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Möller K, Gulzar T, Lennartz M, Viehweger F, Kluth M, Hube-Magg C, Bernreuther C, Bawahab AA, Simon R, Clauditz TS, Sauter G, Schlichter R, Hinsch A, Kind S, Jacobsen F, Burandt E, Frost N, Reck M, Marx AH, Krech T, Lebok P, Fraune C, Steurer S. TTF-1 is a highly sensitive but not fully specific marker for pulmonary and thyroidal cancer: a tissue microarray study evaluating more than 17,000 tumors from 152 different tumor entities. Virchows Arch 2024:10.1007/s00428-024-03926-1. [PMID: 39377914 DOI: 10.1007/s00428-024-03926-1] [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: 08/20/2024] [Revised: 08/20/2024] [Accepted: 09/06/2024] [Indexed: 10/09/2024]
Abstract
Thyroid transcription factor 1 (TTF-1) immunohistochemistry (IHC) is routinely used for the distinction of primary pulmonary adenocarcinomas. However, TTF-1 can also occur in other malignancies. A tissue microarray containing 17,772 samples from 152 different tumor types was analyzed. Napsin-A, CK20, SATB2, FABP1, and Villin-1 IHC data were available from previous studies. TTF-1 staining was seen in 82 of 152 tumor categories including thyroidal cancers (19-100%), adenocarcinomas (94%), neuroendocrine tumors (67%) of the lung, small cell neuroendocrine carcinomas (71-80%), mesenchymal tumors (up to 42%), and thymomas (39%). Comparative analysis of TTF-1 and Napsin-A revealed a sensitivity/specificity of 94%/86% (TTF-1), 87%/98% (Napsin-A), and 85%/99.1% (TTF-1 and Napsin-A) for the distinction of pulmonary adenocarcinomas. Combined analysis of TTF-1 and enteric markers revealed a positivity for TTF-1 and at least one enteric marker in 22% of pulmonary adenocarcinomas but also a TTF-1 positivity in 6% of colorectal, 2% of pancreatic, and 3% of gastric adenocarcinomas. TTF-1 is a marker of high sensitivity but insufficient specificity for pulmonary adenocarcinomas. A small fraction of TTF-1-positive gastrointestinal adenocarcinomas represents a pitfall mimicking enteric-type pulmonary adenocarcinoma. Combined analysis of TTF-1 and Napsin-A improves the specificity of pulmonary adenocarcinoma diagnosis.
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Affiliation(s)
- Katharina Möller
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Tayyaba Gulzar
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Florian Viehweger
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martina Kluth
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ahmed Abdulwahab Bawahab
- Department of Basic Medical Sciences, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Till S Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ria Schlichter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Andrea Hinsch
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Simon Kind
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Nikolaj Frost
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
| | - Andreas H Marx
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
| | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck, Germany
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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2
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Saliba M, Smithgall MC, Saqi A, Crapanzano JP, Sung S. Case of lung fine needle aspiration showing mucinous cells and extracellular mucin. Diagn Cytopathol 2024; 52:546-552. [PMID: 38409908 DOI: 10.1002/dc.25294] [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: 01/14/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
Mucinous neoplasm with extracellular mucin can be challenging to interpret on fine needle aspiration and core biopsies. Determining the biologic origin of the mucin/mucinous cells, that is, benign/incidental versus neoplasm, invasive versus in situ, and primary versus metastatic tumors, requires a thorough multidisciplinary evaluation. The work up of these lesions includes morphologic analysis with ancillary immunohistochemical and/or molecular studies and correlation with clinical and imaging studies. This review outlines a practical approach to the diagnosis of mucinous lesions in the lung with comprehensive review of literature.
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Affiliation(s)
- Maelle Saliba
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Marie C Smithgall
- Division of Molecular Pathology, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NewYork, USA
| | - Anjali Saqi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - John P Crapanzano
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Simon Sung
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
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3
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Zhong F, Wu L, Liu Z, Li W, Zhao S. Nomogram model for the diagnosis of solitary nodular pulmonary mucinous adenocarcinoma. Sci Rep 2024; 14:18085. [PMID: 39103468 PMCID: PMC11300590 DOI: 10.1038/s41598-024-69138-4] [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: 05/15/2024] [Accepted: 07/31/2024] [Indexed: 08/07/2024] Open
Abstract
The objective of this study was to develop a nomogram model based on the natural progression of tumor and other radiological features to discriminate between solitary nodular pulmonary mucinous adenocarcinoma and non-mucinous adenocarcinomas. A retrospective analysis was conducted on 15,655 cases of lung adenocarcinoma diagnosed at our institution between January 2010 and June 2023. Primary nodular invasive mucinous adenocarcinomas and non-mucinous adenocarcinomas with at least two preoperative CT scans were included. These patients were randomly assigned to training and validation sets. Univariate and multivariate analyses were employed to compare tumor growth rates and clinical radiological characteristics between the two groups in the training set. A nomogram model was constructed based on the results of multivariate analysis. The diagnostic value of the model was evaluated in both the training and validation sets using calibration curves and receiver operating characteristic curves (ROC). The study included 174 patients, with 58 cases of mucinous adenocarcinoma and 116 cases of non-mucinous adenocarcinoma. The nomogram model incorporated the maximum tumor diameter, the consolidation/tumor ratio (CTR), and the specific growth rate (SGR) to generate individual scores for each patient, which were then accumulated to obtain a total score indicative of the likelihood of developing mucinous or non-mucinous adenocarcinoma. The model demonstrated excellent discriminative ability with an area under the receiver operating characteristic curve of 0.784 for the training set and 0.833 for the testing set. The nomogram model developed in this study, integrating SGR with other radiological and clinical parameters, provides a valuable and accurate tool for differentiating between solitary nodular pulmonary mucinous adenocarcinoma and non-mucinous adenocarcinomas. This prognostic model offers a robust and objective basis for personalized management of patients with pulmonary adenocarcinomas.
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Affiliation(s)
- Feiyang Zhong
- Department of Radiology, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
- Nankai University, Tianjin, China
| | - Lijun Wu
- Department of Radiology, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Zhenxing Liu
- Department of Neurology, Yiling Hospital of Yichang City, Yichang, Hubei, China
| | - Wenping Li
- Department of Radiology, The Sixth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Shaohong Zhao
- Department of Radiology, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
- Nankai University, Tianjin, China.
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4
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Beauchamp K, Moran B, O'Brien T, Brennan D, Crown J, Sheahan K, Cotter MB. Carcinoma of unknown primary (CUP): an update for histopathologists. Cancer Metastasis Rev 2023; 42:1189-1200. [PMID: 37394540 PMCID: PMC10713813 DOI: 10.1007/s10555-023-10101-6] [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: 01/18/2023] [Accepted: 04/03/2023] [Indexed: 07/04/2023]
Abstract
Carcinoma of unknown primary (CUP) is a heterogeneous group of metastatic cancers in which the site of origin is not identifiable. These carcinomas have a poor outcome due to their late presentation with metastatic disease, difficulty in identifying the origin and delay in treatment. The aim of the pathologist is to broadly classify and subtype the cancer and, where possible, to confirm the likely primary site as this information best predicts patient outcome and guides treatment. In this review, we provide histopathologists with diagnostic practice points which contribute to identifying the primary origin in such cases. We present the current clinical evaluation and management from the point of view of the oncologist. We discuss the role of the pathologist in the diagnostic pathway including the control of pre-analytical conditions, assessment of sample adequacy, diagnosis of cancer including diagnostic pitfalls, and evaluation of prognostic and predictive markers. An integrated diagnostic report is ideal in cases of CUP, with results discussed at a forum such as a molecular tumour board and matched with targeted treatment. This highly specialized evolving area ultimately leads to personalized oncology and potentially improved outcomes for patients.
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Affiliation(s)
- Katie Beauchamp
- Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Bruce Moran
- Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Timothy O'Brien
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Donal Brennan
- Systems Biology Ireland, UCD School of Medicine, Belfield, Dublin4, Ireland
- UCD Gynaecological Oncology Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Kieran Sheahan
- Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Maura Bríd Cotter
- Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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5
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Lin YT, Lin CH, Wang SC, Huang YJ, Wu RC, Lee CS, Chang CH. Mucinous Adenocarcinoma of the Lung Diagnosed by Radial Endobronchial Ultrasound-guided Bronchoscopic Cryobiopsy and Presenting as Interstitial Lung Disease in a Patient with Systemic Sclerosis. J Med Ultrasound 2023; 31:314-317. [PMID: 38264591 PMCID: PMC10802878 DOI: 10.4103/jmu.jmu_56_22] [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: 05/30/2022] [Revised: 07/10/2022] [Accepted: 08/09/2022] [Indexed: 01/25/2024] Open
Abstract
We report a patient with systemic sclerosis who was diagnosed with advanced-stage mucinous adenocarcinoma of the lungs. The clinical presentation, imaging findings, pathological results, and molecular diagnoses are presented. A 64-year-old woman with systemic sclerosis was administered prednisolone and hydroxychloroquine sulfate to control her disease. High-resolution computed tomography (HRCT) revealed an interstitial pattern in both lungs during annual imaging. Connective tissue disease-associated interstitial lung disease (CTD-ILD) was diagnosed using blood tests, pulmonary function tests, and imaging findings. One year later, the patient underwent follow-up chest HRCT, which showed progressive lung disease. The patient underwent endobronchial ultrasound (EBUS)-guided transbronchial lung cryobiopsy and computed tomography-guided biopsy for a pathological diagnosis. The pathology reports of bilateral lungs disclosed mucinous adenocarcinoma. After tumor staging and mutation testing, the patient received chemotherapy with pemetrexed and cisplatin. The bilateral lung lesions subsided after four cycles of first-line chemotherapy. Patients with CTD and lung involvement may be diagnosed with CTD-ILD. Although histopathological results are not mandatory for ILD diagnosis, EBUS-guided transbronchial lung biopsy or lung cryobiopsy should be considered when ILD has atypical or unexplained features.
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Affiliation(s)
- Yan-Ting Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
| | - Chiung-Hung Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
| | - Shao-Chung Wang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Ju Huang
- Department of Allergy, Immunology, Rheumatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Shu Lee
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
| | - Chih-Hao Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
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6
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Wu F, Jiang R, Zhu W, Zuo Z, Du F, Yun H, Wang P. Misdiagnosis of giant pulmonary mucinous adenocarcinoma in a posterior mediastinum mass: a case description and literature analysis. Quant Imaging Med Surg 2023; 13:7385-7391. [PMID: 37869354 PMCID: PMC10585517 DOI: 10.21037/qims-23-141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/09/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Fa Wu
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Rui Jiang
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Wei Zhu
- The Second People’s Hospital of Deyang City, Deyang, China
| | - Zhiwei Zuo
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Feizhou Du
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Hailong Yun
- Department of Pathology, The General Hospital of Western Theater Command, Chengdu, China
| | - Peng Wang
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
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7
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Xu M, Hao Y, Zhou H, Shi Z, Si J, Song Z. Comparison of the immunotherapy efficacy between invasive mucinous and non-mucinous adenocarcinoma in advanced lung cancer patients with KRAS mutation: a retrospective study. Med Oncol 2023; 40:198. [PMID: 37294384 DOI: 10.1007/s12032-023-02059-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/20/2023] [Indexed: 06/10/2023]
Abstract
Invasive mucinous adenocarcinoma (IMA) is a rare variant of adenocarcinoma with unique clinical, radiological, and pathological features, among which KRAS mutation is the most common. However, the differences in the efficacy of immunotherapy between KRAS-positive IMA and invasive non-mucinous adenocarcinoma (INMA) patients remain unclear. Patients with KRAS mutated adenocarcinomas receiving immunotherapy between June 2016 and December 2022 were enrolled. Based on mucin-producing status, the patients were placed into two subgroups: the IMA group and INMA group. Patients with IMA were further classified into two subtypes according to the presence of mucin patterns: pure IMA (≥ 90%) and mixed mucinous/nonmucinous adenocarcinoma (≥ 10% of each histological component). Kaplan-Meier Curves and log-rank tests were used to analyze survival. Cox regression analysis of PFS were used to analyze the independent factors associated with efficacy. Sixty-five advanced adenocarcinoma patients with KRAS mutations received immunotherapy, including 24 patients with IMA and 41 with INMA. The median progression-free survival (PFS) was 7.7 months, whereas the median overall survival (OS) was 24.0 months. Significant difference in PFS could be observed in IMA and INMA (3.5 months vs. 8.9 months; P = 0.047). Patients with pure IMA tended toward prolonger survival in contrast to mixed mucinous/nonmucinous adenocarcinoma in PFS (8.4 months vs. 2.3 months; P = 0.349). The multivariable analysis demonstrated that IMA was an independent risk factor for PFS. In KRAS mutated patients, IMA was associated with poorer PFS after immunotherapy compared with INMA.
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Affiliation(s)
- Manyi Xu
- The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, People's Republic of China
- Department of Clinical Trail, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People's Republic of China
| | - Yue Hao
- The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, People's Republic of China
- Department of Clinical Trail, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People's Republic of China
| | - Huan Zhou
- The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, People's Republic of China
- Department of Clinical Trail, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People's Republic of China
| | - Zheng Shi
- Department of Clinical Trail, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People's Republic of China
| | - Jinfei Si
- The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, People's Republic of China
- Department of Clinical Trail, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People's Republic of China
| | - Zhengbo Song
- Department of Clinical Trail, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China.
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People's Republic of China.
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8
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Jung M. Mucinous carcinoma of the breast: distinctive histopathologic and genetic characteristics. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.22.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Mucinous carcinoma is a rare histologic type of breast cancer that, when classified with favorable histology, can be treated with different therapeutic options. This study reviews the histologic findings of mucinous carcinoma that support or exclude favorable histology and emphasizes the necessity of an appropriate gross examination with radiologic findings for an accurate diagnosis. In addition, unusual findings such as micropapillary arrangements and lobular differentiation in mucinous carcinoma and their implications for prognosis and treatment are reviewed. Mucinous carcinoma involves upregulation of MUC2, a mucus-associated gene common in mucinous carcinoma of the breast as well as various other organs. In mucinous carcinoma, the fraction of genome altered and tumor mutation burden are lower than those of invasive carcinoma of no special type, the most common histology of breast cancer. In addition, the genetic alterations found in mucinous carcinoma are diverse, unlike the pathognomonic genetic alterations observed in other histologic types of breast cancer. These genetic features support the importance of conventional microscopic evaluations for the pathologic differential diagnosis of mucinous carcinoma of the breast in routine practice. A variety of breast lesions, including mucinous cystadenocarcinoma and mucocele-like lesions, as well as mucinous carcinoma from other organs, can mimic mucinous carcinoma of the breast. In order to obtain an accurate pathologic diagnosis, careful evaluation of the overall histopathologic characteristics and ancillary testing are required to provide information on appropriate treatment and prognosis.
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9
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Bradbury M, Akurang D, Nasser A, Moore S, Sekhon HS, Wheatley-Price P. Clinicopathological features of pulmonary mucinous adenocarcinoma: A descriptive analysis. Cancer Treat Res Commun 2022; 32:100570. [PMID: 35523040 DOI: 10.1016/j.ctarc.2022.100570] [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: 03/29/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Mucinous adenocarcinoma is a rare subtype of lung cancer characterized by abnormal mucin production. We sought to investigate the clinical and pathological features of pulmonary mucinous adenocarcinomas and to identify prognostic factors. METHODS This was a single-institution retrospective review of patients with pulmonary mucinous adenocarcinoma diagnosed between January 1, 2015 and December 31, 2020. Descriptive analysis included demographics, diagnostic data, and treatment modalities. The primary outcome was overall survival (OS). RESULTS Fifty-six patients were included in the study. Median age was 65 years (range: 26-84), 30 (54%) were female, 48 (86%) had a smoking history, and 41 (73%) patients had ECOG performance status 0-1. Nearly half (26, 46%) were stage IV at presentation, while 11 (20%) presented as stage I, 10 (18%) stage II, and 9 (16%) stage III. Biomarker testing increased through the study period. Where performed, 4/48 (8%) cases were ALK positive, but there were no EGFR cases identified (0/36). Only 3/20 cases had PD-L1 expression >50%. Curative intent therapy was performed in 23 patients (17 had surgery +/- chemotherapy/radiation, 4 had radiotherapy alone, 2 had chemoradiation). Median OS in the entire population was 16.1 months (m). OS by stage was 50.0m for stage I, not reached for stage II, 20.7m for stage III, and 8.1m for stage IV. CONCLUSIONS The overall prognosis of pulmonary mucinous adenocarcinoma appears similar to that of non-mucinous adenocarcinomas, with distinct differences noted in the incidence of oncogenic driver mutations, particularly an absence of EGFR mutations.
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Affiliation(s)
- Michelle Bradbury
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | | | - Abdullah Nasser
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Sara Moore
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Harmanjatinder S Sekhon
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Paul Wheatley-Price
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada; Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada.
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10
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Han Y, Luo Y. Primary lung invasive adenocarcinoma misdiagnosed as infectious pneumonia in 18F-FDG PET/CT:A case report. Radiol Case Rep 2022; 17:808-811. [PMID: 35024081 PMCID: PMC8733036 DOI: 10.1016/j.radcr.2021.12.023] [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: 11/25/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
A 64-year-old woman presented to our hospital with cough and a large amount of white foam sputum, F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) showed diffuse ground-glass opacities in both lungs, which was considered as infectious pneumonia. However, after ineffective anti-infection, the primary invasive mucinous adenocarcinoma was finally diagnosed. Pulmonary invasive mucinous adenocarcinoma is rare and special subtype of lung adenocarcinoma, it has a variety of imaging manifestations. When intense tracer uptake, air bronchial sign, honeycomb sign present in diffuse ground-glass opacities in F-FDG PET/CT, lung invasive mucinous adenocarcinoma should be highly suspected.
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Affiliation(s)
- Yuping Han
- Department of Nuclear Medicine, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China
| | - Yongjun Luo
- Department of Nuclear Medicine, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China
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11
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Metastatic Cancer of Apparent Colon Origin With No Intraluminal Cancer After Resection of Colorectal Lateral Spreading Lesions. ACG Case Rep J 2022; 9:e00716. [PMID: 34977261 PMCID: PMC8716091 DOI: 10.14309/crj.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
We report a case of metastatic adenocarcinoma to the liver that presented 5 months after piecemeal endoscopic mucosal resection of 3 benign lateral spreading adenomas in the cecum. The pathologic features of the metastatic cancer indicated a probable colonic origin. However, when the cancer was identified, there was no endoscopic evidence of recurrent polyp or another primary lesion in the colon.
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12
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Gu R, Shi Z, Duan T, Song M. Feasibility and Safety of Neoadjuvant Alectinib in Pulmonary Invasive Mucinous Adenocarcinoma with ALK Rearrangement: Case Report and Literature Review. Onco Targets Ther 2021; 14:5107-5113. [PMID: 34707369 PMCID: PMC8544264 DOI: 10.2147/ott.s334213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background Pulmonary invasive mucinous adenocarcinoma (IMA) is a rare variant of lung adenocarcinoma that rarely shows anaplastic lymphoma kinase (ALK) rearrangement. Alectinib (tyrosine kinase inhibitors) has been listed as category 1 recommendations for advanced ALK + NSCLC first-line therapy due to low toxicity and excellent efficacy, and its median progression-free survival is 34.8 months. Here, we report a case of a patient with ALK-rearranged lung IMA who showed favorable results to neoadjuvant alectinib. Case A 67-year-old man with no history of smoking was diagnosed with clinical stage as IIIB invasive mucinous adenocarcinoma based on clinical symptoms, chest CT and pathological findings. The anaplastic lymphoma kinase (ALK) fusion status was assessed by real-time PCR. After acquiring informed consent from the patient, we offered neoadjuvant alectinib at a dosage of 150 mg twice per day for three cycles (84 days), all lesions were undetectable on chest CT. Later, a thoracoscopic left lobectomy was performed. The postoperative pathological showed that a small amount of tumor cells remained, and the TNM stage was downstaged as T1aN0M0 IA. Conclusion To our knowledge, this is the first case discussing the treatment of ALK-rearranged IMA of the lung with neoadjuvant alectinib. Alectinib is an effective ALK inhibitor, and in cases of lung adenocarcinoma with ALK rearrangement, alectinib treatment is a reasonable and priority option. Neoadjuvant alectinib may be clinically feasible and well tolerated in locally advanced NSCLC.
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Affiliation(s)
- Rumeng Gu
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.,Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, People's Republic of China
| | - Ziling Shi
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.,Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, People's Republic of China
| | - Ting Duan
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Meijun Song
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
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Aoki T, Kondo Y, Karakida K, Naito H, Kajiwara H, Ota Y. A mucinous adenocarcinoma of the lip with elevated serum carcinoembryonic antigen levels: a case report. Oral Maxillofac Surg 2020; 24:127-132. [PMID: 31828452 DOI: 10.1007/s10006-019-00818-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mucinous adenocarcinoma (MAC) rarely occurs in the salivary glands, especially in the labial gland. MACs arising from the salivary glands are characterized by an aggressive behavior due to high invasiveness and a high rate of regional lymph node metastasis. CASE PRESENTATION Here, we report a case of MAC arising from the lower lip, shown to have elevated serum carcinoembryonic antigen (CEA) levels by the medical checkup. The tumor showed aggressive behavior and serum CEA levels increased with repeated recurrence. CEA has been shown to have surprisingly diverse functions in cell adhesion, intracellular and intercellular signaling, and complex biological processes such as cancer progression, inflammation, angiogenesis, and metastasis. A MAC arising from the salivary glands may have a poor prognosis because CEA is highly expressed. CONCLUSIONS Generally, serum CEA levels have not been used as tumor markers for salivary gland malignancies; however, it may be useful for MAC arising from salivary glands. We recommend prospective research to determine whether serum CEA estimation is useful as a component of routine pre-treatment workup for MACs arising from the salivary glands.
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Affiliation(s)
- Takayuki Aoki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Yusuke Kondo
- Department of Pathology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kazunari Karakida
- Department of Oral and Maxillofacial Surgery, Tokai University Hachioji Hospital, 1838 Ishikawamachi, Hachioji, Tokyo, 192-0032, Japan
| | - Hiroyuki Naito
- Department of Oral and Maxillofacial Surgery, Iwaki City Medical Center, 16 Uchigo-Mimayamachi-Kusehara, Iwaki, Fukushima, 973-8555, Japan
| | - Hiroshi Kajiwara
- Department of Pathology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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14
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Chen Z, Li M, Ma K, Shang G, Liang J, Yin J, Luo J, Zhan C, Shi Y, Wang Q. Analysis of the clinicopathological characteristics, genetic phenotypes, and prognostic of pure mucinous adenocarcinoma. Cancer Med 2019; 9:517-529. [PMID: 31769218 PMCID: PMC6970056 DOI: 10.1002/cam4.2726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/15/2019] [Accepted: 11/09/2019] [Indexed: 12/25/2022] Open
Abstract
Background Primary pure mucinous adenocarcinoma of the lung (PMA) is a rare subtype. However, correlations between clinicopathological features and genetic phenotypes with survival have not been described comprehensively. Methods Pure mucinous adenocarcinoma patient information collected from the Surveillance, Epidemiology, and End Results (SEER) database, the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University (FDZSH), and the Cancer Genome Atlas (TCGA) were extracted, evaluated, and compared with other lung adenocarcinomas (LUAD) patient data. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were performed to explore the functional importance of underlying molecular changes. Overall survival (OS) was evaluated with the Kaplan‐Meier method. Univariate and multivariate analysis through Cox proportional hazard regression identified risk factors that predicted OS, and the results were used to construct a nomogram to predict OS for PMA patients. Results Overall, 3622 patients, 41 patients, and 15 patients with PMA were identified from the SEER, FDZSH, and TCGA databases, respectively. There were 345 differentially expressed genes, 30 differentially mutated genes and 72 differentially methylated genes were identified between PMA and other LUAD samples. In the SEER database, PMA had a better prognosis compared to other LUAD. Compared with patients with other LUAD, patients with PMA exhibited unique clinicopathological features, including fewer grade III/IV tumors, less pleural invasion, more early‐stage cancer, and more lower lobe carcinomas. Multivariate analyses showed that age, race, T stage, N stage, surgery, and chemotherapy were independent risk factors. The nomogram had a calibration index of 0.724. Conclusions Our research identified unique clinicopathological characteristics and genetic phenotypes for PMA and other LUAD. The nomogram accurately predicted OS.
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Affiliation(s)
- Zhencong Chen
- Department of Thoracic of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Li
- Department of Thoracic of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ke Ma
- Department of Thoracic of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guoguo Shang
- Department of Pathology of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Liang
- Department of Thoracic of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiacheng Yin
- Department of Thoracic of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jizhuang Luo
- Department of Thoracic of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Shi
- Department of Thoracic of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic of Zhongshan Hospital, Fudan University, Shanghai, China
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15
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Annexin A2 Expression in Aerogenous Metastasis of Pulmonary Invasive Mucinous Adenocarcinoma: A Case Report including Immunohistochemical Analysis. Case Rep Oncol Med 2019; 2019:5064852. [PMID: 31485361 PMCID: PMC6702807 DOI: 10.1155/2019/5064852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/24/2019] [Indexed: 12/15/2022] Open
Abstract
Aerogenous metastasis (AM) is a form of lung cancer that spreads in a unique fashion, but its mechanisms are still unclear. Annexin A2 (ANX A2), a membrane-binding protein, promotes cancer invasion and is involved in cell adhesion and polarity. The relationship between ANX A2 and cancers with poor stromal invasion capacity has not been studied. We immunohistochemically analyzed ANX A2 expression in AM observed in a patient with pulmonary invasive mucinous adenocarcinoma. In the primary site, ANX A2 immunopositivity on the cell-cell borders weakened as tumor cells projected and separated into alveolar spaces. In AM, tumor cell aggregates with ANX A2 immunopositivity near the surface and within the cytoplasm attached to alveolar epithelial cells, then engulfed them and formed a protrusion. As tumor cell aggregates adhered to the alveolar wall and formed a single layer, cytoplasmic ANX A2-positive products accumulated in the lateral sides of the tumor cells and exhibited distinct membranous positivity. These results indicated that ANX A2 near the tumor cell surface was related to alveolar wall attachment. Furthermore, the translocation of cytoplasmic ANX A2 to cell-cell borders changed cell morphology, adhesion, and polarity restoration.
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16
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Shang G, Jin Y, Zheng Q, Shen X, Yang M, Li Y, Zhang L. Histology and oncogenic driver alterations of lung adenocarcinoma in Chinese. Am J Cancer Res 2019; 9:1212-1223. [PMID: 31285953 PMCID: PMC6610061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 05/21/2019] [Indexed: 06/09/2023] Open
Abstract
Little is known about association of mucin abundancy with oncogenic-driver alterations, immunohistochemical and clinicopathologic features in lung adenocarcinomas among Chinese. We here retrospectively examined the clinicopathologic and molecular characteristics of pulmonary mucin-producing adenocarcinoma (PMPA) and previously-reported non-mucinous lung adenocarcinomas collected at our institution. Among the 897 non-mucinous adenocarcinomas, 61 PMPA with ≤90% mucin and 39 PMPA with >90% mucin, ALK rearrangements were found in 47 (5.2%) non-mucinous adenocarcinomas, 9 (14.8%) PMPA with ≤90% mucin and 12 (30.8%) PMPA with >90% mucin, respectively, with an ordinal association (coefficient, 95% CI=0.11, 0.06 to 0.17). Similarly, KRAS mutations was found in 53 (5.9%) non-mucinous adenocarcinomas, 7 (11.5%) PMPA with ≤90% mucin and 14 (35.9%) PMPA with >90% mucin (coefficient, 95% CI=0.11, 0.05 to 0.16). However, mucinous abundancy was inversely, ordinally linked to the EGFR mutations (coefficient, 95% CI=-0.28, -0.33 to -0.22). Mucin abundancy seemed not associated with the alterations of HER2, BRAF, ROS1, MET and RET. We divided PMPA with >90% mucin into three histologic types, namely columnar mucinous cell with basal nuclei (type I, n=11), cuboidal cell with goblet cell feature (type II, n=16) and mucinous cribriform pattern (type III, n=12). These histologic subtypes were associated with alterations of ALK, KRAS and MET, and the immunohistochemical reactivity of MUC1, MUC2, MUC5ac, MUC6, TTF-1 and CK20, including high positive rate of MUC6 (90.9%) and CK20 (36.4%) in type I, MUC2 (50%) in type II and MUC1 (100%) in type III. In summary, mucin abundancy is associated with immunohistochemical and oncogenic-driver profiles of lung adenocarcinomas among Chinese.
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Affiliation(s)
- Guoguo Shang
- Department of Pathology, Fudan University Shanghai Cancer CenterShanghai, China
- Department of Oncology, Shanghai Medical College, Fudan UniversityShanghai, China
- Department of Pathology, Fudan University Zhongshan HospitalShanghai, China
| | - Yan Jin
- Department of Pathology, Fudan University Shanghai Cancer CenterShanghai, China
- Department of Oncology, Shanghai Medical College, Fudan UniversityShanghai, China
| | - Qiang Zheng
- Department of Pathology, Fudan University Shanghai Cancer CenterShanghai, China
- Department of Oncology, Shanghai Medical College, Fudan UniversityShanghai, China
| | - Xuxia Shen
- Department of Pathology, Fudan University Shanghai Cancer CenterShanghai, China
- Department of Oncology, Shanghai Medical College, Fudan UniversityShanghai, China
| | - Mu Yang
- Department of Pathology, Shanghai First People’s Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
| | - Yuan Li
- Department of Pathology, Fudan University Shanghai Cancer CenterShanghai, China
- Department of Oncology, Shanghai Medical College, Fudan UniversityShanghai, China
| | - Lanjing Zhang
- Department of Biological Sciences, Rutgers UniversityNewark, NJ, USA
- Department of Pathology, Princeton Medical CenterPlainsboro, NJ, USA
- Rutgers Cancer Institute of New JerseyNew Brunswick, NJ, USA
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers UniversityPiscataway, NJ, USA
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