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Wu C, Pai RK, Kosiorek H, Banerjee I, Pfeiffer A, Hagen CE, Hartley CP, Graham RP, Sonbol MB, Bekaii-Saab T, Xie H, Sinicrope FA, Patel B, Westerling-Bui T, Shivji S, Conner J, Swallow C, Savage P, Cyr DP, Kirsch R, Pai RK. Improved risk stratification scheme for mismatch repair proficient stage II colorectal cancers using the digital pathology biomarker QuantCRC. Clin Cancer Res 2024:734991. [PMID: 38421684 DOI: 10.1158/1078-0432.ccr-23-3211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/27/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE There is a need to improve current risk stratification of stage II colorectal cancer (CRC) to better inform risk of recurrence and guide adjuvant chemotherapy. We sought to examine whether integration of QuantCRC, a digital pathology biomarker utilizing hematoxylin and eosin-stained slides, provides improved risk stratification over current American Society of Clinical Oncology (ASCO) guidelines. EXPERIMENTAL DESIGN ASCO and QuantCRC-integrated schemes were applied to a cohort of 398 mismatch repair proficient (MMRP) stage II CRCs from three large academic medical centers. The ASCO stage II scheme was taken from recent guidelines. The QuantCRC-integrated scheme utilized pT3 vs. pT4 and a QuantCRC-derived risk classification. Evaluation of recurrence free survival (RFS) according to these risk schemes was compared using the log-rank test and hazard ratios. RESULTS Integration of QuantCRC provides improved risk stratification compared to the ASCO scheme for stage II MMRP CRCs. The QuantCRC-integrated scheme placed more stage II tumors in the low-risk group compared to the ASCO scheme (62.5% vs. 42.2%) without compromising excellent 3-year RFS. The QuantCRC-integrated scheme provided larger hazard ratios (HR) for both intermediate-risk (2.27, 95%CI 1.32-3.91, P=0.003) and high-risk (3.27, 95%CI 1.42-7.55, P=0.006) groups compared to ASCO intermediate-risk (1.58, 95%CI 0.87-2.87, P=0.1) and high-risk (2.24, 95%CI 1.09-4.62, P=0.03) groups. The QuantCRC-integrated risk groups remained prognostic in the subgroup of patients that did not receive any adjuvant chemotherapy. CONCLUSIONS Incorporation of QuantCRC into risk stratification provides a powerful predictor of RFS that has potential to guide subsequent treatment and surveillance for stage II MMRP CRCs.
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Affiliation(s)
- Christina Wu
- Mayo Clinic Hospital, Phoenix, Arizona, United States
| | - Reetesh K Pai
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | | | | | | | | | | | | | - Hao Xie
- Mayo Clinic, Rochester, MN, United States
| | | | | | | | | | | | - Carol Swallow
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Paul Savage
- University of Toronto, Toronto, ONTARIO, Canada
| | - David P Cyr
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | | | - Rish K Pai
- Mayo Clinic, Scottsdale, AZ, United States
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Righi FA, Vander Heide RS, Graham RP, Aubry MC, Trejo-Lopez JA, Bois MC, Roden AC, Reichard R, Maleszewski JJ, Alexander MP, Quinton RA, Jenkins SM, Hartley CP, Hagen CE. A case-control autopsy series of liver pathology associated with novel coronavirus disease (COVID-19). Ann Diagn Pathol 2024; 68:152240. [PMID: 37995413 DOI: 10.1016/j.anndiagpath.2023.152240] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for coronavirus disease 2019 (COVID-19) is most well-known for causing pulmonary injury, a significant proportion of patients experience hepatic dysfunction. The mechanism by which SARS-CoV2 causes liver injury is not fully understood. The goal of this study was to describe the hepatic pathology in a large cohort of deceased patients with COVID-19 as compared to a control group of deceased patients without COVID-19. METHODS Consented autopsy cases at two institutions were searched for documentation of COVID-19 as a contributing cause of death. A group of consecutive consented autopsy cases during the same period, negative for SARS-CoV-2 infection, was used as a control group. The autopsy report and electronic medical records were reviewed for relevant clinicopathologic information. H&E-stained liver sections from both groups were examined for pertinent histologic features. Select cases underwent immunohistochemical staining for CD 68 and ACE2 and droplet digital polymerase chain reaction (ddPCR) assay for evaluation of SARS-CoV2 RNA. RESULTS 48 COVID-19 positive patients (median age 73, M:F 3:1) and 40 COVID-19 negative control patients (median age 67.5, M:F 1.4:1) were included in the study. The COVID-19 positive group was significantly older and had a lower rate of alcoholism and malignancy, but there was no difference in other comorbidities. The COVID-19 positive group was more likely to have received steroids (75.6 % vs. 36.1 %, p < 0.001). Hepatic vascular changes were seen in a minority (10.6 %) of COVID-19 positive cases. When all patients were included, there were no significant histopathologic differences between groups, but when patients with chronic alcoholism were excluded, the COVID-19 positive group was significantly more likely to have steatosis (80.9 % vs. 50.0 %, p = 0.004) and lobular inflammation (45.7 % vs. 20.7 %, p = 0.03). Testing for viral RNA by ddPCR identified 2 of the 18 (11.1 %) COVID-19 positive cases to have SARS-CoV-2 RNA detected within the liver FFPE tissue. CONCLUSIONS The most significant findings in the liver of COVID-19 positive patients were mild lobular inflammation and steatosis. The high rate of steroid therapy in this population may be a possible source of steatosis. Hepatic vascular alterations were only identified in a minority of patients and did not appear to play a predominant role in COVID-19 mediated hepatic injury. Low incidence of SARS-CoV-2 RNA positivity in liver tissue in our cohort suggests hepatic injury in the setting of COVID-19 may be secondary in nature.
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Affiliation(s)
- Fabiola A Righi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Richard S Vander Heide
- Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Marie Christine Aubry
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Jorge A Trejo-Lopez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Reade A Quinton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States of America
| | - Christopher P Hartley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Catherine E Hagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America.
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Burr SD, Chen Y, Hartley CP, Zhao X, Liu J. Replacement of saturated fatty acids with linoleic acid in western diet attenuates atherosclerosis in a mouse model with inducible ablation of hepatic LDL receptor. Sci Rep 2023; 13:16832. [PMID: 37803087 PMCID: PMC10558454 DOI: 10.1038/s41598-023-44030-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023] Open
Abstract
Dietary saturate fatty acids (SFAs) have been consistently linked to atherosclerosis and obesity, both of which are characterized by chronic inflammation and impaired lipid metabolism. In comparison, the effects of linoleic acid (LA), the predominant polyunsaturated fatty acid in the Western diet, seem to diverge. Data from human studies suggest a positive association between high dietary intake of LA and the improvement of cardiovascular risk. However, excessive LA intake has been implicated in the development of obesity. Concerns have also been raised on the potential pro-inflammatory properties of LA metabolites. Herein, by utilizing a mouse model with liver-specific Ldlr knockdown, we directly determined the effects of replacing SFAs with LA in a Western diet on the development of obesity and atherosclerosis. Specifically, mice treated with a Ldlr ASO were placed on a Western diet containing either SFA-rich butter (WD-B) or LA-rich corn oil (WD-CO) for 12 weeks. Despite of showing no changes in body weight gain or adiposity, mice on WD-CO exhibited significantly less atherosclerotic lesions compared to those on WD-B diet. Reduced lesion formation in the WD-CO-fed mice corresponded with a reduction of plasma triglyceride and cholesterol content, especially in VLDL and LDL, and ApoB protein levels. Although it increased expression of proinflammatory cytokines TNF-α and IL-6 in the liver, WD-CO did not appear to affect hepatic injury or damage when compared to WD-B. Collectively, our results indicate that replacing SFAs with LA in a Western diet could reduce the development of atherosclerosis independently of obesity.
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Affiliation(s)
- Stephanie D Burr
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic in Rochester, Guggenheim Building 14-11A, 222 3Rd Avenue SW, Rochester, MN, 55905, USA
| | - Yongbin Chen
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA
| | - Christopher P Hartley
- Department of Laboratory Medicine and Pathology, Mayo Clinic in Rochester, Rochester, MN, 55905, USA
| | - Xianda Zhao
- Department of Laboratory Medicine and Pathology, Mayo Clinic in Rochester, Rochester, MN, 55905, USA
| | - Jun Liu
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA.
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic in Rochester, Guggenheim Building 14-11A, 222 3Rd Avenue SW, Rochester, MN, 55905, USA.
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Ricaurte Archila L, Smith L, Sihvo HK, Koponen V, Jenkins SM, O'Sullivan DM, Cardenas Fernandez MC, Wang Y, Sivasubramaniam P, Patil A, Hopson PE, Absah I, Ravi K, Mounajjed T, Dellon ES, Bredenoord AJ, Pai R, Hartley CP, Graham RP, Moreira RK. Performance of an Artificial Intelligence Model for Recognition and Quantitation of Histologic Features of Eosinophilic Esophagitis on Biopsy Samples. Mod Pathol 2023; 36:100285. [PMID: 37474003 DOI: 10.1016/j.modpat.2023.100285] [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] [Received: 02/13/2023] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
We have developed an artificial intelligence (AI)-based digital pathology model for the evaluation of histologic features related to eosinophilic esophagitis (EoE). In this study, we evaluated the performance of our AI model in a cohort of pediatric and adult patients for histologic features included in the Eosinophilic Esophagitis Histologic Scoring System (EoEHSS). We collected a total of 203 esophageal biopsy samples from patients with mucosal eosinophilia of any degree (91 adult and 112 pediatric patients) and 10 normal controls from a prospectively maintained database. All cases were assessed by a specialized gastrointestinal (GI) pathologist for features in the EoEHSS at the time of original diagnosis and rescored by a central GI pathologist (R.K.M.). We subsequently analyzed whole-slide image digital slides using a supervised AI model operating in a cloud-based, deep learning AI platform (Aiforia Technologies) for peak eosinophil count (PEC) and several histopathologic features in the EoEHSS. The correlation and interobserver agreement between the AI model and pathologists (Pearson correlation coefficient [rs] = 0.89 and intraclass correlation coefficient [ICC] = 0.87 vs original pathologist; rs = 0.91 and ICC = 0.83 vs central pathologist) were similar to the correlation and interobserver agreement between pathologists for PEC (rs = 0.88 and ICC = 0.91) and broadly similar to those for most other histologic features in the EoEHSS. The AI model also accurately identified PEC of >15 eosinophils/high-power field by the original pathologist (area under the curve [AUC] = 0.98) and central pathologist (AUC = 0.98) and had similar AUCs for the presence of EoE-related endoscopic features to pathologists' assessment. Average eosinophils per epithelial unit area had similar performance compared to AI high-power field-based analysis. Our newly developed AI model can accurately identify, quantify, and score several of the main histopathologic features in the EoE spectrum, with agreement regarding EoEHSS scoring which was similar to that seen among GI pathologists.
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Affiliation(s)
| | | | | | | | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Donnchadh M O'Sullivan
- Department of Pediatric and Adolescence Medicine, Mayo Clinic, Rochester, Minnesota; Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota
| | - Maria Camila Cardenas Fernandez
- Department of Pediatric and Adolescence Medicine, Mayo Clinic, Rochester, Minnesota; Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota
| | - Yaohong Wang
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Ameya Patil
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Puanani E Hopson
- Department of Pediatric and Adolescence Medicine, Mayo Clinic, Rochester, Minnesota; Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota
| | - Imad Absah
- Department of Pediatric and Adolescence Medicine, Mayo Clinic, Rochester, Minnesota; Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota
| | - Karthik Ravi
- Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota
| | - Taofic Mounajjed
- Department of Pathology, Allina Hospitals and Clinics, Minneapolis, Minnesota
| | - Evan S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Albert J Bredenoord
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rish Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
| | | | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Roger K Moreira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
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Patil A, Salvatori R, Smith L, Jenkins SM, Cannon A, Hartley CP, Graham RP, Moreira RK. Artificial intelligence-based reticulin proportionate area - a novel histological outcome predictor in hepatocellular carcinoma. Histopathology 2023; 83:512-525. [PMID: 37387193 DOI: 10.1111/his.15001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/18/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
AIMS Reticulin stain is used routinely in the histological evaluation of hepatocellular carcinoma (HCC). The goal of this study was to assess whether the histological reticulin proportionate area (RPA) in HCCs predicts tumour-related outcomes. METHODS AND RESULTS We developed and validated a supervised artificial intelligence (AI) model that utilises a cloud-based, deep-learning AI platform (Aiforia Technologies, Helsinki, Finland) to specifically recognise and quantify the reticulin framework in normal livers and HCCs using routine reticulin staining. We applied this reticulin AI model to a cohort of consecutive HCC cases from patients undergoing curative resection between 2005 and 2015. A total of 101 HCC resections were included (median age = 68 years, 64 males, median follow-up time = 49.9 months). AI model RPA reduction of > 50% (compared to normal liver tissue) was predictive of metastasis [hazard ratio (HR) = 3.76, P = 0.004, disease-free survival (DFS, HR = 2.48, P < 0.001) and overall survival (OS), HR = 2.80, P = 0.001]. In a Cox regression model, which included clinical and pathological variables, RPA decrease was an independent predictor of DFS and OS and the only independent predictor of metastasis. Similar results were found in the moderately differentiated HCC subgroup (WHO grade 2), in which reticulin quantitative analysis was an independent predictor of metastasis, DFS and OS. CONCLUSION Our data indicate that decreased RPA is a strong predictor of various HCC-related outcomes, including within the moderately differentiated subgroup. Reticulin, therefore, may represent a novel and important prognostic HCC marker, to be further explored and validated.
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Affiliation(s)
- Ameya Patil
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Rebecca Salvatori
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Sarah M Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Andrew Cannon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Roger K Moreira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Sivasubramaniam P, Stokes N, Patil A, Smith L, Hartley CP, Graham RP, Moreira RK. Digital Hepatic Iron Content: An Artificial Intelligence Model for Spatially Resolved Histologic Iron Quantitative Analysis in Liver Samples. J Transl Med 2023; 103:100200. [PMID: 37331629 DOI: 10.1016/j.labinv.2023.100200] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
Currently, the precise evaluation of tissue hepatic iron content (HIC) requires laboratory testing using tissue-destructive methods based on colorimetry or spectrophotometry. To maximize the use of routine histologic stains in this context, we developed an artificial intelligence (AI) model for the recognition and spatially resolved measurement of iron in liver samples. Our AI model was developed using a cloud-based, supervised deep learning platform (Aiforia Technologies). Using digitized Pearl Prussian blue iron stain whole slide images representing the full spectrum of changes seen in hepatic iron overload, our training set consisted of 59 cases, and our validation set consisted of 19 cases. The study group consisted of 98 liver samples from 5 different laboratories, for which tissue quantitative analysis using inductively coupled plasma mass spectrometry was available, collected between 2012 and 2022. The correlation between the AI model % iron area and HIC was Rs = 0.93 for needle core biopsy samples (n = 73) and Rs = 0.86 for all samples (n = 98). The digital hepatic iron index (HII) was highly correlated with HII > 1 (area under the curve [AUC] = 0.93) and HII > 1.9 (AUC = 0.94). The percentage area of iron within hepatocytes (vs Kupffer cells and portal tract iron) identified patients with any hereditary hemochromatosis-related mutations (either homozygous or heterozygous) (AUC = 0.65, P = .01) with at least similar accuracy than HIC, HII, and any histologic iron score. The correlation between the Deugnier and Turlin score and the AI model % iron area for all patients was Rs = 0.87 for total score, Rs = 0.82 for hepatocyte iron score, and Rs = 0.84 for Kupffer cell iron score. Iron quantitative analysis using our AI model was highly correlated with both detailed histologic scoring systems and tissue quantitative analysis using inductively coupled plasma mass spectrometry and offers advantages (related to the spatial resolution of iron analysis and the nontissue-destructive nature of the test) over standard quantitative methods.
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Affiliation(s)
| | - Nadarra Stokes
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Ameya Patil
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Lindsey Smith
- Aiforia Plc. Cambridge Innovation Center, Cambridge, Minnesota
| | | | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Roger K Moreira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
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Naso JR, Chan J, Reisenauer J, Edell ES, Stackhouse K, Bungum AO, Vierkant RA, Pierson K, Seidl A, Sturgis CD, Meroueh C, Huang Y, Hartley CP. Remotely operated robotic microscopy for rapid diagnosis of bronchoscopic cytology specimens. Diagn Cytopathol 2023. [PMID: 37288984 DOI: 10.1002/dc.25177] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Obtaining a diagnosis and treating pulmonary malignancies during the same anesthesia requires either an on-site pathologist or a system for remotely evaluating microscopic images. Cytology specimens are challenging to remotely assess given the need to navigate through dispersed and three-dimensional cell clusters. Remote navigation is possible using robotic telepathology, but data are limited on the ease of use of current systems, particularly for pulmonary cytology. METHODS Air dried modified Wright-Giemsa stained slides from 26 touch preparations of transbronchial biopsies and 27 smears of endobronchial ultrasound guided fine needle aspirations were scored for ease of adequacy assessment and ease of diagnosis on robotic (rmtConnect Microscope) and non-robotic telecytology platforms. Diagnostic classifications were compared between glass slides and the robotic and non-robotic telecytology assessments. RESULTS Compared to non-robotic telecytology, robotic telecytology had a greater ease of adequacy assessment and non-inferior ease of diagnosis. The median time to diagnosis using robotic telecytology was 85 s (range 28-190 s). Diagnostic categories were concordant for 76% of cases in robotic versus non-robotic telecytology and 78% of cases in robotic telecytology versus glass slide diagnosis. Weighted Cohen's kappa scores for agreement in these comparisons were 0.84 and 0.72, respectively. CONCLUSIONS Use of a remote-controlled robotic microscope improved the ease of adequacy assessment compared to non-robotic telecytology and enabled strongly concordant diagnoses to be expediently rendered. This study provides evidence that modern robotic telecytology is a feasible and user-friendly method of remotely and potentially intraoperatively rendering adequacy assessments and diagnoses on bronchoscopic cytology specimens.
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Affiliation(s)
- Julia R Naso
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Jackie Chan
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Janani Reisenauer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine Stackhouse
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Aaron O Bungum
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Karlyn Pierson
- Clinical Research Office, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew Seidl
- Department of Practice Optimization and Acceleration, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles D Sturgis
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Chady Meroueh
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Yajue Huang
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Christopher P Hartley
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Baban F, Koepplin JW, Ahmad M, Clarke-Brodber AL, Bois MC, Hartley CP, Sturgis CD. TRPS1 outperforms GATA3 in pleural effusions with metastatic breast carcinoma versus mesothelioma. Diagn Cytopathol 2023. [PMID: 37096814 DOI: 10.1002/dc.25148] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION In evaluating malignant pleural fluid cytology, metastatic adenocarcinomas and mesotheliomas are often differential diagnoses. GATA binding protein 3 (GATA3) has historically been used to confirm metastatic breast carcinomas; however, GATA3 has low specificity if mesothelioma is included in differential diagnoses. Trichorhinophalangeal syndrome type 1 (TRPS1) protein is expressed in all types of breast carcinomas, with reported high specificity and sensitivity. We investigated the performance of TRPS1 immunohistochemistry (IHC) and compared it to GATA3 in pleural fluids diagnosed with metastatic breast carcinoma and mesothelioma. METHODS Thirty-six consecutive ThinPrep pleural fluids and 4 pleural fine needle aspirations (FNAs) with diagnoses of metastatic breast carcinoma (21) and mesothelioma (19) were retrieved, and IHC with TRPS1 and GATA3 was performed on all. Immunoreactivity scores for TRPS1 were calculated by multiplying percentage of immunoreactive cells by staining intensity. Immunoreactivity scores were negative if 0 or 1, low positive if 2, intermediate positive if 3 or 4, or high positive if 6 or 9. Nuclear immunoreactivity of ≥10% with at least moderate intensity was judged GATA3 positive. RESULTS GATA3 showed immunoreactivity in all metastatic breast carcinomas and 84% of mesotheliomas. TRPS1 was immunoreactive in all breast carcinoma cases (18 with a score of 9 and 3 with a score of 6). TRPS1 showed low positivity in 5% of mesothelioma cases with all other cases being negative. CONCLUSION When cytomorphologic differential diagnoses of mesothelioma exist, TRPS1 is a more specific marker than GATA3 for confirmation of metastatic breast carcinoma in pleural fluid cytology.
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Affiliation(s)
- Farah Baban
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology-Mayo Clinic, Rochester, Minnesota, USA
| | - Justin W Koepplin
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology-Mayo Clinic, Rochester, Minnesota, USA
| | - Muhammad Ahmad
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology-Mayo Clinic, Rochester, Minnesota, USA
| | - Anna-Lee Clarke-Brodber
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology-Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology-Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher P Hartley
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology-Mayo Clinic, Rochester, Minnesota, USA
| | - Charles D Sturgis
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology-Mayo Clinic, Rochester, Minnesota, USA
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Baban F, Auen T, Eschbacher KL, Swanson AA, Hartley CP. Invasive urothelial carcinoma with squamous differentiation and associated high-risk human papilloma virus infection: Clinical, cytologic, and histologic features of a rare entity. Ann Diagn Pathol 2023; 63:152103. [PMID: 36640642 DOI: 10.1016/j.anndiagpath.2022.152103] [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] [Received: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
We correlate the fine needle aspiration (FNA) cytologic findings with the histologic features of an invasive high-grade urothelial carcinoma showing squamous differentiation in the setting of high-risk Human Papilloma Virus (hrHPV) infection. To our knowledge, only extensive urinary bladder catheterization has been associated with hrHPV-positive urothelial carcinoma with squamous differentiation, and rarely at that. Herein, we present a case arising in a patient with only sparse and intermittent catheterization. A 69-year-old woman presented with voiding difficulties, and after continued symptoms, a Foley catheter was placed, and a cystoscopy procedure revealed two 1-2 cm inflammatory masses. Excisional biopsies were interpreted as papillary urothelial carcinoma. One month follow-up pelvic imaging demonstrated a new mass involving the urinary bladder neck, with irregular wall thickening and perivesical fat stranding, as well as probable vaginal involvement. CT-guided FNA (CT-FNA) to collect smears and core biopsies revealed an invasive urothelial carcinoma with squamous differentiation. HPV-cytopathic changes amid squamous metaplasia and dysplasia were noted on FNA smears with HPV E6/E7 RNA in situ hybridization (ISH) showing on the FNA core biopsy specimen. Immunostains showed that the tumor cells were positive for P16 (strong, diffuse), CK7, p63, ER, and GATA3 (patchy). Subsequent radical cystectomy revealed the extent of the patient's carcinoma, with direct extension to the vaginal wall, and involvement of the radial soft tissue resection margins. Describing the cytomorphologic features of a hrHPV positive urothelial carcinoma with squamous differentiation, without an extensive history of urinary catheterization or prior known history of HPV infection, emphasizes the role of cytopathology as a powerful diagnostic tool for recognizing a unique and unexpected lesion.
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Affiliation(s)
- Farah Baban
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Thomas Auen
- Department of Pathology and Microbiology, University of Nebraska Medical Center, NE, USA
| | - Kathryn L Eschbacher
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Amy A Swanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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10
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Jawaid T, Swanson AA, Bois MC, Folpe AL, Rivera M, Hartley CP, Sturgis CD. Lymphangioleiomyomatosis in lymph node cytology: Another "Floating Island" to visit. Diagn Cytopathol 2023; 51:E204-E208. [PMID: 36975549 DOI: 10.1002/dc.25131] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease with variable presentations. The neoplastic cells in LAM demonstrate a unique and diagnostically important "myomelanocytic" phenotype. Cytologic reports of LAM are infrequent and have not in the past emphasized the floating island pattern in which circumscribed aggregates of lesional cells are rimmed by appliques of flattened endothelium. This case illustrates the cytology of LAM and emphasizes that the floating island cytoarchitectural pattern more classically associated with entities such as hepatocellular carcinomas may be seen in cytological preparations of LAM at unanticipated body sites.
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Affiliation(s)
- Tabinda Jawaid
- Genetics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy A Swanson
- Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie C Bois
- Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew L Folpe
- Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Rivera
- Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Clarke-Brodber AL, Hartley CP, Ahmed F, Thangaiah JJ, Tiegs-Heiden C, Hagen CE. Desmoid fibromatosis involving the pancreas: A retrospective case series with clinical, cytopathologic and radiologic correlation. Ann Diagn Pathol 2022; 60:152015. [DOI: 10.1016/j.anndiagpath.2022.152015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/17/2022] [Indexed: 11/01/2022]
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12
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Farooq A, González IA, Byrnes K, Jenkins SM, Hartley CP, Hagen CE. Multi-institutional development and validation of a novel histologic grading system for colonic graft-versus-host disease. Mod Pathol 2022; 35:1254-1261. [PMID: 35365769 DOI: 10.1038/s41379-022-01065-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/09/2022]
Abstract
Graft-versus-host disease (GVHD) remains a major complication for patients who have undergone hematopoietic stem cell transplantation. The Lerner system is the most widely used histologic grading score for gastrointestinal GVHD but its clinic utility is debated. The aim of our study was to develop a novel histologic grading system for gastrointestinal GVHD that incorporates independent evaluation of both apoptotic counts and crypt destruction. Colonic biopsies taken to assess for GVHD were retrospectively assessed for: Crypt damage (No crypt dropout or ulceration-0; crypt dropout without ulceration-1; ulceration-2) and crypt apoptotic counts (No apoptosis-0; 1-6 apoptotic bodies per 10 contiguous crypts-1; >6apoptotic bodies per 10 contiguous crypts-2). The two scores were added together to get an overall grade (0-4). Alternative apoptotic cutoff points were examined. An apoptotic cutoff of >9 apoptotic bodies per 10 contiguous crypts marginally improved the area under the curve (AUC), but the AUCs from the resulting novel grade calculations were not significantly different (p = 0.10). Lerner grading was also applied. The study group consisted of an initial analysis cohort (n = 191) and a second validation cohort from a separate institution (n = 97). In the initial analysis cohort, our histologic grading system provided prognostic stratification for GVHD-related death within 6 months (p = 0.0004, AUC = 0.705). The Lerner system performed similarly in terms of providing prognostic stratification for GVHD-related death (p = 0.0001, AUC = 0.707). In the external validation cohort, our histologic grading system was not associated with GVHD-related death (p = 0.14, AUC = 0.621), but the Lerner system was associated with GVHD-related death (p = 0.048, AUC = 0.663). While our grading system may have some advantages compared to the Lerner system, due to lack of reproducibility we do not currently recommend widespread adoption of this system. Nonetheless, we present a standardized tool for assessing both apoptosis and crypt damage. Future studies assessing alternative histologic grading systems with external validation and further examination the lower apoptotic threshold for GVHD diagnosis are warranted.
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Affiliation(s)
- Ayesha Farooq
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Iván A González
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathleen Byrnes
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Catherine E Hagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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13
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Firwana M, Clarke-Brodber AL, King RL, Dalland JC, Hartley CP, Boire NA, Sturgis CD. Cyto-histologic correlation of crystal-storing histiocytosis: Rare presentation in breast, predating diagnosis of B-cell lymphoma by two years. Ann Diagn Pathol 2022; 59:151979. [DOI: 10.1016/j.anndiagpath.2022.151979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/01/2022]
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14
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Thangaiah JJ, Venable ER, Sivasubramaniam P, Tiegs-Heiden C, Rech KL, Hartley CP. Erdheim-Chester disease: Cytomorphologic clues for a rare histiocytic neoplasm including a distinct tigroid background pattern on smears. Ann Diagn Pathol 2022; 60:151998. [DOI: 10.1016/j.anndiagpath.2022.151998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
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15
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Jophlin LL, Hartley CP, Katzka DA. Ectopic Esophageal Sebaceous Glands. Clin Gastroenterol Hepatol 2022; 20:e647. [PMID: 33279776 DOI: 10.1016/j.cgh.2020.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/29/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Loretta L Jophlin
- Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, Minnesota
| | | | - David A Katzka
- Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, Minnesota
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16
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McCarthy MR, Tiegs-Heiden CA, Sturgis CD, Swanson AA, Gupta S, Thangaiah JJ, Hartley CP. Biphasic squamoid alveolar renal cell carcinoma: Cytologic features of a rare entity. Ann Diagn Pathol 2022; 58:151906. [DOI: 10.1016/j.anndiagpath.2022.151906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
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17
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Sivasubramaniam P, Tiegs-Heiden CA, Geiersbach KB, Hagen CE, Sturgis CD, Thangaiah JJ, Hartley CP. Mammary analogue secretory carcinoma: A challenging case arising in a young man with radiation exposure. Ann Diagn Pathol 2021; 57:151862. [PMID: 34953444 DOI: 10.1016/j.anndiagpath.2021.151862] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2022]
Abstract
Mammary Analogue Secretory Carcinoma (MASC) is a recently described salivary gland tumor frequently sampled via fine-needle aspiration. The cytologic features of MASC are not entirely distinctive and can simulate acinic cell carcinoma, but the tumor harbors an ETV6 gene rearrangement resulting in an ETV6-NTRK3 fusion gene. We present a case of MASC arising in a 31 year old man with a history of multiple radio-embolization procedures.
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Affiliation(s)
| | | | | | - Catherine E Hagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Charles D Sturgis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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18
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Sivasubramaniam P, Tiegs-Heiden CA, Sturgis CD, Hagen CE, Hartley CP, Thangaiah JJ. Malignant gastrointestinal neuroectodermal tumor: Cytologic, histologic, immunohistochemical, and molecular pitfalls. Ann Diagn Pathol 2021; 55:151813. [PMID: 34509898 DOI: 10.1016/j.anndiagpath.2021.151813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022]
Abstract
Malignant gastrointestinal neuroectodermal tumor (GNET) is a rare malignant primary gastrointestinal mesenchymal tumor which can be diagnosed via fine-needle aspiration (FNA) cytology. In the context of FNA, the diagnosis requires a cell block and the use of significant resources including immunohistochemical stains and molecular testing. The differential diagnosis of GNET includes clear cell sarcoma (CCS), gastrointestinal stromal tumor (GIST), gastric schwannoma, metastatic melanoma, malignant perivascular epithelioid cell tumor (PEComa) and granular cell tumor, among others. Here we describe a case which was initially diagnosed as malignant granular cell tumor by FNA which was later revised to GNET following the finding of an EWSR1-ATF1 fusion gene rearrangement.
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Affiliation(s)
| | | | - Charles D Sturgis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Catherine E Hagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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19
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Nisar US, Erickson LA, Folpe AL, Hartley CP, Littrell LA, Adamo DA, Sturgis CD. Eccrine angiomatous hamartoma: First case in the cytology literature. Ann Diagn Pathol 2021; 54:151796. [PMID: 34311301 DOI: 10.1016/j.anndiagpath.2021.151796] [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] [Received: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
A 34-year-old male presented with a swelling on the volar surface of the third digit of his right hand. This swelling was associated with pain and erythema. Ultrasound-guided needle biopsy was performed. Cytologic and histologic preparations together confirmed the diagnosis of a rarely encountered mixed epithelial and mesenchymal proliferation, an eccrine angiomatous hamartoma. To our knowledge, this case is the first to illustrate the cytomorphologic features of this rare lesion.
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Affiliation(s)
- U Salma Nisar
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, USA
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | | | | | | | - Charles D Sturgis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
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20
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Lian X, Bond JS, Bharathy N, Boudko SP, Pokidysheva E, Shern JF, Lathara M, Sasaki T, Settelmeyer T, Cleary MM, Bajwa A, Srinivasa G, Hartley CP, Bächinger HP, Mansoor A, Gultekin SH, Berlow NE, Keller C. Defining the Extracellular Matrix of Rhabdomyosarcoma. Front Oncol 2021; 11:601957. [PMID: 33708626 PMCID: PMC7942227 DOI: 10.3389/fonc.2021.601957] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/05/2021] [Indexed: 01/20/2023] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood with a propensity to metastasize. Current treatment for patients with RMS includes conventional systemic chemotherapy, radiation therapy, and surgical resection; nevertheless, little to no improvement in long term survival has been achieved in decades-underlining the need for target discovery and new therapeutic approaches to targeting tumor cells or the tumor microenvironment. To evaluate cross-species sarcoma extracellular matrix production, we have used murine models which feature knowledge of the myogenic cell-of-origin. With focus on the RMS/undifferentiated pleomorphic sarcoma (UPS) continuum, we have constructed tissue microarrays of 48 murine and four human sarcomas to analyze expression of seven different collagens, fibrillins, and collagen-modifying proteins, with cross-correlation to RNA deep sequencing. We have uncovered that RMS produces increased expression of type XVIII collagen alpha 1 (COL18A1), which is clinically associated with decreased long-term survival. We have also identified significantly increased RNA expression of COL4A1, FBN2, PLOD1, and PLOD2 in human RMS relative to normal skeletal muscle. These results complement recent studies investigating whether soft tissue sarcomas utilize collagens, fibrillins, and collagen-modifying enzymes to alter the structural integrity of surrounding host extracellular matrix/collagen quaternary structure resulting in improved ability to improve the ability to invade regionally and metastasize, for which therapeutic targeting is possible.
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Affiliation(s)
- Xiaolei Lian
- Pediatric Cancer Biology, Children’s Cancer Therapy Development Institute, Beaverton, OR, United States
| | - J. Steffan Bond
- Department of Pathology, Oregon Health & Science University, Portland, OR, United States
| | - Narendra Bharathy
- Pediatric Cancer Biology, Children’s Cancer Therapy Development Institute, Beaverton, OR, United States
| | - Sergei P. Boudko
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elena Pokidysheva
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jack F. Shern
- Pediatric Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD, United States
| | - Melvin Lathara
- Bioinformatics, Omics Data Automation, Beaverton, OR, United States
| | - Takako Sasaki
- Department of Matrix Medicine, Oita University, Oita, Japan
| | - Teagan Settelmeyer
- Pediatric Cancer Biology, Children’s Cancer Therapy Development Institute, Beaverton, OR, United States
| | - Megan M. Cleary
- Pediatric Cancer Biology, Children’s Cancer Therapy Development Institute, Beaverton, OR, United States
| | - Ayeza Bajwa
- Pediatric Cancer Biology, Children’s Cancer Therapy Development Institute, Beaverton, OR, United States
| | | | | | - Hans Peter Bächinger
- Department of Biochemistry and Molecular Biology, Shriners Hospital for Children, Portland, OR, United States
| | - Atiya Mansoor
- Department of Pathology, Oregon Health & Science University, Portland, OR, United States
| | - Sakir H. Gultekin
- Department of Pathology, Oregon Health & Science University, Portland, OR, United States
| | - Noah E. Berlow
- Pediatric Cancer Biology, Children’s Cancer Therapy Development Institute, Beaverton, OR, United States
| | - Charles Keller
- Pediatric Cancer Biology, Children’s Cancer Therapy Development Institute, Beaverton, OR, United States
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21
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González IA, Hartley CP, Nalbantoglu ILK. Recurrent Autoimmune Hepatitis and De Novo Autoimmune Hepatitis in the Liver Allograft. Am J Clin Pathol 2021; 155:435-445. [PMID: 33252121 DOI: 10.1093/ajcp/aqaa147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/06/2023] Open
Abstract
OBJECTIVES Autoimmune hepatitis (AIH) is a form of severe hepatitis that can recur after orthotopic liver transplant (OLT). Presentation of AIH in patients with OLT who do not have a history of AIH is called de novo AIH (DNAIH). We evaluated the clinicopathologic characteristics of AIH and DNAIH. METHODS Clinicopathologic and outcome measures of 11 patients with recurrent AIH (RAIH) and 22 with DNAIH identified between 2000 and 2017 were compared. RESULTS Both cohorts showed female predominance. The mean clinical follow-up was 13 and 7.8 years in the in the RAIH and DNAIH groups, respectively (P = .1). Moderate portal inflammation was more common in patients with RAIH (64% vs 27%, P = .043). A trend was observed for more cases of DNAIH showing severe inflammation (36% vs 9%, P = .09) and submassive necrosis compared with RAIH (23% vs 0%, P = .086). A trend for more advanced fibrosis was also noted in the RAIH group (27% vs 5%, P = .059). Three patients with RAIH lost their grafts because of RAIH. Five-year disease-specific graft survival (GS) (P = .012) and overall GS (P = .015) were worse in patients with RAIH. Complement component 4d immunohistochemistry was positive in 2 patients with RAIH and 3 with DNAIH but showed no correlation with GS or other parameters. CONCLUSIONS RAIH seems to have a more aggressive clinical course than DNAIH and warrants closer clinical follow-up and aggressive treatment.
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Affiliation(s)
- Iván A González
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Christopher P Hartley
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - ILKe Nalbantoglu
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
- Department of Pathology, Yale School of Medicine, New Haven, CT
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22
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Farooq A, Evans JJ, Hagen CE, Hartley CP. Lymphoepithelial cyst of the pancreas: A challenging diagnosis on fine needle aspiration. Ann Diagn Pathol 2020; 49:151603. [PMID: 32949892 DOI: 10.1016/j.anndiagpath.2020.151603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Abstract
Lymphoepithelial cysts (LECs) of the pancreas are rare, benign pancreatic cysts comprising approximately 0.5% of all pancreatic cysts. They occur predominantly in men in the 5th and 6th decades of life. LECs are true cysts lined by stratified squamous epithelium with adjacent subepithelial lymphoid tissue. They range in size from 1.2 to 17 cm (mean size 4.6 cm) and can arise in any part of the pancreas. 1 LEC resembles other benign and malignant pancreatic cysts clinically and radiologically. The cytomorphologic features of LECs have been described in a small number of case reports and it has been indicated that features may overlap with other benign and malignant pancreatic lesions. Herein, we report clinical, radiological, cytological and histopathological features of a pancreatic LEC in a 62-year-old male.
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Affiliation(s)
- Ayesha Farooq
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John J Evans
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
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23
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Hagen CE, Christians K, Hopp A, Giorgadze T, Hartley CP, Hunt B, Basturk O, Klimstra D. Intraductal papillary squamous neoplasm of the pancreas: Cyto-histologic correlation of a novel entity. Ann Diagn Pathol 2020; 48:151583. [PMID: 32847795 DOI: 10.1016/j.anndiagpath.2020.151583] [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] [Received: 07/23/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
We correlate the cytologic and histologic features of a squamous-lined pancreatic cystic lesion with a complex papillary architecture and an associated KRAS mutation, which to our knowledge has not been previously described. A 69 year-old woman presented with intermittent left upper quadrant pain. CT imaging revealed a 1 cm solid lesion in the pancreatic tail with peripheral calcification. Endoscopic ultrasound-guided fine needle biopsy showed a proliferation of epithelial cells with fibrovascular cores. An immunohistochemical stain for p40 was positive in the lesional cells. A distal pancreatectomy revealed a unilocular, cystic, well-circumscribed, soft and friable mass measuring 1.0 × 1.0 × 0.8 cm. Histologically, the cyst was lined by nonkeratinizing stratified squamous epithelium with a complex papillary architecture, filling the cyst lumen. Molecular sequencing revealed a KRAS G12V missense mutation. While the lesion shared some histologic features with the previously described "squamoid cyst of the pancreatic ducts", the complex papillary architecture and presence of a KRAS mutation are unique to the entity we describe herein and we propose the name "intraductal papillary squamous neoplasm of the pancreas." Reporting the cytomorphologic features of this novel entity may help in identification of similar lesions and understanding of the clinicopathologic significance.
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Affiliation(s)
- Catherine E Hagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Kathleen Christians
- Department of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amanda Hopp
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tamara Giorgadze
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Bryan Hunt
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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24
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Terra SBSP, Henry MR, Pritt BS, Hartley CP, Zanish JM, Chua HK, Sturgis CD. Incidental Giardia duodenalis cysts in exfoliative anal cytology: An immunocompetent adult female with prior squamous dysplasia. Diagn Cytopathol 2020; 48:1141-1143. [PMID: 32472971 DOI: 10.1002/dc.24472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Bobbi S Pritt
- Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Heidi K Chua
- Colorectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
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25
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Mostafa M, Hartley CP, Hagen CE. Evaluation of the lower histologic threshold for gastric graft versus host disease. Mod Pathol 2020; 33:962-970. [PMID: 31857676 DOI: 10.1038/s41379-019-0421-7] [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: 08/15/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/09/2022]
Abstract
Data regarding the lower diagnostic threshold for gastric graft-versus-host disease is lacking. The aim of this study was to review a cohort of gastric biopsies taken to evaluate for graft-versus-host disease, and to correlate histologic findings with clinical and endoscopic evidence of graft-versus-host disease as well as biopsy findings from other locations to define a lower diagnostic threshold for gastric graft-versus-host disease. Gastric biopsies were evaluated for the maximum number of apoptotic bodies per 10 contiguous gastric pits, presence of ≥1 apoptotic body per biopsy (NIH criteria), and presence of gastric pit dropout and/or ulceration. To evaluate histologic specificity, sixty gastric biopsies from non-stem cell transplant patients were selected as a control group. Clinical information was collected from chart review. The study group consisted of 65 gastric biopsies from 52 stem cell transplant patients. The mean apoptotic count per 10 contiguous gastric pits for stem cell transplant biopsies was 1.8 (range 0-8) and for control cases 1.0 (range 0-5). Nineteen stem cell transplant biopsies (29%) had ≥1 apoptotic body per biopsy and only a single case had >6 apoptotic bodies per 10 contiguous gastric pits. When the NIH guidelines were combined with presence of at least two apoptotic bodies per 10 contiguous gastric pits, this cutoff point was significantly associated with treatment for graft-versus-host disease (OR = 9.4, 95% CI = 1.7-176.7, p = 0.04) and evidence of extraintestinal graft-versus-host disease (OR = 3.2, 95% CI = 1.1-10.7, p = 0.04). The diagnostic specificity for our proposed cutoff value is 94%. We present criteria for the lower diagnostic threshold of gastric graft-versus-host disease, which uses a lower apoptotic cutoff value than has been utilized in colonic biopsies. Although sensitivity remains a challenge for gastric graft-versus-host disease biopsies, this newly proposed cutoff provides higher specificity than NIH guidelines alone and better correlates with clinical evidence of graft-versus-host disease.
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Affiliation(s)
- Mohamed Mostafa
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Catherine E Hagen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Rowan DJ, Hartley CP, Aldakkak M, Christians KK, Evans DB, Tsai S, Hagen CE. Gross tumor size using the AJCC 8th ed. T staging criteria does not provide prognostic stratification for neoadjuvant treated pancreatic ductal adenocarcinoma. Ann Diagn Pathol 2020; 46:151485. [PMID: 32172219 DOI: 10.1016/j.anndiagpath.2020.151485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/07/2020] [Accepted: 02/25/2020] [Indexed: 10/28/2022]
Abstract
The 8th edition AJCC T stage criteria for pancreatic ductal adenocarcinoma (PDAC) are now size based. These criteria provide better prognostic stratification in patients without neoadjuvant therapy. Our aim was to determine if gross tumor size is prognostically significant using the 8th ed. staging criteria for neoadjuvant treated PDAC. The study included 289 patients who underwent resection for PDAC following neoadjuvant therapy. By AJCC 7th ed., there were 12 (4.2%) ypT0, 32 (11.1%) ypT1, 64 (22.1%) ypT2, and 181 (62.6%) ypT3 patients. By AJCC 8th ed., there were 12 (4.2%) ypT0, 74 (25.6%) ypT1 (6 ypT1a, 1 ypT1b, 67 ypT1c), 161 (55.7%) ypT2, and 42 (14.5%) ypT3 patients. 182 patients had negative lymph nodes and 107 had positive lymph nodes. 77 patients were ypN1 and 30 were ypN2 by 8th ed. criteria. 7th ed. T stage significantly correlated with OS (p = 0.048), while 8th ed. T stage did not correlate with OS (p = 0.13). In ypN0 patients, neither the 7th ed. or 8th ed. T stages significantly correlated with patient OS (p = 0.065 and 0.26, respectively). Higher 7th ed. T stage correlated with lymph node status (p ≤ 0.001) more strongly than 8th ed. T stage (p = 0.04). 7th ed. and 8th ed. N stage correlated with OS (p = 0.004 and p = 0.0002, respectively). By 8th ed. AJCC staging criteria, gross tumor size does not provide good prognostic stratification in neoadjuvant therapy PDAC. Mapped grossing techniques combining gross and microscopic examination to determine tumor size may provide more accurate staging of neoadjuvant treated tumors.
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Affiliation(s)
- Daniel J Rowan
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Mohammed Aldakkak
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Susan Tsai
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Catherine E Hagen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Abstract
CONTEXT.— Fatty liver disease is now one of the most commonly encountered entities in the practice of liver pathology. Distinguishing simple steatosis from steatohepatitis is critical because the latter requires follow-up because of long-term risks that include cirrhosis and hepatocellular carcinoma. An organized approach for evaluating liver biopsies with steatosis is recommended to capture all of the relevant features: (1) degree of steatosis, (2) presence or absence of ballooning degeneration, (3) lobular inflammation, and (4) fibrosis. Herein, we provide a stepwise approach that readers can use to evaluate liver biopsies with steatosis, including examples, pitfalls, differential diagnostic considerations, and suggested diagnostic phrasing. OBJECTIVE.— To provide a stepwise approach for the evaluation of liver biopsies showing significant steatosis (involving ≥5% of liver parenchyma). DATA SOURCES.— Biopsies demonstrating fatty liver disease encountered in our daily practice were examined as well as recent literature. CONCLUSIONS.— Effective evaluation of liver biopsies with steatosis requires careful histologic examination and correlation with clinical history, particularly regarding medications, nutrition status, and alcohol use. Examples of uniform reporting, including appropriate use of the nonalcoholic steatohepatitis Clinical Research Network Activity Score, are provided.
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Affiliation(s)
- Mohamed Mostafa
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee
| | - Amrou Abdelkader
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee
| | - John J Evans
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee
| | - Catherine E Hagen
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee
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Abdelkader A, Hunt B, Hartley CP, Panarelli NC, Giorgadze T. Cystic Lesions of the Pancreas: Differential Diagnosis and Cytologic-Histologic Correlation. Arch Pathol Lab Med 2019; 144:47-61. [PMID: 31538798 DOI: 10.5858/arpa.2019-0308-ra] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT.— Pancreatic cystic lesions (PCLs) are very common, and their detection is increasing with the advances in imaging techniques. Because of the major implications for management, distinguishing between neoplastic and nonneoplastic PCLs is critical. Neoplastic cysts with potential to progress into cancer include mucinous PCLs (intraductal papillary mucinous neoplasms and mucinous cystic neoplasms) and nonmucinous cysts (solid pseudopapillary tumors, serous cystic neoplasms, and neuroendocrine tumors with cystic degeneration). Nonneoplastic cysts with no risk of malignant transformation include pseudocysts, retention cysts, lymphoepithelial cysts, cystic pancreatic lymphangioma, and duplication cyst/ciliated foregut cysts. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology with cyst fluid analysis in the diagnosis of PCLs has evolved during the last decade; however, a definitive diagnosis on cytologic specimens is hampered by the sparse cellularity and can be challenging. EUS-FNA can play an important role to differentiate low-risk from high-risk pancreatic cysts and to distinguish between patients with cysts who need clinical follow-up versus those who require surgery. OBJECTIVE.— To provide an integrative approach to diagnose pancreatic cystic lesions using EUS-FNA cytology and cyst fluid analysis, along with clinical, radiologic, histologic, genetic, and molecular characteristics. DATA SOURCES.— The review and analysis of the latest literature describing pancreatic cystic lesions. CONCLUSIONS.— Accurate diagnosis of PCLs requires a multidisciplinary and multimodal team approach, including the integration of clinical findings, imaging, cytology, cyst fluid analysis, and molecular testing.
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Affiliation(s)
- Amrou Abdelkader
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
| | - Bryan Hunt
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
| | - Christopher P Hartley
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
| | - Nicole C Panarelli
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
| | - Tamara Giorgadze
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
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Farooq A, Goyal A, Giorgadze T, Scherr G, Evans JJ, Hartley CP. Cytomorphological features of glomus tumors arising in the stomach: A series of two cases diagnosed on FNA. Ann Diagn Pathol 2019; 42:42-47. [PMID: 31306858 DOI: 10.1016/j.anndiagpath.2019.07.002] [Citation(s) in RCA: 5] [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] [Received: 06/26/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ayesha Farooq
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Abha Goyal
- Department of Pathology, Weill Cornell Medicine, New York, NY, USA
| | - Tamara Giorgadze
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gary Scherr
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John J Evans
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
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Kravtsov O, Hartley CP, Compérat EM, Iczkowski KA. KIF3B protein expression loss correlates with metastatic ability of prostate cancer. Am J Clin Exp Urol 2019; 7:178-181. [PMID: 31317057 PMCID: PMC6627541] [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] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
UNLABELLED Kinesin family member 3B (KIF3B) is a microtubule motor kinesin involved in mitotic progression and vasculotropism. A novel therapeutic target, it is overexpressed in several cancers [PMID 29904055]. Its significance in prostate cancer (PC) was uncertain. METHODS 89 cases, including tissue microarrays from 70 prostatectomies comprising matched cancer and benign spots, 19 additional prostatectomy tissues, plus 16 prostate cancer metastases (7 nodal and 9 distant sites; 8 had matched primary PC) were stained with rabbit polyclonal KIF3B antibody. Cytoplasmic immunoreactivity was scored: 0 (negative) to 3+ (strong and diffuse). 39 patients had no nodal metastases, 31 had positive lymph nodes, and 19 had nodes not sampled. Gleason grade groups were 1 (9), 2 (28), 3 (39), 4 (1), and 5 (12). 15 cases had cribriform pattern. AJCC stages were 2 (48), 3 (29), unknown (12). RESULTS KIF3B in PC (mean 1.0) was higher than in benign prostate (mean 0.1, P<0.01, Student t-test). All 7 available nodal metastases of PC were negative. One-third of primary PCs with nodal metastases lost all expression, compared to retained expression in all but one PC without nodal metastasis (P<0.01, chi-square). The former group also had stronger staining (mean 1.0) than metastases (mean 0.3) (P<0.01, Student t-test) and had fewer cases with any positive (>0) expression compared to cases without metastases or with unsampled lymph nodes (P<0.01, chi-square test). Reactivity of paired metastatic tissue and primary PC correlated strongly (Pearson coefficient: +0.7). No significant trends were found by grade group, cribriform status, or stage. CONCLUSIONS KIF3B is a PC marker. Metastatic cancers showed less KIF3B expression than their primary PC counterparts, and primary cases with positive nodes demonstrated reduced positivity, suggesting use as a prognostic marker. It is possible that KIF3B protein becomes altered prior to metastases, preventing immunohistochemical detection.
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Affiliation(s)
| | | | - Eva-Maria Compérat
- Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie CurieParis, France
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Mostafa ME, Flynn T, Hartley CP, Ledeboer NA, Buchan BW. Effective utilization of C. difficile PCR and identification of clinicopathologic factors associated with conversion to a positive result in symptomatic patients. Diagn Microbiol Infect Dis 2018; 90:307-310. [PMID: 29290473 DOI: 10.1016/j.diagmicrobio.2017.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES We assess the diagnostic yield of repeat testing for C. difficile using molecular methods within 7days of a negative test and identify specific factors associated with conversion from negative to positive test result within a 7-day period to aid in selective test utilization. METHODS A retrospective chart review of 20,866 laboratory test orders for C. difficile PCR was conducted. The test result, clinicopathologic patient features, and previous test results were recorded. Univariate and multivariate analysis was conducted to compare patients with initial and repeat negative results (n=248) to a group of patients with conversion from negative to positive results within 7days. RESULTS Univariate analysis demonstrated a history of C. difficile infection, receipt of antibiotics within 14days, and duration of hospital stay as factors significantly different between patients with repeat negative and conversion to positive C. difficile test result. Only history of C. difficile infection was significantly different upon multivariate analysis. CONCLUSIONS Identification of prior C. difficile infection as the only factor significantly correlated with conversion from negative to positive C. difficile test result within 7days aids in selective test utilization and reduces the costs associated with unnecessary laboratory testing.
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Affiliation(s)
- Mohamed E Mostafa
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI
| | - Timothy Flynn
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI
| | | | - Nathan A Ledeboer
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI
| | - Blake W Buchan
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI.
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Hartley CP, Mahajan AM, Selvaggi SM, Rehrauer WM. FNA smears of pancreatic ductal adenocarcinoma are superior to formalin-fixed paraffin-embedded tissue as a source of DNA: Comparison of targeted KRAS amplification and genotyping in matched preresection and postresection samples. Cancer Cytopathol 2017; 125:838-847. [PMID: 29024530 DOI: 10.1002/cncy.21935] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/01/2017] [Accepted: 09/13/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND The current study was conducted to compare DNA yield, including normalization to nuclear area, DNA amplification functionality, and detection of KRAS mutations between matched fine-needle aspiration (FNA) specimens and pancreatic resections diagnostic of pancreatic ductal adenocarcinoma. METHODS A retrospective sample of 30 matched single FNA smears and macrodissected formalin-fixed, paraffin-embedded (FFPE) curls (2 5-μm curls) were compared by measuring the following: nuclear area (via digital image analysis), DNA yield (via NanoDrop spectrophotometry and Quantus fluorometry), and polymerase chain reaction threshold cycles for KRAS amplifications. Variants in KRAS codons 12/13 and 61 were detected by fluorescent melt curve analyses, followed by Sanger DNA sequencing. RESULTS Despite a similar nuclear area, FNA smears yielded greater DNA per nuclear area via 2 DNA quantification methods. KRAS codon 12 mutations were detected in 23 of 30 FNA specimens (77%) compared with 17 of 30 matched FFPE specimens (57%), for a concordance rate of 74%. No KRAS codon 13 or 61 mutations were detected. CONCLUSIONS FNA specimens are a more optimal source of DNA, and represent an important resource in the preresection and postresection molecular analysis of pancreatic ductal adenocarcinoma. Cancer Cytopathol 2017;125:838-47. © 2017 American Cancer Society.
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Affiliation(s)
- Christopher P Hartley
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aparna M Mahajan
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Suzanne M Selvaggi
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - William M Rehrauer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Hartley CP, Kwiatkowski DJ, Hamieh L, Lefferts JA, Smith KD, Lisovsky M. Pancreatic PEComa is a novel member of the family of tuberous sclerosis complex-associated tumors: case report and review of the literature. Virchows Arch 2016; 469:707-710. [DOI: 10.1007/s00428-016-2032-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/25/2016] [Accepted: 10/09/2016] [Indexed: 11/28/2022]
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Rowan DJ, Hartley CP, Carrillo-Polanco LF, Oshima K, Hagen CE. Diagnostic phrasing is independently correlated with the decision to treat for graft-versus-host disease: retrospective review of colon biopsies with rare apoptosis. Histopathology 2016; 69:802-811. [DOI: 10.1111/his.13003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/28/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel J Rowan
- Department of Pathology; Medical College of Wisconsin; Milwaukee WI USA
| | | | | | - Kiyoko Oshima
- Department of Pathology; Medical College of Wisconsin; Milwaukee WI USA
| | - Catherine E Hagen
- Department of Pathology; Medical College of Wisconsin; Milwaukee WI USA
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Hembrough T, Liao WL, Hartley CP, Ma PC, Velcheti V, Lanigan C, Thyparambil S, An E, Monga M, Krizman D, Burrows J, Tafe LJ. Quantification of Anaplastic Lymphoma Kinase Protein Expression in Non-Small Cell Lung Cancer Tissues from Patients Treated with Crizotinib. Clin Chem 2015; 62:252-61. [PMID: 26585927 DOI: 10.1373/clinchem.2015.245860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/15/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crizotinib has antitumor activity in ALK (anaplastic lymphoma receptor tyrosine kinase)-rearranged non-small cell lung cancer (NSCLC). The current diagnostic test for ALK rearrangement is breakapart fluorescence in situ hybridization (FISH), but FISH has low throughput and is not always reflective of protein concentrations. The emergence of multiple clinically relevant biomarkers in NSCLC necessitates efficient testing of scarce tissue samples. We developed an anaplastic lymphoma kinase (ALK) protein assay that uses multiplexed selected reaction monitoring (SRM) to quantify absolute amounts of ALK in formalin-fixed paraffin-embedded (FFPE) tumor tissue. METHODS After validation in formalin-fixed cell lines, the SRM assay was used to quantify concentrations of ALK in 18 FFPE NSCLC samples that had been tested for ALK by FISH and immunohistochemistry. Results were correlated with patient response to crizotinib. RESULTS We detected ALK in 11 of 14 NSCLC samples with known ALK rearrangements by FISH. Absolute ALK concentrations correlated with clinical response in 5 of 8 patients treated with crizotinib. The SRM assay did not detect ALK in 3 FISH-positive patients who had not responded to crizotinib. In 1 of these cases, DNA sequencing revealed a point mutation that predicts a nonfunctional ALK fusion protein. The SRM assay did not detect ALK in any tumor tissue with a negative ALK status by FISH or immunohistochemistry. CONCLUSIONS ALK concentrations measured by SRM correlate with crizotinib response in NSCLC patients. The ALK SRM proteomic assay, which may be multiplexed with other clinically relevant proteins, allows for rapid identification of patients potentially eligible for targeted therapies.
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Affiliation(s)
- Todd Hembrough
- OncoPlex Diagnostics, Rockville, MD; NantOmics, LLC, Rockville, MD
| | - Wei-Li Liao
- OncoPlex Diagnostics, Rockville, MD; NantOmics, LLC, Rockville, MD
| | - Christopher P Hartley
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; current affiliation: Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Patrick C Ma
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Department of Hematology and Medical Oncology, Taussig Cancer Institute, and current affiliation: Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV
| | - Vamsidhar Velcheti
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, and
| | - Christopher Lanigan
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | | | - Eunkyung An
- OncoPlex Diagnostics, Rockville, MD; NantOmics, LLC, Rockville, MD
| | - Manish Monga
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV
| | - David Krizman
- OncoPlex Diagnostics, Rockville, MD; NantOmics, LLC, Rockville, MD
| | | | - Laura J Tafe
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH;
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Hartley CP, Steinmetz HB, Memoli VA, Tafe LJ. Small cell neuroendocrine carcinomas of the lung do not harbor high-risk human papillomavirus. Hum Pathol 2015; 46:577-82. [DOI: 10.1016/j.humpath.2014.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/17/2014] [Accepted: 12/24/2014] [Indexed: 01/06/2023]
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Liao WL, Thyparambil S, An E, Hartley CP, Ma P, Rodriguez J, Wistuba I, Burrows J, Hembrough T, Tafe LJ. Abstract B09: Multiplexed mass spectrometry-based assay to quantify translocation markers from non-small cell lung cancer (NSCLC) FFPE tissue. Clin Cancer Res 2014. [DOI: 10.1158/1078-0432.14aacriaslc-b09] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Translocations in ALK, ROS1 and RET have been shown to be oncogenic in NSCLC. Lung cancers having ALK or ROS1 rearrangements represent unique subpopulations that are seen in only 2-5% and 1-2% of NSCLC, respectively. ALK fusions lead to constitutive activation of ALK signaling involved in cell proliferation. Crizotinib has significant anti-tumor activity in ALK rearranged NSCLC and break-apart FISH is the approved diagnostic test to determine treatment eligibility. However, FISH is laborious, expensive and low throughput, and thus is not ideal for the detection of oncogenic drivers of low frequencies. In patients with advanced disease, a small tissue biopsy is often the only material available so yielding as much information as possible from a limited sample is necessary. The aim of this study was to develop a multiplexed quantitative Liquid-Tissue-selected reaction monitoring (LT-SRM) assay for assessing ALK, ROS1, and RET expression within our “Lung OncoPlex” MS test. The LT-SRM platform quantitates these translocation markers along with several diagnostic and potentially targetable biomarkers, e.g. TTF1, K7, p63, K5, EGFR, HER2, HER3, MET, KRAS and IGF1R, in NSCLC.
Methods: We used trypsin digestion mapping of recombinant proteins specific for ALK, ROS1, and RET to identify optimal quantitative peptides. Stable isotope-labeled peptides were synthesized as internal standards, and standard curves were generated in Pyrococcus complex matrix to determine LOD, LLOQ, accuracy, precision and linearity of the assays. The ALK assay was pre-clinically validated in an EML4-ALK rearrangement positive cell line-H3122. ALK and ROS1 were screened in 87 archived FFPE sections from NSCLC.
Results: We identified at least two optimal peptides for each target. At least one peptide from each protein had acceptable technical assay performance and was used for assay development. H3122 cell expressed 396 amol ALK/ug cell protein, while 11 ALK translocation positive NSCLC tissues expressed ALK from 107 to 437 amol/ug protein. ALK peptides were not detected in ALK negative control NSCLC tissues or in a single ALK translocation positive case. ROS1 was detected in 2 of 87 NSCLC samples at levels of 659 amol/ug in a case of unknown translocation status and 377 amol/ug in a ROS1 translocation positive case. Finally, the Lung OncoPlex assay successfully subtyped lung adenocarcinoma and quantified the other potentially targetable biomarkers.
Conclusions: The Lung OncoPlex assay was able to detect ALK protein in 11/12 ALK rearranged samples. In the one proteomically negative/FISH+ case, we are performing ALK IHC to assess ALK protein expression, as well as DNA sequencing to evaluate for potential mutations within the MS targeted peptides. Of the two cases positive for ROS1 by the MS assay, one is known to be FISH positive and the other is undergoing FISH verification. RET protein expression has not yet been assessed in any known RET translocation positive cases; however, the RET technical performance suggests this is a promising assay and we are continuing to screen for RET positive control samples. While additional studies are needed to validate the clinically utility of the ALK, ROS1, and RET assay; multiplexed proteomic screening of patient tissue could be performed at the time of initial biopsy, allowing for simultaneous assessment of multiple clinically actionable gene rearrangements and biomarker targets.
Citation Format: Wei-Li Liao, Sheeno Thyparambil, Eunkyung An, Christopher P. Hartley, patrick Ma, Jaime Rodriguez, Ignacio Wistuba, Jon Burrows, Todd Hembrough, Laura J. Tafe. Multiplexed mass spectrometry-based assay to quantify translocation markers from non-small cell lung cancer (NSCLC) FFPE tissue. [abstract]. In: Proceedings of the AACR-IASLC Joint Conference on Molecular Origins of Lung Cancer; 2014 Jan 6-9; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2014;20(2Suppl):Abstract nr B09.
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Affiliation(s)
- Wei-Li Liao
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
| | - Sheeno Thyparambil
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
| | - Eunkyung An
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
| | - Christopher P. Hartley
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
| | - patrick Ma
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
| | - Jaime Rodriguez
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
| | - Ignacio Wistuba
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
| | - Jon Burrows
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
| | - Todd Hembrough
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
| | - Laura J. Tafe
- 1OncoPlex Diagnostics Inc., Rockville, MD, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, 3Cleveland Clinic Cancer Institute, Cleveland, OH, 4MD Anderson Cancer Center, Houston, TX
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Hartley CP. Some Apple Leaf-Spot Fungi. Science 1908; 28:157-9. [PMID: 17738382 DOI: 10.1126/science.28.709.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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