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Deng H. Utility of Immunohistochemistry in the Diagnosis of Pleuropulmonary and Mediastinal Cancers: A Review and Update. Arch Pathol Lab Med 2024; 148:267-283. [PMID: 37406295 DOI: 10.5858/arpa.2022-0483-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: 04/04/2023] [Indexed: 07/07/2023]
Abstract
CONTEXT.— Immunohistochemistry has become a valuable ancillary tool for the accurate classification of pleuropulmonary and mediastinal neoplasms necessary for therapeutic decisions and predicting prognostic outcome. Diagnostic accuracy has significantly improved because of the continuous discoveries of tumor-associated biomarkers and the development of effective immunohistochemical panels. OBJECTIVE.— To increase the accuracy of diagnosis and classify pleuropulmonary neoplasms through immunohistochemistry. DATA SOURCES.— Literature review and the author's research data and personal practice experience. CONCLUSIONS.— This review article highlights that appropriately selecting immunohistochemical panels enables pathologists to effectively diagnose most primary pleuropulmonary neoplasms and differentiate primary lung tumors from a variety of metastatic tumors to the lung. Knowing the utilities and pitfalls of each tumor-associated biomarker is essential to avoid potential diagnostic errors.
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Affiliation(s)
- Hongbing Deng
- From the Department of Pathology, Geisinger Commonwealth Medical School and Pathology, Geisinger Wyoming Valley Medical Center, Geisinger Health System, Wilkes-Barre, Pennsylvania
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2
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Tripathi N, Jo Y, Tripathi A, Sayegh N, Li H, Nussenzveig R, Haaland B, Thomas VM, Gupta S, Maughan BL, Swami U, Pal SK, Grivas P, Agarwal N, Sirohi D. Genomic landscape of locally advanced or metastatic urothelial carcinoma with squamous differentiation compared to pure urothelial carcinoma. Urol Oncol 2022; 40:493.e1-493.e7. [DOI: 10.1016/j.urolonc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/01/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022]
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Characterization of Desmoglein 3 (DSG3) as a Sensitive and Specific Marker for Esophageal Squamous Cell Carcinoma. Gastroenterol Res Pract 2022; 2022:2220940. [PMID: 35251162 PMCID: PMC8894070 DOI: 10.1155/2022/2220940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
Although P40 and P63 are both sensitive and specific for routine esophageal squamous cell carcinoma (SCC) diagnosis, we recently showed that P40 and P63 immunoreactivities were significantly lower in well-differentiated SCC than those in higher grade tumors. Therefore, a novel esophageal SCC marker, ideally performing better in well-differentiated SCC, is still needed. We characterized desmoglein 3 (DSG3) immunohistochemistry in esophageal SCC, esophageal adenocarcinoma, small-cell lung carcinoma, and large B-cell lymphoma, alongside P40 and CK5/6. The World Health Organization classification was used to grade tumors as well-differentiated (WD), moderately differentiated (MD), or poorly differentiated (PD). There were 20 WD, 26 MD, and 17 PD components among 39 esophageal SCC cases. All esophageal SCC components showed significant DSG3 immunoreactivity (mean, 80%; range, 30%–100%), and the proportions of DSG3 immunoreactive cells were higher in the WD and MD components than in the PD components. No esophageal adenocarcinoma cases showed more than 10% DSG3 immunoreactivity with only weak cytoplasmic staining. With a 5% immunoreactivity cutoff, DSG3 positivity was 100% in all 63 SCC components, 18% in adenocarcinoma cases, and 0% in small-cell lung carcinoma or large B-cell lymphoma cases. The overall DSG3 specificity was 94%. To the best of our knowledge, this is the first study to characterize DSG3 as a sensitive and specific marker for esophageal SCC.
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Ericson Lindquist K, Gudinaviciene I, Mylona N, Urdar R, Lianou M, Darai-Ramqvist E, Haglund F, Béndek M, Bardoczi E, Dobra K, Brunnström H. Real-World Diagnostic Accuracy and Use of Immunohistochemical Markers in Lung Cancer Diagnostics. Biomolecules 2021; 11:biom11111721. [PMID: 34827719 PMCID: PMC8615395 DOI: 10.3390/biom11111721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives: Accurate and reliable diagnostics are crucial as histopathological type influences selection of treatment in lung cancer. The aim of this study was to evaluate real-world accuracy and use of immunohistochemical (IHC) staining in lung cancer diagnostics. Materials and Methods: The diagnosis and used IHC stains for small specimens with lung cancer on follow-up resection were retrospectively investigated for a 15-month period at two major sites in Sweden. Additionally, 10 pathologists individually suggested diagnostic IHC staining for 15 scanned bronchial and lung biopsies and cytological specimens. Results: In 16 (4.7%) of 338 lung cancer cases, a discordant diagnosis of potential clinical relevance was seen between a small specimen and the follow-up resection. In half of the cases, there was a different small specimen from the same investigational work-up with a concordant diagnosis. Diagnostic inaccuracy was often related to a squamous marker not included in the IHC panel (also seen for the scanned cases), the case being a neuroendocrine tumor, thyroid transcription factor-1 (TTF-1) expression in squamous cell carcinomas (with clone SPT24), or poor differentiation. IHC was used in about 95% of cases, with a higher number of stains in biopsies and in squamous cell carcinomas and especially neuroendocrine tumors. Pre-surgical transthoracic samples were more often diagnostic than bronchoscopic ones (72–85% vs. 9–53% for prevalent types). Conclusions: Although a high overall diagnostic accuracy of small specimens was seen, small changes in routine practice (such as consequent inclusion of p40 and TTF-1 clone 8G7G3/1 in the IHC panel for non-small cell cancer with unclear morphology) may lead to improvement, while reducing the number of IHC stains would be preferable from a time and cost perspective.
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Affiliation(s)
- Kajsa Ericson Lindquist
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
- Division of Pathology, Department of Clinical Sciences, Lund University, SE-221 00 Lund, Sweden
| | - Inga Gudinaviciene
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
| | - Nektaria Mylona
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
| | - Rodrigo Urdar
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
| | - Maria Lianou
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
| | - Eva Darai-Ramqvist
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (E.D.-R.); (F.H.)
| | - Felix Haglund
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (E.D.-R.); (F.H.)
- Department of Oncology-Pathology, Karolinska Institute, SE-171 77 Stockholm, Sweden
| | - Mátyás Béndek
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden; (M.B.); (E.B.); (K.D.)
| | - Erika Bardoczi
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden; (M.B.); (E.B.); (K.D.)
| | - Katalin Dobra
- Department of Clinical Pathology and Cytology, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden; (M.B.); (E.B.); (K.D.)
- Division of Laboratory Medicine, Department of Pathology, Karolinska Institute, SE-141 86 Stockholm, Sweden
| | - Hans Brunnström
- Department of Genetics and Pathology, Laboratory Medicine Region Skåne, SE-221 85 Lund, Sweden; (K.E.L.); (I.G.); (N.M.); (R.U.); (M.L.)
- Division of Pathology, Department of Clinical Sciences, Lund University, SE-221 00 Lund, Sweden
- Correspondence: ; Tel.: +46-046-4617-3510
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Jeong JH, Kim NY, Pyo JS. Analysis of PAX8 immunohistochemistry in lung cancers: a meta-analysis. J Pathol Transl Med 2020; 54:300-309. [PMID: 32702943 PMCID: PMC7385260 DOI: 10.4132/jptm.2020.06.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/24/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In this meta-analysis, we aimed to evaluate the PAX8 immunohistochemical expressions in primary lung cancers and metastatic cancers to the lung. METHODS We identified and reviewed relevant articles from the PubMed databases. Ultimately, 18 articles were included in this meta-analysis. PAX8 expression rates were analyzed and compared between primary and metastatic lung cancers. RESULTS The PAX8 expression rate in primary lung cancers was 0.042 (95% confidence interval [CI], 0.025 to 0.071). PAX8 expression rates of small cell (0.129; 95% CI, 0.022 to 0.496) and non-small cell carcinomas of the lung (0.037; 95% CI, 0.022 to 0.061) were significantly different (p=.049 in a meta-regression test). However, the PAX8 expression rates of adenocarcinoma (0.013; 95% CI, 0.006 to 0.031) and squamous cell carcinoma (0.040; 95% CI, 0.016 to 0.097) were not significantly different. PAX8 expression rates of metastatic carcinomas to the lung varied, ranging from 1.8% to 94.9%. Metastatic carcinomas from the lung to other organs had a PAX8 expression rate of 6.3%. The PAX8 expression rates of metastatic carcinomas from the female genital organs, kidneys, and thyroid gland to the lung were higher than those of other metastatic carcinomas. CONCLUSIONS Primary lung cancers had a low PAX8 expression rate regardless of tumor subtype. However, the PAX8 expression rates of metastatic carcinomas from the female genital organs, kidneys, and thyroid were significantly higher than those of primary lung cancers.
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Affiliation(s)
- Jae Han Jeong
- Department of Thoracic and Cardiovascular Surgery, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
| | - Nae Yu Kim
- Department of Internal Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jung-Soo Pyo
- Department of Pathology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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6
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An Algorithmic Immunohistochemical Approach to Define Tumor Type and Assign Site of Origin. Adv Anat Pathol 2020; 27:114-163. [PMID: 32205473 DOI: 10.1097/pap.0000000000000256] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immunohistochemistry represents an indispensable complement to an epidemiology and morphology-driven approach to tumor diagnosis and site of origin assignment. This review reflects the state of my current practice, based on 15-years' experience in Pathology and a deep-dive into the literature, always striving to be better equipped to answer the age old questions, "What is it, and where is it from?" The tables and figures in this manuscript are the ones I "pull up on the computer" when I am teaching at the microscope and turn to myself when I am (frequently) stuck. This field is so exciting because I firmly believe that, through the application of next-generation immunohistochemistry, we can provide better answers than ever before. Specific topics covered in this review include (1) broad tumor classification and associated screening markers; (2) the role of cancer epidemiology in determining pretest probability; (3) broad-spectrum epithelial markers; (4) noncanonical expression of broad tumor class screening markers; (5) a morphologic pattern-based approach to poorly to undifferentiated malignant neoplasms; (6) a morphologic and immunohistochemical approach to define 4 main carcinoma types; (7) CK7/CK20 coordinate expression; (8) added value of semiquantitative immunohistochemical stain assessment; algorithmic immunohistochemical approaches to (9) "garden variety" adenocarcinomas presenting in the liver, (10) large polygonal cell adenocarcinomas, (11) the distinction of primary surface ovarian epithelial tumors with mucinous features from metastasis, (12) tumors presenting at alternative anatomic sites, (13) squamous cell carcinoma versus urothelial carcinoma, and neuroendocrine neoplasms, including (14) the distinction of pheochromocytoma/paraganglioma from well-differentiated neuroendocrine tumor, site of origin assignment in (15) well-differentiated neuroendocrine tumor and (16) poorly differentiated neuroendocrine carcinoma, and (17) the distinction of well-differentiated neuroendocrine tumor G3 from poorly differentiated neuroendocrine carcinoma; it concludes with (18) a discussion of diagnostic considerations in the broad-spectrum keratin/CD45/S-100-"triple-negative" neoplasm.
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7
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Roberts EA, Morrison LE, Behman LJ, Draganova-Tacheva R, O'Neill R, Solomides CC. Chromogenic immunohistochemical quadruplex provides accurate diagnostic differentiation of non-small cell lung cancer. Ann Diagn Pathol 2019; 45:151454. [PMID: 31923744 DOI: 10.1016/j.anndiagpath.2019.151454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 12/21/2022]
Abstract
Lung cancer is the most common cancer worldwide and has the highest mortality rate. Carcinomas comprise 95% of all lung malignancies, the vast majority of which are non-small cell lung carcinomas (NSCLC). Increasingly, the diagnosis of lung cancer is established by examination of small tissue specimens obtained by minimally invasive techniques. It is critical to employ these tissues at maximum efficiency in order to render an accurate pathologic diagnosis and to perform theranostic studies, either genomic or by immunohistochemistry, to demonstrate genetic mutations that make patients eligible for molecularly targeted agents. Currently Thyroid Transcription Factor-1 (TTF-1) and Napsin A are the most commonly used immunohistochemical (IHC) stains to identify primary lung adenocarcinoma, and p40 and cytokeratin 5/6 (CK5/6) are used for squamous cell carcinoma. IHC stains for these markers, are performed either individually (IHC brown staining) or in combination as dual immunostains (i.e. TTF-1 + Napsin A and p40 + CK5/6, utilizing brown and red chromogens). Here we present a novel, truly multiplex immunohistochemical approach that combines staining with the above four antibodies on a single tissue section utilizing four different chromogens to accurately diagnose primary lung adenocarcinomas, squamous cell carcinomas, and combined adenosquamous carcinomas of the lung. Each marker is represented by a distinct color that can be read by a pathologist, using standard, bright field microscopy. We evaluated the ability of pathologists to differentiate NSCLCs using the multiplexed assay as compared to standard, single marker per slide diaminobenzidine (DAB)-based IHC. All cases in a cohort of 264 NSCLCs showed concordance of information (including positivity of stain, intensity of stain and coverage) between single IHC stains and the multiplex assay. This new multiplex IHC offers the capability to accurately diagnose and sub-classify primary lung NSCLCs, while conserving precious tissue for additional testing.
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Affiliation(s)
- Esteban A Roberts
- Ventana Medical Systems, Inc., 1910 Innovation Park Drive, Tucson, AZ 85755, United States of America.
| | - Larry E Morrison
- Ventana Medical Systems, Inc., 1910 Innovation Park Drive, Tucson, AZ 85755, United States of America.
| | - Lauren J Behman
- Ventana Medical Systems, Inc., 1910 Innovation Park Drive, Tucson, AZ 85755, United States of America.
| | - Rossitza Draganova-Tacheva
- Penn Medicine at Chester County Hospital, Department of Pathology and Laboratory Medicine, 701 East Marshall Street, West Chester, PA 19380, United States of America.
| | - Raymond O'Neill
- Thomas Jefferson University Hospital, Department of Pathology, Philadelphia, PA, United States of America.
| | - Charalambos C Solomides
- Thomas Jefferson University Hospital, Department of Pathology, Philadelphia, PA, United States of America.
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Nakajima N, Yoshizawa A, Moriyoshi K, Sonobe M, Menju T, Sumiyoshi S, Date H, Haga H. P40 expression in small cell lung cancer: The presence of p40-positive cells does not always indicate squamous differentiation. Thorac Cancer 2019; 10:1188-1192. [PMID: 30957413 PMCID: PMC6501015 DOI: 10.1111/1759-7714.13062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 01/17/2023] Open
Abstract
Background Small cell lung cancer (SCLC) is normally diagnosed with hematoxylin and eosin stains, although some cases require immunohistochemistry (IHC). P40 is highly sensitive and specific for squamous cell carcinoma and is thus considered the best marker for this cancer. However, the status of p40 expression in SCLC is not well known. The aim of this study was to analyze p40 expression in resected SCLC using IHC. Methods Forty‐four surgically resected SCLC cases were enrolled. Clinical data were obtained from the patients’ medical records. Pathologists blinded to the patients’ clinical data reviewed the SCLC slides. IHC was performed on a representative slide of each case. Results Although p40 was not diffusely expressed in any of the SCLC cases, p40‐positive cells were observed in the tumors in 15 cases (34.1%). Ten of these exhibited p40 in < 1% of tumor cells. In the remaining five cases, 1–5% of tumor cells expressed p40, and in three of these, the cells expressing p40 also expressed TTF‐1 and neuroendocrine markers. There was no statistically significant relationship between p40 positivity and any other clinicopathological characteristics. Conclusions Some resected SCLCs express p40 focally. This result suggests that the presence of positive p40 cells does not exclude a diagnosis of SCLC. Thus, small biopsy or cytology specimens with p40‐positive cells must be diagnosed carefully.
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Affiliation(s)
- Naoki Nakajima
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shinji Sumiyoshi
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
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9
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Triple marker composed of p16, CD56, and TTF1 shows higher sensitivity than INSM1 for diagnosis of pulmonary small cell carcinoma: proposal for a rational immunohistochemical algorithm for diagnosis of small cell carcinoma in small biopsy and cytology specimens. Hum Pathol 2019; 85:58-64. [DOI: 10.1016/j.humpath.2018.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 11/18/2022]
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10
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Walia R, Jain D, Madan K, Sharma MC, Mathur SR, Mohan A, Iyer VK, Kumar L. p40 & thyroid transcription factor-1 immunohistochemistry: A useful panel to characterize non-small cell lung carcinoma-not otherwise specified (NSCLC-NOS) category. Indian J Med Res 2018; 146:42-48. [PMID: 29168459 PMCID: PMC5719606 DOI: 10.4103/ijmr.ijmr_1221_15] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background & objectives: Accurate histopathological subtyping of non-small cell lung carcinoma (NSCLC) is essential for targeted therapeutic agents. Immunohistochemistry (IHC) is helpful in identification of different tumour subtypes. In this study two marker approaches, one each for glandular and squamous cell differentiation was applied to maximize the proportion of accurately subtyped NSCLC not otherwise specified (NOS) tumours on small biopsy samples. Methods: Two hundred and sixty three consecutive lung biopsies of primary lung carcinoma were prospectively studied. These were subtyped first morphologically and then by IHC for p40 and thyroid transcription factor-1 (TTF-1). The diagnosis of NSCLC-NOS before and after addition of IHC was evaluated. Results were correlated and validated with morphologically proven cases and matched surgical specimens. Results: Based on morphology, only 140 of the 263 (53.2%) cases of NSCLC were characterized, whereas 123 (46.7%) were classified as NSCLC-NOS type. With addition of IHC (p40 and TTF-1), the latter category reduced to 14.4 per cent and a sum of 225 (85.5%) cases were accurately subtyped into squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma. p40 showed 100 per cent sensitivity and specificity for squamous differentiation whereas TTF-1 showed sensitivity of 85.3 per cent and specificity of 98.1 per cent. Ninety per cent correlation of morphologic subtypes was achieved with matched resected specimens. Interpretation & conclusions: Our results showed that an approach of using only a two-antibody panel (p40 and TTF-1) might help in reduction of diagnostic category of NSCLC-NOS significantly and contribute in saving tissue for future molecular testing.
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Affiliation(s)
- Ritika Walia
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine & Sleep Disorder, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine & Sleep Disorder, All India Institute of Medical Sciences, New Delhi, India
| | - Venkateswaran K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Advancement in the understanding of lung tumor biology enables continued refinement of lung cancer classification, reflected in the recently introduced 2015 World Health Organization classification of lung cancer. In small biopsy or cytology specimens, special emphasis is placed on separating adenocarcinomas from the other lung cancers to effectively select tumors for targeted molecular testing. In resection specimens, adenocarcinomas are further classified based on architectural pattern to delineate tissue types of prognostic significance. Neuroendocrine tumors are divided into typical carcinoid, atypical carcinoid, small cell carcinoma, and large cell neuroendocrine carcinoma based on a combination of features, especially tumor cell proliferation rate.
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Affiliation(s)
- Min Zheng
- Department of Pathology, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA.
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12
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Lu H, Chen B, Qin J, Xie F, Han N, Huang Z. Transformation to small-cell lung cancer following treatment with icotinib in a patient with lung adenocarcinoma. Oncol Lett 2018; 15:5799-5802. [PMID: 29552210 DOI: 10.3892/ol.2018.8040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/27/2017] [Indexed: 12/13/2022] Open
Abstract
The present study describes the case of a 48-year-old man who was diagnosed with lung adenocarcinoma with an epidermal growth factor receptor (EGFR) 21 L858R mutation. The patient received surgery and adjuvant chemotherapy. When multiple lung metastases appeared, icotinib was administered. Following resistance to icotinib, biopsy by endobroncheal ultrasonography for a right lung hilar lymph node revealed transformation to a neuroendocrine morphology. Neuron-specific enolase (NSE) levels were elevated, accompanied with disease progression following transformation to the neuroendocrine morphology. The post-operative and biopsy specimens were analyzed for 416 genes using next-generation sequencing, and phosphatidylinositol-3-kinase catalytic α mutation and retinoblastoma loss were evident. Five cycles of etoposide combined with cisplatin were administered and a partial response was achieved. The disease progressed again accompanied with an elevated NSE level, and bronchoscopy examination revealed small cell lung cancer (SCLC) after 3 months. The patient received chemotherapy consisting of irinotecan combined with carboplatin for two cycles and achieved stable disease. Overall, a secondary biopsy is important for the evaluation of genetic and histological changes and the selection of an appropriate treatment following tyrosine kinase inhibitor (TKI) resistance, and NSE may be useful for the early detection of SCLC transformation in cases that are resistant to EGFR-TKI therapy.
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Affiliation(s)
- Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China.,Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Bo Chen
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Jing Qin
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Fajun Xie
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Na Han
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Zhiyu Huang
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
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Del C Monroig-Bosque P, Driver B, Morales-Rosado JA, Deavers M, Tacha D, Bernicker E, Cagle PT, Miller RA. Correlation Between Programmed Death Receptor-1 Expression in Tumor-Infiltrating Lymphocytes and Programmed Death Ligand-1 Expression in Non-Small Cell Lung Carcinoma. Arch Pathol Lab Med 2018; 142:1388-1393. [PMID: 29431467 DOI: 10.5858/arpa.2017-0516-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The interaction between programmed death ligand-1 (PD-L1) and programmed death receptor-1 (PD-1) on activated T cells sends an inhibitory signal that dampens the immune response. Tumors can express PD-L1 and evade the immune system. In advanced non-small cell lung carcinoma, expression of PD-1 in tumor-infiltrating lymphocytes (TILs) correlates with PD-L1 expression in tumor cells (TCs). However, this relationship has not been thoroughly explored in early disease. OBJECTIVE.— To investigate the correlation of PD-1 and PD-L1 in non-small cell lung carcinoma tumor samples, with emphasis on stage I disease. DESIGN.— Whole tissue sections from non-small cell lung carcinoma tumors were retrospectively evaluated by immunohistochemistry for PD-1 and PD-L1 expression. The scoring was based on the percentage of cells positive for PD-1 in TILs and PD-L1 in TCs and tumor-infiltrating immune cells (ICs). RESULTS.— Expression of PD-1 in TILs was observed in 147 of 161 non-small cell lung carcinoma cases (91%). The majority of cases negative for PD-1 also lacked PD-L1 in TCs. The 68 cases with highest PD-1 expression in TILs included 33 (49%) with expression of PD-L1 in TCs and ICs. Strong correlations were observed in patients with elevated PD-1 expression in TILs and PD-L1 in TCs ( P = .01) and ICs ( P = .003). Expression of PD-1 also correlated with increased PD-L1 in TCs and ICs when the 2 were grouped together ( P < .001). Finally, stage I patients with negative PD-1 and PD-L1 expression showed trends toward increased disease-specific survival. CONCLUSIONS.— Expression of PD-1 in TILs correlates with PD-L1 expression in both TCs and ICs. Furthermore, negative expression of PD-1 and PD-L1 suggest trends toward disease-specific survival, even in early disease stages.
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Affiliation(s)
| | | | | | | | | | | | | | - Ross A Miller
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Monroig-Bosque, Deavers, Bernicker, Cagle, and Miller); the Department of Pathology, Weill Cornell Medicine, New York, New York (Drs Monroig-Bosque, Bernicker, Cagle, and Miller); the Department of Pathology, University of Arkansas for Medical Science, Little Rock (Dr Driver); the Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan (Dr Morales-Rosado); and Biocare Medical LLC, Pacheco, California (Dr Tacha)
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Cameselle-Teijeiro JM, Mato Mato JA, Fernández Calvo O, García Mata J. Neuroendocrine Pulmonary Tumors of Low, Intermediate and High Grade: Anatomopathological Diagnosis—Prognostic and Predictive Factors. Mol Diagn Ther 2018; 22:169-177. [DOI: 10.1007/s40291-018-0315-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Osmani L, Askin F, Gabrielson E, Li QK. Current WHO guidelines and the critical role of immunohistochemical markers in the subclassification of non-small cell lung carcinoma (NSCLC): Moving from targeted therapy to immunotherapy. Semin Cancer Biol 2017; 52:103-109. [PMID: 29183778 DOI: 10.1016/j.semcancer.2017.11.019] [Citation(s) in RCA: 461] [Impact Index Per Article: 65.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/21/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022]
Abstract
Recent large scale genomic studies from the Clinical Lung Cancer Genome Project have identified different driver gene mutations in the subtypes of non-small cell lung carcinoma (NSCLC). These findings not only lead to remarkable progress in targeted therapies for lung cancer patients, but also provide fundamental knowledge for the subclassification of NSCLC. More recently, the advancement and clinical application of immunotherapy have reinforced the need for the accurate subclassification of NSCLC. In 2015, the World Health Organization (WHO) and the International Association for the Study of Lung Cancer (IASLC) updated their guidelines for the subclassification of lung cancers. These guidelines emphasize: (1) the subclassification of NSCLC, (2) the critical role of molecular characterization of tumors for targeted therapy, (3) the unique terminology for subclassifying NSCLC using small biopsy specimens, and (4) the utility of IHC biomarkers in the accurate diagnosis and subclassification of lung cancer. The guidelines have significant prognostic impact on oncologic practice and patient care. In this review, we summarize the current WHO guidelines for the classification of lung cancer, discuss advancements of targeted therapy and immunotherapy, and address the utility and limitation of immunomarkers in the subclassification of NSCLC, as well as the prospective future of the field.
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Affiliation(s)
- Lais Osmani
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States
| | - Frederic Askin
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States
| | - Edward Gabrielson
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States
| | - Qing Kay Li
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21224, United States.
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Švajdler M, Mezencev R, Ondič O, Šašková B, Mukenšnábl P, Michal M. P16 is a useful supplemental diagnostic marker of pulmonary small cell carcinoma in small biopsies and cytology specimens. Ann Diagn Pathol 2017; 33:23-29. [PMID: 29566943 DOI: 10.1016/j.anndiagpath.2017.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/10/2017] [Indexed: 12/21/2022]
Abstract
Pulmonary small cell carcinoma (SCLC) is usually diagnosed in small biopsy or cytological specimens based on cytomorphology; however in ambiguous cases diagnosis requires additional support by immunohistochemistry. While TP53 and RB1 alterations with secondary overexpression of p16 are mainstay events in SCLC pathogenesis, diagnostic value of p16-positivity in the diagnosis of SCLC has not yet been fully investigated. We examined the expression of p16, CD56, synaptophysin (SYP), chromogranin A and thyroid transcription factor-1 (TTF1) in a series of pulmonary and extrapulmonary small cell carcinomas, pulmonary carcinoids and non-small cell lung carcinomas, and compared diagnostic performance of these markers in the diagnosis of SCLC. P16 was positive in 95 of 101 SCLCs, and displayed highest diagnostic sensitivity of ~94%. Composite biomarkers CD56+p16+TTF1 and CD56+p16+SYP were both able to detect correctly all SCLC cases. Importantly, three (~3%) SCLC cases completely negative for all conventional markers displayed diffuse positivity for p16. CD56 and p16 demonstrated highest concordance between paired small biopsy and cytology specimens. 50% of squamous cell carcinomas, ~41% of adenocarcinoma/NSCLC-favour adenocarcinoma cases, and ~93% of extrapulmonary small cell carcinomas also showed p16-positivity. Combination of CD56, p16 and TTF1 produced diagnostic classifier that outperformed best single marker CD56 in differential diagnosis between SCLC and NSCLC. In conclusion, in the appropriate morphological context p16 represents a useful supplementary marker for diagnosis of SCLC, even in cases where only cytological material is available.
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Affiliation(s)
- Marián Švajdler
- Šikl's Department of Pathology, Charles University in Prague, The Faculty of Medicine and Faculty Hospital in Pilsen, Czech Republic; Bioptická laboratoř s.r.o., Pilsen, Czech Republic.
| | - Roman Mezencev
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Ondrej Ondič
- Šikl's Department of Pathology, Charles University in Prague, The Faculty of Medicine and Faculty Hospital in Pilsen, Czech Republic; Bioptická laboratoř s.r.o., Pilsen, Czech Republic
| | - Bohuslava Šašková
- Šikl's Department of Pathology, Charles University in Prague, The Faculty of Medicine and Faculty Hospital in Pilsen, Czech Republic; Bioptická laboratoř s.r.o., Pilsen, Czech Republic
| | - Petr Mukenšnábl
- Šikl's Department of Pathology, Charles University in Prague, The Faculty of Medicine and Faculty Hospital in Pilsen, Czech Republic
| | - Michal Michal
- Šikl's Department of Pathology, Charles University in Prague, The Faculty of Medicine and Faculty Hospital in Pilsen, Czech Republic; Bioptická laboratoř s.r.o., Pilsen, Czech Republic
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17
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Driver BR, Miller RA, Miller T, Deavers M, Gorman B, Mody D, Ge Y, Barrios R, Bernicker E, Kim M, Cagle PT. Programmed Death Ligand-1 (PD-L1) Expression in Either Tumor Cells or Tumor-Infiltrating Immune Cells Correlates With Solid and High-Grade Lung Adenocarcinomas. Arch Pathol Lab Med 2017; 141:1529-1532. [DOI: 10.5858/arpa.2017-0028-oa] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Programmed death ligand-1 (PD-L1) expression in non–small cell lung carcinoma (NSCLC) is heterogeneous and known to be underestimated on small biopsies. Correlation of PD-L1 expression with clinicopathologic features may provide additional useful information. To our knowledge, the clinicopathologic features of NSCLC have not been reported for subsets defined by PD-L1 expression in either tumor cells or tumor-infiltrating immune cells.
Objective.—
To investigate the clinicopathologic characteristics of NSCLC subsets defined by PD-L1 expression in either tumor cells or tumor-infiltrating immune cells.
Design.—
PD-L1 immunohistochemistry with the SP142 clone was performed on whole-tissue sections and given semiquantitative scores (0/1/2/3) according to percent of PD-L1+ tumor cells (TCs) and percent tumor area with PD-L1+ tumor-infiltrating immune cells (ICs).
Results.—
Adenocarcinoma cases that were scored either TC 1/2/3 or IC 1/2/3 included most (22 of 34; 65%) high–histologic grade cases and most (25 of 36; 69%) solid subtype cases. Compared with the adenocarcinoma TC 0 and IC 0 subset, the TC 1/2/3 or IC 1/2/3 subset correlated with higher histologic grade (P = .005, χ2 test for trend) and solid subtype (P < .001, Fisher exact test). Compared with the adenocarcinoma TC 0/1 or IC 0/1 subset, the TC 2/3 or IC 2/3 subset correlated with higher histologic grade (P = .002, χ2 test for trend), solid subtype (P < .001, Fisher exact test), and higher smoking pack-years (P = .01, Mann-Whitney test).
Conclusions.—
Lung adenocarcinoma subsets defined by PD-L1 expression in either tumor cells or tumor-infiltrating immune cells correlated with high histologic grade, solid subtype, and high smoking pack-years.
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Affiliation(s)
- Brandon R. Driver
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Ross A. Miller
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Tara Miller
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Michael Deavers
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Blythe Gorman
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Dina Mody
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Yimin Ge
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Roberto Barrios
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Eric Bernicker
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Min Kim
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
| | - Philip T. Cagle
- From the Departments of Pathology and Genomic Medicine (Drs Driver, R.A. Miller, T. Miller, Deavers, Gorman, Mody, Ge, Barrios, and Cagle), Medicine (Dr Bernicker), and Surgery (Dr Kim), Houston Methodist Hospital, Houston, Texas
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18
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Kaur G, Nijhawan R, Gupta N, Singh N, Rajwanshi A. Pleural fluid cytology samples in cases of suspected lung cancer: An experience from a tertiary care centre. Diagn Cytopathol 2017; 45:195-201. [DOI: 10.1002/dc.23659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Gurwinder Kaur
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Raje Nijhawan
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Nalini Gupta
- Department of Pulmonary Medicine; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Navneet Singh
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Arvind Rajwanshi
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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19
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Wang X, Lopez-Beltran A, Osunkoya AO, Wang M, Zhang S, Davidson DD, Emerson RE, Williamson SR, Tan PH, Kaimakliotis HZ, Baldridge LA, MacLennan GT, Montironi R, Cheng L. TERT promoter mutation status in sarcomatoid urothelial carcinomas of the upper urinary tract. Future Oncol 2017; 13:705-714. [PMID: 28052688 DOI: 10.2217/fon-2016-0414] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIM To determine TERT promoter mutation status as well as the expression of PAX8, GATA3, p63, p40, p53 and uroplakin III in 17 patients with the upper urinary tract sarcomatoid urothelial carcinoma. METHODS & RESULTS TERT C228T mutations were found in six of 17 cases (35%). p53 was expressed in 77% of these tumors. PAX8, GATA3, p40 and uroplakin III are less frequently expressed. Lymph node metastases were present in ten cases (59%). Eight patients (47%), including all three patients with TERT mutation, died of cancer within 2 years after surgery. CONCLUSION Sarcomatoid carcinoma of the upper urinary tract is an aggressive tumor and the presence of TERT mutation may portend poor prognosis.
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Affiliation(s)
- Xiaoyan Wang
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Adeboye O Osunkoya
- Departments of Pathology & Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mingsheng Wang
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shaobo Zhang
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Darrell D Davidson
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert E Emerson
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean R Williamson
- Department of Pathology & Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Puay-Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore
| | | | - Lee Ann Baldridge
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory T MacLennan
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Rodolfo Montironi
- Institute of Pathological Anatomy & Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy
| | - Liang Cheng
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology & Surgery, Faculty of Medicine, Cordoba, Spain
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20
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A combination of p40, GATA-3 and uroplakin II shows utility in the diagnosis and prognosis of muscle-invasive urothelial carcinoma. Pathology 2016; 48:543-9. [DOI: 10.1016/j.pathol.2016.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 11/18/2022]
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21
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Takamochi K, Ohmiya H, Itoh M, Mogushi K, Saito T, Hara K, Mitani K, Kogo Y, Yamanaka Y, Kawai J, Hayashizaki Y, Oh S, Suzuki K, Kawaji H. Novel biomarkers that assist in accurate discrimination of squamous cell carcinoma from adenocarcinoma of the lung. BMC Cancer 2016; 16:760. [PMID: 27681076 PMCID: PMC5041559 DOI: 10.1186/s12885-016-2792-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 09/16/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Targeted therapies based on the molecular and histological features of cancer types are becoming standard practice. The most effective regimen in lung cancers is different between squamous cell carcinoma (SCC) and adenocarcinoma (AD). Therefore a precise diagnosis is crucial, but this has been difficult, particularly for poorly differentiated SCC (PDSCC) and AD without a lepidic growth component (non-lepidic AD). Biomarkers enabling a precise diagnosis are therefore urgently needed. METHODS Cap Analysis of Gene Expression (CAGE) is a method used to quantify promoter activities across the whole genome by determining the 5' ends of capped RNA molecules with next-generation sequencing. We performed CAGE on 97 frozen tissues from surgically resected lung cancers (22 SCC and 75 AD), and confirmed the findings by immunohistochemical analysis (IHC) in an independent group (29 SCC and 45 AD). RESULTS Using the genome-wide promoter activity profiles, we confirmed that the expression of known molecular markers used in IHC for SCC (CK5, CK6, p40 and desmoglein-3) and AD (TTF-1 and napsin A) were different between SCC and AD. We identified two novel marker candidates, SPATS2 for SCC and ST6GALNAC1 for AD, as showing comparable performance and complementary utility to the known markers in discriminating PDSCC and non-lepidic AD. We subsequently confirmed their utility at the protein level by IHC in an independent group. CONCLUSIONS We identified two genes, SPATS2 and ST6GALNAC1, as novel complemental biomarkers discriminating SCC and AD. These findings will contribute to a more accurate diagnosis of NSCLC, which is crucial for precision medicine for lung cancer.
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Affiliation(s)
- Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Hiroko Ohmiya
- Preventive Medicine and Applied Genomics Unit, RIKEN Advanced Center for Computing and Communication, 1-7-22 Suehiro-cho, Tsurumi-ku, 230-0045, Yokohama, Japan
| | - Masayoshi Itoh
- RIKEN Preventive Medicine and Diagnosis Innovation Program, 2-1 Hirosawa, Wako-shi, Saitama, 351-0198, Japan
| | - Kaoru Mogushi
- Center for Genomic and Regenerative Medicine, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kieko Hara
- Department of Human Pathology, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Keiko Mitani
- Department of Human Pathology, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Yasushi Kogo
- RIKEN Preventive Medicine and Diagnosis Innovation Program, 2-1 Hirosawa, Wako-shi, Saitama, 351-0198, Japan
| | - Yasunari Yamanaka
- RIKEN Preventive Medicine and Diagnosis Innovation Program, 2-1 Hirosawa, Wako-shi, Saitama, 351-0198, Japan
| | - Jun Kawai
- RIKEN Preventive Medicine and Diagnosis Innovation Program, 2-1 Hirosawa, Wako-shi, Saitama, 351-0198, Japan
| | - Yoshihide Hayashizaki
- RIKEN Preventive Medicine and Diagnosis Innovation Program, 2-1 Hirosawa, Wako-shi, Saitama, 351-0198, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Hideya Kawaji
- Preventive Medicine and Applied Genomics Unit, RIKEN Advanced Center for Computing and Communication, 1-7-22 Suehiro-cho, Tsurumi-ku, 230-0045, Yokohama, Japan.,RIKEN Preventive Medicine and Diagnosis Innovation Program, 2-1 Hirosawa, Wako-shi, Saitama, 351-0198, Japan
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22
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Lilo MT, Allison D, Wang Y, Ao M, Gabrielson E, Geddes S, Zhang H, Askin F, Li QK. Expression of P40 and P63 in lung cancers using fine needle aspiration cases. Understanding clinical pitfalls and limitations. J Am Soc Cytopathol 2016; 5:123-132. [PMID: 27699149 PMCID: PMC5044754 DOI: 10.1016/j.jasc.2015.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) biopsy of lung lesions is a highly accurate method for diagnosing and staging of lung cancers, particularly in patients with advanced cancer. Although, the majority of FNA cases of non-small cell lung carcinoma (NSCLC) can be subclassified by hematoxylin and eosin (H&E) sections, immunohistochemical (IHC) markers are usually necessary for difficult cases. Our previous study has shown that both P40 and P63 demonstrate differential sensitivity and specificity in the subclassification of squamous cell carcinoma (SqCC) using tumor tissue microarrays (TMA). In the present study, we further evaluated the utility of P40 and P63 and the potential pitfalls and limitations associated with the usefulness of these stains in FNA cases. METHODS By a computer search of pathology archives, 144 FNA biopsies with diagnoses of lung cancers and P40/P63 stains were identified, including 50 adenocarcinomas (ADCs), 56 SqCCs, 8 small cell lung carcinomas (SCLCs), and 12 cases of poorly differentiated carcinoma (PD CA). Ten benign FNA lung lesions and 8 other malignant neoplasms were also included as controls. Nuclear staining patterns of P40 and P63 were scored semi-quantitatively as 0 (negative), 1 (<10%, weak and focal), or 2 (>10%, strong and diffuse). RESULTS In lung SqCCs, P40 and P63 were positive in 77.3% and 89.5% cases, respectively. In ADCs, P40 was weakly and focally positive in 6.1% cases, and P63 was variably positive in 62.8% cases. In SCLCs, P40 and P63 were focally positive in 12.5% and 50% cases. In PD CAs, no P40 or P63 immunoreactivity was detected. In the group of other neoplasms (n=8) both P40 and P63 were positive in the case of metastatic non-seminomatous germ cell tumor (NSGCT) (n=1), and P63 was positive in the case of metastatic Merkel cell carcinoma (n=1). The sensitivity and specificity of P40 and P63 were 76.9%/93.3%, and 90.2%/50.7% in the lung SqCC. CONCLUSIONS P63 has a better sensitivity, and P40 has a better specificity for SqCC. A positive staining pattern with both markers was also found in certain non-SqCC cases. Recognizing limitations of these markers are particularly important in FNA cases.
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Affiliation(s)
- Mohammed T. Lilo
- The Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, MD 21224
| | - Derek Allison
- The Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, MD 21224
| | - Yuting Wang
- The Department of Chemistry, Magdalen College, University of Oxford, OX1 4AU, United Kingdom
| | - MingHui Ao
- The Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, MD 21224
| | - Edward Gabrielson
- The Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, MD 21224
| | - Susan Geddes
- The Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, MD 21224
| | - Hui Zhang
- The Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, MD 21224
| | - Frederic Askin
- The Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, MD 21224
| | - Qing Kay Li
- The Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, MD 21224
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23
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Nishino M, Hoang MP, Della Pelle P, Morales-Oyarvide V, Huynh TG, Mark EJ, Mino-Kenudson M. Napsin A/p40 antibody cocktail for subtyping non-small cell lung carcinoma on cytology and small biopsy specimens. Cancer Cytopathol 2016; 124:472-84. [PMID: 27412420 DOI: 10.1002/cncy.21707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/30/2016] [Accepted: 02/04/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Subtyping non-small cell lung carcinomas (NSCLC) into adenocarcinoma (ACA) or squamous cell carcinoma (SQCC) is important for treatment and specimen triage for molecular studies. To preserve tissue for molecular studies in cytology/small biopsy specimens, a 2-antibody cocktail for NSCLC subtyping was developed. METHODS Markers for lung ACA (thyroid transcription factor 1 and napsin A) and SQCC (cytokeratin 5/6 and p40) were evaluated on tissue microarrays (TMAs) with 143 ACA and 98 SQCC specimens. The napsin A/p40 combination was selected for NSCLC subtyping and validated on the TMA as well as on a cohort of cell block/small biopsy specimens from 80 poorly differentiated NSCLCs. RESULTS Using TMA analysis, the napsin A-positive (+)/p40± immunophenotype identified ACA with 94% sensitivity and 100% specificity, whereas the napsin A (negative)-/p40+ immunophenotype identified SQCC with 100% sensitivity and specificity. On the validation cohort of 80 cell block and small biopsy specimens, the napsin A/p40 cocktail accurately subtyped 63 of 70 NSCLC (90%) as ACA or SQCC using the subsequent surgical resection as reference histology. Of the remaining 17 cases, 15 were classified as NSCLC-not otherwise specified based on a napsin A-/p40- immunophenotype; their corresponding resections were diagnosed as ACA (7 cases), large cell carcinoma (7 cases), or pleomorphic carcinoma (1 case). Two additional large cell carcinoma cases showed a napsin A-/p40+ or napsin A+/p40+ profile in the preoperative cell block/small biopsy sample. CONCLUSIONS A napsin A/p40 cocktail can accurately subtype NSCLC into ACA and SQCC in most cell block/small biopsy specimens of poorly differentiated NSCLC. In the minority of cases in which the napsin A/p40 immunophenotype is indeterminate, additional stains may be necessary for precise classification. Cancer Cytopathol 2016;124:472-84. © 2016 American Cancer Society.
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Affiliation(s)
- Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mai P Hoang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Tiffany G Huynh
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eugene J Mark
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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24
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Clark DJ, Fondrie WE, Yang A, Mao L. Triple SILAC quantitative proteomic analysis reveals differential abundance of cell signaling proteins between normal and lung cancer-derived exosomes. J Proteomics 2016; 133:161-169. [DOI: 10.1016/j.jprot.2015.12.023] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/07/2015] [Accepted: 12/17/2015] [Indexed: 01/06/2023]
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25
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Clark DJ, Mei Y, Sun S, Zhang H, Yang AJ, Mao L. Glycoproteomic Approach Identifies KRAS as a Positive Regulator of CREG1 in Non-small Cell Lung Cancer Cells. Am J Cancer Res 2016; 6:65-77. [PMID: 26722374 PMCID: PMC4679355 DOI: 10.7150/thno.12350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/09/2015] [Indexed: 01/05/2023] Open
Abstract
Protein glycosylation plays a fundamental role in a multitude of biological processes, and the associated aberrant expression of glycoproteins in cancer has made them attractive biomarkers and therapeutic targets. In this study, we examined differentially expressed glycoproteins in cell lines derived from three different states of lung tumorigenesis: an immortalized bronchial epithelial cell (HBE) line, a non-small cell lung cancer (NSCLC) cell line harboring a Kirsten rat sarcoma viral oncogene homolog (KRAS) activation mutation and a NSCLC cell line harboring an epidermal growth factor receptor (EGFR) activation deletion. Using a Triple SILAC proteomic quantification strategy paired with hydrazide chemistry N-linked glycopeptide enrichment, we quantified 118 glycopeptides in the three cell lines derived from 82 glycoproteins. Proteomic profiling revealed 27 glycopeptides overexpressed in both NSCLC cell lines, 6 glycopeptides overexpressed only in the EGFR mutant cells and 19 glycopeptides overexpressed only in the KRAS mutant cells. Further investigation of a panel of NSCLC cell lines found that Cellular repressor of E1A-stimulated genes (CREG1) overexpression was closely correlated with KRAS mutation status in NSCLC cells and could be down-regulated by inhibition of KRAS expression. Our results indicate that CREG1 is a down-stream effector of KRAS in a sub-type of NSCLC cells and a novel candidate biomarker or therapeutic target for KRAS mutant NSCLC.
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Ginter PS, Varma S, Liu YF, Shin SJ. The minimal carcinoma triple stain is superior to commercially available multiplex immunohistochemical stains: breast triple stain and LC/DC breast cocktail. Am J Clin Pathol 2015; 144:869-79. [PMID: 26572993 DOI: 10.1309/ajcps2ucgj5ynhnz] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES The Minimal Carcinoma (MC) Triple Stain is a tri-chromogen multiplex immunostain (CK7, p63, and E-cadherin) helpful in classifying morphologically ambiguous and/or small carcinomas as either ductal or lobular and/or in situ or invasive. We compared the utility of this stain with two commercially available duplex/multiplex immunostains: Breast Triple Stain (BTS) (Clarient, Aliso Viejo, CA; CK5, p63, and CK8/18) and LC/DC Breast Cocktail (LCDC) (Biocare, Concord, CA; E-cadherin and p120). METHODS Ninety-seven mammary carcinomas stained with the MC Triple Stain, BTS, and LCDC were compared. RESULTS The MC Triple Stain, LCDC, and BTS were diagnostic in 90 (93%) of 97, 82 (85%) of 97, and 85 (88%) of 97 of cases, respectively. All stains showed decreased diagnostic utility due to variability in tissue integrity, quality of the staining, and/or ease of interpretation. In cases where all immunostains were interpretable, the MC Triple Stain yielded the most information. CONCLUSIONS When technically sufficient, all three immunostains demonstrated relative strengths and weaknesses in their ability to provide diagnostic information with the highest consistency and ease of use. Many cases stained with LCDC were technically insufficient due to a suboptimal staining protocol provided by the company. Overall, the MC Triple Stain outperformed BTS and LCDC by more consistently providing more diagnostic information. The MC Triple Stain is a viable alternative to other multiplex immunostains in evaluating small foci of carcinoma, particularly when both the histologic type and extent of disease (in situ vs invasive) require clarification.
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Driver BR, Barrios R, Ge Y, Haque A, Tacha D, Cagle PT. Folate Receptor α Expression Level Correlates With Histologic Grade in Lung Adenocarcinoma. Arch Pathol Lab Med 2015; 140:682-5. [PMID: 26599808 DOI: 10.5858/arpa.2015-0431-oa] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Folate receptor α (FRA) is a glycosylphosphatidylinositol-anchored high-affinity folate receptor that localizes to the apical surface of epithelia when it is expressed in normal tissue. Unlike normal tissues, FRA may localize to the basolateral side in tumors. These features make FRA an attractive drug target, and several FRA-targeted drugs have been developed and are in phases of clinical testing. Folate receptor α protein expression shows intertumoral variability that may correlate with response to therapy and to clinicopathologic parameters. Using immunohistochemistry, a recent study of breast carcinomas found FRA protein expression was associated with triple-negative status and high histologic grade in breast cancer. Although a prior study of lung adenocarcinomas found the expression level of the gene encoding FRA, FOLR1, was significantly increased in low-histologic-grade tumors compared to high-histologic-grade tumors, the relationship between FRA protein expression and histologic grade has not been reported for lung adenocarcinomas. OBJECTIVE -To investigate the relationship between FRA protein expression level and clinicopathologic parameters in lung adenocarcinomas, including histologic grade, by performing immunohistochemistry for FRA on a cohort of non-small cell lung carcinomas. DESIGN -High-density tissue microarrays constructed from 188 non-small cell lung carcinomas and used in prior studies were immunostained with FRA-specific antibody clone 26B3. Folate receptor α membranous staining intensity was given a semiquantitative score from 0 to 3+ for triplicate cores of tumor and averaged for each tumor. An average semiquantitative score from 0 to 1.4 was considered low expression, and an average semiquantitative score greater than 1.4 was considered high expression. RESULTS -The majority (60 of 78; 77%) of lung adenocarcinomas and a minority (4 of 41; 10%) of lung squamous cell carcinomas were positive for FRA. Folate receptor α expression in lung adenocarcinomas compared with squamous cell carcinomas was statistically different (P < .001, χ(2) test). In lung adenocarcinomas, FRA expression level correlated with histologic grade (P = .005, χ(2) test for trend), but no other clinicopathologic parameter. The majority (23 of 27; 85%) of grade 1 adenocarcinomas had high FRA protein expression, whereas approximately half of grade 2 (10 of 19; 53%) and grade 3 (12 of 25; 48%) adenocarcinomas had high FRA protein expression. Out of adenocarcinomas with lepidic growth pattern, 16 of 20 (80%) showed high FRA protein expression. Out of adenocarcinomas with solid growth pattern, 2 of 6 (33%) showed high FRA protein expression. In lung adenocarcinomas, FRA expression level did not correlate with thyroid transcription factor 1, napsin A, or survival. CONCLUSIONS -Folate receptor α protein was expressed in the majority of lung adenocarcinomas and a minority of lung squamous cell carcinomas. Folate receptor α protein expression correlated with histologic grade for lung adenocarcinomas, and the greatest difference was observed between grade 1 and grade 3. Our results indicate that poorly differentiated adenocarcinomas or focuses of poor differentiation in a heterogeneous tumor may lack FRA protein expression and be more likely to be resistant to FRA-targeting drugs.
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Affiliation(s)
- Brandon R Driver
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver, Barrios, Ge, Haque, and Cagle); and Biocare Medical LLC, Concord, California (Dr Tacha)
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Driver BR, Portier BP, Mody DR, Deavers M, Bernicker EH, Kim MP, Teh BS, Santacruz JF, Kopas L, Munden RF, Cagle PT. Next-Generation Sequencing of a Cohort of Pulmonary Large Cell Carcinomas Reclassified by World Health Organization 2015 Criteria. Arch Pathol Lab Med 2015; 140:312-7. [PMID: 26430808 DOI: 10.5858/arpa.2015-0361-oa] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The classification of pulmonary large cell carcinoma has undergone a major revision with the recent World Health Organization (WHO) 2015 Classification. Many large cell carcinomas are now reassigned to either adenocarcinoma with solid pattern or nonkeratinizing squamous cell carcinoma based on immunopositivity for adenocarcinoma markers or squamous cell carcinoma markers, respectively. Large cell carcinomas that are negative for adenocarcinoma and squamous cell carcinoma immunomarkers are now classified as large cell carcinoma with null immunohistochemical features (LCC-N). Although a few studies investigated the mutation profile of large cell carcinomas grouped by immunostain profile before the publication of the new WHO classification, investigation of tumors previously diagnosed as large cell carcinoma and reclassified according to the 2015 WHO classification has not, to our knowledge, been reported. OBJECTIVE To determine the mutation profiles of pulmonary large cell carcinomas reclassified by WHO 2015 criteria. DESIGN Archival cases of non-small cell lung carcinoma with large cell carcinoma morphology (n = 17) were reclassified according to 2015 WHO criteria. To determine mutation profile, we employed Ion Torrent (Life Technologies, Carlsbad, California)-based next-generation sequencing (50 genes; more than 2800 mutations) in addition to real-time quantitative reverse transcription polymerase chain reaction for ALK translocation detection. RESULTS Two of 17 cases (12%) were reclassified as LCC-N, and both had mutations-BRAF D594N in one case and KRAS G12C in the other case. Seven of 17 cases (41%) were reclassified in the adenocarcinoma with solid pattern group, which showed one KRAS G12C and one EGFR E709K + G719C double mutation in addition to mutations in TP53. Eight of 17 cases (47%) were reclassified in the nonkeratinizing squamous cell carcinoma group, which showed mutations in PIK3CA, CDKN2A, and TP53. No ALK translocations or amplifications were detected. CONCLUSIONS The adenocarcinoma with solid pattern group showed mutations typical of adenocarcinoma, whereas the nonkeratinizing squamous cell carcinoma group showed mutations typical of squamous cell carcinoma. Both LCC-N cases had mutations associated with adenocarcinoma, supporting the hypothesis that LCC-N is related to adenocarcinoma.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Philip T Cagle
- From the Departments of Pathology and Genomic Medicine (Drs Driver, Portier, Mody, Deavers, and Cagle); Medicine, Thoracic Medical Oncology (Dr Bernicker); Thoracic Surgery (Dr Kim); Radiation Oncology (Dr Teh); Interventional Pulmonology, Critical Care, and Pulmonary Medicine (Drs Santacruz and Kopas); Radiology (Dr Munden), Houston Methodist Hospital, Houston; and Weill Cornell Medical College, New York, New York
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El-Maqsoud NMRA, Tawfiek ER, Abdelmeged A, Rahman MFA, Moustafa AAE. The diagnostic utility of the triple markers Napsin A, TTF-1, and PAX8 in differentiating between primary and metastatic lung carcinomas. Tumour Biol 2015; 37:3123-34. [DOI: 10.1007/s13277-015-3964-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/20/2015] [Indexed: 12/17/2022] Open
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Zhan C, Yan L, Wang L, Sun Y, Wang X, Lin Z, Zhang Y, Shi Y, Jiang W, Wang Q. Identification of immunohistochemical markers for distinguishing lung adenocarcinoma from squamous cell carcinoma. J Thorac Dis 2015; 7:1398-405. [PMID: 26380766 DOI: 10.3978/j.issn.2072-1439.2015.07.25] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/16/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Immunohistochemical staining has been widely used in distinguishing lung adenocarcinoma (LUAD) from lung squamous cell carcinoma (LUSC), which is of vital importance for the diagnosis and treatment of lung cancer. Due to the lack of a comprehensive analysis of different lung cancer subtypes, there may still be undiscovered markers with higher diagnostic accuracy. METHODS Herein first, we systematically analyzed high-throughput data obtained from The Cancer Genome Atlas (TCGA) database. Combining differently expressed gene screening and receiver operating characteristic (ROC) curve analysis, we attempted to identify the genes which might be suitable as immunohistochemical markers in distinguishing LUAD from LUSC. Then we detected the expression of six of these genes (MLPH, TMC5, SFTA3, DSG3, DSC3 and CALML3) in lung cancer sections using immunohistochemical staining. RESULTS A number of genes were identified as candidate immunohistochemical markers with high sensitivity and specificity in distinguishing LUAD from LUSC. Then the staining results confirmed the potentials of the six genes (MLPH, TMC5, SFTA3, DSG3, DSC3 and CALML3) in distinguishing LUAD from LUSC, and their sensitivity and specificity were not less than many commonly used markers. CONCLUSIONS The results revealed that the six genes (MLPH, TMC5, SFTA3, DSG3, DSC3 and CALML3) might be suitable markers in distinguishing LUAD from LUSC, and also validated the feasibility of our methods for identification of candidate markers from high-throughput data.
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Affiliation(s)
- Cheng Zhan
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Li Yan
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lin Wang
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yang Sun
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xingxing Wang
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zongwu Lin
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yongxing Zhang
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu Shi
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei Jiang
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun Wang
- 1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China ; 3 Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Walts AE, Hiroshima K, Marchevsky AM. Desmoglein 3 and p40 immunoreactivity in neoplastic and nonneoplastic thymus: a potential adjunct to help resolve selected diagnostic and staging problems. Ann Diagn Pathol 2015; 19:216-20. [DOI: 10.1016/j.anndiagpath.2015.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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Lin F, Liu H. Immunohistochemistry in undifferentiated neoplasm/tumor of uncertain origin. Arch Pathol Lab Med 2015; 138:1583-610. [PMID: 25427040 DOI: 10.5858/arpa.2014-0061-ra] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Immunohistochemistry has become an indispensable ancillary study in the identification and classification of undifferentiated neoplasms/tumors of uncertain origin. The diagnostic accuracy has significantly improved because of the continuous discoveries of tissue-specific biomarkers and the development of effective immunohistochemical panels. OBJECTIVES To identify and classify undifferentiated neoplasms/tumors of uncertain origin by immunohistochemistry. DATA SOURCES Literature review and authors' research data and personal practice experience were used. CONCLUSIONS To better guide therapeutic decisions and predict prognostic outcomes, it is crucial to differentiate the specific lineage of an undifferentiated neoplasm. Application of appropriate immunohistochemical panels enables the accurate classification of most undifferentiated neoplasms. Knowing the utilities and pitfalls of each tissue-specific biomarker is essential for avoiding potential diagnostic errors because an absolutely tissue-specific biomarker is exceptionally rare. We review frequently used tissue-specific biomarkers, provide effective panels, and recommend diagnostic algorithms as a standard approach to undifferentiated neoplasms.
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Affiliation(s)
- Fan Lin
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
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Zhang K, Deng H, Cagle PT. Utility of Immunohistochemistry in the Diagnosis of Pleuropulmonary and Mediastinal Cancers: A Review and Update. Arch Pathol Lab Med 2014; 138:1611-28. [DOI: 10.5858/arpa.2014-0092-ra] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Immunohistochemistry has become an indispensable ancillary tool for the accurate classification of pleuropulmonary and mediastinal neoplasms necessary for therapeutic decisions and predicting prognostic outcome in the era of personalized medicine. Diagnostic accuracy has significantly improved because of the continuous discoveries of tumor-associated biomarkers and the development of effective immunohistochemical panels.
Objective
To increase the accuracy of diagnosis and classify pleuropulmonary neoplasms through immunohistochemistry.
Data Sources
Literature review, authors' research data, and personal practice experience.
Conclusions
This review article has shown that appropriately selecting immunohistochemical panels enables pathologists to effectively diagnose most primary pleuropulmonary neoplasms and differentiate primary lung tumors from a variety of metastatic tumors to the lung. The discovery of new mutation-specific antibodies identifying a subset of specific gene-arranged lung tumors provides a promising alternative and cost-effective approach to molecular testing. Knowing the utilities and pitfalls of each tumor-associated biomarker is essential to avoiding potential diagnostic errors.
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Affiliation(s)
- Kai Zhang
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Drs Zhang and Deng)
| | - Hongbin Deng
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Drs Zhang and Deng)
| | - Philip T. Cagle
- and the Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas (Dr Cagle)
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The high diagnostic accuracy of combined test of thyroid transcription factor 1 and Napsin A to distinguish between lung adenocarcinoma and squamous cell carcinoma: a meta-analysis. PLoS One 2014; 9:e100837. [PMID: 25003505 PMCID: PMC4086931 DOI: 10.1371/journal.pone.0100837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/30/2014] [Indexed: 12/14/2022] Open
Abstract
Background Accurate classification of non-small cell lung cancer (NSCLC) using morphological features has several limitations. However, the use of thyroid transcription factor 1 (TTF-1) and Napsin A as markers for the identification of various subtypes of NSCLC has shown promise. This meta-analysis was designed to evaluate the diagnostic value of combined TTF-1 and Napsin A test to distinguish lung adenocarcinoma from squamous cell carcinoma. Methods The Medline, EMBASE and Web of Science databases were searched, along with the reference lists of relevant articles (up to May 4, 2014). Ten studies containing 1,446 subjects were identified. The sensitivity, specificity, diagnostic odds ratio (DOR) and area under the summary receiver operating characteristics curve (AUC) were calculated to estimate the combined diagnostic value of TTF-1 and Napsin A. Results The pooled sensitivity and specificity were 0.76 (95% CI: 0.69–0.83) and 1.00 (95% CI: 0.92–1.00), respectively. The positive and negative likelihood ratios were 877.60 (95% CI: 8.40–91533.40) and 0.24 (95% CI: 0.18–0.32). The DOR was 3719 (95% CI: 33–414884). The AUC was 0.92 (95%CI: 0.89–0.94). The patient's location was a source of heterogeneity for sensitivity. The patient's location, the study's sample size and the threshold used to determine positive staining were consistently found to be sources of heterogeneity for specificity in subgroup analyses and meta-regression. Conclusions The combined test of TTF-1 and Napsin A presents a promising alternative method, useful to distinguish between lung adenocarcinoma and squamous cell carcinoma.
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Rafael OC, Aziz M, Raftopoulos H, Vele OE, Xu W, Sugrue C. Molecular testing in lung cancer: fine-needle aspiration specimen adequacy and test prioritization prior to the CAP/IASLC/AMP Molecular Testing Guideline publication. Cancer Cytopathol 2014; 122:454-8. [PMID: 24723383 DOI: 10.1002/cncy.21426] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Subtyping of lung carcinoma with immunohistochemistry is essential for diagnosis, whereas molecular testing (MT) is required for therapy guidance. In the current study, the authors report on MT performed on fine-needle aspiration specimens at the study institution over a 2-year period preceding the April 2013 College of American Pathologists (CAP)/International Association for the Study of Lung Cancer (IASLC)/Association for Molecular Pathology (AMP) Molecular Testing Guideline (MTG) publication. METHODS The database of the study institution was retrospectively queried for cases of lung and thoracic/lower cervical lymph node fine-needle aspiration specimens for 2011 through 2012. RESULTS Of 246 selected cases, 26 featured a limited amount of material in cell blocks. MT increased significantly between 2011 and 2012 and was requested in 39.4% of cases (97 of 246 cases): 86 of those cases had at least 1 MT result and 11 had insufficient material for any MT. Anaplastic lymphoma kinase (ALK) testing was performed in 9 cases in which DNA was insufficient for epidermal growth factor receptor (EGFR) testing. In addition, 13 cases of adenocarcinoma/non-small cell lung carcinoma had at least 1 MT canceled because of insufficient DNA, but at the same time had an average of 3.46 immunohistochemical stains performed. CONCLUSIONS Of all the cytology specimens, 10.6% featured limited material; however, no universally accepted testing sequence priority was available at the time the study was performed. As per the MTG, MT should take precedence over immunohistochemistry in cases of adenocarcinoma/non-small cell lung carcinoma. Approximately 5.3% of the specimens in the current study had insufficient material for MT while having multiple stains performed instead. The MTG also recommend performing EGFR before ALK testing; the authors found 9 cases with insufficient material for EGFR testing that had ALK testing performed. The results of the current study underscore the need for a testing prioritization algorithm in view of the MTG publication to serve as reference for both clinicians and pathologists.
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Affiliation(s)
- Oana C Rafael
- Department of Pathology, North Shore LIJ - Lenox Hill Hospital, New York, New York
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Brandler TC, Aziz MS, Rosen LM, Bhuiya TA, Yaskiv O. Usefulness of GATA3 and p40 immunostains in the diagnosis of metastatic urothelial carcinoma in cytology specimens. Cancer Cytopathol 2014; 122:468-73. [DOI: 10.1002/cncy.21424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/11/2014] [Accepted: 03/12/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Tamar C. Brandler
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | - Mohamed S. Aziz
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | - Lisa M. Rosen
- Department of Biostatistics; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | - Tawfiqul A. Bhuiya
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | - Oksana Yaskiv
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
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HooKim K, Kavuri S, Lauer SR, Cohen C, Reid MD. Napsin A expression in small cell carcinoma of the lung: a cytologic study with review of differentials. J Am Soc Cytopathol 2014; 3:90-95. [PMID: 31051707 DOI: 10.1016/j.jasc.2013.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/09/2013] [Accepted: 11/13/2013] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Napsin A is a diagnostic marker for pulmonary adenocarcinoma and a useful alternative to thyroid transcription factor 1 (TTF-1). TTF-1 also stains pulmonary small cell carcinoma (SCCA). Napsin A expression in SCCAs is not as established as it is in non-SCCAs. We analyzed napsin A and TTF-1 expression in 36 previously confirmed cytologic cases of pulmonary SCCA. Ours is currently the largest cytologic series of such cases examined for napsin A expression. MATERIALS AND METHODS Thirty-six patients, (20 men, 16 women), age 43-87 years, mean 57 years, had primary or metastatic pulmonary SCCA diagnosed by fine-needle aspiration biopsies of mediastinum (n = 5); liver (n = 3); subcutaneous nodule (n = 1); lung (n = 6); and axillary, cervical, and mediastinal lymph nodes (n = 20), as well as a pleural effusion (n = 1). Napsin A and TTF-1 expression was tested. Also, previous expression (or lack thereof) with immunocytochemical stains pancytokeratin and neuroendocrine markers (synaptophysin, chromogranin, and cluster of differentiation marker CD56) were noted. RESULTS All cases of pulmonary SCCA were positive for pancytokeratin. TTF-1 was positive in 35 of 36 cases (97%), and napsin A was negative in all 36 cases (100%). All 36 cases expressed ≥ 1 neuroendocrine marker, including the TTF-1 negative case. CONCLUSIONS This study showed napsin A was negative in all pulmonary SCCAs. This stain may prove to be a useful exclusionary marker in distinguishing pulmonary SCCA from other poorly differentiated lung carcinomas with similar morphologic features, especially those with concomitant TTF-1 expression.
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Affiliation(s)
- Kim HooKim
- Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Sravankumar Kavuri
- Department of Pathology, Georgia Health Sciences University, Augusta, Georgia
| | - Scott R Lauer
- Department of Pathology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, Georgia
| | - Cynthia Cohen
- Department of Pathology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, Georgia
| | - Michelle D Reid
- Department of Pathology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, Georgia.
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Tacha D, Bremer R, Haas T, Qi W. An immunohistochemical analysis of a newly developed, mouse monoclonal p40 (BC28) antibody in lung, bladder, skin, breast, prostate, and head and neck cancers. Arch Pathol Lab Med 2014; 138:1358-64. [PMID: 24528495 DOI: 10.5858/arpa.2013-0342-oa] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Immunohistochemistry is important to the pathologist for accurate diagnosis of lung cancer. In recent studies, a rabbit polyclonal p40 (RPp40) antibody demonstrated equivalent staining versus anti-p63 in lung squamous cell carcinoma, and superior specificity because it stains a lesser percentage of lung adenocarcinoma. OBJECTIVES To develop an anti-p40 mouse monoclonal antibody (MMp40) for immunohistochemistry, and to evaluate its sensitivity and specificity in normal and neoplastic tissues, with emphasis on lung cancer. DESIGN The MMp40 (BC28) antibody was developed and tested for specificity and sensitivity on normal (n = 34) and neoplastic tissues (n = 493). Staining of MMp40, p63, and RPp40 were directly compared in lung cancers, and MMp40 was evaluated in breast, bladder, skin, prostate, and head and neck cancers. Benign prostate glands and prostatic intraepithelial neoplasia were also tested in a direct comparison of MMp40 versus p63. RESULTS The MMp40 provided equivalent staining versus RPp40 and p63 in lung squamous cell carcinoma, but stained a lesser percentage of lung adenocarcinoma than p63 did. The MMp40 staining was observed in a greater percentage of urothelial carcinomas, squamous and basal cell skin cancers, and head and neck cancers of squamous cell origin. No breast-infiltrating ductal carcinomas or prostatic adenocarcinomas were stained. The MMp40 expression in basal cells of prostate glands and prostatic intraepithelial neoplasia were almost identical to those of p63. CONCLUSION The MMp40 (BC28) monoclonal antibody is a high-quality screening antibody for determining squamous cell carcinoma in lung cancers, skin cancers of squamous or basal cell origin, squamous cell head and neck cancers, and urothelial carcinomas.
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Affiliation(s)
- David Tacha
- From the Department of Research and Development, Biocare Medical, LLC, Concord, California (Drs Tacha, Bremer, and Qi); and the Department of Pathology, Mercy General Hospital, Janesville, Wisconsin (Dr Haas)
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39
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Ao MH, Zhang H, Sakowski L, Sharma R, Illei PB, Gabrielson E, Askin F, Li QK. The utility of a novel triple marker (combination of TTF1, napsin A, and p40) in the subclassification of non-small cell lung cancer. Hum Pathol 2014; 45:926-34. [PMID: 24746197 DOI: 10.1016/j.humpath.2014.01.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/09/2014] [Accepted: 01/10/2014] [Indexed: 01/15/2023]
Abstract
In lung cancer, targeted therapies depend on accurate histological subclassification of the tumor. The majority of lung cancers can be subclassified based on hematoxylin and eosin staining; however, classification may be difficult in small biopsies. In this study, we investigated the utility of a newly developed triple marker (combination of TTF1/Napsin A/p40) and compared the sensitivity and specificity of this novel marker with individual markers in the subclassification of non-small cell lung carcinomas. Lung cancer tissue microarrays were constructed using surgical resection material from the Johns Hopkins Hospital. They included 77 adenocarcinomas (ADCs), 77 squamous cell carcinomas (SqCCs), and 46 cases of metastatic lung ADCs. Immunostaining patterns of all markers were scored semi-quantitatively and compared. In ADCs, the sensitivity and specificity of the triple marker were 93.5% and 77.5%, respectively. The sensitivity and specificity of TTF1 and Napsin A were 85.7% and 75.0%, and 89.6% and 90.0%. In SqCCs, the sensitivity and specificity of the triple marker were 88.3% and 92.5%, while the p40, p63 and CK5/6 showed 80.5% and 90.0%; 93.5% and 80.0%; and 89.6% and 80.0%. In addition, the sensitivity and specificity of the triple marker in metastatic ADCs showed 71.7% and 73.5%, respectively. Our triple marker (combination of TTF1/Napsin A/p40) showed a similar sensitivity and specificity for the subclassification of NSCLC when compared to individual markers. Our study not only demonstrates a useful combination of immunomarkers but also optimally conserves tissue for molecular marker testing.
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Affiliation(s)
- Ming-Hui Ao
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Hui Zhang
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Lynne Sakowski
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Rajni Sharma
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Peter B Illei
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Edward Gabrielson
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Frederic Askin
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA
| | - Qing Kay Li
- The Department of Pathology The Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore MD 21224, USA.
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40
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Shankar S, Thanasekaran V, Dhanasekar T, Duvooru P. Clinicopathological and immunohistochemical profile of non-small cell lung carcinoma in a tertiary care medical centre in South India. Lung India 2014; 31:23-8. [PMID: 24669077 PMCID: PMC3960804 DOI: 10.4103/0970-2113.125889] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Lung cancer is a highly aggressive malignancy causing high morbidity and mortality. An increasing incidence of lung cancer has been observed in India. Currently, the classification of lung carcinoma has gone beyond small cell lung carcinoma and non-small cell lung carcinoma (NSCLC). Precise subtyping of poorly differentiated NSCLC into adenocarcinoma and squamous cell carcinoma has a direct impact on patient management and prognosis. With this background, many molecules are under study for developing targeted therapies. Epidermal growth factor receptor (EGFR) is one such biomarker considered to be useful in targeted therapy for adenocarcinoma. OBJECTIVE The aim of this study was to subtype poorly differentiated NSCLC based on the expression of thyroid transcription factor-1 (TTF-1) and p-63 and to evaluate EGFR expression in adenocarcinomas. MATERIALS AND METHODS A retrospective analysis of 84 cases of poorly differentiated carcinomas of the lung was performed. Paraffin sections were immunostained with TTF-1 and p-63 and the tumors were subtyped. EGFR expression was assessed in adenocarcinomas by immunohistochemistry. RESULTS Fifty-five percent of the NSCLC were adenocarcinoma, with a peak incidence between 61 and 70 years of age and a male predominance. EGFR was expressed in 89% of the adenocarcinomas. CONCLUSIONS Poorly differentiated non-small cell carcinoma can be subtyped by immunohistochemical markers and hence has a direct impact on the current therapeutic strategies.
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Affiliation(s)
| | | | - T. Dhanasekar
- Department of Pulmonology, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Prathiba Duvooru
- Department of Pathology, Sri Ramachandra University, Chennai, Tamil Nadu, India
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Pelosi G, Haspinger ER, Bimbatti M, Leone G, Paolini B, Fabbri A, Tamborini E, Perrone F, Testi A, Garassino M, Maisonneuve P, de Braud F, Pilotti S, Pastorino U. Does Immunohistochemistry Affect Response to Therapy and Survival of Inoperable Non–Small Cell Lung Carcinoma Patients? A Survey of 145 Stage III-IV Consecutive Cases. Int J Surg Pathol 2013; 22:136-48. [DOI: 10.1177/1066896913511527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Whether non–small cell lung carcinoma (NSCLC) unveiled by immunohistochemistry (IHC) has the same clinical outcome as those typed by morphology is still matter of debate. A total of 145 stage III-IV, consecutive inoperable NSCLC patients treated by chemotherapy (133 cases) or EGFR tyrosine kinase inhibitor (12 cases) and including 100 biopsies, 11 surgical specimens, and 34 cytological samples had originally accounted for 120 adenocarcinomas (ADs), 19 squamous cell carcinomas (SQCs), and 6 adenosquamous carcinomas (ADSQCs) by integrating morphology and thyroid transcription factor-1 (TTF1)/p40 IHC. Thirty-two NSCLC–not otherwise specified (NSCLC-NOS) cases were identified by morphology revision of the original diagnoses, which showed solid growth pattern ( P < .001), 22 ADs, 5 SQCs, and 5 ADSQCs by IHC profiling ( P < .001), and 10 gene-altered tumors (3 EGFR, 5 KRAS, and 2 ALK). While no significant relationships were observed between response to therapy and original, morphology or IHC diagnoses, driver mutations and tumor differentiation by TTF1 expression, AD run better progression-free survival (PFS) or overall survival (OS) than other tumor types by morphology ( P = .010 and P = .047) and IHC ( P = .033 and P = .046), respectively. Furthermore, patients with NSCLC-NOS confirmed as AD by IHC tended to have poorer OS ( P = .179) and PFS ( P = .193) similar to that of ADSQC and SQC ( P = .702 and P = .540, respectively). A category of less differentiated AD with poorer prognosis on therapy could be identified by IHC, while there were no differences for SQC or ADSQC. The terminology of “NSCLC-NOS, favor by IHC” is appropriate to alert clinicians toward more aggressive tumors.
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Affiliation(s)
- Giuseppe Pelosi
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi, Milan, Italy
| | | | | | - Giorgia Leone
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Biagio Paolini
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Elena Tamborini
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Adele Testi
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Patrick Maisonneuve
- Department of Medical Oncology, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Silvana Pilotti
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Ugo Pastorino
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Rüschoff J, Zielinski D, Heinmöller E. [New development lines in immunology. Perspective of pathology]. DER PATHOLOGE 2013; 34 Suppl 2:226-9. [PMID: 24196618 DOI: 10.1007/s00292-013-1811-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J Rüschoff
- Institut für Pathologie Nordhessen, Germaniastr. 7, 34119, Kassel, Deutschland,
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Cagle PT, Olsen RJ. The proposed new classification of pulmonary adenocarcinoma and the conservation of small tissue samples for testing. Arch Pathol Lab Med 2013; 137:453-4. [PMID: 23544933 DOI: 10.5858/arpa.2013-0950-ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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