1
|
Marginean EC, Gotfrit J, Marginean H, Yokom DW, Bateman JJ, Daneshmand M, Sud S, Gown AM, Jonker D, Asmis T, Goodwin RA. Phosphorylated transducer and activator of transcription-3 (pSTAT3) immunohistochemical expression in paired primary and metastatic colorectal cancer. Transl Oncol 2020; 14:100996. [PMID: 33341488 PMCID: PMC7750168 DOI: 10.1016/j.tranon.2020.100996] [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] [Received: 11/11/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Signal Transducer and Activator of Transcription-3 (STAT3) mediates cellular functions. We assessed the IHC expression of phosphorylated STAT3 (pSTAT3) in paired primary tumors and liver metastases in patients with advanced stage colorectal cancer (CRC). METHODS We included patients with tissue blocks available from both the primary CRC and a surgically resected liver metastasis. The IHC pSTAT3 expression agreement was measured using Cohen's kappa statistic. RESULTS The study included 103 patients, 55% male, median age was 64. 43% tumors originated in rectum, and 63% of the primary tumors were synchronous. Expression of pSTAT3 was 76% in liver metastases and 71% in primary tumors. A difference in pSTAT3 staining between the primary tumor and liver metastases was noted in 64%. There was lost expression of pSTAT3 in the liver metastases in 28% and gained expression in 36% of cases compared to the primary. The kappa statistic comparing agreement between staining patterns of the primary tumors and liver metastases was a "less-than-chance", at -0.02. Median survival was 4.9 years, with no difference in survival outcomes by pSTAT3 expression in the primary tumor or liver metastases. DISCUSSION STAT3 is not a prognostic marker in the selective setting of metastatic CRC to liver, but it may remain a potential therapeutic target given most liver metastases expressed pSTAT3. Discordant pSTAT3 expression in between primary tumors and paired liver metastases suggests that use of this class of drug to treat liver predominant metastatic colorectal cancer in a biomarker-driven approach may require confirmatory liver tumor biopsy.
Collapse
Affiliation(s)
- Esmeralda C Marginean
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa ON K1H 8L6 Canada; Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9.
| | - Joanna Gotfrit
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa ON K1H 8L6 Canada; Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9.
| | - Horia Marginean
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa ON K1H 8L6 Canada; Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9.
| | - Daniel W Yokom
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa ON K1H 8L6 Canada; Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9.
| | - Justin J Bateman
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9; The Ottawa Hospital, Department of Pathology, 501 Smyth Road, Ottawa ON K1H 8L6 Canada.
| | - Manijeh Daneshmand
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa ON K1H 8L6 Canada; Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9.
| | - Shelly Sud
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa ON K1H 8L6 Canada; Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9.
| | - Allen M Gown
- PhenoPath Laboratories, 551 N. 34th Street Seattle 98103 USA.
| | - Derek Jonker
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa ON K1H 8L6 Canada; Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9.
| | - Timothy Asmis
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa ON K1H 8L6 Canada; Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9.
| | - Rachel A Goodwin
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa ON K1H 8L6 Canada; Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9.
| |
Collapse
|
2
|
Sinn BV, Fu C, Lau R, Litton J, Tsai TH, Murthy R, Tam A, Andreopoulou E, Gong Y, Murthy R, Gould R, Zhang Y, King TA, Viale A, Andrade V, Giri D, Salgado R, Laios I, Sotiriou C, Marginean EC, Kwiatkowski DN, Layman RM, Booser D, Hatzis C, Vicente Valero V, Fraser Symmans W. SET ER/PR: a robust 18-gene predictor for sensitivity to endocrine therapy for metastatic breast cancer. NPJ Breast Cancer 2019; 5:16. [PMID: 31231679 PMCID: PMC6542807 DOI: 10.1038/s41523-019-0111-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
There is a clinical need to predict sensitivity of metastatic hormone receptor-positive and HER2-negative (HR+/HER2-) breast cancer to endocrine therapy, and targeted RNA sequencing (RNAseq) offers diagnostic potential to measure both transcriptional activity and functional mutation. We developed the SETER/PR index to measure gene expression microarray probe sets that were correlated with hormone receptors (ESR1 and PGR) and robust to preanalytical and analytical influences. We tested SETER/PR index in biopsies of metastastic HR+/HER2- breast cancer against the treatment outcomes in 140 patients. Then we customized the SETER/PR assay to measure 18 informative, 10 reference transcripts, and sequence the ligand-binding domain (LBD) of ESR1 using droplet-based targeted RNAseq, and tested that in residual RNA from 53 patients. Higher SETER/PR index in metastatic samples predicted longer PFS and OS when patients received endocrine therapy as next treatment, even after adjustment for clinical-pathologic risk factors (PFS: HR 0.534, 95% CI 0.299 to 0.955, p = 0.035; OS: HR 0.315, 95% CI 0.157 to 0.631, p = 0.001). Mutated ESR1 LBD was detected in 8/53 (15%) of metastases, involving 1-98% of ESR1 transcripts (all had high SETER/PR index). A signature based on probe sets with good preanalytical and analytical performance facilitated our customization of an accurate targeted RNAseq assay to measure both phenotype and genotype of ER-related transcription. Elevated SETER/PR was associated with prolonged sensitivity to endocrine therapy in patients with metastatic HR+/HER2- breast cancer, especially in the absence of mutated ESR1 transcript.
Collapse
Affiliation(s)
- Bruno V. Sinn
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Department of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institut of Health, Berlin, Germany
| | - Chunxiao Fu
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Rosanna Lau
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Jennifer Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Tsung-Heng Tsai
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Rashmi Murthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Alda Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Eleni Andreopoulou
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Yun Gong
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Ravi Murthy
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Rebekah Gould
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Ya Zhang
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Tari A. King
- Department of Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, MA USA
| | - Agnes Viale
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY USA
| | - Victor Andrade
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY USA
- Department of Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Dilip Giri
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY USA
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA, Antwerp, Belgium
- Division of Research, Peter Mac Callum Cancer Centre, Melbourne, Australia
| | - Ioanna Laios
- Department of Pathology, Institut Jules Bordet, Brussels, Belgium
| | - Christos Sotiriou
- Translational Breast Cancer Laboratory, Institut Jules Bordet, Brussels, Belgium
| | | | - Danielle N. Kwiatkowski
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Rachel M. Layman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Daniel Booser
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Christos Hatzis
- Department of Medicine, Yale University School of Medicine, New Haven, CT USA
| | - V. Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - W. Fraser Symmans
- Department of Pathology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| |
Collapse
|
3
|
Horgan AM, Darling G, Wong R, Guindi M, Liu G, Jonker DJ, Lister J, Xu W, MacKay HM, Dinniwell R, Kim J, Pierre A, Shargall Y, Asmis TR, Agboola O, Seely AJ, Ringash J, Wells J, Marginean EC, Haider M, Knox JJ. Adjuvant sunitinib following chemoradiotherapy and surgery for locally advanced esophageal cancer: a phase II trial. Dis Esophagus 2016; 29:1152-1158. [PMID: 26663741 DOI: 10.1111/dote.12444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prognosis for locally advanced esophageal cancer is poor despite the use of trimodality therapy. In this phase II study, we report the feasibility, tolerability and efficacy of adjuvant sunitinib. Included were patients with stage IIa, IIB or III cancer of the thoracic esophagus or gastroesophageal junction. Neoadjuvant therapy involved Irinotecan (65 mg/m2 ) + Cisplatin (30 mg/m2 ) on weeks 1 and 2, 4 and 5, 7 and 8 with concurrent radiation (50Gy/25 fractions) on weeks 4-8. Sunitinib was commenced 4-13 weeks after surgery and continued for one year. Sixty-one patients were included in the final analysis, 36 patients commenced adjuvant sunitinib. Fourteen patients discontinued sunitinib due to disease recurrence (39%) within the 12-month period, 12 (33%) discontinued due to toxicity, and 3 (8%) requested cessation of therapy. In the overall population, median survival was 26 months with a 2 and 3-year survival rate of 52% and 35%, respectively. The median survival for the 36 patients treated with sunitinib was 35 months and 2-year survival probability of 68%. In a historical control, a prior phase II study with the same trimodality therapy (n = 43), median survival was 36 months, with a 2-year survival of 67%. Initiation of adjuvant sunitinib is feasible, but poorly tolerated, with no signal of additional benefit over trimodality therapy for locally advanced esophageal cancer.
Collapse
Affiliation(s)
- A M Horgan
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - G Darling
- Department of Surgical Oncology, Division of Thoracic Surgery, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - R Wong
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - M Guindi
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - G Liu
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - D J Jonker
- Department of Medical Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - J Lister
- Department of Surgical Oncology, Division of Thoracic Surgery, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - H M MacKay
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - R Dinniwell
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - A Pierre
- Department of Surgical Oncology, Division of Thoracic Surgery, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - Y Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - T R Asmis
- Department of Medical Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - O Agboola
- Department of Thoracic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - A J Seely
- Department of Pathology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - J Ringash
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - J Wells
- Department of Radiation Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - E C Marginean
- Department of Pathology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - M Haider
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - J J Knox
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Kotha VK, Khandelwal A, Saboo SS, Shanbhogue AKP, Virmani V, Marginean EC, Menias CO. Radiologist's perspective for the Meckel's diverticulum and its complications. Br J Radiol 2014; 87:20130743. [PMID: 24611767 PMCID: PMC4075535 DOI: 10.1259/bjr.20130743] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract, often presenting with complications such as gastrointestinal bleeding, intussusception, bowel obstruction and diverticulitis, which are often misdiagnosed. Imaging plays an important role in the early diagnosis and characterization of these conditions and is very helpful in decision making. The Meckel's diverticulum and its complications have myriad presentations and appearances on various imaging modalities. Thus, sound knowledge of the anatomy, embryology, clinical presentation, imaging characteristics and complications is crucial to the practice of abdominal imaging. We present a review of the literature and current radiological practices in the diagnosis and management of the Meckel's diverticulum and its various complications with special emphasis on the imaging of various complications, mimickers and pathological correlation.
Collapse
Affiliation(s)
- V K Kotha
- Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
Abstract
Background: Standard immunohistochemistry (IHC) performed for invasive breast carcinoma includes ER, PR and Her2/Neu status, and these markers are used in conjunction with other patient and tumour factors to determine prognosis and guide treatment. Many, but not all, low stage, lymph node (LN) negative, ER positive patients have a good prognosis without chemotherapy. Thus a demand exists for predictive tools to stratify patient risk within this subgroup. It has been reported that, for a subset of ER positive Her2/Neu negative patients, the 21 gene OncotypeDX recurrence score (Onco-RS) adds independent prognostic information to that obtained from these standard IHC markers (1). As several genes analyzed for the Onco-RS relate to ER, PR, HER2/neu and proliferative status, it is reasonable to try to incorporate clinical-pathological variables and these IHC scores into a predictive model. Indeed, recent studies suggest that most of the additional information provided by the OncoDX-RS may be obtained more cost effectively using the Ki-67 IHC based proliferation percentage combined with a semi-quantitative assessment of standard IHC markers including ER and PR and Her2/neu (2). The aim of this study is to assess the ability of a simple combined IHC recurrence score (IHC-RS) to predict Onco-RS. The IHC-RS was derived from a simple semi-quantitative assessment of ER and PR combined with Ki-67 proliferation percentage.
Design: A cohort of 159 women aged 27–78 with ER positive, HER2/neu negative breast cancer completed Oncodx testing between March 2010 and May 2012. This sample reflects the population selected at our institution for Oncotype testing. The variables investigated for inclusion in a model to predict RS score included tumor grade, stage, patient age, Allred ER & PR and Ki-67 percentage.
Results and Discussion: A predictive model was developed to generate a recurrence score (IHC-RS) using stepwise multiple regression incorporating Allred ER score, Allred PR score and Ki-67 percentage. The best subset model (Schwartz BIC) accounted for 60.7% of the Onco-RS variability (adjusted R2 = 60.7, p = 0.05).
In addition, analysis of individual cases where the IHC-RS was not in agreement with the Onco-RS reveals that the Onco-RS, although technically highly reproducible, may suffer from sampling error. The IHC-RS is more robust with respect to sampling error, owing to the retention of tumor architecture inherent in IHC. IHC, however, can lack the technical reproducibility and transportability inherent in the Onco-RS methodology. There are clearly advantages to an ICH derived multi-score such as IHC-4 (3) or the simpler IHC-RS proposed in this study. Full utility of any IHC-based recurrence score will require standardization of testing and scoring both within and across different testing laboratories. In addition, full utility of any IHC based model will require direct correlation to patient outcome, rather than to a surrogate marker such as the Onco-RS used in this study.
1. M Dowsett et al. J Clin Oncol. 2010 Apr 10; 1829–1834 2. Cuzick J et al. J Clin Oncol. 2011 Nov 10;4273-8. 3. S Barton et al. British Journal of Cancer (2012) 106, 1760–1765.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-01-01.
Collapse
Affiliation(s)
| | - DH Gravel
- The Ottawa Hospital, Ottawa, ON, Canada
| | - X Song
- The Ottawa Hospital, Ottawa, ON, Canada
| | | | | |
Collapse
|
6
|
Mai KT, Teo I, Belanger EC, Robertson SJ, Marginean EC, Islam S. Progesterone receptor reactivity in renal oncocytoma and chromophobe renal cell carcinoma. Histopathology 2008; 52:277-82. [DOI: 10.1111/j.1365-2559.2007.02931.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Abstract
Recently, we encountered 2 cases of diffuse iron deposition in gastric antral and fundic glandular epithelium, which in 1 patient eventually led to the diagnosis of hemochromatosis. Gastric mucosal siderosis (GS) has previously been described in hemochromatosis patients, alcoholics, and in association with iron medications. However, the prevalence of various patterns of iron deposition in the gastric mucosa and their clinical significance have not been studied in detail. The 2 index cases mentioned above and 500 additional consecutive gastric biopsies examined over a period of 8 months at our institution were stained for iron by the Prussian blue method. In addition, all patients with genetic hemochromatosis diagnosed by liver biopsy in our department between 1998 and 2003 who also had gastric biopsies were identified from the surgical pathology files and included in the study (n = 3). The location of iron deposition [stromal cells (endothelium, fibroblasts, macrophages), glandular epithelium, or extracellular] was recorded and subjectively graded as 1+ to 3+ according to the severity of deposition within the mucosa. Relevant histologic changes (inflammation, presence of H. pylori, ulceration) and clinical features were reviewed. Three patterns of GS were identified: A) "nonspecific GS" with predominant iron deposition in the stromal cells including macrophages, and focally in epithelium; B) "iron-pill gastritis" with often mild gastritis and reactive gastropathy type changes, and mostly extracellular deposition with focal stromal cells and epithelial deposition; and C) predominant deposition in antral and fundic glandular epithelium. Of the 500 cases studied, a total of 18 (3.6%) cases were found to have GS. Of these 18 cases, 11 (2.2%) showed pattern A, 4 (0.8%) showed pattern B, and 3 (0.6%) showed pattern C. The GS in patterns A and B was always focal or patchy (1+ to 2+), whereas in pattern C it was generally diffuse and strong (2+ to 3+). A history of oral iron medication was present in 2 (n = 11, 0.4%) patients with pattern A, in all patients with pattern B (n = 4, 100%), and in none of patients with pattern C (n=3, 0%). Varying degrees of mucosal inflammation were noted in patients with pattern A cases, and 2 had evidence of active Helicobacter pylori infection. Of the 3 cases with known hemochromatosis, only one gastric biopsy showed pattern C GS (1+). In conclusion, gastric mucosal siderosis is relatively uncommon (3%) but is important to look for as it may lead to a diagnosis of hemochromatosis in some cases. Three patterns are recognized: A) a "nonspecific" stromal cell predominant pattern, which may be associated with gastric inflammation, possibly prior mucosal hemorrhages or iron medications; B) extracellular coarse clumps of crystalline iron deposition associated with oral iron medications, mild gastritis, and reactive gastropathy type changes ("Iron-pill gastritis"); and C) gastric glandular siderosis, which may be associated with systemic iron overload/hemochromatosis.
Collapse
Affiliation(s)
- Esmeralda C Marginean
- Department of Anatomic Pathology, Program in Gastrointestinal Pathology, Yale University School of Medicine, New Haven, CT 06510, USA
| | | | | | | | | |
Collapse
|
8
|
Costa DB, Chen AA, Marginean EC, Inzucchi SE. Diabetes Mellitus As The Presenting Feature Of Extrahepatic Cholangiocarcinoma In Situ: Case Report And Review Of Literature. Endocr Pract 2004; 10:417-23. [PMID: 15760789 DOI: 10.4158/ep.10.5.417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report a case of newly recognized diabetes, manifested by hyperglycemic crisis, as the presenting feature of an extrahepatic cholangiocarcinoma in situ. METHODS We summarize the initial clinical manifestations and pertinent laboratory, radiologic, and pathologic findings in a patient with hyperglycemic emergency and a biliary carcinoma in situ. A review of the literature involving cholangiocarcinoma, pancreatic tumors, and diabetes mellitus is also presented. RESULTS An 85-year-old woman with no prior history of hyperglycemia presented to the hospital in hyperglycemic crisis, without identifiable precipitants. Further work-up disclosed a tumor in the common bile duct. Pathologic analysis, after pancreatoduodenectomy, demonstrated a carcinoma in situ without extension to nearby structures. Adjacent pancreatic islet cells appeared normal. Screening for all relevant islet cell autoantibodies was negative. After tumor removal, mild hyperglycemia persisted, although without insulin requirements. CONCLUSION Extrahepatic cholangiocarcinoma and diabetes are not usually associated, and to our knowledge, this is the first reported case of a hyperglycemic emergency with this specific type of tumor. The cause-and-effect relationship between the patient's biliary carcinoma in situ and diabetes obviously cannot be confirmed; however, in the absence of other identifiable conditions, it is reasonable to speculate that some factor (or factors) produced by the tumor had a role in the metabolic decompensation. Such a relationship has been considered by others concerning the well-described association between diabetes and carcinoma of the pancreas, in which the underlying pathophysiologic process seems to be insulin resistance. This unusual case of secondary diabetes emphasizes the importance of considering the precise "cause" of the hyperglycemia when the presentation is atypical, as it was in this older, lean patient without risk factors for diabetes.
Collapse
Affiliation(s)
- Daniel B Costa
- Department of Internal Medicine, Yale University School of Medicine, New, Haven, Connecticut 06520, USA
| | | | | | | |
Collapse
|
9
|
|