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Vizcaino MA, Giannini C, Lalich D, Nael A, Jenkins RB, Tran Q, Orr BA, Abdullaev Z, Aldape K, Vaubel RA. Ganglioglioma with anaplastic/high-grade transformation: Histopathologic, molecular, and epigenetic characterization of 3 cases. J Neuropathol Exp Neurol 2024:nlae038. [PMID: 38699943 DOI: 10.1093/jnen/nlae038] [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] [Indexed: 05/05/2024] Open
Abstract
Ganglioglioma (GG) with anaplasia (anaplastic ganglioglioma) is a rare and controversial diagnosis. When present, anaplasia involves the glial component of the tumor, either at presentation or at recurrence. To date, most published cases lack molecular characterization. We describe the histologic and molecular features of 3 patients presenting with BRAF p. V600E-mutant GG (CNS WHO grade 1) with high-grade glial transformation at recurrence. The tumors occurred in pediatric patients (age 9-16 years) with time to recurrence from 20 months to 7 years. At presentation, each tumor was low-grade, with a BRAFV600E-positive ganglion cell component and a glial component resembling pleomorphic xanthoastrocytoma (PXA) or fibrillary astrocytoma. At recurrence, tumors resembled anaplastic PXA or high-grade astrocytomas without neuronal differentiation. CDKN2A homozygous deletion (HD) was absent in all primary tumors. At recurrence, 2 cases acquired CDKN2A HD; the third case showed loss of p16 and MTAP immunoexpression, but no CDKN2A/B HD or mutation was identified. By DNA methylation profiling, all primary and recurrent tumors either grouped or definitely matched to different methylation classes. Our findings indicate that malignant progression of the glial component can occur in GG and suggest that CDKN2A/B inactivation plays a significant role in this process.
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Affiliation(s)
- M Adelita Vizcaino
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota, USA
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Daniel Lalich
- Department of Pathology, Robert J. Dole VA Medical Center and Wesley Healthcare Center, Wichita, Kansas, USA
| | - Ali Nael
- Department of Pathology, Children's Hospital of Orange County and University of California Irvine, Orange County, California, USA
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota, USA
| | - Quynh Tran
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Brent A Orr
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Zied Abdullaev
- Laboratory of Pathology, National Cancer Institute/Center for Cancer Research, Bethesda, Maryland, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute/Center for Cancer Research, Bethesda, Maryland, USA
| | - Rachael A Vaubel
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota, USA
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Abstract
Primary rectal squamous cell carcinoma is rare compared to adenocarcinoma, which is the predominant histologic type most commonly discovered at the time of colorectal carcinoma diagnosis. Due to the infrequent nature of this malignancy, data on tumor pathogenesis and risk factors remains sparse. Moreover, no standardized therapeutic regimen exists. This report describes a case of advanced rectal squamous cell carcinoma diagnosed in a 46-year-old female who initially presented with abdominal pain. Her clinical course was uncomplicated and she responded well to the selected therapy. Much work remains to be accomplished for patients with rectal squamous cell carcinoma.
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Affiliation(s)
- Nathaniel A Parker
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Yasmine Hussein Agha
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Charles Scott Buess
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Daniel Lalich
- Wesley Medical Center, 550 N. Hillside St, Wichita, KS, 67214, USA
| | - Jeremy M Deutsch
- Cancer Center of Kansas, 818 N. Emporia #403, Wichita, KS, 67230, USA
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Al-Obaidi A, Parker NA, Choucair K, Lalich D, Truong P. Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type: A Case Report. Cureus 2020; 12:e8651. [PMID: 32566435 PMCID: PMC7301429 DOI: 10.7759/cureus.8651] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Primary cutaneous diffuse large B-cell lymphoma, leg type, is an exceedingly rare and aggressive variant of primary cutaneous lymphoma. An 84-year-old male presented to an oncologist for new skin lesions on his abdomen and right thigh. Excisional biopsy followed by histopathology and immunohistochemistry confirmed the diagnosis of primary cutaneous diffuse large B-cell lymphoma, leg type. His clinical course was complicated by multiple relapses and refractory disease. Ultimately, he achieved complete response with fourth-line ibrutinib therapy. Due to the contentious nature of this disease, poor prognosis, and higher rates of recurrence, prompt identification and aggressive treatment are recommended. Given the different cellular pathways and genomic alterations identified in its carcinogenesis, various chemotherapy regimens and targeted immunotherapies have emerged as potential therapeutic options to halt disease progression and prevent future relapses.
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Affiliation(s)
- Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Nathaniel A Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Khalil Choucair
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | | | - Phu Truong
- Hematology/Oncology, Cancer Center of Kansas, Wichita, USA
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Parker NA, Al-Obaidi A, Lalich D, Deutsch JM. SMARCB1/INI1-Deficient Extrarenal Rhabdoid Tumor: A Case Report of a Rare and Aggressive Soft Tissue Sarcoma. Cureus 2020; 12:e8273. [PMID: 32467817 PMCID: PMC7250519 DOI: 10.7759/cureus.8273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/05/2022] Open
Abstract
Malignant SMARCB1/INI1-deficient extrarenal rhabdoid tumors are aggressive tumors that are extremely rare in adults. A 56-year-old male presented with the chief complaints of unilateral lower abdominal and pelvic pain. He underwent urgent surgical intervention and mass resection with tissue sampling. After pathology confirmed the diagnosis, systemic chemotherapy with vincristine, doxorubicin plus ifosfamide, and mesna was administered. Following treatment, he experienced a durable and long-lasting response to therapy for this aggressive and rare soft tissue sarcoma. To date, the patient remains in complete remission following the cessation of chemotherapy. Malignant SMARCB1/INI1-deficient extrarenal rhabdoid tumors are aggressive neoplasms that are extremely rare in adults. We report a rare case of such a tumor and review the literature for its molecular, clinical, and imaging features.
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Affiliation(s)
- Nathaniel A Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
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Abstract
Sporotrichosis is a mycotic infection caused by the Sporothrix schenckii species complex. It typically presents as a localized, mostly cutaneous or lymphocutaneous infection, but has been increasingly presenting as a disseminated infection in immunocompromised individuals, especially in HIV/AIDS patients. We also included a literature review of sporotrichosis in this patient population. The aim of this case report is to raise awareness about atypical presentations of sporotrichosis in an attempt to decrease the time to diagnosis, initiate treatment earlier when infection is suspected, and improve overall survival in vulnerable patient populations.
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Affiliation(s)
- Nathaniel Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Nora Strong
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | | | | | - Thomas Moore
- Infectious Disease, University of Kansas School of Medicine, Wichita, USA
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Parker NA, McBride C, Forge J, Lalich D. Bowel obstruction caused by colonic metastasis of lung adenocarcinoma: a case report and literature review. World J Surg Oncol 2019; 17:63. [PMID: 30961608 PMCID: PMC6454752 DOI: 10.1186/s12957-019-1611-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/20/2019] [Accepted: 03/29/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction Lung cancer is the most common cause of cancer-related deaths globally. Metastatic disease is often found at the time of initial diagnosis in the majority of lung cancer patients. However, colonic metastases are rare. This report describes an uncommon case of colonic metastasis from lung adenocarcinoma. Case presentation A 64-year-old female presented to her gastroenterologist for progressively worsening abdominal pain and constipation. Exploratory colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. Her specialist recommended she immediately go to her regional hospital for further workup. On admission, she complained of continued abdominal pain and constipation. Notably, she had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed 1 year prior. She was thought to be in remission following radiation and immunotherapy with pembrolizumab. Upon hospital admission, she underwent an urgent colostomy, ileocecectomy and anastomosis, and rectosigmoid mass resection with tissue sampling. Pathology confirmed the diagnosis of colonic metastasis from primary lung adenocarcinoma. Treatment was with systemic chemotherapy followed by localized radiation to the pelvic region was started. She did not respond well to these therapies. Subsequent imaging showed refractory tumor growth in the pelvic region. Treatment could not be completed due to the patient experiencing a debilitating stroke, and she was transitioned to hospice care. Conclusions Clinicians should have a low threshold for intestinal investigation and considerations for colonic metastasis when patients with a history of primary lung cancer have abdominal symptoms.
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Affiliation(s)
- N A Parker
- Department of Internal Medicine, University of Kansas School of Medicine, 2817 N Tallgrass St, Wichita, KS, 67226, USA.
| | - C McBride
- Department of Internal Medicine, University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - J Forge
- Department of Internal Medicine, University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - D Lalich
- Department of Anatomical and Clinical Pathology, Wesley Medical Center, 550 N. Hillside St, Wichita, KS, 67214, USA
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Parker N, McBride C, Forge J, Lalich D. Colonic Metastasis of Lung Adenocarcinoma: A Case Report. Cureus 2019; 11:e4341. [PMID: 31187006 PMCID: PMC6541151 DOI: 10.7759/cureus.4341] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Colonic metastases are extremely rare, regardless of primary lung cancer type. A 64-year-old female was referred to the hospital by her gastroenterologist after a same-day colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. On admission, she complained of abdominal pain and constipation. She had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed one year prior. She was thought to be in remission following radiation and immunotherapy with pembrolizumab. She underwent urgent surgical intervention and mass resection with tissue sampling. Pathology confirmed the diagnosis of metastatic lung adenocarcinoma. Systemic chemotherapy with pemetrexed and carboplatin followed by localized radiation to the pelvic region was administered. A refractory pelvic region tumor growth was evident on subsequent imaging. Cessation of chemoradiation therapy occurred after the patient experienced a debilitating stroke and she was transferred to hospice care. Colonic metastasis should be considered when patients with a history of primary lung cancer have abdominal symptoms.
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Affiliation(s)
- Nathaniel Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Chloe McBride
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - John Forge
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
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Abstract
A 55-year-old female presented to the emergency department with seizures, left hemiparesis, and memory loss. Her past medical history was notable for a right triple-negative breast adenocarcinoma that was diagnosed approximately two years prior. She underwent treatment with chemotherapy, right breast lumpectomy, and radiation near her rural hometown. Radiologic studies were performed in the emergency department. Brain imaging revealed a new 2-cm mass in the left breast and a 4-cm left frontal lobe brain lesion. She underwent an urgent craniotomy. Immunohistochemical staining of the brain tumor tissue suggested metastatic triple-negative breast adenocarcinoma. She was discharged with recommendations to follow up with her prior oncologist near her home for systemic chemotherapy. Three months after metastatic breast cancer to the brain was diagnosed, the patient experienced headaches, fever, and nuchal rigidity. MRI of the brain showed new leptomeningeal enhancement. A lumbar puncture with a cerebrospinal fluid analysis revealed the presence of malignant cells. Together with imaging and cerebrospinal fluid findings, leptomeningeal carcinomatosis was diagnosed. This case report presents an uncommon but well-known complication of breast cancer.
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Affiliation(s)
- Nathaniel Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - John Forge
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
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Parker NA, Dakhil CS, Dakhil SR, Lalich D. Metastasis of Benign Leiomyomas Outside the Uterus. Kans J Med 2018; 11:1-11. [PMID: 29796157 PMCID: PMC5962322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lalich D, O’Neil M, Madan R, Tawfik O, Thomas P, Fan F. Atypia of Undetermined Significance in Thyroid Fine-Needle Aspirations: Cytological Features and Clinical Follow-up. Am J Clin Pathol 2012. [DOI: 10.1093/ajcp/138.suppl1.250] [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: 11/15/2022] Open
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Joseph S, Thomas P, Lalich D, Mathur SC, McGregor DH, Reese J. Hematopoietic neoplasm of the stomach. J Clin Oncol 2010; 28:e593-5. [PMID: 20713866 DOI: 10.1200/jco.2010.28.6278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sigi Joseph
- University of Missouri, Kansas City, MO, USA
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