodal treatment. As epithelioid MPM shows remarkable morphological variability, the prognostic role of the five defined morphologies, the impact of the nuclear grading system and the mitosis-necrosis score were investigated in this study. METHODS AND RESULTS Tumour specimens of 192 patients with epithelioid MPM from five European centres were histologically subtyped. Nuclear grading and mitosis-necrosis score were determined and correlated with clinicopathological parameters and overall survival (OS). Digital slides of 55 independent cases from The Cancer Genome Atlas (TCGA) database were evaluated for external validation. Histological subtypes were collapsed into three groups based on their overlapping survival curves. The tubulopapillary/microcystic group had a significantly longer OS than the solid/trabecular group (732 days versus 397 days, P = 0.0013). Pleomorphic tumours had the shortest OS (173 days). The solid/trabecular variants showed a significant association with high nuclear grade and mitosis-necrosis score. The mitosis-necrosis score was a robust and independent prognostic factor in our patient cohort. The prognostic significance of all three parameters was externally validated in the TCGA cohort. Patients with tubulopapillary or microcystic tumours showed a greater improvement in OS after receiving multimodal therapy than those with solid or trabecular tumours. CONCLUSIONS Histological subtypes of epithelioid MPM have a prognostic impact, and might help to select patients for intensive multimodal treatment approaches.
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Affiliation(s)
- Agnes Bilecz
- 2nd Institute of Pathology, Semmelweis University, Budapest, Hungary
| | - Paul Stockhammer
- Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Izidor Kern
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Marko Jakopovic
- Department for Respiratory Diseases Jordanovac, University Hospital Center, University of Zagreb, Zagreb, Croatia
| | - Miroslav Samarzija
- Department for Respiratory Diseases Jordanovac, University Hospital Center, University of Zagreb, Zagreb, Croatia
| | - Thomas Klikovits
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Mir A Hoda
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Balázs Döme
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Leonhard Muellauer
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - János Fillinger
- Department of Pathology, National Koranyi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Ildikó Kovács
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Christine Pirker
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Walter Berger
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Luka Brcic
- Medical University of Graz, Diagnostic and Research Institute of Pathology, Graz, Austria
| | - Viktória Laszlo
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Balazs Hegedus
- 2nd Institute of Pathology, Semmelweis University, Budapest, Hungary
- Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
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Ceresoli GL, Gianoncelli L, Grosso F. Tumour Treating Fields for mesothelioma - Authors' reply. Lancet Oncol 2020; 21:e10. [PMID: 31908296 DOI: 10.1016/s1470-2045(19)30831-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 11/16/2022]
Affiliation(s)
| | - Letizia Gianoncelli
- Department of Oncology, Cliniche Humanitas Gavazzeni, 24125 Bergamo, Italy; Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milano, Italy
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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25
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Nicholson AG, Sauter JL, Nowak AK, Kindler HL, Gill RR, Remy-Jardin M, Armato SG, Fernandez-Cuesta L, Bueno R, Alcala N, Foll M, Pass H, Attanoos R, Baas P, Beasley MB, Brcic L, Butnor KJ, Chirieac LR, Churg A, Courtiol P, Dacic S, De Perrot M, Frauenfelder T, Gibbs A, Hirsch FR, Hiroshima K, Husain A, Klebe S, Lantuejoul S, Moreira A, Opitz I, Perol M, Roden A, Roggli V, Scherpereel A, Tirode F, Tazelaar H, Travis WD, Tsao MS, van Schil P, Vignaud JM, Weynand B, Lang-Lazdunski L, Cree I, Rusch VW, Girard N, Galateau-Salle F. EURACAN/IASLC Proposals for Updating the Histologic Classification of Pleural Mesothelioma: Towards a More Multidisciplinary Approach. J Thorac Oncol 2020; 15:29-49. [DOI: 10.1016/j.jtho.2019.08.2506] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
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26
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Abstract
Mesothelioma is a rare neoplasm that arises from mesothelial cells lining body cavities including the pleura, pericardium, peritoneum, and tunica vaginalis. Most malignant mesotheliomas occur in the chest and are frequently associated with a history of asbestos exposure. The diagnosis of malignant mesothelioma is challenging and fraught with pitfalls, particularly in small biopsies. This article highlights what the pathologist needs to know regarding the clinical and radiographic presentation of mesothelioma, histologic features including subtypes and variants, and recent advances in immunohistochemical markers and molecular testing.
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27
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Marcq E, Audenaerde JRV, Waele JD, Jacobs J, Loenhout JV, Cavents G, Pauwels P, Meerbeeck JPV, Smits EL. Building a Bridge between Chemotherapy and Immunotherapy in Malignant Pleural Mesothelioma: Investigating the Effect of Chemotherapy on Immune Checkpoint Expression. Int J Mol Sci 2019; 20:E4182. [PMID: 31455014 PMCID: PMC6747385 DOI: 10.3390/ijms20174182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/30/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022] Open
Abstract
In light of the promising results of immune checkpoint blockade (ICPB) in malignant pleural mesothelioma (MPM), we investigated the effect of different chemotherapeutic agents on the expression of immune checkpoints (ICPs) in order to rationally design a good treatment schedule for their combination with ICP blocking antibodies. Cisplatin, oxaliplatin and pemetrexed are interesting chemotherapeutic agents to combine with immunotherapy given their immunomodulatory capacities. We looked into cisplatin and pemetrexed because their combination is used as first-line treatment of MPM. Additionally, the effect of the immunogenic chemotherapeutic agent, oxaliplatin, was also studied. Three different MPM cell lines were used for representation of both epithelioid and sarcomatoid subtypes. The desired inhibitory concentrations of the chemotherapeutic agents were determined with the SRB-assay. Allogeneic co-cultures of MPM cells with healthy donor peripheral blood mononuclear cells (PBMC) were set up to assess the effect of these chemotherapeutic agents on the expression of ICPs (PD-1, LAG-3, TIM-3) and their ligands (PD-L1, PD-L2, galectin-9). Cisplatin might be a promising treatment to combine with ICP blocking antibodies since our MPM cell lines were most susceptible to this stand-alone treatment. We found that the expression of ICPs and their ligands on both MPM cells and PBMC was mostly downregulated or unaltered when treated with chemotherapeutic agents, though no clear trend could be determined.
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Affiliation(s)
- Elly Marcq
- Center for Oncological Research, University of Antwerp, Antwerp 2000, Belgium.
| | | | - Jorrit De Waele
- Center for Oncological Research, University of Antwerp, Antwerp 2000, Belgium
| | - Julie Jacobs
- Center for Oncological Research, University of Antwerp, Antwerp 2000, Belgium
| | - Jinthe Van Loenhout
- Center for Oncological Research, University of Antwerp, Antwerp 2000, Belgium
| | - Glenn Cavents
- Center for Oncological Research, University of Antwerp, Antwerp 2000, Belgium
| | - Patrick Pauwels
- Center for Oncological Research, University of Antwerp, Antwerp 2000, Belgium
- Department of Pathology, Antwerp University Hospital, Antwerp 2650, Belgium
| | - Jan P van Meerbeeck
- Center for Oncological Research, University of Antwerp, Antwerp 2000, Belgium
- Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital, Antwerp 2650, Belgium
| | - Evelien Lj Smits
- Center for Oncological Research, University of Antwerp, Antwerp 2000, Belgium
- Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Antwerp 2650, Belgium
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