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Tavolari S, Brandi G. Mutational Landscape of Cholangiocarcinoma According to Different Etiologies: A Review. Cells 2023; 12:cells12091216. [PMID: 37174616 PMCID: PMC10177226 DOI: 10.3390/cells12091216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Recent next-generation sequencing (NGS) studies on large cohorts of cholangiocarcinoma (CCA) patients have clearly revealed the extreme intra- and inter-tumoral molecular heterogeneity that characterizes this malignancy. The lack of a stereotyped molecular signature in CCA makes the identification of actionable therapeutic targets challenging, making it mandatory to have a better understanding of the origin of such heterogeneity in order to improve the clinical outcome of these patients. Compelling evidence has shown that the CCA genomic landscape significantly differs according to anatomical subtypes and the underlying etiology, highlighting the importance of conducting molecular studies in different populations of CCA patients. Currently, some risk factors have been recognized in CCA development, while others are emerging from recent epidemiological studies. Nevertheless, the role of each etiologic factor in driving CCA genetic heterogeneity still remains unclear, and available studies are limited. In an attempt to shed more light on this issue, here we review the current literature data on the mutational spectrum of this disease according to different etiologies.
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Affiliation(s)
- Simona Tavolari
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Giovanni Brandi
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
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Vasuri F, Deserti M, Corradini AG, Tavolari S, Relli V, Palloni A, Frega G, Curti S, Mattioli S, Cescon M, D'Errico A, Brandi G. Asbestos exposure as an additional risk factor for small duct intrahepatic cholangiocarcinoma: a pilot study. Sci Rep 2023; 13:2580. [PMID: 36781903 PMCID: PMC9925780 DOI: 10.1038/s41598-023-27791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a rare malignancy, recently classified in small duct and large duct morphological subtypes. Growing evidence suggests asbestos as a putative risk factor for iCCA, albeit no correlation between asbestos and iCCA morphology has been investigated so far. The aim of the present study was to assess the relationship between asbestos exposure and iCCA morphological subtype. Forty patients with surgically removed iCCA were prospectively enrolled: asbestos exposure was assessed according to the Italian National Mesothelioma Register questionnaire. From the surgical iCCA specimens the main histopathological variables were collected, including the small duct (sd-iCCA, 32 patients) and large duct subtypes (ld-iCCA, 8 patients). Five sd-iCCA cases had a definite/probable occupational exposure to asbestos, while no cases of ld-iCCA were classified as being occupationally exposed (definite/probable). Other kind of asbestos exposure (i.e. possible occupational, familial, environmental) were recorded in 16 sd-iCCA and 3 ld-iCCA. Cases with unlikely exposure to asbestos were 11 sd-iCCA (35.5%) and 5 ld-iCCA (62.5%). In conclusion, these findings seem to indicate that sd-iCCA might be more frequently associated to asbestos exposure rather than ld-iCCA, suggesting that asbestos fibres might represent a parenchymal, rather than a ductal risk factor for iCCA. This pilot study must be confirmed by further case-control studies or large independent cohorts.
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Affiliation(s)
- Francesco Vasuri
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Marzia Deserti
- Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Angelo G Corradini
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Simona Tavolari
- Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Valeria Relli
- Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Andrea Palloni
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Giorgio Frega
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Mattioli
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Matteo Cescon
- General and Transplant Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Antonia D'Errico
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Giovanni Brandi
- Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy.
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.
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Exposure to Asbestos and Increased Intrahepatic Cholangiocarcinoma Risk: Growing Evidences of a Putative Causal Link. Ann Glob Health 2022; 88:41. [PMID: 35755315 PMCID: PMC9205375 DOI: 10.5334/aogh.3660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/25/2022] [Indexed: 11/20/2022] Open
Abstract
To date the true global incidence of intrahepatic cholangiocarcinoma (iCCA) and the underlying risk factors remain to be fully defined, in particular, the role of occupational and environmental factors. Currently, the putative role of asbestos exposure as a risk factor for iCCA is gaining increased attention in the international scientific community and agencies. In this commentary we review and integrate available epidemiological and mechanistic evidences that support a potential role of asbestos exposure in iCCA etiology.
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Seeherunwong A, Chaiear N, Khuntikeo N, Ekpanyaskul C. The Proportion of Occupationally Related Cholangiocarcinoma: A Tertiary Hospital Study in Northeastern Thailand. Cancers (Basel) 2022; 14:cancers14102386. [PMID: 35625989 PMCID: PMC9139931 DOI: 10.3390/cancers14102386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Northeastern Thailand has the world’s highest incidence rate of cholangiocarcinoma (CCA), whereas a consequence, approximately 14,000 patients die annually. In most cases, the causal factors are identified, but, for some, they remain unknown. Legally imported industrial chemicals such as 1,2-dichloropropane (1,2-DCP), dichloromethane (DCM), and asbestos fibers are defined as occupational causes of CCA. An investigation into these vis-à-vis the diagnosis of occupationally related CCA in Thailand has not been conducted, but is important for understanding the potential magnitude of the problem. The current study found that the proportion of occupationally related CCA was approximately 5.5%, as well as a lower proportion of occupational history taken by treating physicians. Improving physician skills and developing an assistive tool for exploring occupational history might improve the documentation of work-related conditions. Abstract Northeastern Thailand registers the highest worldwide incidence of cholangiocarcinoma (CCA). Most of the cases are associated with liver flukes, while unknown causes comprise approximately 10–30% of cases, and these could be due to occupational exposures. Our aim was to determine the magnitude of occupational causes of CCA in a tertiary hospital in northeastern Thailand. We conducted a cross-sectional study with a sample of 220 patients between March and November 2021. Descriptive statistics were used to analyze the findings. Clinical information and telephone interviews were used to explore significant occupational histories. An occupational consensus meeting was held with two occupational physicians, an industrial hygienist, and a hepatobiliary surgeon to decide on the final diagnosis. The response rate was 90.9% (200/220). Based on the medical records and telephone interviews, researchers found that 11 participants had significant exposure. After occupational consensus, it was agreed that the eleven had possible occupational causes, 5.5% (11/200)–54.5% (6/11) being due to asbestos fibers, 45.5% (5/11) due to dichloromethane, and 9.1% (1/11) due to 1,2-dichloropropane. Only 4% (8/200) had occupational histories collected by their treating physicians. Taken together, occupationally related CCA appears to have been underestimated, so improving occupational history taking is needed to properly identify and classify work-related CCA—both for patient treatment and occupational hazard prevention.
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Affiliation(s)
- Anantapat Seeherunwong
- Department of Community, Family and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Naesinee Chaiear
- Department of Community, Family and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
- Correspondence: ; Tel.: +66-43363587
| | - Narong Khuntikeo
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
- Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Chatchai Ekpanyaskul
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand;
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Brandi G, Tavolari S. Asbestos and Intrahepatic Cholangiocarcinoma. Cells 2020; 9:E421. [PMID: 32059499 PMCID: PMC7072580 DOI: 10.3390/cells9020421] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 02/07/2023] Open
Abstract
The link between asbestos exposure and the onset of thoracic malignancies is well established. However epidemiological studies have provided evidences that asbestos may be also involved in the development of gastrointestinal tumors, including intrahepatic cholangiocarcinoma (ICC). In line with this observation, asbestos fibers have been detected in the liver of patients with ICC. Although the exact mechanism still remains unknown, the presence of asbestos fibers in the liver could be explained in the light of their translocation pathway following ingestion/inhalation. In the liver, thin and long asbestos fibers could remain trapped in the smaller bile ducts, particularly in the stem cell niche of the canals of Hering, and exerting their carcinogenic effect for a long time, thus inducing hepatic stem/progenitor cells (HpSCs) malignant transformation. In this scenario, chronic liver damage induced by asbestos fibers over the years could be seen as a classic model of stem cell-derived carcinogenesis, where HpSC malignant transformation represents the first step of this process. This phenomenon could explain the recent epidemiological findings, where asbestos exposure seems mainly involved in ICC, rather than extrahepatic cholangiocarcinoma, development.
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Affiliation(s)
- Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy
| | - Simona Tavolari
- Center for Applied Biomedical Research, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy;
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Micro-Raman Spectroscopy, a Powerful Technique Allowing Sure Identification and Complete Characterization of Asbestiform Minerals. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9153092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Micro-Raman spectroscopy has been applied to fibrous minerals regulated as “asbestos”—anthophyllite, actinolite, amosite, crocidolite, tremolite, and chrysotile—responsible of severe diseases affecting mainly, but not only, the respiratory system. The technique proved to be powerful in the identification of the mineral phase and in the recognition of particles of carbonaceous materials (CMs) lying on the “asbestos” fibers surface. Also, erionite, a zeolite mineral, from different outcrops has been analyzed. To erionite has been ascribed the peak of mesothelioma noticed in Cappadocia (Turkey) during the 1970s. On the fibers, micro-Raman spectroscopy allowed to recognize many grains, micrometric in size, of iron oxy-hydroxides or potassium iron sulphate, in erionite from Oregon, or particles of CMs, in erionite from North Dakota, lying on the crystal surface. Raman spectroscopy appears therefore to be the technique allowing, without preparation of the sample, a complete characterization of the minerals and of the associated phases.
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