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Taylor AS, Spratt DE, Dhanasekaran SM, Mehra R. Contemporary Renal Tumor Categorization With Biomarker and Translational Updates: A Practical Review. Arch Pathol Lab Med 2020; 143:1477-1491. [PMID: 31765248 DOI: 10.5858/arpa.2019-0442-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Renal tumor classification has evolved in recent decades, as evidenced by the comparable complexity of the 2016 revision to the World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs. A recent expansion of the knowledge base surrounding the cells of origin and evolutionary genomic characteristics of renal tumors has led to molecular characterization of novel entities and enriched understanding of established entities. This pace of research and its implementation into clinical practice has again begun to surpass that of our own classification schemata, with significant discoveries having been made since the introduction of the 2016 revision to the World Health Organization classification. In particular, biomarkers for renal tumor diagnosis and prognosis are in translation for future clinical application. OBJECTIVES.— To provide a brief framework for clinical characterization of renal tumors rooted in morphologic assessment, to briefly review the current and future status of renal tumor biomarkers with an emphasis on practical use of these ancillary tools for accurate diagnosis, and to discuss the impact of emerging technologies and clinical trials relevant to renal cell carcinoma classification and biomarker development. DATA SOURCES.— We review recent literature relevant to renal tumor classification (including established and proposed entities), focusing on molecular characterization and biomarker assessment. CONCLUSIONS.— Accurate renal tumor diagnosis requires an up-to-date understanding of renal tumor classification, including an awareness of morphologic clues that should stimulate consideration of molecularly defined entities, as well as the ancillary biomarker testing required to confirm diagnoses.
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Affiliation(s)
- Alexander S Taylor
- From the Departments of Pathology (Drs Taylor, Dhanasekaran, and Mehra) and Radiation Oncology (Dr Spratt), University of Michigan Medical School, Ann Arbor; the Rogel Cancer Center, Michigan Medicine, Ann Arbor (Drs Spratt and Mehra); and the Michigan Center for Translational Pathology, Ann Arbor (Drs Dhanasekaran and Mehra)
| | - Daniel E Spratt
- From the Departments of Pathology (Drs Taylor, Dhanasekaran, and Mehra) and Radiation Oncology (Dr Spratt), University of Michigan Medical School, Ann Arbor; the Rogel Cancer Center, Michigan Medicine, Ann Arbor (Drs Spratt and Mehra); and the Michigan Center for Translational Pathology, Ann Arbor (Drs Dhanasekaran and Mehra)
| | - Saravana M Dhanasekaran
- From the Departments of Pathology (Drs Taylor, Dhanasekaran, and Mehra) and Radiation Oncology (Dr Spratt), University of Michigan Medical School, Ann Arbor; the Rogel Cancer Center, Michigan Medicine, Ann Arbor (Drs Spratt and Mehra); and the Michigan Center for Translational Pathology, Ann Arbor (Drs Dhanasekaran and Mehra)
| | - Rohit Mehra
- From the Departments of Pathology (Drs Taylor, Dhanasekaran, and Mehra) and Radiation Oncology (Dr Spratt), University of Michigan Medical School, Ann Arbor; the Rogel Cancer Center, Michigan Medicine, Ann Arbor (Drs Spratt and Mehra); and the Michigan Center for Translational Pathology, Ann Arbor (Drs Dhanasekaran and Mehra)
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2
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VSTM2A Overexpression Is a Sensitive and Specific Biomarker for Mucinous Tubular and Spindle Cell Carcinoma (MTSCC) of the Kidney. Am J Surg Pathol 2019; 42:1571-1584. [PMID: 30285995 DOI: 10.1097/pas.0000000000001150] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Our recent study revealed recurrent chromosomal losses and somatic mutations of genes in the Hippo pathway in mucinous tubular and spindle cell carcinoma (MTSCC). Here, we performed an integrative analysis of 907 renal cell carcinoma (RCC) samples (combined from The Cancer Genome Atlas and in-house studies) and the Knepper data set of microdissected rat nephrons. We identified VSTM2A and IRX5 as novel cancer-specific and lineage-specific biomarkers in MTSCC. We then assessed their expression by RNA in situ hybridization (ISH) in 113 tumors, including 33 MTSCC, 40 type 1 papillary RCC, 8 type 2 papillary RCC, 2 unclassified RCC, 15 clear cell RCC, and 15 chromophobe RCC. Sensitivity and specificity were calculated as the area under the receiver operating characteristics curve (AUC). All MTSCC tumors demonstrated moderate to high expression of VSTM2A (mean ISH score=255). VSTM2A gene expression assessed by RNA sequencing strongly correlated with VSTM2A ISH score (r(2)=0.81, P=0.00016). The majority of non-MTSCC tumors demonstrated negative or low expression of VSTM2A. IRX5, nominated as a lineage-specific biomarker, showed moderate to high expression in MTSCC tumors (mean ISH score=140). IRX5 gene expression assessed by RNA sequencing strongly correlated with IRX5 ISH score (r(2)=0.69, P=0.00291). VSTM2A (AUC: 99.2%) demonstrated better diagnostic efficacy than IRX5 (AUC: 87.5%), and may thus serve as a potential diagnostic marker to distinguish tumors with overlapping histology. Furthermore, our results suggest MTSCC displays an overlapping phenotypic expression pattern with the loop of Henle region of normal nephrons.
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3
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Skala SL, Dhanasekaran SM, Mehra R. Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome (HLRCC): A Contemporary Review and Practical Discussion of the Differential Diagnosis for HLRCC-Associated Renal Cell Carcinoma. Arch Pathol Lab Med 2019; 142:1202-1215. [PMID: 30281371 DOI: 10.5858/arpa.2018-0216-ra] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Hereditary leiomyomatosis and renal cell carcinoma syndrome (HLRCC) is an uncommon disorder with germline-inactivating mutations in the fumarate hydratase ( FH) gene. The kidney cancers that develop in patients with HLRCC are often unilateral and solitary, with a potentially aggressive clinical course; morphologic identification of suspicious cases is of the utmost importance. OBJECTIVE.— To review classic morphologic features of HLRCC-associated renal cell carcinoma, the reported morphologic spectrum of these tumors and their mimics, and the evidence for use of immunohistochemistry and molecular testing in diagnosis of these tumors. DATA SOURCES.— University of Michigan cases and review of pertinent literature about HLRCC and the morphologic spectrum of HLRCC-associated renal cell carcinoma. CONCLUSIONS.— Histologic features, such as prominent nucleoli with perinucleolar halos and multiple architectural patterns within one tumor, are suggestive of HLRCC-associated renal cell carcinoma. However, the morphologic spectrum is broad. Appropriate use of FH immunohistochemistry and referral to genetic counseling is important for detection of this syndrome.
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Affiliation(s)
| | | | - Rohit Mehra
- From the Department of Pathology, University of Michigan Medical School, Ann Arbor (Drs Skala and Mehra); the Rogel Cancer Center, Michigan Medicine, Ann Arbor (Dr Mehra); and the Department of Pathology, Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor (Drs Dhanasekaran and Mehra)
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4
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Association of ERG/PTEN status with biochemical recurrence after radical prostatectomy for clinically localized prostate cancer. Med Oncol 2018; 35:152. [PMID: 30291535 DOI: 10.1007/s12032-018-1212-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022]
Abstract
We have previously demonstrated a significant correlative relationship between PTEN deletion and ERG rearrangement, both in the development of clinically localized prostate cancers and metastases. Herein, we evaluate the cooperative role of ERG and PTEN in oncological outcomes after radical prostatectomy for clinically localized prostate cancer. We evaluated ERG and PTEN status using three previously described cohorts. The first cohort included 235 clinically localized prostate cancer cases represented on tissue microarrays (TMA), evaluated using previously validated FISH assays for ERG and PTEN. The second cohort included 167 cases of clinically localized prostate cancer on TMAs evaluated for PTEN by FISH, and for PTEN and ERG by dual IHC. The third cohort comprised 59 clinically localized prostate cancer cases assessed by array comparative genomic hybridization (aCGH). Kaplan-Meir plots and long rank tests were used to assess the association of ERG and PTEN status with biochemical recurrence after radical prostatectomy for clinically localized prostate cancer. Of the 317 cases eligible for analyses with evaluable ERG and PTEN status, 88 (27.8%) patients developed biochemical recurrence over a median follow-up of 5.7 years. Overall, 45% (142/317) of cases demonstrated ERG rearrangement and 20% (62/317) of cases demonstrated PTEN loss. Hemizygous and homozygous deletion of PTEN was seen in 10% (18/175) and 3% (5/175) of ERG-negative cases, respectively. In contrast, hemizygous and homozygous deletion of PTEN was seen in 11% (15/142) and 17% (24/123) of ERG-positive cases, respectively. PTEN loss (heterozygous or homozygous) was significantly associated with shorter time to biochemical recurrence compared to no PTEN loss (p < 0.001). However, ERG rearrangement versus no rearrangement was not associated with time to PSA recurrence (p = 0.15). Patients who exhibited ERG rearrangement and loss of PTEN had no significant difference in time to recurrence compared to patients with wild-type ERG and loss of PTEN (p = 0.30). Our findings confirm a mutual cooperative role of ERG and PTEN in the pathogenesis of prostate cancer, particularly for homozygous PTEN deletion. ERG did not stratify outcome either alone or in combination with PTEN in this cohort.
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Detection of 6 TFEB-amplified renal cell carcinomas and 25 renal cell carcinomas with MITF translocations: systematic morphologic analysis of 85 cases evaluated by clinical TFE3 and TFEB FISH assays. Mod Pathol 2018; 31:179-197. [PMID: 28840857 DOI: 10.1038/modpathol.2017.99] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/16/2017] [Accepted: 06/29/2017] [Indexed: 01/14/2023]
Abstract
Renal cell carcinomas with MITF aberrations demonstrate a wide morphologic spectrum, highlighting the need to consider these entities within the differential diagnosis of renal tumors encountered in clinical practice. Herein, we describe our experience with application of clinical fluorescence in situ hybridization (FISH) assays for detection of TFE3 and TFEB gene aberrations from 85 consecutive renal cell carcinoma cases submitted to our genitourinary FISH service. Results from 170 FISH assays performed on these tumors were correlated with available clinicopathologic findings. Ninety-eight percent of renal tumors submitted for FISH evaluation were from adult patients. Thirty-one (37%) tumors were confirmed to demonstrate MITF aberrations (21 TFE3 translocation, 4 TFEB translocation, and 6 TFEB amplification cases). Overall, renal cell carcinomas with MITF aberrations demonstrated morphologic features overlapping with clear cell, papillary, or clear cell papillary renal cell carcinomas. Renal cell carcinomas with MITF aberrations were significantly more likely to demonstrate dual (eosinophilic and clear) cytoplasmic tones (P=0.030), biphasic TFEB translocation renal cell carcinoma-like morphology (P=0.002), psammomatous calcifications (P=0.002), and nuclear pseudoinclusions (P=0.001) than renal cell carcinomas without MITF aberrations. Notably, 7/9 (78%) renal cell carcinomas exhibiting subnuclear clearing and linear nuclear array (6 of which showed high World Health Organization/International Society of Urological Pathology nucleolar grade) demonstrated TFE3 translocation, an association that was statistically significant when compared with renal cell carcinomas without MITF aberrations (P=0.009). In this cohort comprising consecutive cases, TFEB-amplified renal cell carcinomas were more commonly identified than renal cell carcinomas with TFEB translocations, and four (67%) of these previously unreported TFEB-amplified renal cell carcinomas demonstrated oncocytic and papillary features with a high World Health Organization/International Society of Urological Pathology nucleolar grade. In summary, TFE3 and TFEB FISH evaluation aids in identification and accurate classification of renal cell carcinomas with MITF aberrations, including TFEB-amplified renal cell carcinoma, which may demonstrate aggressive behavior.
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Renal Cell Carcinoma Occurring in Patients With Prior Neuroblastoma: A Heterogenous Group of Neoplasms. Am J Surg Pathol 2017; 40:989-97. [PMID: 26975037 DOI: 10.1097/pas.0000000000000632] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Renal cell carcinoma (RCC) associated with neuroblastoma (NB) was included as a distinct entity in the 2004 World Health Organization classification of kidney tumors. A spectrum of RCC subtypes has been reported in NB survivors. We herein describe a series of 8 RCCs diagnosed in 7 patients with a history of NB. Microscopic evaluation, immunohistochemical staining for PAX8, cathepsin K, and succinate dehydrogenase subunit B (SDHB), and fluorescence in situ hybridization (FISH) for TFE3 and TFEB were performed. Four distinct morphologic subtypes were identified: 3 tumors were characterized by cells with abundant oncocytoid cytoplasm and irregular nuclei; 3 showed features of microphthalmia transcription factor family translocation RCC (MiTF-RCC); 1 had features of hybrid oncocytic-chromophobe tumor; 1 had papillary RCC histology. All RCCs expressed PAX8 and retained SDHB expression. Cathepsin K was positive in 2 MiTF-RCCs, 1 was TFEB FISH positive, and the other was indeterminate. Cathepsin K was negative in a third MiTF-RCC with TFE3 rearrangement. TFE3 FISH was negative in 4 and insufficient in 1 of the other 5 RCCs. While a subset of RCCs associated with NB is characterized by cells with prominent oncocytoid cytoplasm, other RCC subtypes also occur in post-NB patients. Renal neoplasms occurring in patients with a history of NB do not represent a single entity but a heterogenous group of RCCs. SDHB mutations do not explain the subset of nontranslocation RCCs with oncocytoid features; therefore, further studies are needed to clarify whether they may represent a distinct entity with unique molecular abnormalities or may belong to other emerging RCC subtypes.
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Udager AM, Mehra R. Morphologic, Molecular, and Taxonomic Evolution of Renal Cell Carcinoma: A Conceptual Perspective With Emphasis on Updates to the 2016 World Health Organization Classification. Arch Pathol Lab Med 2017; 140:1026-37. [PMID: 27684973 DOI: 10.5858/arpa.2016-0218-ra] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Molecular and morphologic interrogation has driven a much-needed reexamination of renal cell carcinoma (RCC). Indeed, the recently released 2016 World Health Organization classification now recognizes 12 distinct RCC subtypes, as well as several other emerging/provisional RCC entities. From a clinical perspective, accurate RCC classification may have important implications for patients and their families, including prognostic risk stratification, targeted therapeutics selection, and identification for genetic testing. In this review, we provide a conceptual framework for approaching RCC diagnosis and classification by categorizing RCCs as tumors with clear cytoplasm, papillary architecture, and eosinophilic (oncocytic) cytoplasm. The currently recognized 2016 World Health Organization classification for RCC subtypes is briefly discussed, including new diagnostic entities (clear cell papillary RCC, hereditary leiomyomatosis and RCC-associated RCC, succinate dehydrogenase-deficient RCC, tubulocystic RCC, and acquired cystic disease-associated RCC) and areas of evolving RCC classification, such as transcription elongation factor B subunit 1 (TCEB1)-mutated RCC/RCC with angioleiomyoma-like stroma/RCC with leiomyomatous stroma, RCC associated with anaplastic lymphoma receptor tyrosine kinase (ALK) gene rearrangement, thyroidlike follicular RCC, and RCC in neuroblastoma survivors. For each RCC subtype, relevant clinical, molecular, gross, and microscopic findings are reviewed, and ancillary studies helpful for its differential diagnosis are presented, providing a practical approach to modern RCC classification.
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Affiliation(s)
- Aaron M Udager
- From the Department of Pathology (Drs Udager and Mehra) and the Comprehensive Cancer Center (Dr Mehra), University of Michigan Health System, Ann Arbor; and the Michigan Center for Translational Pathology, Ann Arbor (Dr Mehra)
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8
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Mehra R, Vats P, Cieslik M, Cao X, Su F, Shukla S, Udager AM, Wang R, Pan J, Kasaian K, Lonigro R, Siddiqui J, Premkumar K, Palapattu G, Weizer A, Hafez KS, Wolf JS, Sangoi AR, Trpkov K, Osunkoya AO, Zhou M, Giannico G, McKenney JK, Dhanasekaran SM, Chinnaiyan AM. Biallelic Alteration and Dysregulation of the Hippo Pathway in Mucinous Tubular and Spindle Cell Carcinoma of the Kidney. Cancer Discov 2016; 6:1258-1266. [PMID: 27604489 DOI: 10.1158/2159-8290.cd-16-0267] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/02/2016] [Indexed: 11/16/2022]
Abstract
Mucinous tubular and spindle cell carcinoma (MTSCC) is a relatively rare subtype of renal cell carcinoma (RCC) with distinctive morphologic and cytogenetic features. Here, we carry out whole-exome and transcriptome sequencing of a multi-institutional cohort of MTSCC (n = 22). We demonstrate the presence of either biallelic loss of Hippo pathway tumor suppressor genes (TSG) and/or evidence of alteration of Hippo pathway genes in 85% of samples. PTPN14 (31%) and NF2 (22%) were the most commonly implicated Hippo pathway genes, whereas other genes such as SAV1 and HIPK2 were also involved in a mutually exclusive fashion. Mutations in the context of recurrent chromosomal losses amounted to biallelic alterations in these TSGs. As a readout of Hippo pathway inactivation, a majority of cases (90%) exhibited increased nuclear YAP1 protein expression. Taken together, nearly all cases of MTSCC exhibit some evidence of Hippo pathway dysregulation. SIGNIFICANCE MTSCC is a rare and relatively recently described subtype of RCC. Next-generation sequencing of a multi-institutional MTSCC cohort revealed recurrent chromosomal losses and somatic mutations in the Hippo signaling pathway genes leading to potential YAP1 activation. In virtually all cases of MTSCC, there was evidence of Hippo pathway dysregulation, suggesting a common mechanistic basis for this disease. Cancer Discov; 6(11); 1258-66. ©2016 AACR.This article is highlighted in the In This Issue feature, p. 1197.
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Affiliation(s)
- Rohit Mehra
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan.,Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Pankaj Vats
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Ann Arbor, Michigan.,Department of Biomedical Science, School of Basic Medical Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Marcin Cieslik
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Xuhong Cao
- Michigan Center for Translational Pathology, Ann Arbor, Michigan.,Howard Hughes Medical Institute, Ann Arbor, Michigan
| | - Fengyun Su
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Sudhanshu Shukla
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Aaron M Udager
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Rui Wang
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Jincheng Pan
- Department of Urology, First Affiliated Hospital, Sun-Yat Sen University, Guangzhou, China
| | - Katayoon Kasaian
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Robert Lonigro
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Kumpati Premkumar
- Department of Biomedical Science, School of Basic Medical Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Ganesh Palapattu
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Alon Weizer
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan.,Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Khaled S Hafez
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - J Stuart Wolf
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Ankur R Sangoi
- El Camino Hospital, Department of Pathology, Mountain View, California
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adeboye O Osunkoya
- Departments of Pathology and Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Ming Zhou
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Giovanna Giannico
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jesse K McKenney
- Cleveland Clinic, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Saravana M Dhanasekaran
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan. .,Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Ann Arbor, Michigan.,Howard Hughes Medical Institute, Ann Arbor, Michigan.,Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
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Magers MJ, Udager AM, Mehra R. MiT Family Translocation-Associated Renal Cell Carcinoma: A Contemporary Update With Emphasis on Morphologic, Immunophenotypic, and Molecular Mimics. Arch Pathol Lab Med 2016; 139:1224-33. [PMID: 26414466 DOI: 10.5858/arpa.2015-0196-ra] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Translocation-associated renal cell carcinoma (t-RCC) is a relatively uncommon subtype of renal cell carcinoma characterized by recurrent gene rearrangements involving the TFE3 or TFEB loci. TFE3 and TFEB are members of the microphthalmia transcription factor (MiT) family, which regulates differentiation in melanocytes and osteoclasts, and MiT family gene fusions activate unique molecular programs that can be detected immunohistochemically. Although the overall clinical behavior of t-RCC is variable, emerging molecular data suggest the possibility of targeted approaches to advanced disease. Thus, distinguishing t-RCC from its morphologic, immunophenotypic, and molecular mimics may have important clinical implications. The differential diagnosis for t-RCC includes a variety of common renal neoplasms, particularly those demonstrating clear cell and papillary features; in addition, because of immunophenotypic overlap and/or shared molecular abnormalities (ie, TFE3 gene rearrangement), a distinctive set of nonepithelial renal tumors may also warrant consideration. Directed ancillary testing is an essential aspect to the workup of t-RCC cases and may include a panel of immunohistochemical stains, such as PAX8, pancytokeratins, epithelial membrane antigen, carbonic anhydrase IX, HMB-45, and Melan-A. Dual-color, break-apart fluorescent in situ hybridization for TFE3 or TFEB gene rearrangement may be helpful in diagnostically challenging cases or when molecular confirmation is needed.
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Affiliation(s)
- Martin J Magers
- From the Department of Pathology (Drs Magers, Udager, and Mehra), and the Comprehensive Cancer Center (Dr Mehra), University of Michigan Health System, Ann Arbor; and the Michigan Center for Translational Pathology, Ann Arbor (Dr Mehra)
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10
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Mehra R, Udager AM, Ahearn TU, Cao X, Feng FY, Loda M, Petimar JS, Kantoff P, Mucci LA, Chinnaiyan AM. Overexpression of the Long Non-coding RNA SChLAP1 Independently Predicts Lethal Prostate Cancer. Eur Urol 2015; 70:549-552. [PMID: 26724257 DOI: 10.1016/j.eururo.2015.12.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/04/2015] [Indexed: 11/26/2022]
Abstract
The long noncoding RNA SChLAP1 is overexpressed in a subset of prostate cancers (PCa), and high SChLAP1 expression by in situ hybridization (ISH) independently predicts biochemical recurrence after radical prostatectomy. Importantly, although biochemical recurrence is a significant clinical outcome, it is not a validated surrogate for PCa-related mortality. Thus, we evaluated the association between SChLAP1 expression and development of lethal PCa in a large cohort of American men with PCa and long-term follow-up. SChLAP1 ISH was performed on tissue microarrays containing representative formalin-fixed, paraffin-embedded PCa tissue from all patients and scored using a semiquantitative method (ISH score range 0-400). Hazard ratios (HRs) for the association between SChLAP1 expression and time to development of lethal PCa were estimated using multivariable Cox regression analysis. Of the 937 patients evaluated, 89 (9.5%) had high SChLAP1 expression (ISH score ≥100), which in patients treated with radical prostatectomy was strongly associated with development of lethal PCa independent of age, Gleason score, pathologic stage, and PTEN status (HR 2.2, 95% confidence interval 1.1-4.1). These results suggest that SChLAP1 may be a useful tissue-based biomarker for identifying PCa patients at higher risk of lethal progression. PATIENT SUMMARY We examined expression of the RNA molecule SChLAP1 in a large group of prostate cancer patients with long-term follow-up and found that patients with high SChLAP1 expression had a significantly higher chance of developing lethal disease.
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Affiliation(s)
- Rohit Mehra
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI, USA; Michigan Center for Translational Pathology, Ann Arbor, MI, USA.
| | - Aaron M Udager
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Thomas U Ahearn
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Xuhong Cao
- Michigan Center for Translational Pathology, Ann Arbor, MI, USA
| | - Felix Y Feng
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI, USA; Michigan Center for Translational Pathology, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Massimo Loda
- Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joshua S Petimar
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Philip Kantoff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI, USA; Michigan Center for Translational Pathology, Ann Arbor, MI, USA; Howard Hughes Medical Institute, Ann Arbor, MI, USA.
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Abstract
This article reviews emerging entities in renal epithelial neoplasia, including tubulocystic carcinoma, clear-cell-papillary renal cell carcinoma (RCC), thyroid-like follicular RCC, ALK-related RCC, translocation RCC, acquired cystic disease-related RCC, succinate dehydrogenase-deficient RCC, and hereditary leiomyomatosis-RCC syndrome-associated RCC. Many of these rarer subtypes of RCC were recently studied in more depth and are included in the upcoming version of the World Health Organization classification of tumors. Emphasis is placed on common gross and morphologic features, differential diagnoses, use of ancillary studies for making accurate diagnoses, molecular alterations, and predicted biologic behavior based on previous studies.
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Affiliation(s)
- Rohit Mehra
- Department of Pathology, University of Michigan Hospital and Health Systems, 1500, East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Steven C Smith
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Mukul Divatia
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Mahul B Amin
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
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12
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Fallahabadi ZR, Noori Daloii MR, Mahdian R, Behjati F, Shokrgozar MA, Abolhasani M, Asgari M, Shahrokh H. Frequency of PTEN alterations, TMPRSS2-ERG fusion and their association in prostate cancer. Gene 2015; 575:755-60. [PMID: 26424596 DOI: 10.1016/j.gene.2015.09.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/31/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Phosphatase and tensin homolog (PTEN) gene aberration and trans membrane protease, serine 2 (TMPRSS2)-v-ets avian erythroblastosis virus E26 oncogene homolog (ERG) fusion are the most prevalent genomic events in prostate cancer. In this study we aimed to evaluate the frequency of PTEN alteration and TMPRSS2-ERG fusion and possible link between these two biomarkers in Iranian men. METHODS We assessed 42 fresh frozen tissue samples of prostate cancer (PCA) obtained by radical prostatectomy, interrogating the TMPRSS2-ERG fusion gene along with PTEN gene status using Real Time PCR and FISH methods. RESULTS Using Real Time PCR we identified the TMPRSS2-ERG fusion in 64% (27/42) of tumor samples, which was confirmed by FISH technique, giving 21 positive samples with deletion, suggesting the presence of TMPRSS2-ERG fusion gene. By contrast, PTEN deletion was detected in 52% (11/21) of PCA samples, which all showed low expression in Real Time. Concomitance of PTEN deletion or low expression and TMPRSS2-ERG fusion was present in PCA samples (P=0.005). All of the PTEN deletion samples showed TMPRSS2-ERG fusion, (11/11, 100%) while not all of the TMPRSS2-ERG fusion positive samples showed PTEN deletion. None of 29 cases of BPH and 8 cases of normal zone of tumor tissue showed TMPRSS2-ERG fusion. CONCLUSIONS These results indicate that PTEN loss occurs in cooperation with TMPRSS2-ERG fusion in PCA. While the majority of PCA samples harbor TMPRSS2-ERG fusion as well as PTEN gene deletion, normal tissues do not show these molecular aberrations.
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Affiliation(s)
- Zahra Rafiei Fallahabadi
- Molecular Medicine Department, Pasteur Institute of Iran, Tehran, Iran; National Cell Bank of Iran, Pasteur Institute of Iran, Tehran, Iran; Medical Genetics Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Mahdian
- Molecular Medicine Department, Pasteur Institute of Iran, Tehran, Iran.
| | - Farhkondeh Behjati
- Genetics Research Center, University of Social Walfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Maryam Abolhasani
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Pathology, Hasheminejad kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mojgan Asgari
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Pathology, Hasheminejad kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Shahrokh
- Department of Urology, Hasheminejad kidney Center, Iran University of Medical Sciences, Tehran, Iran
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A novel RNA in situ hybridization assay for the long noncoding RNA SChLAP1 predicts poor clinical outcome after radical prostatectomy in clinically localized prostate cancer. Neoplasia 2015; 16:1121-7. [PMID: 25499224 PMCID: PMC4309259 DOI: 10.1016/j.neo.2014.11.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/19/2014] [Indexed: 01/16/2023] Open
Abstract
Long noncoding RNAs (lncRNAs) are an emerging class of oncogenic molecules implicated in a diverse range of human malignancies. We recently identified SChLAP1 as a novel lncRNA that demonstrates outlier expression in a subset of prostate cancers, promotes tumor cell invasion and metastasis, and associates with lethal disease. Based on these findings, we sought to develop an RNA in situ hybridization (ISH) assay for SChLAP1 to 1) investigate the spectrum of SChLAP1 expression from benign prostatic tissue to metastatic castration-resistant prostate cancer and 2) to determine whether SChLAP1 expression by ISH is associated with outcome after radical prostatectomy in patients with clinically localized disease. The results from our current study demonstrate that SChLAP1 expression increases with prostate cancer progression, and high SChLAP1 expression by ISH is associated with poor outcome after radical prostatectomy in patients with clinically localized prostate cancer by both univariate (hazard ratio = 2.343, P = .005) and multivariate (hazard ratio = 1.99, P = .032) Cox regression analyses. This study highlights a potential clinical utility for SChLAP1 ISH as a novel tissue-based biomarker assay for outcome prognostication after radical prostatectomy.
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14
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Udager AM, Shi Y, Tomlins SA, Alva A, Siddiqui J, Cao X, Pienta KJ, Jiang H, Chinnaiyan AM, Mehra R. Frequent discordance between ERG gene rearrangement and ERG protein expression in a rapid autopsy cohort of patients with lethal, metastatic, castration-resistant prostate cancer. Prostate 2014; 74:1199-208. [PMID: 25043157 PMCID: PMC4156519 DOI: 10.1002/pros.22836] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/21/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND ERG rearrangements in localized prostate cancer can be detected with high sensitivity and specificity by immunohistochemistry (IHC). However, recent data suggest that ERG IHC may be less sensitive for ERG rearrangements in castration-resistant prostate cancer (CRPC). Thus, we sought to examine ERG protein expression in a cohort of rapid autopsy patients with lethal metastatic CRPC (mCRPC). METHODS A tissue microarray (TMA) of tumor sites from these patients was evaluated for ERG, prostate-specific antigen (PSA), and androgen receptor (AR) expression by IHC and correlated with ERG rearrangement status by fluorescent in situ hybridization (FISH). IHC was scored as the product of tumor cell staining intensity (0-3) and percentage of cells positive (0-100) (overall product score range = 0-300). RESULTS All 16 (100%) ERG rearrangement negative (ERG(neg) ) patients were also negative for ERG tumor cell expression (i.e., IHC product score = 0). Of the 10 ERG rearrangement positive (ERG(pos) ) patients, two (20%) were completely negative for ERG tumor cell expression, while eight (80%) had weak ERG expression (median IHC product score = 5-110). Of these eight ERG(pos) patients, five (63%) had at least one tumor site without any detectable ERG expression. For a given ERG(pos) patient, ERG expression varied both between and within tumor sites; AR and PSA expression also varied between tumor sites, and there was no significant correlation between ERG and AR or PSA expression. CONCLUSIONS These data reveal frequent discordance between ERG IHC and ERG FISH in ERG(pos) patients from this unique cohort of heavily treated lethal mCRPC.
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Affiliation(s)
- Aaron M. Udager
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109
| | - Yang Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109
- Michigan Center for Translational Pathology, Ann Arbor, MI 48109
| | - Scott A. Tomlins
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109
- Department of Urology, University of Michigan Health System, Ann Arbor, MI 48109
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109
- Michigan Center for Translational Pathology, Ann Arbor, MI 48109
| | - Ajjai Alva
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Health System, Ann Arbor, MI 48109
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, Ann Arbor, MI 48109
| | - Xuhong Cao
- Michigan Center for Translational Pathology, Ann Arbor, MI 48109
| | - Kenneth J. Pienta
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Hui Jiang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109
| | - Arul M. Chinnaiyan
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109
- Department of Urology, University of Michigan Health System, Ann Arbor, MI 48109
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109
- Michigan Center for Translational Pathology, Ann Arbor, MI 48109
- Howard Hughes Medical Institute, Ann Arbor, MI 48109
| | - Rohit Mehra
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109
- Michigan Center for Translational Pathology, Ann Arbor, MI 48109
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