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Wang L, Li Y, Han L. Pulmonary metastasis of stage I, low-grade endometrioid carcinoma: two case reports and the literature review. Front Oncol 2023; 13:1266485. [PMID: 37901321 PMCID: PMC10602667 DOI: 10.3389/fonc.2023.1266485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
Endometrial cancer (EC) is the most common malignant tumor of the female reproductive system, and the majority of ECs are low histological grade and confined to the uterus, resulting in a good prognosis. However, metastasis to the lung from a low-grade and early-stage endometrial endometrioid carcinoma (EEC) is extremely rare. Therefore, it is crucial to accurately differentiate between primary pulmonary malignancy and extra-thoracic malignancy presenting as metastatic disease, and flexible bronchoscopy with tissue acquisition plays a key role in this process. Despite its importance, there is limited literature available on the cytology of metastatic endometrial carcinoma in liquid-based cytology of bronchial brush (BB). In this article, we present two rare cases of lung metastasis from low-grade and early-stage EEC, along with a detailed analysis of the cytologic features observed in BB samples. These cases highlight the significance of cytological and histological pathology, complemented by immunohistochemistry (ICH) analysis, in the diagnosis and management of EEC patients. Pathologists should pay close attention to these aspects, while gynecologists need to be mindful of the follow-up and management of early-stage, low-grade EEC patients. By focusing on these areas, healthcare professionals can effectively contribute to the improved care and outcomes of patients with EEC.
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Affiliation(s)
- Li Wang
- Department of Gynecology & Obstetrics, Liaocheng People's Hospital, School of Medicine, Liaocheng University, Liaocheng, China
- Biomedical Laboratory, School of Medicine, Liaocheng University, Liaocheng, China
| | - Yingxue Li
- Department of Pathology, Liaocheng People's Hospital, Liaocheng, China
| | - Lin Han
- Department of Pathology, Liaocheng People's Hospital, Liaocheng, China
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Chibbar R, Foerstner S, Suresh J, Chibbar R, Piche A, Kundapur D, Kanthan R, Kundapur V, Lee CH, Agrawal A, Lai R. Estrogen/Progesterone Receptor Loss, CTNNB1 and KRAS Mutations Are Associated With Local Recurrence or Distant Metastasis in Low-Grade Endometrial Endometrioid Carcinoma. Appl Immunohistochem Mol Morphol 2023; 31:181-188. [PMID: 36695555 PMCID: PMC9988232 DOI: 10.1097/pai.0000000000001102] [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: 10/15/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023]
Abstract
A subset of endometrial endometrioid carcinomas (EECs) with low-grade histology recur with poor outcomes. Published evidence suggests that poor outcomes may be associated with loss of expression of ER-alpha (ER-α) as well as with β-Catenin-1 ( CTNNB1 ) and Kirsten rat sarcoma viral oncogene homolog ( KRAS ) mutations. This study reports on institutional experience with the incidence of recurrence in low-grade EEC and their association with CTNNB1 and KRAS mutations as well as estrogen/progesterone receptor (ER/PR) expression. Forty-eight (8.5%) out of 568 cases of low-grade EEC with biopsy-proven recurrence were identified; and were analyzed by immunohistochemistry for ER, PR, p53, MMR protein, and mutation analysis for exon 3 of the CTNNB1 and exon 2 of KRAS in relation to recurrence type, local or distant metastasis/recurrence. Twenty-three patients (4%) developed local, and 25 patients (4.4%) developed distant metastases/recurrence. Decreased expression or loss of ER/PR was found in 17/44 (38.6%) patients with recurrence. Eighty-four percent of patients with low-grade EEC and local recurrence had CTNNB1 mutations. Seventy-three percent of patients with distant metastasis/recurrence had KRAS mutations. The association of these mutations with the type of recurrence was statistically significant for both. Five cases with the morphology of low-grade EEC were reclassified as mesonephric-like carcinoma and were universally characterized by distant metastasis/recurrence, loss of ER/PR expression, large tumor size, absence of CTNNB1 mutations, and the presence of KRAS mutations. In low-grade EEC, CTNNB1 and KRAS mutations are associated with local recurrence and distant metastasis/recurrence, respectively, suggesting that these 2 different progression types may be conditioned by tumor genotype. ER/PR immunohistochemistry may be helpful in identifying poor performers in low-grade EEC. Furthermore, identification of the decreased expression or loss of ER/PR in tumors with low-grade histology should prompt consideration of mesonephric-like carcinoma, which is a more aggressive tumor than the low-grade EEC. KRAS mutations were associated with distant metastasis/recurrence in tumors with and without mesonephric-like phenotype.
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Affiliation(s)
- Rajni Chibbar
- Department of Laboratory Medicine and Pathology, University of Saskatchewan, Saskatoon, SK
| | - Sabrina Foerstner
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB
| | - Janarathnee Suresh
- Department of Laboratory Medicine and Pathology, University of Saskatchewan, Saskatoon, SK
| | | | - Alexandre Piche
- Department of Laboratory Medicine and Pathology, University of Saskatchewan, Saskatoon, SK
| | | | - Rani Kanthan
- Department of Laboratory Medicine and Pathology, University of Saskatchewan, Saskatoon, SK
| | | | - Cheng Han Lee
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB
| | - Anita Agrawal
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, ON
| | - Raymond Lai
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB
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van den Heerik ASVM, Aiyer KTS, Stelloo E, Jürgenliemk-Schulz IM, Lutgens LCHW, Jobsen JJ, Mens JWM, van der Steen-Banasik EM, Creutzberg CL, Smit VTHBM, Horeweg N, Bosse T. Microcystic elongated and fragmented (MELF) pattern of invasion: Molecular features and prognostic significance in the PORTEC-1 and -2 trials. Gynecol Oncol 2022; 166:530-537. [PMID: 35840357 DOI: 10.1016/j.ygyno.2022.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Microcystic, elongated fragmented (MELF) pattern of myometrial invasion is a distinct histologic feature occasionally seen in low-grade endometrial carcinomas (EC). The prognostic relevance of MELF invasion was uncertain due to conflicting data, and it had not yet appropriately been studied in the context of the molecular EC classification. We aimed to determine the relation of MELF invasion with clinicopathological and molecular characteristics, and define its prognostic relevance in early-stage low/intermediate risk EC. METHODS Single whole tumor slides of 979 (85.8%) out of 1141 (high)intermediate-risk EC of women who participated in the PORTEC-1/-2 trials were available for review. Clinicopathological and molecular features were compared between MELF invasion positive and negative cases. Time-to-event analyses were done by Kaplan-Meier method, log-rank tests and Cox' proportional hazards models. RESULTS MELF invasion was found in 128 (13.1%) cases, and associated with grade 1-2 histology, deep myometrial invasion and substantial lymph-vascular space invasion (LVSI). 85.6% of MELF invasion positive tumors were no-specific-molecular-profile (NSMP) EC. NSMP EC with MELF invasion were CTNNB1 wild type in 92.2% and KRAS mutated in 24.4% of cases. Risk of recurrence was lower for MELF invasion positive as compared to MELF invasion negative cases (4.9% vs. 12.7%, p = 0.026). However, MELF invasion had no independent impact on risk of recurrence (HR 0.65, p = 0.30) after correction for clinicopathological and molecular factors. CONCLUSIONS MELF invasion has no independent impact on risk of recurrence in early-stage EC, and is frequently observed in low-grade NSMP tumors. Routine assessment of MELF invasion has no clinical implications and is not recommended.
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Affiliation(s)
- A S V M van den Heerik
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - K T S Aiyer
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - E Stelloo
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - I M Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L C H W Lutgens
- Department of Radiation Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - J J Jobsen
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J W M Mens
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - V T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - N Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
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Pereira AHB, Pissinatti L, Moreira SB, Pissinatti A, Ubiali DG. Metastatic endometrioid carcinoma in a hybrid Leontopithecus sp. J Med Primatol 2022; 51:381-383. [PMID: 35394073 DOI: 10.1111/jmp.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
Primary female reproductive neoplasms in Platyrrhines species are few reported. We present the gross, histological, and immunohistochemical findings of metastatic endometrioid carcinoma in the uterus, urinary bladder, jejunum, and rectum of a Leontopithecus sp. The neoplastic endometrial cells expressed strong cytoplasmic immunolabeling of cytokeratin 7.
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Affiliation(s)
- Asheley Henrique Barbosa Pereira
- Pathological Anatomy Sector (SAP), Department of Epidemiology and Public Health, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | | | | | - Alcides Pissinatti
- Rio de Janeiro Primatology Center (CPRJ/INEA), Guapimirim, Brazil.,Serra dos Órgãos University Center, Teresópolis, Brazil
| | - Daniel Guimarães Ubiali
- Pathological Anatomy Sector (SAP), Department of Epidemiology and Public Health, Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
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5
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Tahara S, Nojima S, Ohshima K, Hori Y, Sato K, Kurashige M, Matsui T, Okuzaki D, Morii E. Nicotinamide N-methyltransferase is related to MELF pattern invasion in endometrioid carcinoma. Cancer Med 2021; 10:8630-8640. [PMID: 34655178 PMCID: PMC8633241 DOI: 10.1002/cam4.4359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 12/20/2022] Open
Abstract
Grade 1 (G1) endometrioid carcinoma (EC) is relatively a good prognosis. However, in a minority of cases, G1 shows an aggressive histological pattern known as the microcystic, elongated, and fragmented (MELF) pattern. We previously reported that EC with high expression levels of S100A4 and serum deprivation-response protein (SDPR) was related to MELF pattern invasion. However, the molecular features of the invasive front area of the MELF pattern have not been investigated. In this study, we searched for genes preferentially expressed in the invasive front area of EC with the MELF pattern using laser microdissection and RNA sequencing, and showed that nicotinamide N-methyltransferase (NNMT) is related to MELF pattern invasiveness. Immunohistochemical analyses confirmed high NNMT expression in the invasive front area of the MELF pattern. Moreover, NNMT promoted migration, invasion, colony formation, epithelial-mesenchymal transition (EMT), and chemoresistance using EC cell lines. We speculate that depletion of NNMT promotes histone methylation and leads to tumor suppression because NNMT consumes S-adenosyl methionine (SAM), which is an essential methylation cofactor. NNMT knockout cells showed enhanced expression of H3K9me2. RNA sequencing using NNMT knockout cell lines suggested that methylation of H3K9 leads to repression of the transcription of various oncogenic genes. Our findings demonstrate the possibility that NNMT inhibitors, which are expected to be used for the treatment of metabolic disorders, would be effective for the treatment of aggressive EC. This is the first report of gene analyses focusing on the morphological changes associated with MELF pattern invasion of EC.
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Affiliation(s)
- Shinichiro Tahara
- Department of PathologyOsaka University Graduate School of MedicineOsakaJapan
| | - Satoshi Nojima
- Department of PathologyOsaka University Graduate School of MedicineOsakaJapan
| | - Kenji Ohshima
- Department of PathologyOsaka University Graduate School of MedicineOsakaJapan
| | - Yumiko Hori
- Department of PathologyOsaka University Graduate School of MedicineOsakaJapan
| | - Kazuaki Sato
- Department of PathologyOsaka University Graduate School of MedicineOsakaJapan
| | - Masako Kurashige
- Department of PathologyOsaka University Graduate School of MedicineOsakaJapan
| | - Takahiro Matsui
- Department of PathologyOsaka University Graduate School of MedicineOsakaJapan
| | - Daisuke Okuzaki
- Single Cell GenomicsHuman ImmunologyWPI Immunology Frontier Research CenterOsaka UniversityOsakaJapan
- Genome Information Research CenterResearch Institute for Microbial DiseasesOsaka UniversityOsakaJapan
- Institute for Open and Transdisciplinary Research InitiativesOsaka UniversityOsakaJapan
| | - Eiichi Morii
- Department of PathologyOsaka University Graduate School of MedicineOsakaJapan
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Patterns of Myometrial Invasion in Endometrial Adenocarcinoma with Emphasizing on Microcystic, Elongated and Fragmented (MELF) Glands Pattern: A Narrative Review of the Literature. Diagnostics (Basel) 2021; 11:diagnostics11091707. [PMID: 34574048 PMCID: PMC8469256 DOI: 10.3390/diagnostics11091707] [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: 07/03/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Endometrioid endometrial adenocarcinoma (EEC) is the most common malignancy of the female genital tract. According to the 2009 FIGO staging system, the depth of myometrial invasion (MI), and tumor spread to adjacent organs or tissues are the staging criteria for endometrial carcinoma (EC). Therefore, assessment of the depth of MI is of great importance. There is a spectrum of morphological patterns of MI. Still, their number and features vary according to the scientific literature, with a certain overlap that creates difficulties and controversies in the precise assessment of MI depth. The purpose of this review is to present and discuss the most important and recent information about patterns of MI, focusing on the more aggressive and the elongated and fragmented glands (MELF) pattern in particular. Assessment of MI depth and correct staging of EC is possible only after the precise recognition of each MI pattern.
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7
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Yamamoto M, Kaizaki Y, Kogami A, Hara T, Sakai Y, Tsuchida T. Prognostic significance of tumor budding, poorly differentiated cluster, and desmoplastic reaction in endometrioid endometrial carcinomas. J Obstet Gynaecol Res 2021; 47:3958-3967. [PMID: 34448279 DOI: 10.1111/jog.14997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/03/2021] [Accepted: 08/14/2021] [Indexed: 11/30/2022]
Abstract
AIMS The tumor budding (TB); poorly differentiated cluster (PDC); desmoplastic reaction (DR); and microcystic, elongated, and fragmented (MELF) patterns of invasion are pathological findings at the tumor invasion front associated with epithelial-to-mesenchymal transition. This study aimed to clarify the clinical significance of the TB, PDC, DR, and MELF patterns in endometrioid endometrial carcinomas (EEC). METHODS Two hundred and eight cases of histologically proven EEC retrieved from the archives of the Department of Pathology, Fukui Prefectural Hospital, and diagnosed between January 2000 and August 2020 were retrospectively analyzed. RESULTS The TB, PDC, DR, and MELF patterns were identified in 29 (13.9%), 47 (22.6%), 45 (21.6%), and 23 (11.1%) cases, respectively. Kaplan-Meier curve analysis with log-rank test demonstrated that TB, PDC, and DR were associated with a lower progression-free survival (p = 0.010, 0.002, and <0.0001, respectively), whereas the MELF pattern did not show any association (p = 0.668). In multivariate analyses, only DR was significantly associated with lower progression-free survival (p = 0.034). Moreover, only PDC was associated with lower overall survival in univariate analysis (p = 0.018), but the association lost significance in multivariate analysis. CONCLUSIONS The present study revealed that the histological confirmation of TB, PDC, and DR at the tumor invasive front predicts poor prognosis in EEC. However, the MELF pattern was not a predictor of poor prognosis in EEC.
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Affiliation(s)
- Megumi Yamamoto
- Department of Obstetrics and Gynecology, Fukui Prefectural Hospital, Fukui, Japan
| | - Yasuharu Kaizaki
- Department of Pathology, Fukui Prefectural Hospital, Fukui, Japan
| | - Akiya Kogami
- Department of Pathology, Fukui Prefectural Hospital, Fukui, Japan
| | - Toshie Hara
- Department of Pathology, Fukui Prefectural Hospital, Fukui, Japan
| | - Yuya Sakai
- Department of Obstetrics and Gynecology, Fukui Prefectural Hospital, Fukui, Japan
| | - Toru Tsuchida
- Department of Obstetrics and Gynecology, Fukui Prefectural Hospital, Fukui, Japan
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POLE mutation combined with microcystic, elongated and fragmented (MELF) pattern invasion in endometrial carcinomas might be associated with poor survival in Chinese women. Gynecol Oncol 2020; 159:36-42. [PMID: 32800323 DOI: 10.1016/j.ygyno.2020.07.102] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE POLE mutation is a prognostic marker associated with excellent outcome in endometrial carcinoma (EC). However, these EC tumors frequently have aggressive histology. The aim of this study was to determine how to integrate the implications of POLE mutations into existing risk assessment strategies and further stratify patients. METHODS We detected POLE mutations in a cohort of 426 ECs from Chinese women and observed their prognostic significance in terms of survival and recurrence outcomes in combination with histological and other molecular characteristics, including microcystic, elongated and fragmented (MELF) pattern invasion, histologic subtype, tumor grade, myometrial invasion and p53 protein and mismatch repair protein expression status. RESULTS POLE mutations were identified in 38 of 426 ECs (8.9%). The most common mutations were P286R (31.6%), V411L (15.8%) and Q453R (15.8%). We confirmed that POLE mutation was associated with improved overall survival (P = .047), although it did not show a statistically significant relationship with progression-free survival (P = .45). Interestingly, further analyses indicated that in POLE-mutant tumors, MELF pattern invasion was associated with a 15.1-fold increase in tumor recurrence or progression risk (HR = 15.1, 95%CI = 1.57-145.3, P = .018), whereas this phenomenon was not present in the POLE-wild-type subgroup (HR = 0.90, 95%CI = 0.39-2.08, P = .80). Furthermore, higher staging and deeper myometrial invasion also showed much higher risk in patients harboring POLE mutations compared with those without POLE mutations. CONCLUSIONS Although POLE mutation was associated with favorable overall survival, the combined consideration of POLE mutation status and established clinicopathologic factors in the risk assessment of endometrial cancer is more accurate than the consideration of clinicopathologic factors alone and might lead to precise and individualized therapeutic strategies.
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Tahara S, Nojima S, Ohshima K, Hori Y, Kurashige M, Wada N, Motoyama Y, Okuzaki D, Ikeda JI, Morii E. Serum deprivation-response protein regulates aldehyde dehydrogenase 1 through integrin-linked kinase signaling in endometrioid carcinoma cells. Cancer Sci 2019; 110:1804-1813. [PMID: 30907484 PMCID: PMC6500992 DOI: 10.1111/cas.14007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/15/2019] [Accepted: 03/20/2019] [Indexed: 12/31/2022] Open
Abstract
Endometrioid carcinoma (EC) is one of the most common malignancies of the female genital system. We reported previously that aldehyde dehydrogenase 1 (ALDH1), a predominant isoform of the ALDH family in mammals and a potential marker of normal and malignant stem cells, is related to the tumorigenic potential of EC. We compared the levels of various proteins in human EC cells with high and low ALDH1 expression using shotgun proteomics and found that serum deprivation‐response protein (SDPR) was preferentially expressed in cells with high ALDH1 expression. Also known as cavin‐2, SDPR is a member of the cavin protein family, which is required for the formation of caveolae. Using SDPR‐knockout EC cells generated using the CRISPR/Cas9 system, we revealed that SDPR was correlated with invasion, migration, epithelial‐mesenchymal transition, and colony formation, as well as the expression of ALDH1. RNA sequencing showed that integrin‐linked kinase (ILK) signaling is involved in the effect of SDPR on ALDH1. Immunohistochemical analysis revealed that the localization of ILK at the cell cortex was disrupted by SDPR knockout, potentially interfering with ILK signaling. Moreover, immunohistochemical analysis of clinical samples showed that SDPR is related to histological characteristics associated with invasiveness, such as poor differentiation, lymphatic invasion, and the microcystic, elongated, and fragmented histopathological pattern. This is, to our knowledge, the first report that SDPR is related to tumor progression.
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Affiliation(s)
- Shinichiro Tahara
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nojima
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Ohshima
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masako Kurashige
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Wada
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichi Motoyama
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Okuzaki
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Jun-Ichiro Ikeda
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
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Eriksson LSE, Nastic D, Frühauf F, Fischerova D, Nemejcova K, Bono F, Franchi D, Fruscio R, Ghioni M, Haak LA, Hejda V, Meskauskas R, Opolskiene G, Pascual MA, Testa A, Tresserra F, Zannoni GF, Carlson JW, Epstein E. Clinical and ultrasound characteristics of the microcystic elongated and fragmented (MELF) pattern in endometrial cancer according to the International Endometrial Tumor Analysis (IETA) criteria. Int J Gynecol Cancer 2019; 29:119-125. [DOI: 10.1136/ijgc-2018-000045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/04/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022] Open
Abstract
ObjectivesTo describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer.Methods/materialsWe included 850 women with endometrioid endometrial cancer from the prospective IETA 4 study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases.ResultsThe MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with deep myometrial invasion ≥ 50% (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011).ConclusionsTumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.
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Tumor Budding is a Valuable Diagnostic Parameter in Prediction of Disease Progression of Endometrial Endometrioid Carcinoma. Pathol Oncol Res 2019; 25:723-730. [DOI: 10.1007/s12253-018-0554-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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12
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Baek TH, Kang DW, Kim JH, Son HJ. Gland Attenuation, a Novel Morphological Feature of Colorectal Cancer: Evidence for an Epithelial-Mesenchymal Transition. Ann Coloproctol 2018; 34:187-196. [PMID: 30208682 PMCID: PMC6140364 DOI: 10.3393/ac.2017.12.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/02/2017] [Indexed: 12/11/2022] Open
Abstract
Purpose Along the invasive margin, colorectal cancer may show distinctive morphologic changes characterized by an asymmetrically attenuating tumor gland with loss of polarity. The author coined the term ‘gland attenuation (GA)’ for these peculiar changes. The aims of this study were to compare the immunoreactivity of the epithelial-mesenchymal transition (EMT) markers E-cadherin and β-catenin and thus determine whether EMTs occurs at tumor budding (TB) or GA sites and to assess the association of TB and/or GA levels with clinicopathological parameters and prognosis. Methods Expression patterns of E-cadherin and β-catenin in the tumor centers at GA and TB sites were examined in 101 patients with well or moderately differentiated CRCs, and the prognostic significance of TB and/or GA was statistically evaluated. Results GA foci, as well as TB foci, revealed loss of membranous and cytoplasmic E-cadherin expressions and aberrant β-catenin expression with reduced membranous expression and increased localization to the nucleus, suggesting that EMTs occur in GA as well as in TB. The high-TB and the TB-dominant groups were significantly correlated with advanced invasion depth, presence of lymph node metastasis, advanced pathologic staging and presence of lymphovascular invasion. The high-TB and the TB-dominant groups showed poor overall survival (OS) and recurrence-free survival (RFS), and high TB was an independent prognostic factor in the multivariate analyses for OS and RFS. Conclusion This study showed evidence that EMTs occurs at GA sites as well as TB foci. TB is a strong and independent prognostic factor, and TB-dominance may be an indicator of adverse clinical outcome.
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Affiliation(s)
- Tae-Hwa Baek
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Dong-Wook Kang
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Joo-Heon Kim
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun-Jin Son
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
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Zinovkin DA, Pranjol MZI, Bilsky IA, Zmushko VA. Tumor-Associated T-Lymphocytes and Macrophages are Decreased in Endometrioid Endometrial Carcinoma with MELF-Pattern Stromal Changes. CANCER MICROENVIRONMENT 2018; 11:107-114. [PMID: 30008066 DOI: 10.1007/s12307-018-0213-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/12/2018] [Indexed: 11/26/2022]
Abstract
Microcystic, elongated, fragmented (MELF)-pattern is an unusual morphology of myometrial invasive front in endometrioid endometrial carcinoma (EA). The aim of the study was to investigate potential correlation between MELF-pattern and peritumoral inflammatory immune response. A total of 96 out of 368 patients were included in this study. CD3, CD20, CD57. CD68 and S100 markers were used for the detection of tumor-associated T-lymphocytes (TAT), tumor-associated B-lymphocytes (TAB), tumor-associated NK-lymphocytes (NK), tumor-associated macrophages and dendritic cells respectively. Mann-Whitney tests, receiver operating characteristic (ROC) curve analysis, and Spearman correlation were used as methods for statistical analyses. Odds ratio with 95% confidence interval (95% CI) was determined with the use of a logistic regression model. A p < 0.05 was considered statistically significant. Our results suggested that the number of CD3 and CD68 cells were significantly lower (p < 0.001) in cases of endometrioid carcinoma with MELF-pattern. A significant correlation between the presence of MELF-pattern and decrease of CD3 positive T-lymphocytes (r = 0.691; p < 0.001) was also observed. Additionally, we found an inverse correlation between the presence of MELF-pattern and TAM (r = 0.568; p = 0.001). Therefore, our data suggest that MELF-pattern may be associated with EA stroma fibrosis that contains immune cells infiltration and demonstrated a decrease in the number of TAT and TAM cells. This may indicate the poor clinical prognosis of this disease.
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Affiliation(s)
| | - Md Zahidul Islam Pranjol
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry Queen Mary University of London, London, UK
| | - Il'ya Andreevich Bilsky
- Department of Pathology, Gomel State Medical University, Lange str. 5, Gomel, 246029, Republic of Belarus
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CXCL14-CXCR4 and CXCL12-CXCR4 Axes May Play Important Roles in the Unique Invasion Process of Endometrioid Carcinoma With MELF-Pattern Myoinvasion. Int J Gynecol Pathol 2018; 36:530-539. [PMID: 28277316 DOI: 10.1097/pgp.0000000000000362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The term "MELF-pattern myometrial invasion" (MELF pattern) denotes an unusual morphology of myometrial invasion in endometrioid carcinomas, and is associated with frequent lymphovascular invasion and lymph node metastasis. In this study, tumor cells were directly collected from a MELF pattern site, using laser microdissection. Comprehensive microarray analysis of the genes was conducted, and based on the results, expression of a metastasis progression gene, CXCR4, and its ligands CXCL14 and CXCL12, was further investigated. In vitro studies of endometrioid carcinoma cell lines revealed elevated invasion activity in a manner dependent on the CXCL14-CXCR4 or CXCL12-CXCR4 axis. Immunohistochemical analysis of 93 (MELF group, 46; non-MELF group, 47) cases illustrated CXCR4 was expressed in all endometrioid carcinomas, while based on CXCL14 and CXCL12 expression score, high proportions of cells were positive at the sites of the MELF pattern (P<0.01). There was no significant difference in progression-free survival or overall survival between MELF group and non-MELF group by Kaplan-Meier analysis. These findings suggest a possibility that cells at the sites of MELF pattern had acquired increased invasiveness through the function of the CXCL14-CXCR4 and CXCL12-CXCR4 axes.
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Tresserra F, Pascual MÁ, Arenas M, Blancafort C, Martínez-Lanao MÁ, Rodríguez I, Fábregas R. [MELF pattern in myometrial infiltration in endometrioid adenocarcinoma of the endometrium. A retrospective study of 70 cases]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2018; 51:77-83. [PMID: 29602378 DOI: 10.1016/j.patol.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/02/2017] [Accepted: 10/12/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Endometrioid adenocarcinoma of the endometrium (EAE) usually has a favorable prognosis. Recently, the MELF (microcystic, elongated and fragmented) pattern of myometrial infiltration has been described. It is associated with lymphovascular invasion and lymph node metastasis. Seventy cases of EAE were reviewed to identify the presence of MELF and its correlation with other prognostic factors. MATERIAL AND METHODS Hysterectomies performed for EAE during a 5-year period were reviewed, searching for MELF pattern. Its presence was correlated with other variables such as histological grade, depth of myometrial infiltration, pelvic and/or aortic lymph node metastasis, peritoneal implants and evolution. RESULTS In 17 (24%) cases MELF pattern was detected. It was more frequent in low grade tumors; it was present in four grade 3 cases. In 9 (53%) cases there was deep myometrial infiltration. Five cases had lymph node metastasis in the pelvis and three in the para-aortic region. One of the patients died, another presented a vulvar recurrence and another pulmonary metastasis. CONCLUSION MELF pattern can be seen in high grade EAE and correlates with deep myometrial infiltration and pelvic lymph node metastasis. Its presence does not seem to influence survival.
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Affiliation(s)
- Francisco Tresserra
- Comité de Mastología y Ginecología Oncológica, Hospital Universitario Dexeus, Grupo Quirón Salud, Barcelona, España.
| | - María Ángela Pascual
- Comité de Mastología y Ginecología Oncológica, Hospital Universitario Dexeus, Grupo Quirón Salud, Barcelona, España
| | - Mireia Arenas
- Comité de Mastología y Ginecología Oncológica, Hospital Universitario Dexeus, Grupo Quirón Salud, Barcelona, España
| | - Claudia Blancafort
- Comité de Mastología y Ginecología Oncológica, Hospital Universitario Dexeus, Grupo Quirón Salud, Barcelona, España
| | - María Ángeles Martínez-Lanao
- Comité de Mastología y Ginecología Oncológica, Hospital Universitario Dexeus, Grupo Quirón Salud, Barcelona, España
| | - Ignacio Rodríguez
- Comité de Mastología y Ginecología Oncológica, Hospital Universitario Dexeus, Grupo Quirón Salud, Barcelona, España
| | - Rafa Fábregas
- Comité de Mastología y Ginecología Oncológica, Hospital Universitario Dexeus, Grupo Quirón Salud, Barcelona, España
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16
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Liu DN, Lv A, Tian ZH, Tian XY, Guan XY, Dong B, Zhao M, Hao CY. Superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic adenocarcinoma. Oncotarget 2018; 8:7766-7776. [PMID: 27999192 PMCID: PMC5352359 DOI: 10.18632/oncotarget.13950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/01/2016] [Indexed: 12/15/2022] Open
Abstract
The aim of this study is trying to describe more details of superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, to evaluate biological and prognostic implications of tumor budding in this margin, and to provide more evidence for evaluation of R0 surgery in pancreaticoduodenectomy. 46 patients in 5-years period are included in this study. Immunochemistry and immunofluorescence are used to analyze tumor budding and epithelial-mesenchymal transition. Superior mesenteric artery margin might be described from four aspects including location, gross appearance, microscopic appearance and tumor budding. We find that 1mm rule for R1 surgery is more appropriate to predict prognosis (P = 0.009) than 0mm rule (P = 0.141). Expression of cytokeratin in tumor budding is significantly lower than primary tumor (P = 0.001), and it suggests that tumor budding may participate the procedure of epithelial-mesenchymal transition. High-grade tumor budding and decreasing cytokeratin of tumor budding correlate with distant metastasis and has negative influence on prognosis. So superior mesenteric artery margin might be not only an area that tumor cells may invade, but also a pathway for distant metastasis. It is necessary to evaluate superior mesenteric artery margin in pancreaticoduodenectomy for pancreatic cancer.
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Affiliation(s)
- Dao-Ning Liu
- Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Ang Lv
- Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Zhi-Hua Tian
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing, People's Republic of China
| | - Xiu-Yun Tian
- Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Xiao-Ya Guan
- Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Bin Dong
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing, People's Republic of China
| | - Min Zhao
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Chun-Yi Hao
- Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
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17
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Significance of microcystic, elongated, and fragmented glandular-like features in intraductal papillary mucinous neoplasm of the pancreas. Hum Pathol 2018; 78:18-27. [PMID: 29410139 DOI: 10.1016/j.humpath.2018.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 11/21/2022]
Abstract
Microcystic, elongated, and fragmented (MELF) glandular features are associated with epithelial-mesenchymal transition, invasion, and progression in endometrioid adenocarcinoma of the uterus. Similar histological features are also observed at the periphery of pancreatic intraductal papillary mucinous neoplasms (IPMNs). However, the clinicopathological significance of MELF-like features-particularly whether they represent regenerative or truly neoplastic conditions-in IPMNs remains unclear. We assessed a total of 152 surgically resected IPMNs. Fifty cases exhibited MELF-like features, including 26 cases of IPMNs with accompanying adenocarcinomas and 24 cases of IPMNs without accompanying adenocarcinomas. MELF-like features were more frequently observed in IPMN cases with accompanying adenocarcinomas, larger tumors, main-duct type, and non-gastric histologic subtype. A positive correlation between the presence of MELF-like features and high-grade dysplasia was observed in IPMNs without accompanying adenocarcinomas. Moreover, DPC4 loss and p53 overexpression in MELF-like glands were more commonly observed in IPMNs with high-grade dysplasia. IPMN patients with MELF-like features had worse overall and disease-specific survival by univariate analyses. Our observations suggest that MELF-like features in some IPMNs with high-grade dysplasia could be related to stromal invasion. Hence, when MELF-like features are observed in IPMNs, pathologists should carefully evaluate the results of microscopic examinations to identify the invasive components; and, immunohistochemical staining for DPC4 and p53 could help clarify its clinicopathological significance.
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18
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Hashimoto S, Tabuchi Y, Yurino H, Hirohashi Y, Deshimaru S, Asano T, Mariya T, Oshima K, Takamura Y, Ukita Y, Ametani A, Kondo N, Monma N, Takeda T, Misu S, Okayama T, Ikeo K, Saito T, Kaneko S, Suzuki Y, Hattori M, Matsushima K, Torigoe T. Comprehensive single-cell transcriptome analysis reveals heterogeneity in endometrioid adenocarcinoma tissues. Sci Rep 2017; 7:14225. [PMID: 29079795 PMCID: PMC5660171 DOI: 10.1038/s41598-017-14676-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/16/2017] [Indexed: 01/06/2023] Open
Abstract
Single cell transcriptome analysis of a cancer tissue can provide objective assessment of subtype population or the activation of each of various microenvironment component cells. In this study, we applied our newly developed technique of single cell analysis to the myometrial infiltration side (M-side) and the endometrial side (E-side) of a human endometrioid adenocarcinoma with squamous differentiation tissues. We also analyzed spherogenic cultures derived from the same tissue to identify putative regulators of stemness in vivo. Cancer cells in the E-side were highly malignant compared with those in the M-side. Many cells on the E-side were positive for spheroid-specific tumorigenesis-related markers including SOX2. In addition, there were higher numbers of epithelial-to-mesenchymal transition (EMT) cells in the E-side compared with the M-side. This study identified a site containing cells with high malignant potential such as EMT and cancer stem-like cells in cancer tissues. Finally, we demonstrate that established endometrioid adenocarcinoma subtype classifiers were variably expressed across individual cells within a tumor. Thus, such intratumoral heterogeneity may be related to prognostic implications.
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Affiliation(s)
- Shinichi Hashimoto
- Department of Integrative Medicine for Longevity, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, 920-8641, Japan.
- CREST, Japan Science and Technology Agency, Tokyo, 102-0076, Japan.
| | - Yuta Tabuchi
- Department of Pathology, School of Medicine, Sapporo Medical University, Hokkaido, 060-0061, Japan
| | - Hideaki Yurino
- Department of Integrative Medicine for Longevity, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, 920-8641, Japan
- CREST, Japan Science and Technology Agency, Tokyo, 102-0076, Japan
| | - Yoshihiko Hirohashi
- CREST, Japan Science and Technology Agency, Tokyo, 102-0076, Japan
- Department of Pathology, School of Medicine, Sapporo Medical University, Hokkaido, 060-0061, Japan
| | - Shungo Deshimaru
- Department of Molecular Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Takuya Asano
- Department of Pathology, School of Medicine, Sapporo Medical University, Hokkaido, 060-0061, Japan
| | - Tasuku Mariya
- Department of Pathology, School of Medicine, Sapporo Medical University, Hokkaido, 060-0061, Japan
| | - Kenshiro Oshima
- Department of Computational Biology, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, 277-8561, Japan
| | - Yuzuru Takamura
- Department of Bioscience and Biotechnology, Japan Advanced Institute of Science and Technology, Ishikawa, 923-1292, Japan
| | - Yoshiaki Ukita
- Faculty of Engineering, Graduate Faculty of Interdisciplinary Research, University of Yamanashi, Yamanashi, 400-8511, Japan
| | - Akio Ametani
- Department of Molecular Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Naoto Kondo
- RIKEN Center for Life Science Technologies, Kanagawa, 230-0045, Japan
| | - Norikazu Monma
- Laboratory of DNA Data Analysis, National Institute of Genetics, Shizuoka, 411-8540, Japan
| | - Tadayuki Takeda
- RIKEN Center for Life Science Technologies, Kanagawa, 230-0045, Japan
| | - Sadahiko Misu
- Laboratory of DNA Data Analysis, National Institute of Genetics, Shizuoka, 411-8540, Japan
| | - Toshitugu Okayama
- Laboratory of DNA Data Analysis, National Institute of Genetics, Shizuoka, 411-8540, Japan
| | - Kazuho Ikeo
- Laboratory of DNA Data Analysis, National Institute of Genetics, Shizuoka, 411-8540, Japan
| | - Tsuyoshi Saito
- Department of Obsterics and Gynecology, School of Medicine, Sapporo Medical University, Hokkaido, 060-0061, Japan
| | - Shuich Kaneko
- Department of Disease Control and Homeostasis, Faculty of Medicine, Kanazawa University, Ishikawa, 920-8641, Japan
| | - Yutaka Suzuki
- Department of Computational Biology, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, 277-8561, Japan
| | - Masahira Hattori
- Department of Computational Biology, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, 277-8561, Japan
- Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, 169-8555, Japan
| | - Kouji Matsushima
- Department of Molecular Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Toshihiko Torigoe
- CREST, Japan Science and Technology Agency, Tokyo, 102-0076, Japan
- Department of Pathology, School of Medicine, Sapporo Medical University, Hokkaido, 060-0061, Japan
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Association between Morphological Patterns of Myometrial Invasion and Cancer Stem Cell Markers in Endometrial Endometrioid Carcinoma. Pathol Oncol Res 2017; 25:123-130. [PMID: 28990139 DOI: 10.1007/s12253-017-0320-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/21/2017] [Indexed: 01/22/2023]
Abstract
In endometrial endometrioid adenocarcinoma (EEC), the depth of myometrial invasion (MI) is an important parameter for determining whether additional treatment is warranted. The present study investigated the association between MI patterns, cancer stem cell (CSC) phenotypes, and their clinicopathological significance in EEC. A total of 73 cases of EEC with MI were examined in this study. Haematoxylin and eosin-stained tissue specimens were analysed for MI pattern, which was categorised as infiltrating; expansile; adenomyosis (AM)-like; or microcystic, elongated, and fragmented (MELF)-type. The expression of CSC markers such as cluster of differentiation (CD)44, CD133, and Nanog1, as well as oestrogen receptor (ER) and progesterone receptor (PR) was examined by immunohistochemistry. Clinicopathological features including age, DOI, MI pattern, LVI, lymph node (LN) metastasis, disease progression, and survival outcome were recorded. Most examined cases (45/73) were International Federation of Gynecology and Obstetrics (FIGO) stage I. MI showed infiltrating (49.3%), AM-like (26.3%), MELF (15.1%), and expansile (9.6%) patterns. Tumours with the infiltrating pattern were associated with high FIGO grade (P = 0.002), reduced ER and PR, and CD44 expression (P = 0.014, 0.026, and 0.030, respectively); those with a MELF pattern showed LN metastasis (P < 0.001), lymphovascular invasion (P = 0.011), and reduced ER, CD44, and CD133 expression (P = 0.036, 0.006, and 0.016, respectively). EEC with infiltrating/MELF patterns of MI is associated with worse prognosis. These results suggest that CSC expression profiles are an unfavourable indicator of EEC.
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20
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Naki MM, Oran G, Tetikkurt SÜ, Sönmez CF, Türkmen İ, Köse F. Microcystic, elongated, and fragmented pattern of invasion in relation to histopathologic and clinical prognostic factors in endometrioid endometrial adenocarcinoma. J Turk Ger Gynecol Assoc 2017; 18:139-142. [PMID: 28890428 PMCID: PMC5590210 DOI: 10.4274/jtgga.2017.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To investigate the association of microcystic, elongated, and fragmented (MELF) pattern of invasion with prognostic factors in endometrioid endometrial adenocarcinoma (EEA). Material and Methods: Stained tissue sections from 83 cases of EEA operated by the same gynecologic oncologist were reviewed to identify cases showing MELF-type invasion in this retrospective study. The association of MELF pattern with age, tumor grade, depth of myometrial invasion, and presence of lymphovascular space invasion (LVSI) was analyzed. Results: FIGO grade 2 and grade 1 tumors were evident in 53.0% and 38.6% of patients, respectively. Depth of myometrial invasion was <50% in 72.0% of patients, and LVSI was absent in 77.1%. MELF pattern was confirmed in 35 (42.2%) patients. Presence of MELF pattern was associated with significantly higher mean ± standard deviation age (62.9±6.9) years vs. 58.9±9.1 years, p=0.033), and found to be more likely in patients with high-grade tumor (FIGO grade III; 85.7% vs. 14.3%, p<0.001), deep (≥50%) myometrial invasion (78.3% vs. 21.7%, p<0.001), and presence of LVSI (94.7% vs. 5.3%, p<0.001) as compared with absence of MELF pattern. Conclusion: In conclusion, our findings revealed a high rate of MELF pattern among patients with EEA alongside the association of MELF pattern with poor prognostic factors such as high grade tumor, deep myometrial invasion, and LVSI.
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Affiliation(s)
- M Murat Naki
- Department of Obstetrics and Gynecology, Acıbadem University Faculty of Medicine, İstanbul, Turkey
| | - Gülbin Oran
- Department of Pathology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Seza Ümit Tetikkurt
- Department of Pathology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Cavide Fatma Sönmez
- Department of Pathology, Bezmialem Vakıf University Faculty of Medicine, İstanbul, Turkey
| | - İlknur Türkmen
- Department of Pathology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Faruk Köse
- Department of Obstetrics and Gynecology, Acıbadem University Faculty of Medicine, İstanbul, Turkey
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21
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Clinicopathologic Association and Prognostic Value of Microcystic, Elongated, and Fragmented (MELF) Pattern in Endometrial Endometrioid Carcinoma. Am J Surg Pathol 2017; 41:896-905. [DOI: 10.1097/pas.0000000000000856] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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L1CAM: amending the “low-risk” category in endometrial carcinoma. J Cancer Res Clin Oncol 2016; 143:255-262. [DOI: 10.1007/s00432-016-2276-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/20/2016] [Indexed: 11/25/2022]
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23
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Makker A, Goel MM. Tumor progression, metastasis, and modulators of epithelial-mesenchymal transition in endometrioid endometrial carcinoma: an update. Endocr Relat Cancer 2016; 23:R85-R111. [PMID: 26538531 DOI: 10.1530/erc-15-0218] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 12/17/2022]
Abstract
Endometrioid endometrial carcinoma (EEC), also known as type 1 endometrial cancer (EC), accounts for over 70-80% of all cases that are usually associated with estrogen stimulation and often develops in a background of atypical endometrial hyperplasia. The increased incidence of EC is mainly confined to this type of cancer. Most EEC patients present at an early stage and generally have a favorable prognosis; however, up to 30% of EEC present as high risk tumors, which have invaded deep into the myometrium at diagnosis and progressively lead to local or extra pelvic metastasis. The poor survival of advanced EC is related to the lack of effective therapies, which can be attributed to poor understanding of the molecular mechanisms underlying the progression of disease toward invasion and metastasis. Multiple lines of evidence illustrate that epithelial-mesenchymal transition (EMT)-like events are central to tumor progression and malignant transformation, endowing the incipient cancer cell with invasive and metastatic properties. The aim of this review is to summarize the current knowledge on molecular events associated with EMT in progression, invasion, and metastasis of EEC. Further, the role of epigenetic modifications and microRNA regulation, tumor microenvironment, and microcystic elongated and fragmented glands like invasion pattern have been discussed. We believe this article may perhaps stimulate further research in this field that may aid in identifying high risk patients within this clinically challenging patient group and also lead to the recognition of novel targets for the prevention of metastasis - the most fatal consequence of endometrial carcinogenesis.
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Affiliation(s)
- Annu Makker
- Post Graduate Department of PathologyKing George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Madhu Mati Goel
- Post Graduate Department of PathologyKing George's Medical University, Lucknow 226003, Uttar Pradesh, India
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24
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Soslow RA. Practical issues related to uterine pathology: staging, frozen section, artifacts, and Lynch syndrome. Mod Pathol 2016; 29 Suppl 1:S59-77. [PMID: 26715174 PMCID: PMC4821462 DOI: 10.1038/modpathol.2015.127] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/18/2015] [Accepted: 09/26/2015] [Indexed: 12/30/2022]
Abstract
This review covers three areas in endometrial tumor pathology: International Federation of Gynecology and Obstetrics (FIGO) staging, the use of frozen section, and Lynch syndrome. The section on FIGO staging will emphasize problems that practicing pathologists often confront, such as measuring the depth of myometrial invasion, assessing for the presence of cervical stromal invasion, detecting low-volume lymph node metastases, and recognizing synchronous endometrial and ovarian tumors and artifacts. The frozen section portion of this review will focus on the performance characteristics of intraoperative examination of the uterus to determine tumor grade and depth of myometrial invasion, including suggestions for alternative methods. The last portion of this review will provide an overview of Lynch syndrome and a discussion of the rationale and methods of screening for Lynch syndrome.
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Affiliation(s)
- Robert A. Soslow
- Memorial Sloan Kettering Cancer Center, Department of Pathology, 1275 York Avenue, New York, NY 10065, Tel. 212-639-5905
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25
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How to approach the many faces of endometrioid carcinoma. Mod Pathol 2016; 29 Suppl 1:S29-44. [PMID: 26715172 DOI: 10.1038/modpathol.2015.142] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/09/2015] [Indexed: 01/04/2023]
Abstract
This article reviews the salient features of variants of endometrioid carcinoma (ECa) that can pose a diagnostic challenge and/or are associated with unique clinicopathological findings. Variants with distinct architectural and cytologic features include the following: (1) ECa with a villoglandular pattern (tumor with finger-like papillae lined by bland cells with a tendency for vascular/lymphatic invasion and lymph node metastasis once this pattern is seen within the myoinvasive component); (2) papillary ECa of intermediate grade (grade 2) (tumor that can be mistaken for serous carcinoma, as it contains papillae showing slightly irregular contours, moderately atypical cells, and it is associated with vascular/lymphatic invasion/lymph node metastasis, but with common association with mucinous metaplasia, MELF (microcystic, elongated, and fragmented) pattern of invasion, and wild p53 expression); (3) ECa with non-villous papillae (tumor containing pseudopapillae within glands with bland-appearing cytology commonly associated with abortive squamous differentiation and otherwise not different from usual ECa); (4) ECa with microglandular-like pattern (tumor that mimics microglandular hyperplasia of the cervix, often lacking the typical appearance of microglandular hyperplasia and showing Ki-67 index >10%, strong CD10 expression, and negative PAX-2, p63, and CD34); and (5) ECa with sex cord-like formations and hyalinization (tumor with interconnected cords and nests of bland epithelioid and spindled cells that merge with a typical component of low-grade ECa, usually associated with squamous differentiation and hyalinization). This tumor should be distinguished from carcinosarcoma and, in contrast to the latter, it shows nuclear β-catenin expression, ER/PR and patchy p16 positivity, tends to present at a low stage, and has a favorable prognosis and (6) dedifferentiated ECa (tumor showing a low-grade ECa juxtaposed to an undifferentiated carcinoma-the latter characterized by variably sized monotonous, often non-cohesive cells with brisk mitotic activity and usually arranged in sheets). Undifferentiated carcinoma tends to be negative for PAX8 and ER/PR with variable expression of keratins and can be associated with microsatellite instability (may be part of Lynch syndrome). Variants with distinct cytological features include the following: (1) ECa with clear cells (tumors with clearing due to 'clear' (glycogenated) squamous cells, distinct vacuoles, or not otherwise specified. EC with clear cells should be distinguished from clear cell carcinoma by the absence of the variety of architectural patterns, lack of cuboidal/flattened/hobnail cells, and lack of degree of atypia usually detected in clear cell carcinoma. In addition, they are ER/PR positive and Napsin A and p504S negative in contrast to clear cell carcinoma); (2) ECa with spindle cells (tumor with transition from spindle cells to the glandular component of a low-grade ECa. The spindle cells are keratin, ER/PR, and patchy p16 positive and show wild-type p53 expression); (3) ECa with mucinous differentiation (this tumor can be mistaken for a cervical adenocarcinoma, as they have overlapping features. Expression of ER/PR and vimentin in the context of a negative or patchy p16 positivity and the absence of high-risk HPV allows a correct diagnosis).
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Rutgers JKL. Update on pathology, staging and molecular pathology of endometrial (uterine corpus) adenocarcinoma. Future Oncol 2015; 11:3207-18. [PMID: 26551559 DOI: 10.2217/fon.15.262] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Endometrial carcinoma is comprised of two major groups: type I that is hormonally driven with a good prognosis and type II that is hormone independent with a poor prognosis. The two most common subtypes are endometrioid adenocarcinoma, the prototypic type I cancer, and uterine serous carcinoma, the prototypic type II cancer, each with their own distinct precursor lesion. The histologic type, as codified by the WHO Tumor Classification system, grade, and stage are used to guide treatment. There is an increasing interest in screening for familial risk factors, specifically Lynch syndrome. A molecular classification of endometrial cancers holds promise for future improvements in care.
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Affiliation(s)
- Joanne K L Rutgers
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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Endometrial Synovial-like Metaplasia Associated With Levonorgestrel-releasing Intrauterine System. Int J Gynecol Pathol 2015; 34:570-5. [DOI: 10.1097/pgp.0000000000000183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roma AA, Rybicki LA, Barbuto D, Euscher E, Djordjevic B, Frauenhoffer E, Kim I, Hong SR, Montiel D, Ali-Fehmi R, Malpica A, Silva EG. Risk factor analysis of recurrence in low-grade endometrial adenocarcinoma. Hum Pathol 2015; 46:1529-39. [DOI: 10.1016/j.humpath.2015.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/03/2015] [Accepted: 06/10/2015] [Indexed: 11/27/2022]
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Koh YW, Jun SY, Kim KR. Prognostic significance of single isolated cells with decreased E-cadherin expression in pseudomyxoma peritonei. Pathol Int 2014; 64:164-72. [PMID: 24750186 DOI: 10.1111/pin.12157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 03/17/2014] [Indexed: 12/17/2022]
Abstract
Pseudomyxoma peritonei (PMP) cases can be classified into the prognosis-related subtypes of disseminated peritoneal adenomucinosis (DPAM) and peritoneal mucinous carcinomatosis (PMCA). To investigate the mechanisms of mucinous invasion and the differing prognoses of these two subtypes, we examined the expression levels of proteins involved in cellular adhesion and invasion, including E-cadherin, vimentin, β-catenin, and S100A4, in single isolated tumor cells (SICs) and cohesive cellular strips within mucin pools isolated from DPAM (n = 31) and PMCA (n = 21) patients. In both PMCA and DPAM cases, SICs showed a complete loss of E-cadherin expression, whereas cells in cohesive cellular clusters retained E-cadherin expression. The frequency of high numbers of SICs (>8) in PMCA cases was significantly greater than that in DPAM cases (86% and 26%, respectively) and was correlated with poor progression-free survival (P = 0.019) in a univariate analysis. In both PMP subtypes, strong vimentin expression was identified in most of the SICs but not the cohesive cellular strips. The relatively slow progression of DPAM may be attributable to the smaller number of SICs that lack E-cadherin expression and have increased vimentin expression, whereas the rapid progression of PMCA may be due to larger numbers of these SICs.
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Affiliation(s)
- Young Wha Koh
- Department of Pathology, Ajou University School of Medicine, Suwon, South Korea
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Dogan Altunpulluk M, Kir G, Topal CS, Cetiner H, Gocmen A. The association of the microcystic, elongated and fragmented (MELF) invasion pattern in endometrial carcinomas with deep myometrial invasion, lymphovascular space invasion and lymph node metastasis. J OBSTET GYNAECOL 2014; 35:397-402. [DOI: 10.3109/01443615.2014.960827] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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The pattern of myometrial invasion as a predictor of lymph node metastasis or extrauterine disease in low-grade endometrial carcinoma. Am J Surg Pathol 2013; 37:1728-36. [PMID: 24061515 DOI: 10.1097/pas.0b013e318299f2ab] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to examine predictors of lymph node (LN) metastases or extrauterine disease (ED) in low-grade (FIGO grade 1 or 2) endometrioid carcinoma (LGEC) in a multi-institutional setting. For LGEC with and without LN metastasis or ED, each of the 9 participating institutions evaluated patients' age, tumor size, myometrial invasion (MI), FIGO grade, % solid component, the presence or absence of papillary architecture, microcystic, elongated, and fragmented glands (MELF), single-cell/cell-cluster invasion (SCI), lymphovascular invasion (LVI), lower uterine segment (LUS) and cervical stromal (CX) involvement, and numbers of pelvic and para-aortic LNs sampled. A total of 304 cases were reviewed: LN(+) or ED(+), 96; LN(-)/ED(-), 208. Patients' ages ranged from 23 to 91 years (median 61 y). Table 1 summarizes the histopathologic variables that were noted for the LN(+) or ED(+) group: tumor size ≥2 cm, 93/96 (97%); MI>50%, 54/96 (56%); MELF, 67/96 (70%); SCI, 33/96 (34%); LVI, 79/96 (82%); >20% solid, 65/96 (68%); papillary architecture present, 68/96 (72%); LUS involved, 64/96 (67%); and CX involved, 41/96 (43%). For the LN(-)/ED(-) group, the results were as follows: tumor size ≥2 cm, 152/208 (73%); MI>50%, 56/208 (27%); MELF, 79/208 (38%); SCI, 19/208 (9%); LVI, 56/208 (27%); >20% solid, 160/208 (77%); papillary architecture present, 122/208 (59%); LUS involved, 77/208 (37%); CX involved, 24/208 (12%). There was no evidence of a difference in the number of pelvic or para-aortic LNs sampled between groups (P=0.9 and 0.1, respectively). After multivariate analysis, the depth of MI, CX involvement, LVI, and SCI emerged as significant predictors of advanced-stage disease. Although univariate analysis pointed to LUS involvement, MELF pattern of invasion, and papillary architecture as possible predictors of advanced-stage disease, these were not shown to be significant by multivariate analysis. This study validates MI, CX involvement, and LVI as significant predictors of LN(+) or ED(+). The association of SCI pattern with advanced-stage LGEC is a novel finding.
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Han G, Lim D, Leitao MM, Abu-Rustum NR, Soslow RA. Histological features associated with occult lymph node metastasis in FIGO clinical stage I, grade I endometrioid carcinoma. Histopathology 2013; 64:389-98. [PMID: 24215212 DOI: 10.1111/his.12254] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/09/2013] [Indexed: 11/26/2022]
Abstract
AIMS Lymph node involvement affects prognosis/treatment in endometrial carcinoma patients. We assessed various histological features associated with nodal metastasis in patients with grade I, stage I endometrial endometrioid carcinoma (EEC). METHODS AND RESULTS Eighteen stage I EECs with occult positive lymph nodes and 36 controls were assessed for depth of myoinvasion; microcystic, elongated and fragmented (MELF) pattern of myometrial invasion; lymphovascular invasion (LVI); and epithelial metaplasia. Nodal metastases were subclassified as isolated tumour cells (ITCs; ≤0.2 mm), micrometastasis (>0.2 mm and <2 mm), or macrometastasis (≥2 mm). Node-positive cases had significantly higher rates of LVI (P < 0.001) and MELF invasion (P = 0.003) on univariate analysis. Only LVI was associated significantly with nodal metastasis on multivariate analysis (P = 0.002). Tumours with MELF invasion demonstrated reduced E-cadherin expression. Macrometastases were identified in seven cases (39%) with or without micrometastasis/ITCs. Eight (44%) contained only ITCs. Eleven (61%) had histiocyte-like nodal metastases. Biopsy material from four of six (67%) and five of 17 (29%) cases with and without nodal metastasis showed detached eosinophilic tumour cell buds. Of the former, three were associated with histiocyte-like nodal metastases - a feature absent in biopsies without tumour budding. CONCLUSIONS Lymph nodes from grade I EEC exhibiting cellular budding or LVI should be examined for occult metastases, especially in the form of histiocyte-like cells.
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Affiliation(s)
- Guangming Han
- Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Stewart CJR, Crook ML. Fascin and cyclin D1 immunoreactivity in non-neoplastic vulvar squamous epithelium, vulvar intraepithelial neoplasia and invasive squamous carcinoma: correlation with Ki67 and p16 protein expression. J Clin Pathol 2013; 67:319-25. [PMID: 24218024 DOI: 10.1136/jclinpath-2013-201920] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS To investigate cyclin D1 and fascin immunoreactivity in normal, reactive and neoplastic vulvar skin correlating the findings with p16 protein and Ki67 expression. METHODS 66 vulvar biopsy or resection specimens demonstrating normal appearances, reactive epidermal changes, usual-type vulvar intraepithelial neoplasia (uVIN), differentiated-type VIN (dVIN), p16-positive squamous cell carcinoma (SCC) and p16-negative SCC were examined immunohistochemically for cyclin D1, fascin, Ki67 and p16 protein. Where applicable, expression patterns were compared in microanatomically distinct areas, particularly at the invasive front (deep tumour margin) of SCC. RESULTS Normal epidermis showed parabasal Ki67 and cyclin D1 staining while fascin labelled cells in the lower one-third of the epithelium. Reactive and dVIN specimens demonstrated mildly increased Ki67 and cyclin D1 expression that maintained parabasal polarity, whereas uVIN and p16-positive SCC were characterised by loss of cyclin D1 staining. However, in 14 of 20 p16-positive SCC small infiltrative tumour groups and single infiltrating cells at the invasive front showed a cyclin D1-positive/ Ki67-negative phenotype. In contrast, p16-negative SCC generally showed diffuse and concordant cyclin D1 and Ki67 labelling, including at the invasive margin. Fascin expression was increased in all VIN and SCC lesions. CONCLUSIONS Variations in cyclin D1 and Ki67 expression between p16-positive and p16-negative vulvar SCCs suggest different mechanisms of invasion in these tumour subgroups. Fascin is upregulated in vulvar squamous neoplasia but immunostaining does not discriminate in situ from invasive lesions nor putative human papilloma virus (HPV)-associated and HPV-independent SCCs.
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Affiliation(s)
- C J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, , Perth, Western Australia, Australia
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Epithelial-to-mesenchymal transition in endometrioid adenocarcinoma of the endometrium. Hum Pathol 2013; 44:1956-7. [DOI: 10.1016/j.humpath.2013.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 04/26/2013] [Indexed: 11/20/2022]
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Zeimet AG, Reimer D, Huszar M, Winterhoff B, Puistola U, Abdel Azim S, Müller-Holzner E, Ben-Arie A, van Kempen LC, Petru E, Jahn S, Geels YP, Massuger LF, Amant F, Polterauer S, Lappi-Blanco E, Bulten J, Meuter A, Tanouye S, Oppelt P, Stroh-Weigert M, Reinthaller A, Mariani A, Hackl W, Netzer M, Schirmer U, Vergote I, Altevogt P, Marth C, Fogel M. L1CAM in Early-Stage Type I Endometrial Cancer: Results of a Large Multicenter Evaluation. ACTA ACUST UNITED AC 2013; 105:1142-50. [DOI: 10.1093/jnci/djt144] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Stewart CJR, McCluggage WG. Epithelial-mesenchymal transition in carcinomas of the female genital tract. Histopathology 2013; 62:31-43. [PMID: 23240668 DOI: 10.1111/his.12057] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Invasion is a defining feature of malignancy, but the mechanisms of invasion in many common cancers, including gynaecological malignancies, remain unclear. However, it has been proposed that malignant cells may usurp a normal embryological process, epithelial-mesenchymal transition (EMT), as a means of acquiring migratory capacity. The synergistic role of the tumour microenvironment in EMT induction has also been explored and helps to explain the spatially restricted distribution of EMT at the deep tumour margin (invasive front). Furthermore, tumour cells undergoing EMT may acquire cancer stem cell characteristics, and this may be relevant to the entire metastatic process and to tumour recurrence and treatment failure. Nevertheless, doubts persist regarding the role of EMT in malignant progression in vivo, partly because few studies have correlated molecular and histological alterations in clinical pathology specimens. In the current review we summarize the evidence for EMT in the common gynaecological epithelial malignancies, and discuss the morphological and immunohistochemical changes occurring at the invasive tumour front that may represent EMT-like processes. The possibility that carcinosarcomas represent a variant type of EMT with 'fixed' mesenchymal differentiation is also considered. Diagnostic histopathologists are ideally placed to critically evaluate the role of EMT in gynaecological and other types of malignancy.
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Affiliation(s)
- Colin J R Stewart
- Departments of Histopathology, King Edward Memorial Hospital, Perth, Australia.
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Abstract
Endometrial endometrioid adenocarcinoma (EEC) is the most common malignancy of the female genital tract, partly attributable to chronic estrogen exposure secondary to increased obesity rates. Tumor stage, which in most cases is based on depth of invasion (DOI), is of critical importance in determining if additional treatment is needed. However, the array of invasive morphologies within the spectrum of ECC can make the determination of DOI difficult. Several morphologic patterns of invasion have been described, including diffusely infiltrating irregular glands, "broad front" (or pushing border), adenoma malignum, adenomyosis-like, and microcystic, elongated, and fragmented glands. EEC may often contain a mixture of invasive patterns, which can further complicate evaluation of these common tumors. Recognition of these patterns may lead to more accurate staging, but perhaps more importantly, some patterns may be associated with adverse prognostic features. The purpose of this review is to highlight the various invasive patterns of EEC and note their unique pitfalls and prognostic implications in an effort to improve staging accuracy and treatment and follow-up for the thousands of women affected by this disease each year.
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Immunohistochemical expression and prognostic significance of oestrogen receptor-alpha, oestrogen receptor-beta, and progesterone receptor in stage 1 adult-type granulosa cell tumour of the ovary. Pathology 2012; 44:611-6. [DOI: 10.1097/pat.0b013e328359d636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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39
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The EMT signaling pathways in endometrial carcinoma. Clin Transl Oncol 2012; 14:715-20. [PMID: 22911547 DOI: 10.1007/s12094-012-0866-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
Abstract
Endometrial cancer (EC) is the most common gynecologic malignancy of the female genital tract and the fourth most common neoplasia in women. In EC, myometrial invasion is considered one of the most important prognostic factors. For this process to occur, epithelial tumor cells need to undergo an epithelial to mesenchymal transition (EMT), either transiently or stably, and to differing degrees. This process has been extensively described in other types of cancer but has been poorly studied in EC. In this review, several features of EMT and the main molecular pathways responsible for triggering this process are investigated in relation to EC. The most common hallmarks of EMT have been found in EC, either at the level of E-cadherin loss or at the induction of its repressors, as well as other molecular alterations consistent with the mesenchymal phenotype-like L1CAM and BMI-1 up-regulation. Pathways including progesterone receptor, TGFβ, ETV5 and microRNAs are deeply related to the EMT process in EC.
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Voutsadakis IA. Epithelial to mesenchymal transition in the pathogenesis of uterine malignant mixed Müllerian tumours: the role of ubiquitin proteasome system and therapeutic opportunities. Clin Transl Oncol 2012; 14:243-53. [PMID: 22484631 DOI: 10.1007/s12094-012-0792-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Malignant mixed Müllerian tumours (malignant mixed mesodermal tumours, MMMT) of the uterus are metaplastic carcinomas with a sarcomatous component and thus they are also called carcinosarcomas. It has now been accepted that the sarcomatous component is derived from epithelial elements that have undergone metaplasia. The process that produces this metaplasia is epithelial to mesenchymal transition (EMT), which has recently been described as a neoplasia-associated programme shared with embryonic development and enabling neoplastic cells to move and metastasise. The ubiquitin proteasome system (UPS) regulates the turnover and functions of hundreds of cellular proteins. It plays important roles in EMT by being involved in the regulation of several pathways participating in the execution of this metastasis-associated programme. In this review the specifi c role of UPS in EMT of MMMT is discussed and therapeutic opportunities from UPS manipulations are proposed.
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Affiliation(s)
- I A Voutsadakis
- Centre Pluridisciplinaire d'Oncologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Llauradó M, Ruiz A, Majem B, Ertekin T, Colás E, Pedrola N, Devis L, Rigau M, Sequeiros T, Montes M, Garcia M, Cabrera S, Gil-Moreno A, Xercavins J, Castellví J, Garcia A, Ramón y Cajal S, Moreno G, Alameda F, Vázquez-Levin M, Palacios J, Prat J, Doll A, Matías-Guiu X, Abal M, Reventós J. Molecular bases of endometrial cancer: new roles for new actors in the diagnosis and the therapy of the disease. Mol Cell Endocrinol 2012; 358:244-55. [PMID: 22037169 DOI: 10.1016/j.mce.2011.10.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/30/2011] [Accepted: 10/04/2011] [Indexed: 12/31/2022]
Abstract
Endometrial carcinoma (EC) is the most commonly diagnosed gynecologic malignancy in the western world. The majority of these cancers are curable, but a subset about 15-20% of endometrial tumors exhibits an aggressive phenotype. Based on clinic-pathological and molecular characteristics, EC has been classified into two groups: Type I estrogen-dependent adenocarcinomas, which have a good prognosis and an endometrioid histology, and Type II or non-estrogen-dependent EC associated with poor prognosis and non-endometrioid histology. EC develops as a result of a stepwise accumulation of alterations that seem to be specific of each histological type. However, more knowledge is needed to better understand the differences in the biology and the clinical outcome of EC. We would like to highlight the need to explore new potential biomarkers of EC as a tool for the detection and monitoring of aggressive endometrial tumors that, at the same time, will allow us to develop novel and more selective molecular targeted therapies against EC.
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Affiliation(s)
- Marta Llauradó
- Biomedical Research Unit, Vall d'Hebron Research Institute and University Hospital, Barcelona, Spain
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Luo WR, Chen XY, Li SY, Wu AB, Yao KT. Neoplastic spindle cells in nasopharyngeal carcinoma show features of epithelial-mesenchymal transition. Histopathology 2012; 61:113-22. [PMID: 22486228 DOI: 10.1111/j.1365-2559.2012.04205.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To investigate whether the neoplastic spindle cells in nasopharyngeal carcinoma (NPC) are associated with the process of epithelial-mesenchymal transition (EMT). METHODS AND RESULTS We used immunohistochemistry to analyse the expression of cytokeratin, E-cadherin, β-catenin, vimentin, fibronectin, Snail1, Slug and aldehyde dehydrogenase 1 (ALDH1) in 115 cases of NPC in which there were neoplastic spindle cells; in 47 cases a neoplastic squamous cell component was also present. There was no significant difference in the expression of cytokeratin observed in the neoplastic spindle cells (P = 0.644), compared to the squamous component whereas E-cadherin expression was reduced. By contrast, the expression of β-catenin, vimentin, fibronectin, Snail1, Slug and ALDH1 was up-regulated in the spindle cells (all P = 0.000). Furthermore, E-cadherin expression was associated negatively with β-catenin (P < 0.001), vimentin (P < 0.001), fibronectin (P < 0.001), Slug (P < 0.001) and ALDH1 (P < 0.001) in neoplastic spindle cells, but did not correlate with Snail1 expression (P = 0.093). CONCLUSIONS Our findings demonstrate for the first time that EMT might play an important role in the development of neoplastic spindle cells in NPC.
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Affiliation(s)
- Wei-Ren Luo
- Key Lab for Transcriptomics and Proteomics of Human Fatal Diseases, Cancer Research Institute, Southern Medical University, Guangzhou, China
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Stewart C. Keratin expression in colorectal cancer: freak of nature or significant finding? Histopathology 2012; 60:846-7. [DOI: 10.1111/j.1365-2559.2011.04124.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cytokeratin 19 Expression in Normal Endometrium and in Low-grade Endometrioid Adenocarcinoma of the Endometrium. Int J Gynecol Pathol 2011; 30:484-91. [DOI: 10.1097/pgp.0b013e3182158944] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Stewart CJR, Crook ML, Manso L. Fascin expression in low-grade uterine endometrioid adenocarcinoma: correlation with microcystic, elongated and fragmented (MELF)-type alteration at the deep invasive margin. Histopathology 2011; 59:73-80. [DOI: 10.1111/j.1365-2559.2011.03893.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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46
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Pavlakis K, Messini I, Vrekoussis T, Panoskaltsis T, Chrysanthakis D, Yiannou P, Voulgaris Z. MELF invasion in endometrial cancer as a risk factor for lymph node metastasis. Histopathology 2011; 58:966-73. [DOI: 10.1111/j.1365-2559.2011.03802.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Stewart CJR, Crook ML, Little L, Louwen K. Correlation between invasive pattern and immunophenotypic alterations in endocervical adenocarcinoma. Histopathology 2011; 58:720-8. [DOI: 10.1111/j.1365-2559.2011.03787.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stewart CJR, Crook ML. Galectin-3 expression in uterine endometrioid adenocarcinoma: comparison of staining in conventional tumor glands and in areas of MELF pattern myometrial invasion. Int J Gynecol Pathol 2011; 29:555-61. [PMID: 20881856 DOI: 10.1097/pgp.0b013e3181e4ee4ea] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Endometrioid adenocarcinoma (EAC) of the uterus can show varying patterns of invasion, 1 of which, "MELF," is characterized by the presence of microcystic, elongated, and fragmented glands. However, at present, little is known of the functional alterations in neoplastic cells that are associated with the different patterns of myometrial invasion, including those in MELF. Galectin-3 is a widely distributed and multifunctional carbohydrate binding protein that has been shown to influence many aspects of tumor development and progression, but there are limited and conflicting data regarding galectin-3 expression in EAC. In this study, galectin-3 immunoreactivity was investigated in 22 EACs with specific comparison of staining in the "conventional" endometrioid-type tumor glands and in areas exhibiting MELF pattern invasion. Cytoplasmic galectin-3 was present in all tumors although <50% of cells were stained in approximately one-third of the cases. Nuclear staining was evident in 11 cases, but usually only in a small proportion of cells. The neoplastic epithelium within MELF areas showed a consistent reduction in protein expression, often contrasting with the adjacent galectin-3-positive conventional glands and reactive stromal cells. Conversely, intravascular tumor foci often showed cytoplasmic and nuclear galectin-3 immunoreactivity. The microanatomical variation in galectin-3 expression in EAC suggests that there are localized functional alterations in the neoplastic epithelium and the surrounding stroma during the invasive process. As MELF pattern invasion is associated with the loss of galectin-3 expression, there may be implications for the use of galectin inhibitors in the treatment of endometrial carcinomas and other malignancies.
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Affiliation(s)
- Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, Western Australia, Australia.
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Stewart C, Crook M. CD147 (EMMPRIN) and matrix metalloproteinase-2 expression in uterine endometrioid adenocarcinoma. Pathol Res Pract 2011; 207:30-6. [DOI: 10.1016/j.prp.2010.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 10/11/2010] [Accepted: 10/25/2010] [Indexed: 02/08/2023]
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