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Jain M, Crites MK, Rich P, Bajantri B. Malignant Pleural Mesothelioma: A Comprehensive Review. J Clin Med 2024; 13:5837. [PMID: 39407894 PMCID: PMC11476893 DOI: 10.3390/jcm13195837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/27/2024] [Accepted: 09/27/2024] [Indexed: 10/20/2024] Open
Abstract
Mesotheliomas are hyperplastic tumors that envelop the serosal membranes that safeguard the body's external surfaces. Although certain instances may exhibit indolent characteristics, a significant number of tumors demonstrate rapid progression and a poor prognosis. Mesotheliomas are typically categorized as benign or malignant, with malignant mesothelioma being more frequently linked to asbestos exposure. Malignant pleural mesothelioma (MPM) predominantly impacts males and often emerges in the late 50 s or beyond, characterized by a median age of early 70 s among patients exposed to asbestos lasting from 2 to 4 decades. Respiratory exposure to asbestos particles leads to the development of malignant mesothelioma, characterized by recurrent inflammation, disruption of cell division, activation of proto-oncogenes, and generation of free radicals. In pleural mesothelioma, BAP1, CDKN2A, and NF are the most often mutated genes. Accurate diagnosis and assessment usually require the use of chest computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET). Radiation therapy, immunotherapy, chemotherapy, and surgery are some of the treatment options that are currently available. This systematic review provides a comprehensive analysis of the latest research, biomarkers, evaluation, and management strategies for malignant pleural mesothelioma.
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Affiliation(s)
- Molly Jain
- Parkview Health, Fort Wayne, IN 46845, USA (P.R.)
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2
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Calabrese F, Montero-Fernandez MA, Kern I, Pezzuto F, Lunardi F, Hofman P, Berezowska S, Attanoos R, Burke L, Mason P, Balestro E, Molina Molina M, Giraudo C, Prosch H, Brcic L, Galateau-Salle F. The role of pathologists in the diagnosis of occupational lung diseases: an expert opinion of the European Society of Pathology Pulmonary Pathology Working Group. Virchows Arch 2024; 485:173-195. [PMID: 39030439 PMCID: PMC11329671 DOI: 10.1007/s00428-024-03845-1] [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: 03/12/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 07/21/2024]
Abstract
Occupational lung/thoracic diseases are a major global public health issue. They comprise a diverse spectrum of health conditions with complex pathology, most of which arise following chronic heavy workplace exposures to various mineral dusts, metal fumes, or following inhaled organic particulate reactions. Many occupational lung diseases could become irreversible; thus accurate diagnosis is mandatory to minimize dust exposure and consequently reduce damage to the respiratory system. Lung biopsy is usually required when exposure history is inconsistent with imaging, in case of unusual or new exposures, in case of unexpected malignancy, and in cases in which there are claims for personal injury and legal compensation. In this paper, we provide an overview of the most frequent occupational lung diseases with a focus on pathological diagnosis. This is a paper that summarizes the expert opinion from a group of European pathologists, together with contributions from other specialists who are crucial for the diagnosis and management of these diseases. Indeed, tight collaboration of all specialists involved in the workup is mandatory as many occupational lung diseases are misdiagnosed or go unrecognized. This document provides a guide for pathologists in practice to facilitate the accurate diagnosis of occupational lung disease. The review article reports relevant topics discussed during an educational course held by expert pathologists, active members of the Pulmonary Pathology Working Group of the European Society of Pathology. The course was endorsed by the University of Padova as a "winter school" (selected project in the call for "Shaping a World-class University" 2022).
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Affiliation(s)
- Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy.
| | | | - Izidor Kern
- Cytology and Pathology Laboratory, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Francesca Lunardi
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, IHU RespirERA, Nice Hospital, University Côte d'Azur, Nice, France
| | - Sabina Berezowska
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Richard Attanoos
- Department of Cellular Pathology, Cardiff University, Cardiff, UK
| | - Louise Burke
- Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Paola Mason
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | | | - Maria Molina Molina
- Respiratory Department, University Hospital of Bellvitge, IDIBELL, CIBERES, L'Hospitalet de Llobregat, Spain
| | - Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Helmut Prosch
- Division of Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Luka Brcic
- Diagnostic and Research Centre for Molecular BioMedicine, Diagnostic & Research Institute of Pathology, Medical University of Graz, Graz, Austria
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Hassan A, Prabhakaran S, Pulford E, Hocking AJ, Godbolt D, Ziad F, Pandita A, Wessels A, Hussey M, Russell PA, Klebe S. The significance of BAP1 and MTAP/CDKN2A expression in well-differentiated papillary mesothelial tumour: a series of 21 cases and a review of the literature. Pathology 2024; 56:662-670. [PMID: 38789301 DOI: 10.1016/j.pathol.2024.02.016] [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: 11/08/2023] [Revised: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 05/26/2024]
Abstract
The nomenclature and diagnostic criteria of well-differentiated papillary mesothelial tumour (WDPMT) have been changed in the 2021 World Health Organization (WHO) classification of thoracic tumours, and a new entity, mesothelioma in situ (MIS), introduced. Histologically these two entities may be similar. However, MIS is regarded as a precursor to invasive mesothelioma and requires demonstration of loss of BAP1 and/or MTAP/CDKN2A for diagnosis, whereas performance of these ancillary tests is desirable but not essential for a diagnosis of WDPMT, in which the significance of BAP1 and/or MTAP/CDKN2A loss is not well understood or well defined. Against this backdrop, we undertook an investigation of 21 cases of WDPMT, identified from our case files and diagnosed according to 2021 WHO criteria, to explore the relationship between histology and BAP1 and MTAP/CDKN2A expression with clinical features including asbestos exposure, focality of tumours and clinical outcome. There were 18 women and three men, with ages ranging from 23-77 years (median 62 years), in which six had a history of asbestos exposure, two had no exposure, and in 13 exposure history was unavailable. Of 20 peritoneal tumours and one pleural tumour, 13 were detected incidentally at the time of surgery for unrelated conditions and eight peritoneal tumours were multifocal at the time of diagnosis. BAP1 immunohistochemistry (IHC) was performed in all 21 tumours, with nine tumours showing BAP1 expression loss. MTAP/CDKN2A testing was performed in 14 tumours, comprising MTAP IHC in 12 and CDKN2A fluorescence in situ hybridisation (FISH) in two, with three tumours showing MTAP/CDKN2A expression loss. Two tumours with MTAP/CDKN2A loss also showed BAP1 expression loss. Four patients progressed to invasive mesothelioma, including one male with a pleural tumour and asbestos exposure, and three females with multifocal peritoneal tumours, two with asbestos exposure and one without exposure. BAP1 expression loss was seen in all tumours from the four patients who progressed to invasive mesothelioma, whilst two of these tumours showed retained MTAP IHC and two were not tested. There was one patient with a tumour with MTAP loss and retained BAP1 who died from unrelated causes 5 months after diagnosis. Eight patients received WDPMT-specific treatment in addition to the initial excision. Survival for all patients ranged from 4-218 months, with one patient dying of mesothelioma at 49 months. Based on our results in this series of 21 patients with WDPMT diagnosed according to 2021 WHO criteria, we propose that WDPMT with BAP1 expression loss may best be regarded as papillary MIS and that a history of asbestos exposure and the presence of multifocal tumours in patients diagnosed with WDPMT should prompt ancillary testing with BAP1 IHC. Further we propose that BAP1 IHC should be essential in the diagnosis of WDPMT, with the diagnosis restricted to those tumours which show retained BAP1 expression. However more studies in larger cohorts of patients are needed to explore the relationship between BAP1 expression and MTAP loss in WDPMT, which will help to define this entity and separate it more clearly from MIS and invasive mesothelioma.
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Affiliation(s)
- Aniza Hassan
- Department of Surgical Pathology, SA Pathology at Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sarita Prabhakaran
- Department of Anatomical Pathology, Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Bedford Park, SA, Australia
| | - Emily Pulford
- Department of Anatomical Pathology, Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Bedford Park, SA, Australia
| | - Ashleigh J Hocking
- Department of Anatomical Pathology, Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Bedford Park, SA, Australia
| | - David Godbolt
- Pathology Queensland, Prince Charles Hospital, Brisbane, Qld, Australia
| | - Fouzia Ziad
- Department of Pathology, Waikato District Health Board, Hamilton, New Zealand
| | - Archana Pandita
- Department of Pathology, Waikato District Health Board, Hamilton, New Zealand
| | - Annesu Wessels
- Department of Anatomical Pathology, Te What Ora Te Tai Toker au, Whangarei Hospital, Northland, New Zealand
| | - Matthew Hussey
- Department of Surgical Pathology, SA Pathology at Flinders Medical Centre, Bedford Park, SA, Australia
| | - Prudence A Russell
- LifeStrands Genomics and TissuPath Pathology, Mount Waverley, Vic, Australia
| | - Sonja Klebe
- Department of Surgical Pathology, SA Pathology at Flinders Medical Centre, Bedford Park, SA, Australia; Department of Anatomical Pathology, Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Bedford Park, SA, Australia.
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4
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Zhang N, Li Y, Sun Z, Dong Y, Zhou L, Zhang C, Liu Z, Zhang Q, Li K, Xu F, Zhang L, She B, Ren X, Che N. Combined detection of SHOX2 and PTGER4 methylation with serum marker CYFRA21-1 for improved diagnosis of malignant pleural mesothelioma. J Clin Pathol 2024:jcp-2024-209592. [PMID: 39060112 DOI: 10.1136/jcp-2024-209592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
AIMS To investigate the performance of a combined biomarker approach using the methylation status of the short stature homeobox 2 (SHOX2) and prostaglandin E2 receptor EP4 (PTGER4) genes, along with the serum levels of CYFRA21-1, for differential diganosis of malignant pleural mesothelioma (MPM) from benign reactive mesothelial hyperplasia (RMH). METHODS We analysed 48 MPM tissue or pleural effusion cell block specimens and 42 cases with RMH. Real-time quantitative methylation-specific PCR was used to examine the methylation status of SHOX2, PTGER4, ras association domain family 1 isoform A, septin 9 gene and homeobox gene A9 genes. Additionally, we employed electrochemiluminescence immunoassay to measure nine serum tumour markers commonly used in pan-cancer screening tests. RESULTS The receiver operating curve indicated that SHOX2, PTGER4 gene methylation and serum biomarker CYFRA21-1 exhibited good diagnostic performance in identifying MPM, with area under curves (AUCs) of 0.761, 0.904 and 0.847, respectively. The combination of SHOX2, PTGER4 methylation and CYFRA21-1 yielded an AUC value of 0.972. The diagnostic sensitivity and specificity of this panel in differentiating MPM from RMH were 91.3% (42/46) and 97.6% (41/42), respectively. Both tissue and cell block specimens can be used in the diagnostic process. Furthermore, elevated CYFRA21-1 levels were associated with poor prognosis (p<0.05). Hypermethylation level of PTGER4 may indicate an unfavourable prognosis of MPM, but the difference was not statistically significant. CONCLUSIONS The combined detection of SHOX2 and PTGER4 methylation alongside serum CYFRA21-1 level significantly enhances the diagnosis of MPM. Additionally, CYFRA21-1 can serve as a prognostic indicator for MPM.
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Affiliation(s)
- Nana Zhang
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Yongmeng Li
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Zuyu Sun
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Yujie Dong
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Lijuan Zhou
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Chen Zhang
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Zichen Liu
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Qiuyi Zhang
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Kun Li
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Fudong Xu
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Li Zhang
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
| | - Bin She
- Shanghai Methyldia Technology Co, Shanghai, China
| | - Xiaosha Ren
- Shanghai Methyldia Technology Co, Shanghai, China
| | - Nanying Che
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Tongzhou District, Beijing, China
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5
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Novelli F, Yoshikawa Y, Vitto VAM, Modesti L, Minaai M, Pastorino S, Emi M, Kim JH, Kricek F, Bai F, Onuchic JN, Bononi A, Suarez JS, Tanji M, Favaron C, Zolondick AA, Xu R, Takanishi Y, Wang Z, Sakamoto G, Gaudino G, Grzymski J, Grosso F, Schrump DS, Pass HI, Atanesyan L, Smout J, Savola S, Sarin KY, Abolhassani H, Hammarström L, Pan-Hammarström Q, Giorgi C, Pinton P, Yang H, Carbone M. Germline BARD1 variants predispose to mesothelioma by impairing DNA repair and calcium signaling. Proc Natl Acad Sci U S A 2024; 121:e2405231121. [PMID: 38990952 PMCID: PMC11260134 DOI: 10.1073/pnas.2405231121] [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: 03/13/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024] Open
Abstract
We report that ~1.8% of all mesothelioma patients and 4.9% of those younger than 55, carry rare germline variants of the BRCA1 associated RING domain 1 (BARD1) gene that were predicted to be damaging by computational analyses. We conducted functional assays, essential for accurate interpretation of missense variants, in primary fibroblasts that we established in tissue culture from a patient carrying the heterozygous BARD1V523A mutation. We found that these cells had genomic instability, reduced DNA repair, and impaired apoptosis. Investigating the underlying signaling pathways, we found that BARD1 forms a trimeric protein complex with p53 and SERCA2 that regulates calcium signaling and apoptosis. We validated these findings in BARD1-silenced primary human mesothelial cells exposed to asbestos. Our study elucidated mechanisms of BARD1 activity and revealed that heterozygous germline BARD1 mutations favor the development of mesothelioma and increase the susceptibility to asbestos carcinogenesis. These mesotheliomas are significantly less aggressive compared to mesotheliomas in asbestos workers.
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Affiliation(s)
- Flavia Novelli
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Yoshie Yoshikawa
- Department of Genetics, School of Medicine, Hyogo Medical University, Hyogo663-8501, Japan
| | - Veronica Angela Maria Vitto
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara44121, Italy
| | - Lorenzo Modesti
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara44121, Italy
| | - Michael Minaai
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Sandra Pastorino
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Mitsuru Emi
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Jin-Hee Kim
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Franz Kricek
- NBS-C Bioscience & Consulting GmbH, Vienna1230, Austria
| | - Fang Bai
- Shanghai Institute for Advanced Immunochemical Studies, Shanghai Tech University, Shanghai201210, China
| | - José N. Onuchic
- Center for Theoretical Biological Physics, Rice University, Houston, TX77005
| | - Angela Bononi
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Joelle S. Suarez
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Mika Tanji
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Cristina Favaron
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Alicia A. Zolondick
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
- Department of Molecular Biosciences and Bioengineering, University of Hawaii at Manoa, Honolulu, HI96822
| | - Ronghui Xu
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Yasutaka Takanishi
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Zhanwei Wang
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Greg Sakamoto
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Giovanni Gaudino
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | | | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera Santo Antonio and Santo Biagio (SS) Antonio e Biagio e Cesare Arrigo, Alessandria15121, Italy
| | - David S. Schrump
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD20892-1201
| | - Harvey I. Pass
- Department of Cardiothoracic Surgery, New York University, New York, NY10016
| | - Lilit Atanesyan
- Department of Oncogenetics, MRC Holland, Amsterdam 1057, the Netherlands
| | - Jan Smout
- Department of Oncogenetics, MRC Holland, Amsterdam 1057, the Netherlands
| | - Suvi Savola
- Department of Oncogenetics, MRC Holland, Amsterdam 1057, the Netherlands
| | - Kavita Y. Sarin
- Department of Dermatology, Stanford University Medical Center, Stanford, CA94305
| | - Hassan Abolhassani
- Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm17165, Sweden
| | - Lennart Hammarström
- Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm17165, Sweden
| | - Qiang Pan-Hammarström
- Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm17165, Sweden
| | - Carlotta Giorgi
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara44121, Italy
| | - Paolo Pinton
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara44121, Italy
| | - Haining Yang
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Michele Carbone
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
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Davidson B, Holth A, Hummel C, Flatmark K, Torgunrud A. Different Frequency and Clinical Role for MTAP Loss in Pleural and Peritoneal Mesothelioma. Appl Immunohistochem Mol Morphol 2024; 32:280-284. [PMID: 38812360 DOI: 10.1097/pai.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/26/2024] [Indexed: 05/31/2024]
Abstract
The objective of this study was to analyze the expression and prognostic role of methylthioadenosine phosphorylase (MTAP) in mesothelioma. MTAP protein expression by immunohistochemistry was analyzed in 113 mesotheliomas (60 pleural and 53 peritoneal), consisting of 36 effusions and 77 surgical specimens. MTAP expression was fully lost in 38 tumors and partially lost in 8 tumors. Loss of expression was significantly more common in effusions compared with biopsies/surgical resection specimens (20/36 vs. 26/77; P =0.017), and in pleural compared with peritoneal mesotheliomas (35/60 vs. 11/53; P <0.001). MTAP performed less robustly than BAP1 in comparative analysis of 57 tumors previously analyzed for expression of the latter protein (46 vs. 25 cases with loss of expression). In survival analysis for 69 patients with partial clinical data, male gender was significantly associated with shorter overall survival (OS; P =0.042), whereas loss of MTAP was associated with a trend for shorter OS ( P =0.058), with no prognostic role for patient age ( P =0.379) or anatomic site ( P =0.381). The association between loss of MTAP and poor OS became significant when survival analysis was limited to patients with pleural mesothelioma ( P =0.018). In conclusion, loss of MTAP expression is more frequent in pleural compared with peritoneal mesothelioma and has limited diagnostic relevance at the latter anatomic site. More frequent loss in effusion specimens suggests a role for this marker in effusion cytology. MTAP loss in pleural mesothelioma is associated with poor survival.
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Affiliation(s)
- Ben Davidson
- Departments of Pathology
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Charlotte Hummel
- Tumor Biology
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Flatmark
- Tumor Biology
- Gastroenterological Surgery, Norwegian Radium Hospital, Oslo University Hospital
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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7
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Bafaquh M, Alghanuim N, Alzhrani G, Alghabban FA, AlShamekh AS, Daghriri M, Almutairi OT, Abdulqader SB, Soualmi L, Alomar N, Alraddadi KK, AlSubaie FR. WITHDRAWN: Brain Biopsy Revolution: Unveiling the Core Syringe Technique with Clinical Insights. World Neurosurg 2024:S1878-8750(24)00916-1. [PMID: 38825309 DOI: 10.1016/j.wneu.2024.05.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/04/2024]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Mohammed Bafaquh
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Noor Alghanuim
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Gmaan Alzhrani
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Arwa S AlShamekh
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammed Daghriri
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Othman T Almutairi
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Lahbib Soualmi
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Najeeb Alomar
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Fahd R AlSubaie
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
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8
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Troncoso I, Brown J, Isla C, Lajara JM, Ebner M, Fehrmann-Cartes K. Case report: Abdominal mesothelioma in Atelerix albiventris. Front Vet Sci 2024; 11:1341815. [PMID: 38807940 PMCID: PMC11131417 DOI: 10.3389/fvets.2024.1341815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/25/2024] [Indexed: 05/30/2024] Open
Abstract
Hedgehogs, as exotic species, are more susceptible to various neoplastic conditions affecting diverse bodily systems, particularly the tegumentary, hemolymphatic, and digestive systems. Among these conditions, epithelial tumors are the most prevalent, followed by round cell tumors and mesenchymal tumors. A striking characteristic is the malignant nature of over 8% of these tumors, leading to a generally unfavorable prognosis. This study aims to present a unique case involving a 2.5 year-old male African pygmy hedgehog in Concepción, Biobío District, Chile, diagnosed with a mesenchymal neoplasia originating from mesothelial cells. The hedgehog presented to the veterinary clinic with acute abdominal pain, prompting ultrasound imaging, and comprehensive cytological, histopathological, and immunohistochemical analyses. During abdominal ultrasound, a mass was observed, and its cytological examination revealed the presence of malignant cells. The histopathological examination unveiled a diffuse mesothelial cell tissue interwoven with abundant fibrous tissue and small cysts containing serous fluid, all enveloped by flattened or cuboidal cells of mesothelial origin. Immunohistochemistry further confirmed the diagnosis, demonstrating positive immunostaining for calretinin and mesothelin markers, corroborating the diagnosis of fibrous malignant peritoneal mesothelioma. This case highlights the complexity of neoplastic conditions in hedgehogs and emphasizes the importance of multimodal diagnostic approaches for accurate identification and understanding of these rare diseases.
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Affiliation(s)
- Ignacio Troncoso
- Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Concepción, Chile
- Facultad de Recursos Naturales y Medicina Veterinaria, Universidad Santo Tomás, Sede Talca, Concepción, Chile
- Servicio Patológico y Anestesiológico veterinario (SERPAVET), Concepción, Chile
| | - John Brown
- Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Concepción, Chile
| | - Carla Isla
- Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Concepción, Chile
| | | | - Max Ebner
- Servicio Patológico y Anestesiológico veterinario (SERPAVET), Concepción, Chile
| | - Karen Fehrmann-Cartes
- Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Concepción, Chile
- Núcleo de Investigaciones Aplicadas en Ciencias Veterinarias y Agronómicas, Universidad de Las Américas, Concepción, Chile
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9
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Parra-Medina R, Castañeda-González JP, Chaves-Cabezas V, Alzate JP, Chaves JJ. Diagnostic performance of immunohistochemistry markers for malignant pleural mesothelioma diagnosis and subtypes. A systematic review and meta-analysis. Pathol Res Pract 2024; 257:155276. [PMID: 38603842 DOI: 10.1016/j.prp.2024.155276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) poses diagnostic challenges due to its resemblance to benign pleural pathologies and different histological subtypes. Several immunohistochemistry markers have been employed to aid in accurate diagnosis. METHODS The present systematic review and meta-analysis aimed to assess the diagnostic performance of various immunohistochemistry markers in malignant pleural mesothelioma diagnosis and its histological subtypes. Following the PRISMA guidelines, we systematically searched the literature for articles on using different immunohistochemical markers in MPM and its histological subtypes. EMBASE, LILACS, MEDLINE, and Virtual Health Library were searched for studies published up to August 2023. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) criteria to assess the quality of the included articles. Meta-analyses were performed to determine prevalence using a random-effects model. RESULTS 103 studies met the inclusion criteria, comprising a diverse range of immunohistochemistry markers. EMA and desmin-loss exhibited high sensitivity (96% and 92%, respectively) in distinguishing malignant pleural mesothelioma from benign pleural pathologies. Specificity was notably high for both BAP1-loss and survivin expression at 100%. Subtype-specific analyses demonstrated that EMA and HEG1 were sensitive markers for epithelioid mesothelioma, while GLUT1 showed high sensitivity for sarcomatoid mesothelioma. In cases comparing epithelioid mesothelioma and lung adenocarcinoma, CAM5.2 and calretinin displayed high sensitivity, while WT1 and BAP1-loss demonstrated exceptional specificity for malignant epithelioid mesothelioma. In the case of sarcomatoid mesothelioma and sarcomatoid lung carcinoma, GATA3 exhibited the most heightened sensitivity, while GATA3 and D2-40 displayed the best specificity for sarcomatoid malignant mesothelioma diagnosis. CONCLUSION Immunohistochemistry markers are essential in accurately diagnosing malignant pleural mesothelioma and its histological subtypes. This systematic review and meta-analysis provide a comprehensive insight into the diagnostic performance of these markers, facilitating their potential clinical utility in the discrimination of malignant pleural mesothelioma from other pleural pathologies and the differentiation of malignant pleural mesothelioma subtypes.
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Affiliation(s)
- Rafael Parra-Medina
- Research Institute, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia; Department of Pathology, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia; Department of Pathology, Instituto Nacional de Cancerología, Bogotá.
| | - Juan Pablo Castañeda-González
- Research Institute, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia; Department of Pathology, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.
| | - Viviana Chaves-Cabezas
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.
| | - Juan Pablo Alzate
- Research Institute, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.
| | - Juan José Chaves
- Department of Medicine, Norwalk Hospital, Yale School of Medicine, Norwalk, CT, United States.
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10
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Syed Ahmad SD, Kirk F, Wijesinghe W, He C, Stroebel A. A peculiar presentation of tamponade: pericardial mesothelioma. J Surg Case Rep 2024; 2024:rjae279. [PMID: 38711818 PMCID: PMC11070792 DOI: 10.1093/jscr/rjae279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/10/2024] [Indexed: 05/08/2024] Open
Abstract
Pericardial mesothelioma (PM) is rare with only 200 cases recorded, and a post-mortem prevalence of <0.0022%. It is the third most common cardiac/pericardial tumour, behind angiosarcoma and rhabdomyosarcoma. PM incidence increases with age, typically incidentally diagnosed between 50 and 70 years, with a 3:1 male predominance. Occasional PM can cause chest pain, dyspnoea, cough and even dysphagia. PMs are often misdiagnosed with only 25% of cases being antemortem diagnoses. Unlike pleural mesothelioma, the link between asbestos exposure and malignancy is less convincing, with only 20% of cases having known exposure. 6 There are three histological types: epithelioid, fibrous (spindle cell), and biphasic (mixed). The average life-expectancy post diagnosis is 3-10 months. Due to the heterogeneity of the presentation and rarity there is no standardized management algorithm, and the diagnostic imaging or laboratory investigations are scarcely described. We are presenting one of the cases diagnosed in our unit here in the Gold Coast.
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Affiliation(s)
- Syed Danial Syed Ahmad
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Level 4, D Block, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast 4215, Australia
| | - Frazer Kirk
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Level 4, D Block, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast 4215, Australia
| | - Wisalya Wijesinghe
- Bond University Faculty of Health Sciences & Medicine, 14 University Dr, Robina QLD 4226, Australia
| | - Cheng He
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Level 4, D Block, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast 4215, Australia
| | - Andrie Stroebel
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Level 4, D Block, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast 4215, Australia
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11
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Potesta MA, Guld E, Laman J. Dual Malignancies Discovered: A Rare Case of Malignant Peritoneal Epithelioid Mesothelioma and Lung Adenocarcinoma. Cureus 2024; 16:e59962. [PMID: 38854177 PMCID: PMC11162274 DOI: 10.7759/cureus.59962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Clinicians diagnosing malignant peritoneal epithelioid mesothelioma (MPM or MPeM) have historically had challenges due to the low incidence of the disease, as well as the often vague symptomatology that patients present with. Newer advances in technology, specifically in immunocytochemistry, have provided a clearer path to diagnosis. Additionally, malignant mesotheliomas must be differentiated from carcinomas. This is done via histology, immunocytochemistry, as well as a careful incorporation of the patient's clinical history. In this case, we present an asymptomatic 73-year-old non-smoker female with no past medical history of asbestos exposure. She was diagnosed with MPM following a routine abdominal hernia repair. Subsequent workup revealed a lung infiltrate that was successfully biopsied and resected, evidently found to be adenocarcinoma. A careful review of the resulting pathology, as well as the interpretation of immunocytochemistry, supported the notion that the patient had two independent malignant processes occurring at once. This case underscores the rarity of two similar, yet distinct cancers, as well as epidemiology, symptomatology, histology, immunocytochemistry, and prognosis.
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Affiliation(s)
- Mark A Potesta
- Internal Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Emma Guld
- Pediatrics, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Jennifer Laman
- Family Medicine, Access Healthcare Physicians, Hudson, USA
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12
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Choi JH, Thung SN. Recent Advances in Pathology of Intrahepatic Cholangiocarcinoma. Cancers (Basel) 2024; 16:1537. [PMID: 38672619 PMCID: PMC11048541 DOI: 10.3390/cancers16081537] [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: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Intrahepatic cholangiocarcinoma (ICCA) is a malignant epithelial neoplasm characterized by biliary differentiation within the liver. ICCA is molecularly heterogeneous and exhibits a broad spectrum of histopathological features. It is a highly aggressive carcinoma with high mortality and poor survival rates. ICCAs are classified into two main subtypes: the small-duct type and large-duct types. These two tumor types have different cell origins and clinicopathological features. ICCAs are characterized by numerous molecular alterations, including mutations in KRAS, TP53, IDH1/2, ARID1A, BAP1, BRAF, SAMD4, and EGFR, and FGFR2 fusion. Two main molecular subtypes-inflammation and proliferation-have been proposed. Recent advances in high-throughput assays using next-generation sequencing have improved our understanding of ICCA pathogenesis and molecular genetics. The diagnosis of ICCA poses a significant challenge for pathologists because of its varied morphologies and phenotypes. Accurate diagnosis of ICCA is essential for effective patient management and prognostic determination. This article provides an updated overview of ICCA pathology, focusing particularly on molecular features, histological subtypes, and diagnostic approaches.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea
| | - Swan N. Thung
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA;
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13
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Gopal P, Robert ME, Zhang X. Cholangiocarcinoma: Pathologic and Molecular Classification in the Era of Precision Medicine. Arch Pathol Lab Med 2024; 148:359-370. [PMID: 37327187 DOI: 10.5858/arpa.2022-0537-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT.— Cholangiocarcinoma (CCA) is a heterogeneous cancer of the bile duct, and its diagnosis is often challenging. OBJECTIVE.— To provide insights into state-of-the-art approaches for the diagnosis of CCA. DATA SOURCES.— Literature review via PubMed search and authors' experiences. CONCLUSIONS.— CCA can be categorized as intrahepatic or extrahepatic. Intrahepatic CCA is further classified into small-duct-type and large-duct-type, whereas extrahepatic CCA is classified into distal and perihilar according to site of origin within the extrahepatic biliary tree. Tumor growth patterns include mass forming, periductal infiltrating, and intraductal tumors. The clinical diagnosis of CCA is challenging and usually occurs at an advanced tumor stage. Pathologic diagnosis is made difficult by tumor inaccessibility and challenges in distinguishing CCA from metastatic adenocarcinoma to the liver. Immunohistochemical stains can assist in differentiating CCA from other malignancies, such as hepatocellular carcinoma, but no distinctive CCA-specific immunohistochemical profile has been identified. Recent advances in next-generation sequencing-based high-throughput assays have identified distinct genomic profiles of CCA subtypes, including genomic alterations that are susceptible to targeted therapies or immune checkpoint inhibitors. Detailed histopathologic and molecular evaluations of CCA by pathologists are critical for correct diagnosis, subclassification, therapeutic decision-making, and prognostication. The first step toward achieving these goals is to acquire a detailed understanding of the histologic and genetic subtypes of this heterogeneous tumor group. Here, we review state-of-the-art approaches that should be applied to establish a diagnosis of CCA, including clinical presentation, histopathology, staging, and the practical use of genetic testing methodologies.
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Affiliation(s)
- Purva Gopal
- From the Department of Pathology, UT Southwestern Medical Center, Dallas, Texas (Gopal)
| | - Marie E Robert
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Robert, Zhang)
| | - Xuchen Zhang
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Robert, Zhang)
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14
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Mervic A, Goricar K, Blagus T, Franko A, Trebusak-Podkrajsek K, Fikfak MD, Dolzan V, Kovac V. Telomere length and TERT polymorphisms as biomarkers in asbestos-related diseases. Radiol Oncol 2024; 58:87-98. [PMID: 38378028 PMCID: PMC10878767 DOI: 10.2478/raon-2024-0009] [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: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Asbestos exposure has been proposed as a risk factor for shorter telomere length. The aim of our study was to investigate whether telomere length in leukocytes and hTERT genetic polymorphisms may serve as potential biomarkers for the risk of developing asbestos-related diseases and as biomarkers of progression and chemotherapy response rate in malignant mesothelioma (MM). SUBJECTS AND METHODS We conducted two retrospective studies. In the first study, a case-control study, telomere length and hTERT polymorphisms were determined in patients with MM, subjects with pleural plaques and controls without the asbestos related disease, who were occupationally exposed to asbestos. In the second study, a longitudinal observational study, telomere length was also determined in samples from MM patients before and after chemotherapy. Telomere length was determined by monochromatic multiplex quantitative polymerase chain reaction (PCR), while competitive allele-specific PCR was used to genotype hTERT rs10069690, rs2736100 and rs2736098. Logistic regression and survival analysis were used in statistical analysis. RESULTS Patients with MM had shorter telomere length than subjects with pleural plaques (p < 0.001). After adjustment for age, rs2736098 CT, and rs10069690 TT and CT+TT genotypes were significantly associated with a higher risk of MM (padj = 0.023; padj = 0.026 and padj = 0.017), while rs2736100 AA and CA+AA genotypes conferred to a lower risk for MM compared to all other subjects (padj = 0.017, and padj = 0.026). Telomere length was not associated with a response to chemotherapy (p > 0.05) or time to disease progression (p > 0.05). Carriers of one or two polymorphic rs10069690 T alleles had a good response to chemotherapy (p = 0.039, and p = 0.048), these associations remained statistically significant after adjustment for age (padj = 0.019; padj = 0.017). Carriers of two polymorphic rs2736100 A alleles had a longer time to disease progression (p = 0.038). CONCLUSIONS Shorter telomere length and hTERT polymorphisms may serve as a biomarker for the risk of developing MM. Additionally, rs10069690 and rs2736100 polymorphisms, but not telomere length, were associated with a chemotherapy response or MM progression.
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Affiliation(s)
- Ana Mervic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Goricar
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Blagus
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alenka Franko
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Clinical Institute of Occupational Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katarina Trebusak-Podkrajsek
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Clinical Institute for Special Laboratory Diagnostics, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Metoda Dodic Fikfak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Clinical Institute of Occupational Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vita Dolzan
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Viljem Kovac
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
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15
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Klebe S, Judge M, Brcic L, Dacic S, Galateau-Salle F, Nicholson AG, Roggli V, Nowak AK, Cooper WA. Mesothelioma in the pleura, pericardium and peritoneum: Recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2024; 84:633-645. [PMID: 38044849 DOI: 10.1111/his.15106] [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: 08/27/2023] [Revised: 10/19/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023]
Abstract
AIMS Mesothelioma is a rare malignancy of the serosal membranes that is commonly related to exposure to asbestos. Despite extensive research and clinical trials, prognosis to date remains poor. Consistent, comprehensive and reproducible pathology reporting form the basis of all future interventions for an individual patient, but also ensures that meaningful data are collected to identify predictive and prognostic markers. METHODS AND RESULTS This article details the International Collaboration on Cancer Reporting (ICCR) process and the development of the international consensus mesothelioma reporting data set. It describes the 'core' and 'non-core' elements to be included in pathology reports for mesothelioma of all sites, inclusive of clinical, macroscopic, microscopic and ancillary testing considerations. An international expert panel consisting of pathologists and a medical oncologist produced a set of data items for biopsy and resection specimens based on a critical review and discussion of current evidence, and in light of the changes in the 2021 WHO Classification of Tumours. The commentary focuses particularly upon new entities such as mesothelioma in situ and provides background on relevant and essential ancillary testing as well as implementation of the new requirement for tumour grading. CONCLUSION We recommend widespread and consistent implementation of this data set, which will facilitate accurate reporting and enhance the consistency of data collection, improve the comparison of epidemiological data, support retrospective research and ultimately help to improve clinical outcomes. To this end, all data sets are freely available worldwide on the ICCR website (www.iccr-cancer.org/data-sets).
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Affiliation(s)
- Sonja Klebe
- Department of Anatomical Pathology, Flinders University and SA Pathology, Adelaide, SA, Australia
| | - Meagan Judge
- International Collaboration on Cancer Reporting, Sydney, NSW, Australia
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Andrew G Nicholson
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Victor Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Anna K Nowak
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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16
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Nazar T, Gopalakrishnabhaktan A, Tashrifwala FAA, Sathish A, Dave T. Testicular mesothelioma disguised as hydrocele: a case report. J Med Case Rep 2024; 18:114. [PMID: 38409016 PMCID: PMC10898004 DOI: 10.1186/s13256-024-04348-y] [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: 12/02/2023] [Accepted: 12/29/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Testicular tumors have many different manifestations. The majority of these cases are presented as an incidental finding during hydrocelectomy. Malignant mesotheliomas are uncommon tumours that can arise from the coelomic epithelium of the pleura, peritoneum, pericardium, and tunica vaginalis. CASE PRESENTATION We present a 51-year-old South Asian (Indian) male patient with a rare case of mesothelioma, presenting with right hydrocele, to whom a right hydrocelectomy was performed. Any history of trauma or asbestos exposure was not present. Histopathological and immunohistochemistry reports revealed a malignant mesothelioma of tunica vaginalis. There was no invasion of the tumour to the epididymis and spermatic cord. Imaging studies showed no signs of metastasis. 1 month later, a high inguinal orchidectomy was performed. The patient underwent adjuvant chemotherapy thereafter and is still on follow-up. CONCLUSION Although hydrocele is common, detailed evaluation is mandatory to rule out certain rare tumours-testicular and paratesticular variants.
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Affiliation(s)
- Tanya Nazar
- VPS Lakeshore Hospital & Research Centre, Kochi, Kerala, India
| | | | | | - Aroma Sathish
- VPS Lakeshore Hospital & Research Centre, Kochi, Kerala, India
| | - Tirth Dave
- Bukovinian State Medical University, Chernivtsi, Ukraine.
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17
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Mascaro N, Aboelnasr LS, Masood M, Yague E, Moran L, El-Bahrawy M. Exploring the histogenesis of STK11 adnexal tumour using electron microscopy. Virchows Arch 2024:10.1007/s00428-024-03763-2. [PMID: 38376618 DOI: 10.1007/s00428-024-03763-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
STK11 adnexal tumour is a recently described female genital tract tumour, usually identified in a paratubal location, often associated with Peutz-Jeghers syndrome (PJS) and with STK11 gene alterations identified in most of the cases. Morphologically, this tumour is composed of cells arranged in a variety of patterns, including cords, trabeculae, tubules and cystic and acinar structures. The cells are only moderately pleomorphic and mitotic activity is variable. As tumour cells express epithelial, sex cord stromal and mesothelial markers, STK11 adnexal tumour may be of sex cord stromal, epithelial or mesothelial origin; a Wolffian origin has also been suggested. We report the ultrastructural features of two STK11 adnexal tumours and compare their ultrastructural features with those of other sex cord stromal tumours, a granulosa cell tumour cell line, as well as the known ultrastructural features of epithelial, mesothelial and Wolffian cells. On ultrastructural examination, two STK11 adnexal tumours showed an admixture of elongated cells with regular elongated nuclei and polygonal cells with nuclei showing markedly irregular outlines and prominent nucleoli. Extracellular collagen fibres were identified. These are common ultrastructural features of sex cord stromal tumours, principally sex cord tumour with annular tubules; no ultrastructural features of epithelial, mesothelial or Wolffian cells were found. These findings in conjunction with the shared clinical and genetic association with PJS and shared molecular changes in STK11 gene suggest that STK11 adnexal tumour represents a poorly differentiated sex cord tumour.
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Affiliation(s)
- Nuria Mascaro
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0NN, UK
| | - Lamia Sabry Aboelnasr
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0NN, UK
| | - Motasim Masood
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0NN, UK
| | - Ernesto Yague
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Linda Moran
- Electron Microscopy Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Mona El-Bahrawy
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0NN, UK.
- Department of Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
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18
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Xiao LX, Liu L, Deng W. Case report: The first account of undifferentiated sarcoma with epithelioid features originating in the pleura. Front Med (Lausanne) 2024; 11:1301941. [PMID: 38362539 PMCID: PMC10867128 DOI: 10.3389/fmed.2024.1301941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
Undifferentiated epithelioid sarcoma (USEF) is a rare subtype of undifferentiated soft tissue sarcoma that presents unique challenges in clinical diagnosis and treatment. Here, we report a case of USEF occurring in the pleura of a 51-year-old man for the first time. Thoracoscopic examination revealed widespread nodular changes, and pathological analysis confirmed the presence of numerous epithelioid atypical cells. Immunohistochemical (IHC) analysis demonstrated an undifferentiated phenotype with distinct characteristics: epithelial membrane antigen (foci +), vimentin (+), Ki-67 (+70% +), TTF-1 (+), P53 (mutant type +90%), INI-1 (+), and CK5/6 (small foci +). Immunohistochemical examination of the tumor showed that the tumor was an undifferentiated epithelioid sarcoma. High-throughput DNA sequencing revealed pivotal mutations, including a nonsense mutation in the NF1 gene (c.641A > G(p.H214R)). and critical TP53 missense mutation (c.641A > G(p.H214R)). This TP53 mutation, with a tumor mutation burden of 16.5 Muts/Mb, signifies a high level of genomic instability, likely contributing to the rapid progression and aggressiveness of the disease. Detection of the TP53 mutation provides essential insights, indicating the disease's rapid progression and highlighting the potential for targeted therapies. Although the patient's disease progressed extremely rapidly and he tragically died within a week, we discussed the results of IHC and DNA sequencing in detail and discussed his possible treatment options. Insights gained from this case will be critical in shaping future diagnostic and therapeutic paradigms for USEF, particularly in the context of TP53 mutations.
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Affiliation(s)
- Ling-Xi Xiao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Liu
- Department of Pathology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wang Deng
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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19
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Yuce TH, Ak G, Metintas S, Dundar E, Roe OD, Panou V, Metintas M. BAP1, Wilms' tumor 1, and calretinin in predicting survival and response to first-line chemotherapy in patients with pleural mesothelioma. J Cancer Res Clin Oncol 2024; 150:38. [PMID: 38280040 PMCID: PMC10821830 DOI: 10.1007/s00432-023-05565-6] [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: 11/26/2023] [Accepted: 12/13/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE There are currently no methods to predict response to chemotherapy in pleural mesothelioma (PM). The aim of this study is to investigate the predictive and prognostic role of BAP1, WT1 and calretinin expression and their combinations in pre-treatment tumor samples by immunohistochemical (IHC) staining. METHODS The study included consecutive PM patients treated with chemotherapy alone at a University hospital between 2009 and 2020. BAP1 analyses were performed on formalin-fixed, paraffin-embedded tumor tissue samples of the patients, while WT1 and calretinin information were obtained from the histopathological diagnosis records. RESULTS Of the total 107 patients included, 64% had loss of BAP1 expression, whereas 77% had WT1 and 86% had calretinin expression. Patients with the presence of BAP1 expression, one or both of the other two markers, or loss of expression of all three markers (unfavorable status) were more likely to not respond to chemotherapy than those with the presence of all three markers or loss of BAP1 expression and expression of one or two other markers (favorable status) (p = 0.001). Median survival time of patients with favorable and unfavorable status was 15 ± 1.7 and 8.0 ± 2.4 months, respectively (p = 0.027). After adjustment for histopathology and stage, loss of BAP1 (HR = 0.54, 95%CI 0.35-0.83), WT1 (1.75, 1.06-2.90), calretinin (2.09, 1.14-3.84) expression and favourable panel (0.50, 0.27-0.92) was associated with prognosis. CONCLUSIONS The IHC biomarkers BAP1, WT1, and calretinin, used in the routine diagnosis of PM and their combinations, are the first biomarkers associated with response to chemotherapy and may be a useful tool to select patients for first-line platinum pemetrexed treatment in PM patients. Validation in a large cohort is ongoing.
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Affiliation(s)
- Tuna Han Yuce
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Guntulu Ak
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Selma Metintas
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey
- Department of Public Health, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Emine Dundar
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey
- Department of Pathology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Oluf Dimitri Roe
- Department of Oncology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vasiliki Panou
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Muzaffer Metintas
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey.
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey.
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20
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Pateras IS, Igea A, Nikas IP, Leventakou D, Koufopoulos NI, Ieronimaki AI, Bergonzini A, Ryu HS, Chatzigeorgiou A, Frisan T, Kittas C, Panayiotides IG. Diagnostic Challenges during Inflammation and Cancer: Current Biomarkers and Future Perspectives in Navigating through the Minefield of Reactive versus Dysplastic and Cancerous Lesions in the Digestive System. Int J Mol Sci 2024; 25:1251. [PMID: 38279253 PMCID: PMC10816510 DOI: 10.3390/ijms25021251] [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: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
In the setting of pronounced inflammation, changes in the epithelium may overlap with neoplasia, often rendering it impossible to establish a diagnosis with certainty in daily clinical practice. Here, we discuss the underlying molecular mechanisms driving tissue response during persistent inflammatory signaling along with the potential association with cancer in the gastrointestinal tract, pancreas, extrahepatic bile ducts, and liver. We highlight the histopathological challenges encountered in the diagnosis of chronic inflammation in routine practice and pinpoint tissue-based biomarkers that could complement morphology to differentiate reactive from dysplastic or cancerous lesions. We refer to the advantages and limitations of existing biomarkers employing immunohistochemistry and point to promising new markers, including the generation of novel antibodies targeting mutant proteins, miRNAs, and array assays. Advancements in experimental models, including mouse and 3D models, have improved our understanding of tissue response. The integration of digital pathology along with artificial intelligence may also complement routine visual inspections. Navigating through tissue responses in various chronic inflammatory contexts will help us develop novel and reliable biomarkers that will improve diagnostic decisions and ultimately patient treatment.
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Affiliation(s)
- Ioannis S. Pateras
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
| | - Ana Igea
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
- Mobile Genomes, Centre for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela (USC), 15706 Santiago de Compostela, Spain
| | - Ilias P. Nikas
- Medical School, University of Cyprus, 2029 Nicosia, Cyprus
| | - Danai Leventakou
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
| | - Nektarios I. Koufopoulos
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
| | - Argyro Ioanna Ieronimaki
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
| | - Anna Bergonzini
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Alfred Nobels Allé 8, 141 52 Stockholm, Sweden;
- Department of Molecular Biology and Umeå Centre for Microbial Research (UCMR), Umeå University, 901 87 Umeå, Sweden;
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul 03080, Republic of Korea;
| | - Antonios Chatzigeorgiou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Teresa Frisan
- Department of Molecular Biology and Umeå Centre for Microbial Research (UCMR), Umeå University, 901 87 Umeå, Sweden;
| | - Christos Kittas
- Department of Histopathology, Biomedicine Group of Health Company, 156 26 Athens, Greece;
| | - Ioannis G. Panayiotides
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
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21
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Malik S, Zaheer S. ChatGPT as an aid for pathological diagnosis of cancer. Pathol Res Pract 2024; 253:154989. [PMID: 38056135 DOI: 10.1016/j.prp.2023.154989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
Diagnostic workup of cancer patients is highly reliant on the science of pathology using cytopathology, histopathology, and other ancillary techniques like immunohistochemistry and molecular cytogenetics. Data processing and learning by means of artificial intelligence (AI) has become a spearhead for the advancement of medicine, with pathology and laboratory medicine being no exceptions. ChatGPT, an artificial intelligence (AI)-based chatbot, that was recently launched by OpenAI, is currently a talk of the town, and its role in cancer diagnosis is also being explored meticulously. Pathology workflow by integration of digital slides, implementation of advanced algorithms, and computer-aided diagnostic techniques extend the frontiers of the pathologist's view beyond a microscopic slide and enables effective integration, assimilation, and utilization of knowledge that is beyond human limits and boundaries. Despite of it's numerous advantages in the pathological diagnosis of cancer, it comes with several challenges like integration of digital slides with input language parameters, problems of bias, and legal issues which have to be addressed and worked up soon so that we as a pathologists diagnosing malignancies are on the same band wagon and don't miss the train.
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Affiliation(s)
- Shaivy Malik
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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22
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Zupanc C, Franko A, Štrbac D, Kovač V, Dolžan V, Goričar K. Serum Calretinin and Genetic Variability as a Prognostic and Predictive Factor in Malignant Mesothelioma. Int J Mol Sci 2023; 25:190. [PMID: 38203360 PMCID: PMC10778798 DOI: 10.3390/ijms25010190] [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: 11/25/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Calretinin is a promising diagnostic biomarker for malignant mesothelioma (MM), but less is known about its prognostic role. Our aim was to evaluate the association between serum calretinin concentration or genetic factors and the survival or outcome of cisplatin-based chemotherapy in MM. Our study included 265 MM patients. Serum calretinin concentration was determined using ELISA. Patients were genotyped for seven polymorphisms in CALB2, E2F2, MIR335, NRF1, and SEPTIN7 using competitive allele-specific PCR. Nonparametric tests, logistic regression, and survival analysis were used for statistical analysis. Higher serum calretinin concentration was associated with shorter progression-free (PFS) (HR = 1.18 (1.02-1.37), p = 0.023) and overall survival (OS) (HR = 1.20 (1.03-1.41), p = 0.023), but the association was not significant after adjusting for clinical factors (HR = 1.05 (0.85-1.31), p = 0.653 and HR = 1.06 (0.84-1.34), p = 0.613, respectively). SEPTIN7 rs3801339 and MIR335 rs3807348 were associated with survival even after adjustment (HR = 1.76 (1.17-2.64), p = 0.007 and HR = 0.65 (0.45-0.95), p = 0.028, respectively). Calretinin concentration was higher in patients who progressed after treatment with cisplatin-based chemotherapy (1.68 vs. 0.45 ng/mL, p = 0.001). Calretinin concentration above 0.89 ng/mL was associated with shorter PFS and OS from the start of chemotherapy (HR = 1.88 (1.28-2.77), p = 0.001 and HR = 1.91 (1.22-2.97), p = 0.004, respectively), even after adjusting for clinical factors (p < 0.05). MIR335 rs3807348 was associated with a better response to chemotherapy (OR = 2.69 (1.17-6.18), p = 0.020). We showed that serum calretinin is associated with survival and chemotherapy treatment outcomes in MM and could serve as a predictive biomarker.
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Affiliation(s)
- Cita Zupanc
- Military Medical Unit-Slovenian Army, 1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.F.); (D.Š.); (V.K.)
| | - Alenka Franko
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.F.); (D.Š.); (V.K.)
- Clinical Institute of Occupational Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Danijela Štrbac
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.F.); (D.Š.); (V.K.)
- Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Viljem Kovač
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.F.); (D.Š.); (V.K.)
- Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Vita Dolžan
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Katja Goričar
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
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23
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Carbone M, Minaai M, Takinishi Y, Pagano I, Yang H. Preventive and therapeutic opportunities: targeting BAP1 and/or HMGB1 pathways to diminish the burden of mesothelioma. J Transl Med 2023; 21:749. [PMID: 37880686 PMCID: PMC10599047 DOI: 10.1186/s12967-023-04614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/27/2023] Open
Abstract
Mesothelioma is a cancer typically caused by asbestos. Mechanistically, asbestos carcinogenesis has been linked to the asbestos-induced release of HMGB1 from the nucleus to the cytoplasm, where HMGB1 promotes autophagy and cell survival, and to the extracellular space where HMGB1 promotes chronic inflammation and mesothelioma growth. Targeting HMGB1 inhibited asbestos carcinogenesis and the growth of mesothelioma. It is hoped that targeting HMGB1 will be a novel therapeutic strategy that benefits mesothelioma patients. Severe restrictions and/or a complete ban on the use of asbestos were introduced in the 80 and early 90s in the Western world. These measures have proven effective as the incidence of mesothelioma/per 100,000 persons is decreasing in these countries. However, the overall number of mesotheliomas in the Western world has not significantly decreased. There are several reasons for that which are discussed here: (1) the presence of asbestos in old constructions; (2) the development of rural areas containing asbestos or other carcinogenic mineral fibers in the terrain; (3) the discovery of an increasing fraction of mesotheliomas caused by germline genetic mutations of BAP1 and other tumor suppressor genes; (4) mesotheliomas caused by radiation therapy; (5) the overall increase in the population and of the fraction of older people who are much more susceptible to develop all types of cancers, including mesothelioma. In summary, the epidemiology of mesothelioma is changing, the ban on asbestos worked, there are opportunities to help mesothelioma patients especially those who develop in a background of germline mutations and there is the opportunity to prevent a mesothelioma epidemic in the developing world, where the use of asbestos is increasing exponentially. We hope that restrictive measures similar to those introduced in the Western world will soon be introduced in developing countries to prevent a mesothelioma epidemic.
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Affiliation(s)
- Michele Carbone
- Thoracic Oncology, University of Hawaii Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA.
| | - Michael Minaai
- Thoracic Oncology, University of Hawaii Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA
| | - Yasutaka Takinishi
- Thoracic Oncology, University of Hawaii Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA
| | - Ian Pagano
- Thoracic Oncology, University of Hawaii Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA
| | - Haining Yang
- Thoracic Oncology, University of Hawaii Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA.
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24
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Grigoraş A, Amălinei C, Căruntu ID, Grigoraş CC, Chiseliţă IR, Crişan-Dabija RA. Symptomatic pericardial cysts and dilemmas in their diagnosis. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2023; 64:517-525. [PMID: 38184832 PMCID: PMC10863696 DOI: 10.47162/rjme.64.4.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024]
Abstract
Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are asymptomatic, being incidentally discovered during a routine chest imaging examination or an autopsy exam. The study involved a retrospective evaluation of clinicopathological findings in a 6-year series of PCs, treated in the Clinic of Pulmonary Diseases, Iaşi, Romania. A group of five cases of PCs, four females and one male, were evaluated. All patients displayed different symptoms, such as dyspnea, chest pain, chronic cough, fatigue, palpitation, and epigastric pain. The cystic lesions were located in the right and left cardiophrenic angle, in four cases, and in the central mediastinum in a single case. The lesions had a fluid content and a maximum diameter that ranged between 35 and 95 mm. The microscopic examination of the surgical resection tissues revealed a thin connective tissue wall without any associated smooth muscle cells. The loose connective tissue band was lined by a layer of mesothelial cells with no cellular atypia, which displayed discrete papillary projections, in one case. Although PCs are rare incidental findings, they should be considered in differential diagnoses of mediastinal cysts, especially as they are associated with non-specific symptoms. Furthermore, considering the possibility of development of severe complications, PCs should be thoroughly explored for suitable patients' management.
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Affiliation(s)
- Adriana Grigoraş
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
- Department of Histopathology, Institute of Legal Medicine, Iaşi, Romania
| | - Cornelia Amălinei
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
- Department of Histopathology, Institute of Legal Medicine, Iaşi, Romania
| | - Irina-Draga Căruntu
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
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25
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Karpes JB, Shamavonian R, Dewhurst S, Cheng E, Wijayawardana R, Ahmadi N, Morris DL. Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions. Cancers (Basel) 2023; 15:4704. [PMID: 37835398 PMCID: PMC10571654 DOI: 10.3390/cancers15194704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/12/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
Malignant peritoneal mesothelioma (MPM) is an extremely rare malignancy usually confined to the abdominal cavity. With an aggressive natural history, morbidity and mortality are consequences of progressive locoregional effects within the peritoneal cavity. The first reported case was in the early 20th century, however, due to the rare nature of the disease and a large gap in understanding of the clinicopathological effects, the next reported MPM cases were only published half a decade later. Since then, there has been exponential growth in our understanding of the disease, however, there are no prospective data and a paucity of literature regarding management. Traditionally, patients were treated with systemic therapy and the outcomes were very poor, with a median survival of less than one year. However, with the advent of cytoreductive surgery and locoregional chemotherapy, there have been significant improvements in survival. Even more recently, with an improved understanding of the molecular pathogenesis of MPM, there have been reports of improved outcomes with novel therapies. Given the disastrous natural history of MPM, the limited data, and the lack of universal treatment guidelines, an in-depth review of the past, present, and future of MPM is critical to improve treatment regimens and, subsequently, patient outcomes.
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Affiliation(s)
- Josh B. Karpes
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Raphael Shamavonian
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Suzannah Dewhurst
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Ernest Cheng
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Ru Wijayawardana
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Nima Ahmadi
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - David L. Morris
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
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26
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Opitz I, Bille A, Dafni U, Nackaerts K, Ampollini L, de Perrot M, Brcic L, Nadal E, Syrigos K, Gray SG, Aerts J, Curioni-Fontecedro A, Rüschoff JH, Monkhorst K, Weynand B, Silini EM, Bavaghar-Zaeimi F, Jakopovic M, Llatjos R, Tsimpoukis S, Finn SP, von der Thüsen J, Marti N, Dimopoulou G, Kammler R, Peters S, Stahel RA, Falcoz PE, Brunelli A, Baas P. European Epidemiology of Pleural Mesothelioma-Real-Life Data From a Joint Analysis of the Mesoscape Database of the European Thoracic Oncology Platform and the European Society of Thoracic Surgery Mesothelioma Database. J Thorac Oncol 2023; 18:1233-1247. [PMID: 37356802 DOI: 10.1016/j.jtho.2023.06.011] [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: 08/12/2022] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Pleural mesothelioma (PM) is an aggressive malignancy with increasing prevalence and poor prognosis. Real-life data are a unique approach to reflect the reality of PM epidemiology, treatment, and prognosis in Europe. METHODS A joint analysis of the European Thoracic Oncology Platform Mesoscape and the European Society of Thoracic Surgeons (ESTS) databases was performed to better understand the characteristics and epidemiology of PM, including histologic subtype, staging, and treatment. Overall survival (OS) was assessed, adjusting for parameters of clinical interest. RESULTS The analysis included 2766 patients (Mesoscape: 497/10 centers/ESTS: 2269/77 centers). The primary histologic subtype was epithelioid (71%), with 57% patients on stages III to IV. Within Mesoscape, the patients received either multimodality (59%) or palliative intention treatment (41%). The median follow-up was 47.2 months, on the basis of 1103 patients (Mesoscape: 491/ESTS: 612), with 823 deaths, and median OS was 17.4 months. In multivariable analysis, female sex, epithelioid subtype, and lower stage were associated with longer OS, when stratifying by cohort, age, and Eastern Cooperative Oncology Group Performance Status. Within Mesoscape, multimodality treatment including surgery was predictive of longer OS (hazard ratio = 0.56, 95% confidence interval: 0.45-0.69), adjusting for sex, histologic subtype, and Eastern Cooperative Oncology Group Performance Status. Overall, surgical candidates with a macroscopic complete resection had a significantly longer median OS compared with patients with R2 (25.2 m versus 16.4 m; log-rank p < 0.001). CONCLUSIONS This combined European Thoracic Oncology Platform/ESTS database analysis offers one of the largest databases with detailed clinical and pathologic outcome. Our finding reflects a benefit for selected patients that undergo multimodality treatment, including macroscopic complete resection, and represents a valuable resource to inform the epidemiology and treatment options for individual patients.
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Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Urania Dafni
- ETOP IBCSG Partners Foundation Statistical Center, Frontier Science Foundation-Hellas & University of Athens, Athens, Greece
| | - Kristiaan Nackaerts
- Department of Respiratory Oncology, University Hospitals KU Leuven, Leuven, Belgium
| | - Luca Ampollini
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Luka Brcic
- Institute of Pathology, Medical Faculty University of Zagreb, Zagreb, Croatia; Current: Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Ernest Nadal
- Department of Medical Oncology, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet, Barcelona, Spain
| | - Konstantinos Syrigos
- Medical School of Athens, National and Kapodistrian University, Sotiria General Hospital, Athens, Greece
| | - Steven G Gray
- Thoracic Oncology, St James's Hospital and Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Joachim Aerts
- Thoracic Oncology Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jan H Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Kim Monkhorst
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Birgit Weynand
- Department of Pathology, University Hospitals KU Leuven, Leuven, Belgium
| | | | - Fatemeh Bavaghar-Zaeimi
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marko Jakopovic
- Department for Lung Diseases, University Hospital Centre Zagreb & University of Zagreb, Zagreb, Croatia
| | - Roger Llatjos
- Department of Pathology, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Sotirios Tsimpoukis
- Medical School of Athens, National and Kapodistrian University, Sotiria General Hospital, Athens, Greece
| | - Stephen P Finn
- Department of Histopathology and Cancer Molecular Diagnostics, St James's Hospital and Trinity College, Dublin, Ireland
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nesa Marti
- Translational Research Coordination, ETOP IBCSG Partners Foundation Coordinating Center, Bern, Switzerland
| | - Georgia Dimopoulou
- ETOP IBCSG Partners Foundation Statistical Center, Frontier Science Foundation-Hellas, Athens, Greece
| | - Roswitha Kammler
- Translational Research Coordination, ETOP IBCSG Partners Foundation Coordinating Center, Bern, Switzerland
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV) and Lausanne University, Lausanne, Switzerland
| | | | | | - Alessandro Brunelli
- European Society of Thoracic Surgeons and Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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27
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Farinea G, Crespi V, Listì A, Righi L, Bironzo P, Merlini A, Malapelle U, Novello S, Scagliotti GV, Passiglia F. The Role of Germline Mutations in Thoracic Malignancies: Between Myth and Reality. J Thorac Oncol 2023; 18:1146-1164. [PMID: 37331604 DOI: 10.1016/j.jtho.2023.05.028] [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: 03/15/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
Considering the established contribution of environmental factors to the development of thoracic malignancies, the inherited susceptibility of these tumors has rarely been explored. However, the recent introduction of next-generation sequencing-based tumor molecular profiling in the real-word setting enabled us to deeply characterize the genomic background of patients with lung cancer with or without smoking-related history, increasing the likelihood of detecting germline mutations with potential prevention and treatment implications. Pathogenic germline variants have been detected in 2% to 3% of patients with NSCLC undergoing next-generation sequencing analysis, whereas the proportion of germline mutations associated with the development of pleural mesothelioma widely varies across different studies, ranging between 5% and 10%. This review provides an updated summary of emerging evidence about germline mutations in thoracic malignancies, focusing on pathogenetic mechanisms, clinical features, therapeutic implications, and screening recommendations for high-risk individuals.
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Affiliation(s)
- Giovanni Farinea
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Veronica Crespi
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Angela Listì
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Luisella Righi
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Alessandra Merlini
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Umberto Malapelle
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
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28
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Abstract
A remarkable amount of new information has been generated on peritoneal mesothelioma (PeM), ranging from nomenclature changes, including the removal of "malignant" when referring to this neoplasm and the use of the term "tumor" rather than "mesothelioma" to designate the neoplasm formerly known as "well-differentiated papillary mesothelioma", to the acknowledgment that PeMs can be associated with tumor predisposition syndromes or germline mutations. Although the disease is still more frequently seen in caucasian males, PeM is not uncommon in women. In addition, it can represent a diagnostic challenge when it has an uncommon presentation (ie, paraneoplastic syndrome or incidental finding) or when it has confounding histologic features. Ancillary testing, including immunohistochemical stains, in situ hybridization for CDKN2A or NF2 , and molecular studies, in selected cases, allows its correct diagnosis. The molecular landscape of PeM is still a work in progress; however, some findings, such as ALK gene rearrangements and EWSR1/FUS-ATF1 fusions, are specifically seen in PeM of young patients. The biological behavior of PeM is variable; however, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have markedly improved the survival of patients affected by this disease.
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Affiliation(s)
- Anais Malpica
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
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Carbone M, Yang H, Pass HI, Taioli E. Did the Ban on Asbestos Reduce the Incidence of Mesothelioma? J Thorac Oncol 2023; 18:694-697. [PMID: 37210180 DOI: 10.1016/j.jtho.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Michele Carbone
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii.
| | - Haining Yang
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University, New York, New York
| | - Emanuela Taioli
- Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai, New York
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Dumoulin DW, Bironzo P, Passiglia F, Scagliotti GV, Aerts JGJV. Rare thoracic cancers: a comprehensive overview of diagnosis and management of small cell lung cancer, malignant pleural mesothelioma and thymic epithelial tumours. Eur Respir Rev 2023; 32:220174. [PMID: 36754434 PMCID: PMC9910338 DOI: 10.1183/16000617.0174-2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/18/2022] [Indexed: 02/10/2023] Open
Abstract
Despite the progress in outcomes seen with immunotherapy in various malignancies, including nonsmall cell lung cancer, the benefits are less in small cell lung cancer, malignant pleural mesothelioma and thymic epithelial tumours. New effective treatment options are needed, guided via more in-depth insights into the pathophysiology of these rare malignancies. This review comprehensively presents an overview of the clinical presentation, diagnostic tools, staging systems, pathophysiology and treatment options for these rare thoracic cancers. In addition, opportunities for further improvement of therapies are discussed.
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Affiliation(s)
- Daphne W Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Paolo Bironzo
- Department of Oncology, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giorgio V Scagliotti
- Department of Oncology, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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31
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Schwartzenberg S, Shapira Y, Rubachevski V, Sharony R. Primary cardiac mesothelioma presenting with fulminant recurrent pericarditis: a case report. Eur Heart J Case Rep 2023; 7:ytad100. [PMID: 36937239 PMCID: PMC10019824 DOI: 10.1093/ehjcr/ytad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/01/2022] [Accepted: 02/22/2023] [Indexed: 02/26/2023]
Abstract
Background Primary pericardial mesothelioma is an extremely rare disease. Prognosis is poor, with little effects of chemo- or radio-therapy. The majority of cases is diagnosed at autopsy. Case summary A 22-year-old man, who presented with recurrent pericarditis and large pericardial effusion 2 months after a second BNT162b2 COVID-19 vaccine, underwent pericardiocentesis and pericardial window. Pathology specimen of pericardium revealed benign mesothelial inflammation, consistent with acute pericarditis. Four months later, he presented with a large pericardial mass manifesting in heart failure and underwent urgent pericardiectomy. A new pathology specimen immunostaining and fluorescence in situ hybridization analysis revealed pericardial mesothelioma. Despite intensive care, the patient died 3 weeks later. Discussion Primary pericardial mesothelial should be considered in the differential diagnosis of refractory recurrent pericarditis, even with prior biopsy-proven pericarditis or when a putative trigger (COVID-19 mRNA prior vaccination) is suspected, as was the case in this patient. Tumour diagnosis and identification consist of multimodal imaging and laboratory tests. A multidisciplinary, individualized care approach should be performed.
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Affiliation(s)
| | - Yaron Shapira
- The Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St., Petah Tikva 4941492, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Victor Rubachevski
- Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Department of Cardiothoracic Surgery, Rabin Medical Center, 39 Jabotinsky St., Petach Tikva 4941492, Israel
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Bonde A, Singh R, Prasad SR, Kamireddy D, Aggarwal A, Ramani N, Saboo S, Shanbhogue K, Dasyam AK, Katabathina VS. Mesotheliomas and Benign Mesothelial Tumors: Update on Pathologic and Imaging Findings. Radiographics 2023; 43:e220128. [PMID: 36757881 DOI: 10.1148/rg.220128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
A diverse spectrum of benign entities and malignant neoplasms originate from the monotonous mesothelium that lines the serosal membranes of the pleural, pericardial, and peritoneal cavities. The mesothelium of myriad sites shows a common origin from the lateral plate mesoderm; primary mesothelial tumors thus demonstrate similar pathogenesis, imaging findings, and treatment options. Significant changes have been made in the 2021 World Health Organization (WHO) classification schemata of the pleural and pericardial tumors on the basis of recent advances in pathology and genetics. While malignant mesotheliomas are biologically aggressive malignancies that occur primarily in patients exposed to asbestos with attendant poor survival rates, well-differentiated papillary mesothelial tumors and adenomatoid tumors charter a benign clinical course with an excellent prognosis. Mesothelioma in situ is a newly characterized entity represented by recurrent unexplained pleural effusions without any identifiable mass at imaging or thoracoscopy. Immunohistochemical markers based on BAP1, MTAP, CDKN2A, and TRAF7 gene mutations help differentiate diffuse mesotheliomas from benign mesothelial proliferations and localized mesotheliomas. Cross-sectional imaging modalities, including US, CT, MRI, and fluorine 18-fluorodeoxyglucose (FDG) PET/CT, permit diagnosis and play a major role in staging and assessing surgical resectability. Imaging studies are invaluable in providing noninvasive and quantitative assessment of tumor response in patients with unresectable disease. Owing to significant overlap in patient characteristics and pathomorphology, accurate diagnosis based on advanced histopathology techniques and genetic abnormalities is imperative for optimal management and prognostication. While patients with nonepithelioid pleural mesotheliomas benefit from immunotherapy, novel targeted therapies for CDKN2A-, NF2-, and BAP1-altered mesotheliomas are under consideration. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Apurva Bonde
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Ramandeep Singh
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Dhiraj Kamireddy
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Aarushi Aggarwal
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Nisha Ramani
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Sachin Saboo
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Krishna Shanbhogue
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Anil K Dasyam
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
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Bononi A, Wang Q, Zolondick AA, Bai F, Steele-Tanji M, Suarez JS, Pastorino S, Sipes A, Signorato V, Ferro A, Novelli F, Kim JH, Minaai M, Takinishi Y, Pellegrini L, Napolitano A, Xu R, Farrar C, Goparaju C, Bassi C, Negrini M, Pagano I, Sakamoto G, Gaudino G, Pass HI, Onuchic JN, Yang H, Carbone M. BAP1 is a novel regulator of HIF-1α. Proc Natl Acad Sci U S A 2023; 120:e2217840120. [PMID: 36656861 PMCID: PMC9942908 DOI: 10.1073/pnas.2217840120] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023] Open
Abstract
BAP1 is a powerful tumor suppressor gene characterized by haplo insufficiency. Individuals carrying germline BAP1 mutations often develop mesothelioma, an aggressive malignancy of the serosal layers covering the lungs, pericardium, and abdominal cavity. Intriguingly, mesotheliomas developing in carriers of germline BAP1 mutations are less aggressive, and these patients have significantly improved survival. We investigated the apparent paradox of a tumor suppressor gene that, when mutated, causes less aggressive mesotheliomas. We discovered that mesothelioma biopsies with biallelic BAP1 mutations showed loss of nuclear HIF-1α staining. We demonstrated that during hypoxia, BAP1 binds, deubiquitylates, and stabilizes HIF-1α, the master regulator of the hypoxia response and tumor cell invasion. Moreover, primary cells from individuals carrying germline BAP1 mutations and primary cells in which BAP1 was silenced using siRNA had reduced HIF-1α protein levels in hypoxia. Computational modeling and co-immunoprecipitation experiments revealed that mutations of BAP1 residues I675, F678, I679, and L691 -encompassing the C-terminal domain-nuclear localization signal- to A, abolished the interaction with HIF-1α. We found that BAP1 binds to the N-terminal region of HIF-1α, where HIF-1α binds DNA and dimerizes with HIF-1β forming the heterodimeric transactivating complex HIF. Our data identify BAP1 as a key positive regulator of HIF-1α in hypoxia. We propose that the significant reduction of HIF-1α activity in mesothelioma cells carrying biallelic BAP1 mutations, accompanied by the significant reduction of HIF-1α activity in hypoxic tissues containing germline BAP1 mutations, contributes to the reduced aggressiveness and improved survival of mesotheliomas developing in carriers of germline BAP1 mutations.
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Affiliation(s)
- Angela Bononi
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Qian Wang
- Center for Theoretical Biological Physics, Rice University, Houston, TX77005
- Hefei National Laboratory for Physical Sciences at the Microscale and Department of Physics, University of Science and Technology of China, Hefei, Anhui230026, China
| | - Alicia A. Zolondick
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
- Department of Molecular Biosciences and Bioengineering, University of Hawaii at Manoa, Honolulu, HI96822
| | - Fang Bai
- Center for Theoretical Biological Physics, Rice University, Houston, TX77005
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai201210, China
- School of Life Science and Technology, ShanghaiTech University, Shanghai201210, China
| | - Mika Steele-Tanji
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Joelle S. Suarez
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Sandra Pastorino
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Abigail Sipes
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | | | - Angelica Ferro
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Flavia Novelli
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Jin-Hee Kim
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Michael Minaai
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
- Department of Molecular Biosciences and Bioengineering, University of Hawaii at Manoa, Honolulu, HI96822
| | - Yasutaka Takinishi
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Laura Pellegrini
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Andrea Napolitano
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Ronghui Xu
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Christine Farrar
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Chandra Goparaju
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Cristian Bassi
- Department of Translational Medicine LTTA Centre University of Ferrara, Ferrara44121, Italy
| | - Massimo Negrini
- Department of Translational Medicine LTTA Centre University of Ferrara, Ferrara44121, Italy
| | - Ian Pagano
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Greg Sakamoto
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Giovanni Gaudino
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Harvey I. Pass
- Department of Cardiothoracic Surgery, New York University, New York, NY10016
| | - José N. Onuchic
- Center for Theoretical Biological Physics, Rice University, Houston, TX77005
| | - Haining Yang
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
| | - Michele Carbone
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96813
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Zuccatosta L, Bizzarro T, Rossi G, Gallo G, Gasparini S, Ambrosini-Spaltro A. Immunohistochemistry for Claudin-4 and BAP1 in the Differential Diagnosis between Sarcomatoid Carcinoma and Sarcomatoid Mesothelioma. Diagnostics (Basel) 2023; 13:diagnostics13020249. [PMID: 36673059 PMCID: PMC9858564 DOI: 10.3390/diagnostics13020249] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/01/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
(1) Background. In the differential diagnosis between sarcomatoid carcinoma (SC) and sarcomatoid mesothelioma (SM), we aimed to investigate the role of Claudin-4 and BAP1, a panel recently used to distinguish conventional carcinoma from epithelioid mesothelioma. (2) Methods. We collected 41 surgical pleural biopsies of SM, 46 surgical resections of SC from different sites and 49 pleural biopsies of normal/hyperplastic mesothelium. All the cases were tested for Claudin-4 and BAP1 using immunohistochemistry. The statistical calculations of the sensitivity, specificity and positive and negative predictive values were performed. (3) Results: Claudin-4 was negative in 41/41 SMs, while it was positive in 18/36 (50.1%) SCs (eight diffusely, 10 focally) within their sarcomatous component. BAP1 was lost in 23/41 SMs, while it was regularly expressed in 46/46 SCs. All the cases of the normal/hyperplastic mesothelium were negative for Claudin-4 and retained the regular expression of BAP1. The Claudin-4 expression was useful for detecting SC (sensitivity, 39.1%; specificity, 100%) and the BAP1 loss was useful for diagnosing SM (sensitivity, 56.1%; specificity, 100%). (4) Conclusions. The staining for Claudin-4 and BAP1 exhibited a low/moderate sensitivity in diagnosing SC and SM (39.1% and 56.1%, respectively), but a very high specificity (100%). Claudin-4 was expressed only in SC and BAP1 loss was noted only in SM.
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Affiliation(s)
- Lina Zuccatosta
- Pulmonary Diseases Unit, Azienda “Ospedali Riuniti”, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-071-5965851
| | - Tommaso Bizzarro
- Operative Unit of Pathologic Anatomy, Azienda USL Della Romagna, Infermi Hospital, 47900 Rimini, Italy
| | - Giulio Rossi
- Pathologic Anatomy Unit, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Graziana Gallo
- Operative Unit of Pathologic Anatomy, Azienda USL della Romagna, “Bufalini” Hospital, 47521 Cesena, Italy
| | - Stefano Gasparini
- Pulmonary Diseases Unit, Azienda “Ospedali Riuniti”, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Region, 60126 Ancona, Italy
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Janes WI, Al-Asaaed S, Johnston PH. Malignant Mesothelioma of the Testes with Retroperitoneal Recurrence and Resection in an 80-Year-Old Male and Review of the Literature. Case Rep Oncol 2023; 16:698-704. [PMID: 37933307 PMCID: PMC10625815 DOI: 10.1159/000531839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/29/2023] [Indexed: 11/08/2023] Open
Abstract
Malignant mesothelioma of the testes is an aggressive, yet rare urogenital malignancy, accounting for an infinitesimally small number of oncologic diagnoses. This infrequent occurrence is accompanied by a relative lack of knowledge surrounding this disease, thus limiting management options beyond surgical intervention. Oftentimes, these malignancies present with a poor prognosis despite early intervention and only worsen in the event of metastatic spread with poor survival and limited response to treatment, if any. Our case documents positive patient outcomes following the use of aggressive surgical intervention in the management of a metastatic testicular mesothelioma. A healthy 80-year-old male with sudden painless testicular swelling requiring radical orchidectomy following failed initial conservative management. Pathologically, the specimen was diagnosed as malignant mesothelioma of the right testis with involvement of the tunica albuginea and tunica vaginalis. Following disease recurrence at 82 years of age, the patient subsequently opted for an open right-sided template non-nerve sparing retroperitoneal lymph node dissection which was undertaken without complication. Malignant mesothelioma of the testes remains an ominous diagnosis with historically poor outcomes and for which surgical intervention remains the mainstay of treatment. The retroperitoneal lymphatic drainage represents the most common route of metastatic spread for testicular tumours; however, retroperitoneal lymph node dissection has rarely been employed in this patient population and never in an individual of this age. Our findings contribute to the growing literature surrounding these rare malignancies and outline the importance of considering both patient autonomy and the clinical picture in disease management.
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Affiliation(s)
- W.C. Ian Janes
- Faculty of Medicine, Memorial University, St. John’s, NL, Canada
| | - Sohaib Al-Asaaed
- Faculty of Medicine, Memorial University, St. John’s, NL, Canada
- Division of Oncology, Health Sciences Centre, St. John’s, NL, Canada
| | - Paul H. Johnston
- Division of Urology, Memorial University, St. John’s, NL, Canada
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Chen Y, Du X, Gao Y, Wu H, Zhao H, Su Y. Methylthioadenosine Phosphorylase and Breast Cancer 1 Protein-Associated Protein 1 as Biomarkers for the Peritoneal Mesothelioma. Cancer Control 2023; 30:10732748231220805. [PMID: 38092371 PMCID: PMC10722924 DOI: 10.1177/10732748231220805] [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: 03/25/2023] [Revised: 10/17/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Combination of Breast Cancer 1 protein-associated protein 1 (BAP1) and methylthioadenosine phosphorylase (MTAP) in the peritoneal mesothelioma (PeM) has yet to be explored. We aim to assess the diagnostic value of combined BAP1 and MTAP to distinguish biphasic mesothelioma (BM) from epithelioid mesothelioma (EM) with reactive stroma in peritoneum, as well as its prognostic value in PeM. METHODS This is a retrospective study from June 2014 to December 2021. This study included 18 cases of BM and 27 cases of EM with reactive stroma, excluded sarcomatoid, and EM without reactive stroma cases, and clinicopathological information was collected. The associations between MTAP and BAP1 levels and clinicopathological features or prognosis were analyzed. Clinical follow-up data were reviewed to correlate with pathological prognostic factors using Kaplan-Meier estimator and univariate/multivariate Cox proportional hazards regression models. RESULTS Loss/decrease of BAP1/MTAP was observed in 6 (33.3%) BM cases and 12 (44.4%) EM cases. In 5 (27.8%) cases, loss of or decreased BAP1/MTAP expression was observed in both EC and SC of BM. BAP1/MTAP loss/decrease was observed in 12 (44.4%) cases of only EC of EM but not in reactive stroma. Compared with histology alone, a combination of BAP1 and MTAP immunohistochemistry (IHC) in spindled PeM provides a more objective mean to distinguish BM from EM with reactive stroma. Loss/decrease of BAP1/MTAP was associated with peritoneal cancer index (PCI) score (P = 0.047) and completeness of cytoreduction (CC) score (P = 0.038). BM patients have worse overall survival (OS) than EM with reactive stroma (P = 0 .007). CONCLUSIONS Combination of BAP1/MTAP by IHC is helpful for differential diagnosis of peritoneal BM from EM with reactive stroma. Nevertheless, BAP1/MTAP may help to evaluate the biological behavior of PeM.
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Affiliation(s)
- Yue Chen
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xuemei Du
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ying Gao
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Heliang Wu
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Ninth School of Clinical Medicine, Peking University, Beijing, China
| | - Hongyu Zhao
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yandong Su
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Wu X, Wang Q, Xu X. Coexistence of a novel STRN-ALK, NBEA-ALK double-fusion in an ovarian malignant mesothelioma patient: a case report and review. Front Oncol 2023; 13:1156329. [PMID: 37152028 PMCID: PMC10160359 DOI: 10.3389/fonc.2023.1156329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
Primary ovarian mesothelioma (POM) is a rare malignant tumor with poor prognosis. Although anaplastic lymphoma kinase gene (ALK) double-fusion partners have been found in various tumors, it is rarely reported in mesothelioma. In this article, we describe the coexistence of a novel STRN-ALK, neurobeachin (NBEA)-ALK double-fusion in a patient with primary ovarian mesothelioma. A 30-year-old woman was found to have pelvic masses for more than a year. Color Doppler ultrasound showed mixed mass in the left ovary and multiple solid masses in the right ovary. the patient underwent laparoscopic surgery, including total hysterectomy, bilateral salpingo-oopherectomy, pelvic lymph node and abdominal aortic lymph node resection, omentum resection and abdominal focus resection. Pathologic examination revealed bilateral ovarian malignant mesothelioma and no evidence of malignancy in the resected bilateral round/broad ligaments, bilateral parametrial tissues, vaginal stump, bilateral fallopian tubes, pelvic and paraaortic lymph nodes. Immunohistochemistry showed that it was positive for Calretinin, VIM, WT1, PAX8, mesothelin, CK5/6, PCK, CK7, MLH1, PMS2, MSH2, MSH6, weakly positive for BAP1, while being negative for Napsin A, P504S, CEA, D2-40, GATA3. The sequencing analysis identified STRN-ALK (intron3:intron19) and NBEA-ALK (intron1:intron16) double-ALK fusion. To the best of our knowledge, this is the first report that a novel NBEA-ALK and EML4-ALK coexist in one patient with POM. The patient has completed 6 cycles of continuous chemotherapy and is in stable condition. Whether ALK inhibitors can bring promising benefits to POM patients in the future deserves further study.
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Usefulness of NF2 hemizygous loss detected by fluorescence in situ hybridization in diagnosing pleural mesothelioma in tissue and cytology material: A multi-institutional study. Lung Cancer 2023; 175:27-35. [PMID: 36442384 DOI: 10.1016/j.lungcan.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/30/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES BAP1, CDKN2A, and NF2 are the most frequently altered genes in pleural mesotheliomas (PM). Discriminating PM from benign mesothelial proliferation (BMP) is sometimes challenging; it is well established that BAP1 loss, determined by immunohistochemistry (IHC), and CDKN2A homozygous deletion (HD), determined by fluorescence in situ hybridization (FISH), are useful. However, data regarding the diagnostic utility of NF2 FISH in PM is limited. Thus, we performed a multi-institutional study examining the utility of NF2 alterations determined by FISH for diagnosing PM in combination with BAP1 loss and CDKN2A HD. MATERIALS AND METHODS Multi-institutional PM cases, including 106 surgical and 107 cell block samples as well as 37 tissue cases of benign mesothelial proliferation (BMP) and 31 cell block cases with reactive mesothelial cells (RMC), were collected and analyzed using IHC for BAP1 and FISH for CDKN2A and NF2. RESULTS In PM, NF2 FISH revealed hemizygous loss (HL) in 54.7% of tissue cases (TC) and 49.5% of cell block cases (CBC), with about 90% of HL being monosomy. CDKN2A HD or BAP1 loss were detected in 75.5%/65.4% TC or 63.6%/60% CBC, respectively. BMP or RMC showed no BAP1 loss, CDKN2A HD, or NF2 HL. For discriminating PM from BMP, a combination of BAP1 loss, CDKN2A HD, and NF2 HL yielded enhanced sensitivity of 98.1% TC/94.4% CBC. BAP1 loss, CDKN2A HD, or NF2 HL were observed in 69%, 70%, or 58% of epithelioid PM, but in 9%, 91%, or 27% of sarcomatoid PM, respectively. Histotype, histological gradings, and CDKN2A deletion status showed significant differences in overall survival, while BAP1 loss and NF2 HL did not. CONCLUSION NF2 HL, consisting predominantly of monosomy, can be detected by FISH in both TC and CBC of PM, and is effective for distinguishing PM from BMP, especially when combined with BAP1 loss and CDKN2A HD.
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Zhai Y, Hui Z, Chen W, Ying J, Li J, Gao S. The epidemic of malignant mesothelioma in China: a prediction of incidence during 2016-2030. Transl Lung Cancer Res 2022; 11:2403-2411. [PMID: 36636406 PMCID: PMC9830266 DOI: 10.21037/tlcr-22-233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/11/2022] [Indexed: 12/16/2022]
Abstract
Background Malignant mesothelioma is an invasive cancer with a poor prognosis. The crude incidence rate of malignant mesothelioma in China increased throughout 2000 to 2013, which attracted attention. In order to predict the incidence trend of malignant mesothelioma in China, a Bayesian age-period-cohort (APC) prediction model was constructed using publicly available data from the National Cancer Registration Network. Methods Based on the annual reports of the national cancer registration from 2005 to 2015, the incidence trend of malignant mesothelioma from 2016 to 2030 in China was forecast using the APC Modeling and Prediction package from the Institute of Biomedical Engineering, London. Results The crude incidence rates of malignant mesothelioma decreased from 2.2 per one million person-years in 2005 to 1.6 per one million person-years in 2015. The incidence rates remained stable over the 11-year time period after age standardization. Aging was found to have a dominant effect on the trends. The Bayesian APC model showed that the crude incidence rates would increase from 1.4 per one million person-years in 2016 to 1.9 per one million person-years in 2030, and the estimated number of new incident cases would increase to 2,775 in 2030. The age-standardized incidence rate (ASR) remained steady. Conclusions In the future decade, the incidence of malignant mesothelioma may increase, but the ASR will remain stable. Considering its high degree of malignancy, malignant mesothelioma still needs to be taken seriously.
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Affiliation(s)
- Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China;,Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Chen
- National Office for Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianming Ying
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junling Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Ucer O, Kocaman N. New candidates in the differential diagnosis of malignant mesothelioma from benign mesothelial hyperplasia and adenocarcinoma; DARS2 and suprabasin. Tissue Cell 2022; 79:101920. [DOI: 10.1016/j.tice.2022.101920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022]
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Barnett SE, Herrmann A, Shaw L, Gash EN, Poptani H, Sacco JJ, Coulson JM. The Chick Embryo Xenograft Model for Malignant Pleural Mesothelioma: A Cost and Time Efficient 3Rs Model for Drug Target Evaluation. Cancers (Basel) 2022; 14:5836. [PMID: 36497318 PMCID: PMC9740959 DOI: 10.3390/cancers14235836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) has limited treatment options and poor prognosis. Frequent inactivation of the tumour suppressors BAP1, NF2 and P16 may differentially sensitise tumours to treatments. We have established chick chorioallantoic membrane (CAM) xenograft models of low-passage MPM cell lines and protocols for evaluating drug responses. Ten cell lines, representing the spectrum of histological subtypes and tumour suppressor status, were dual labelled for fluorescence/bioluminescence imaging and implanted on the CAM at E7. Bioluminescence was used to assess viability of primary tumours, which were excised at E14 for immunohistological staining or real-time PCR. All MPM cell lines engrafted efficiently forming vascularised nodules, however their size, morphology and interaction with chick cells varied. MPM phenotypes including local invasion, fibroblast recruitment, tumour angiogenesis and vascular remodelling were evident. Bioluminescence imaging could be used to reliably estimate tumour burden pre- and post-treatment, correlating with tumour weight and Ki-67 staining. In conclusion, MPM-CAM models recapitulate important features of the disease and are suitable to assess drug targets using a broad range of MPM cell lines that allow histological or genetic stratification. They are amenable to multi-modal imaging, potentially offering a time and cost-efficient, 3Rs-compliant alternative to rodent xenograft models to prioritise candidate compounds from in vitro studies.
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Affiliation(s)
- Sarah E. Barnett
- Molecular Physiology & Cell Signalling, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK
- Technology, Infrastructure & Environment Directorate, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L69 7ZX, UK
| | - Anne Herrmann
- Molecular Physiology & Cell Signalling, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK
| | - Liam Shaw
- Molecular Physiology & Cell Signalling, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK
| | - Elisabeth N. Gash
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7ZX, UK
| | - Harish Poptani
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7ZX, UK
| | - Joseph J. Sacco
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7ZX, UK
| | - Judy M. Coulson
- Molecular Physiology & Cell Signalling, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK
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Li F, Xu Z, Xie Z, Sun X, Li C, Chen Y, Xu J, Pi G. Adipose mesenchymal stem cells-derived exosomes alleviate osteoarthritis by transporting microRNA -376c-3p and targeting the WNT-beta-catenin signaling axis. Apoptosis 2022; 28:362-378. [PMID: 36396777 DOI: 10.1007/s10495-022-01787-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
Osteoarthritis (OA), one of the major diseases afflicting the elderly, is a type of degenerative joint disease related to cartilage and synovium. This study aimed to clarify the role and mechanism of adipose mesenchymal stem cell (ADSC)-derived exosomes (Exos) in OA-induced chondrocyte degradation and synovial hyperplasia, thus improving the quality of life of patients. The rat OA model, chondrocytes, synovial fibroblast models and immunofluorescence were applied to observe the in vivo and in vitro functions of human ADSC (hADSC)-derived Exos in OA and its possible regulatory signaling pathways. Bioinformatics software and luciferase reporter assay were carried out to verify the mechanism of microRNA-376c-3p (miR-376c-3p) in hADSC-derived Exos in OA in vitro. Moreover, Safranine O-Fast Green Cartilage staining, Masson staining, immunohistochemistry and immunofluorescence were conducted to verify the role of miR-376c-3p in hADSC-derived Exos in OA in vivo. hADSC-derived Exos mitigated OA-induced chondrocyte degradation and synovial fibrosis both in vivo and in vitro models by repressing the WNT-beta-catenin signaling pathway. For the mechanism exploration in vitro, miR-376c-3p was raised in hADSC-derived Exos and mediated the fibrosis of synovial fibroblasts in OA, and miR-376c-3p targeted the 3'-untranslated region of WNT3 or WNT9a. Meanwhile, the in vivo experiments also corroborated that the miR-376c-3p in hADSC-derived Exos mitigated OA-induced chondrocyte degradation and synovial fibrosis. MiR-376c-3p in hADSC-derived Exos repressed the WNT-beta-catenin pathway by targeting WNT3 or WNT9a, and then mitigating OA-induced chondrocyte degradation and synovial fibrosis, thereby providing theoretical basis for clinical implementation of treatment.
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Affiliation(s)
- Feng Li
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan, People's Republic of China.
| | - Zhiming Xu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zheng Xie
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xing Sun
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Chengxiang Li
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yangyang Chen
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Jianzhong Xu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan, People's Republic of China.
| | - Guofu Pi
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan, People's Republic of China.
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Lennartz M, Atug D, Dwertmann Rico S, Reiswich V, Viehweger F, Büscheck F, Kluth M, Hube-Magg C, Hinsch A, Bernreuther C, Sauter G, Burandt E, Marx AH, Krech T, Simon R, Minner S, Clauditz TS, Jacobsen F, Lebok P, Gorbokon N, Möller K, Steurer S, Fraune C. Analysis of More than 16,000 Human Tumor and Normal Tissues Identifies Uroplakin 3B as a Useful Diagnostic Marker for Mesothelioma and Normal Mesothelial Cells. Diagnostics (Basel) 2022; 12:2516. [PMID: 36292206 PMCID: PMC9600073 DOI: 10.3390/diagnostics12102516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 10/02/2023] Open
Abstract
Uroplakin 3B (Upk3b) is involved in stabilizing and strengthening the urothelial cell layer of the bladder. Based on RNA expression studies, Upk3b is expressed in a limited number of normal and tumor tissues. The potential use of Upk3b as a diagnostic or prognostic marker in tumor diagnosis has not yet been extensively investigated. A tissue microarray containing 17,693 samples from 151 different tumor types/subtypes and 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry. In normal tissues, Upk3b expression was largely limited to mesothelial cells, urothelial umbrella cells, and amnion cells. In tumor tissues, Upk3b was detectable in only 17 of 151 (11.3%) of tumor types. Upk3b expression was most frequent in mesotheliomas (82.1% of epithelioid and 30.8% of biphasic) and in urothelial tumors of the urinary bladder, where the positivity rate decreased from 61.9% in pTaG2 (low grade) to 58.0% in pTaG3 (high grade) and 14.6% in pT2-4 cancers. Among pT2-4 urothelial carcinomas, Upk3b staining was unrelated to tumor stage, lymph node status, and patient prognosis. Less commonly, Upk3b expression was also seen in Brenner tumors of the ovary (10.8%), as well as in four other subtypes of ovarian cancer (0.9-10.6%). Four additional tumor entities showed a weak to moderate Upk3b positivity in less than 5% of cases. In summary, Upk3b immunohistochemistry is a useful diagnostic tool for the distinction of mesotheliomas from other thoracic tumors and the visualization of normal mesothelial and umbrella cells.
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Affiliation(s)
- Maximilian Lennartz
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Dennis Atug
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | | | - Viktor Reiswich
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Florian Viehweger
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Franziska Büscheck
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Martina Kluth
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Claudia Hube-Magg
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andrea Hinsch
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Bernreuther
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Guido Sauter
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Eike Burandt
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andreas H. Marx
- Department of Pathology, Academic Hospital Fuerth, 90766 Fuerth, Germany
| | - Till Krech
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Ronald Simon
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Sarah Minner
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Till S. Clauditz
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Frank Jacobsen
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Patrick Lebok
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Natalia Gorbokon
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Katharina Möller
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Stefan Steurer
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christoph Fraune
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Huang X, Hong Y, Xie SY, Liao HL, Huang HM, Liu JH, Long WJ. Malignant peritoneal mesothelioma with massive ascites as the first symptom: A case report. World J Clin Cases 2022; 10:10317-10325. [PMID: 36246798 PMCID: PMC9561583 DOI: 10.12998/wjcc.v10.i28.10317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is an extremely rare tumor with nonspecific clinical manifestations, which is extremely difficult to diagnose. Herein, we reported a case of MPM in the abdominal cavity with massive short-term ascites as the first symptom.
CASE SUMMARY A 65-year-old woman presented to the hospital with abdominal pain, distention, and shortness of breath that persisted for 15 d. The serum CA-125 level was 1075 U/mL. The abdominal computed tomography showed massive ascites and no obvious tumor lesions. The pathological examination of the ascitic fluid showed numerous heterotypic cells with some papillary structures. The immunohistochemistry and fluorescence in situ hybridization showed the deletion of CDX2 (-), WT-1 (-), Ki-67 (about 10% +), CEA (-), Glut-1 (+++), desmin (-), PD-L1 (-), and CDKN2A (P16). The final diagnosis was MPM. The patient refused tumor cytoreductive surgery and received two cycles of cisplatin plus pemetrexed bidirectional chemotherapy. In the second cycle, she received an additional cycle of hyperthermic intraperitoneal chemotherapy and immune checkpoint inhibitor therapy due to massive recalcitrant ascites. She died of disease progression 2 mo after diagnosis.
CONCLUSION In case of massive unexplained ascites, the possibility of MPM should not be excluded to avoid misdiagnosis and delay in treatment.
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Affiliation(s)
- Xi Huang
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Yu Hong
- Department of Chinese Internal Medicine, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Si-Ya Xie
- Department of Chinese Internal Medicine, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Hui-Li Liao
- Department of Geriatrics, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Hao-Ming Huang
- Department of Emergency, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Jian-Hong Liu
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Wen-Jie Long
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
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Chapel DB, Hornick JL, Barlow J, Bueno R, Sholl LM. Clinical and molecular validation of BAP1, MTAP, P53, and Merlin immunohistochemistry in diagnosis of pleural mesothelioma. Mod Pathol 2022; 35:1383-1397. [PMID: 35459788 PMCID: PMC9529776 DOI: 10.1038/s41379-022-01081-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 12/28/2022]
Abstract
BAP1 and MTAP immunostains play an important role in diagnosis of mesothelioma, but additional markers are needed to increase sensitivity. We analyzed 84 pleural mesotheliomas (51 epithelioid, 27 biphasic, 6 sarcomatoid) by a hybrid-capture next-generation sequencing (NGS) panel including complete coverage of coding and splicing regions for BAP1, CDKN2A/MTAP, NF2, and TP53 and correlated molecular findings with diagnostic immunostains for BAP1, MTAP, Merlin, and p53, respectively. Fifty-seven reactive mesothelial proliferations served as benign comparators. Loss of BAP1, MTAP, and Merlin protein expression were, respectively, 54%, 46%, and 52% sensitive and 100% specific for mesothelioma. Two-marker immunopanels of BAP1 + MTAP, BAP1 + Merlin, and MTAP + Merlin were 79%, 85%, and 71% sensitive for mesothelioma, while a three-marker immunopanel of BAP1 + MTAP + Merlin was 90% sensitive. Diffuse (mutant-pattern) p53 immunostaining was seen in only 6 (7%) tumors but represented the only immunohistochemical abnormality in 2 cases. Null-pattern p53 was not specific for malignancy. An immunopanel of BAP1 + MTAP + Merlin + p53 was 93% sensitive for mesothelioma, and panel NGS detected a pathogenic alteration in BAP1, MTAP, NF2, and/or TP53 in 95%. Together, 83 (99%) of 84 tumors showed a diagnostic alteration by either immunohistochemistry or panel NGS. Adding Merlin to the standard BAP1 + MTAP immunopanel increases sensitivity for mesothelioma without sacrificing specificity. p53 immunohistochemistry and panel NGS with complete coverage of BAP1, CDKN2A/MTAP, TP53, and NF2 may be useful in diagnostically challenging cases.
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Affiliation(s)
- David B Chapel
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Department of Pathology, University of Michigan - Michigan Medicine, Ann Arbor, MI, 48109, USA.
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Julianne Barlow
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Raphael Bueno
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, Boston, MA, 02115, USA
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Challenges and limitation of MTAP immunohistochemistry in diagnosing desmoplastic mesothelioma/sarcomatoid pleural mesothelioma with desmoplastic features. Ann Diagn Pathol 2022; 60:152004. [DOI: 10.1016/j.anndiagpath.2022.152004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 12/24/2022]
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Fukasawa N, Agemi Y, Shiba A, Aga M, Hamakawa Y, Miyazaki K, Taniguchi Y, Misumi Y, Shimokawa T, Ono K, Hayashi H, Okamoto H. A case of slowly progressive malignant pericardial mesothelioma suggesting the involvement of BAP1 loss. Respirol Case Rep 2022; 10:e01004. [PMID: 35950141 PMCID: PMC9356387 DOI: 10.1002/rcr2.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022] Open
Abstract
Malignant pericardial mesothelioma (MPM) is a rare tumour that arises from the mesothelial cells of the pericardium. No standard treatment has been established owing to a poor treatment response; therefore, MPM has a poor prognosis. We herein report a rare case of MPM in a 70-year-old man that was diagnosed immunohistopathologically using cell block sections of pericardial fluid and in which long-term survival for more than 3 years was achieved with only periodic pericardial drainage. Immunohistopathological staining investigations, especially BRCA1-associated protein 1 (BAP1) immunostaining using cell block sections of pericardial effusion, are effective in making a diagnosis of MPM. Well-differentiated papillary mesothelioma (WDPM) with BAP1 loss progresses to MPM in the long term, showing that BAP1 loss may induce phenotypical evolution of WDPM. BAP1 loss may also progress to malignant mesothelioma in situ and then to invasive mesothelioma. BAP1 immunohistochemistry should be considered for the early diagnosis of MPM.
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Affiliation(s)
- Naoto Fukasawa
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Yoko Agemi
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Aya Shiba
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Masaharu Aga
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Yusuke Hamakawa
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Kazuhito Miyazaki
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Yuri Taniguchi
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Yuki Misumi
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Tsuneo Shimokawa
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Kyoko Ono
- Department of PathologyKanagawa Cancer CenterYokohamaJapan
| | - Hiroyuki Hayashi
- Department of PathologyYokohama Municipal Citizen's HospitalYokohamaJapan
| | - Hiroaki Okamoto
- Department of Respiratory MedicineYokohama Municipal Citizen's HospitalYokohamaJapan
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48
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Nabeshima K, Hamasaki M, Kinoshita Y, Matsumoto S, Sa-Ngiamwibool P. Update of pathological diagnosis of pleural mesothelioma using genomic-based morphological techniques, for both histological and cytological investigations. Pathol Int 2022; 72:389-401. [PMID: 35596704 DOI: 10.1111/pin.13235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
As more than 80% of pleural mesothelioma (PM) cases start with pleural effusions, diagnosis with effusion smear cytology or pleural biopsy is important. For diagnosing PM, a three-step approach is used: (1) detecting atypical cells; (2) verifying their mesothelial origin using immunohistochemistry (IHC); and (3) discriminating PM from benign mesothelial proliferations (BMP). The third step is critical for diagnosing early lesions. In small biopsy or cytologic specimens in which tumor cell fat invasion cannot be assessed, genomic-based assays, including IHC-detected BAP1 loss and fluorescence in situ hybridization (FISH)-detected homozygous deletion (HD) of CDKN2A/p16, are effective for differentiation. Both BAP1 IHC and CDKN2A FISH can equally be applied to histologic and cytologic specimens, with 100% specificity in discriminating PM from BMP. We found that methylthioadenosine phosphorylase (MTAP) loss as detected by IHC could serve as a feasible alternative in tissue and cytologic preparations for CDKN2A FISH. However, a combination including FISH was still most effective: the addition of NF2 FISH to CDKN2A FISH and BAP1 IHC yielded a greater sensitivity of close to 100% in diagnosing PM tissues. Although IHC is more feasible than FISH, owing to remaining challenges in data interpretation, caution and familiarity are warranted when diagnosing PM.
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Affiliation(s)
- Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Makoto Hamasaki
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Yoshiaki Kinoshita
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Shinji Matsumoto
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Prakasit Sa-Ngiamwibool
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan.,Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand
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49
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5-hmC loss is another useful tool in addition to BAP1 and MTAP immunostains to distinguish diffuse malignant peritoneal mesothelioma from reactive mesothelial hyperplasia in peritoneal cytology cell-blocks and biopsies. Virchows Arch 2022; 481:23-29. [DOI: 10.1007/s00428-022-03336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
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50
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Reiswich V, Akdeniz G, Lennartz M, Menz A, Chirico V, Hube-Magg C, Fraune C, Bernreuther C, Simon R, Clauditz TS, Sauter G, Uhlig R, Hinsch A, Kind S, Jacobsen F, Möller K, Steurer S, Minner S, Burandt E, Marx AH, Lebok P, Krech T, Dum D. Large-scale human tissue analysis identifies Uroplakin 1b as a putative diagnostic marker in surgical pathology. Hum Pathol 2022; 126:108-120. [PMID: 35550834 DOI: 10.1016/j.humpath.2022.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
Uroplakin 1B (Upk1b) stabilizes epithelial cells lining the bladder lumen to prevent rupturing during bladder distension. Little is known about Upk1b expression in other normal and malignant tissues. To comprehensively evaluate the potential diagnostic and prognostic utility of Upk1b expression analysis, a tissue microarray containing 14,061 samples from 127 different tumor types and subtypes and 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry. Upk1b immunostaining was found in 61 (48%) different tumor types including 50 (39%) with at least one moderately positive and 39 tumor types (31%) with at least one strongly positive tumor. Highest positivity rates were found in urothelial neoplasms (58-95%), Brenner tumors of the ovary (92%), epitheloid mesothelioma (87%), serous carcinoma of the ovary (58%) and the endometrium (53%) as well as in squamous cell carcinoma of the head and neck (18-37%), lung (39%) and esophagus (26%). In urothelial carcinoma, low Upk1b expression was linked to high grade and invasive tumor growth (p<0.0001 each) and nodal metastasis (p=0.0006). Our data suggest diagnostic applications of Upk1b immunohistochemistry in panels for the distinction of malignant mesothelioma from adenocarcinoma of the lung, urothelial carcinoma from prostatic adenocarcinoma in the bladder, or pancreatico-biliary and gastro-esophageal from colorectal adenocarcinoma.
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Affiliation(s)
- Viktor Reiswich
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gonca Akdeniz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Menz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Viktoria Chirico
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Till S Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ria Uhlig
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Hinsch
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Kind
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Möller
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas H Marx
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Pathology, Academic Hospital Fuerth, Fuerth Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck, Germany
| | - David Dum
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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