1
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Peng G, Sosnowski DW, Murphy SK, Johnson SB, Skaar D, Schleif WS, Hernandez RG, Monforte H, Zhao H, Hoyo C. An epigenetic clock for gestational age based on human umbilical vein endothelial cells from a diverse population of newborns. Res Sq 2023:rs.3.rs-3112428. [PMID: 37461438 PMCID: PMC10350106 DOI: 10.21203/rs.3.rs-3112428/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background Epigenetic clocks are emerging as a useful tool in many areas of research. Many epigenetic clocks have been developed for adults; however, there are fewer clocks focused on newborns and most are trained using blood from European ancestry populations. In this study, we built an epigenetic clock based on primary human umbilical vein endothelial cells from a racially and ethnically diverse population. Results Using human umbilical vein endothelial cell [HUVEC]-derived DNA, we calculated epigenetic gestational age using 83 CpG sites selected through elastic net regression. In this study with newborns from different racial/ethnic identities, epigenetic gestational age and clinical gestational age were more highly correlated (r = 0.85), than epigenetic clocks built from adult and other pediatric populations. The correlation was also higher than clocks based on blood samples from newborns with European ancestry. We also found that birth weight was positively associated with epigenetic gestational age acceleration (EGAA), while NICU admission was associated with lower EGAA. Newborns self-identified as Hispanic or non-Hispanic Black had lower EGAA than self-identified as non-Hispanic White. Conclusions Epigenetic gestational age can be used to estimate clinical gestational age and may help index neonatal development. Caution should be exercised when using epigenetic clocks built from adults with children, especially newborns. We highlight the importance of cell type-specific epigenetic clocks and general pan tissue epigenetic clocks derived from a large racially and ethnically diverse population.
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Affiliation(s)
- Gang Peng
- Indiana University School of Medicine
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2
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Markovitz M, Monforte H, Shieh HF, Smithers CJ, Kucera JN. Endobronchial mucoepidermoid carcinoma in a pediatric patient: A case report. Radiol Case Rep 2022; 17:2034-2037. [PMID: 35432680 PMCID: PMC9010688 DOI: 10.1016/j.radcr.2022.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) is an uncommon type of salivary gland tumor that can present as an endobronchial neoplasm, most commonly in the adult population. Neuroendocrine carcinoid tumors comprise the majority of bronchial neoplasms in the pediatric population and are nearly indistinguishable from MEC on imaging. We present a rare case of MEC in a 3-year-old presenting with recurrent symptoms of lower airway obstruction and discuss its typical associated symptoms and imaging features.
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Affiliation(s)
- Michael Markovitz
- Department of Radiology, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL STC 6102, USA
- Corresponding author.
| | - Hector Monforte
- Department of Pathology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Hester F. Shieh
- Department of Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | | | - Jennifer Neville Kucera
- Department of Radiology, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL STC 6102, USA
- Department of Radiology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
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3
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Chitty-Lopez M, Duff C, Vaughn G, Trotter J, Monforte H, Lindsay D, Haddad E, Keller MD, Oshrine BR, Leiding JW. Case Report: Unmanipulated Matched Sibling Donor Hematopoietic Cell Transplantation In TBX1 Congenital Athymia: A Lifesaving Therapeutic Approach When Facing a Systemic Viral Infection. Front Immunol 2022; 12:721917. [PMID: 35095830 PMCID: PMC8794793 DOI: 10.3389/fimmu.2021.721917] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Congenital athymia can present with severe T cell lymphopenia (TCL) in the newborn period, which can be detected by decreased T cell receptor excision circles (TRECs) on newborn screening (NBS). The most common thymic stromal defect causing selective TCL is 22q11.2 deletion syndrome (22q11.2DS). T-box transcription factor 1 (TBX1), present on chromosome 22, is responsible for thymic epithelial development. Single variants in TBX1 causing haploinsufficiency cause a clinical syndrome that mimics 22q11.2DS. Definitive therapy for congenital athymia is allogeneic thymic transplantation. However, universal availability of such therapy is limited. We present a patient with early diagnosis of congenital athymia due to TBX1 haploinsufficiency. While evaluating for thymic transplantation, she developed Omenn Syndrome (OS) and life-threatening adenoviremia. Despite treatment with anti-virals and cytotoxic T lymphocytes (CTLs), life threatening adenoviremia persisted. Given the imminent need for rapid establishment of T cell immunity and viral clearance, the patient underwent an unmanipulated matched sibling donor (MSD) hematopoietic cell transplant (HCT), ultimately achieving post-thymic donor-derived engraftment, viral clearance, and immune reconstitution. This case illustrates that because of the slower immune recovery that occurs following thymus transplantation and the restricted availability of thymus transplantation globally, clinicians may consider CTL therapy and HCT to treat congenital athymia patients with severe infections.
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Affiliation(s)
- Maria Chitty-Lopez
- Division of Pediatric Allergy and Immunology, University of South Florida, Tampa, FL, United States
| | - Carla Duff
- Division of Pediatric Allergy and Immunology, University of South Florida, Tampa, FL, United States
| | - Gretchen Vaughn
- Center for Cell and Gene Therapy for Non-Malignant Conditions, Cancer and Blood Disorders Institute at Johns Hopkins All Children’s Hospital, St. Petersburg, FL, United States
| | - Jessica Trotter
- Division of Pediatric Allergy and Immunology, University of South Florida, Tampa, FL, United States
| | - Hector Monforte
- Department of Pathology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, United States
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States
| | - David Lindsay
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States
- Division of Immuno-Allergy and Rheumatology, The Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Elie Haddad
- Division of Immuno-Allergy and Rheumatology, The Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
- Division of Allergy and Immunology, Children’s National Hospital, Washington, DC, United States
| | - Michael D. Keller
- Division of Allergy and Immunology, Children’s National Hospital, Washington, DC, United States
| | - Benjamin R. Oshrine
- Center for Cell and Gene Therapy for Non-Malignant Conditions, Cancer and Blood Disorders Institute at Johns Hopkins All Children’s Hospital, St. Petersburg, FL, United States
| | - Jennifer W. Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, United States
- Infectious Diseases and Immunology Division. Arnold Palmer Hospital for Children, Orlando, FL, United States
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4
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Schleif W, Hamblin F, Everett AD, Graham EM, Cross J, Fernald C, Follett R, Lopes B, Martinez D, Monforte H, Ross-Wilkinson J, Sellers A, Brooks S. Tiny Bodies, Big Needs: Prospective Biobanking of Neonatal Clinical Remnant Samples. Biopreserv Biobank 2021; 19:106-110. [PMID: 33481645 DOI: 10.1089/bio.2020.0113] [Citation(s) in RCA: 3] [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] [Indexed: 11/12/2022] Open
Abstract
Repurposing biological samples collected for required diagnostic purposes into suitable biobanking projects is a particularly useful method for enabling research in vulnerable populations. This approach is especially appropriate for the neonate in the neonatal intensive care unit (NICU), where blood volume reductions can quickly increase beyond minimal risk for adverse events, such as iatrogenic anemia, and proxy consent provided by parents or guardians is required. The method described in this study provides a framework to prospectively collect and store blood-derived clinical samples after all clinical and regulatory requirements are fulfilled. The consent approach incorporated a 30-day window to allow parents and guardians ample consideration time with follow-up involvement with NICU embedded study team members. The study enrolled 875 participants over a 3-year period. This established a critically needed biobank to support investigator-initiated research with explicit study aims requiring samples at defined day of life frequencies within the NICU and created a normative control reference bank for case comparisons for premature and full-term neonates with brain injury.
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Affiliation(s)
- William Schleif
- Program in Pediatric Biospecimen Science, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA.,Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Frances Hamblin
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Allen D Everett
- Blalock-Taussig-Thomas Congenital Heart Center, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ernest M Graham
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer Cross
- Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Christy Fernald
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Robert Follett
- Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Bryan Lopes
- Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Denise Martinez
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Hector Monforte
- Program in Pediatric Biospecimen Science, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA.,Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Jennifer Ross-Wilkinson
- Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Austin Sellers
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Sandra Brooks
- Johns Hopkins All Children's Maternal, Fetal, and Neonatal Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Division of Neonatology, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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5
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Moore C, Monforte H, Teer JK, Zhang Y, Yoder S, Brohl AS, Reed DR. TRIM28 congenital predisposition to Wilms' tumor: novel mutations and presentation in a sibling pair. Cold Spring Harb Mol Case Stud 2020; 6:mcs.a004796. [PMID: 32699065 PMCID: PMC7476416 DOI: 10.1101/mcs.a004796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
Wilms’ tumor is the most common renal malignancy in children. In addition to staging, molecular risk stratification, such as loss of heterozygosity (LOH) in Chromosomes 1 and 16, is being increasingly used. Although genetic predisposition syndromes have been well-characterized in some Wilms’ tumors, recent sequencing and biology efforts are expanding the classification of this malignancy. Here we present a case of siblings with remarkably similar presentations of bilateral Wilms’ tumor at ∼12 mo of age. Thorough exam after the younger sibling was diagnosed did not reveal any signs to suggest one of the known Wilms’ predisposition syndromes. Both were treated with standard therapies with good response and long-term sustained complete remission of 53 and 97 mo, respectively. Whole-exome sequencing was performed on a tumor sample from each patient and matched blood from one, revealing a shared truncation mutation of TRIM28 in all three samples with heterozygosity in the germline sample. TRIM28 loss has been recently implicated in early-stage Wilms’ tumors with epithelioid morphology. These siblings expand the phenotype for presentation with multifocal disease with retained excellent response to standard therapy.
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Affiliation(s)
- Colin Moore
- Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.,Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.,Center for Cancer and Blood Disorders, Johns Hopkins All Children's Hospital, St. Petersburg, Florida 33701, USA
| | - Hector Monforte
- Department of Anatomic Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida 33701, USA
| | - Jamie K Teer
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
| | - Yonghong Zhang
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
| | - Sean Yoder
- Molecular Genomics Core Facility, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
| | - Andrew S Brohl
- Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
| | - Damon R Reed
- Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.,Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.,Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.,Cancer Biology and Evolution Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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6
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Peck J, Kimsey KM, Harris E, Monforte H, Wilsey M. Solitary Duodenal Ulcer Causing Biliary Obstruction Requiring Rendezvous Procedure in a Pediatric Patient With Eosinophilic Gastroenteritis. Cureus 2020; 12:e9377. [PMID: 32850245 PMCID: PMC7444993 DOI: 10.7759/cureus.9377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Eosinophilic gastroenteritis (EGE) is an uncommon disease characterized by immune cell-mediated inflammation of the gastrointestinal (GI) tract resulting in vague abdominal symptoms, most commonly nausea, vomiting, diarrhea, and abdominal pain. We report the case of a 16-year-old male presenting with a six-week history of progressive pruritus, jaundice, fatigue, abdominal pain, acholic stools, and dark-colored urine. This patient was diagnosed via endoscopy with biliary obstruction caused by a large, solitary, duodenal ulcer secondary to EGE. This is a severe complication of EGE and to our knowledge, this is the first reported case of biliary obstruction caused by a duodenal ulcer in a pediatric patient with EGE. Additionally, we describe the first pediatric combined percutaneous-endoscopic rendezvous technique after failed therapeutic endoscopic retrograde cholangiography (ERCP) to relieve the biliary obstruction.
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Affiliation(s)
- Jacquelin Peck
- Anesthesiology, Mount Sinai Medical Center, Miami Beach, USA
| | - Kathryn M Kimsey
- Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | - Evan Harris
- Vascular and Interventional Radiology, Center for Vien Restoration, Glastonbury, USA
| | - Hector Monforte
- Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | - Michael Wilsey
- Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, USA.,Pediatrics, University of South Florida College of Medicine, Tampa, USA
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7
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Henderson ER, Monforte H, Neustadt JB. Fibrocartilaginous Dysplasia of the Proximal Part of the Femur with a Pathological Fracture in a Child: A Case Report. JBJS Case Connect 2014; 4:e90. [PMID: 29252758 DOI: 10.2106/jbjs.cc.m.00254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Eric R Henderson
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, the Geisel School of Medicine at Dartmouth College, One Medical Center Drive, Lebanon, NH 03766.
| | - Hector Monforte
- Anatomic Pathology, Pediatric Pathology, 501 6th Avenue South, All Children's Hospital, St. Petersburg, FL 33701.
| | - Jeffrey B Neustadt
- Children's Orthopaedic & Scoliosis Surgery Associates, 625 6th Avenue South, Suite 450, St. Petersburg, FL 33701.
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8
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Nugent D, Cheong D, Monforte H, Ayala AG, Letson GD, Keen J. Periosteal Mesenchymal Chondrosarcoma in the Distal Part of the Tibia of a Four-Year-Old Boy: A Case Report. JBJS Case Connect 2013; 3:e117. [PMID: 29252517 DOI: 10.2106/jbjs.cc.m.00044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dylan Nugent
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL 32209.
| | - David Cheong
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612-9416
| | - Hector Monforte
- Anatomic Pathology, All Children's Hospital-Johns Hopkins Medicine, 801 6th Avenue South, St. Petersburg, FL 33701
| | - Alberto G Ayala
- Department of Pathology, The Methodist Hospital, 6565 Fannin Street, Houston, TX 77030
| | - G Douglas Letson
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612-9416
| | - Jeffrey Keen
- Flagler Orthopaedics and Sports Medicine, 61 Memorial Medical Parkway, Suite 2801, Palm Coast, FL 32164
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9
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Abstract
Subcutaneous Panniculitis-Like T-cell Lymphoma (SPTCL) is a rare lymphoma with fewer than twenty cases reported in children less than 18 years of age. Trisomy 21 is a chromosomal abnormality associated with a risk of malignancy that differs from their normal counterparts. Leukemia is diagnosed 10-20 times over the general population while solid tumors are underrepresented. The risk for Lymphoma historically has been elevated as well. We describe a case of a 3 year-old girl with Down syndrome who was successfully treated for SPTCL.
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Affiliation(s)
- Benjamin Mixon
- Department of Pediatric Hematology/Oncology, Vanderbilt University, Nashville, Tennessee 37232, USA.
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10
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Modi VK, Monforte H, Geller KA, Koempel JA. Histologic assessment of thermal injury to tonsillectomy specimens: a comparison of electrocautery, coblation, harmonic scalpel, and tonsillotome. Laryngoscope 2009; 119:2248-51. [PMID: 19688863 DOI: 10.1002/lary.20612] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the extent of thermal injury to the tonsillar tissue following the use of various types of instrumentation. To determine if tonsillectomy specimens routinely contain tissue other than lymphoid tissue. STUDY DESIGN Retrospective histologic analysis. METHODS A histologic analysis performed on 228 tonsillectomy specimens removed by use of an electrocautery in 132 specimens, harmonic scalpel in 46, coblation device in 24, and a tonsillotome in 26. The specimens were evaluated for presence and percentage of skeletal muscle and depth of thermal tissue injury. RESULTS The mean percentage of skeletal muscle present in the specimens was 0.79% for electrocautery, 1.74% for harmonic scalpel, 0.97% for coblation device, and 1.66% for the tonsillotome. Skeletal muscle was absent in only 8 of 228 specimens (3.5%). Electrocautery has a statistically significant (P < .05) lower percentage of muscle tissue compared to harmonic scalpel and the tonsillotome. There was no statistically significant difference in the mean depth of thermal injury among the harmonic scalpel (0.68 mm), electrocautery (0.58 mm), and coblation device (0.71 mm) specimens. The tonsillotome specimens had no thermal injury. CONCLUSIONS Attempts to remove the entire tonsil results in a similar depth of thermal injury to tonsillectomy specimens when using the harmonic scalpel, electrocautery, and coblation device. Skeletal muscle is a nearly ubiquitous finding in routine tonsillectomy specimens. The use of an electrocautery with a needle point may allow for a more precise dissection as it results in tonsillectomy specimens with a smaller percentage of muscle present.
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Affiliation(s)
- Vikash K Modi
- Department of Otorhinolaryngology, Weill Cornell Medical College of Cornell University, New York, New York 10021, USA.
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11
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Gografe SI, Sanberg PR, Chamizo W, Monforte H, Garbuzova-Davis S. Novel pathologic findings associated with urinary retention in a mouse model of mucopolysaccharidosis type IIIB. Comp Med 2009; 59:139-146. [PMID: 19389305 PMCID: PMC2703152] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 06/23/2008] [Accepted: 11/13/2008] [Indexed: 05/27/2023]
Abstract
Mucopolysaccharidosis type IIIB (MPS IIIB; Sanfilippo syndrome type B) is a metabolic disorder with devastating clinical characteristics starting in early childhood and leading to premature death. A knockout mouse strain was developed that models this disease. Mice of the strain B6.129S6- Naglu(tm1Efn)/J are invaluable for investigating pathogenesis and possible treatment modalities. However, the mouse strain also exhibits some objectionable phenotypic features. One such feature, urinary retention, not only is atypical of human MPS IIIB but often leads to early termination of experiments due to animal welfare concerns. The aim of this study was to investigate abnormalities associated with the urinary retention. Necropsies were performed on 9-mo-old mice; urinalysis, hematology and blood chemistry parameters were evaluated, and urogenital specimens were microscopically examined. Histopathologic examinations of urinary tract specimens proved illuminating regarding pathology in the urinary tract. A large mononuclear cell infiltrate was discovered in mutant mice of both sexes, more pronounced in females compared with male mice. The infiltrate comprises of large rounded or polygonal cells with generous variably vacuolated, granular eosinophilic cytoplasm and small round vesicular nuclei. These cells were present throughout and expand the interstitium of the lower urinary tract. Either this results in extrinsic compression of the lumen of the urethra, eventually leading to obstructive uropathy, bladder hyperdistension, and urinary retention or possibly interferes with the neurogenic component of micturition needs to be further investigated. The novel finding of an unexpected mononuclear cell infiltrate in the urinary tract in the knockout mice B6.129S6- Naglu(tm1Efn)/J is reported.
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Affiliation(s)
- Sylvia I Gografe
- Center for Aging and Brain Repair, University of South Florida, College of Medicine, Tampa, Florida, USA.
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12
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Abstract
An inflammatory myofibroblastic tumor as a distinct clinicopathologic entity in the lung has gained wide acceptance. The majority of these tumors are either contained within a single segment or pulmonary lobe and may cross the interlobar fissure and/or extend into the mediastinum, especially if arising in a perihilar location. We describe the case of a 13-year-old male with a 4-year history of an unresponsive lung mass in the left hemithorax. The resected tumor showed the typical morphology of a fasciculated fibroblastic/myofibroblastic lesion.
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Affiliation(s)
- Bruce Schnapf
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida 33606, USA.
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13
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Wells WJ, Yu RJ, Batra AS, Monforte H, Sintek C, Starnes VA. Obstruction in Modified Blalock Shunts: A Quantitative Analysis With Clinical Correlation. Ann Thorac Surg 2005; 79:2072-6. [PMID: 15919312 DOI: 10.1016/j.athoracsur.2004.12.050] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Revised: 12/22/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite numerous reports describing the clinical course of patients undergoing a modified Blalock-Taussig shunt (MBTS), there is limited information on shunt obstruction. No studies have quantified MBTS stenosis histopathologically and correlated that with demographic and clinical risk factors. METHODS From June 2001 to June 2003, 155 patients had MBTS takedown. The shunt operation (at median age 6 days; shunt size 3.5 mm in 56 [36%]; 4 mm in 84 [54%]; 5 mm in 15 [10%]) was performed on cardiopulmonary bypass (CPB) in 96 patients (62%). At elective takedown (at median 8.1 months), the shunt was excised and histopathologically analyzed for maximal narrowing. Demographics and clinical variables including age, weight, shunt size and duration, diagnosis, use of cardiopulmonary bypass, blood products, anastomosis sites, and concomitant antegrade flow were then tested for correlation with shunt stenosis. RESULTS The mean value for maximal narrowing of the shunt lumen was 34% +/- 22%, and 32 patients (21%) had greater than 50% stenosis. Myofibroblastic proliferation, often associated with organized thrombus, caused the obstruction. Smaller shunt size (<4 mm) was a statistically significant risk factor for stenosis greater than 50% (odds ratio [OR] = 2.51; p = 0.028). Other variables that showed a clinically important association with obstruction but did not reach statistical significance included age less than 14 days at shunt (OR = 2.08, confidence interval [CI] 0.8 to 5.2), shunt on bypass (OR = 2.07, CI 0.9 to 4.8), and platelet use at shunt operation (OR = 1.96, CI 0.9 to 4.4). CONCLUSIONS Most MBTS develop stenosis by the time of takedown, and 21% have greater than 50% obstruction. Shunt size less than 4 mm is a risk factor for high-grade stenosis. Younger age, CPB, and use of platelets are other clinically important factors. Better conduits and suppression of intimal proliferation could potentially improve outcomes.
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Affiliation(s)
- Winfield J Wells
- Childrens Hospital Los Angeles, Los Angeles, California 90027, USA.
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14
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Ortega JA, Rowland J, Monforte H, Malogolowkin M, Triche T. Presence of well-differentiated rhabdomyoblasts at the end of therapy for pelvic rhabdomyosarcoma: implications for the outcome. J Pediatr Hematol Oncol 2000; 22:106-11. [PMID: 10779022 DOI: 10.1097/00043426-200003000-00005] [Citation(s) in RCA: 34] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of well-differentiated rhabdomyoblasts at the end of therapy for rhabdomyosarcoma has been noted. This study was undertaken to investigate the therapeutic implications of the presence of well-differentiated rhabdomyoblasts at the end of therapy for pelvic rhabdomyosarcoma. Six patients with pelvic rhabdomyosarcoma (bladder-prostate, 4; vulvovaginal, 2) with disease diagnosed between the years 1974 and 1992 were sequentially investigated by cystoscopic or vaginoscopic examination and biopsy during and after completing therapy. All six patients received treatment according to prevailing therapeutic protocols. Biopsy material from all six patients at the end of therapy documented the presence of well-differentiated rhabdomyoblasts. Repeated biopsies demonstrated the presence of rhabdomyoblasts; however, they appeared to decrease in number with time. Mitotic activity was not observed in the biopsy materials obtained. All six patients are alive without evidence of disease from 37 to 233 months after therapy ended. The presence of well-differentiated rhabdomyoblasts at the end of therapy for pelvic rhabdomyosarcoma is a common finding. The biologic nature of these well-differentiated rhabdomyoblasts is not completely known, but they do not appear to connote the persistent presence of malignant disease and are not an indication for the continuation of therapy.
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Affiliation(s)
- J A Ortega
- Department of Pediatric, University of Southern California, School of Medicine, Childrens Hospital Los Angeles, USA
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Kawakami T, Monobe Y, Monforte H, Woods WG, Tuchman M, Lemieux B, Brisson L, Bernstein M, Brossard J, Leclerc JM, Byrne TD, Triche TJ, Shimada H. Pathology review of screening negative neuroblastomas: a report from the Quebec Neuroblastoma Screening Project. Cancer 1998; 83:575-81. [PMID: 9690552 DOI: 10.1002/(sici)1097-0142(19980801)83:3<575::aid-cncr28>3.0.co;2-s] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Quebec Neuroblastoma Screening (QNS) Project completed a 5-year program for measuring urinary vanillylmandelic acid (VMA)/homovanillic acid (HVA) levels at age 3 weeks and/or 6 months in 89% of 476,603 Quebec-born infants from 1989-1994; 45 screening positive preclinical cases (S-positive cases) and 20 congenital/neonatal (C/N) cases were identified. As of April 1997, an additional 59 cases in the same birth cohort were diagnosed clinically; these neuroblastomas developed after screening verified normal VMA/HVA levels (S-negative cases). METHODS Pathology specimens from 45 of 59 S-negative cases were reviewed centrally and classified according to the Shimada system. Results were compared with clinical data and also with S-positive and C/N cases. RESULTS Of 45 S-negative cases, 27 tumors had favorable histology (FH) and 18 had unfavorable histology (UH). Approximately 52% of FH tumors were diagnosed before age 1 year, whereas UH tumors were nearly exclusively (94%) diagnosed after age 1 year (P < 0.01). Approximately 89% of FH tumors were Stage I, II, or IV-S, whereas 72% UH tumors were Stage III or IV (P < 0.001). All children with FH tumors were alive at last follow-up (range of follow-up period: 9-79 months; median, 35 months), whereas 8 children with UH tumors died of disease even after limited follow-up (range of follow-up period: 0-60 months; median, 20 months). By contrast, S-positive and C/N cases were predominantly (97%) FH tumors, often (76%) Stage I, II, or IV-S, with excellent clinical outcome (survival rate of 98%). CONCLUSIONS The majority of the UH neuroblastomas that developed in the birth cohort of the QNS Project were included in the group of S-negative cases and could not be detected by the screening at age 3 weeks and/or 6 months.
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Affiliation(s)
- T Kawakami
- Department of Pathology, Children's Hospital Los Angeles, California 90027, USA
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Gould EW, Manivel JC, Albores-Saavedra J, Monforte H. Locally infiltrative glomus tumors and glomangiosarcomas. A clinical, ultrastructural, and immunohistochemical study. Cancer 1990. [PMID: 2153045 DOI: 10.1002/1097-0142(19900115)65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Six cases of locally aggressive and/or potentially malignant glomus tumors are described. On the basis of clinical and pathologic criteria, the following classification is proposed. The first category is a locally infiltrative glomus tumor (LIGT) which has the usual glomus histologic features. The second group is a cytologically malignant tumor arising and merging with a typical glomus tumor, designated glomangiosarcoma arising in a benign glomus (GABG). The third category and the most difficult to recognize is the de novo glomangiosarcoma (GADN), which must be distinguished from other round cell sarcomas. Most of these locally aggressive glomus tumors are vimentin positive and are immunoreactive for muscle-specific actin. Electron microscopic examination in one GABG case showed cells with numerous microfilaments and pinocytotic vesicles; a second GADN case contained cells with microfilaments and an incomplete basal lamina. As a group these locally aggressive or potentially malignant glomus tumors are larger and more deeply located than the conventional glomus tumor. Although 50% of these tumors recurred locally, none have metastasized.
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Affiliation(s)
- E W Gould
- Department of Pathology, University of Miami/Jackson Memorial Hospital, Florida
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Abstract
Six cases of locally aggressive and/or potentially malignant glomus tumors are described. On the basis of clinical and pathologic criteria, the following classification is proposed. The first category is a locally infiltrative glomus tumor (LIGT) which has the usual glomus histologic features. The second group is a cytologically malignant tumor arising and merging with a typical glomus tumor, designated glomangiosarcoma arising in a benign glomus (GABG). The third category and the most difficult to recognize is the de novo glomangiosarcoma (GADN), which must be distinguished from other round cell sarcomas. Most of these locally aggressive glomus tumors are vimentin positive and are immunoreactive for muscle-specific actin. Electron microscopic examination in one GABG case showed cells with numerous microfilaments and pinocytotic vesicles; a second GADN case contained cells with microfilaments and an incomplete basal lamina. As a group these locally aggressive or potentially malignant glomus tumors are larger and more deeply located than the conventional glomus tumor. Although 50% of these tumors recurred locally, none have metastasized.
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Affiliation(s)
- E W Gould
- Department of Pathology, University of Miami/Jackson Memorial Hospital, Florida
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18
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Abstract
Six cases of locally aggressive and/or potentially malignant glomus tumors are described. On the basis of clinical and pathologic criteria, the following classification is proposed. The first category is a locally infiltrative glomus tumor (LIGT) which has the usual glomus histologic features. The second group is a cytologically malignant tumor arising and merging with a typical glomus tumor, designated glomangiosarcoma arising in a benign glomus (GABG). The third category and the most difficult to recognize is the de novo glomangiosarcoma (GADN), which must be distinguished from other round cell sarcomas. Most of these locally aggressive glomus tumors are vimentin positive and are immunoreactive for muscle-specific actin. Electron microscopic examination in one GABG case showed cells with numerous microfilaments and pinocytotic vesicles; a second GADN case contained cells with microfilaments and an incomplete basal lamina. As a group these locally aggressive or potentially malignant glomus tumors are larger and more deeply located than the conventional glomus tumor. Although 50% of these tumors recurred locally, none have metastasized.
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Affiliation(s)
- E W Gould
- Department of Pathology, University of Miami/Jackson Memorial Hospital, Florida
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Abstract
An immunohistochemical study was conducted on the number and distribution of C-cells in the nonneoplastic thyroid tissue adjacent to tumors of follicular cell origin. It consisted of 49 cases, of which 25 were papillary carcinomas, 22 were follicular adenomas, and 2 were follicular carcinomas. Twenty normal adult thyroids from the Broward's Medical Examiner's morgue served as controls. In 17 of the 49 cases (34.6%), there was a statistically significant increase in the number of C-cells in the normal-appearing thyroid tissue adjacent to follicular cell tumors, with at least 50 C-cells in one low power field, while only one of 20 normal thyroids had a similar number of cells. (P = .02; chi 2 = 5.05). In two tumor cases there were more than 100 C-cells in several low power fields with formation of small C-cell nodules similar to those described in the type II Multiple Endocrine Neoplasia Syndrome (MEN). It was concluded that the nonneoplastic thyroid tissue adjacent to 34.6% of tumors with follicular cell phenotypes contains significantly more C-cells than those present in normal adult thyroids. The possible pathogenesis and clinical significance of these findings are discussed.
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Affiliation(s)
- J Albores-Saavedra
- Department of Pathology, University of Miami Jackson Memorial Medical Center, FL 33101
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Abstract
Two primary lumbosacral tumors arising at the site of neural tube defects are presented. One was a teratoma diagnosed in an infant with myelomeningocele. The other was an ependymoma that developed in an adult with meningocele. It is postulated that these cases represent a neoplastic transformation of heterotopic primordial elements that have been incorporated within the defect, supporting the view that overgrowth of neural tissue may be the result rather than the cause of neural tube deformity. Such rare occurrences may be due to interaction between intrauterine teratogenic factors and familial predisposition in affected patients.
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