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Abreu RF, Oliveira TBD, Hertzler H, Toledo RN, D'Almeida Costa F, Lopes Pinto CA, Nunes WA, Nascimento AF, French CA, Nascimento AG. NUT Carcinoma, an under-recognized malignancy: a clinicopathologic and molecular series of 6 cases showing a subset of patients with better prognosis and a rare ZNF532::NUTM1 fusion. Hum Pathol 2022; 126:87-99. [PMID: 35623465 DOI: 10.1016/j.humpath.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/21/2022]
Abstract
NUT carcinoma (NC) is a rare malignancy with aggressive clinical behavior, defined by rearrangements involving the NUTM1 gene locus. This entity is often under recognized and its diagnosis may be challenging. In this study, we describe a subset of patients that, despite the molecularly proven diagnosis of NC, show improved outcome. In addition, we describe one case with the novel ZNF532::NUTM1 fusion. All cases of NC diagnosed from 2013 to 2022 in our department were retrieved. FISH using dual color bring-together probes and next-generation sequencing assay were performed to characterize the fusions involving NUTM1. Amongst 6 patients identified, 5 were male with a median age of 35.6 years. Four patients had primary tumor in the head and neck region (2 ethmoid sinus, 1 parotid gland, 1 lacrimal gland); 1 in the mediastinum, and another presented with femoral bone tumor. In all cases, the initial diagnoses were not NC. The cases showed different morphological patterns, including monomorphic, rhabdoid and pleomorphic appearance. One case showed pseudopapillary pattern. By immunohistochemistry, all tumors showed squamous differentiation and ≥ 50% of neoplastic cells with nuclear positivity for NUT antibody. One case expressed WT1 (C-terminus) and other showed chromogranin positivity. Genetic study revealed a BRD4::NUTM1 fusion in all head and neck cases, BRD3::NUTM1 in mediastinum case, and ZNF532::NUTM1 fusion in the femur bone case. They were treated with surgical resection plus chemo and radiotherapy. The median overall survival was 23.11 months (1.6-83.3 mo) and the median disease free survival was 14.86 months (0-54.4 mo). The patients with longer overall survival were one with a lacrimal gland primary (83.3 months) and other with a parotid lesion (31.9 months). Both patients were primarily treated with complete surgical resection. Anatomic location may be directly related to the overall survival in NC cases. Resectability of the lesion is also an important factor related to survival. Pathologists should include NC in the differential diagnosis of any poorly differentiated and undifferentiated monomorphic malignancy, regardless of its anatomic location.
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Affiliation(s)
| | | | - Hans Hertzler
- Clinical Research Coordinator for NUT Carcinoma Patients, Brigham and Women's Hospital, Harvard Medical School, Boston, 02115, USA
| | - Ronaldo Nunes Toledo
- Department of Head and Neck Surgery, A.C.Camargo Cancer Center, Sao Paulo, 01509-010, Brazil
| | | | | | - Warley Abreu Nunes
- Department of Pathology, A.C.Camargo Cancer Center, Sao Paulo, 01509-010, Brazil
| | - Alessandra F Nascimento
- Department of Pathology, University Hospitals Cleveland Medical Center, Associate Professor of Pathology, Case Western Reserve University, Cleveland, 44106, USA
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Nascimento AF, Kilpatrick SE, Reith JD. Osteofibrous Dysplasia and Adamantinoma. Surg Pathol Clin 2021; 14:723-735. [PMID: 34742490 DOI: 10.1016/j.path.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
For decades, the diagnosis, treatment, and even pathogenesis of the osteofibrous dysplasia/osteofibrous dysplasia-like adamantinoma/classic adamantinoma spectrum of neoplasms have been controversial. Herein, we discuss and illustrate the radiographic and histologic spectrum, differential diagnoses, unifying chromosomal and molecular abnormalities, and current controversies and treatment recommendations for each entity.
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Scott E Kilpatrick
- Department of Pathology, L25, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - John D Reith
- Department of Pathology, L25, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Ruddocks LA, Nascimento AF, Bhattacharyya I, Islam MN, Cohen DM. Central odontogenic fibroma in association with brown tumor of hyperparathyroidism in a patient with neurofibromatosis type 1. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:e26-e32. [PMID: 34511348 DOI: 10.1016/j.oooo.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/04/2021] [Indexed: 11/24/2022]
Abstract
We present a patient with bone abnormalities and a myriad of lesions secondary to his redeveloping renal failure and neurofibromatosis type 1 (NF1). A 21-year-old male renal transplant recipient with NF1 presented with painless masses and large, irregular radiolucent lesions in the maxilla and mandible. After histologic examination, the lesion was diagnosed as a central odontogenic fibroma (COdF) in association with a central giant cell lesion, most consistent with brown tumor of hyperparathyroidism. The bone changes were interpreted to be highly suggestive of renal osteodystrophy. Around 30 cases of hybrid central giant cell granuloma-like lesion in association with central odontogenic fibroma have been reported. This, to our knowledge, is the first reported case of brown tumor in association with COdF. Our case provides further evidence of the giant cell component as the initiating entity in these hybrid lesions.
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Affiliation(s)
- Lauren A Ruddocks
- Resident, Oral & Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.
| | - Alessandra F Nascimento
- Unit Director, Bone & Soft Tissue Pathology, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Division Director, Oral & Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- Program Director, Oral & Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Donald M Cohen
- Department Chair, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
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Abstract
Palmar fibromatosis (Dupuytren disease/contracture) is the most common type of fibromatosis, defined as a benign proliferation of fibroblasts and myofibroblasts. The disease process is most common in white, middle-aged and older men occurring at the distal palmar crease leading to nodules and contracture, which in many cases recur after surgical treatment. In a similar process, plantar fibromatosis (Ledderhose disease) is a proliferation of fibroblasts and myofibroblasts on the plantar aponeurosis of mostly middle-aged patients that may lead to painful nodules but usually does not lead to contracture. Both processes are histologically similar, composed of a bland cellular proliferation of spindle cells with a bluish appearance and with a variable amount of background collagen, depending on the age of the lesion. The etiology of both lesions is still uncertain, while treatment ranges from observation to surgery, with some pharmacologic agents being investigated with mixed success. In this paper we provide an overview of both processes with regards to clinical and radiologic findings, pathophysiology, diagnosis, treatment, and prognosis.
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Affiliation(s)
- Brian D Stewart
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alessandra F Nascimento
- CWRU School of Medicine, University Hospitals, Bone and Soft Tissue Pathology, Cleveland, OH, USA
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Shenoy A, Newsom K, Gray B, Zhang Y, Lagmay JP, Islam S, Knapik JA, Reith JD, Starostik P, Nascimento AF. Malignant round cell tumor with SS18-POU5F1 fusion: is it a myoepithelial neoplasm, a synovial sarcoma or a new entity? Histopathology 2020; 77:681-684. [PMID: 32516451 DOI: 10.1111/his.14171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Archana Shenoy
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kimberly Newsom
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Brian Gray
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Yanping Zhang
- Gene Expression & Genotyping, Interdisciplinary Center of Biotechnology Research, University of Florida, Gainesville, FL, USA
| | - Joanne P Lagmay
- Division of Hematology and Oncology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jacquelyn A Knapik
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - John D Reith
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Petr Starostik
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alessandra F Nascimento
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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Nascimento M, Piran R, Da Costa RM, Giordani MA, Carneiro FS, Aguiar DH, Dias MC, Sugizaki MM, Luvizotto RA, Nascimento AF, Bomfim GF. Hepatic injury induced by thioacetamide causes aortic endothelial dysfunction by a cyclooxygenase-dependent mechanism. Life Sci 2018; 212:168-175. [PMID: 30292829 DOI: 10.1016/j.lfs.2018.09.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/22/2018] [Accepted: 09/30/2018] [Indexed: 02/07/2023]
Abstract
Liver cirrhosis is associated with a wide range of cardiovascular abnormalities including hyperdynamic circulation and cirrhotic cardiomyopathy. The pathogenic mechanisms of these cardiovascular changes are multifactorial and include vascular dysregulations. AIM The present study tested the hypothesis that the systemic vascular hyporesponsiveness in thioacetamide (TAA)-induced liver injury model is dependent on nitric oxide (NO) and cyclooxygenase (COX) derivatives. MAIN METHODS Wistar rats were treated with TAA for eight weeks to induce liver injury. KEY FINDINGS The maximal contractile response in concentration-effect curves to phenylephrine was decreased in aorta from TAA-treated rats, but no differences were found in aorta without endothelium, suggesting an endothelium-dependent mechanism in decreased contractile response. There was no difference in the contractile response with and without L-NAME (N(ω)-nitro-l-arginine methyl ester) in rats with liver injury, showing that the TAA treatment impairs NO synthesis. Pre-incubation of the aorta with indomethacin, a COX-inhibitor, normalized the reduced contractile response to phenylephrine in arteries from TAA group. Also, COX-2 and iNOS (inducible nitric oxide syntase) protein expression was increased in aorta from TAA group compared to control group. Animals submitted to TAA treatment had a reduction in systolic blood pressure. Our findings demonstrated that liver injury induced by TAA caused a decrease in aortic contractile response by a COX-dependent mechanism but not by NO release. Also, it was demonstrated an inflammatory process in the aorta of TAA-treated rats by increased expression of COX-2 and iNOS. SIGNIFICANCE Therefore, there is an essential contribution of COX-2 activation in extra-hepatic vascular dysfunction and inflammation present in cirrhosis induced by TAA.
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Affiliation(s)
- M Nascimento
- Institute of Health Science, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - R Piran
- Institute of Health Science, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - R M Da Costa
- Department of Physiology, Institute of Health Sciences, Federal University of Goias, Jatai, Brazil
| | - M A Giordani
- Institute of Health Science, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - F S Carneiro
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - D H Aguiar
- Institute of Health Science, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - M C Dias
- Institute of Health Science, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - M M Sugizaki
- Institute of Health Science, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - R A Luvizotto
- Institute of Health Science, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - A F Nascimento
- Institute of Health Science, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - G F Bomfim
- Institute of Health Science, Federal University of Mato Grosso, Sinop, MT, Brazil.
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Nascimento AF, Oliveira JS, Silva Junior JC, Barbosa AAL. Genomic ancestry evaluated by ancestry-informative markers in patients with sickle cell disease. Genet Mol Res 2016; 15:gmr7604. [PMID: 27051031 DOI: 10.4238/gmr.15017604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The β(s) mutation is responsible for the most aggressive form of sickle cell disease, has a predominantly African origin, and arrived in Brazil through the slave trade. However, the Brazilian population is highly miscegenated, underscoring the importance of ancestry-informative markers (AIMs) for the identification of the genetic structure of a population. In this study, we have estimated the genetic contributions of various ethnicities in individuals with sickle cell disease in the microregion of Jequié, Bahia, in Brazil, by using AIMs, and compared the findings to those from a phenotypic characterization. Eight AIMs were analyzed: AT3 (rs3138521), DRD2 (rs1079598), APO (rs3138522), PV92, Sb19.3 (rs3138524), CKM (rs4884), LPL (rs285), and CCR5Δ32 (rs333). Samples were subjected to polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism. The amplified products were electrophoresed on agarose gels, and the data were statistically analyzed using Genepop, FSTAT 2.9, and Admix3. Phenotypic classification showed a high frequency of mulattos (85%) in the Brazilian population; however, ancestry-informative markers indicated that 44, 42, and 11% of the population had European, African, and native American ancestries, respectively. The phenotypic classification is justified as a complementary method for the characterization of the genetic ancestry in patients with sickle cell disease, as it confirms the molecular findings regarding ancestry.
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Affiliation(s)
- A F Nascimento
- Programa de Pós-Graduação em Genética Biodiversidade e Conservação, Departamento de Ciências Biológicas, Universidade Estadual do Sudoeste da Bahia, Jequié, BA, Brasil
| | - J S Oliveira
- Departamento de Ciências Biológicas, Universidade Estadual do Sudoeste da Bahia, Jequié, BA, Brasil
| | - J C Silva Junior
- Departamento de Ciências Biológicas, Universidade Estadual do Sudoeste da Bahia, Jequié, BA, Brasil
| | - A A L Barbosa
- Departamento de Ciências Biológicas, Universidade Estadual do Sudoeste da Bahia, Jequié, BA, Brasil
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Leopoldo AS, Lima-Leopoldo AP, Nascimento AF, Luvizotto RAM, Sugizaki MM, Campos DHS, da Silva DCT, Padovani CR, Cicogna AC. Classification of different degrees of adiposity in sedentary rats. Braz J Med Biol Res 2016; 49:e5028. [PMID: 26909787 PMCID: PMC4792506 DOI: 10.1590/1414-431x20155028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/17/2015] [Indexed: 01/23/2023] Open
Abstract
In experimental studies, several parameters, such as body weight, body mass index,
adiposity index, and dual-energy X-ray absorptiometry, have commonly been used to
demonstrate increased adiposity and investigate the mechanisms underlying obesity and
sedentary lifestyles. However, these investigations have not classified the degree of
adiposity nor defined adiposity categories for rats, such as normal, overweight, and
obese. The aim of the study was to characterize the degree of adiposity in rats fed a
high-fat diet using cluster analysis and to create adiposity intervals in an
experimental model of obesity. Thirty-day-old male Wistar rats were fed a normal
(n=41) or a high-fat (n=43) diet for 15 weeks. Obesity was defined based on the
adiposity index; and the degree of adiposity was evaluated using cluster analysis.
Cluster analysis allowed the rats to be classified into two groups (overweight and
obese). The obese group displayed significantly higher total body fat and a higher
adiposity index compared with those of the overweight group. No differences in
systolic blood pressure or nonesterified fatty acid, glucose, total cholesterol, or
triglyceride levels were observed between the obese and overweight groups. The
adiposity index of the obese group was positively correlated with final body weight,
total body fat, and leptin levels. Despite the classification of sedentary rats into
overweight and obese groups, it was not possible to identify differences in the
comorbidities between the two groups.
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Affiliation(s)
- A S Leopoldo
- Departamento de Desportos, Centro de Educação Física e Esportes, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - A P Lima-Leopoldo
- Departamento de Desportos, Centro de Educação Física e Esportes, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - A F Nascimento
- Instituto de Ciências da Saúde, Universidade Federal do Mato Grosso, Sinop, MT, Brasil
| | - R A M Luvizotto
- Instituto de Ciências da Saúde, Universidade Federal do Mato Grosso, Sinop, MT, Brasil
| | - M M Sugizaki
- Instituto de Ciências da Saúde, Universidade Federal do Mato Grosso, Sinop, MT, Brasil
| | - D H S Campos
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - D C T da Silva
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - C R Padovani
- Departamento de Bioestatística, Instituto de Biociências, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - A C Cicogna
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
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Luvizotto RAM, Nascimento AF, Miranda NCM, Wang XD, Ferreira ALA. Lycopene-rich tomato oleoresin modulates plasma adiponectin concentration and mRNA levels of adiponectin, SIRT1, and FoxO1 in adipose tissue of obese rats. Hum Exp Toxicol 2015; 34:612-9. [DOI: 10.1177/0960327114551395] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aim: To investigate whether lycopene can modulate adiponectin levels and SIRT1 and FoxO1 gene expression in the adipose tissue of diet-induced obese rats. Methods: Male Wistar rats were first fed with hypercaloric diet (HD, n = 12) for 6 weeks, and afterward, these rats were randomly assigned to receive HD ( n = 6) or HD with lycopene-rich tomato oleoresin (equivalent to lycopene 10 mg/kg body weight (BW)/day, HD + L, n = 6) by gavage for additional 6 weeks. Plasma lycopene and adiponectin levels were analyzed by high-performance liquid chromatography and immunoassay, respectively. The messenger RNA (mRNA) expressions of adiponectin, Sirtuin 1 (SIRT1), Forkhead box O 1 (FoxO1), fatty acid translocase/cluster of differentiation 36 (FAT/CD36), and PPARγ in adipose tissues were determined by quantitative polymerase chain reaction. Results: Lycopene was detected in the plasma of rats in HD + L group but not in the HD group. Although both BW and adiposity were not different between the two groups, there was a significant increase in both plasma concentration and mRNA expression of adiponectin in the adipose tissue of the HD + L group. In addition, the lycopene supplementation upregulated mRNA expressions of SIRT1, FoxO1, and FAT/CD36 but downregulated PPARγ in adipose tissue of obese rats. Conclusion: These data suggest that lycopene, in the concentration used, is not toxic and also its health benefits in adipose tissue may play a role against obesity-related complications.
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Affiliation(s)
- RAM Luvizotto
- Institute of Health Science, Federal University of Mato Grosso (UFMT), Sinop, Mato Grosso, Brazil
- Department of Internal Medicine, Botucatu Medical School (UNESP), Botucatu, São Paulo, Brazil
| | - AF Nascimento
- Institute of Health Science, Federal University of Mato Grosso (UFMT), Sinop, Mato Grosso, Brazil
| | - NCM Miranda
- Department of Internal Medicine, Botucatu Medical School (UNESP), Botucatu, São Paulo, Brazil
| | - X-D Wang
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - ALA Ferreira
- Department of Internal Medicine, Botucatu Medical School (UNESP), Botucatu, São Paulo, Brazil
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Pierine DT, Navarro MEL, Minatel IO, Luvizotto RAM, Nascimento AF, Ferreira ALA, Yeum KJ, Corrêa CR. Lycopene supplementation reduces TNF-α via RAGE in the kidney of obese rats. Nutr Diabetes 2014; 4:e142. [PMID: 25383746 PMCID: PMC4259904 DOI: 10.1038/nutd.2014.39] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/28/2014] [Accepted: 09/08/2014] [Indexed: 02/07/2023] Open
Abstract
Background: The kidney is a target organ for injuries caused by advanced glycation end products (AGEs) in obesity. The receptor of AGEs (RAGE) is proinflammatory and appears to have a role in the pathogenesis of renal disease due to obesity. Objective: The aim was to verify the effect of obesity on renal damage and the effect of lycopene on these complications Design and Methods: Male Wistar rats were randomly assigned to receive a control diet (C, n=7) or a high-fat diet plus sucrose (HD+S, n=14) for 6 weeks. After this period, the HD+S animals were randomized into two groups: HD+S (n=7) and HD+S supplemented with lycopene (HD+S+L, n=7). The animals received maize oil (C and HD+S) or lycopene (HD+S+L) for a 6-week period. Results: The HD+S and HD+S+L animals demonstrated insulin resistance (OGTT glucose after 150 min; C: 117.6±3.9<HD+S: 138.1±5.1=HD+S+L: 137.8±5.2 mg dl−1; P=0.01); however, no changes were seen in fasting glucose, plasma lipids, blood pressure or renal function. Renal concentrations of RAGE and TNF-α increased in the HD+S group and lycopene supplementation restored these to control group values (RAGE: C: 3.1±0.3=DH+S+L: 3.1±0.3<DH+S: 3.6±0.4 μg g−1; P=0.014; TNF-α: C: 227.8±2.7=DH+S+L: 227.4±2.2<DH+S: 238.7±3.0 pg/ml; P=0.014). Conclusions: Lycopene may be beneficial in the prevention and treatment of oxidative stress and inflammation in the kidney due to obesity.
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Affiliation(s)
- D T Pierine
- 1] Pathology Department, Botucatu Medical School-São Paulo State University-UNESP, Botucatu, Brazil [2] Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - M E L Navarro
- Pathology Department, Botucatu Medical School-São Paulo State University-UNESP, Botucatu, Brazil
| | - I O Minatel
- 1] Pathology Department, Botucatu Medical School-São Paulo State University-UNESP, Botucatu, Brazil [2] Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - R A M Luvizotto
- 1] Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA [2] Internal Medicine Department, Botucatu Medical School-São Paulo State University-UNESP, Botucatu, Brazil
| | - A F Nascimento
- 1] Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA [2] Internal Medicine Department, Botucatu Medical School-São Paulo State University-UNESP, Botucatu, Brazil
| | - A L A Ferreira
- Internal Medicine Department, Botucatu Medical School-São Paulo State University-UNESP, Botucatu, Brazil
| | - K-J Yeum
- 1] Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA [2] Food and Nutrition Major, Division of Food Bioscience, College of Biomedical and Health Sciences, Konkuk University, Glocal Campus, Seoul, South Korea
| | - C R Corrêa
- Pathology Department, Botucatu Medical School-São Paulo State University-UNESP, Botucatu, Brazil
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Abstract
AIMS The purpose of this study was to evaluate the expression patterns of B-cell specific activator protein (BSAP)/PAX5 and PAX8 in a wide variety of B-cell and T-cell neoplasms. METHODS AND RESULTS A wide range of B-cell and T-cell neoplasms were subjected to immunohistochemical staining with antibodies against BSAP/PAX5 and PAX8 (polyclonal, pPAX8; monoclonal, mPAX8). Ten non-neoplastic lymph node specimens were examined with the same panel. All of the tested neoplastic and non-neoplastic B-cells reacted with the BSAP/PAX5 and pPAX8 antibodies, but did not show reactivity with the mPAX8 antibody. All tested T-cell neoplasms were negative using the BSAP/PAX5, pPAX8 and mPAX8 antibodies. CONCLUSIONS This is the first study to show the absence of reactivity to an mPAX8 antibody in an expanded panel of B-cell lymphomas as well as in a variety of T-cell neoplasms. In contrast to the mPAX8 antibody, the pPAX8 antibody shows nuclear positivity in non-neoplastic B cells and mature B-cell neoplasms; however, this expression is probably a result of cross-reactivity with PAX5. Given that many laboratories use the pPAX8 antibody, a clear understanding of the differential staining patterns is necessary. The differential diagnosis of a B-cell lymphoma should be entertained when a pPAX8-positive, epithelial marker-negative neoplasm of uncertain primary origin is encountered.
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Affiliation(s)
- Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Morgan EA, Kozono DE, Wang Q, Mery CM, Butrynski JE, Baldini EH, George S, Nascimento AF, Raut CP. Cutaneous Radiation-Associated Angiosarcoma of the Breast: Poor Prognosis in a Rare Secondary Malignancy. Ann Surg Oncol 2012; 19:3801-8. [DOI: 10.1245/s10434-012-2563-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Indexed: 01/26/2023]
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Luvizotto RAM, Síbio MT, Olímpio RMC, Nascimento AF, Lima-Leopoldo AP, Leopoldo AS, Padovani CR, Cicogna AC, Nogueira CR. Supraphysiological triiodothyronine doses diminish leptin and adiponectin gene expression, but do not alter resistin expression in calorie restricted obese rats. Horm Metab Res 2011; 43:452-7. [PMID: 21557150 DOI: 10.1055/s-0031-1277187] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Thyroid hormones regulate energy balance and act on adipokines. However, while it is unclear what the effects are of calorie restriction and high doses of triiodothyronine (T(3)) on adipokines in obesity, thyroid hormones are illicitly administered in isolation or in association with a hypocaloric diet as an obesity treatment. The present study determined the effect of T(3) on serum concentrations and gene expression of the adipokines leptin, resistin, and adiponectin in calorie-restricted obese rats. Male Wistar rats received a hypercaloric diet for 20 weeks followed by calorie restriction for 8 weeks. The animals were then randomly divided into 3 groups: calorie restriction (OR), OR with 5 μg of T(3)/100 g BW (RS1), and OR with 25 μg of T(3)/100 g BW (RS2) for 2 weeks. Blood and adipose tissue samples were collected for biochemical, hormonal, and gene expression analyses. Serum concentrations of leptin (OR: 3.7±0.6, RS1: 3.8±1, RS2 0.2±0.07 ng/dl) and resistin (OR: 2.5±0.6, RS1: 2.5±0.5, RS2 1.6±0.3 ng/dl) were diminished at the higher dose, while serum adiponectin (OR: 31±7, RS1: 24±5, RS2 26±7 ng/dl) levels were lower in the low dose group. Administration of T(3) reduced leptin gene expression (OR: 0.91±0.1, RS1: 0.95±0.1, RS2 0.22±0.1) only at the higher dose, resistin expression (OR: 1.06±0.2, RS1: 1.04±0.1, RS2 0.88±0.2) was not influenced by T(3) treatment, and adiponectin expression (OR: 1.55±0.5, RS1: 0.95±0.15, RS2 0.97±0.13) was diminished independent of the T(3) dose. These results indicate that T(3), directly or indirectly, inhibits the expression of leptin and adiponectin in calorie restricted obese animals.
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Affiliation(s)
- R A M Luvizotto
- Department of Clinical Medicine, Botucatu School of Medicine, UNESP - University of São Paulo State, Botucatu, São Paulo, Brazil.
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Nascimento AF, Fletcher CDM. The controversial nosology of benign nerve sheath tumors: neurofilament protein staining demonstrates intratumoral axons in many sporadic schwannomas. Am J Surg Pathol 2007; 31:1363-70. [PMID: 17721192 DOI: 10.1097/pas.0b013e318031bc0c] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Schwannomas are benign peripheral nerve sheath tumors believed to be composed purely of cells with ultrastructural features of Schwann cells; these tumors are believed to develop eccentrically from the surface of nerves and not to contain axons, other than immediately beneath the capsule. This concept has recently been disputed in cases associated with neurofibromatosis type 2. The usual presence of intratumoral axons in neurofibromas is said to allow easy distinction from schwannomas. Eighty sporadic schwannomas (20 conventional, 20 cellular, 20 ancient, 10 gastric, and 10 plexiform) were retrieved from the authors' files. Hematoxylin-and-eosin stained slides were reviewed, diagnoses were confirmed and all tumors were stained for S-100 protein and neurofilament protein (NFP). The amount (rare, focal, multifocal, and diffuse) and distribution (central and/or peripheral) of axons within the tumors were analyzed. All tumors were strongly and diffusely positive for S-100 protein (nuclear and cytoplasmic staining). NFP-positive axons were identified in 11 of 20 (55%) conventional schwannomas (2 rare, 4 focal, 3 multifocal, and 2 diffuse; 5 central, 4 peripheral, and 2 central and peripheral) and in 15 of 20 (75%) cellular schwannomas (3 rare, 6 focal, and 6 multifocal; 12 central, 1 peripheral, and 2 central and peripheral). Of the 20 ancient schwannomas, 7 cases (35%) showed intratumoral axons, highlighted by NFP immunostaining (1 rare, 4 focal, 1 multifocal, and 1 diffuse; 4 peripheral, 2 central, and 1 central and peripheral). Most cases of gastric schwannoma showed no evidence of intratumoral axons; 9 cases (90%) were negative for NFP and only 1 case (10%) was positive (focal and central). Seven of 10 cases (70%) of plexiform schwannomas were negative for NFP, whereas only 3 cases (30%) showed positive axons (2 multifocal and 1 focal; 3 central). The unexpected but quite frequent presence of intratumoral axons in schwannomas argues against conventional views of these lesions' pathogenesis as an eccentric encapsulated lesion and raises the possibility that a more diverse cell population, perhaps more closely resembling neurofibromas, may constitute these neoplasms. Although NFP-positive axons were most often present in the conventional and cellular variants of schwannoma, their presence was also observed in a minority of ancient, gastric and plexiform schwannomas. Differentiation between neurofibroma and schwannoma in cases with overlapping cytoarchitectural features should not be based solely on the presence or absence of NFP-positive axons within a given tumor.
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Nascimento AF, Winters GL, Pinkus GS. Primary cardiac lymphoma: clinical, histologic, immunophenotypic, and genotypic features of 5 cases of a rare disorder. Am J Surg Pathol 2007; 31:1344-50. [PMID: 17721189 DOI: 10.1097/pas.0b013e3180317341] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary lymphomas of the heart are rare and frequently are diagnosed at autopsy. Modern imaging technology now permits early diagnosis and treatment. This report describes the clinical, histologic, immunophenotypic, and molecular genetic findings for 5 patients with malignant lymphoma restricted to the cardiac muscle, with or without pericardial involvement. All patients were women, with ages ranging from 40 to 68 years (median 55 y). The right atrium was involved in all cases with the left atrium, right ventricle, and pericardium affected in 1 case each. Clinical presentation included pericardial effusions associated with precordial pain, dyspnea, and bradycardia. Electrocardiographic changes included junctional rhythm, incomplete right bundle branch block and ST and T waves abnormalities, and ST segment elevation and first-degree atrioventricular block with intermittent complete heart block. In all cases, biopsy or resection of the lesion or cytologic examination of the pericardial fluid established a diagnosis. All tumors were of B-cell phenotype and included 4 cases of large cell lymphoma and one unclassifiable small cell lymphoma. In 2 cases, a follicular center cell origin was supported by reactivity of the neoplastic cells for CD10 and bcl-6 and by bcl-2 gene rearrangement by molecular analysis. One patient died shortly after diagnosis due to cerebral infarction. Two patients are alive without disease after chemotherapy with CHOP after 120 and 192 months. One patient underwent chemotherapy with CHOP and rituximab, and shows persistent cardiac involvement by lymphoma but with a decrease in tumor burden at 7 months of follow-up. One patient was lost to follow-up. Clinical outcome is variable; however, early diagnosis in conjunction with effective treatment (surgery and/or chemotherapy) may result in an excellent prognosis. Primary cardiac lymphoma should be included in the differential diagnosis of a right atrial mass.
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MESH Headings
- Adult
- Aged
- Antigens, CD/analysis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/therapeutic use
- Diagnosis, Differential
- Doxorubicin/administration & dosage
- Doxorubicin/therapeutic use
- Female
- Gene Expression Regulation, Neoplastic
- Gene Rearrangement
- Genotype
- Heart Atria/pathology
- Heart Neoplasms/diagnosis
- Heart Neoplasms/drug therapy
- Heart Neoplasms/genetics
- Heart Neoplasms/immunology
- Heart Neoplasms/pathology
- Heart Ventricles/pathology
- Humans
- Immunophenotyping
- Karyotyping
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Pericardium/pathology
- Prednisone/administration & dosage
- Prednisone/therapeutic use
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/therapeutic use
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Abstract
Monitoring the relative frequency of the interpretations of atypical squamous cells (ASC) and squamous intraepithelial lesions (SIL) has been proposed as a quality control measure. To assess its value, an ASC/SIL ratio was calculated every 6 months for 3.5 years, and confidential feedback was provided to 10 cytopathologists (CPs). By using simple regression analysis, we analyzed the initial and final ASC/SIL ratios for individual CPs and for the entire group. The ratio was below the upper benchmark of 3:1 for all but 1 CP during every 6-month period. The ratio for all CPs combined showed a downward trend (from 2.05 to 1.73). The ratio for 6 CPs decreased, and for two of them the decrease was statistically significant. One CP showed a statistically significant increase in the ASC/SIL ratio. The decrease for some CPs likely reflects the salutary effect of confidential feedback and counseling.
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Abstract
Granular cell tumors (GCTs), especially if atypical or malignant, may share cytomorphologic and architectural features with malignant melanoma, when the latter shows granular cell change. In many cases, these neoplasms can be differentiated from each other on histologic grounds, but distinction may sometimes be challenging. By immunohistochemistry, both tumors are strongly positive for S-100 protein and frequently express other nonspecific markers such as CD68, NSE, and NKIC3. In the current study, we reviewed 60 cases of conventional cutaneous, mucosal, and visceral GCT and studied the use of immunoperoxidase staining for the differential diagnosis between malignant melanoma and GCT. Immunohistochemical stains for S-100 protein, A, HMB-45, and microphthalmia transcription factor (MITF) were performed in all cases. All of the tumors were positive for S-100 protein. MITF immunostaining was diffusely positive in 53 (88%) cases, focally positive in three (5%) cases, and negative in four (7%). Fifty-seven (95%) tumors were negative for Melan-A, one case was focally positive, and two cases showed rare positive tumor cells. None of the tumors expressed HMB-45. In conclusion, GCT and malignant melanoma can be reliably differentiated on the basis of immunohistochemical stains in the majority of cases. Although not always positive in malignant melanoma, in this context, HMB-45 expression seems to be 100% specific for the diagnosis of melanoma. Melan-A is slightly less specific, with rare cases of GCT showing focal positivity. MITF is not useful in this differential-93% of the GCTs in our series showed nuclear reactivity for this marker. The latter finding highlights the limited specificity of this antibody in the diagnosis of melanocytic tumors.
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Affiliation(s)
- Briana C Gleason
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Nascimento AF, Bertoni F, Fletcher CDM. Epithelioid Variant of Myxofibrosarcoma: Expanding the Clinicomorphologic Spectrum of Myxofibrosarcoma in a Series of 17 Cases. Am J Surg Pathol 2007; 31:99-105. [PMID: 17197925 DOI: 10.1097/01.pas.0000213379.94547.e7] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Myxofibrosarcoma (MFS) is one of the most common soft tissue sarcomas of elderly patients and has a predilection for the limbs. Herein, we report a previously undescribed variant of MFS showing epithelioid morphology. Seventeen cases diagnosed as epithelioid MFS were retrieved from the authors' files from among 570 cases of MFS. Hematoxylin and eosin-stained sections were reexamined and immunostains for pan-keratin (15 cases), S-100 protein (15), desmin (15), and alpha-smooth muscle actin (13) were performed. Nine patients were men and 8 were women (age range 43 to 89 y; median 63.5). Fifteen patients presented with a mass, and in 2 of these there was also pain. Duration of symptoms varied from 1 to 24 months (median 3). Tumor size ranged from 2 to 15 cm (median 6.75). In 10 cases, the tumor was located in subcutaneous tissue and in 6 cases it was subfascial. The majority of the tumors were located on the limbs (8 lower extremities and 6 upper extremities) followed by neck (1), scalp (1), and trunk (1). Follow-up was available for 14 patients (range 2 to 240 mo; median 16). Twelve patients were treated by surgery followed by chemotherapy and/or radiation (8 cases). One patient received chemotherapy after an incisional biopsy and 1 patient was treated by surgery alone. Ten patients (71.4%) developed local recurrences. Seven patients (50%) developed metastases to lungs or retroperitoneum. Five patients (35.7%) have died of disease so far. Two patients were lost to follow-up. Morphologically, 14 cases were high grade, 2 were intermediate, and 1 was low grade. Tumors were characterized by a multinodular, infiltrating growth pattern with alternation of hypercellular and hypocellular myxoid areas; the latter showed prominent curvilinear vessels. Neoplastic cells were arranged singly and in small clusters in the myxoid areas or formed sheets in the hypercellular areas, where they showed epithelioid morphology with round nuclei, vesicular chromatin, prominent nucleoli, and moderate amounts of eosinophilic cytoplasm. The epithelioid areas were generally multifocal with admixed areas of conventional MFS. Immunostains were negative for all markers studied. Differential diagnosis included carcinoma, melanoma, myoepithelial carcinoma, pleomorphic liposarcoma, and pleomorphic rhabdomyosarcoma. In conclusion, epithelioid MFS is a rare variant of MFS, accounting for <3% of MFS in consultation material. Its natural history seems more aggressive than usual high-grade MFS, with approximately 70% local recurrence and 50% metastases, even within a relatively short follow-up period.
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Vieira Neto L, Taboada GF, Corrêa LL, Polo J, Nascimento AF, Chimelli L, Rumilla K, Gadelha MR. Acromegaly secondary to growth hormone-releasing hormone secreted by an incidentally discovered pheochromocytoma. Endocr Pathol 2007; 18:46-52. [PMID: 17652801 DOI: 10.1007/s12022-007-0006-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 10/23/2022]
Abstract
Ectopic growth hormone-releasing hormone (GHRH)-secreting tumors are rare and cause acromegaly with somatotroph hyperplasia. We report a case of acromegaly secondary to GHRH secretion by an incidentally discovered pheochromocytoma in a normotensive patient. A 23-year-old man presented with signs and symptoms of acromegaly. Laboratory evaluation confirmed the diagnosis and magnetic resonance imaging (MRI) revealed a sellar mass which was thought to be a macroadenoma and surgically resected. The patient was not cured and medical treatment was indicated. An abdominal ultrasound performed before initiation of medical treatment showed a solid/cystic lesion superiorly to the right kidney. An abdominal MRI confirmed an adrenal tumor. Hormonal workup of the adrenal incidentaloma revealed elevated urinary catecholamine and total metanephrines findings strongly suggestive of a pheochromocytoma. Acromegaly was then suspected to be due to ectopic secretion of GHRH by the tumor. Patient underwent surgical resection and histopathologic examination confirmed a pheochromocytoma which stained positively for GHRH. Also, review of the pituitary specimen confirmed somatotrophic hyperplasia. Genetic analysis of the ret proto-oncogene showed no mutation. Pituitary MRI was repeated 10 months after pheochromocytoma resection and revealed a slightly enlarged pituitary and partial empty sella. The diagnosis of acromegaly caused by ectopic production of GHRH is a challenging task. A careful histopathological examination of the surgically excised pituitary tissue has a key role to arouse the suspicion and guide the investigation of a secondary cause of acromegaly.
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Affiliation(s)
- L Vieira Neto
- Endocrinology Section, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Nascimento AF, Fletcher CDM. Spindle cell rhabdomyosarcoma in adults. Am J Surg Pathol 2005; 29:1106-13. [PMID: 16006807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The spindle cell variant of rhabdomyosarcoma (RMS) is uncommon and is most often encountered in the paratesticular region of children in whom it has a good prognosis. Only isolated cases in adulthood have been described. Sixteen cases of spindle cell RMS occurring in adults were retrieved from our files. Eleven patients were male and 5 were female. Patient age ranged from 18 to 79 years (median, 32 years). Tumor size varied from 1.5 to 35 cm (median, 6 cm). The head and neck region, including the oral cavity, parotid gland, nasopharynx, and nasal cavity, was the commonest affected area, accounting for >50% of the cases, followed by retroperitoneum, thigh, leg, subscapular area, hand, vulva, and paratesticular region (1 case each). Follow-up was available in 12 cases, ranging from 1 to 102 months (median, 16.5 months). Treatment modalities included surgery, chemotherapy, and radiation. Two patients died of uncontrolled local disease 13 and 27 months after diagnosis; 4 were alive without disease at 12, 17, 24, and 102 months, including 1 patient with metastasis to 10 of 50 pelvic lymph nodes at presentation; 3 are alive with localized disease at 16, 17, and 19 months; and 1 was followed for 6 months and showed persistent local disease. One patient is alive at 10 months after diagnosis with evidence of metastatic disease to bone, lungs, and breast. All the tumors showed long fascicles of spindle cells with elongated, vesicular nuclei and pale indistinct cytoplasm. Scattered spindled or polygonal rhabdomyoblasts with abundant brightly eosinophilic cytoplasm were present in all cases. In 3 cases, focal areas showed pseudovascular, sclerosing features. There were no round cell or pleomorphic areas. Positive immunohistochemical results were as follows: desmin (15 of 15 cases), myf-4 (12 of 12), fast myosin (7 of 9), myoglobin (2 of 3), HHF-35 (9 of 9), and SMA (11 of 14). One tumor was focally positive for keratins and EMA. All tumors were negative for caldesmon, S-100 protein, and GFAP. Spindle cell RMS is a rare neoplasm in adults and appears to have distinct clinicopathologic features when compared with cases occurring in the pediatric population. Specifically, it appears to be most common in the head and neck region, and although only limited follow-up is available so far, these lesions appear to have a more aggressive clinical course in adults.
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Abstract
The recognition and classification of preinvasive vulvar neoplasia are complicated by the facts that (a) their respective carcinomas have a diverse (human papillomavirus [HPV]- and non-HPV-related) pathogenesis; (b) not all vulvar squamous carcinomas are associated with precursors with strictly defined morphologic features; (c) many carcinomas have epithelial changes that are abnormal but lack sufficient nuclear atypia to warrant classification as an intraepithelial neoplasm; and (d) even lesions associated with a common etiologic agent (HPV) present a diverse morphologic spectrum. In this review, five categories of early vulvar neoplasia are defined, based on the available literature, into (a) low-grade lesions with minimal cancer risk, (b) high-grade lesions associated with HPV, (c) high-grade lesions associated with other etiologies, (d) squamous atypias defined by abnormalities in differentiation rather than abnormalities in nuclear morphology, and (d) early carcinomas that do not exhibit conspicuous stromal invasion. The first three groups are arranged into low- and high-grade intraepithelial lesions, the fourth into intraepithelial atypias that bear careful follow-up and attention to the co-existing squamous mucosa, and the fifth into a category that, depending on the degree of cell differentiation, may warrant local excision or lymph node dissection. Recognition of these five categories is germane to proper management of women with squamous lesions of the vulva.
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Affiliation(s)
- Fabiola Medeiros
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Nascimento AF, Dal Cin P, Cilento BG, Perez-Atayde AR, Kozakewich HPW, Nosé V. Urachal inflammatory myofibroblastic tumor with ALK gene rearrangement: a study of urachal remnants. Urology 2004; 64:140-4. [PMID: 15245952 DOI: 10.1016/j.urology.2004.02.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Accepted: 02/25/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Abnormalities of the urachus are rare among children and include a patent tract and cyst formation. These structures can also be affected by infection and abscess development. They are usually diagnosed during infancy and treated by surgical resection. Involvement of this remnant by either benign or malignant tumors is very infrequent. A few cases of mesenchymal tumors, such as desmoid tumor and leiomyoma, involving the urachus have been described in published reports. METHODS We studied an inflammatory myofibroblastic tumor arising from the urachus in a 10-year-old boy. In addition, we reviewed 101 cases of urachal remnants retrieved from the surgical pathology and autopsy files in the Department of Pathology at the Children's Hospital Boston diagnosed in the past 82 years. RESULTS The urachal inflammatory myofibroblastic tumor showed anaplastic lymphoma kinase (ALK) rearrangement by immunohistochemistry and fluorescence in situ hybridization techniques. No other neoplasms were diagnosed in the analyzed population. CONCLUSIONS We describe an example of inflammatory myofibroblastic tumor involving the urachus. Involvement of the urachus by tumors is rare, but these should be considered in the differential diagnosis of urachal lesions.
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Nascimento AF, Pinkus JL, Pinkus GS. Clusterin, a marker for anaplastic large cell lymphoma immunohistochemical profile in hematopoietic and nonhematopoietic malignant neoplasms. Am J Clin Pathol 2004; 121:709-17. [PMID: 15151211 DOI: 10.1309/gq2r-lndw-lb9w-y6uu] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
We evaluated the immunohistochemical staining profile of clusterin in paraffin sections of 143 neoplasms (non-Hodgkin lymphoma, 83, including 41 anaplastic large cell lymphomas [ALCLs]; Hodgkin lymphoma, 17; primary and metastatic carcinoma, 30; and other neoplasms, 13). In 40 of 41 ALCLs (34 systemic, 7 cutaneous), neoplastic cells revealed clusterin reactivity characterized by a Golgi staining pattern. The proportion of reactive cells varied with more than 25% positive cells in the majority of cases. In 7 non-Hodgkin lymphomas of other types, fine cytoplasmic (3 cases) or strong membranous reactivity (4 cases) was observed for clusterin. In Hodgkin lymphoma, rare Reed-Sternberg cells exhibited focal cytoplasmic or membranous clusterin positivity. In the nonhematopoietic neoplasms, a Golgi staining pattern was apparent in only 2 cases, 1 lobular carcinoma of the breast and 1 poorly differentiated colonic carcinoma; however, cytoplasmic reactivity was noted in 12 of 30 carcinomas and 1 of 5 neuroendocrine neoplasms. A Golgi pattern of reactivity for clusterin seems highly characteristic of ALCL among hematopoietic neoplasms, but also might be observed in rare nonhematopoietic tumors, necessitating the use of a broad immunohistochemical panel for evaluation of poorly differentiated neoplasms of indeterminate derivation.
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA
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Abstract
Verrucous carcinoma (VC) of the vulva is a rare variant of squamous cell carcinoma (SCC) of the vulva that afflicts older women and is characterized by a well-differentiated morphology with minimal nuclear atypia. The pathogenesis of VC is uncertain and a putative role for human papillomavirus (HPV) is doubtful. We analyzed 9 vulvar VCs from 7 patients diagnosed as VC of the vulva over the past 10 years at Brigham and Women's Hospital and Beth Israel Deaconess Medical Center. The patients ranged from 75 to 93 years in age (median, 83 years). One also involved the vagina and another coexisted with a keratinizing SCC. VC was associated with lichen sclerosus in 1 case; 7 others contained lichen simplex chronicus with verrucous architecture. In 7 cases, a distinctive noninvasive squamous epithelial proliferation, exhibiting a triad of marked acanthosis with variable verruciform architecture, loss of the granular cell layer with superficial epithelial cell pallor, and multilayered parakeratosis. We have designated these changes vulvar acanthosis with altered differentiation. In 5 of the 9 lesions, formalin-fixed, paraffin-embedded material was available for polymerase chain reaction analysis of HPV nucleic acids and all scored HPV negative. In conclusion, VC is a rare HPV-negative neoplasm that may be associated with other HPV-negative SCCs or its precursors, shares similar morphologic risk factors (lichen sclerosus and lichen simplex chronicus), and is frequently associated with an unusual intraepithelial lesion that can be distinguished from both classic and differentiated forms of vulvar intraepithelial neoplasia. The possibility that vulvar acanthosis with altered differentiation is a precursor to, or a risk factor for, vulvar carcinoma, merits further study.
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Affiliation(s)
- Alessandra F Nascimento
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Wu CJ, Hochberg EP, Rogers SA, Kutok JL, Biernacki M, Nascimento AF, Marks P, Bridges K, Ritz J. Molecular assessment of erythroid lineage chimerism following nonmyeloablative allogeneic stem cell transplantation. Exp Hematol 2003; 31:924-33. [PMID: 14550808 DOI: 10.1016/s0301-472x(03)00227-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Nonmyeloablative conditioning regimens for allogeneic stem cell transplantation are now commonly used in the treatment of patients with hematologic malignancies. Since this treatment often results in the establishment of mixed hematopoietic chimerism, this approach may also prove to be useful in the treatment of nonmalignant disorders, such as sickle cell disease and thalassemia major. To apply this approach to these diseases, it will be necessary to determine the levels of donor erythropoiesis required to correct hemolysis and ameliorate disease symptoms. Current methods for measuring hematopoietic chimerism are based on DNA polymorphisms that distinguish recipient from donor. These methods accurately measure donor leukocyte engraftment but do not quantify the relative contributions of recipient and donor erythropoiesis following transplant. METHODS To specifically measure erythroid-lineage chimerism, we used pyrosequencing of the sickle cell mutation to quantify the relative levels of normal and sickle beta-globin mRNA in patient samples. Results of beta-globin RNA chimerism were compared to assessment of beta-globin DNA chimerism as well as analysis of short tandem repeat (STR) polymorphisms, cytogenetics, and hemoglobin electrophoresis. RESULTS Donor engraftment was measured in two adult patients following nonmyeloablative stem cell transplant for sickle cell disease. In Patient 1, 25 to 30% of peripheral leukocytes were donor derived after day 41. In contrast, more than 55% of peripheral blood beta-globin mRNA was of donor origin, and these results correlated with posttransplant clinical improvement. Patient 2 achieved 40 to 50% donor leukocyte engraftment from day 33 onward. This was associated with 70 to 100% peripheral blood donor beta-globin mRNA. CONCLUSIONS These studies demonstrate that relatively low levels of donor leukocyte engraftment can be associated with higher levels of donor erythropoiesis and with significant clinical improvement. Pyrosequencing of lineage-specific mRNA directly measures functional reconstitution of donor cells and provides valuable information that can affect clinical decisions in patients with nonmalignant diseases following allogeneic transplant.
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Affiliation(s)
- Catherine J Wu
- Departments of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Nascimento AF, Hirsch MS, Cviko A, Quade BJ, Nucci MR. The role of CD10 staining in distinguishing invasive endometrial adenocarcinoma from adenocarcinoma involving adenomyosis. Mod Pathol 2003; 16:22-7. [PMID: 12527709 DOI: 10.1097/01.mp.0000043523.03519.fc] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adenomyosis may be involved by endometrial adenocarcinoma, but in contrast to true myometrial invasion, the depth of an adenomyotic focus involved by carcinoma does not alter pathologic tumor staging. Therefore, distinction from carcinoma invading myometrium is clinically relevant. We hypothesized that CD10, a marker of non-neoplastic and neoplastic endometrial stroma, would highlight the stromal component of adenomyotic foci and be useful in this distinction. Thirty-nine cases of endometrial adenocarcinoma were analyzed and divided into three groups: I, invasive endometrial adenocarcinoma (n = 14); II, endometrial adenocarcinoma involving adenomyosis but without myometrial invasion (n = 18); and III, adenomyosis involved by endometrial adenocarcinoma with concomitant invasive component (n = 7). All cases of adenomyosis involved by endometrial adenocarcinoma demonstrated CD10 expression in the stromal cells of adenomyotic foci. Eleven of 21 cases (52%) of invasive adenocarcinoma also showed CD10 expression, at least focally, in cells immediately surrounding the infiltrating glands. Of these, two cases (from Group III) also had associated adenomyotic involvement by carcinoma. The remaining cases of invasive carcinoma were negative for CD10. Therefore, presence of CD10 staining immediately surrounding neoplastic glands does not equate with involvement of adenomyosis by endometrial adenocarcinoma. In contrast, absence of CD10 expression excludes involvement of adenomyosis by adenocarcinoma.
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Nascimento AF, Ruiz R, Hornick JL, Fletcher CDM. Calcifying fibrous 'pseudotumor': clinicopathologic study of 15 cases and analysis of its relationship to inflammatory myofibroblastic tumor. Int J Surg Pathol 2002; 10:189-96. [PMID: 12232572 DOI: 10.1177/106689690201000304] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Calcifying fibrous pseudotumor (CFP) has been postulated to be a "late" stage of inflammatory myofibroblastic tumor (IMT). We analyzed 15 cases (8 females and 7 males; aged 1 to 65 years). The anatomic distribution was wide, including 3 cases each in neck, mesentery/omentum, and GI tract and 2 cases each in mediastinum and paratesticular sites. Follow-up information was available in 10 patients (range 4 to 228 months). Local recurrence occurred in 3 patients and was repeated in 2. Tumor size ranged from 0.6 to 25 cm. Lesions were well-circumscribed hypocellular spindle cell proliferations with dense stromal collagen, a lymphoplasmacytic infiltrate, and stromal calcifications. Features of conventional IMT were not seen. Immunostaining showed CD34 positivity in most cases as well as rare cells positive for smooth muscle actin and desmin, and consistent negativity for ALK-1 and S-100 protein. These findings suggest that CFP is a distinctive benign mesenchymal neoplasm with a low risk for recurrence and, therefore, best labelled as "calcifying fibrous tumor." There is no convincing evidence to support an association between CFP and IMT.
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
Liposarcomas in the oral cavity have rarely been described, with less than 50 reported cases to date and a purported predominance of the myxoid type. We reviewed our experience with 23 atypical lipomatous tumors/liposarcomas of the oral cavity. Twelve patients were men, 10 were women, and gender was not stated in one case. Age at presentation ranged from 28 to 83 years (median, 49.5 years). The most commonly affected site was the tongue and most cases presented as a slowly growing, painless mass. The clinical impression was lipoma or fibroma in the majority of cases. Tumor size ranged from 0.6 to 8.0 cm (median, 1.5 cm). Five cases were well circumscribed, 5 cases were focally infiltrative, and 13 cases had markedly infiltrative margins. Twenty-one cases were classified as atypical lipomatous tumors (of which 10 showed spindle cell features), one as dedifferentiated liposarcoma, and one as myxoid liposarcoma. Follow-up data was available in 13 of the 23 cases. Five others were lost to follow-up after a short period. Eleven patients remained free of disease without local recurrence or metastasis during the period of follow-up that ranged from 10 months to 9 years (median, 24 months). Two patients had multiple local recurrences. Our study shows that atypical lipomatous tumor is the most common type of malignant fatty tumor to arise in the oral cavity with an apparently low risk of recurrence if widely excised, although follow-up is relatively limited thus far.
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Affiliation(s)
- Alessandra F Nascimento
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Kasamon YL, Nguyen TN, Chan JA, Nascimento AF. EBV-associated lymphoma and chronic inflammatory demyelinating polyneuropathy in an adult without overt immunodeficiency. Am J Hematol 2002; 69:289-93. [PMID: 11921025 DOI: 10.1002/ajh.10079] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epstein-Barr virus (EBV)-associated lymphoproliferative disease occurs almost exclusively in immunocompromised states. This type of malignancy nevertheless developed in a woman without overt immunocompromise. She presented with rapidly progressive lower extremity weakness that was consistent with a chronic inflammatory demyelinating polyneuropathy (CIDP). CIDP has been documented in Hodgkin's disease but rarely in non-Hodgkin's disease. Diagnosis was confirmed by lymph node and sural nerve biopsies and by nerve conduction studies. Prednisone, rituximab, cyclophosphamide, doxorubicin, and etoposide were administered with regression of lymphadenopathy and improvement in neurologic symptoms. EBV-associated lymphoproliferative disease can thus develop in the absence of overt immunodeficiency and may trigger a demyelinating polyneuropathy.
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Affiliation(s)
- Yvette L Kasamon
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Castro IM, Lima AA, Nascimento AF, Ruas MM, Nicoli JR, Brandão RL. Characterization and regulation of glycine transport in Fusarium oxysporum var. lini. Braz J Med Biol Res 1996; 29:949-55. [PMID: 9181075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Glycine was transported in Fusarium oxysporum cells, grown on glycine as the sole source of carbon and nitrogen, by a facilitated diffusion transport system with a half-saturation constant (Ks) of 11 mM and a maximum velocity (Vmax) of 1.2 mM (g dry weight)-1 h-1 at pH 5.0 and 26 degrees C. Under conditions of nitrogen starvation, the same system was present together with a high-affinity one (Ks) of about 47 microM and Vmax of about 60 microM (g dry weight)-1 h-1). The low-affinity system was more specific than the high-affinity system. Cells grown on gelatine showed the same behavior. In cells grown on glucose-gelatine medium, the low-affinity system was poorly expressed even after carbon and nitrogen starvation. Moreover, addition of glucose to cells grown on glycine and resuspended in mineral medium caused an increase of the glycine transport probably due to a boost in protein synthesis. This stimulation did not affect the Ks of the low-affinity system. These results demonstrate that, as is the case for other eukaryotic systems, F. oxysporum glycine transport is under control of nitrogen sources but its regulation by carbon sources appears to be more complex.
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Affiliation(s)
- I M Castro
- Laboratorio de Bioquimica e Fisiologia de Microorganismos, Escola de Farmácia, NUPEB/ICEB II, Universidade Federal de Ouro Preto, MG, Brasil
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