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Yu Y, Liang Y, Xie F, Zhang Z, Zhang P, Zhao X, Zhang Z, Liang Z, Li D, Wang L, Chen Y, Sun L, Niu H, Wang Y. Tumor-associated macrophage enhances PD-L1-mediated immune escape of bladder cancer through PKM2 dimer-STAT3 complex nuclear translocation. Cancer Lett 2024; 593:216964. [PMID: 38762193 DOI: 10.1016/j.canlet.2024.216964] [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: 02/27/2024] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
Tumor-associated macrophages (TAMs) are important components of the tumor microenvironment (TME) and strongly associated with poor prognosis and drug resistance, including checkpoint blockade immunotherapy in solid tumor patients. However, the mechanism by which TAM affects immune metabolism reprogramming and immune checkpoint signalling pathway in the TME remains elusive. In this study we found that transforming growth factor-beta (TGF-β) secreted by M2-TAMs increased the level of glycolysis in bladder cancer (BLCA) and played important role in PD-L1-mediated immune evasion through pyruvate kinase isoenzymes M2 (PKM2). Mechanistically, TGF-β promoted high expression of PKM2 by promoting the nuclear translocation of PKM2 dimer in conjunction with phosphorylated signal transducer and activator of transcription (p-STAT3), which then exerted its kinase activity to promote PD-L1 expression in BLCA. Moreover, SB-431542 (TGF-β blocker) and shikonin (PKM2 inhibitor) significantly reduced PD-L1 expression and inhibited BLCA growth and organoids by enhancing anti-tumor immune responses. In conclusion, M2-TAM-derived TGF-β promotes PD-L1-mediated immune evasion in BLCA by increasing the PKM2 dimer-STAT3 complex nuclear translocation. Combined blockade of the TGF-β receptor and inhibition of PKM2 effectively prevent BLCA progression and immunosuppression, providing a potential targeted therapeutic strategy for BLCA.
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Affiliation(s)
- Yongbo Yu
- Urology Department, The Affiliated Hospital of Qingdao University, China; Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China; Medicine College, Qingdao University, Qingdao, China; Department of Urology, Weifang People's Hospital, Weifang Medical University, Weifang, China
| | - Ye Liang
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Fei Xie
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Zhao Zhang
- Urology Department, The Affiliated Hospital of Qingdao University, China; Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China; Medicine College, Qingdao University, Qingdao, China
| | - Pengfei Zhang
- Urology Department, The Affiliated Hospital of Qingdao University, China; Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China; Medicine College, Qingdao University, Qingdao, China
| | - Xinzhao Zhao
- Urology Department, The Affiliated Hospital of Qingdao University, China; Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China; Medicine College, Qingdao University, Qingdao, China
| | - Zhilei Zhang
- Department of Urology, Weifang People's Hospital, Weifang Medical University, Weifang, China
| | - Zhijuan Liang
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Dan Li
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Liping Wang
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yuanbin Chen
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Lijiang Sun
- Urology Department, The Affiliated Hospital of Qingdao University, China
| | - Haitao Niu
- Urology Department, The Affiliated Hospital of Qingdao University, China; Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| | - Yonghua Wang
- Urology Department, The Affiliated Hospital of Qingdao University, China; Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
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Mert M, Bozdogan O, Bozdogan N, Gamsızkan M, Safali M. PRAME and Historical Immunohistochemical Antibodies Ki-67, P16, and HMB-45 in Ambiguous Melanocytic Tumors. Am J Dermatopathol 2024:00000372-990000000-00374. [PMID: 38916203 DOI: 10.1097/dad.0000000000002768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
ABSTRACT Ambiguous melanocytic lesions/tumors (AMLs) can be simply described as melanocytic neoplasms that cannot be differentiated as either a melanoma or a nevus. Preferentially expressed antigen in melanoma (PRAME) is a novel antibody that can help differentiate between nevi and melanomas. However, its usefulness remains controversial in AMLs. The aim of this study was to demonstrate the importance of PRAME and diagnostic auxiliary antibodies (Ki-67, p16, HMB-45) in the diagnosis of melanocytic lesions, especially in AMLs. This study included 52 ambiguous melanocytic lesions, 40 nevi, and 40 melanomas. All immunohistochemical studies were performed automatically using the Universal Alkaline Phosphatase Red Detection Kit. Different analytic approaches were used for each antibody based on the literature. Statistically, the multinomial forward stepwise elimination logistic regression analysis was used to create a statistical model to predict the diagnosis of melanocytic lesions based on clinical, morphological, and immunohistochemical data. PRAME positivity was very strong and diffuse in the melanoma group and statistically significantly higher than that of the AML and nevus groups. There was no statistically significant difference between the nevus and AML groups. The Ki-67 proliferation index and HMB-45 staining pattern provided valuable indications for distinguishing between these 3 groups. The P16 antibody was limited in supporting the differential diagnosis. Our statistical model showed that a high mitosis count, central pagetoid spread, and PRAME positivity increased the probability of melanoma against an AML diagnosis. This study showed the advantages of evaluating the PRAME antibody together with morphological features and other immunohistochemical markers (Ki-67 and HMB-45) in the differential diagnosis of melanocytic lesions.
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Affiliation(s)
- Merve Mert
- Medical Pathology Department, Afyonkarahisar Public Hospital, Afyonkarahisar, Turkey
| | - Onder Bozdogan
- Medical Pathology Department, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Nazan Bozdogan
- Medical Pathology Department, University of Health Sciences, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey; and
| | - Mehmet Gamsızkan
- Medical Pathology Department, Duzce University School of Medicine, Duzce, Turkey
| | - Mukerrem Safali
- Medical Pathology Department, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
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Hiraki T, Oishi T, Yoshikawa S, Honma K, Ohe S, Isei T, Kukita Y, Takai T, Shimada K, Takei Y, Goto K. Loss of p16 Immunoexpression and Deletions of CDKN2A in the Progression of Extramammary Paget Disease: An Immunohistochemical and Genetic Study of 24 Invasive/Metastatic Cases. Am J Dermatopathol 2024:00000372-990000000-00340. [PMID: 38648029 DOI: 10.1097/dad.0000000000002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
ABSTRACT Information regarding the genetic alterations in extramammary Paget disease (EMPD) is scarce. This study investigated the significance of CDKN2A and MTAP alterations in EMPD progression using immunohistochemistry and panel DNA sequencing. In total, 24 invasive/metastatic EMPD cases were included in this study. The immunoexpression of p16 and MTAP in the primary in situ, primary invasive, and metastatic tumor components was evaluated. Panel DNA sequencing was performed for metastatic tumor components in 5 of the 24 cases. Immunoexpression of p16 in the in situ tumor component was at least partially preserved in all 19 tested cases (100%). By contrast, the invasive tumor component was diffusely or partially lost in 18 (81.8%) of 22 tested cases. Regarding the foci of lymph node metastasis, 13 (81.2%) of the 16 patients showed a significant loss of p16 expression. Loss of MTAP immunoexpression was observed less frequently compared with the loss of p16 expression. CDKN2A homozygous deletions were confirmed in all 5 tested cases by sequencing, whereas MTAP deletions were detected in only 2 cases. In conclusion, p16 expression loss and CDKN2A deletions can be frequently seen in invasive/metastatic cases of EMPD.
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Affiliation(s)
- Tsubasa Hiraki
- Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
| | - Takuma Oishi
- Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
| | - Shusuke Yoshikawa
- Department of Dermatology, Shizuoka Cancer Center Hospital, Sunto, Japan
| | - Keiichiro Honma
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Shuichi Ohe
- Department of Dermatologic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taiki Isei
- Department of Dermatologic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Kukita
- Laboratory of Genomic Pathology, Research Center, Osaka International Cancer Institute, Osaka, Japan
| | - Toshihiro Takai
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Keiji Shimada
- Department of Pathology, Nara City Hospital, Nara, Japan
| | - Yusuke Takei
- Department of Clinical Laboratory, National Hospital Organization Himeji Medical Center, Himeji, Japan
| | - Keisuke Goto
- Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
- Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
- Department of Diagnostic Pathology, Chutoen General Medical Center, Kakegawa, Japan
- Department of Diagnostic Pathology, Osaka National Hospital, Osaka, Japan; and
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
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Nurla LA, Gheorghe E, Aşchie M, Cozaru GC, Orășanu CI, Boşoteanu M. P16-CD8-Ki67 Triple Algorithm for Prediction of CDKN2A Mutations in Patients with Multiple Primary and Familial Melanoma. Diagnostics (Basel) 2024; 14:813. [PMID: 38667459 PMCID: PMC11049611 DOI: 10.3390/diagnostics14080813] [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: 03/13/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Melanoma, a malignant neuroectodermic tumor originating from the neural crest, presents a growing global public health challenge and is anticipated to become the second most prevalent malignancy in the USA by 2040. The CDKN2A gene, particularly p16INK4a, plays a pivotal role in inhibiting the cell cycle via the cyclin D/CDK2-pRb pathway in certain tumors. In familial melanomas (FM), 40% exhibit CDKN2A mutations affecting p16INK4a, impacting checkpoint G1, and stabilizing p53 expression. This study aims to establish a scoring system using immunohistochemical antibodies, providing a cost-saving approach to classify multiple primary melanomas (MPM) and FM patients based on their mutational status, thus mitigating genetic testing expenses. This retrospective study included 23 patients with MPM and FM, assessing the p16, CD8, and Ki67 immunohistochemical status. Analyses of each parameter and associations between their value intervals and genetic CDKN2A status were conducted. A total score of at least 9 out of 10 points per tumor defined melanomas with homozygous CDKN2A deletions, exhibiting a sensitivity of 100% and specificity of 94.11%. In conclusion, p16, CD8, and Ki67 individually serve as valuable indicators for predicting melanoma evolution. The algorithm, comprising these three immunohistochemical parameters based on their prognostic and evolutionary significance, proves to be a valuable auxiliary diagnostic tool for cost-effective prediction of mutational status in detecting multiple and familial primary melanomas with CDKN2A homozygous deletion.
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Affiliation(s)
- Luana-Andreea Nurla
- Department of Dermatovenerology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
- Institute of Doctoral Studies, Doctoral School of Medicine, “Ovidius” University of Constanţa, 900573 Constanta, Romania
| | - Emma Gheorghe
- Department of Dermatology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Department of Histology, Faculty of Medicine, “Ovidius” University of Constanţa, 900527 Constanta, Romania
| | - Mariana Aşchie
- Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanţa, 900527 Constanta, Romania
- Department VIII—Medical Sciences, Academy of Romanian Scientists, 030167 Bucharest, Romania
| | - Georgeta Camelia Cozaru
- Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), 900591 Constanta, Romania
| | - Cristian Ionuț Orășanu
- Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), 900591 Constanta, Romania
| | - Mǎdǎlina Boşoteanu
- Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanţa, 900527 Constanta, Romania
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Yip HM, Cameron A, Sheppard K, Fasanmade A, Garg M. Oral mucosal melanoma in situ: a case report and review of the literature. Int J Oral Maxillofac Surg 2023; 52:1230-1234. [PMID: 37179134 DOI: 10.1016/j.ijom.2023.04.002] [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: 11/01/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
Oral mucosal melanoma is a rare presentation of malignant melanoma with a 5-year survival rate of only 15%. Oral mucosal melanoma in situ (OMMIS) is its assumed precursor. This report describes one of only 20 documented cases of OMMIS and outlines how early clinical recognition resulted in prompt histopathological diagnosis and subsequent complete surgical excision. A literature review of existing reported cases, their management, and latest outcomes was also performed, highlighting this rare condition for consideration in the differential diagnosis of pigmented oral pathologies.
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Affiliation(s)
- H M Yip
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Headington, Oxford, UK.
| | - A Cameron
- Department of Oral Surgery, Great Western Hospital, Swindon, UK
| | - K Sheppard
- Department of Pathology, John Radcliffe Hospital, Headington, Oxford, UK
| | - A Fasanmade
- Department of Oral and Maxillofacial Surgery, Churchill Hospital, Headington, Oxford, UK
| | - M Garg
- Department of Oral and Maxillofacial Surgery, Churchill Hospital, Headington, Oxford, UK
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Rasic D, Korsgaard N, Marcussen N, Precht Jensen EM. Diagnostic utility of combining PRAME and HMB-45 stains in primary melanocytic tumors. Ann Diagn Pathol 2023; 67:152211. [PMID: 37717457 DOI: 10.1016/j.anndiagpath.2023.152211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Pathologists face ongoing challenges distinguishing between benign and malignant melanocytic tumors. PRAME (PReferentially expressed Antigen in Melanoma) has a demonstrated value distinguishing between these types of lesions. However, the sensitivity of single immunohistochemistry is variable. HMB-45 is another valuable marker, but on its own, has a limited ability in setting of primary melanocytic tumors. This study sought to evaluate the diagnostic potential of a dual panel combining PRAME and HMB-45 in the assessment of primary melanocytic tumors. METHODS 259 tumors, of which 141 were benign nevi, 31 dysplastic nevi (either low- or high grade dysplasia), and further 87 malignant melanomas, were retrieved from the department's archives and assessed by two experienced dermatopathologists. New sections were stained with PRAME and HMB-45, respectively. For PRAME, a nuclear, and for HMB-45, a cytoplasmic staining, was considered positive and scored as described in the literature on a scale from 0 to 4+. Only dermal component was assessed on HMB-45 stain. RESULTS PRAME was diffusely expressed in only 1 benign nevus, with focal expression in further 28 compared to 22 diffusely and 103 focally HMB-45-positive benign nevi. 5 high-grade dysplastic nevi showed diffuse PRAME expression in epidermal component, with varying degree of positivity in adjacent dermal compartment, and further 8 dysplastic nevi showed only focal expression. HMB-45 was diffusely expressed in only 2, with focal expression in 23, and no apparent positivity in remaining 6 dysplastic nevi. In invasive melanoma group, PRAME stained >75 % cells in 64/87 tumors, however, 10/87 melanomas were completely negative. HMB-45 was captured diffusely in 49/87 melanomas, 32 showed patchy expression, and 6 tumors were blank negative. Diffuse 4+ PRAME positivity showed superior sensitivity and specificity of 73,6 % and 96,5 %, respectively, compared to HMB-45, 56,3 % and 86,0 %, respectively. No nevi showed double 4+ positivity, however, the sensitivity for double positivity was only 49,4 %. CONCLUSION Our results confirm the superiority of PRAME over HMB-45 in the differential diagnosis of melanocytic tumors. However, combined staining can significantly increase specificity, rendering a benign diagnosis more unlikely in a double 4+ diffuse positivity setting.
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Affiliation(s)
- Dusan Rasic
- Department of Pathology, Research Unit of Pathology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark.
| | - Niels Korsgaard
- Department of Clinical Pathology, Hospital South West Jutland, 6700 Esbjerg, Denmark.
| | - Niels Marcussen
- Department of Pathology, Research Unit of Pathology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark.
| | - Eva Magrethe Precht Jensen
- Department of Pathology, Research Unit of Pathology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark.
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Kim JC, Choi JW, Kim YC. Comparison of Melanocyte-Associated Immunohistochemical Markers in Acral Lentiginous Melanoma and Acral Benign Nevi. Am J Dermatopathol 2023; 45:748-752. [PMID: 37856738 DOI: 10.1097/dad.0000000000002555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
ABSTRACT Acral lentiginous melanoma (ALM) is a relatively rare clinicopathologic subtype of cutaneous malignant melanoma, but it is the most common type of melanoma among Asians. Although the research to identify immunohistochemical (IHC) markers to differentiate nevi from melanoma is being conducted, specific markers for ALM are not well-known. Therefore, we aimed to analyze and compare the differences in the expression of melanocyte-associated IHC markers between ALM and acral benign nevi (ABN). Two independent groups of 53 and 19 paraffin-embedded specimens (from patients with pathologically confirmed ALM and ABN, respectively) were subjected to IHC staining for MART-1, preferentially expressed antigen in melanoma (PRAME), SOX10, HMB-45, Ki-67, and p16. We performed a quantitative analysis of PRAME, SOX10, KI-67, and p16 expression and gradient pattern analysis of HMB-45 expression for each specimen. The PRAME (60.1% and 28.5%, P < 0.05) and Ki-67 (7.8% and 3.5%, P < 0.05) expression levels were significantly higher in the ALM group than in the ABN group. The p16 expression was significantly lower (14.2% and 19.4%, P < 0.05), and the absence of HMB-45 gradient was more frequent in the ALM group than in the ABN group. However, no statistical significance was noted in SOX10 (54.8% and 44.7%). Receiver operating characteristic curves showed that PRAME had the highest area under the curve value. In summary, among various IHC markers, PRAME was the most valuable marker for the diagnosis of ALM; however, further large-scale studies are needed to validate these findings.
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Affiliation(s)
- Jin Cheol Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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Wang R, Zhang T, Lu Y, Lin Y, Kou S, Li X, Wang Y, Xie L. Antitumor activity of pegylated human interferon β as monotherapy or in combination with immune checkpoint inhibitors via tumor growth inhibition and dendritic cell activation. Cell Immunol 2023; 393-394:104782. [PMID: 37931572 DOI: 10.1016/j.cellimm.2023.104782] [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: 05/17/2023] [Revised: 10/10/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
Type I interferons (IFN), especially human IFN alpha (IFNα), have been utilized for antitumor therapy for decades. Human interferon beta (IFNβ) is rarely used for cancer treatment, despite advantages over IFNα in biological activities such as tumor growth inhibition and dendritic cell (DC) activation. The utilization of pegylated human IFNβ (PEG-IFNβ), as monotherapy or in combination with immune checkpoint inhibitors (ICIs) was evaluated in this study through in vivo efficacy studies in syngeneic mouse melanoma, non-small cell lung cancer (NSCLC), and colon adenocarcinoma (COAD) models resistant to immune checkpoint inhibitors (ICIs). In vitro comparative study of PEG-IFNβ and pegylated IFNα-2b was performed in terms of tumor growth inhibition against human melanoma, NSCLC and COAD cell lines and activation of human monocyte-derived DCs (MoDCs). Our data demonstrate that the in vivo antitumor effects of PEG-IFNβ are partially attributable to tumor growth-inhibitory effects and DC-activating activities, superior to pegylated IFNα-2b. Our findings suggest that utilizing PEG-IFNβ as an antitumor therapy can enhance the therapeutic effect of ICIs in ICI-resistant tumors by directly inhibiting tumor growth and induction of DC maturation.
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Affiliation(s)
- Rui Wang
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China
| | - Tao Zhang
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China
| | - Yuan Lu
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China
| | - Yalong Lin
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China
| | - Shuyuan Kou
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China
| | - Xuefeng Li
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China
| | - Yang Wang
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China
| | - Liangzhi Xie
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing 100176, China; Beijing Key Laboratory of Monoclonal Antibody Research and Development, Sino Biological Inc., Beijing 100176, China; Cell Culture Engineering Center, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China.
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Lam GT, Martini C, Brooks T, Prabhakaran S, Hopkins AM, Ung BSY, Tang J, Caruso MC, Brooks RD, Johnson IRD, Sorvina A, Hickey SM, Karageorgos L, Klebe S, O’Leary JJ, Brooks DA, Logan JM. Insights into Melanoma Clinical Practice: A Perspective for Future Research. Cancers (Basel) 2023; 15:4631. [PMID: 37760601 PMCID: PMC10526186 DOI: 10.3390/cancers15184631] [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: 08/03/2023] [Revised: 08/30/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Early diagnosis is the key to improving outcomes for patients with melanoma, and this requires a standardized histological assessment approach. The objective of this survey was to understand the challenges faced by clinicians when assessing melanoma cases, and to provide a perspective for future studies. METHODS Between April 2022 and February 2023, national and international dermatologists, pathologists, general practitioners, and laboratory managers were invited to participate in a six-question online survey. The data from the survey were assessed using descriptive statistics and qualitative responses. RESULTS A total of 54 responses were received, with a 51.4% (n = 28) full completion rate. Of the respondents, 96.4% reported ambiguity in their monthly melanoma diagnosis, and 82.1% routinely requested immunohistochemistry (IHC) testing to confirm diagnosis. SOX10 was the most frequently requested marker, and most respondents preferred multiple markers over a single marker. Diagnostic and prognostic tests, as well as therapeutic options and patient management, were all identified as important areas for future research. CONCLUSIONS The respondents indicated that the use of multiple IHC markers is essential to facilitate diagnostic accuracy in melanoma assessment. Survey responses indicate there is an urgent need to develop new biomarkers for clinical decision making at multiple critical intervention points.
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Affiliation(s)
- Giang T. Lam
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Carmela Martini
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Tiffany Brooks
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia
- Aware Women’s Health Private Clinic, Adelaide, SA 5006, Australia
| | - Sarita Prabhakaran
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Ashley M. Hopkins
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Ben S.-Y. Ung
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Jingying Tang
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Maria C. Caruso
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Robert D. Brooks
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Ian R. D. Johnson
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Alexandra Sorvina
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Shane M. Hickey
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Litsa Karageorgos
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Sonja Klebe
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
- Department of Surgical Pathology, SA Pathology at Flinders Medical Centre, Adelaide, SA 5042, Australia
| | - John J. O’Leary
- Department of Histopathology, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Douglas A. Brooks
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
- Department of Histopathology, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Jessica M. Logan
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
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Nguyen TQ, Schneider G, Kaliappan A, Buscaglia R, Brock GN, Hall MB, Miller DM, Chesney JA, Garbett NC. Plasma Thermogram Parameters Differentiate Status and Overall Survival of Melanoma Patients. Curr Oncol 2023; 30:6079-6096. [PMID: 37504313 PMCID: PMC10378067 DOI: 10.3390/curroncol30070453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Melanoma is the fifth most common cancer in the United States and the deadliest of all skin cancers. Even with recent advancements in treatment, there is still a 13% two-year recurrence rate, with approximately 30% of recurrences being distant metastases. Identifying patients at high risk for recurrence or advanced disease is critical for optimal clinical decision-making. Currently, there is substantial variability in the selection of screening tests and imaging, with most modalities characterized by relatively low accuracy. In the current study, we built upon a preliminary examination of differential scanning calorimetry (DSC) in the melanoma setting to examine its utility for diagnostic and prognostic assessment. Using regression analysis, we found that selected DSC profile (thermogram) parameters were useful for differentiation between melanoma patients and healthy controls, with more complex models distinguishing melanoma patients with no evidence of disease from patients with active disease. Thermogram features contributing to the third principal component (PC3) were useful for differentiation between controls and melanoma patients, and Cox proportional hazards regression analysis indicated that PC3 was useful for predicting the overall survival of active melanoma patients. With the further development and optimization of the classification method, DSC could complement current diagnostic strategies to improve screening, diagnosis, and prognosis of melanoma patients.
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Affiliation(s)
- Taylor Q. Nguyen
- UofL Health–Brown Cancer Center and Division of Medical Oncology and Hematology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Gabriela Schneider
- UofL Health–Brown Cancer Center and Division of Medical Oncology and Hematology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Alagammai Kaliappan
- UofL Health–Brown Cancer Center and Division of Medical Oncology and Hematology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Robert Buscaglia
- Department of Mathematics and Statistics, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Guy N. Brock
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Melissa Barousse Hall
- UofL Health–Brown Cancer Center and Division of Medical Oncology and Hematology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Donald M. Miller
- UofL Health–Brown Cancer Center and Division of Medical Oncology and Hematology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Jason A. Chesney
- UofL Health–Brown Cancer Center and Division of Medical Oncology and Hematology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Nichola C. Garbett
- UofL Health–Brown Cancer Center and Division of Medical Oncology and Hematology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
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11
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Bahmad HF, Oh KS, Alexis J. Potential diagnostic utility of PRAME and p16 immunohistochemistry in melanocytic nevi and malignant melanoma. J Cutan Pathol 2023. [PMID: 37114299 DOI: 10.1111/cup.14438] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND PRAME (PReferentially expressed Antigen in MElanoma) is a tumor-associated antigen that has been studied in various cutaneous melanocytic lesions. p16, on the other hand, has been proposed to aid in distinguishing between benign and malignant melanocytic neoplasms. Studies on the diagnostic utility of PRAME and p16 in combination in differentiating nevi from melanoma are limited. We aimed to assess the diagnostic utility of PRAME and p16 in melanocytic tumors and their role in distinguishing between malignant melanomas and melanocytic nevi. METHODS This is a single-center retrospective cohort analysis over a 4-year period (2017-2020). We used the pathological database of malignant melanomas (77 cases) and melanocytic nevi (51 cases) specimens from patients who underwent shave/punch biopsies or surgical excisions and evaluated immunohistochemical staining percentage positivity and intensity for PRAME and p16. RESULTS Most malignant melanomas showed positive/diffuse PRAME expression (89.6%); on the other hand, 96.1% of nevi did not express PRAME diffusely. p16 was expressed consistently in nevi (98.0%). However, p16 expression in malignant melanoma was infrequent in our study. PRAME had a sensitivity and specificity of 89.6% and 96.1%, respectively, for melanomas versus nevi; on the other hand, p16 had a sensitivity and specificity of 98.0% and 28.6%, respectively, for nevi versus melanoma. Also, a PRAME+/p16- melanocytic lesion is unlikely to be a nevus where most nevi were PRAME-/p16+. CONCLUSION In conclusion, we confirm the potential utility of PRAME and p16 for distinguishing melanocytic nevi from malignant melanomas.
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Affiliation(s)
- Hisham F Bahmad
- The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Kei Shing Oh
- The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - John Alexis
- The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
- Department of Pathology, Herbert Wertheim College of Medicine, Florida International University, Miami Beach, Florida, USA
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12
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Kunc M, Żemierowska N, Skowronek F, Biernat W. Diagnostic test accuracy meta-analysis of PRAME in distinguishing primary cutaneous melanomas from benign melanocytic lesions. Histopathology 2023. [PMID: 36942814 DOI: 10.1111/his.14904] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
PRAME is a novel immunohistochemical marker that aids the diagnosis of melanocytic lesions. Diffuse PRAME positivity suggests melanoma, whereas benign naevi are negative or only weakly positive. However, the factual diagnostic accuracy of PRAME is not well established. Moreover, some studies have suggested that the threshold of 3+/50% positive cells may be more useful in practice than the most widely used cut-off (4+/75% of positive cells). Hence, we performed a systematic review and diagnostic accuracy meta-analysis to evaluate sensitivity, specificity, likelihood ratios and optimal threshold for PRAME in distinguishing benign melanocytic proliferations from melanomas. Twenty-six studies were enrolled into the meta-analysis. A total of 2915 melanocytic lesions were analysed. The optimal threshold for PRAME positivity was estimated at 3.11, which translates into 3+ in practice. Sensitivity and specificity calculated from SROC at the 3+ threshold were 0.735 (0.631-0.818) and 0.915 (0.834-0.958), respectively, compared to 0.679 (0.559-0.957) and 0.957 (0.908-0.981) at the 4+ cut-off. In subgroup analysis, the spitzoid subgroup was characterised by the lowest sensitivity and diagnostic odds ratio of PRAME. Our findings indicate that PRAME immunohistochemistry may serve as an ancillary marker to support the diagnosis of melanoma. Nevertheless, the accuracy of PRAME may be lower in spitzoid neoplasms. Our meta-analysis suggests that the 3+/50% threshold might be more useful in practice than the 4+/75% cut-off, as it shows higher sensitivity with retained satisfactory specificity.
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Affiliation(s)
- Michał Kunc
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk
| | - Natalia Żemierowska
- Student Scientific Circle of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
- University Clinical Hospital in Białystok, Białystok, Poland
| | - Filip Skowronek
- Student Scientific Circle, Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk
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13
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Lam GT, Prabhakaran S, Sorvina A, Martini C, Ung BSY, Karageorgos L, Hickey SM, Lazniewska J, Johnson IRD, Williams DB, Klebe S, Malone V, O'Leary JJ, Jackett L, Brooks DA, Logan JM. Pitfalls in Cutaneous Melanoma Diagnosis and the Need for New Reliable Markers. Mol Diagn Ther 2023; 27:49-60. [PMID: 36477449 DOI: 10.1007/s40291-022-00628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
Cutaneous melanoma is one of the most aggressive forms of skin cancer, with the development of advanced stage disease resulting in a high rate of patient mortality. Accurate diagnosis of melanoma at an early stage is essential to improve patient outcomes, as this enables treatment before the cancer has metastasised. Histopathologic analysis is the current gold standard for melanoma diagnosis, but this can be subjective due to discordance in interpreting the morphological heterogeneity in melanoma and other skin lesions. Immunohistochemistry (IHC) is sometimes employed as an adjunct to conventional histology, but it remains occasionally difficult to distinguish some benign melanocytic lesions and melanoma. Importantly, the complex morphology and lack of specific biomarkers that identify key elements of melanoma pathogenesis can make an accurate confirmation of diagnosis challenging. We review the diagnostic constraints of melanoma heterogeneity and discuss issues with interpreting routine histology and problems with current melanoma markers. Innovative approaches are required to find effective biomarkers to enhance patient management.
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Affiliation(s)
- Giang T Lam
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Sarita Prabhakaran
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia.,Department of Anatomical Pathology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Alexandra Sorvina
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Carmela Martini
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Ben S-Y Ung
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Litsa Karageorgos
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Shane M Hickey
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Joanna Lazniewska
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Ian R D Johnson
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Desmond B Williams
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Sonja Klebe
- Department of Anatomical Pathology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Surgical Pathology, SA Pathology at Flinders Medical Centre, Adelaide, SA, Australia
| | - Victoria Malone
- Department of Pathology, The Coombe Women and Infants University Hospital, Dublin, Ireland
| | - John J O'Leary
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Louise Jackett
- Department of Anatomical Pathology, Austin Health, Melbourne, VIC, Australia
| | - Doug A Brooks
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Jessica M Logan
- Clinical and Health Sciences, University of South Australia, North Terrace, Adelaide, SA, Australia.
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14
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Ricci C, Dika E, Ambrosi F, Lambertini M, Veronesi G, Barbara C. Cutaneous Melanomas: A Single Center Experience on the Usage of Immunohistochemistry Applied for the Diagnosis. Int J Mol Sci 2022; 23:5911. [PMID: 35682589 PMCID: PMC9180684 DOI: 10.3390/ijms23115911] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 12/12/2022] Open
Abstract
Cutaneous melanoma (cM) is the deadliest of all primary skin cancers. Its prognosis is strongly influenced by the stage at diagnosis, with early stages having a good prognosis and being potentially treatable with surgery alone; advanced stages display a much worse prognosis, with a high rate of recurrence and metastasis. For this reason, the accurate and early diagnosis of cM is crucial-misdiagnosis may have extremely dangerous consequences for the patient and drastically reduce their chances of survival. Although the histological exam remains the "gold standard" for the diagnosis of cM, a continuously increasing number of immunohistochemical markers that could help in diagnosis, prognostic characterization, and appropriate therapeutical choices are identified every day, with some of them becoming part of routine practice. This review aims to discuss and summarize all the data related to the immunohistochemical analyses that are potentially useful for the diagnosis of cM, thus rendering it easier to appropriately applicate to routine practice. We will discuss these topics, as well as the role of these molecules in the biology of cM and potential impact on diagnosis and treatment, integrating the literature data with the experience of our surgical pathology department.
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Affiliation(s)
- Costantino Ricci
- Pathology Unit, Ospedale Maggiore, 40139 Bologna, Italy; (C.R.); (F.A.)
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40139 Bologna, Italy;
| | - Emi Dika
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40139 Bologna, Italy;
| | - Francesca Ambrosi
- Pathology Unit, Ospedale Maggiore, 40139 Bologna, Italy; (C.R.); (F.A.)
| | - Martina Lambertini
- Dermatology Unit, IRCCS Policlinico Sant’Orsola-Malpighi, University of Bologna, 40139 Bologna, Italy; (M.L.); (G.V.)
| | - Giulia Veronesi
- Dermatology Unit, IRCCS Policlinico Sant’Orsola-Malpighi, University of Bologna, 40139 Bologna, Italy; (M.L.); (G.V.)
| | - Corti Barbara
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40139 Bologna, Italy
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15
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Tímár J, Ladányi A. Molecular Pathology of Skin Melanoma: Epidemiology, Differential Diagnostics, Prognosis and Therapy Prediction. Int J Mol Sci 2022; 23:5384. [PMID: 35628196 PMCID: PMC9140388 DOI: 10.3390/ijms23105384] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/11/2022] Open
Abstract
Similar to other malignancies, TCGA network efforts identified the detailed genomic picture of skin melanoma, laying down the basis of molecular classification. On the other hand, genome-wide association studies discovered the genetic background of the hereditary melanomas and the susceptibility genes. These genetic studies helped to fine-tune the differential diagnostics of malignant melanocytic lesions, using either FISH tests or the myPath gene expression signature. Although the original genomic studies on skin melanoma were mostly based on primary tumors, data started to accumulate on the genetic diversity of the progressing disease. The prognostication of skin melanoma is still based on staging but can be completed with gene expression analysis (DecisionDx). Meanwhile, this genetic knowledge base of skin melanoma did not turn to the expected wide array of target therapies, except the BRAF inhibitors. The major breakthrough of melanoma therapy was the introduction of immune checkpoint inhibitors, which showed outstanding efficacy in skin melanoma, probably due to their high immunogenicity. Unfortunately, beyond BRAF, KIT mutations and tumor mutation burden, no clinically validated predictive markers exist in melanoma, although several promising biomarkers have been described, such as the expression of immune-related genes or mutations in the IFN-signaling pathway. After the initial success of either target or immunotherapies, sooner or later, relapses occur in the majority of patients, due to various induced genetic alterations, the diagnosis of which could be developed to novel predictive genetic markers.
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Affiliation(s)
- József Tímár
- 2nd Department of Pathology, Semmelweis University, 1191 Budapest, Hungary
| | - Andrea Ladányi
- Department of Surgical and Molecular Pathology and the National Tumor Biology Laboratory, National Institute of Oncology, 1122 Budapest, Hungary;
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16
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Palkina NV, Ruksha TG, Khorzhevskii VA, Sergeeva EY, Fefelova YA. [Gene expression profiling in melanoma diagnostics: problems and future application in clinical practice]. Arkh Patol 2022; 84:64-71. [PMID: 35417951 DOI: 10.17116/patol20228402164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Difficulties in the diagnosis and differential diagnosis of melanoma in the work of a pathologist include not only conflicting structural and morphological features, but also the insufficient effectiveness of biochemical and some molecular markers in immunohistochemical studies. The review presents modern alternative methods for diagnosing malignant tumors based on the assessment of gene expression, the performance, objectivity and reliability of the determination of which may in the future have clinical application as an addition to histopathological methods in the diagnosis and differential diagnosis of various malignant neoplasms, including melanocytic neoplasms, which is changing the paradigm of routine medical practice, introducing diagnostic tests that carry molecular information into it.
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Affiliation(s)
- N V Palkina
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - T G Ruksha
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - V A Khorzhevskii
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - E Yu Sergeeva
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Yu A Fefelova
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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17
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Sturm B, Creytens D, Smits J, Ooms AHAG, Eijken E, Kurpershoek E, Küsters-Vandevelde HVN, Wauters C, Blokx WAM, van der Laak JAWM. Computer-Aided Assessment of Melanocytic Lesions by Means of a Mitosis Algorithm. Diagnostics (Basel) 2022; 12:diagnostics12020436. [PMID: 35204526 PMCID: PMC8871065 DOI: 10.3390/diagnostics12020436] [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: 11/26/2021] [Revised: 12/31/2021] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
An increasing number of pathology laboratories are now fully digitised, using whole slide imaging (WSI) for routine diagnostics. WSI paves the road to use artificial intelligence (AI) that will play an increasing role in computer-aided diagnosis (CAD). In melanocytic skin lesions, the presence of a dermal mitosis may be an important clue for an intermediate or a malignant lesion and may indicate worse prognosis. In this study a mitosis algorithm primarily developed for breast carcinoma is applied to melanocytic skin lesions. This study aimed to assess whether the algorithm could be used in diagnosing melanocytic lesions, and to study the added value in diagnosing melanocytic lesions in a practical setting. WSI’s of a set of hematoxylin and eosin (H&E) stained slides of 99 melanocytic lesions (35 nevi, 4 intermediate melanocytic lesions, and 60 malignant melanomas, including 10 nevoid melanomas), for which a consensus diagnosis was reached by three academic pathologists, were subjected to a mitosis algorithm based on AI. Two academic and six general pathologists specialized in dermatopathology examined the WSI cases two times, first without mitosis annotations and after a washout period of at least 2 months with mitosis annotations based on the algorithm. The algorithm indicated true mitosis in lesional cells, i.e., melanocytes, and non-lesional cells, i.e., mainly keratinocytes and inflammatory cells. A high number of false positive mitosis was indicated as well, comprising melanin pigment, sebaceous glands nuclei, and spindle cell nuclei such as stromal cells and neuroid differentiated melanocytes. All but one pathologist reported more often a dermal mitosis with the mitosis algorithm, which on a regular basis, was incorrectly attributed to mitoses from mainly inflammatory cells. The overall concordance of the pathologists with the consensus diagnosis for all cases excluding nevoid melanoma (n = 89) appeared to be comparable with and without the use of AI (89% vs. 90%). However, the concordance increased by using AI in nevoid melanoma cases (n = 10) (75% vs. 68%). This study showed that in general cases, pathologists perform similarly with the aid of a mitosis algorithm developed primarily for breast cancer. In nevoid melanoma cases, pathologists perform better with the algorithm. From this study, it can be learned that pathologists need to be aware of potential pitfalls using CAD on H&E slides, e.g., misinterpreting dermal mitoses in non-melanotic cells.
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Affiliation(s)
- Bart Sturm
- Department of Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Pathan B.V., 3045 PM Rotterdam, The Netherlands; (J.S.); (A.H.A.G.O.); (E.K.)
| | - David Creytens
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Jan Smits
- Pathan B.V., 3045 PM Rotterdam, The Netherlands; (J.S.); (A.H.A.G.O.); (E.K.)
| | | | - Erik Eijken
- Laboratory for Pathology Oost Nederland (LabPON), 7550 AM Hengelo, The Netherlands;
| | - Eline Kurpershoek
- Pathan B.V., 3045 PM Rotterdam, The Netherlands; (J.S.); (A.H.A.G.O.); (E.K.)
| | | | - Carla Wauters
- Department of Pathology, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands; (H.V.N.K.-V.); (C.W.)
| | - Willeke A. M. Blokx
- Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands;
| | - Jeroen A. W. M. van der Laak
- Department of Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Center for Medical Image Science and Visualization, Linköping University, 581 83 Linköping, Sweden
- Correspondence: ; Tel.: +31-638-814-869
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18
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Saleem A, Narala S, Raghavan SS. Immunohistochemistry in melanocytic lesions: Updates with a practical review for pathologists. Semin Diagn Pathol 2022; 39:239-247. [PMID: 35016807 DOI: 10.1053/j.semdp.2021.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023]
Abstract
This review provides a summary of the immunohistochemical markers pertinent to the diagnosis of melanocytic lesions. There is considerable morphologic overlap between benign and malignant melanocytic lesions, and given the significant differences in clinical management, the diagnostic workup becomes crucial. Immunohistochemistry aids in the distinction between various melanocytic proliferations and recent contributions to the literature have furthered our optimization of panels in the diagnostic workup. In recent years, SOX10 has been considered as the optimal marker for melanocytic lesions given the similar sensitivity but higher specificity than S100. HMB-45 is less sensitive than S100 but demonstrates utility in confirmation of deceptively banal small cell and nevoid melanoma variants where deep nests of melanocytes are highlighted. Melan-A (MART-1) and MiTF show similar sensitivity to S100 however there is a lack of expression in spindle cell and desmoplastic melanomas.
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Affiliation(s)
- Atif Saleem
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Saisindhu Narala
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Shyam S Raghavan
- Department of Pathology, University of Virginia, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA.
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19
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Costa PAC, Silva WN, Prazeres PHDM, Picoli CC, Guardia GDA, Costa AC, Oliveira MA, Guimarães PPG, Gonçalves R, Pinto MCX, Amorim JH, Azevedo VAC, Resende RR, Russo RC, Cunha TM, Galante PAF, Mintz A, Birbrair A. Chemogenetic modulation of sensory neurons reveals their regulating role in melanoma progression. Acta Neuropathol Commun 2021; 9:183. [PMID: 34784974 PMCID: PMC8594104 DOI: 10.1186/s40478-021-01273-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/10/2021] [Indexed: 02/08/2023] Open
Abstract
Sensory neurons have recently emerged as components of the tumor microenvironment. Nevertheless, whether sensory neuronal activity is important for tumor progression remains unknown. Here we used Designer Receptors Exclusively Activated by a Designer Drug (DREADD) technology to inhibit or activate sensory neurons' firing within the melanoma tumor. Melanoma growth and angiogenesis were accelerated following inhibition of sensory neurons' activity and were reduced following overstimulation of these neurons. Sensory neuron-specific overactivation also induced a boost in the immune surveillance by increasing tumor-infiltrating anti-tumor lymphocytes, while reducing immune-suppressor cells. In humans, a retrospective in silico analysis of melanoma biopsies revealed that increased expression of sensory neurons-related genes within melanoma was associated with improved survival. These findings suggest that sensory innervations regulate melanoma progression, indicating that manipulation of sensory neurons' activity may provide a valuable tool to improve melanoma patients' outcomes.
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Affiliation(s)
- Pedro A. C. Costa
- grid.8430.f0000 0001 2181 4888Departamento de Patologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Walison N. Silva
- grid.8430.f0000 0001 2181 4888Departamento de Patologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Pedro H. D. M. Prazeres
- grid.8430.f0000 0001 2181 4888Departamento de Patologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Caroline C. Picoli
- grid.8430.f0000 0001 2181 4888Departamento de Patologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Gabriela D. A. Guardia
- grid.413471.40000 0000 9080 8521Centro de Oncologia Molecular, Hospital Sirio-Libanes, Sao Paulo, SP Brasil
| | - Alinne C. Costa
- grid.8430.f0000 0001 2181 4888Departamento de Patologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Mariana A. Oliveira
- grid.8430.f0000 0001 2181 4888Departamento de Bioquimica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Pedro P. G. Guimarães
- grid.8430.f0000 0001 2181 4888Departamento de Fisiologia e Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Ricardo Gonçalves
- grid.8430.f0000 0001 2181 4888Departamento de Patologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Mauro C. X. Pinto
- grid.411195.90000 0001 2192 5801Departamento de Farmacologia, Universidade Federal de Goiás, Goiânia, GO Brasil
| | - Jaime H. Amorim
- grid.472638.c0000 0004 4685 7608Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, BA Brasil
| | - Vasco A. C. Azevedo
- grid.8430.f0000 0001 2181 4888Departamento de Genetica, Ecologia e Evolucao, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Rodrigo R. Resende
- grid.8430.f0000 0001 2181 4888Departamento de Bioquimica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Remo C. Russo
- grid.8430.f0000 0001 2181 4888Departamento de Fisiologia e Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brasil
| | - Thiago M. Cunha
- grid.11899.380000 0004 1937 0722Departamento de Farmacologia, Universidade de São Paulo, Ribeirão Preto, SP Brasil
| | - Pedro A. F. Galante
- grid.413471.40000 0000 9080 8521Centro de Oncologia Molecular, Hospital Sirio-Libanes, Sao Paulo, SP Brasil
| | - Akiva Mintz
- grid.239585.00000 0001 2285 2675Department of Radiology, Columbia University Medical Center, New York, NY USA
| | - Alexander Birbrair
- Departamento de Patologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. .,Department of Radiology, Columbia University Medical Center, New York, NY, USA.
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20
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Nedelcu R, Dobre A, Brinzea A, Hulea I, Andrei R, Zurac S, Balaban M, Antohe M, Manea L, Calinescu A, Coman A, Pantelimon F, Dobritoiu A, Popescu C, Popescu R, Balasescu E, Ion D, Turcu G. Current Challenges in Deciphering Sutton Nevi-Literature Review and Personal Experience. J Pers Med 2021; 11:jpm11090904. [PMID: 34575681 PMCID: PMC8470687 DOI: 10.3390/jpm11090904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023] Open
Abstract
Halo nevi, known as leukoderma acquisitum centrifugum, Sutton nevus, leukopigmentary nevus, perinevoid vitiligo, or perinevoid leukoderma, together with vitiligo and melanoma-associated hypopigmentation, belong to the group of dermatoses designated as immunological leukodermas. The etiology and pathogenesis of halo nevi has not been fully elucidated. There are several mechanisms through which a lymphocytic infiltrate can induce tumoral regression. In this review, we aimed to update the knowledge about Sutton nevi starting with the clinical appearance and dermoscopic features, continuing with information regarding conventional microscopy, immunohistochemistry, and the immunological mechanisms responsible for the occurrence of halo nevi. We also included in the article original unpublished results when discussing dermoscopic, pathologic and immunohistochemical results in halo nevi. Sutton nevi are valuable models for studying antitumor reactions that the human body can generate. The slow and effective mechanism against a melanocytic skin tumor can teach us important lessons about both autoimmune diseases and anticancer defenses.
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Affiliation(s)
- Roxana Nedelcu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Alexandra Dobre
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Correspondence: ; Tel.: +40-740-853-353
| | - Alice Brinzea
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
- National Institute for Infectious Diseases, Outpatient Clinic, 021105 Bucharest, Romania
| | - Ionela Hulea
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
| | - Razvan Andrei
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
- Synevo Medical Laboratory, 014192 Bucharest, Romania
| | - Sabina Zurac
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Mihaela Balaban
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Mihaela Antohe
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Lorena Manea
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
- Department of Dermatovenerology, Centre Hospitalier Régional D’orléans, 45100 Orléans, France
| | - Andreea Calinescu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Anastasia Coman
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | | | - Adina Dobritoiu
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
| | - Catalin Popescu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Raluca Popescu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Elena Balasescu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
| | - Daniela Ion
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
| | - Gabriela Turcu
- General Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.N.); (A.B.); (I.H.); (S.Z.); (M.A.); (L.M.); (A.C.); (A.C.); (C.P.); (R.P.); (E.B.); (D.I.); (G.T.)
- Derma 360 Clinic, 11273 Bucharest, Romania; (M.B.); (F.P.); (A.D.)
- Department of Pathology and Dermatovenerology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
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21
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Alomari AK, Tharp AW, Umphress B, Kowal RP. The utility of PRAME immunohistochemistry in the evaluation of challenging melanocytic tumors. J Cutan Pathol 2021; 48:1115-1123. [PMID: 33660310 DOI: 10.1111/cup.14000] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND PRAME (PReferentially expressed Antigen in Melanoma) immunohistochemistry has demonstrated high specificity for unequivocal melanomas; however, its utility in ambiguous melanocytic neoplasms has yet to be fully elucidated. METHODS Cases of challenging melanocytic neoplasms were subclassified into one of three categories: challenging, favor benign (FB), challenging, cannot be subclassified (CCS), or challenging, favor malignant (FM). Using a previously published system, whereby cases with diffuse staining (>75%) were considered positive, scoring of PRAME was performed. Additionally, tumors with hotspot staining were also considered positive. RESULTS Sixteen out of 85 tumors showed positive staining representing 5% of FB tumors, 24% of CCS tumors, and 47% of FM. In FB and CCS tumors, positive staining was mainly encountered in atypical intraepidermal melanocytic proliferations and spitzoid neoplasms. The specificity of positive PRAME staining was 95% and its concordance with the final diagnostic interpretation was 75%. CONCLUSIONS PRAME positivity is more common in neoplasms favored to be malignant by histopathologic evaluation. Its clinical utility may include early diagnosis of incipient melanoma in situ. Rarely, benign melanocytic neoplasms could show diffuse expression of PRAME, and additional studies are needed to determine optimal utilization. Lastly, hotspot staining may increase its sensitivity without much compromise in specificity.
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Affiliation(s)
- Ahmed K Alomari
- Department of Pathology, Indiana University, School of Medicine, Indianapolis, Indiana, USA
- Department of Dermatology, Indiana University, School of Medicine, Indianapolis, Indiana, USA
| | - Andrew W Tharp
- Department of Pathology, Indiana University, School of Medicine, Indianapolis, Indiana, USA
| | - Brandon Umphress
- Department of Pathology, Indiana University, School of Medicine, Indianapolis, Indiana, USA
| | - Rachel P Kowal
- Department of Pathology, Indiana University, School of Medicine, Indianapolis, Indiana, USA
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22
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Preferentially Expressed Antigen in Melanoma Immunostaining in a Series of Melanocytic Neoplasms. Am J Dermatopathol 2021; 43:794-800. [PMID: 33989214 DOI: 10.1097/dad.0000000000001885] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In their 2018 article, Lezcano et al [AJSP 2018(11):1456] show that diffuse tumor cell nuclear reactivity for Preferentially expressed Antigen in Melanoma (PRAME) is a feature of melanoma and that benign and atypical melanocytic tumors are PRAME negative or show only focal positivity for PRAME. We report our observations of PRAME staining in 253 melanocytic tumors. Tumors were classified by hematoxylin and eosin sections. The nuclear PRAME staining of neoplastic melanocytes in each case was categorized as absent, focally present, or diffusely present. The results were compared with those of Lezcano et al 105 of 134 (78%) melanocytic nevi were completely PRAME negative. Of the 29 PRAME-positive benign lesions, 28 exhibited focal but not diffuse positivity, including atypical (n = 11) and dysplastic nevi (n = 11). One of 11 Spitz nevi showed diffuse positivity (9%). Thirty-nine of 51 (76%) invasive melanomas, 41 of 50 (82%) melanoma in situ, and 15 of 18 (83%) metastatic melanomas were diffusely PRAME positive. Excluding desmoplastic melanomas, 39 of 49 (80%) primary melanomas were diffusely PRAME positive. Our findings of PRAME staining in melanocytic neoplasia are in general agreement with those of Lezcano et al. Diffuse PRAME reactivity in neoplastic melanocytes is a feature of malignancy and was only otherwise seen in 1 Spitz nevus. Caution is advised in interpretation of PRAME reactivity in melanocytic tumors of uncertain classification because melanoma arising in association with nevus and some atypical melanocytic tumors may show focal or incomplete PRAME staining. Routine histopathological findings, clinical information, PRAME staining, and judicious application of molecular studies are steps leading to accurate classification of melanocytic neoplasia.
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23
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Deacon DC, Smith EA, Judson-Torres RL. Molecular Biomarkers for Melanoma Screening, Diagnosis and Prognosis: Current State and Future Prospects. Front Med (Lausanne) 2021; 8:642380. [PMID: 33937286 PMCID: PMC8085270 DOI: 10.3389/fmed.2021.642380] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/17/2021] [Indexed: 12/22/2022] Open
Abstract
Despite significant progress in the development of treatment options, melanoma remains a leading cause of death due to skin cancer. Advances in our understanding of the genetic, transcriptomic, and morphologic spectrum of benign and malignant melanocytic neoplasia have enabled the field to propose biomarkers with potential diagnostic, prognostic, and predictive value. While these proposed biomarkers have the potential to improve clinical decision making at multiple critical intervention points, most remain unvalidated. Clinical validation of even the most commonly assessed biomarkers will require substantial resources, including limited clinical specimens. It is therefore important to consider the properties that constitute a relevant and clinically-useful biomarker-based test prior to engaging in large validation studies. In this review article we adapt an established framework for determining minimally-useful biomarker test characteristics, and apply this framework to a discussion of currently used and proposed biomarkers designed to aid melanoma detection, staging, prognosis, and choice of treatment.
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Affiliation(s)
- Dekker C. Deacon
- Department of Dermatology, University of Utah, Salt Lake City, UT, United States
| | - Eric A. Smith
- Department of Pathology, University of Utah, Salt Lake City, UT, United States
| | - Robert L. Judson-Torres
- Department of Dermatology, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, Salt Lake City, UT, United States
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24
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Ruby KN, Li Z, Yan S. Aberrant expression of HMB45 and negative PRAME expression in halo nevi. J Cutan Pathol 2021; 48:519-525. [PMID: 33184871 DOI: 10.1111/cup.13916] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/13/2020] [Accepted: 11/04/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Traditionally, most cutaneous nevi show a gradient of HMB45 (human melanoma black 45) and negative PRAME (preferentially expressed antigen in melanoma) immunostaining, while melanomas often show irregularly positive, diffusely positive or completely negative HMB45 expression, and PRAME immunopositivity. However, we have occasionally observed benign halo nevi with loss of HMB45 gradient, raising diagnostic consideration for melanoma. The purpose of this study was to elucidate the expression pattern of HMB45 and PRAME in nevi with the halo phenomenon (NHP). METHODS PRAME and HMB45 staining patterns in 20 cases of NHP and 16 cases of conventional nevi were evaluated using light microscopy. An HMB45 gradient was defined as immunopositivity in only superficial melanocytes. HMB45 aberrant expression consisted of superficial and deep immunopositivity. RESULTS Aberrant HMB45 expression was observed in 10 of 20 NHP (50%). A gradient of HMB45 staining was seen in most conventional nevi, with only one showing focal weak expression in the deep dermis (6.3%). All cases of NHP and conventional nevi showed essentially negative immunostaining by PRAME. CONCLUSION Aberrant HMB45 expression in NHP is not uncommon and may be a diagnostic pitfall. Negative PRAME immunostaining may be a reassuring finding to help differentiate halo nevus from malignant melanoma.
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Affiliation(s)
- Kristen N Ruby
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Zhongze Li
- Biomedical Data Science Department, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Shaofeng Yan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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25
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Ronchi A, Pagliuca F, Zito Marino F, Argenziano G, Brancaccio G, Alfano R, Signoriello G, Moscarella E, Franco R. Second Diagnostic Opinion by Experienced Dermatopathologists in the Setting of a Referral Regional Melanoma Unit Significantly Improves the Clinical Management of Patients With Cutaneous Melanoma. Front Med (Lausanne) 2021; 7:568946. [PMID: 33614670 PMCID: PMC7890120 DOI: 10.3389/fmed.2020.568946] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/21/2020] [Indexed: 01/22/2023] Open
Abstract
The diagnosis of cutaneous melanoma and melanocytic neoplasms in general is one of the most challenging fields in pathology, and the reported interobserver diagnostic agreement in the evaluation of melanocytic lesions is poor. Nevertheless, a correct histopathological diagnosis is crucial to ensure a good clinical management of the patients. The institution of multidisciplinary teams has recently modified the approach to the patients with cutaneous melanoma. Patients referred to a multidisciplinary melanoma unit after receiving a diagnosis of melanoma elsewhere are encouraged to have their histopathological diagnosis confirmed by a second opinion from the experienced pathologist of the team before any treatment is initiated. We performed a retrospective analysis on a series of 121 histopathological revisions required for melanocytic neoplasms in the context of a multidisciplinary team, in order to evaluate the effects of second diagnostic opinion (SDO) on the clinical management of the patients. We defined three types of diagnostic discrepancies between the first diagnosis and the second opinion, according to the greatness of their clinical impact. Overall, the incidence of diagnostic discrepancies of any type was quite high in our series (56%). Interestingly, the SDO determined relevant changes in the clinical management of the patients in 33 out of 121 (27.3%) cases. This study confirms that SDO by expert pathologists significantly affects the course of treatment of melanoma patients and helps improving the diagnostic accuracy and clinical outcome.
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Affiliation(s)
- Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Francesca Pagliuca
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Gabriella Brancaccio
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Roberto Alfano
- Department of Anaesthesiology, Surgery and Emergency, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Giuseppe Signoriello
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Elvira Moscarella
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
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26
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Na K, Kim M, Kim CY, Lim JS, Cho JY, Shin H, Lee HJ, Kang BJ, Han DH, Kim H, Baik JH, Swiatek-de Lange M, Karl J, Paik YK. Potential Regulatory Role of Human-Carboxylesterase-1 Glycosylation in Liver Cancer Cell Growth. J Proteome Res 2020; 19:4867-4883. [PMID: 33206527 DOI: 10.1021/acs.jproteome.0c00787] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We previously reported that human carboxylesterase 1 (CES1), a serine esterase containing a unique N-linked glycosyl group at Asn79 (N79 CES1), is a candidate serological marker of hepatocellular carcinoma (HCC). CES1 is normally present at low-to-undetectable levels in normal human plasma, HCC tumors, and major liver cancer cell lines. To investigate the potential mechanism underlying the suppression of CES1 expression in liver cancer cells, we took advantage of the low detectability of this marker in tumors by overexpressing CES1 in multiple HCC cell lines, including stable Hep3B cells. We found that the population of CES1-overexpressing (OE) cells decreased and that their doubling time was longer compared with mock control liver cancer cells. Using interactive transcriptome, proteome, and subsequent Gene Ontology enrichment analysis of CES1-OE cells, we found substantial decreases in the expression levels of genes involved in cell cycle regulation and proliferation. This antiproliferative function of the N79 glycan of CES1 was further supported by quantitative real-time polymerase chain reaction, flow cytometry, and an apoptosis protein array assay. An analysis of the levels of key signaling target proteins via Western blotting suggested that CES1 overexpression exerted an antiproliferative effect via the PKD1/PKCμ signaling pathway. Similar results were also seen in another HCC cell line (PLC/RFP/5) after transient transfection with CES1 but not in similarly treated non-HCC cell lines (e.g., HeLa and Tera-1 cells), suggesting that CES1 likely exerts a liver cell-type-specific suppressive effect. Given that the N-linked glycosyl group at Asn79 (N79 glycan) of CES1 is known to influence CES1 enzyme activity, we hypothesized that the post-translational modification of CES1 at N79 may be linked to its antiproliferative activity. To investigate the regulatory effect of the N79 glycan on cellular growth, we mutated the single N-glycosylation site in CES1 from Asn to Gln (CES1-N79Q) via site-directed mutagenesis. Fluorescence 2-D difference gel electrophoresis protein expression analysis of cell lysates revealed an increase in cell growth and a decrease in doubling time in cells carrying the N79Q mutation. Thus our results suggest that CES1 exerts an antiproliferative effect in liver cancer cells and that the single N-linked glycosylation at Asn79 plays a potential regulatory role. These functions may underlie the undetectability of CES1 in human HCC tumors and liver cancer cell lines. Mass spectrometry data are available via ProteomeXchange under the identifier PXD021573.
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Affiliation(s)
- Keun Na
- Yonsei Proteome Research Center, Yonsei University, 50 Yonsei-ro, Seodaemoon-ku, Seoul 03722, South Korea
| | - Minjoo Kim
- Yonsei Proteome Research Center, Yonsei University, 50 Yonsei-ro, Seodaemoon-ku, Seoul 03722, South Korea
| | - Chae-Yeon Kim
- Yonsei Proteome Research Center, Yonsei University, 50 Yonsei-ro, Seodaemoon-ku, Seoul 03722, South Korea
| | - Jong-Sun Lim
- Yonsei Proteome Research Center, Yonsei University, 50 Yonsei-ro, Seodaemoon-ku, Seoul 03722, South Korea
| | - Jin-Young Cho
- Yonsei Proteome Research Center, Yonsei University, 50 Yonsei-ro, Seodaemoon-ku, Seoul 03722, South Korea
| | - Heon Shin
- Yonsei Proteome Research Center, Yonsei University, 50 Yonsei-ro, Seodaemoon-ku, Seoul 03722, South Korea
| | - Hyo Jin Lee
- Department of Life Sciences, Korea University, 145 Anamro, Seongbuk-ku, Seoul 02841, South Korea
| | - Byeong Jun Kang
- Department of Life Sciences, Korea University, 145 Anamro, Seongbuk-ku, Seoul 02841, South Korea
| | | | | | - Ja-Hyun Baik
- Department of Life Sciences, Korea University, 145 Anamro, Seongbuk-ku, Seoul 02841, South Korea
| | | | - Johann Karl
- Roche Diagnostics, GmbH, Nonnenwald 2, 82377 Penzberg, Germany
| | - Young-Ki Paik
- Yonsei Proteome Research Center, Yonsei University, 50 Yonsei-ro, Seodaemoon-ku, Seoul 03722, South Korea
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27
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Lin YY, Lin LY, Hang JF, Lin CH, Ho HL, Chou TY. Programmed death-ligand 1 (PD-L1)/thyroid transcription factor-1 double immunohistochemical staining facilitates scoring of tumor PD-L1 expression in cytopathology specimens from lung adenocarcinoma patients. Cancer Cytopathol 2020; 129:148-155. [PMID: 32976705 DOI: 10.1002/cncy.22359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Immune checkpoint inhibitor therapy has revolutionized lung adenocarcinoma therapy. Treatment with antibodies against the immune checkpoint molecules programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) can induce a durable response in a subset of patients. Immunohistochemistry characterization of tumor PD-L1 expression using either a histopathology specimen or a cytopathology specimen has been shown to correlate with treatment response. However, the current practice relies on pathologists' visual estimation of tumor PD-L1 staining, which can be variable in certain conditions. Highlighting tumor cells via double immunostaining with PD-L1 and thyroid transcription factor-1 (TTF-1) may improve estimation accuracy. METHODS We performed PD-L1 single staining and PD-L1/TTF-1 double staining in 42 pairs of cytopathology and histopathology specimens from lung adenocarcinoma patients. An experienced pathologist visually estimated PD-L1 expression in each case and placed tumor PD-L1 expression into 1 of 3 categories: <1%, 1%-49%, or ≥50%. A medical technologist also performed estimations of the same cases based on a count of 200 tumor cells, and the results were compared. RESULTS PD-L1/TTF-1 double immunohistochemistry could better identify the PD-L1-positive tumor cells in cytopathology specimens compared with PD-L1 single staining. The concordance of PD-L1 expression categorization between the pathologist's visual estimation and the medical technologist's counting was increased by double staining in cytopathology specimens (Cohen's weighted kappa: single stain, 0.784; double stain, 0.880). Double staining reduced possible error in the pathologist's visual estimation of PD-L1 expression from 9.5% to 4.8%. The benefit was not observed in histopathology specimens. CONCLUSION A simple PD-L1/TTF-1 double immunohistochemistry technique can be applied successfully to cytopathology specimens in better identifying patients who can potentially benefit from immune checkpoint blockade treatment.
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Affiliation(s)
- Yen-Yu Lin
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cancer Progression Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Li-Ya Lin
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Hung Lin
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiang-Ling Ho
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Teh-Ying Chou
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cancer Progression Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
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28
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May CJ, Piepkorn MW, Knezevich SR, Elder DE, Barnhill RL, Lee AC, Flores MJ, Kerr KF, Reisch LM, Elmore JG. Factors associated with use of immunohistochemical markers in the histopathological diagnosis of cutaneous melanocytic lesions. J Cutan Pathol 2020; 47:896-902. [PMID: 32383301 DOI: 10.1111/cup.13736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 04/06/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Melanocytic tumors are often challenging and constitute almost one in four skin biopsies. Immunohistochemical (IHC) studies may assist diagnosis; however, indications for their use are not standardized. METHODS A test set of 240 skin biopsies of melanocytic tumors was examined by 187 pathologists from 10 US states, interpreting 48 cases in Phase I and either 36 or 48 cases in Phase II. Participant and diagnosis characteristics were compared between those who reported they would have ordered, or who would have not ordered IHC on individual cases. Intraobserver analysis examined consistency in the intent to order when pathologists interpreted the same cases on two occasions. RESULTS Of 187 participants interpreting 48 cases each, 21 (11%) did not request IHC tests for any case, 85 (45%) requested testing for 1 to 6 cases, and 81 (43%) requested testing for ≥6 cases. Of 240 cases, 229 had at least one participant requesting testing. Only 2 out of 240 cases had more than 50% of participants requesting testing. Increased utilization of testing was associated with younger age of pathologist, board-certification in dermatopathology, low confidence in diagnosis, and lesions in intermediate MPATH-Dx classes 2 to 4. The median intraobserver concordance for requesting tests among 72 participants interpreting the same 48 cases in Phases I and II was 81% (IQR 73%-90%) and the median Kappa statistic was 0.20 (IQR 0.00, 0.39). CONCLUSION Substantial variability exists among pathologists in utilizing IHC.
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Affiliation(s)
- Caitlin J May
- Dermatopathology Northwest, Bellevue, Washington, USA.,Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael W Piepkorn
- Dermatopathology Northwest, Bellevue, Washington, USA.,Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond L Barnhill
- Department of Translational Research Institut Curie, Paris Sciences and Lettres Research University; Faculty of Medicine, University of Paris Descartes, Paris, France
| | - Annie C Lee
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Kathleen F Kerr
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Lisa M Reisch
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Joann G Elmore
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA.,Division of Dermatology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
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Sun X, Wang X, Yu D, Wang Y, Bi L, Xie D. Primary Female Urethral Malignant Melanoma: A Case Report. Urology 2020; 142:e8-e10. [PMID: 32422157 DOI: 10.1016/j.urology.2020.04.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Xin Sun
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
| | - Xin Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
| | - DeXin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China.
| | - Yi Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
| | - LiangKuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
| | - DongDong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui 230032, PR China
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30
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Utility of p16-Ki-67-HMB45 score in sorting benign from malignant Spitz tumors. Pathol Res Pract 2019; 215:152550. [DOI: 10.1016/j.prp.2019.152550] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/14/2019] [Accepted: 07/20/2019] [Indexed: 01/27/2023]
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Abstract
Melanoma is the deadliest form of skin cancer. In the early stages, melanoma can be treated successfully with surgery alone and survival rates are high, but after metastasis survival rates drop significantly. Therefore, early and correct diagnosis is key for ensuring patients have the best possible prognosis. Melanoma misdiagnosis accounts for more pathology and dermatology malpractice claims than any cancer other than breast cancer, as an early misdiagnosis can significantly reduce a patient’s chances of survival. As far as treatment for metastatic melanoma goes, there have been several new drugs developed over the last 10 years that have greatly improved the prognosis of patients with metastatic melanoma, however, a majority of patients do not show a lasting response to these treatments. Thus, new biomarkers and drug targets are needed to improve the accuracy of melanoma diagnosis and treatment. This article will discuss the major advancements of melanoma diagnosis and treatment from antiquity to the present day.
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Affiliation(s)
- Lauren E Davis
- University of Arkansas for Medical Sciences, Department of Biochemistry and Molecular Biology , Little Rock , AR , USA
| | - Sara C Shalin
- University of Arkansas for Medical Sciences, Department of Pathology , Little Rock , AR , USA
| | - Alan J Tackett
- University of Arkansas for Medical Sciences, Department of Biochemistry and Molecular Biology , Little Rock , AR , USA
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32
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Observational Study Examining the Diagnostic Practice of Ki67 Staining for Melanocytic Lesions. Am J Dermatopathol 2019; 41:488-491. [DOI: 10.1097/dad.0000000000001379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Dedifferentiated Melanoma With Expression of Cytokeratin and GATA3 in a Patient With History of Breast Carcinoma. Am J Dermatopathol 2019; 41:502-504. [DOI: 10.1097/dad.0000000000001322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Xie S, Jiang Z. Primary spinal cord melanocytoma: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:669-673. [PMID: 31933873 PMCID: PMC6945073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/22/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Primary spinal cord melanocytoma is an extremely rare condition and the pathogenesis of melanocytomas remains unclear. The diagnosis and treatment of primary spinal cord melanocytomas does not have a standard method. CASE PRESENTATION We present a case of a 73-year-old male who presented with a six-month history of progressive numbness and weakness in his lower extremities without gatism. Spinal magnetic resonance image (MRI) revealed a spinal cord tumor at the level of T10-T11. At surgery, the spinal cord was covered with black-brown neoplastic tissue. There were no metastatic lesions. At one year after surgery, the patient is still alive. CONCLUSIONS The diagnosis of melanocytoma needs to take a comprehensive consideration and surgical resection is still the best treatment.
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Affiliation(s)
- Shan Xie
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College Bengbu, Anhui, China
| | - Zhiquan Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College Bengbu, Anhui, China
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35
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Sivaraju L, Ghosal N, Mahadevan A, Uday Krishna AS, Rao S, Hegde AS. Aggressive Primary Pediatric Intracranial Malignant Melanoma: Sphinx of the Tissue Diagnosis. Asian J Neurosurg 2019; 14:275-279. [PMID: 30937053 PMCID: PMC6417341 DOI: 10.4103/ajns.ajns_253_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
It is often intriguing to suspect and confirm the diagnosis of primary malignant melanoma (PMM) in the brain without any evidence of neurocutaneous melanosis. We report a 16-year-old male patient with malignant melanoma which intraoperatively was small sized, soft, fleshy, hemorrhagic in appearance resembling hematoma. Interestingly, the histopathology showed prominent papillary architecture with a differential diagnosis of papillary meningioma and ependymoma and perplexed the tissue diagnosis. This case is discussed in light of very uncommon occurrence of intracranial PMM in pediatric age group, enigmatic histological features, and aggressive nature of lesion with rapid progression despite complete excision following radiation therapy.
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Affiliation(s)
- Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Nandita Ghosal
- Department of Pathology and Transfusion Medicine, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - A S Uday Krishna
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Hillen LM, Van den Oord J, Geybels MS, Becker JC, Zur Hausen A, Winnepenninckx V. Genomic Landscape of Spitzoid Neoplasms Impacting Patient Management. Front Med (Lausanne) 2018; 5:344. [PMID: 30619857 PMCID: PMC6300473 DOI: 10.3389/fmed.2018.00344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/23/2018] [Indexed: 12/27/2022] Open
Abstract
Spitzoid neoplasms are a distinct group of melanocytic proliferations characterized by epithelioid and/ or spindle shaped melanocytes. Intermediate forms that share features of both benign Spitz nevi (SN) and Spitz melanoma, i.e., malignant Spitz tumor (MST) represent a diagnostically and clinically challenging group of melanocytic lesions. A multitude of descriptive diagnostic terms exist for these ambiguous lesions with atypical Spitz tumor (AST) or Spitz tumor of uncertain malignant potential (STUMP) just naming two of them. This diagnostic gray zone creates confusion and high insecurity in clinicians and in patients. Biological behavior and clinical course of this intermediate group still remains largely unknown, often leading to difficulties with uncertainties in clinical management and prognosis. Consequently, a better stratification of Spitzoid neoplasms in benign and malignant forms is required thereby keeping the diagnostic group of AST/STUMP as small as possible. Ancillary diagnostic techniques such as immunohistochemistry, comparative genomic hybridization, fluorescence in situ hybridization, next generation sequencing, micro RNA and mRNA analysis as well as mass spectrometry imaging offer new opportunities for the distinct diagnosis, thereby allowing the best clinical management of Spitzoid neoplasms. This review gives an overview on these additional diagnostic techniques and the recent developments in the field of molecular genetic alterations in Spitzoid neoplasms. We also discuss how the recent findings might facilitate the diagnosis and stratification of atypical Spitzoid neoplasms and how these findings will impact the diagnostic work up as well as patient management. We suggest a stepwise implementation of ancillary diagnostic techniques thereby integrating immunohistochemistry and molecular pathology findings in the diagnosis of challenging ambiguous Spitzoid neoplasms. Finally, we will give an outlook on pending future research objectives in the field of Spitzoid melanocytic lesions.
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Affiliation(s)
- Lisa M Hillen
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Joost Van den Oord
- Laboratory for Translational Cell and Tissue Research, Department of Pathology, KU Leuven, Leuven, Belgium
| | - Milan S Geybels
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Jürgen C Becker
- Institute for Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner Site Essen, University Hospital Essen, Essen, Germany
| | - Axel Zur Hausen
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Véronique Winnepenninckx
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
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37
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Conway K, Edmiston SN, Parker JS, Kuan PF, Tsai YH, Groben PA, Zedek DC, Scott GA, Parrish EA, Hao H, Pearlstein MV, Frank JS, Carson CC, Wilkerson MD, Zhao X, Slater NA, Moschos SJ, Ollila DW, Thomas NE. Identification of a Robust Methylation Classifier for Cutaneous Melanoma Diagnosis. J Invest Dermatol 2018; 139:1349-1361. [PMID: 30529013 DOI: 10.1016/j.jid.2018.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022]
Abstract
Early diagnosis improves melanoma survival, yet the histopathological diagnosis of cutaneous primary melanoma can be challenging, even for expert dermatopathologists. Analysis of epigenetic alterations, such as DNA methylation, that occur in melanoma can aid in its early diagnosis. Using a genome-wide methylation screening, we assessed CpG methylation in a diverse set of 89 primary invasive melanomas, 73 nevi, and 41 melanocytic proliferations of uncertain malignant potential, classified based on interobserver review by dermatopathologists. Melanomas and nevi were split into training and validation sets. Predictive modeling in the training set using ElasticNet identified a 40-CpG classifier distinguishing 60 melanomas from 48 nevi. High diagnostic accuracy (area under the receiver operator characteristic curve = 0.996, sensitivity = 96.6%, and specificity = 100.0%) was independently confirmed in the validation set (29 melanomas, 25 nevi) and other published sample sets. The 40-CpG melanoma classifier included homeobox transcription factors and genes with roles in stem cell pluripotency or the nervous system. Application of the 40-CpG melanoma classifier to the diagnostically uncertain samples assigned melanoma or nevus status, potentially offering a diagnostic tool to assist dermatopathologists. In summary, the robust, accurate 40-CpG melanoma classifier offers a promising assay for improving primary melanoma diagnosis.
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Affiliation(s)
- Kathleen Conway
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Department of Dermatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA; Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Sharon N Edmiston
- Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joel S Parker
- Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Pei Fen Kuan
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, USA
| | - Yi-Hsuan Tsai
- Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Pamela A Groben
- Department of Dermatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA; Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daniel C Zedek
- Department of Dermatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA; Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Glynis A Scott
- Department of Dermatology, University of Rochester School of Medicine, Rochester, New York, USA; Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine, Rochester, New York, USA
| | - Eloise A Parrish
- Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Honglin Hao
- Department of Dermatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michelle V Pearlstein
- Department of Dermatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jill S Frank
- Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Craig C Carson
- Department of Dermatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew D Wilkerson
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Xiaobei Zhao
- Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nathaniel A Slater
- Department of Dermatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stergios J Moschos
- Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David W Ollila
- Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nancy E Thomas
- Department of Dermatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA; Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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38
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Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson TM, Sober AJ, Thompson JA, Wisco OJ, Wyatt S, Hu S, Lamina T. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2018; 80:208-250. [PMID: 30392755 DOI: 10.1016/j.jaad.2018.08.055] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.
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Affiliation(s)
- Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona
| | - David E Elder
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
| | - Allan C Halpern
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John A Thompson
- Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Oliver J Wisco
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Shasa Hu
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Toyin Lamina
- American Academy of Dermatology, Rosemont, Illinois
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Proliferative Melanocytic Nodule on Small Congenital Nevus During Treatment With Etanercept. Am J Dermatopathol 2018; 40:871-872. [DOI: 10.1097/dad.0000000000001024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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A Diagnostic Algorithm Combining Immunohistochemistry and Molecular Cytogenetics to Diagnose Challenging Melanocytic Tumors. Appl Immunohistochem Mol Morphol 2018; 26:714-720. [DOI: 10.1097/pai.0000000000000511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Another Point of View About Cyclin D1 and p16 Expression in Blue Nevi and Malignant Melanomas. Appl Immunohistochem Mol Morphol 2018; 25:e70-e71. [PMID: 27490765 DOI: 10.1097/pai.0000000000000431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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42
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Abstract
The p16 gene belongs to INK4 family of genes and is made up of four members: p16 INK4A , p15 INK4B , p18 INK4C and p19 INK4D , all of which share biological properties, namely, inhibition of cell growth and tumour suppression. After p53, p16 is the second most common tumour suppressor gene. It has been regarded as the familial melanoma gene. Immunohistochemistry for p16 has a well-defined role in distinct pathological scenarios. It is used to distinguish desmoplastic melanoma from reactive fibrous proliferation, with former showing strong nuclear positivity. In other types of melanoma, p16 protein expression is lost. Spitz nevi show retention of nuclear staining for p16. Benign mesothelial proliferations tend to retain nuclear p16 immunoreactivity, while malignant mesotheliomas lose expression. However, p16 fluorescent in-situ hybridisation analysis is recommended in the workup of malignant mesothelioma. Another common application of p16 immunohistochemistry is as an indicator for human papillomavirus (HPV) infection and p16 protein is overexpressed in HPV-associated tumours. In this context, p16 immunopositivity should be strong, diffuse, nuclear or nuclear and cytoplasmic in location. Another use for p16 is demonstration of p16 immunopositivity in well-differentiated and dedifferentiated liposarcoma.
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Affiliation(s)
- Stefano Serra
- Department of Anatomical Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Runjan Chetty
- Department of Anatomical Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
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43
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The p16-Ki-67-HMB45 Immunohistochemistry Scoring System is Highly Concordant With the Fluorescent In Situ Hybridization Test to Differentiate Between Melanocytic Nevi and Melanomas. Appl Immunohistochem Mol Morphol 2018; 26:361-367. [DOI: 10.1097/pai.0000000000000428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Liang G, Liu M, Wang Q, Shen Y, Mei H, Li D, Liu W. Itraconazole exerts its anti-melanoma effect by suppressing Hedgehog, Wnt, and PI3K/mTOR signaling pathways. Oncotarget 2018; 8:28510-28525. [PMID: 28212537 PMCID: PMC5438669 DOI: 10.18632/oncotarget.15324] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 01/06/2017] [Indexed: 02/05/2023] Open
Abstract
Malignant melanoma is the deadliest form of all skin cancers. Itraconazole, a commonly used systemic antifungal drug, has been tested for its anti-tumor effects on basal cell carcinoma, prostate cancer, and non-small cell lung cancer. Whether itraconazole has any specific anti-tumor effect on melanoma remains unknown. However, the goal of this study is to investigate the effect of itraconazole on melanoma and to reveal some details of its underlying mechanism. In the in vivo xenograft mouse model, we find that itraconazole can inhibit melanoma growth and extend the survival of melanoma xenograft mice, compared to non-itraconazole-treated mice. Also, itraconazole can significantly inhibit cell proliferation, as demonstrated by Ki-67 staining in itraconazole-treated tumor tissues. In in vitro, we show that itraconazole inhibits the proliferation and colony formation of both SK-MEL-28 and A375 human melanoma cells. Moreover, we demonstrate that itraconazole significantly down-regulates Gli-1, Gli-2, Wnt3A, β-catenin and cyclin D1, while it up-regulates Gli-3 and Axin-1, indicating potent inhibitory effects of itraconazole on Hedgehog (Hh) and Wnt signaling pathways. Furthermore, itraconazole significantly suppresses the PI3K/mTOR signaling pathway – indicated by the down-regulated phosphorylation of p70S6K, 4E-BP1 and AKT – but has no effect on the phosphorylation of MEK or ERK. Our data suggest that itraconazole inhibits melanoma growth through an interacting regulatory network that includes Hh, Wnt, and PI3K/mTOR signaling pathways. These results suggest that this agent has several potent anti-melanoma features and may be useful in the synergesis of other anti-cancer drugs via blockage of the Hh, Wnt and PI3K/mTOR signaling pathways.
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Affiliation(s)
- Guanzhao Liang
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Musang Liu
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Qiong Wang
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yongnian Shen
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Huan Mei
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Dongmei Li
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.,Georgetown University Medical Center, Washington, DC, USA
| | - Weida Liu
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
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Abstract
The acquired melanocytic nevus is the most common lesion encountered by pediatric pathologists and dermatopathologists in their daily practice. In most cases, there are few difficulties in histopathologic diagnosis. However, it is the acquired melanocytic lesion known as the Spitz nevus, with its intrinsic atypical features which becomes the challenge since it exists along a histopathologic and biologic continuum from the atypical Spitz tumor to spitzoid melanoma. The frustration with some of these spitzoid lesions is that even the "experts" cannot agree as to the differentiation of one from the other even at the level of molecular genetics. Other melanocytic lesions are discussed including the congenital melanocytic nevus with its proliferative nodule(s) and melanoma as the ultimate complication. Although uncommon, cutaneous melanoma in the first 2 decades is emerging as a clinical problem especially in young women in the second decade of life. These are ultraviolet-associated neoplasms whose histopathologic and prognostic features are identical to the adult experience. Considerable progress has been made over the past 15 to 20 years in our understanding of cutaneous melanocytic lesions, but gaps still exist in the important group of spitzoid lesions. It can also be anticipated that more cutaneous melanomas in children will be seen in the future based upon epidemiologic studies.
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Affiliation(s)
- Chen Yang
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 2 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri
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46
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Reevaluation of established and new criteria in differential diagnosis of Spitz nevus and melanoma. Arch Dermatol Res 2018; 310:329-342. [DOI: 10.1007/s00403-018-1818-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/24/2017] [Accepted: 01/23/2018] [Indexed: 12/24/2022]
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Munhoz de Paula Alves Coelho K, Stall J, Fronza Júnior H, Blasius R, de França PHC. Evaluation of expression of genes CADM1, TWIST1 and CDH1 by immunohistochemestry in melanocytic lesions. Pathol Res Pract 2017; 213:1067-1071. [PMID: 28843749 DOI: 10.1016/j.prp.2017.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/05/2017] [Accepted: 07/28/2017] [Indexed: 01/23/2023]
Abstract
AIM Malignant melanoma is an aggressive disease and its incidence is increasing worldwide. Genetic predisposition and exposure to environmental factors, especially sunlight, are risk factors. Histopathologic distinction between nevi and melanomas can be difficult. It is anticipated that the evaluation of the immunohistochemical expression of some genes could contribute to the differential diagnosis of questionable histologically lesions. The objective of this study was to investigate wether the evaluation of the immunohistochemical expression of genes CADM1, TWIST1 and CDH1 (E-cadherin), that take part in mechanisms of cell adhesion and epithelial-mesenchymal transition, contributes to the differential diagnosis of melanocytic lesions difficult to diagnose. MATERIALS AND METHODS Retrospective cross-sectional study based on immunohistochemistry analysis of samples of 30 dysplastic compound melanocytic nevi, 30 melanomas less than 1.0mm thick and 30 melanomas more than 1.0mm thick, diagnosed between 2013 and 2016. A score was used to evaluate color intensity and percentage of cells stained. RESULT There were significant reductions in the expression of the genes CADM1 and CDH1 in melanomas (below and above 1.00mm of thickness) and in melanomas more than 1.0mm thick, respectively, compared to dysplastic compund melanocytic nevi. There was also lower expression of the genes CADM1 and CDH1 in melanomas greater than 1.0mm thick compared to melanomas less than 1.0mm. The gene TWIST1 showed no significant difference in expression between groups. CONCLUSION These findings allow us to conclude that the immunohistochemical expression of CADM1 has the potential to contribute as an auxiliary tool to the differential diagnosis between nevi and melanomas.
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Affiliation(s)
- Karina Munhoz de Paula Alves Coelho
- Universidade da Região de Joinville - UNIVILLE, Paulo Malschitzki St, 10, 89219-710, Joinville, Santa Catarina, Brazil; Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Mario Lobo St, 61, 89201-330, Joinville, Santa Catarina, Brazil.
| | - Jaqueline Stall
- Universidade da Região de Joinville - UNIVILLE, Paulo Malschitzki St, 10, 89219-710, Joinville, Santa Catarina, Brazil; Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Mario Lobo St, 61, 89201-330, Joinville, Santa Catarina, Brazil
| | - Hercílio Fronza Júnior
- Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Mario Lobo St, 61, 89201-330, Joinville, Santa Catarina, Brazil
| | - Rodrigo Blasius
- Centro de Diagnósticos Anátomo-Patológicos - CEDAP, Mario Lobo St, 61, 89201-330, Joinville, Santa Catarina, Brazil
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48
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Bai G, Chu J, Eli M, Bao Y, Wen H. PAQR3 overexpression suppresses the aggressive phenotype of esophageal squamous cell carcinoma cells via inhibition of ERK signaling. Biomed Pharmacother 2017; 94:813-819. [PMID: 28802234 DOI: 10.1016/j.biopha.2017.07.154] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/16/2017] [Accepted: 07/30/2017] [Indexed: 11/16/2022] Open
Abstract
Progestin and adipoQ receptor family member 3 (PAQR3) has exhibited anticancer activity in multiple malignancies. However, its expression and function in esophageal squamous cell carcinoma (ESCC) is still elusive. In this work, we examined the expression of PAQR3 in 40 surgically resected ESCC specimens and their adjacent normal tissues. The expression of PAQR3 in ESCC cell lines was measured after treatment with the demethylating agent 5-aza-2'-deoxycytidine (5-Aza-CdR). The effects of overexpression of PAQR3 on cell proliferation, colony formation, invasion, and tumorigenesis were investigated. It was found that the PAQR3 mRNA level was significantly lower in ESCC than that in adjacent normal tissues (P=0.0318). Low PAQR3 expression was significantly associated with more advanced TNM stage (P=0.0093) and absent lymph node involvement (P=0.0324). Compared to normal esophageal epithelial cells, ESCC cells had significantly lower levels of PAQR3. 5-Aza-CdR treatment led to an induction of PAQR3 in ESCC cells. Enforced expression of PAQR3 significantly inhibited ESCC cell proliferation, colony formation and invasion. Moreover, PAQR3 overexpression blocked cell cycle transition from G1 to S phase, which was associated with induction of p27 and p21 and reduction of cyclin D1, CDK4, and CDK2. Mechanistically, overexpression of PAQR3 suppressed the phosphorylation of ERK1/2 in ESCC cells. In vivo tumorigenic studies confirmed that PAQR3 overexpression retarded the growth of ECA-109 xenograft tumors and inhibited the activation of ERK signaling. Taken together, PAQR3 is epigenetically silenced in ESCC and restoration of PAQR3 suppresses the aggressive phenotype of ESCC cells. Therefore, PAQR3 may represent a potential target for the treatment of ESCC.
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Affiliation(s)
- Ge Bai
- Cancer Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jianhu Chu
- Department of Thoracic Surgery, Tumor Hospital, Xinjiang Medical University, Urumqi, China
| | - Mayinur Eli
- Cancer Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yongxing Bao
- Cancer Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Hao Wen
- Cancer Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Lilyquist J, White KAM, Lee RJ, Philips GK, Hughes CR, Torres SM. Quantitative Analysis of Immunohistochemistry in Melanoma Tumors. Medicine (Baltimore) 2017; 96:e6432. [PMID: 28403073 PMCID: PMC5403070 DOI: 10.1097/md.0000000000006432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Identification of positive staining is often qualitative and subjective. This is particularly troublesome in pigmented melanoma lesions, because melanin is difficult to distinguish from the brown stain resulting from immunohistochemistry (IHC) using horse radish peroxidase developed with 3,3'-Diaminobenzidine (HRP-DAB). We sought to identify and quantify positive staining, particularly in melanoma lesions. We visualized G-protein coupled estrogen receptor (GPER) expression developed with HRP-DAB and counterstained with Azure B (stains melanin) in melanoma tissue sections (n = 3). Matched sections (n = 3), along with 22 unmatched sections, were stained only with Azure B as a control. Breast tissue (n = 1) was used as a positive HRP-DAB control. Images of the stained tissues were generated using a Nuance Spectral Imaging Camera. Analysis of the images was performed using the Nuance Spectral Imaging software and SlideBook. Data was analyzed using a Kruskal-Wallis one way analysis of variance (ANOVA). We showed that a pigmented melanoma tissue doubly stained with anti-GPER HRP-DAB and Azure B can be unmixed using spectra derived from a matched, Azure B-only section, and an anti-GPER HRP-DAB control. We unmixed each of the melanoma lesions using each of the Azure B spectra, evaluated the mean intensity of positive staining, and examined the distribution of the mean intensities (P = .73; Kruskal-Wallis). These results suggest that this method does not require a matched Azure B-only stained control tissue for every melanoma lesion, allowing precious tissues to be conserved for other studies. Importantly, this quantification method reduces the subjectivity of protein expression analysis, and provides a valuable tool for accurate evaluation, particularly for pigmented tissues.
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Affiliation(s)
- Jenna Lilyquist
- Department of Internal Medicine, Division of Epidemiology, University of New Mexico, Albuquerque, NM
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kirsten Anne Meyer White
- Department of Internal Medicine, Division of Epidemiology, University of New Mexico, Albuquerque, NM
| | | | | | - Christopher R. Hughes
- Department of Internal Medicine, Division of Epidemiology, University of New Mexico, Albuquerque, NM
| | - Salina M. Torres
- Center for HPV Prevention, Department of Pathology, University of New Mexico, Albuquerque, NM
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50
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Romaine ST, Wells-Jordan P, de Haro T, Dave-Thakrar A, North J, Pringle JH, Saldanha G. A small multimarker panel using simple immunohistochemistry methods is an adjunct to stage for cutaneous melanoma prognosis. Melanoma Res 2016; 26:580-587. [PMID: 27603549 DOI: 10.1097/cmr.0000000000000293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Melanoma is an aggressive cancer. Outcomes can vary significantly for lesions within the same pathological stage - a problem of increasing relevance with the promise of adjuvant treatments on the basis of immune checkpoint modulators and targeted therapies. The use of a panel of prognostic molecular biomarkers as an adjunct to stage represents a possible solution. Immunohistochemistry-based biomarkers offer greater potential for translation into clinical practice than biomarkers utilizing more complex methods. Many immunohistochemistry-based biomarkers have been identified through discovery studies, but rigorous validation of these is scarce. We take the first steps towards validating a combination of three such biomarkers in a prognostic panel - 5hmC, ki-67 and p16. Immunohistochemistry was performed on a cohort of 50 melanomas to determine the expression of 5hmC, ki-67 and p16. 5hmC and p16 showed statistically significant differences in metastasis-free survival between low-score and high-score groups, whereas the use of all three biomarkers together with stage could predict the 5-year metastasis risk more accurately than stage alone. Our results suggest that the use of multimarker panels to improve the accuracy of prognostic predictions is feasible and worthy of further study. We have shown that a small immunohistochemistry-based panel utilizing simple, inexpensive, reproducible methods can be an effective adjunct to stage in prognostic prediction. A follow-up study consisting of a large cohort of melanomas is now indicated to continue the development of the prognostic panel.
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Affiliation(s)
- Sam T Romaine
- aDepartment of Cancer Studies, University of Leicester bEMPATH Department of Cellular Pathology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
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