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Srivastava S, Kak I, Major P, Bonert M. What is your count? An observational study of lymph node counting in 2,028 colorectal cancer resections. PLoS One 2024; 19:e0295209. [PMID: 38329946 PMCID: PMC10852306 DOI: 10.1371/journal.pone.0295209] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/20/2023] [Accepted: 11/15/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Lymph node status and lymph node count (LNC) are predictors of colorectal cancer outcome. Under-sampling of lymph nodes may lead to clinically relevant stage migration. METHODS Colorectal cancer (CRC) cases with a synoptic report, accessioned 2012-2020 at a regional laboratory, were extracted and retrospectively studied. LNC, positive lymph node count (PLNC), tumour deposits present (TDpos), and 'y' (staging) prefix (YS) were retrieved and tabulated by pathologist using custom software. Statistical analyses were done with R. DATA AND RESULTS The cohort had 2,543 CRC resections. Seventeen pathologists interpreted >50 cases (range: 56-356) each and collectively saw 2,074. After cases with unavailable data were purged, 2,028 cases remained with 43,996 lymph nodes, of which 2,637/43,996 were positive. 368 cases had a 'y' prefix, and 379 had TDpos. The 17 pathologists' median LNC/case was 19.0 (range: 14.0-24.0), and the mean PLNC per case was 1.4 (range: 1.0-2.0). Kruskal-Wallis rank sum tests showed there were differences in LNC (p<0.001) among pathologists; however, PLNC did not show this association (p = 0.2917). T-tests showed that mean LNC (p<0.001) and PLNC (p<0.035) differed between YS. 138 of 2,028 cases had less than the 12 LNC target. Logistic regression revealed a strong association between meeting the LNC target and pathologist (p<0.001) but TDpos was non-predictive (p = 0.4736). CONCLUSIONS Positive lymph node call rate has a good consistency in the laboratory; however, lymph node count varies significantly between pathologists. Standardized counting criteria are needed to improve uniformity and could be aided by synoptic reporting data.
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Affiliation(s)
- Shivali Srivastava
- Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Ipshita Kak
- Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Pierre Major
- Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Michael Bonert
- Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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2
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Fuoco J, Dong M, MacMillan C, Kak I, Perez-Ordonez B, Bradley G, Xu W, Magalhaes M. A 10-Year Review of Intraoral Salivary Gland Tumor Diagnoses: Diagnostic Challenges and Inter-Observer Agreement. Head Neck Pathol 2023; 17:193-203. [PMID: 36171535 PMCID: PMC10063724 DOI: 10.1007/s12105-022-01487-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Salivary gland tumors (SGT) are a diverse group of neoplasms arising from the major and minor glands. The oral cavity is the most common site for minor SGT (IMSGT), and these lesions frequently pose a challenge to the pathologist due to overlapping histopathological features and limited material for analysis. Our objective was to determine specific clinical and histopathological features associated with challenges in IMSGT diagnoses and pathologists' agreement. METHODS We conducted a retrospective analysis of 248 IMSGT received between 2010 and 2019. We evaluated the diagnostic challenge of the cases by stratifying according to whether a definitive, favored, or indeterminate (challenging) diagnosis was provided. Inter-observer agreement and concordance of biopsy diagnoses with the final diagnoses after tumor resection were evaluated. RESULTS Of the 248 biopsies, 191 had a definitive diagnosis, 38 favored diagnoses, and 19 were indeterminate. The predominant diagnoses considered for the indeterminate category were pleomorphic adenoma/myoepithelioma (PA), polymorphous adenocarcinoma (PAC), adenoid cystic carcinoma (AdCC), and low-grade adenocarcinoma. Using multivariate analysis of clinical features, younger patient age, smaller tumor size, and larger biopsy size increased the likelihood of a definitive diagnosis (p = 0.014, p = 0.037, p = 0.012). The inter-observer agreement for 68 representative cases was moderate overall (Fleiss's Kappa 0.575) and good for the 40 cases with a definitive diagnosis (Fleiss's Kappa 0.66). Sixty-five biopsy diagnoses were matched with corresponding tumor resection diagnoses and found to show a good concordance (Cramer's V test 0.76). The discordant diagnoses predominantly involved PA, carcinoma exPA, PAC, AdCC, and adenocarcinoma NOS. CONCLUSION Diagnostic challenges in IMSGT incisional biopsies were infrequent, especially if multiple pathologists were consulted. PA, PAC, AdCC, and adenocarcinoma NOS were the histologic types more commonly posing diagnostic challenges. Younger patient age, smaller tumor size, and larger biopsy are associated with a definitive diagnosis. This data highlights the importance of appropriate sampling in IMSGT.
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Affiliation(s)
- Jessie Fuoco
- Oral & Maxillofacial Pathology & Oral Medicine, University of Toronto, 457-124 Edward Street, M5G 1G6, Toronto, ON, Canada
| | - Mei Dong
- Department of Biostatistics, University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Christina MacMillan
- Department of Laboratory Medicine & Pathobiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ipshita Kak
- Department of Laboratory Medicine & Pathobiology, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Bayardo Perez-Ordonez
- Department of Laboratory Medicine & Pathobiology, University Health Network, Toronto, ON, Canada
| | - Grace Bradley
- Oral & Maxillofacial Pathology & Oral Medicine, University of Toronto, 457-124 Edward Street, M5G 1G6, Toronto, ON, Canada
- Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Wei Xu
- Department of Biostatistics, University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Marco Magalhaes
- Oral & Maxillofacial Pathology & Oral Medicine, University of Toronto, 457-124 Edward Street, M5G 1G6, Toronto, ON, Canada.
- Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Muacevic A, Adler JR, Jalilzadeh Afshari S, Kak I, Alowami S. Gastric Schwannoma as an Important and Infrequent Differential Diagnosis of Gastric Mesenchymal Tumours: A Case Report and Review of Literature. Cureus 2022; 14:e32112. [PMID: 36601161 PMCID: PMC9805384 DOI: 10.7759/cureus.32112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
The spectrum for gastrointestinal tract mesenchymal tumours includes leiomyomas, leiomyosarcomas, gastrointestinal stromal tumours (GISTs) and schwannomas. Schwannomas (also known as neuroma, neurilemmomas or neurinomas of Verocay) are well-known slow-growing, benign neoplasms that originate from nerve plexuses within a Schwann cell sheath. They can arise anywhere along the course of the peripheral nerve and are frequently reported around the head and neck, brachial plexus and along the gastrointestinal tract. Usually, these tumours are detected as solitary; however, they can occur at multiple sites around the body. Schwannomatosis (multiple schwannomas) is usually associated with neurofibromatosis type 2; the pathogenesis is triggered by mutations of the neurofibromatosis 2 tumour suppressor gene resulting in a loss of its function. Solitary gastric schwannomas are rare lesions that arise from the nerve plexus of the gastric wall. Frequently they are detected incidentally or may present with nonspecific abdominal pain or bleeding. This paper reports the case of a 79-year-old patient diagnosed with gastric schwannoma after presenting with abdominal pain. Gastric schwannomas should be taken into consideration while making a differential diagnosis of lesions that are gastric mesenchymal tumours, which span a broad spectrum. Gastric schwannomas are typically benign, considerably less common than gastric GISTs, and have an excellent prognosis following excision.
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Shivji S, Kak I, Reid SL, Muir J, Hafezi-Bakhtiari S, Li-Chang H, Deliallisi A, Newell KJ, Grin A, Conner J, Kirsch R. Feasibility and Performance of Elastin Trichrome as a Primary Stain in Colorectal Cancer Resection Specimens: Results of an Interobserver Variability Study. Am J Surg Pathol 2021; 45:1419-1427. [PMID: 33756495 DOI: 10.1097/pas.0000000000001707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Venous invasion (VI) is a powerful prognostic factor in colorectal cancer (CRC) that is widely underreported. The ability of elastin stains to improve VI detection is now recognized in several international CRC pathology protocols. However, concerns related to the cost and time required to perform and evaluate these stains in addition to routine hematoxylin and eosin (H&E) stains remains a barrier to their wider use. We therefore sought to determine whether an elastin trichrome (ET) stain could be used as a "stand-alone" stain in CRC resections, by comparing the sensitivity, accuracy, and reproducibility of detection of CAP-mandated prognostic factors using ET and H&E stains. Representative H&E- and ET-stained slides from 50 CRC resections, including a representative mix of stages and prognostic factors, were used to generate 2 study sets. Each case was represented by H&E slides in 1 study set and by corresponding ET slides from the same blocks in the other study set. Ten observers (3 academic gastrointestinal [GI] pathologists, 4 community pathologists, 3 fellows) evaluated each study set for CAP-mandated prognostic factors. ET outperformed H&E in the assessment of VI with respect to detection rates (50% vs. 28.6%; P<0.0001), accuracy (82% vs. 59%, P<0.0001), and reproducibility (k=0.554 vs. 0.394). No significant differences between ET and H&E were observed for other features evaluated. In a poststudy survey, most observers considered the ease and speed of assessment at least equivalent for ET and H&E for most prognostic factors, and felt that ET would be feasible as a stand-alone stain in practice. If validated by others, our findings support the use of ET, rather than H&E, as the primary stain for the evaluation of CRC resections.
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Affiliation(s)
- Sameer Shivji
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Ipshita Kak
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Stephanie L Reid
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Jennifer Muir
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Sara Hafezi-Bakhtiari
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
- Lakeridge Health, Oshawa
| | | | | | | | - Andrea Grin
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - James Conner
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Richard Kirsch
- Mount Sinai Hospital
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
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Bonert M, Zafar U, Maung R, El-Shinnawy I, Kak I, Cutz JC, Naqvi A, Juergens RA, Finley C, Salama S, Major P, Kapoor A. Evolution of anatomic pathology workload from 2011 to 2019 assessed in a regional hospital laboratory via 574,093 pathology reports. PLoS One 2021; 16:e0253876. [PMID: 34185808 PMCID: PMC8241038 DOI: 10.1371/journal.pone.0253876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Quantify changes in workload in relation to the anatomic pathologist workforce. METHODS In house pathology reports for cytology and surgical specimens from a regional hospital laboratory over a nine- year period (2011-2019) were analyzed, using custom computer code. Report length for the diagnosis+microscopic+synoptic report, number of blocks, billing classification (L86x codes), billings, national workload model (L4E 2018), regional workload model (W2Q), case count, and pathologist workforce in full-time equivalents (FTEs) were quantified. Randomly selected cases (n = 1,100) were audited to assess accuracy. RESULTS The study period had 574,093 pathology reports that could be analyzed. The coding accuracy was estimated at 95%. From 2011 to 2019: cases/year decreased 6% (66,056 to 61,962), blocks/year increased 20% (236,197 to 283,751), L4E workload units increased 23% (165,276 to 203,894), W2Q workload units increased 21% (149,841 to 181,321), report lines increased 19% (606,862 to 723,175), workforce increased 1% (30.42 to 30.77 FTEs), billings increased 13% ($6,766,927 to $7,677,109). W2Q in relation to L4E underweights work in practices with large specimens by up to a factor of 2x. CONCLUSIONS Work by L4E for large specimens is underrated by W2Q. Reporting requirements and pathology work-up have increased workload per pathology case. Work overall has increased significantly without a commensurate workforce increase. The significant practice changes in the pathology work environment should prompt local investment in the anatomic pathology workforce.
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Affiliation(s)
- Michael Bonert
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Uzma Zafar
- Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Raymond Maung
- Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ihab El-Shinnawy
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ipshita Kak
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Claude Cutz
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Asghar Naqvi
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Christian Finley
- Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Samih Salama
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pierre Major
- Medical Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Anil Kapoor
- Urology, McMaster University, Hamilton, Ontario, Canada
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Ajisebutu A, Kak I, Thompson N, Honomichl R, Moul D, Mehra R, Shah V. 0906 Identification Of Physical Exam Findings With High Predictive Value For Moderate To Severe Pediatric Obstructive Sleep Apnea(osa) In Overweight/obese Children. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.902] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Obstructive sleep apnea(OSA) is highly prevalent and under-diagnosed in the overweight/obese pediatric population largely due to limitations of existing pediatric OSA screening instruments including lack of efficiency and practical implementation and lack of careful consideration of physical examination(PE) findings with high predictive value for OSA. We sought to identify PE finding(s) predictive of pediatric OSA in overweight/obese patients to inform development of an OSA screening tool.
Methods
Overweight/obese patients presenting to the Cleveland Clinic weight-management clinic between 2013-2018 with polysomnogram (PSG) data were included. The association of PE predictors: age, sex, race (white, black, other), neck (NC), waist circumference (WC), tonsil size (TS), height, systolic and diastolic blood pressure (BP) percentiles) in relation to OSA defined by apnea-hypopnea index (AHI)≥5,i.e. clinically significant pediatric OSA, were assessed using univariate and multivariate logistic regression models (OR,95%CI).
Results
Retrospective analysis of 180 overweight/obese patients (BMI percentile>85th for age and sex) and age 12.5±3.7 years were included. The multivariate model showed that only WC was significantly associated (1.03, 1.00 - 1.07, p=0.038) with OSA defined as AHI≥5. A statistically significant interaction of age and sex was observed such that the likelihood of OSA increased in males with older age and conversely decreased in females with older age. (1.26,1.04 -1.52, p=0.038) The reduced multivariate model, which included age, sex, WC, and age*sex interaction term, correctly discriminated AHI <5 vs. ≥ 5 66.5% of the time.
Conclusion
In this large clinic-based overweight/obese pediatric sample, males, older age and WC were significant predictors of OSA and TS was not. A significant interaction of age and sex was observed supporting increased OSA with increasing age in males. Data generated supports value of PE findings of age, sex and WC to incorporate in development of an OSA screening tool for overweight/obese children.
Support
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Affiliation(s)
- A Ajisebutu
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - I Kak
- Department of Pediatrics, Cleveland Clinic, Cleveland, OH
| | - N Thompson
- Section of Biostatistics, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - R Honomichl
- Section of Biostatistics, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - D Moul
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - R Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - V Shah
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
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7
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Donovan EK, Corbett T, Vansantvoort J, Kak I, Popvic S, Heller B. Radical chest wall resection and hyperfractionated accelerated radiotherapy for radiation-associated angiosarcoma of the breast: A safe and effective treatment strategy. Breast J 2017; 24:245-252. [PMID: 28845531 DOI: 10.1111/tbj.12886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/27/2022]
Abstract
Radiation-associated angiosarcomas (RAS) of the breast are vascular tumors arising in a previous radiation field for primary breast cancer. They occur rarely but confer a high probability of local recurrence (LR) and poor prognosis. A wide range of treatment strategies exists due to limited evidence, and although resection is the definitive treatment, LR rates remain high. It has been suggested hyperfractionated accelerated radiotherapy (HART) has the potential to prevent LR. The sarcoma group at the Juravinski Cancer Centre (JCC) reports our experience of nine patients treated with radical resection and adjuvant HART. This is one of the largest reported cohorts we are aware of to receive this treatment. The JCC pathologic data base was reviewed between the year 2006-2015 for patients with RAS. Patients who received radical surgery and immediate HART were eligible. Patients underwent radical chest wall resection and en bloc mastectomy. Radiotherapy was then delivered to 4500 cGy in 45 fractions three times daily using parallel opposed photon beams and electron patching, or volumetric modulated arc therapy. Primary outcome was recurrence-free survival in months, and records were reviewed for descriptive reports of toxicity. We compared our results to other institutions experience with surgery alone or other adjuvant therapies. Median follow-up was 19 months (range 3-41 months). One of nine patients developed LR and developed metastasis, one died of other causes, and seven are alive with no recurrent disease. There were seven reports of mild skin toxicity during treatment. One patient developed chronic wound healing complications which eventually resolved and one patient developed asymptomatic radiation osteitis of a rib. On the basis of our experience at the JCC, we recommend treatment with radical chest wall resection and adjuvant HART to prevent recurrence in RAS patients. As demonstrated in our patients, the large normal tissue volume irradiated is tolerable with in combination with small fraction sizes, and no major toxicities were seen. Further investigation into adjuvant therapy regimens and prospective studies are required to reach consensus on optimal treatment for this disease.
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Affiliation(s)
- Elysia K Donovan
- Department of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Thomas Corbett
- Department of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Ipshita Kak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Snezana Popvic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Barbara Heller
- Department of Surgery, Division of Surgical Oncology, McMaster University, Hamilton, ON, Canada
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Kak I, Sadikovic B, Pare G, Corbett T, Popovic S. Abstract 521: c-MYC as a differentiating marker between angiosarcoma and atypical vascular lesion. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-521] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Angiosarcoma is a rare, aggressive malignancy that accounts for less than 1% of all sarcomas, characterized by a dismal 5 year survival of 20-30% at best. In striking contrast, atypical vascular lesion (AVL), which typically occurs secondary to radiation, follows for the most part, a benign course. However, debate rages over the true nature of AVL with reports describing both benign and malignant behavior. Further compounding the issue is the fact that overlapping histological features make the important differentiation between AVL and angiosarcoma difficult, especially on limited biopsy specimens. There have been a number of recent studies of c-MYC expression in vascular tumors in relation to this question, yielding varied results.
Objectives: This pilot study aimed to investigate c-MYC expression in atypical vascular lesions and angiosarcomas (primary and secondary) to evaluate the clinical utility of c-MYC testing as an adjunct to the histological diagnosis.
Methods: A retrospective search for biopsy, resection specimens and internal consult cases with diagnosis of angiosarcoma and/or atypical vascular lesion from January 2008- February 2014 was performed. A total of 32 cases (including controls) obtained after review were stained by dual colour c-MYC copy number probe set. The expression of c-MYC was read by two independent evaluators and final data was collated along with histology findings, follow-up and survival data.
Results: c-MYC amplification was found to be a major differentiating factor (p value: 0.00002, 68% sensitivity, 96% specificity) between AVL and angiosarcoma(median c-MYC expression 1.0 vs. 12.14, 95% confidence interval: 0.8-1.9 vs. 9.2-22.3 respectively). The amplification levels of primary (median c-MYC expression:10.9, 95% confidence interval: 3.8-16.6) and secondary angiosarcoma (median c-MYC expression:13.2, 95% confidence interval: 9.0-25.5) were statistically not found to be significantly different (p = 0.07). Although no correlation was found between level of c-MYC amplification and outcome, the study was underpowered to accurately evaluate this relation.
Conclusion: Amplification of c-MYC can be used as a reliable ancillary test to differentiate between diagnostically challenging cases of angiosarcoma and AVL.
Citation Format: Ipshita Kak, Bekim Sadikovic, Guillaume Pare, Tom Corbett, Snezana Popovic. c-MYC as a differentiating marker between angiosarcoma and atypical vascular lesion. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 521.
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Affiliation(s)
- Ipshita Kak
- 1McMaster University, Hamilton, Ontario, Canada
| | - Bekim Sadikovic
- 2Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Guillaume Pare
- 3David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
| | - Tom Corbett
- 4Juravinski Cancer Center, Hamilton, Ontario, Canada
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Kak I, Salama S, Gohla G, Naqvi A, Alowami S. A Case of Patch Stage of Kaposi's Sarcoma and Discussion of the Differential Diagnosis. Rare Tumors 2016; 8:6123. [PMID: 27134709 PMCID: PMC4827646 DOI: 10.4081/rt.2016.6123] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/16/2015] [Accepted: 11/28/2015] [Indexed: 12/03/2022] Open
Abstract
A 55 year old HIV positive male had a skin lesion biopsy which showed atypical vascular proliferation within the superficial and deep dermis with mild atypia of lining endothelial cells. A sparse lymphoplasmacytic infiltrate surrounding the irregular vascular channels was noted. Immunohistochemistry highlighted the atypical blood vessels with the vascular markers CD31, CD34 and Factor VIII. The differential diagnosis included unusual vascular or lymphatic proliferations, stasis dermatitis, kaposiform hemangioendothelioma, progressive lymphangioma and angiosarcoma with focal Kaposi’s sarcoma features. Characteristic human herpes virus-8 positive staining helped support the diagnosis of patch stage of Kaposi’s sarcoma. Herein, we discuss the case findings, differential diagnosis and characteristic histological findings associated with the patch stage of Kaposi’s sarcoma which can be an elusive diagnosis.
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Affiliation(s)
- Ipshita Kak
- Department of Pathology and Molecular Medicine, McMaster University , Hamilton, ON, Canada
| | - Samih Salama
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Gabriella Gohla
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Asghar Naqvi
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Salem Alowami
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
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10
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Gusenbauer K, Ruzhynsky V, Kak I, Adili AF, Giedraitis K, Popovic S, Kapoor A. Angiosarcoma of the adrenal gland with concurrent contralateral advanced renal cell carcinoma: A diagnostic and management dilemma. Can Urol Assoc J 2015; 9:E302-5. [PMID: 26029301 DOI: 10.5489/cuaj.2322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Angiosarcoma is a rare high-grade malignant neoplasm with poor clinical outcome and survival rates, occurring most commonly in the skin and soft tissue. It is composed of neoplastic cells that demonstrate endothelial differentiation. The diagnosis of angiosarcoma can be difficult due to its pathohistologic presentation as a poorly differentiated neoplasm with associated secondary changes. We report a case of angiosarcoma of the adrenal gland with concurrent contralateral renal cell carcinoma (RCC) and renal vein thrombus. The presumptive clinical diagnosis was metastatic renal cell carcinoma to the contralateral adrenal gland. Pathohistologic evaluation demonstrated massive hematoma associated with intravascular papillary endothelial hyperplasia (IPEH)-like features. We discuss the pathohistological features used to ascertain a diagnosis of angiosarcoma in the presence of IPEH-like changes and differentiate it from reactive vascular proliferation seen in IPEH (Masson's tumour).
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Affiliation(s)
- Kaela Gusenbauer
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
| | - Vladimir Ruzhynsky
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
| | - Ipshita Kak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
| | - Anthony F Adili
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
| | - Kyle Giedraitis
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
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Kaur J, Matta A, Kak I, Srivastava G, Assi J, Leong I, Witterick I, Colgan TJ, Macmillan C, Siu KWM, Walfish PG, Ralhan R. S100A7 overexpression is a predictive marker for high risk of malignant transformation in oral dysplasia. Int J Cancer 2013; 134:1379-88. [PMID: 24122701 DOI: 10.1002/ijc.28473] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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: 12/01/2012] [Revised: 08/10/2013] [Accepted: 08/21/2013] [Indexed: 12/14/2022]
Abstract
Early detection of oral lesions (OLs) at high risk of cancer development is of utmost importance for intervention. There is an urgent unmet clinical need for biomarkers that allow identification of high-risk OLs. Recently, we identified and verified a panel of five candidate protein biomarkers namely S100A7, prothymosin alpha, 14-3-3ζ, 14-3-3σ and heterogeneous nuclear ribonucleoprotein K using proteomics to distinguish OLs with dysplasia and oral cancers from normal oral tissues. The objective of our study was to evaluate the potential of these candidate protein biomarkers for identification of oral dysplastic lesions at high risk of cancer development. Using immunohistochemistry, we analyzed expressions of these five candidate protein biomarkers in 110 patients with biopsy-proven oral dysplasia and known clinical outcome and determined their correlations with p16 expression and HPV 16/18 status. Kaplan-Meier survival analysis showed reduced oral cancer-free survival (OCFS) of 68.6 months (p = 0.007) in patients showing cytoplasmic S100A7 overexpression when compared to patients with weak or no S100A7 immunostaining in cytoplasm (mean OCFS = 122.8 months). Multivariate Cox regression analysis revealed cytoplasmic S100A7 overexpression as the most significant candidate marker associated with cancer development in dysplastic lesions (p = 0.041, hazard ratio = 2.36). In conclusion, our study suggested the potential of S100A7 overexpression in identifying OLs with dysplasia at high risk of cancer development.
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Affiliation(s)
- Jatinder Kaur
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, ON, Canada
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12
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Chaker S, Kashat L, Voisin S, Kaur J, Kak I, MacMillan C, Ozcelik H, Michael Siu KW, Ralhan R, Walfish PG. Secretome proteins as candidate biomarkers for aggressive thyroid carcinomas. Proteomics 2013; 13:771-87. [DOI: 10.1002/pmic.201200356] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/15/2012] [Accepted: 12/10/2012] [Indexed: 12/28/2022]
Affiliation(s)
- Seham Chaker
- Alex and Simona Shnaider Laboratory in Molecular Oncology; Samuel Lunenfeld Research Institute; Mount Sinai Hospital; Toronto ON Canada
- Institute of Medical Science; University of Toronto; Toronto ON Canada
| | - Lawrence Kashat
- Alex and Simona Shnaider Laboratory in Molecular Oncology; Samuel Lunenfeld Research Institute; Mount Sinai Hospital; Toronto ON Canada
| | - Sebastien Voisin
- Department of Chemistry and Centre for Research in Mass Spectrometry; York University; Toronto ON Canada
| | - Jatinder Kaur
- Alex and Simona Shnaider Laboratory in Molecular Oncology; Samuel Lunenfeld Research Institute; Mount Sinai Hospital; Toronto ON Canada
| | - Ipshita Kak
- Alex and Simona Shnaider Laboratory in Molecular Oncology; Samuel Lunenfeld Research Institute; Mount Sinai Hospital; Toronto ON Canada
| | - Christina MacMillan
- Department of Pathology & Laboratory Medicine; Mount Sinai Hospital; Toronto ON Canada
| | - Hilmi Ozcelik
- Samuel Lunenfeld Research Institute; Mount Sinai Hospital L6-303; Toronto ON Canada
| | - K. W. Michael Siu
- Department of Chemistry and Centre for Research in Mass Spectrometry; York University; Toronto ON Canada
| | - Ranju Ralhan
- Alex and Simona Shnaider Laboratory in Molecular Oncology; Samuel Lunenfeld Research Institute; Mount Sinai Hospital; Toronto ON Canada
- Institute of Medical Science; University of Toronto; Toronto ON Canada
- Department of Pathology & Laboratory Medicine; Mount Sinai Hospital; Toronto ON Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases; Department of Otolaryngology-Head and Neck Surgery Program; Mount Sinai Hospital; Toronto ON Canada
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto ON Canada
| | - Paul G. Walfish
- Alex and Simona Shnaider Laboratory in Molecular Oncology; Samuel Lunenfeld Research Institute; Mount Sinai Hospital; Toronto ON Canada
- Institute of Medical Science; University of Toronto; Toronto ON Canada
- Department of Pathology & Laboratory Medicine; Mount Sinai Hospital; Toronto ON Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases; Department of Otolaryngology-Head and Neck Surgery Program; Mount Sinai Hospital; Toronto ON Canada
- Department of Medicine; Endocrine Division; Mount Sinai Hospital and University of Toronto Medical School; Toronto ON Canada. Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto ON Canada
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Chaker S, Kak I, MacMillan C, Ralhan R, Walfish PG. Activated leukocyte cell adhesion molecule is a marker for thyroid carcinoma aggressiveness and disease-free survival. Thyroid 2013; 23:201-8. [PMID: 23148625 DOI: 10.1089/thy.2012.0405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 12/15/2022]
Abstract
BACKGROUND Currently, there are no protein biomarkers for aggressive subtypes of thyroid carcinomas (TC) in clinical use that would allow for early detection and patient management. We hypothesized that activated leukocyte cell adhesion molecule (ALCAM or CD166) expression in thyroid tissues will reveal ALCAM to be a potential diagnostic and/or prognostic marker for TC aggressiveness. METHODS Forty-five benign and 158 malignant thyroid tissues were analyzed for ALCAM expression using immunohistochemistry. ALCAM expression was correlated with different subtypes and clinicopathological features of TC, as well as patient disease-free survival. RESULTS Combined membranous and cytoplasmic (total) expression of ALCAM was significantly reduced in patients with poorly/undifferentiated (aggressive) TC as compared to well-differentiated (nonaggressive) tumors (p<0.001; area-under-curve=0.865, sensitivity=82%, specificity=74%). The decreased ALCAM expression in TC correlated significantly with extrathyroidal extension, distant metastasis, and TC histotype. Notably, Kaplan-Meier survival analysis for follow-up data of 134 patients revealed significantly reduced disease-free survival for patients with TC with decreased ALCAM membranous, cytoplasmic, and total expression. Median survival of patients with decreased cytoplasmic ALCAM expression was 6 years, as compared to 13.7 years for patients with higher ALCAM expression (p<0.001). CONCLUSION ALCAM has the potential to serve as a diagnostic and prognostic biomarker for aggressive TC. This protein can be taken forward for analysis in sera of patients with TC to determine its applicability as a minimally invasive serum biomarker for TC aggressiveness and patient disease-free survival.
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Affiliation(s)
- Seham Chaker
- Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Canada
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14
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Kunavisarut T, Kak I, Macmillan C, Ralhan R, Walfish PG. Immunohistochemical analysis based Ep-ICD subcellular localization index (ESLI) is a novel marker for metastatic papillary thyroid microcarcinoma. BMC Cancer 2012; 12:523. [PMID: 23153310 PMCID: PMC3518100 DOI: 10.1186/1471-2407-12-523] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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: 06/27/2012] [Accepted: 11/09/2012] [Indexed: 11/27/2022] Open
Abstract
Background Thyroid cancer is among the fastest growing malignancies; almost fifty-percent of these rapidly increasing incidence tumors are less than or equal to 1cm in size, termed papillary thyroid microcarcinoma (PTMC). The management of PTMC remains a controversy due to differing natural history of these patients. Epithelial cell adhesion molecule (EpCAM) is comprised of an extracellular domain (EpEx), a single transmembrane domain and an intracellular domain (Ep-ICD). Our group reported nuclear Ep-ICD correlated with poor prognosis in thyroid cancer (Ralhan et al., BMC Cancer 2010,10:331). Here in, we hypothesized nuclear and cytoplasmic accumulation of Ep-ICD and loss of membranous EpEx may aid in distinguishing metastatic from non-metastatic PTMC, which is an important current clinical challenge. To test our hypothesis, Ep-ICD and EpEx expression levels were analyzed in PTMC and the staining was correlated with metastatic potential of these carcinomas. Methods Thirty-six PTMC patients (tumor size 0.5 - 1cm; metastatic 8 cases and non-metastatic 28 cases) who underwent total thyroidectomy were selected. The metastatic group consisted of patients who developed lymph node or distant metastasis at diagnosis or during follow up. The patients’ tissues were stained for Ep-ICD and EpEx using domain specific antibodies by immunohistochemistry and evaluated. Results PTMC patients with metastasis had higher scores for nuclear and cytoplasmic Ep-ICD immunostaining than the patients without metastasis (1.96 ± 0.86 vs. 1.22 ± 0.45; p = 0.007 and 5.37 ± 0.33 vs. 4.72 ± 1.07; p = 0.016, respectively). Concomitantly, the former had lower scores for membrane EpEx than the non-metastatic group (4.64 ± 1.08 vs. 5.64 ± 1.51; p = 0.026). An index of aggressiveness, Ep-ICD subcellular localization index (ESLI), was defined as sum of the IHC scores for accumulation of nuclear and cytoplasmic Ep-ICD and loss of membranous EpEx; ESLI = [Ep − ICDnuc + Ep − ICDcyt + loss of membranous EpEx]. Notably, ESLI correlated significantly with lymph node metastasis in PTMC (p = 0.008). Conclusion Nuclear and cytoplasmic Ep-ICD expression and loss of membranous EpEx were found to correlate positively with metastasis in PTMC patients. In addition, ESLI had the potential to identify metastatic behavior in PTMC which could serve as a valuable tool for solving a current dilemma in clinical practice.
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Affiliation(s)
- Tada Kunavisarut
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology & Laboratory Medicine, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, 60 Murray Street, Suite L6-304, Toronto, ON, M5T 3L9, Canada
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He HCH, Kashat L, Kak I, Kunavisarut T, Gundelach R, Kim D, So AKC, MacMillan C, Freeman JL, Ralhan R, Walfish PG. An Ep-ICD based index is a marker of aggressiveness and poor prognosis in thyroid carcinoma. PLoS One 2012; 7:e42893. [PMID: 23049733 PMCID: PMC3458098 DOI: 10.1371/journal.pone.0042893] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/12/2012] [Indexed: 01/10/2023] Open
Abstract
Background Nuclear accumulation of the intracellular domain of epithelial cell adhesion molecule (Ep-ICD) in tumor cells was demonstrated to predict poor prognosis in thyroid carcinoma patients in our earlier study. Here, we investigated the clinical significance of Ep-ICD subcellular localization index (ESLI) in distinguishing aggressive papillary thyroid carcinoma (PTC) from non-aggressive cases. Methods Using domain specific antibodies against the intracellular (Ep-ICD) and extracellular (EpEx) domains of epithelial cell adhesion molecule, 200 archived tissues from a new cohort of patients with benign thyroid disease as well as malignant aggressive and non aggressive PTC were analyzed by immunohistochemistry (IHC). ESLI was defined as sum of the IHC scores for accumulation of nuclear and cytoplasmic Ep-ICD and loss of membranous EpEx; ESLI = [Ep-ICDnuc + Ep-ICDcyt + loss of membranous EpEx]. Results For the benign thyroid tissues, non-aggressive PTC and aggressive PTC, the mean ESLI scores were 4.5, 6.7 and 11 respectively. Immunofluorescence double staining confirmed increased nuclear Ep-ICD accumulation and decreased membrane EpEx expression in aggressive PTC. Receiver-operating characteristic (ROC) curve analysis showed an area under the curve (AUC) of 0.841, 70.2% sensitivity and 83.9% specificity for nuclear Ep-ICD for differentiating aggressive PTC from non-aggressive PTC. ESLI distinguished aggressive PTC from non-aggressive cases with improved AUC of 0.924, 88.4% sensitivity and 85.5% specificity. Our study confirms nuclear accumulation of Ep-ICD and loss of membranous EpEx occurs in aggressive PTC underscoring the potential of Ep-ICD and ESLI to serve as diagnostic markers for aggressive PTC. Kaplan Meier survival analysis revealed significantly reduced disease free survival (DFS) for ESLI positive (cutoff >10) PTC (p<0.05), mean DFS = 133 months as compared to 210 months for patients who did not show positive ESLI. Conclusion ESLI scoring improves the identification of aggressive PTC and thereby may serve as a useful index for defining aggressiveness and poor prognosis among PTC patients.
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Affiliation(s)
- Helen C.-H. He
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Lawrence Kashat
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ipshita Kak
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tada Kunavisarut
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Raefe Gundelach
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Medicine, Endocrine Division of Mount Sinai Hospital and University of Toronto Medical School, Toronto, Ontario, Canada
| | - Dae Kim
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Medicine, Endocrine Division of Mount Sinai Hospital and University of Toronto Medical School, Toronto, Ontario, Canada
| | - Anthony K.-C. So
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Christina MacMillan
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jeremy L. Freeman
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Medicine, Endocrine Division of Mount Sinai Hospital and University of Toronto Medical School, Toronto, Ontario, Canada
| | - Ranju Ralhan
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- * E-mail: (PGW); (RR)
| | - Paul G. Walfish
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Medicine, Endocrine Division of Mount Sinai Hospital and University of Toronto Medical School, Toronto, Ontario, Canada
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- * E-mail: (PGW); (RR)
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So AKC, Kaur J, Kak I, Assi J, MacMillan C, Ralhan R, Walfish PG. Biotinidase is a novel marker for papillary thyroid cancer aggressiveness. PLoS One 2012; 7:e40956. [PMID: 22911723 PMCID: PMC3402459 DOI: 10.1371/journal.pone.0040956] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/15/2012] [Indexed: 11/19/2022] Open
Abstract
Biotinidase was identified in secretome analysis of thyroid cancer cell lines using proteomics. The goal of the current study was to analyze the expression of biotinidase in thyroid cancer tissues and fine needle aspiration (FNA) samples to evaluate its diagnostic and prognostic potential in thyroid cancer. Immunohistochemical analysis of biotinidase was carried out in 129 papillary thyroid cancer (PTC, 34 benign thyroid tissues and 43 FNA samples and correlated with patients' prognosis. Overall biotinidase expression was decreased in PTC compared to benign nodules (p = 0.001). Comparison of aggressive and non-aggressive PTC showed decrease in overall biotinidase expression in the former (p = 0.001). Loss of overall biotinidase expression was associated with poor disease free survival (p = 0.019, Hazards ratio (HR) = 3.1). We examined the effect of subcellular compartmentalization of nuclear and cytoplasmic biotinidase on patient survival. Decreased nuclear expression of biotinidase was observed in PTC as compared to benign tissues (p<0.001). Upon stratification within PTC, nuclear expression was reduced in aggressive as compared to non-aggressive tumors (p<0.001). Kaplan-Meier survival analysis showed significant association of loss of nuclear biotinidase expression with reduced disease free survival (p = 0.014, HR = 5.4). Cytoplasmic biotinidase expression was reduced in aggressive thyroid cancers in comparison with non-aggressive tumors (p = 0.002, Odds ratio (OR) = 0.29) which was evident by its significant association with advanced T stage (p = 0.003, OR = 0.28), nodal metastasis (p<0.001, OR = 0.16), advanced TNM stage (p<0.001, OR = 0.21) and extrathyroidal extension (p = 0.001, OR = 0.23). However, in multivariate analysis extrathyroidal extension emerged as the most significant prognostic marker for aggressive thyroid carcinomas (p = 0.015, HR = 12.8). In conclusion, loss of overall biotinidase expression is a novel marker for thyroid cancer aggressiveness.
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Affiliation(s)
- Anthony K.-C. So
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario, Canada
| | - Jatinder Kaur
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario, Canada
| | - Ipshita Kak
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario, Canada
| | - Jasmeet Assi
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario, Canada
| | - Christina MacMillan
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario, Canada
| | - Ranju Ralhan
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario, Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- * E-mail: (PGW); (RR)
| | - Paul G. Walfish
- Alex and Simona Shnaider Laboratory in Molecular Oncology, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario, Canada
- Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- * E-mail: (PGW); (RR)
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Yip J, Orlov S, Orlov D, Vaisman A, Hernández KG, Etarsky D, Kak I, Parvinnejad N, Freeman JL, Walfish PG. Predictive value of metastatic cervical lymph node ratio in papillary thyroid carcinoma recurrence. Head Neck 2012; 35:592-8. [DOI: 10.1002/hed.23047] [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] [Accepted: 03/21/2012] [Indexed: 12/17/2022] Open
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