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Kapustin D, Su V, Yun J, Rubin SJ, Chung D, Modica I, Khan MN, Chai RL, Karasick M, Doyle S, Brandwein-Weber M, Urken ML. iPad Annotation of 3D Surgical Models Using Procreate®: Novel Documentation of Supplemental Margins. Laryngoscope 2024; 134:2783-2786. [PMID: 37921378 DOI: 10.1002/lary.31144] [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: 06/28/2023] [Revised: 09/17/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
We present a novel, efficient approach to demonstrating supplemental margins during oncologic resection. Surgeons and pathologists annotated 10 virtual models of surgical defects and resection specimens in 3D using an iPad-based application, Procreate®. Incorporating this method into the surgical workflow can improve interdepartmental communication and provide visual documentation of surgical steps taken to address at-risk margins. Laryngoscope, 134:2783-2786, 2024.
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Affiliation(s)
- Danielle Kapustin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivian Su
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jun Yun
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel J Rubin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Chung
- Dept. of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ippolito Modica
- Dept. of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohemmed Nazir Khan
- Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raymond L Chai
- Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Karasick
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
| | - Scott Doyle
- Dept. of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | | | - Mark L Urken
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kapustin DA, Yun J, Su V, Rubin SJ, Modica I, Chung D, Fan J, Khan MN, Chai RL, Karasick M, Doyle S, Brandwein-Weber M, Urken ML. Frozen Section Timeout: Pilot Study to Reconcile Margins Using 3D Resected Specimen and Defect Scans. Laryngoscope 2024; 134:725-731. [PMID: 37466312 DOI: 10.1002/lary.30892] [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: 04/17/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Opportunities exist to improve intraoperative communication and documentation of resection margin details. We instituted a "frozen section timeout" that centers around visualization of the paired resection specimen and surgical defect-facilitating effective, bidirectional exchange of information. METHODS We designed an interactive form for use during the "frozen section timeout" including annotated 3D virtual models of the resected specimen and surgical defect, plus a "line-item" table for primary and supplemental margin results. The "timeout" was conducted over a Zoom call between the operating room and frozen section laboratory. The form was simultaneously projected and discussed while all members of the surgical care team stopped activities. Nurses, co-surgeons, and all other members of the surgical team were encouraged to take part in this process. RESULTS Twenty-six frozen section timeouts were conducted during head and neck surgeries in the Department of Otolaryngology at Mount Sinai West Hospital. These timeouts were facilitated by the lead surgeon, and all other activities were halted to ensure that critical information was shared, documented, and agreed upon. During the timeout, the annotated specimen and defect scans were displayed, clearly demonstrating the at-risk margins and the corresponding location and breadth of supplemental margins harvested. CONCLUSION Incorporating a frozen section timeout can improve intraoperative communication, increase transparency, and potentially eliminate uncertainty regarding margin status and tumor clearance. Visualization of at-risk margins and the corresponding location and breadth of supplemental margins promises an unprecedented level of documentation and understanding. This novel technique can establish a new and improved standard of care. LEVEL OF EVIDENCE NA Laryngoscope, 134:725-731, 2024.
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Affiliation(s)
- Danielle A Kapustin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jun Yun
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Vivian Su
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Samuel J Rubin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Ippolito Modica
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Daniel Chung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jun Fan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mohemmed N Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Michael Karasick
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
| | - Scott Doyle
- Department of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, U.S.A
| | | | - Mark L Urken
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Beute JE, Greenberg LA, Wein LE, Kapustin DA, Fan J, Dowling EM, Samankan S, Matloob A, Xing M, Modica I, Chung D, Carroll W, Rosenthal EL, Khan MN, Chai RL, Brandwein-Weber MS, Urken ML. WPOI-5: Accurately Identified at Intraoperative Consultation and Predictive of Occult Cervical Metastases. Head Neck Pathol 2023; 17:479-486. [PMID: 36849672 PMCID: PMC10293149 DOI: 10.1007/s12105-023-01533-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/12/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Frozen section analysis of oral cancer specimens is ideal for assessing margin distances and depth of invasion (DOI); the latter impacts intraoperative decisions regarding elective neck dissection (END). Here, we show that intraoperative determination of worst pattern of invasion (WPOI), specifically WPOI-5, has a high level of accuracy. This relates to our demonstration herein that WPOI-5 predicts occult cervical metastases (OCM) for pT1 oral squamous carcinoma (OSC). METHODS The presence of OCM was correlated with WPOI in 228 patients with primary T1/T2/cN0 OSC undergoing resection and END. Concordance between intraoperative and final pathology WPOI determination was assessed on 51 cases of OSC. RESULTS WPOI-5 predicts OCM in pT1 patients, compared with WPOI-4/WPOI-3 (p < 0.0001). Most pT1 WPOI-5 tumors had DOI of 4-5 mm (24/59 or 40.7%). Only two pT1 WPOI-5 tumors had DOI < 4 mm (3.0 and 3.5 mm). If END were performed in this pT1 cohort for all WPOI-5 OSC patients regardless of DOI, OR all OSC patients with DOI ≥ 4 mm regardless of WPOI, then no OCM would be missed (p = 0.017, 100% sensitivity, 29% specificity, 77% positive predictive value, 23% negative predictive value). With respect to intraoperative WPOI-5 determination, the accuracy, sensitivity, and specificity was 92.16, 73.33, and 100.0%, respectively. CONCLUSIONS DOI ≥ 4 mm is the dominant predictor of OCM. For the rare WPOI-5 OSC with DOI < 4 mm, it is reasonable to suggest that surgeons perform END. WPOI-5 may be accurately determined intraoperatively. As microscopic instruction is needed to accurately assess WPOI-5, a teaching link is included in this manuscript.
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Affiliation(s)
- John E Beute
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Lily A Greenberg
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Lauren E Wein
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Danielle A Kapustin
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA.
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA.
| | - Jun Fan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Eric M Dowling
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Shabnam Samankan
- Department of Pathology, George Washington University, 2300 M Street NW, 7Th Floor, Washington, DC, 20037, USA
| | - Ammar Matloob
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Monica Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Ippolito Modica
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Daniel Chung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - William Carroll
- Department of Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eben L Rosenthal
- Department of Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21St Avenue South Suite 6310, Medical Center East - South Tower, Nashville, TN, 37232-8605, USA
| | - Mohemmed Nazir Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Margaret S Brandwein-Weber
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
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Brandwein-Weber M, Urken ML, Topf MC, Lewis JS, Kang SY, Curry JM, Chai R, Khan M, Modica I, Chung D, Rosenthal EL. Radical shift in the communication paradigm in head and neck frozen section analysis: Intraoperative three-dimensional specimen scanning. Head Neck 2023; 45:7-9. [PMID: 36377564 DOI: 10.1002/hed.27247] [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: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Margaret Brandwein-Weber
- Department of Pathology, Mount Sinai West, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James S Lewis
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Raymond Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohammed Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ippolito Modica
- Department of Pathology, Mount Sinai West, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dan Chung
- Department of Pathology, Mount Sinai West, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Bhalla S, Zhu H, Lin J, Özbek U, Wilck EJ, Chang S, Chen X, Ward S, Harpaz N, Polydorides AD, Miller W, Fiel MI, Modica I, Fan W, Zeizafoun N, Ang C. Impact of pathological response after neoadjuvant chemotherapy on adjuvant therapy decisions and patient outcomes in gastrointestinal cancers. Cancer Rep (Hoboken) 2021; 4:e1412. [PMID: 34032391 PMCID: PMC8714550 DOI: 10.1002/cnr2.1412] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is frequently used in gastrointestinal cancers (GIC), and pathological, radiological, and tumor marker responses are assessed during and after NAC. AIM To evaluate the relationship between pathologic, radiologic, tumor marker responses and recurrence-free survival (RFS), overall survival (OS), adjuvant chemotherapy (AC) decisions, and the impact of changing to a different AC regimen after poor response to NAC. METHODS AND RESULTS Medical records of GIC patients treated with NAC at Mount Sinai between 1/2012 and 12/2018 were reviewed. One hundred fifty-six patients (58.3% male, mean age 63 years) were identified. Primary tumor sites were: 43 (27.7%) pancreas, 62 (39.7%) gastroesophageal, and 51 (32.7%) colorectal. After NAC, 31 (19.9%) patients had favorable pathologic response (FPR; defined as College of American Pathologists [CAP] score 0-1). Of 107 patients with radiological data, 59 (55.1%) had an objective response, and of 113 patients with tumor marker data, 61 (54.0%) had a ≥50% reduction post NAC. FPR, but not radiographic or serological responses, was associated with improved RFS (HR 0.28; 95% CI 0.11-0.72) and OS (HR 0.13; 95% CI 0.2-0.94). Changing to a different AC regimen from initial NAC, among all patients and specifically among those with unfavorable pathological response (UPR; defined as CAP score 2-3) after NAC, was not associated with improved RFS or OS. CONCLUSIONS GIC patients with FPR after NAC experienced significant improvements in RFS and OS. Patients with UPR did not benefit from changing AC. Prospective studies to better understand the role of pathological response in AC decisions and outcomes in GIC patients are needed.
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Affiliation(s)
- Sheena Bhalla
- Division of Hematology and Medical OncologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Huili Zhu
- Department of Internal MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Jung‐Yi Lin
- Department of Population Health Science and PolicyTisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUSA
| | - Umut Özbek
- Department of Population Health Science and PolicyTisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUSA
| | - Eric J. Wilck
- Department of RadiologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Sanders Chang
- Department of RadiologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Xiuxu Chen
- Department of PathologyLoyola University Medical CenterMaywoodIllinoisUSA
| | - Stephen Ward
- Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Noam Harpaz
- Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | | | - William Miller
- Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Maria Isabel Fiel
- Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Ippolito Modica
- Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Wen Fan
- Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Nebras Zeizafoun
- Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Celina Ang
- Division of Hematology and Medical OncologyIcahn School of Medicine at Mount SinaiNew YorkUSA
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Raza R, Matloob A, Mahabir R, Modica I. 225 Utility of PAX8 and PAX2 in Renal and Urothelial Cancers; Is PAX2 Necessary? Am J Clin Pathol 2018. [DOI: 10.1093/ajcp/aqx123.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chugh RK, Olorunnisomo V, Fowle EJ, Modica I, Meisels I, Gupta M. Renal Papillary Necrosis Caused by Protein C Deficiency Leading to Recurrent Hydronephrosis. J Endourol Case Rep 2016; 2:36-7. [PMID: 27579411 PMCID: PMC4996589 DOI: 10.1089/cren.2016.0018] [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] [Indexed: 11/20/2022] Open
Abstract
A patient with history of a solitary functioning kidney and protein C deficiency (PCD) presented with recurrent severe hydronephrosis causing acute kidney injury upon chronic kidney disease. Work-up with endoscopic evaluation revealed renal papillary necrosis (RPN) and sloughed renal papillae to be the true cause of the recurrent obstruction. Pathologic evaluation of the sloughed tissue confirmed the diagnosis of RPN. This is the first case reported in the literature illustrating the unique presentation of RPN in the setting of PCD.
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Affiliation(s)
- Rohit Kumar Chugh
- Department of Urology, Mount Sinai Health System , New York, New York
| | | | - Evan James Fowle
- Department of Pathology, Mount Sinai Health System , New York, New York
| | - Ippolito Modica
- Department of Pathology, Mount Sinai Health System , New York, New York
| | - Ira Meisels
- Department of Nephrology, Mount Sinai Health System , New York, New York
| | - Mantu Gupta
- Department of Urology, Mount Sinai Health System , New York, New York
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8
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Gan Q, Yi C, Modica I. Ovarian Metastasis of Breast Cancer Is Associated With Specific Characteristics. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Affiliation(s)
- Wendi Zhou
- St. Luke's-Roosevelt Hospital and Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ippolito Modica
- St. Luke's-Roosevelt Hospital and Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bruce Wenig
- St. Luke's-Roosevelt Hospital and Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chunhui Yi
- St. Luke's-Roosevelt Hospital and Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY
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Hu W, Feng Z, Modica I, Klimstra DS, Song L, Allen PJ, Brennan MF, Levine AJ, Tang LH. Gene Amplifications in Well-Differentiated Pancreatic Neuroendocrine Tumors Inactivate the p53 Pathway. Genes Cancer 2010; 1:360-368. [PMID: 20871795 DOI: 10.1177/1947601910371979] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine tumors (NETs) comprise a group of rare tumors derived from the diffuse neuroendocrine system or islet endocrine cells of the pancreas. The molecular mechanisms underlying NETs are largely unknown. The tumor suppressor p53 plays a critical role in maintaining genomic stability and tumor prevention. The p53 pathway is tightly regulated by a number of proteins, among which MDM2, MDM4, and WIP1 are key negative regulators of p53 protein levels or activity. Aberrant activation of these negative regulators can attenuate the p53 function that serves as an important mechanism of tumorigenesis. In this study, several genetic alterations in pancreatic NETs were studied. These tumors exhibit various chromosomal aberrations throughout the whole genome as examined by array-based comparative genomic hybridization. Although p53 mutations are rare in NETs (<3%), this study presents evidence that the p53 pathway is altered in pancreatic NETs through aberrant activation of its negative regulators. A high percentage of pancreatic NETs contain extra gene copies of MDM2 (22%), MDM4 (30%), and WIP1 (51%), which are correlated with expression of corresponding mRNAs and proteins. In addition, there is a higher frequency (23% v. 15% in the control population) of the G/G genotype of MDM2 SNP309, a functional single-nucleotide polymorphism in the MDM2 gene that attenuates the function of the p53 protein. Overall, approximately 70% of pancreatic NETs have one or more of these genetic changes. These findings suggest that the negative regulation of p53 function could be an important mechanism for the initiation and/or progression of pancreatic NETs, and reactivation of p53 could be a potential therapeutic strategy for patients with this disease.
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Affiliation(s)
- Wenwei Hu
- Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA
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11
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Modica I, Soslow RA, Black D, Tornos C, Kauff N, Shia J. Utility of immunohistochemistry in predicting microsatellite instability in endometrial carcinoma. Am J Surg Pathol 2007; 31:744-51. [PMID: 17460459 DOI: 10.1097/01.pas.0000213428.61374.06] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Identification of the microsatellite instability (MSI) phenotype in endometrial carcinoma is important given that such tumors are the most common noncolorectal tumors to occur in hereditary nonpolyposis colorectal cancer syndrome, and may bear prognostic relevance. The objective of this study was to assess the utility of immunohistochemistry (IHC), a simple and fast technique, in detecting MSI in endometrial carcinoma. The study subjects consisted of 90 endometrial carcinoma patients with equal representation of MSI-high (MSI-H) and non-MSI-H tumors. MSI was tested using the standard polymerase chain reaction-based method and the 5 NCI-recommended markers. Overall, IHC with MLH1 and MSH2 antibodies detected 69% of MSI-H tumors with a specificity of 100%. Adding PMS2 and MSH6 to the antibody panel increased the sensitivity to 91% but decreased the specificity to 83%. The most common IHC abnormality in MSI tumors was concurrent loss of MLH1/PMS2. Assessment of staining was straightforward in most cases but not in all. Staining inadequacies existed. Five stains (4 MLH1 and 1 MSH6) were not interpretable because of the lack of any internal positive control. Two percent to 10% of the cases (depending on the antibody assessed) had only focal weak staining; the highest frequency (10%) occurred with MLH1 antibody. PMS2 staining detected 7 MLH1-staining present MSI-H cases, thus partly accounting for the increased sensitivity with the 4-antibody panel. MSH6 staining identified 9 cases with loss of MSH6 alone, 6 of 9 were non-MSI-H, thus partly accounting for the decreased specificity with the 4-antibody panel. In conclusion, our results suggest that IHC is useful in detecting MSI in endometrial carcinoma. Although IHC has a lower sensitivity with more apparent staining inadequacies in detecting MSI in endometrial carcinoma than it does in colorectal carcinoma, its use in endometrial carcinoma may be an important adjunct when screening for hereditary cases. In the future, as prognostic and therapeutic implications of MSI phenotype become better defined, it may be reasonable to perform IHC for mismatch repair proteins in large numbers of endometrial carcinomas.
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Affiliation(s)
- Ippolito Modica
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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12
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Kebria M, Black D, Borelli C, Modica I, Hensley M, Chi DS. Primary retroperitoneal lymphangioleiomyomatosis in a postmenopausal woman: a case report and review of the literature. Int J Gynecol Cancer 2007; 17:528-32. [PMID: 17362325 DOI: 10.1111/j.1525-1438.2007.00785.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 11/27/2022] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare progressive disease of unknown etiology that typically affects women of childbearing age. It is characterized by an abnormal proliferation of smooth muscle cells causing gradual obstruction of small airways, frequently resulting in respiratory failure and death. While LAM is predominantly a lung disorder, we report a case of retroperitoneal LAM in a patient who had no evidence of pulmonary involvement. A 59-year-old female presented with postmenopausal bleeding and no other complaints. She was found to have a low attenuation retroperitoneal mass on abdominal and pelvic computed tomography (CT) scan suspicious for lymphoma. CT-guided biopsy was nondiagnostic. Laparoscopic resection of some of the enlarged retroperitoneal lymph nodes confirmed the diagnosis of LAM. This case is an atypical presentation of LAM. The disease typically presents in premenopausal women, with the initial site of involvement being the lungs and mediastinum. In rare cases, such as this of extrapulmonary LAM, patients typically present with a palpable abdominal mass, abdominal pain, or chylous ascites. As in our case, radiographic findings can mimic malignancies such as lymphoma. Laparoscopic lymph node biopsy is a valuable tool in these situations of diagnostic dilemma.
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Affiliation(s)
- M Kebria
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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dos Santos LA, Modica I, Flores RM, D'Angelica M, Aghajanian C, Chi DS, Abu-Rustum NR. En bloc resection of diaphragm with lung for recurrent ovarian cancer: A case report. Gynecol Oncol 2006; 102:596-8. [PMID: 16782176 DOI: 10.1016/j.ygyno.2006.03.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 02/17/2006] [Revised: 03/20/2006] [Accepted: 03/21/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Multiple series have demonstrated the feasibility of full-thickness diaphragm resection for ovarian cancer metastatic to the diaphragm. However, direct extension of tumor into the lung is sometimes encountered, and successful resection of this type of implant has not been previously described in the gynecologic oncology literature. CASE REPORT We present the first case of en bloc full-thickness diaphragm resection including a portion of lung tissue using the EndoGIA stapler with primary diaphragmatic closure. DISCUSSION En bloc full-thickness diaphragm resection including a portion of lung tissue using the EndoGIA stapler is a safe, feasible, and effective method to optimize cytoreduction with disease-free margins in the context of invasive diaphragmatic ovarian cancer metastasis.
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Affiliation(s)
- Lisa A dos Santos
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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