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Kholová I, Chandra A, Faquin WC, Rupp NJ, Touska P, O'Regan E. Updates in head and neck cytopathology: Insights from European Congress of Pathology Short Course. Cytopathology 2024; 35:344-349. [PMID: 38351503 DOI: 10.1111/cyt.13368] [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: 01/21/2024] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
Cytological specimens play a pivotal role in head and neck nodule/mass work up and diagnoses. The specimens´ importance has grown with the onset of personalized medicine and the routine use of molecular markers in the diagnostic work up. The Updates in Head and Neck Cytopathology Short Course ran during the 35th European Congress of Pathology held in Dublin, Ireland, in 2023 and brought together experts in cytopathology, pathology, and related fields to share their expertise and experience in the field of head and neck cytopathology and its future directions. Topics such as a one-stop clinic, the Milan System for Reporting Salivary Gland Cytopathology, next generation sequencing, and human papilloma virus detection in the head and neck area were covered during the short course. These topics are briefly summarized in the present review.
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Affiliation(s)
- Ivana Kholová
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
| | | | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Philip Touska
- Department of Radiology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Esther O'Regan
- Department of Histopathology, St. James's Hospital & Dublin Dental Hospital, Trinity College Dublin, Dublin, Ireland
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2
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Hintze J, Lang B, Subramaniam T, Kruseman N, O'Regan E, Brennan S, Lennon P. Factors influencing nodal yield in neck dissections for head and neck malignancies. J Laryngol Otol 2023; 137:925-929. [PMID: 36651334 DOI: 10.1017/s0022215122002687] [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] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A standard lateral neck dissection should yield at least 18 lymph nodes. The goal of the present study was to examine what factors might influence the number of lymph nodes retrieved during a neck dissection. METHODS This was a retrospective cohort study in a tertiary academic referral centre for head and neck oncology. Two hundred and nineteen consecutive neck dissections were examined. Age of the patient and primary site were recorded, along with tumour histology, previous radiotherapy and final nodal count. RESULTS The mean age was 62.2 ± 13.0 years. The most common primary site was the oral cavity (38.8 per cent). The mean number of lymph nodes was 30.63 ± 13.9. In total, 17.8 per cent had undergone previous radiotherapy. The mean number of lymph nodes was 33.26 ± 13.27 in patients with no previous radiation exposure and 18.47 ± 9.46 in those with previous radiation treatment. CONCLUSION Lymph node yield from a neck dissection is likely multi-factorial in nature. Previous radiotherapy, the only significant contributor, led to a mean reduction of lymph node yield from 33.3 to 18.5.
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Affiliation(s)
- J Hintze
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - B Lang
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - T Subramaniam
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - N Kruseman
- Department of Histopathology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - E O'Regan
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Department of Histopathology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - S Brennan
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Department of Radiation Oncology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - P Lennon
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
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3
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Baněčková M, Thompson LDR, Hyrcza MD, Vaněček T, Agaimy A, Laco J, Simpson RHW, Di Palma S, Stevens TM, Brcic L, Etebarian A, Dimnik K, Majewska H, Stárek I, O'Regan E, Salviato T, Helliwell T, Horáková M, Biernat W, Onyuma T, Michal M, Leivo I, Skalova A. Salivary Gland Secretory Carcinoma: Clinicopathologic and Genetic Characteristics of 215 Cases and Proposal for a Grading System. Am J Surg Pathol 2023; 47:661-677. [PMID: 37070739 DOI: 10.1097/pas.0000000000002043] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/19/2023]
Abstract
Salivary gland secretory carcinoma (SC), previously mammary analog SC, is a low-grade malignancy characterized by well-defined morphology and an immunohistochemical and genetic profile identical to SC of the breast. Translocation t(12;15)(p13;q25) resulting in the ETV6 :: NTRK3 gene fusion is a characteristic feature of SC along with S100 protein and mammaglobin immunopositivity. The spectrum of genetic alterations for SC continues to evolve. The aim of this retrospective study was to collect data of salivary gland SCs and to correlate their histologic, immunohistochemical, and molecular genetic data with clinical behavior and long-term follow-up. In this large retrospective study, we aimed to establish a histologic grading scheme and scoring system. A total of 215 cases of salivary gland SCs diagnosed between 1994 and 2021 were obtained from the tumor registries of the authors. Eighty cases were originally diagnosed as something other than SC, most frequently acinic cell carcinoma. Lymph node metastases were identified in 17.1% (20/117 cases with available data), with distant metastasis in 5.1% (6/117). Disease recurrence was seen in 15% (n=17/113 cases with available data). The molecular genetic profile showed ETV6 :: NTRK3 gene fusion in 95.4%, including 1 case with a dual fusion of ETV6 :: NTRK3 and MYB :: SMR3B . Less frequent fusion transcripts included ETV6 :: RET (n=12) and VIM :: RET (n=1). A 3-tiered grading scheme using 6 pathologic parameters (prevailing architecture, pleomorphism, tumor necrosis, perineural invasion (PNI), lymphovascular invasion (LVI), and mitotic count and/or Ki-67 labeling index) was applied. Grade 1 histology was observed in 44.7% (n=96), grade 2 in 41.9% (n=90), and grade 3 in 13.5% (n=29) of cases. Compared with low-grade and intermediate-grade SC, high-grade tumors were associated with a solid architecture, more prominent hyalinization, infiltrative tumor borders, nuclear pleomorphism, presence of PNI and/or LVI, and Ki-67 proliferative index >30%. High-grade transformation, a subset of grade 2 or 3 tumors, seen in 8.8% (n=19), was defined as an abrupt transformation of conventional SC into high-grade morphology, sheet-like growth, and a tumor lacking distinctive features of SC. Both overall survival and disease-free survival (5 and 10 y) were negatively affected by tumor grade, stage, and TNM status (each P <0.0001). SC is a low-grade malignancy with predominantly solid-microcystic growth patterns, driven by a gene fusion, most commonly ETV6 :: NTRK3 . There is a low risk for local recurrence and a good overall long-term survival, with a low risk for distant metastasis but a higher risk for locoregional lymph node metastasis. The presence of tumor necrosis, hyalinization, PNI and/or LVI, and positive resection margins correlate with higher tumor grade, less favorable prognosis, and increased mortality. The statistical results allowed us to design a 3-tiered grading system for salivary SC.
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Affiliation(s)
- Martina Baněčková
- Department of Pathology, Charles University, Faculty of Medicine in Plzen
- Bioptic Laboratory Ltd Plzen
| | | | - Martin D Hyrcza
- Department of Pathology and Laboratory Medicine, University of Calgary, Arnie Charbonneau Cancer Institute
| | - Tomáš Vaněček
- Molecular Genetic Laboratory, Bioptic Laboratory Ltd, Plzen
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Jan Laco
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove
| | - Roderick H W Simpson
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary Laboratory Services, Foothills Medical Centre, Calgary, AB, Canada
| | - Silvana Di Palma
- Division of Clinical Medicine, Department of Histopathology, University of Surrey, Royal Surrey County Hospital, Guildford, Surrey
| | - Todd M Stevens
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Arghavan Etebarian
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Katarina Dimnik
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Hanna Majewska
- Department of Pathology, Warmia and Mazury University, Olsztyn
| | - Ivo Stárek
- Department of Otorhinolaryngology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Esther O'Regan
- Department of Histopathology, St. James's Hospital & Dublin Dental Hospital, Trinity College Dublin, Dublin, Ireland
| | - Tiziana Salviato
- Division of Pathology, Department of Medical and Surgical Sciences for Children & Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Tim Helliwell
- Department of Cellular Pathology, University of Liverpool, Liverpool, UK
| | - Markéta Horáková
- Department of Pathology, Charles University, Faculty of Medicine in Plzen
- Bioptic Laboratory Ltd Plzen
| | - Wojciech Biernat
- Department of Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Timothy Onyuma
- Department of Pathology, Kenyatta National Hospital, Nairobi, Kenya
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen
- Bioptic Laboratory Ltd Plzen
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Alena Skalova
- Department of Pathology, Charles University, Faculty of Medicine in Plzen
- Bioptic Laboratory Ltd Plzen
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Mulvihill C, Fitzgerald K, O'Regan E, Healy CM, Leahy TR. Successful treatment of oral potentially malignant lesions with ruxolitinib in STAT3 gain-of-function disease. Oral Oncol 2022; 132:106015. [PMID: 35809509 DOI: 10.1016/j.oraloncology.2022.106015] [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] [Received: 05/29/2022] [Revised: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Ciara Mulvihill
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Oral Pathology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland.
| | - Kirsten Fitzgerald
- Departments of Paediatric Dentistry, Children's Health Ireland at Crumlin, Dublin and Dublin Dental University Hospital, Dublin, Ireland
| | - Esther O'Regan
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Oral Pathology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Claire M Healy
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Oral Pathology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Department of Paediatric Immunology and Infectious Diseases, Children's Health Ireland at Crumlin, Dublin, Ireland; Department of Paediatrics, School of Medicine, University of Dublin, Trinity College, Dublin, Ireland
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Barry CP, MacDhabheid C, Tobin K, Stassen LF, Lennon P, Toner M, O'Regan E, Clark JR. 'Out of house' virtual surgical planning for mandible reconstruction after cancer resection: is it oncologically safe? Int J Oral Maxillofac Surg 2020; 50:999-1002. [PMID: 33317906 DOI: 10.1016/j.ijom.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/26/2020] [Revised: 09/14/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate whether the time delay between 'out of house' proprietary virtual surgical planning (OH-VSP) of the mandibular resection for oral cancer and the actual surgery results in compromised margins and oncological disadvantage for the patient. Outcomes of patients who had OH-VSP of their mandibular resection and reconstruction were compared with those of patients who had the same surgery using a conventional non-VSP approach. The groups were similar in patient demographics, tumour stage and size, nodal status, and reconstruction complexity. VSP resulted in a significant reduction in operating time (P<0.01). VSP did not affect bony (P=0.49) or soft tissue (P=0.22) margin status. In summary, VSP reduced the operating theatre time, and despite the time interval between bony resection planning and surgery, there was no compromise to the oncological safety of the operation.
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Affiliation(s)
- C P Barry
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland; School of Dental Science, Trinity College, Dublin, Ireland.
| | - C MacDhabheid
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland
| | - K Tobin
- School of Medicine, Trinity College, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland
| | - L F Stassen
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - P Lennon
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - M Toner
- School of Dental Science, Trinity College, Dublin, Ireland; Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - E O'Regan
- School of Medicine, Trinity College, Dublin, Ireland; Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - J R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
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6
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Fahy E, Mulvihill C, O'Donoghue G, O'Regan E, Collins M. Neurofibromatosis -1 diagnosed from an intraoral swelling - a case series. Aust Dent J 2020; 66:205-211. [PMID: 32990942 DOI: 10.1111/adj.12797] [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] [Accepted: 09/14/2020] [Indexed: 02/02/2023]
Abstract
The neurofibromatoses [NF 1, NF 2 and schwannomatosis] are a group of genetic disorders that lead to the development of nervous system tumours and have diverse dermatologic, neurologic, ophthalmic, skeletal and vascular effects. The most common is NF 1 (Neurofibromatosis 1) also known as von Recklinghausen's disease, which is one of the most common human genetic diseases. Oral manifestations of NF 1 are reported in 72% of cases and in one of our cases precipitated attendance at a general dental practitioner (GDP), subsequent diagnosis and genetic screening for family members. This disease may go undiagnosed due to its variable expressivity of symptoms. The pivotal importance of a GDP in the discovery and early referral to an oral or oral and maxillofacial surgeon for further investigation and diagnosis of this condition is highlighted. Knowledge of the most common features of neurofibromatosis can facilitate the speedy referral and subsequent diagnosis of generalized neurofibromatosis, local surgical management of benign neoplasms and long term management of its other clinical features. Dentists should be aware of the classic symptoms of this condition and of their role in long-term care in view of the risk of local recurrence and malignant transformation.
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Affiliation(s)
- E Fahy
- Dublin Dental University Hospital, Dublin, Ireland
| | - C Mulvihill
- Dublin Dental University Hospital, Dublin, Ireland
| | - G O'Donoghue
- Dublin Dental University Hospital, Dublin, Ireland
| | - E O'Regan
- Dublin Dental University Hospital, Dublin, Ireland.,Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - M Collins
- Dublin Dental University Hospital, Dublin, Ireland
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Abstract
We report an extremely rare case of a hybrid tumour of the maxillary sinus. A 51-year-old man presented with a 6-week history of nasal congestion and epiphora. Radiological imaging demonstrated a maxillary sinus tumour, with extensive local invasion. Surgical excision included maxillectomy, left eye exenteration and free flap closure. Histology of the excised specimen showed a rare hybrid tumour containing adenoid cystic carcinoma, salivary duct carcinoma, epithelial-myoepithelial carcinoma and basal cell adenoma. Hybrid tumours are very rare tumour entities which are composed of at least two distinct tumour types. Each tumour entity conforms with a defined tumour type. The tumour entities of a hybrid tumour are not separated but have an identical origin within a definite topographical area. Diagnosis and appropriate management requires high index of suspicion, pathological endeavour to look for a more aggressive accompanying tumour and adequate oncological treatment according to the highest grade of tumour.
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Affiliation(s)
- Ailbhe White-Gibson
- Department of Head and Neck Surgery, St. James's Hospital, Dublin, Ireland.,Department of Trauma and Orthopaedics, AMNCH, Tallaght Hospital, Dublin, Ireland
| | - Paul Lennon
- Department of Otolaryngology Head and Neck Surgery, St. James's Hospital, Dublin, Ireland
| | - Esther O'Regan
- Department of Histopathology, St. James's Hospital, Dublin, Ireland
| | - Conrad Timon
- Department of Otolaryngology Head and Neck Surgery, St. James's Hospital, Dublin, Ireland
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Abstract
The aim of this study was to determine the number of cases of papillary thyroid carcinoma (PTC) which could be reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in our institute over a 10-year period, document their clinical status and assess the number of slides that had to be reviewed per case to exclude NIFTP. The histopathology reports for thyroid resections for all papillary carcinoma over a 10-year period (2007-2016) were reviewed. Five hundred forty-five histopathology reports were reviewed, and 71 cases were identified as potential cases of NIFTP. Forty-nine (69%) cases had been referred from external departments and the slides were not available for review. Of the remaining 22 (31% of 71) cases, 5 were reclassified as NIFTP. The 17 cases that were not reclassified as NIFTP required review of 114 of 356 slides (median 5.5 slides per case) was required to exclude NIFTP. For the 5 NIFTP cases, 58 slides were reviewed (median 12 slides per case). We found that review of the histology reports alone was adequate for exclusion in most cases, e.g. classic PTC or EVPTC cases with documented lymphovascular invasion or capsular invasion. As a single exclusion criterion is required for exclusion from reclassification as NIFTP, this can be achieved efficiently. Two of the five patients received radioactive iodine [RAI] as per standard treatment at time of diagnosis, on the basis of tumour size. None have recurrent or metastatic disease with mean follow-up of 5.8 years.
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Affiliation(s)
- Kevin O'Hare
- Department of Histopathology, St. James Hospital, Dublin, Ireland.
| | - E O'Regan
- Department of Histopathology, St. James Hospital, Dublin, Ireland
- Department of Oral and Maxillofacial Surgery, Medicine and Pathology, Dublin Dental University Hospital, Dublin, Ireland
| | - A Khattak
- Department of Endocrinology, St. James Hospital, Dublin, Ireland
| | - M L Healy
- Department of Endocrinology, St. James Hospital, Dublin, Ireland
| | - M Toner
- Department of Histopathology, St. James Hospital, Dublin, Ireland
- Department of Oral and Maxillofacial Surgery, Medicine and Pathology, Dublin Dental University Hospital, Dublin, Ireland
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9
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Flavin R, Smyth P, Crotty P, Finn S, Cahill S, Denning K, O'Regan E, O'Leary J, Sheils O. BRAF T1799A Mutation Occurring in a Case of Malignant Struma Ovarii. Int J Surg Pathol 2016; 15:116-20. [PMID: 17478764 DOI: 10.1177/1066896906299131] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Struma ovarii is an extremely rare tumor that occasionally undergoes malignant transformation. Because struma ovarii is composed of thyroid tissue, it is conceivable that the pathogenetic events involved in thyroid follicular transformation may take place also in struma ovarii. The authors describe a case of a classical variant of papillary thyroid carcinoma arising in a struma ovarii of a 22-year-old female. The tumor was heterozygous for BRAF T1799A mutation. No ret/ PTC-1 or ret/PTC-3 rearrangements were detected. This finding would suggest that malignant struma ovarii is similar histologically and genetically to primary papillary thyroid carcinoma.
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Affiliation(s)
- Richard Flavin
- Departments of Histopathology, St. James's Hospital, Trinity College, Dublin, Ireland
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10
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Seiwert TY, Wang X, Heitmann J, Villegas-Bergazzi V, Sprott K, Finn S, O'Regan E, Farrow AD, Weichselbaum RR, Lingen MW, Cohen EEW, Stenson K, Weaver DT, Vokes EE. DNA repair biomarkers XPF and phospho-MAPKAP kinase 2 correlate with clinical outcome in advanced head and neck cancer. PLoS One 2014; 9:e102112. [PMID: 25019640 PMCID: PMC4096922 DOI: 10.1371/journal.pone.0102112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/14/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Induction chemotherapy is a common therapeutic option for patients with locoregionally-advanced head and neck cancer (HNC), but it remains unclear which patients will benefit. In this study, we searched for biomarkers predicting the response of patients with locoregionally-advanced HNC to induction chemotherapy by evaluating the expression pattern of DNA repair proteins. METHODS Expression of a panel of DNA-repair proteins in formalin-fixed paraffin embedded specimens from a cohort of 37 HNC patients undergoing platinum-based induction chemotherapy prior to definitive chemoradiation were analyzed using quantitative immunohistochemistry. RESULTS We found that XPF (an ERCC1 binding partner) and phospho-MAPKAP Kinase 2 (pMK2) are novel biomarkers for HNSCC patients undergoing platinum-based induction chemotherapy. Low XPF expression in HNSCC patients is associated with better response to induction chemoradiotherapy, while high XPF expression correlates with a worse response (p = 0.02). Furthermore, low pMK2 expression was found to correlate significantly with overall survival after induction plus chemoradiation therapy (p = 0.01), suggesting that pMK2 may relate to chemoradiation therapy. CONCLUSIONS We identified XPF and pMK2 as novel DNA-repair biomarkers for locoregionally-advanced HNC patients undergoing platinum-based induction chemotherapy prior to definitive chemoradiation. Our study provides insights for the use of DNA repair biomarkers in personalized diagnostics strategies. Further validation in a larger cohort is indicated.
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Affiliation(s)
- Tanguy Y. Seiwert
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - XiaoZhe Wang
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Jana Heitmann
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, United States of America
| | | | - Kam Sprott
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Stephen Finn
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Esther O'Regan
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Allan D. Farrow
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Ralph R. Weichselbaum
- Department of Radiation Oncology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - Mark W. Lingen
- Department of Pathology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - Ezra E. W. Cohen
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - Kerstin Stenson
- Department of Surgery, Section of Head and Neck Surgery, The University of Chicago, Chicago, Illinois, United States of America
| | - David T. Weaver
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Everett E. Vokes
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
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11
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Flavin R, Finn SP, Choueiri TK, Ingoldsby H, Ring M, Barrett C, Rogers M, Smyth P, O'Regan E, Gaffney E, O'Leary JJ, Loda M, Signoretti S, Sheils O. RET protein expression in papillary renal cell carcinoma. Urol Oncol 2011; 30:900-5. [PMID: 21396847 DOI: 10.1016/j.urolonc.2010.08.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/23/2010] [Accepted: 08/24/2010] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine the role of RET in renal malignancy, in particular papillary renal cell carcinoma (RCC). MATERIALS AND METHODS A cohort of 111 archival renal samples was used consisting of 94 renal cancers (66 papillary RCC, 18 conventional clear cell carcinoma, 10 chromophobe RCC), 4 benign oncocytomas, and 13 normal kidney tissues. RET protein expression was examined by immunohistochemistry and expression levels were correlated with clinicopathologic and patient survival data. RESULTS Positive RET staining was seen in 34/66 (52%) papillary RCCs, 4/10 (40%) chromophobe carcinomas, 4/4 (100%) oncocytomas, and 11/13 (85%) normal kidney samples. All 18 cases of conventional clear cell carcinoma had negative RET staining. RET expression was associated with low Fuhrman nuclear grade. CONCLUSIONS RET protein may be contributing in part to an adaptation of a papillary growth pattern in certain renal malignancies. Given the possible therapeutic benefit of small molecule inhibitors of RET activation, further work needs to be done to highlight the functional relevance of RET protein expression in papillary RCC.
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Affiliation(s)
- Richard Flavin
- Department of Histopathology, St. James's Hospital, Dublin, Ireland
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12
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Sabbisetti V, Di Napoli A, Seeley A, Amato AM, O'Regan E, Ghebremichael M, Loda M, Signoretti S. p63 promotes cell survival through fatty acid synthase. PLoS One 2009; 4:e5877. [PMID: 19517019 PMCID: PMC2691576 DOI: 10.1371/journal.pone.0005877] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 05/05/2009] [Indexed: 11/25/2022] Open
Abstract
There is increasing evidence that p63, and specifically ΔNp63, plays a central role in both development and tumorigenesis by promoting epithelial cell survival. However, few studies have addressed the molecular mechanisms through which such important function is exerted. Fatty acid synthase (FASN), a key enzyme that synthesizes long-chain fatty acids and is involved in both embryogenesis and cancer, has been recently proposed as a direct target of p53 family members, including p63 and p73. Here we show that knockdown of either total or ΔN-specific p63 isoforms in squamous cell carcinoma (SCC9) or immortalized prostate epithelial (iPrEC) cells caused a decrease in cell viability by inducing apoptosis without affecting the cell cycle. p63 silencing significantly reduced both the expression and the activity of FASN. Importantly, stable overexpression of either FASN or myristoylated AKT (myr-AKT) was able to partially rescue cells from cell death induced by p63 silencing. FASN induced AKT phosphorylation and a significant reduction in cell viability was observed when FASN-overexpressing SCC9 cells were treated with an AKT inhibitor after p63 knockdown, indicating that AKT plays a major role in FASN-mediated survival. Activated AKT did not cause any alteration in the FASN protein levels but induced its activity, suggesting that the rescue from apoptosis documented in the p63-silenced cells expressing myr-AKT cells may be partially mediated by FASN. Finally, we demonstrated that p63 and FASN expression are positively associated in clinical squamous cell carcinoma samples as well as in the developing prostate. Taken together, our findings demonstrate that FASN is a functionally relevant target of p63 and is required for mediating its pro-survival effects.
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Affiliation(s)
- Venkata Sabbisetti
- Department of Pathology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Arianna Di Napoli
- Department of Pathology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Apryle Seeley
- Department of Pathology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Angela M. Amato
- Department of Pathology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Musie Ghebremichael
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Massimo Loda
- Department of Pathology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Flavin R, Jackl G, Finn S, Smyth P, Ring M, O'Regan E, Cahill S, Unger K, Denning K, Jinghuan Li, Aherne S, Tallini G, Gaffney E, O'Leary JJ, Zitzelsberger H, Sheils O. RET/PTC rearrangement occurring in primary peritoneal carcinoma. Int J Surg Pathol 2009; 17:187-97. [PMID: 19147513 DOI: 10.1177/1066896908329593] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
RET/PTC rearrangements are initiating events in the development of a significant proportion of papillary thyroid carcinomas. Activated RET/PTC mutations are thought to be restricted to thyroid disease, but this study proposes that these events may also occur in nonthyroid tumors. A total of 57 nonthyroid papillary tumors were examined for RET/PTC rearrangements using interphase fluorescence in situ hybridization, Taqman reverse transcriptase polymerase chain reaction, and immunohistochemistry. Taqman single nucleotide polymorphism detection was used to analyze for expression of mutated BRAF T1799A. In all, 20% (3/15) of primary peritoneal carcinoma had detectable RET/PTC1 rearrangements by all 3 methodologies. A further case of similar histotype had an alternate RET/ PTC rearrangement. No RET/PTC1 rearrangements were detected in the remaining tumor cohort. All 57 tumors were homozygous for wild-type BRAF. The results indicate that RET/PTC rearrangements occur in a small subset of nonthyroid papillary tumors. These rearrangements may not be directly implicated in tumor growth; rather representing "passenger" mutations reflecting RET instability in secondary tumor subclones.
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Affiliation(s)
- Richard Flavin
- Department of Histopathology, Trinity College Medical School, Dublin, Ireland.
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14
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Brady G, O'Regan E, Miller I, Ogungbowale A, Kapas S, Crean SJ. Serum levels of insulin-like growth factors (IGFs) and their binding proteins (IGFBPs), -1, -2, -3, in oral cancer. Int J Oral Maxillofac Surg 2007; 36:259-62. [PMID: 17113753 DOI: 10.1016/j.ijom.2006.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 09/01/2006] [Accepted: 09/22/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Insulin-like growth factor (IGF) possesses mitogenic properties promoting cellular proliferation and inhibiting cellular apoptosis. Reported evidence suggests that cancer (non-oral) is associated with high circulating levels of IGF-1 and low levels of IGFBP-3. AIMS This study measured circulating levels of IFG-1 and IGFBPs -1, -2 and -3 in oral cancer patients. METHODOLOGY Blood was collected from surgical patients and controls. Samples were assayed for IGF-1 and IGFBPs -1, -2, -3, using commercially available enzyme-linked immunosorbant assays (ELISA; R&D Systems Europe, Oxon, UK). RESULTS Twenty-seven oral cancer and 31 age- and sex-matched patients were recruited. Mean IGF-1 and IGFBP-3 levels were significantly lower in cancer patients than controls (85.3 ng/ml and 2008 ng/ml versus 191 ng/ml and 2935 ng/ml, P<0.001). In contrast, levels of IGFBPs 1 and 2 were significantly higher in cancer patients than in controls. No significant association was demonstrated with tumour size or nodal metastases. DISCUSSION This study has shown that in contrast to other cancers, circulating levels of IGF-1 and IGFBP-3 may both be lowered in patients with head and neck cancer.
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15
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Finn S, Smyth P, O'Regan E, Cahill S, Toner M, Timon C, Flavin R, O'Leary J, Sheils O. Low-level genomic instability is a feature of papillary thyroid carcinoma: an array comparative genomic hybridization study of laser capture microdissected papillary thyroid carcinoma tumors and clonal cell lines. Arch Pathol Lab Med 2007; 131:65-73. [PMID: 17227125 DOI: 10.5858/2007-131-65-lgiiaf] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2006] [Indexed: 11/06/2022]
Abstract
CONTEXT Previous chromosomal comparative genomic hybridization (CGH) studies of papillary thyroid carcinoma (PTC) have demonstrated a low prevalence of aberrations, with the majority of tumors showing no evidence of chromosomal instability. The technique of CGH can be optimized, however, using array CGH and laser capture microdissection to ensure pure cell populations for analysis. OBJECTIVE To assess PTC using array CGH applied to laser capture microdissected tumor cells and pure cell cultures. DESIGN Well-characterized PTC (known ret/PTC and BRAF mutation status), including samples from 5 tumors with classic morphology, 3 follicular variant tumors, and 3 clonal PTC cell lines, were analyzed. RESULTS Copy gain and loss occurred in all of the tumor cases and cell lines examined. The most common recurrent aberrations involved gains on chromosomes 1, 5, 7, 11, 15, 17, and 22, with recurrent deletions occurring on chromosomes 4, 18, and 19. Analysis of the data from the 8 tumor samples showed that amplifications of TP73 (1p36.33), SNRPN (15q12), and PDGFB (22q13.1) occurred exclusively in tumors with a wild type BRAF. CONCLUSIONS This study shows a higher prevalence of aberrations detected using array CGH allied to laser capture microdissection than previously described in the literature, and it appears that the combination of laser capture microdissection and arrayed clones optimizes studies utilizing CGH. Copy gain of PDGFB occurs in a subset of tumors showing no evidence of mutated BRAF or rearranged ret, suggesting that copy gain of PDGFB may underlie the increased expression of platelet-derived growth factor described recently in the literature.
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Affiliation(s)
- Stephen Finn
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02441, USA.
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16
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Redahan S, O'Regan E, McCartan B, Toner M. Histological evidence for lichen planus in clinically normal perilesional tissue. Int J Oral Maxillofac Surg 2005; 34:674-7. [PMID: 16053893 DOI: 10.1016/j.ijom.2005.01.012] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Revised: 10/08/2004] [Accepted: 01/25/2005] [Indexed: 11/26/2022]
Abstract
The objective of this study was to examine the histological features of apparently normal oral mucous membrane adjacent to lesions of oral lichen planus. Twenty-six patients attending an oral medicine unit with clinical lesions typical of oral lichen planus had biopsies of lesional and perilesional sites. Biopsies were examined for histopathological features of oral lichen planus. Twenty-two (85%) of lesional biopsies and 12 (46%) of the perilesional biopsies were reported as either typical or showing some features of lichen planus. Twelve of these 22 cases (55%) had both lesional and perilesional biopsies reported as either typical or showing some features of lichen planus. These 12 cases represented 46% of all cases. In four cases (15%) neither the lesional nor the adjacent perilesional biopsy was reported as lichen planus. The inflammatory process in oral lichen planus may extend beyond the confines of the clinical lesion into adjacent mucous membrane of normal appearance.
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Affiliation(s)
- S Redahan
- Dublin Dental Hospital, Lincoln Place, Dublin 2, Ireland
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17
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Smyth P, Finn S, Cahill S, O'Regan E, Flavin R, O'Leary JJ, Sheils O. ret/PTC and BRAF act as distinct molecular, time-dependant triggers in a sporadic Irish cohort of papillary thyroid carcinoma. Int J Surg Pathol 2005; 13:1-8. [PMID: 15735849 DOI: 10.1177/106689690501300101] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to assess BRAF mutation rates in various thyroid tissues and to investigate if concomitant mutations with ret/PTC activation occurred in inflammatory and neoplastic lesions. To this end, we developed a novel Taqman based screening assay for the common T1799A BRAF mutation. Heterozygous T1799A mutations were detected in 13 of 34 (44%) papillary thyroid carcinomas (PTCs) tested. No such mutations were detected in the other tissue types tested. Concomitant presence of both oncogenes was reported in 5 of the 34 PTCs. A significant temporal trend was observed, with ret/PTC chimera detected for the most part before 1997 and BRAF mutations being more prevalent after 1997. The results suggest that some environmental/etiological agent(s) may have influenced the pathobiology of thyroid tumor development, among the population examined, over time.
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Affiliation(s)
- P Smyth
- Department of Histopathology, Trinity College, Dublin, Ireland
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18
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Abstract
Linear IgA disease is a subepidermal blistering disorder of unknown cause. Along with dermatologic blistering, other manifestations include oral ulceration and desquamative gingivitis. We present a case of linear IgA disease that manifested simply as oropharyngeal ulceration and desquamative gingivitis, resulting in considerable delay in diagnosis and treatment. This article (1) highlights the difficulties of diagnosing linear IgA disease when the predominant presenting features are mucosal and (2) reviews the current literature regarding linear IgA disease.
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Affiliation(s)
- Esther O'Regan
- Department of Oral Surgery, Oral Medicine, and Oral Pathology, Dublin Dental School and Hospital, Ireland
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19
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Abstract
Although hyalinizing clear cell carcinoma (HCCC) had been previously illustrated by several authors, it was not until 1994 that this tumour was characterized by Milchgrub et al. [Am J Surg Pathol (1994),18,74] and separated from the heterogeneous group of clear cell carcinomas described in the literature. HCCC is a distinctive infiltrative low-grade, monomorphic, glycogen-rich clear cell carcinoma with prominent stromal hyalinization occurring most often in the minor salivary glands of adult women. A case of hyalinizing clear cell carcinoma arising in the tongue of an adult female is described with special reference to the presence of minor foci of mitotic activity, necrosis and anaplasia in this otherwise typical low-grade carcinoma. Widespread metastases and death within a year of initial presentation in this case suggests that there may be a subset of this indolent tumour in which these features are associated with a poor prognosis.
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Affiliation(s)
- E O'Regan
- Department of Oral Surgery, Oral Medicine and Oral Pathology, Dublin Dental School and Hospital, Dublin, Ireland
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20
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Keogh PV, O'Regan E, Toner M, Flint S. Necrotizing sialometaplasia: An unusual bilateral presentation associated with antecedent anaesthesia and lack of response to intralesional steroids. Case report and review of the literature. Br Dent J 2004; 196:79-81. [PMID: 14739958 DOI: 10.1038/sj.bdj.4810892] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2002] [Accepted: 08/05/2003] [Indexed: 11/08/2022]
Abstract
Necrotizing sialometaplasia is a self-limiting, variably ulcerated benign process affecting minor salivary glands. Accurate histological diagnosis is paramount, as it has been mistaken for malignancy, which has resulted in excessively aggressive and unnecessary radical surgery. A unique case of bilateral necrotizing sialometaplasia, presenting with anaesthesia of the greater palatine nerves, is described. An attempt at active therapy with intralesional steroids had no effect on the course of the condition.
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Affiliation(s)
- P V Keogh
- Department of Oral Surgery, Oral Medicine and Oral Pathology, School of Dental Science, Trinity College Dublin, Ireland.
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21
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O'Regan E. Pay and concessions. Nurs Times 1997; 93:12. [PMID: 9188428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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22
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Abstract
The antitumor agent cis-diamminedichloroplatinum(II) (cisplatin) introduces cytotoxic DNA damage predominantly in the form of intrastrand crosslinks between adjacent purines. Binding assays using a series of duplex oligonucleotides containing a single 1,2 diguanyl intrastrand crosslink indicate that human cell extracts contain factors that preferentially recognise this type of damage when the complementary strand contains T opposite the 3', and C opposite the 5'guanine in the crosslink. Under the conditions of the band-shift assay used, little binding is observed if the positions of the T and C are reversed in the complementary strand. Similarly, duplexes containing CC or TT opposite the crosslink are recognised relatively poorly. The binding activity is absent from extracts of the colorectal carcinoma cell lines LoVo and DLD-1 in which the hMutSalpha mismatch recognition complex is inactivated by mutation. Extensively purified human hMutSalpha exhibits the same substrate preference and binds to the mismatched platinated DNA at least as well as to an identical unplatinated duplex containing a single G.T mismatch. It is likely, therefore, that human mismatch repair may be triggered by 1,2 diguanyl intrastrand crosslinks that have undergone replicative bypass.
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Affiliation(s)
- M Yamada
- Imperial Cancer Research Fund, Clare Hall Laboratories, South Mimms, Hertfordshire EN6 3LD, UK
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23
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Fanning LJ, O'Regan E, McCarthy S, McCarthy TV. Class-switch recombination in extrachromosomal DNA substrates in murine pre-B-cells. Biochem Soc Trans 1990; 18:356-7. [PMID: 2199278 DOI: 10.1042/bst0180356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- L J Fanning
- Department of Biochemistry, University College, Cork, Republic of Ireland
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