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Abstract
The use of intraoperative consultation for indeterminate thyroid lesions is not advocated but is still requested by some surgeons. Obscured cytomorphology and nonrepresentative sampling limit the specificity of intraoperative assessment. Formalin fixation of thyroid glands before sectioning also minimizes artifacts introduced by fresh sectioning. Inking of thyroid may vary based on institutional preferences and information desired by clinical teams. Sectioning may occur in the conventional transverse method or the modified transverse vertical method to more thoroughly evaluate the lesion's periphery. Gross examination of thyroid lesions should always consider possible high-grade features, such as necrosis or extrathyroidal extension.
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Affiliation(s)
- Fouad R Zakka
- Department of Pathology, The University of Chicago, Pritzker School of Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL 60637, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, Pritzker School of Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL 60637, USA.
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Zakka FR, Beffa L, Banet N. Characteristics of Pelvic Cytology in Patients with Gynecologic Malignancies: Comparison of Pre and Post-Neoadjuvant Specimens. Acta Cytol 2022; 66:441-448. [PMID: 35340001 DOI: 10.1159/000522211] [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: 08/09/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The presence of tumor cells in pelvic cytology (PC) specimens can portend a worse outcome for patients undergoing gynecologic surgery. Primary debulking surgery (PDS) was a mainstay for most of these tumors; however, recent advances have triaged selected patients to neoadjuvant chemotherapy (NACT) with interval debulking surgery (IDS). Reduction in tumor cellularity and histologic alterations has been noted in these cases; however, similar cytologic characterization has not been performed. MATERIALS AND METHODS PC was searched to find those in NACT patients. Additional PDS were included as controls. Cases were scored for cellularity of malignant cells and background components were described, and when available, pretreatment and posttreatment specimens from the same patients were compared. RESULTS In all, 19 specimens from 16 patients were found, 6 (32%) of which were paired PTS and IDS from the same patient. Only 6/19 (32%) were from IDS, the remainder PTS. A majority (15/19; 79%) of specimens were malignant; all negative cases were PTS. Few (4/16; 24%) were endometrial primaries; the remainder were pelvic high-grade serous carcinoma. No difference in tumor cell morphology or inflammatory component was noted between the 2 groups, though in 3/3 paired specimens from PDS and IDS, the cellularity of malignant cells decreased in the IDS specimens. DISCUSSION/CONCLUSION No identifiable trend was noted regarding cellularity of specimens in the pre compared to the post-neoadjuvant setting. A trend toward reduced cellularity was noted in individual patients, but no alteration in background cells or tumor morphology was noted.
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Affiliation(s)
- Fouad R Zakka
- Department of Pathology, Rhode Island Hospital, Providence, Rhode Island, USA
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lindsey Beffa
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Departments of Women's Oncology, Women & Infants Hospital, Providence, Rhode Island, USA
| | - Natalie Banet
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, Rhode Island, USA
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Ghanian S, Zakka FR, Shu N, Robinson-Bostom L, Weinstock M, Vezeridis M, Walker J. Paracicatricial melanocytes as a sign of melanoma. J Cutan Pathol 2021; 48:911-914. [PMID: 33547832 DOI: 10.1111/cup.13977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/31/2020] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
Intradermal melanocytes in the setting of melanoma represent a diagnostic challenge to dermatopathologists as their presence may represent superficially invasive melanoma vs benign nevus cells or reactive dermal melanocytes. Previous dermatologic literature suggests that the absence of cytologic atypia in intradermal melanocytes and their presence in nonmelanocytic neoplasms lends to their characterization as reactive, benign, melanocytic proliferation. A 67-year-old female presented for evaluation of a 10-mm irregularly pigmented dark brown macule on the left cheek. Initial shave biopsy showed transected malignant melanoma measuring at least 0.6 mm in thickness. Multiple reexcision specimens demonstrated residual melanoma with banal appearing intradermal epithelioid melanocytes within and surrounding the scar. The melanocytes tracked into the skin graft, which had previously been free from involvement. Positron emission tomography-computed tomography (PET CT) and lymph node biopsies did not show evidence of metastatic melanoma. Ten months after her diagnosis and following five surgical excisions, the patient was diagnosed with metastatic melanoma to the brain and succumbed to intracranial hemorrhage. We present a case in which paracicatricial melanoma may simulate benign paracicatricial melanocytic hyperplasia. These findings have significant therapeutic and prognostic implications for the practicing dermatologist and dermatopathologist.
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Affiliation(s)
- Soha Ghanian
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Fouad R Zakka
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nova Shu
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Martin Weinstock
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Michael Vezeridis
- Department of Surgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joanna Walker
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Affiliation(s)
- Catherine J Choi
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Frederick A Jakobiec
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,David G. Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston
| | - Fouad R Zakka
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,David G. Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston
| | - Angie V Sanchez
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Schepens Eye Research Institute, Boston, Massachusetts
| | - Nahyoung Grace Lee
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Jakobiec FA, Wolkow N, Zakka FR, Rubin PAD. Myeloid Sarcoma with Megakaryoblastic Differentiation Arising in the Conjunctiva. Ocul Oncol Pathol 2019; 5:28-35. [PMID: 30675474 DOI: 10.1159/000488057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/09/2018] [Revised: 02/23/2018] [Indexed: 11/19/2022] Open
Abstract
An 87-year-old woman not known to have either a lymphoma or leukemia developed a left multinodular, fish-flesh superior epibulbar and forniceal mass. A biopsy disclosed a blastic tumor with scattered multinucleated immature megakaryoblasts. Immunophenotyping of bone marrow cells revealed strong positivity for CD7, CD31, CD43, CD45, CD61, and CD117; CD71, myeloperoxidase, and lysozyme were also positive in scattered cells. Forty percent of the neoplastic cells were Ki-67 positive. Cytogenetic studies indicated a trisomy 8 (associated with worse prognosis) and a t(12; 17) translocation. Desmin, smooth muscle actin, pancytokeratin, CAM 5.2, adipophilin, tryptase, S100, SOX10, MART1, and E-cadherin were negative, ruling out a nonhematopoietic tumor. The conjunctival lesion was diagnosed as a myeloid sarcoma with megakaryoblastic differentiation, a rare variant. It probably arose from a myelodysplastic syndrome. This is the first case of its type to develop in the conjunctiva.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Wolkow
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Fouad R Zakka
- Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Jakobiec FA, Zakka FR, Papakostas T, Mukai S. Early Neuroblastic and Astrocytic Differentiation Demonstrated Immunohistochemically in a Small Intraocular Medulloepithelioma. Ocul Oncol Pathol 2018; 4:176-181. [PMID: 29765950 DOI: 10.1159/000481287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/28/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the source of fibrous astrocytes and neuroblasts in a small ciliary body medulloepithelioma appearing as a leukocoria in a 3-week-old baby girl. Methods Histopathologic and immunohistochemical studies included Alcian blue, periodic acid-Schiff, and antisera for the detection of S100 protein, CD99, glial fibrillary acidic protein (GFAP), CRX, NeuN, neurofilaments, synaptophysin, desmin, and myogenin. Results A small, nonteratoid ciliary body medulloepithelioma with collections of Alcian blue+ mucoplysaccharides was present in the enucleated globe. The retinal mass displayed multilaminar dysplastic rosettes that were CRX+, NeuN-, and synaptophysin-. Intraretinal neurofilaments and scattered NeuN+ neurocytes were also identified. At the base of the retinal mass ribbons and pseudopapillae of CRX+, NeuN- medullary epithelium were found. The latter developed from an S100+ and weakly CD99+ monolayer of premedullary epithelium. GFAP+ fibrous astrocytes and NeuN- neuroblasts streamed from the medullary epithelium. Conclusions A multilaminar medullary epithelium and a precursor monolayer of premedullary epithelium were both identified. Neuroblasts and fibrous astrocytes were determined to arise separately from the medullary epithelium. The early stage of tumorigenesis afforded by a small tumor provided the opportunity to discover morphologic and immunohistochemical evidence for these differentiations.
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Affiliation(s)
- Frederick A Jakobiec
- Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Boston, MA, USA.,David G. Cogan Laboratory of Ophthalmic Pathology, Boston, MA, USA.,Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Fouad R Zakka
- Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Boston, MA, USA.,David G. Cogan Laboratory of Ophthalmic Pathology, Boston, MA, USA.,Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Thanos Papakostas
- Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Boston, MA, USA.,Retina Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Shizuo Mukai
- Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Boston, MA, USA.,Retina Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Nguyen HV, Jakobiec FA, Zakka FR, Yoon MK. Bilateral upper and lower eyelid margin swelling and madarosis due to lymphoma. Surv Ophthalmol 2017; 63:589-594. [PMID: 28986312 DOI: 10.1016/j.survophthal.2017.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/11/2017] [Accepted: 09/22/2017] [Indexed: 01/10/2023]
Abstract
Over a 2-year period, swellings of all 4 eyelid margins developed in a 32-year-old woman and was accompanied by complete loss of eyelashes. An inflammatory dermatologic condition was considered the most likely cause. A full-thickness right lower eyelid biopsy revealed a multinodular lymphoid tumor at the eyelid margin which immunophenotypically and genetically was diagnosed as an extranodal marginal zone lymphoma. The mode of presentation of the disease was considered to be most unusual, as was its B cell lineage, since the majority of primary cutaneous lymphomas are of T-cell origin. Systemic workup demonstrated bilateral involvement of the external auditory canals.
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Affiliation(s)
- Huy V Nguyen
- The David Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick A Jakobiec
- The David Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
| | - Fouad R Zakka
- The David Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, The Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Michael K Yoon
- Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, The Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Jakobiec FA, Homer N, Zakka FR, Curtin HD, Fay A. Clinicopathologic and Magnetic Resonance Imaging Analysis of a Multifocal Orbital Lymphoid Tumor. Ocul Oncol Pathol 2017; 4:82-89. [PMID: 30320086 DOI: 10.1159/000478731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/14/2017] [Indexed: 01/21/2023] Open
Abstract
Objective To distinguish between a multifocal orbital lymphoid tumor and a major simulator represented by a diffuse lymphaticovenous malformation. Methods We performed a comparison of clinical and radiographic (magnetic resonance imaging [MRI]) findings of these two disparate entities and demonstrated how a misdiagnosis can be prevented. Results Orbital lymphoid tumors develop in adults at around 60 years of age, whereas extensive lymphaticovenous malformations are generally detected in the first decade. Despite these differences, this is the first description of clinical confusion between them. MRI with gadolinium injection in the current lymphoid tumor displayed a low signal on T2-weighted images, rapid and uniform enhancement, and reduced diffusion. Lymphaticovenous malformations are heterogeneous, display poor or only focal perfusion, and fail to exhibit diminished diffusion. Newer techniques such as diffusion-weighted imaging and dynamic contrast-enhanced imaging may be able to provide additional differential diagnostic information. The final pathologic diagnosis was an extranodal marginal zone lymphoma. Conclusions Despite the obvious distinctions between orbital lymphoid tumors and lymphaticovenous malformations, several clinical radiologic specialists misdiagnosed the present orbital lesion as a vascular lesion. A combined clinicoradiographic analysis should obviate such errors and facilitate the correct diagnosis in the future.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Natalie Homer
- Orbital and Oculoplastics Service, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Fouad R Zakka
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Hugh D Curtin
- Department of Radiology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Aaron Fay
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
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Rahimi Darabad R, Suzuki T, Richards SM, Jakobiec FA, Zakka FR, Barabino S, Sullivan DA. Does estrogen deficiency cause lacrimal gland inflammation and aqueous-deficient dry eye in mice? Exp Eye Res 2014; 127:153-60. [PMID: 25084452 DOI: 10.1016/j.exer.2014.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 03/28/2014] [Revised: 07/17/2014] [Accepted: 07/21/2014] [Indexed: 01/24/2023]
Abstract
Researchers have proposed that estrogen deficiency will lead to a Sjögren's syndrome (SjS)-like lacrimal gland inflammation, aqueous tear deficiency and dry eye. The purpose of this study was to determine whether this proposal is correct. Lacrimal glands were obtained from adult, age-matched wild type (WT) and aromatase knockout (ArKO) mice, in which estrogen synthesis is completely eliminated. Tissues were also obtained from autoimmune MRL/Mp-lpr/lpr (MRL/lpr) mice as inflammation controls. Tear volumes in WT and ArKO mice were measured and glands were processed for molecular biological and histological evaluation. Our results demonstrate that estrogen absence does not lead to a SjS-like inflammation in lacrimal tissue or to an aqueous-deficient dry eye. There was no upregulation of genes associated with inflammatory pathways in lacrimal glands of male or female ArKO mice. Such inflammatory activity was prominent in autoimmune MRL/lpr tissues. We also found no evidence of inflammation in lacrimal gland tissue sections of estrogen-deficient mice, and tear volumes of ArKO males were actually increased as compared to those WT controls. Interestingly, our study did show that estrogen absence influences the expression of thousands of lacrimal gland genes, and that this impact is sex- and genotype-specific. Our findings demonstrate that estrogen absence is not a risk factor for the development of SjS-like lacrimal gland inflammation or for aqueous-deficient dry eye in mice.
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Affiliation(s)
- Raheleh Rahimi Darabad
- Schepens Eye Research Institute, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Tomo Suzuki
- Schepens Eye Research Institute, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Stephen M Richards
- Schepens Eye Research Institute, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Frederick A Jakobiec
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Fouad R Zakka
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Stefano Barabino
- Schepens Eye Research Institute, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - David A Sullivan
- Schepens Eye Research Institute, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
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Darabad RR, Suzuki T, Richards SM, Jensen RV, Jakobiec FA, Zakka FR, Liu S, Sullivan DA. Influence of aromatase absence on the gene expression and histology of the mouse meibomian gland. Invest Ophthalmol Vis Sci 2013; 54:987-98. [PMID: 23233261 DOI: 10.1167/iovs.12-10992] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We hypothesize that aromatase, an enzyme that controls estrogen biosynthesis, plays a major role in the sex-related differences of the meibomian gland. To begin to test this hypothesis, we examined the influence of aromatase absence, which completely eliminates estrogen production, on glandular gene expression and histology in male and female mice. METHODS Meibomian glands were obtained from adult, age-matched wild-type (WT) and aromatase knockout (ArKO) mice. Tissues were processed for histology or the isolation of total RNA, which was analyzed for differentially expressed mRNAs by using microarrays. RESULTS Our results show that aromatase significantly influences the expression of more than a thousand genes in the meibomian gland. The nature of this effect is primarily sex-dependent. In addition, the influence of aromatase on sex-related differences in gene expression is predominantly genotype-specific. However, many of the sex-related variations in biological process, molecular function, and cellular component ontologies, as well as in KEGG (Kyoto Encyclopedia of Genes and Genomes) pathways, are remarkably similar between WT and ArKO mice. The loss of aromatase activity has no obvious effect on the histology of meibomian glands in male or female mice. CONCLUSIONS Our findings demonstrate that aromatase has a significant impact on gene expression in the meibomian gland. The nature of this influence is sex-dependent and genotype-specific; however, many of the sex-related variations in gene ontologies and KEGG pathways are similar between WT and ArKO mice. Consequently, it appears that aromatase, and by extension estrogen, do not play a major role in the sex-related differences of the mouse meibomian gland.
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Affiliation(s)
- Raheleh Rahimi Darabad
- Schepens Eye Research Institute, Department of Ophthalmology, Boston, Massachusetts 02114, USA
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Jakobiec FA, Zakka FR, Perry LP. The cytologic composition of dacryops: an immunohistochemical investigation of 15 lesions compared to the normal lacrimal gland. Am J Ophthalmol 2013; 155:380-396.e1. [PMID: 23114708 DOI: 10.1016/j.ajo.2012.07.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/25/2012] [Accepted: 07/31/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To define the cytologic composition of the double-layered epithelial lining of dacryops (lacrimal duct cyst), improve histopathologic diagnosis, and better understand pathogenesis. DESIGN Clinicopathologic retrospective study with immunohistochemical studies of 15 lesions compared with normal lacrimal gland. METHODS Clinical data from 14 patients were reviewed and microscopy was performed with routine stains and immunohistochemical probes for epithelial membrane antigen (EMA), gross cystic disease fluid protein-15 (GCDFP-15), cytokeratin 7 (CK7), and smooth muscle actin (SMA). RESULTS The major lacrimal gland was involved in 13 lesions; 2 lesions arose in an accessory gland of Krause. One case was bilateral; the average age of the patients was 50.7 years. Neither visual acuity nor motility was disturbed. No lesion was discovered to have recurred after excision. Microscopically, in all dacryops specimens goblet cells and luminal pseudoapocrine apical cytoplasmic projections were identified. Lacrimal acinar cells immunoreacted with GCDFP-15 and CK7, whereas the normal ducts and the epithelium of the dacryops lesions reacted diffusely only with CK7. SMA-positive myoepithelial cells were found in the acini but not in the normal ducts or dacryops epithelium. CONCLUSIONS Negative GCDFP-15 staining ruled out apocrine metaplasia in dacryops. Normal ducts and dacryops showed no immunohistochemical evidence for the presence of myoepithelial cells. Pathogenetic theories of dacryops that implicate a failure of ductular "neuromuscular" contractility must therefore be revised. A dysfunction of the rich neural plexus around the ductules may play a role in the development of dacryops in conjunction with periductular inflammation and induced scarring.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Perry LJ, Jakobiec FA, Zakka FR, Rubin PA. Giant Dacryocystomucopyocele in an Adult: A Review of Lacrimal Sac Enlargements With Clinical and Histopathologic Differential Diagnoses. Surv Ophthalmol 2012; 57:474-85. [DOI: 10.1016/j.survophthal.2012.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 02/01/2012] [Accepted: 02/07/2012] [Indexed: 11/15/2022]
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Jakobiec FA, Callahan AB, Zakka FR. Intraocular PAS-positive macrophages simulating Whipple's disease. Graefes Arch Clin Exp Ophthalmol 2012; 251:1033-6. [PMID: 22669409 DOI: 10.1007/s00417-012-2070-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/11/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022] Open
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Rankin JK, Jakobiec FA, Zakka FR, Foster CS. An improved approach to diagnosing and treating conjunctival mucoepidermoid carcinoma. Surv Ophthalmol 2012; 57:337-46. [PMID: 22541742 DOI: 10.1016/j.survophthal.2011.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 12/13/2011] [Accepted: 12/20/2011] [Indexed: 11/15/2022]
Abstract
The current case of conjunctival mucoepidermoid carcinoma offers features that expand the biologic spectrum afforded by this tumor. More focused strategies should be developed for its earlier histopathologic diagnosis and improved management (historical recurrence rate of 85%). A 63-year-old woman with a history of rheumatoid arthritis and idiopathic sclerosing cholangitis developed scleral thinning, anterior chamber cells and flare, and uveal prolapse. Biopsies of the epibulbar lesion were initially misinterpreted as a squamous cell carcinoma but on review harbored CK7-positive cells and contained rare goblet cells brought out with Alcian blue and mucicarmine staining. Intraocular extension exhibited micro-and macrocysts with minimal goblet cells. Focal CK7 immunopositivity in any epibulbar squamous dysplasia or in invasive carcinoma should lead to suspicion of a mucoepidermoid carcinoma. Behaviorally aggressive or rapidly recurrent epithelial squamous tumors with "inflammatory" features or unusual clinical characteristics should be initially stained at multiple levels for the detection of parsimonious mucus secretion. Surgical options include wide excision and partial sclerectomy with cryotherapy for superficial invasion and/or interferon therapy. Results with radiotherapy and cryotherapy for deep scleral invasion have been unpredictable or unacceptable compared with surgery.
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Affiliation(s)
- Jessica K Rankin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA
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Jakobiec FA, Zakka FR, Kirzhner M, Kim N. Epstein-Barr virus-positive T-cell lymphoma involving the lacrimal gland of an adult. ACTA ACUST UNITED AC 2012; 130:523-5. [PMID: 22491926 DOI: 10.1001/archophthalmol.2011.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Todani A, Behlau I, Fava MA, Cade F, Cherfan DG, Zakka FR, Jakobiec FA, Gao Y, Dohlman CH, Melki SA. Intraocular Pressure Measurement by Radio Wave Telemetry. ACTA ACUST UNITED AC 2011; 52:9573-80. [DOI: 10.1167/iovs.11-7878] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Amit Todani
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and the 2Boston Eye Group, Boston Massachusetts
| | - Irmgard Behlau
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | | | - Fabiano Cade
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | | | - Fouad R. Zakka
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | - Frederick A. Jakobiec
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | - Yuqing Gao
- the Boston Eye Group, Boston Massachusetts
| | - Claes H. Dohlman
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | - Samir A. Melki
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and the 2Boston Eye Group, Boston Massachusetts
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Jakobiec FA, Zakka FR, D'Amato R, Deangelis MM, Walton DS, Rao RC. Unilateral sporadic retinal dysplasia: results of histopathologic, immunohistochemical, chromosomal, genetic, and VEGF-A analyses. J AAPOS 2011; 15:579-86. [PMID: 22153404 PMCID: PMC4242509 DOI: 10.1016/j.jaapos.2011.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/28/2011] [Accepted: 08/19/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe new findings in a case of unilateral retinal dysplasia. METHODS Histopathologic evaluation of an enucleated globe and analysis with immunohistochemical probes, karyotyping, and genetic analysis for the Norrie gene, and aqueous assay for vascular endothelial growth factor A (VEGF-A). RESULTS Histopathological examination of the globe revealed retinal dysplasia with pseudorosette formation, abnormal or absent retinal nuclear lamination, a paucity of disorganized retinal microvasculature, retinal infoldings, advanced gliosis, persistent hyperplastic vitreous, exuberant neovascularization of the vitreous, and iris neovascularization (identical to the findings observed in bilateral Norrie disease). Immunohistochemistry disclosed GFAP-positive and GLUT-1-positive gliosis and retinal and persistent hyperplastic vitreous microvessels that were CD34-positive and GLUT-1-negative. Ki-67-positive retinal cells were polarized toward the subretinal space and absent in the retinal invaginations and pseudorosettes. A normal karyotype was found, and DNA sequencing revealed no known mutation in the region of the Norrie gene (NDP) in sputum or retinal DNA. Aqueous obtained immediately after enucleation contained an exceptionally high concentration of VEGF-A (4.5 ng/mL). CONCLUSIONS Despite the failure to find an abnormal NDP allele, other unexplored NDP regions, an undetected defect restricted to retinal tissues, or an autosomal mutation coupled with disrupted signaling pathways may be responsible for the condition. High aqueous VEGF-A suggests that this cytokine may play a role in pathogenesis in conjunction with other pathways.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Durrani K, Zakka FR, Ahmed M, Memon M, Siddique SS, Foster CS. Systemic Therapy With Conventional and Novel Immunomodulatory Agents for Ocular Inflammatory Disease. Surv Ophthalmol 2011; 56:474-510. [DOI: 10.1016/j.survophthal.2011.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 05/18/2011] [Accepted: 05/24/2011] [Indexed: 12/19/2022]
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20
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Jakobiec FA, Zakka FR, Townsend DJ. Pleomorphic basal cell carcinoma of the eyelid with true ductular differentiation. Graefes Arch Clin Exp Ophthalmol 2011; 250:451-4. [PMID: 22037988 DOI: 10.1007/s00417-011-1836-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 09/28/2011] [Indexed: 11/30/2022] Open
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21
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Behlau I, Mukherjee K, Todani A, Tisdale AS, Cade F, Wang L, Leonard EM, Zakka FR, Gilmore MS, Jakobiec FA, Dohlman CH, Klibanov AM. Biocompatibility and biofilm inhibition of N,N-hexyl,methyl-polyethylenimine bonded to Boston Keratoprosthesis materials. Biomaterials 2011; 32:8783-96. [PMID: 21903257 DOI: 10.1016/j.biomaterials.2011.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 08/05/2011] [Indexed: 10/17/2022]
Abstract
The biocompatibility and antibacterial properties of N,N-hexyl,methyl-polyethylenimine (HMPEI) covalently attached to the Boston Keratoprosthesis (B-KPro) materials was evaluated. By means of confocal and electron microscopies, we observed that HMPEI-derivatized materials exert an inhibitory effect on biofilm formation by Staphylococcus aureus clinical isolates, as compared to the parent poly(methyl methacrylate) (PMMA) and titanium. There was no additional corneal epithelial cell cytotoxicity of HMPEI-coated PMMA compared to that of control PMMA in tissue cultures in vitro. Likewise, no toxicity or adverse reactivity was detected with HMPEI-derivatized PMMA or titanium compared to those of the control materials after intrastromal or anterior chamber implantation in rabbits in vivo.
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Affiliation(s)
- Irmgard Behlau
- Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, United States.
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22
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Jurkunas UV, Jakobiec FA, Shin J, Zakka FR, Michaud N, Jethva R. Reversible corneal epitheliopathy caused by vitamin B12 and folate deficiency in a vegan with a genetic mutation: a new disease. Eye (Lond) 2011; 25:1512-4. [PMID: 21818128 DOI: 10.1038/eye.2011.177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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23
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Jakobiec FA, Zakka FR. A reappraisal of eyelid eccrine and apocrine hidrocystomas: microanatomic and immunohistochemical studies of 40 lesions. Am J Ophthalmol 2011; 151:358-74.e2. [PMID: 21168812 DOI: 10.1016/j.ajo.2010.08.028] [Citation(s) in RCA: 39] [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] [Received: 06/10/2010] [Revised: 08/17/2010] [Accepted: 08/18/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To establish reliable criteria for diagnosing eyelid eccrine and apocrine hidrocystomas. DESIGN Retrospective clinicopathologic and immunohistochemical study. METHODS Twenty-two specimens of normal portions of eyelids were evaluated to establish the distribution and microanatomy of eccrine and apocrine glands. Immunostaining for cytokeratin 7 (CK7), gross cystic disease fluid protein-15 (GCDFP-15), alpha-smooth muscle actin (α-SMA), epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA) was performed on these tissues and on 40 lesions in 33 patients diagnosed with eccrine or apocrine hidrocystomas by unaided light microscopy. RESULTS Eccrine glands were not present in the eyelid margins, the lower half of the upper eyelid pretarsal skin, or the pretarsal lower eyelid skin. Apocrine glands were restricted to the eyelid margins and canthi where the cysts were located. GCDFP-15, CK7, and α-SMA immunoreacted with the eccrine secretory coils but not their ducts; apocrine gland secretory spirals also stained positively for these markers throughout their extended courses, but not their short terminal ducts. Positivity was found in 37 of 40 hidrocystomas for α-SMA and 19 for GCDFP-15; lesions tested for CK7 displayed positivity. CONCLUSIONS Alpha-SMA-, CK7-, and/or GCDFP-15-positive apocrine hidrocystomas were the only type discovered in this series and arose from glandular secretory spirals within the marginal, perimarginal, or canthal skin. Three lesions did not stain for α-SMA, initially suggesting an absent myoepithelium and therefore an eccrine ductal origin; they manifested CK7 positivity, however, another characteristic of the apocrine secretory spiral but not ducts. Our findings disprove the contention that eccrine predominate over apocrine hidrocystomas in the eyelids.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts 02114, USA.
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Zakka FR, Chang PY, Giuliari GP, Foster CS. Current trends in the management of ocular symptoms in Adamantiades-Behçet's disease. Clin Ophthalmol 2009; 3:567-79. [PMID: 19898629 PMCID: PMC2770868 DOI: 10.2147/opth.s4445] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Indexed: 12/14/2022] Open
Abstract
Adamantiades-Behçet’s disease (ABD) is a multisystemic vasculitic disease. It is most prevalent in the Eastern Mediterranean countries and the Eastern region of Asia. Its effect on the eye can range from mild to debilitating, resulting in total blindness. A necrotizing and obliterative vasculitis affects both arteries and veins of organs. Recurrent attacks of uveitis, oral aphthous ulcers, skin lesions, and genital ulcers are common. Topical and systemic corticosteroids have been the mainstay in the treatment of ocular inflammation for many years; however, due to the several known side effects of corticosteroids and thanks to scientific advances, more novel approaches to ABD treatment have been emerging. Antimetabolites such as methotrexate and azathioprine have been utilized with the latter showing positive results. Chlorambucil has been utilized effectively for ocular manifestations of ABD. Interferon alpha has shown encouraging results in the management of refractory ocular inflammation associated with ABD, either alone or in combination with other immunosuppressive agents. Surgical interventions to deal with complications from ABD can be safely done if adequate control of inflammation is achieved peri-operatively. Early detection and aggressive treatment, when needed, have proven to be essential in the management of this relentlessly explosive disease.
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Affiliation(s)
- Fouad R Zakka
- Massachusetts Eye Research and Surgery Institution (MERSI), Cambridge, Massachusetts, USA
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