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Rammal R, Wasserman JK, Singhi AD, Griffith CC, Seethala RR. Glomangiosarcoma-like Anaplastic Transformation in Papillary Thyroid Carcinoma: A Novel Form of Heterologous Differentiation and a Systematic Review of Heterologous Element Prevalence. Endocr Pathol 2023; 34:471-483. [PMID: 37792156 DOI: 10.1007/s12022-023-09787-9] [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] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
Anaplastic thyroid carcinoma (ATC) demonstrates a wide variety of morphologies and is characteristically associated with a differentiated thyroid carcinoma component. Heterologous differentiation is a rare, potentially challenging phenomenon in ATC, mostly observed as osteosarcomatous or chondrosarcomatous differentiation. We now describe a novel 'glomangiosarcoma-like' differentiation, review our archival experience from two institutions (UPMC, CC), and perform a systematic review for the prevalence of heterologous elements in ATC. The patient is a 57-year-old female who presented with 4.5 cm left thyroid, and 3.4 cm neck masses. Histologically, the thyroid demonstrated a differentiated high grade papillary thyroid carcinoma, tall cell and hobnail/micropapillary subtypes transitioning into an anaplastic component with spindled to ovoid cells with hemangiopericytoma-like vasculature showing CD34 positivity, variable muscle marker expression and pericellular lace-like type IV collagen deposition. The neck mass consisted solely of the latter morphology. Targeted next-generation sequencing was performed on high grade DTC and adjacent ATC from the thyroid as well as ATC from the neck metastasis. All three components shared BRAFV600E, TERT promoter, and PIK3CA mutations confirming a clonal origin. Archival (UPMC: n = 150, CC: n = 74) and literature review showed no prior examples. Systematic review and meta-analysis of prevalence showed a baseline pooled prevalence (generalized linear mixed model) of heterologous elements of any type to be 1.6% (95% confidence interval: 1.0-2.6%) for studies where this was specifically addressed. ATC with glomangiosarcoma-like heterologous differentiation is a rarity among an already rare morphologic category with unique diagnostic pitfalls.
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Affiliation(s)
- Rayan Rammal
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Jason K Wasserman
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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2
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Al Zadjali F, Alsaffar H, Odell M, Wasserman JK, Tohme A, Johnson-Obaseki S. Base of the tongue hyalinizing clear cell carcinoma: Case report and literature review. SAGE Open Med Case Rep 2023; 11:2050313X231209670. [PMID: 37954542 PMCID: PMC10637156 DOI: 10.1177/2050313x231209670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Hyalinizing clear cell carcinoma is an uncommon neoplasm arising in minor salivary glands. We present a rare case of hyalinizing clear cell carcinoma in the base of the tongue. We report a case of a 38-year-old female presented with a progressive history of hemoptysis and dysphagia over the course of 4 years. Examination revealed a mass originating from the base of the tongue with a biopsy confirmed as hyalinizing clear cell carcinoma . An Ovid MEDLINE and PubMed literature review was conducted due to the rarity of this type of tumor. The patient underwent surgical excision with immediate reconstruction with radial forearm free flap followed with adjuvant radiotherapy and was disease free at her most recent follow-up (12 months). Our review included a total of 13 new cases, including our case. The majority of the cases presented with dysphagia. Surgical excision is the mainstay of treatment, and overall these patients have a good prognosis. Our case highlights a rare presentation of hyalinizing clear cell carcinoma of the base of the tongue, successfully treated with surgical excision, free tissue reconstruction and adjuvant radiotherapy.
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Affiliation(s)
- Fahad Al Zadjali
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Hussain Alsaffar
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Jason K Wasserman
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Angelina Tohme
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
- Department of Surgery and Department of ENT, The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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3
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Forse CL, Petkiewicz S, Teo I, Purgina B, Klaric KA, Ramsay T, Wasserman JK. Negative Impact of COVID-19 Associated Health System Shutdown on Patients Diagnosed With Colorectal Cancer: A Retrospective Study From a Large Tertiary Center in Ontario, Canada. J Can Assoc Gastroenterol 2022; 5:137-142. [PMID: 35664369 PMCID: PMC8754725 DOI: 10.1093/jcag/gwab044] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background In March 2020, a directive to halt all elective and non-urgent procedures was issued in Ontario, Canada because of COVID-19. The directive caused a temporary slowdown of screening programs including surveillance colonoscopies for colorectal cancer (CRC). Our goal was to determine if there was a difference in patient and tumour characteristics between CRC patients treated surgically prior to the COVID-19 directive compared to CRC patients treated after the slowdown. Methods CRC resections collected within the Champlain catchment area of eastern Ontario in the 6 months prior to COVID-19 (August 1, 2019-January 31, 2020) were compared to CRC resections collected in the 6 months post-COVID-19 slowdown (August 1, 2020-January 31, 2021). Clinical (e.g., gender, patient age, tumour site, and clinical presentation) and pathological (tumour size, tumour stage, nodal stage, and lymphovascular invasion) features were evaluated using chi-square tests, T-tests, and Mann-Whitney tests where appropriate. Results Three hundred and thirty-eight CRC specimens were identified (173 pre-COVID-19, 165 post-COVID-19 slowdown). CRC patients treated surgically post-COVID-19 slowdown had larger tumours (44 mm vs. 35 mm; P = 0.0048) and were more likely to have presented emergently (24% vs. 10%; P < 0.001). Although there was a trend towards higher tumour stage, nodal stage, and clinical stage, these differences did not reach statistical significance. Other demographic and pathologic variables including patient gender, age, and tumour site were similar between the two cohorts. Interpretation The COVID-19 slowdown resulted in a shift in the severity of disease experienced by CRC patients in Ontario. Pandemic planning in the future should consider the long-term consequences to cancer diagnosis and management.
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Affiliation(s)
- Catherine L Forse
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stephanie Petkiewicz
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Iris Teo
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Bibianna Purgina
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kristina-Ana Klaric
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jason K Wasserman
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
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Lafreniere A, Purgina B, Wasserman JK. Putting the patient at the centre of pathology: an innovative approach to patient education-MyPathologyReport.ca. J Clin Pathol 2020; 73:454-455. [PMID: 32107281 DOI: 10.1136/jclinpath-2019-206370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/23/2023]
Abstract
In many centres, patients now have access to their electronic medical record (EMR) and laboratory results, including pathology reports, are amongst the most frequently accessed pieces of information. The pathology report is an important but highly technical medical document that can be difficult for patient and clinicians alike to interpret. To improve communication and patient safety, pathologists are being called upon to play a more direct role in patient care. Novel approaches have been undertaken by pathologists to address this need, including the addition of patient-friendly summaries at the beginning of pathology reports and the development of patient education tools. MyPathologyReport.ca is a novel website exclusively providing pathology education to patients. It has been designed to help patients understand the language of pathology and to effectively navigate their pathology report. At present, the website includes over 150 diagnostic articles and over 125 pathology dictionary definitions. The diagnostic articles span all body sites and include a variety of malignant, benign and non-neoplastic conditions. Since its creation, this website has been visited over 14 000 times, with cancer-related diagnoses and definitions representing the most commonly accessed articles. This website has been embedded in patient accessible EMRs and shared through partnerships with patients, caregivers and their respective advocacy groups. Our next steps involve longitudinal assessment of MyPathologyReport.ca from non-medical community members, evaluation of patient satisfaction and understanding and further collaboration with hospitals and care-providers to increase patient access to this resource.
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Affiliation(s)
- Anthea Lafreniere
- Pathology and Laboratory Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bibianna Purgina
- Pathology and Laboratory Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason K Wasserman
- Pathology and Laboratory Medicine, Ottawa Hospital, Ottawa, Ontario, Canada .,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Wasserman JK, Rourke R, Purgina B, Caulley L, Dimitroulakos J, Corsten M, Johnson-Obaseki S. Correction to: HPV DNA in saliva from patients with SCC of the head and neck is specific for p16-positive oropharyngeal tumours. J Otolaryngol Head Neck Surg 2018; 47:49. [PMID: 30071890 PMCID: PMC6074035 DOI: 10.1186/s40463-018-0294-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
Following publication of the original article [1], the authors reported an error in one of the author names. In this Correction the incorrect and correct author names are listed.
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Affiliation(s)
- Jason K Wasserman
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Ryan Rourke
- Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa Hospital-General Campus S3, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Bibianna Purgina
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Lisa Caulley
- Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa Hospital-General Campus S3, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | | | | | - Stephanie Johnson-Obaseki
- Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa Hospital-General Campus S3, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
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Wasserman JK, AlGhamdi D, de Almeida JR, Stockley TL, Perez-Ordonez B. P53 Gene Mutation Identified by Next Generation Sequencing in Poorly Differentiated Neuroendocrine Carcinoma of the Nasal Cavity. Head Neck Pathol 2018; 13:516-522. [PMID: 29845478 PMCID: PMC6684699 DOI: 10.1007/s12105-018-0934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
Abstract
Neuroendocrine carcinomas (NECs) are epithelial neoplasms showing morphologic, immunophenotypic or ultrastructural evidence of neuroendocrine differentiation. The 2017 WHO Classification of Head and Neck Tumours classifies NECs into well, moderately and poorly differentiated NECs according to light microscopic features, mitotic rate and presence of tumour necrosis. In this study, we performed next generation sequencing (NGS) using a targeted 161 cancer gene panel on a poorly differentiated NEC of the nasal cavity. The tumour was composed of large cells arranged in poorly formed glands and solid nests. The mitotic count rate was 30/10 HPFs and p53 protein was strongly expressed in all tumour cells. NGS identified a missense mutation, c.764T > G (p.Ile255Ser) in the TP53 gene with an allele frequency of 85%. This mutation results in an isoleucine to serine substitution and a non-functional protein. No other mutations were identified. These results suggest that TP53 mutations may drive oncogenesis in poorly differentiated NECs of the head and neck.
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Affiliation(s)
- Jason K. Wasserman
- 0000 0004 0474 0428grid.231844.8Laboratory Medicine Program, University Health Network, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada ,0000 0004 0474 0428grid.231844.8Department of Pathology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Doaa AlGhamdi
- 0000 0004 0474 0428grid.231844.8Laboratory Medicine Program, University Health Network, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - John R. de Almeida
- 0000 0004 0474 0428grid.231844.8Department of Otolaryngology Head and Neck Surgery, Department of Surgical Oncology, University Health Network, Toronto, ON Canada
| | - Tracy L. Stockley
- 0000 0004 0474 0428grid.231844.8Laboratory Medicine Program, University Health Network, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Bayardo Perez-Ordonez
- 0000 0004 0474 0428grid.231844.8Laboratory Medicine Program, University Health Network, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
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Wasserman JK, Papp S, Hope AJ, Perez-Ordóñez B. Epstein-Barr Virus-Positive Large Cell Neuroendocrine Carcinoma of the Nasopharynx: Report of a Case with Complete Clinical and Radiological Response After Combined Chemoradiotherapy. Head Neck Pathol 2018; 12:587-591. [PMID: 29302900 PMCID: PMC6232204 DOI: 10.1007/s12105-017-0883-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/17/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023]
Abstract
Neuroendocrine carcinomas of the head and neck are rare and are classified as well differentiated, moderately differentiated, and poorly differentiated carcinomas with the latter category being subdivided into small cell and large cell neuroendocrine carcinoma (LCNEC). While most carcinomas in the nasopharynx are associated with Epstein-Barr virus (EBV), there has been only one previous report demonstrating a link between EBV and LCNEC of the nasopharynx. In this report we describe a second case of EBV-positive LCNEC arising in the nasopharynx with bilateral cervical metastases. The patient was treated with a combination of radiation and chemotherapy which resulted in a complete clinical and radiological response. The patient is still disease free 3 years after presentation. The results of this case suggest that EBV-positive LCNEC is sensitive to chemoradiotherapy and as a result may have better prognosis than EBV-negative LCNEC arising in the nasopharynx or other sites.
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Affiliation(s)
- Jason K Wasserman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine Program, Department of Pathology, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Sylvia Papp
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine Program, Department of Pathology, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Andrew J Hope
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine Program, Department of Pathology, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Bayardo Perez-Ordóñez
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
- Laboratory Medicine Program, Department of Pathology, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
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8
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Wasserman JK, Rourke R, Purgina B, Caulley L, Dimitroulakos J, Corsten M, Johnson-Obaseki S. HPV DNA in saliva from patients with SCC of the head and neck is specific for p16-positive oropharyngeal tumours. J Otolaryngol Head Neck Surg 2017; 46:3. [PMID: 28061890 PMCID: PMC5217573 DOI: 10.1186/s40463-016-0179-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 12/20/2016] [Indexed: 11/26/2022] Open
Abstract
Background Human papillomavirus (HPV) is an important cause of head and neck squamous cell carcinoma (HNSCC), especially in young people. These tumours overexpress p16 and respond well to treatment. The rapid detection of HPV in patients with HNSCC may expedite treatment when p16 status is not immediately available. Methods Saliva-based DNA collection kits and nested polymerase chain reaction (PCR) were used to determine the HPV status of 62 individuals with biopsy-proven HNSCC. Immunohistochemistry was used to determine tumour p16 status. Results A total of 62 patients were included in the study. Twenty-nine samples (47%) were positive for HPV DNA, the majority of which were high risk (HR) subtypes (79%). Patients who tested positive for HR HPV were more likely to have a tumour arising in the oropharynx compared to a non-oropharyngeal site (74 vs 26%; p = 0.003). A positive HR HPV saliva assay was 100% specific (95% CI 59–100%) and had a 100% positive predictive value (95% CI 75–100%) for a p16 positive tumour arising in the oropharynx. In contrast, a negative HR HPV assay had a 96% negative predictive value (95% CI 80–100%) for tumours arising in a non-oropharyngeal site. Independent of site, the saliva assay had a sensitivity of 77% (95% CI 54–91%) and a specificity of 94% (95% CI 77–99%), respectively, for a p16 positive tumour. Conclusion We show that a saliva based assay is an effective method for detecting HPV in patients with HNSCC and that a positive HR HPV test is highly specific for p16 positive tumours arising in the oropharynx. This simple and rapid test could be used in cases where a biopsy of the primary tumour is not readily available.
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Affiliation(s)
- Jason K Wasserman
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ryan Rourke
- Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa Hospital-General Campus S3, 501 Smyth Rd, Ottawa, Ontario, K1H 8L6, Canada
| | - Bibianna Purgina
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lisa Caulley
- Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa Hospital-General Campus S3, 501 Smyth Rd, Ottawa, Ontario, K1H 8L6, Canada
| | | | | | - Stephanie Johnson-Obaseki
- Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa Hospital-General Campus S3, 501 Smyth Rd, Ottawa, Ontario, K1H 8L6, Canada.
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9
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Wasserman JK, Dickson BC, Perez-Ordonez B, de Almeida JR, Irish JC, Weinreb I. INI1 (SMARCB1)-Deficient Sinonasal Carcinoma: A Clinicopathologic Report of 2 Cases. Head Neck Pathol 2016; 11:256-261. [PMID: 27644951 PMCID: PMC5429275 DOI: 10.1007/s12105-016-0752-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
Poorly differentiated sinonasal malignancies are amongst the hardest differential diagnoses in pathology, owing to the large number of rare entities that arise there. Complicating the matter is that most pathologists, including those with experience in head and neck pathology, have little experience in any one of these rare entities. Most patients with sinonasal carcinoma present with locally advanced disease and in the past a combination of chemotherapy, radiotherapy, and surgery would usually be recommended without the specific disease subtype playing a large part of the decision making. However, in the era of "precision medicine" and targeted therapies, the specific tumour subtype and an accurate diagnosis will become increasingly important even for the so-called "undifferentiated carcinoma". Specific entities that tend to enter into the differential diagnosis include olfactory neuroblastoma, sinonasal undifferentiated carcinoma (SNUC), and non-keratinizing squamous cell carcinoma (viral and non-viral). However, recent new entities, such as NUT-midline carcinoma also have to be considered. Recently it was found that a subset of tumours originally diagnosed as one of the aforementioned entities all demonstrated loss of the ubiquitously expressed protein Integrase Interactor 1 (INI1; SMARCB1). These tumours were often basaloid with at least partial rhabdoid differentiation and most were considered a part of the SNUC spectrum. In this report, we describe two additional cases of INI1-deficient sinonasal carcinoma prospectively identified, both of which appeared to have a marked response to neo-adjuvant chemoradiation, a finding not previously described.
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Affiliation(s)
- Jason K. Wasserman
- 0000 0004 0474 0428grid.231844.8Department of Pathology, University Health Network, Toronto General Hospital Site, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada ,0000 0001 2157 2938grid.17063.33Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Brendan C. Dickson
- 0000 0001 2157 2938grid.17063.33Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada ,0000 0004 0473 9881grid.416166.2Department of Pathology, Mount Sinai Hospital, Toronto, ON Canada
| | - Bayardo Perez-Ordonez
- 0000 0004 0474 0428grid.231844.8Department of Pathology, University Health Network, Toronto General Hospital Site, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada ,0000 0001 2157 2938grid.17063.33Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - John R. de Almeida
- 0000 0004 0474 0428grid.231844.8Department of Head and Neck Surgery, University Health Network, Toronto, ON Canada
| | - Jonathan C. Irish
- 0000 0004 0474 0428grid.231844.8Department of Head and Neck Surgery, University Health Network, Toronto, ON Canada
| | - Ilan Weinreb
- 0000 0004 0474 0428grid.231844.8Department of Pathology, University Health Network, Toronto General Hospital Site, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada ,0000 0001 2157 2938grid.17063.33Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
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Wasserman JK, Williams PA, Islam S, Robertson SJ. GATA-3 expression is not associated with complete pathological response in triple negative breast cancer patients treated with neoadjuvant chemotherapy. Pathol Res Pract 2016; 212:539-44. [DOI: 10.1016/j.prp.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/08/2016] [Accepted: 03/15/2016] [Indexed: 11/26/2022]
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Wasserman JK, Bateman J, Mai KT. Differentiated squamous intraepithelial neoplasia associated with squamous cell carcinoma of the anal canal. Histopathology 2015; 68:834-42. [DOI: 10.1111/his.12874] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jason K Wasserman
- Pathology and Laboratory Medicine; The Ottawa Hospital and University of Ottawa; Ottawa Ontario Canada
| | - Justin Bateman
- Pathology and Laboratory Medicine; The Ottawa Hospital and University of Ottawa; Ottawa Ontario Canada
| | - Kien T Mai
- Pathology and Laboratory Medicine; The Ottawa Hospital and University of Ottawa; Ottawa Ontario Canada
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Abstract
The NUT midline carcinoma (NMC) is a recently described and highly aggressive tumor that usually involves the head and neck and anterior mediastinum. Most patients with NMC present with metastases and are often treated with neoadjuvant chemotherapy and/or radiation therapy. As a consequence, surgical specimens are often piecemeal excisions demonstrating treatment effect. In this report, we provide what is to the best of our knowledge the first complete gross description of NMC resected in toto and without prior treatment. The patient in this case underwent a pneumonectomy for a lung mass with curative intent. On gross examination, the tumor was found to be arising from the mediastinum with a smooth border, and demonstrated only minimal invasion of the surrounding structures. However, lymphovascular invasion was present throughout and there was extensive involvement of surrounding lymph nodes. The gross appearance of the tumor in this case reaffirms that NMC is an aggressive malignancy that usually metastasizes before it invades locally.
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Affiliation(s)
| | - Bibianna Purgina
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Marcio M. Gomes
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Chi Lai
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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13
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Pozzobon LD, Glikstein R, Laurie SA, Hanagandi P, Michaud J, Purgina B, Ayroud Y, Wasserman JK. Primary cutaneous adenoid cystic carcinoma with brain metastases: case report and literature review. J Cutan Pathol 2015; 43:137-41. [DOI: 10.1111/cup.12563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 07/28/2015] [Accepted: 08/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Laura D Pozzobon
- Division of Anatomical Pathology; The Ottawa Hospital; Ottawa Canada
| | - Rafael Glikstein
- Department of Medical Imaging; The Ottawa Hospital; Ottawa Canada
| | - Scott A Laurie
- Division of Medical Oncology; The Ottawa Hospital Regional Cancer Centre; Ottawa Canada
| | - Prasad Hanagandi
- Department of Medical Imaging; The Ottawa Hospital; Ottawa Canada
| | - Jean Michaud
- Division of Anatomical Pathology; The Ottawa Hospital; Ottawa Canada
| | - Bibianna Purgina
- Division of Anatomical Pathology; The Ottawa Hospital; Ottawa Canada
| | - Yasmin Ayroud
- Division of Anatomical Pathology; The Ottawa Hospital; Ottawa Canada
| | - Jason K Wasserman
- Division of Anatomical Pathology; The Ottawa Hospital; Ottawa Canada
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14
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Wasserman JK, Parra-Herran C. Regressive change in high-grade ductal carcinoma in situ of the breast: histopathologic spectrum and biologic importance. Am J Clin Pathol 2015; 144:503-10. [PMID: 26276781 DOI: 10.1309/ajcpw4eadz9bnxxm] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES High-grade ductal carcinoma in situ (HG-DCIS) of the breast often shows tumor attenuation and reactive fibrosis. These changes, previously described as "regressive," have been paradoxically associated with an increased risk of invasive carcinoma. We aimed to further characterize the spectrum of the so-called regressive changes (RCs) in HG-DCIS. METHODS We reviewed 52 consecutive cases of HG-DCIS on biopsy specimens followed by excision. RCs were divided into early (stage 1) and advanced (stages 2 and 3) stages according to the degree of ductal fibrosis and tumor effacement. The presence of inflammation, hormone receptor status, and diagnosis on excision were recorded. RESULTS RCs were seen in 51 (98%) cases: 96%, 76.4%, and 39.2% cases showed stages 1, 2, and 3, respectively. Periductal T cells with a normal CD4/CD8 ratio were constantly seen. Advanced RCs and inflammation were more frequent in estrogen and progesterone receptor-negative tumors. RCs were not associated with invasion but correlated with a larger residual HG-DCIS volume on excision. CONCLUSIONS Regression in HG-DCIS is frequent. It may reflect a targeted immune response to certain phenotypes, mainly hormone receptor-negative lesions. Nonetheless, RCs do not lead to complete tumor obliteration but correlate with aggressive tumor characteristics instead.
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Affiliation(s)
- Jason K. Wasserman
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital and Eastern Ontario Regional Laboratory Association, Ottawa, Canada
| | - Carlos Parra-Herran
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital and Eastern Ontario Regional Laboratory Association, Ottawa, Canada
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15
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Abstract
Osteoclast-like giant cells are frequently encountered in nonskeletal malignancies; however, the evidence to date suggests that they represent a tissue response to the lesion rather than neoplastic differentiation. We describe a case of metastatic melanoma demonstrating osteoclast-like differentiation in the lung. The lung nodule was diagnosed as a metastatic melanoma by histological features and confirmed by immunohistochemistry. Resection specimen showed numerous multinucleated giant cells exhibiting osteoclast-like morphology dispersed throughout the lesion. Both the neoplastic melanocytes and giant cells were reactive for HMB-45, Melan-A, and S100. In addition, the multinucleated neoplastic giant cells were also reactive for the monocyte/macrophage lineage markers CD68 and CD163, and alkaline phosphatase, an enzyme present in normal osteoclasts. The neoplastic melanocytes and the multinucleated neoplastic giant cells were also reactive for microphthalmia-associated transcription factor, a protein required for the development of both melanocytes and osteoclasts. Collectively, a co-expression of monocyte/macrophage markers along with melanocytic markers and alkaline phosphatase in the multinucleated neoplastic giant cells in metastatic melanoma suggest that malignant melanocytes are capable of differentiating into osteoclast-like cells and consequently aid invasion into various structures and eliciting the aggressive behavior.
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Affiliation(s)
| | | | - Yasmine Ayroud
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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16
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Wasserman JK, Nicholas G, Yaworski R, Wasserman AM, Woulfe JM, Jansen GH, Chakraborty S, Nguyen TB. Radiological and pathological features associated with IDH1-R132H mutation status and early mortality in newly diagnosed anaplastic astrocytic tumours. PLoS One 2015; 10:e0123890. [PMID: 25849605 PMCID: PMC4388816 DOI: 10.1371/journal.pone.0123890] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/04/2014] [Accepted: 02/26/2015] [Indexed: 01/14/2023] Open
Abstract
Background Glioblastoma can occur either de novo or by the transformation of a low grade tumour; the majority of which harbor a mutation in isocitrate dehydrogenase (IDH1). Anaplastic tumours are high-grade gliomas that may represent the final step in the evolution of a secondary glioblastoma or the initial presentation of an early primary glioblastoma. We sought to determine whether pathological and/or radiological variables exist that can reliably distinguish IDH1-R132H-positive from IDH1-R132H-negative tumours and to identify variables associated with early mortality. Methods Patients diagnosed with anaplastic astrocytic tumours were included. Magnetic resonance imaging was performed and immunohistochemistry was used to identify tumours with the IDH1-R132H mutation. Survival was assessed 12 months after diagnosis. Variables associated with IDH1-R132H status were identified by univariate and ROC analysis. Results 37 gliomas were studied; 18 were positive for the IDH1-R132H mutation. No tumours demonstrated a combined loss of chromosomes 1p/19q. Patients with IDH1-R132H-positive tumours were less likely to die within 12 months of diagnosis (17% vs. 47%; p=0.046), more likely to have tumours located in the frontal lobe (55% vs. 16%; p=0.015), and have a higher minimum apparent diffusion coefficient (1.115 x 10-3 mm2/sec vs. 0.838 x 10-3 mm2/sec; p=0.016), however, these variables demonstrated only moderate strength for predicting the IDH1-R132H mutation status (AUC=0.735 and 0.711, respectively). The Ki-67 index was significantly lower in IDH1-R132H-positive tumours (0.13 vs. 0.21; p=0.034). An increased risk of death was associated with contrast-enhancement ≥ 5 cm3 in patients with IDH1-R132H-positive tumours while edema ≥ 1 cm beyond the tumour margin and < 5 mitoses/mm2 were associated with an increased risk of death in patients with IDH1-R132H-negative tumours. Conclusions IDH1-R132H-positive and -negative anaplastic tumours demonstrate unique features. Factors associated with early mortality are also dependent on IDH1-R132H status and can be used to identify patients at high risk for death.
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Affiliation(s)
- Jason K. Wasserman
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Garth Nicholas
- The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rebecca Yaworski
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
| | | | - John M. Woulfe
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gerard H. Jansen
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Santanu Chakraborty
- Division of Neuro-imaging, Department of Medical Imaging, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Thanh B. Nguyen
- Division of Laboratory Medicine, Department of Anatomical Pathology, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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17
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Wasserman JK, Tsai EC, Glikstein R, Mai KT, Jansen GH. Metastatic renal cell carcinoma mimicking a schwannoma in a dorsal root ganglion: case report. J Neurosurg Spine 2015; 22:314-7. [DOI: 10.3171/2014.9.spine131075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Peripheral nerve tumors are soft-tissue tumors that can occur in any nerve throughout the body. The majority of peripheral nerve tumors arise from elements of the nerve sheath with the two most common being neurofibromas and schwannomas. More than 90% of all peripheral nerve tumors are benign. When there is peripheral nerve involvement in metastatic carcinoma, it is often via contiguous spread from the primary mass; hematogenous seeding to a peripheral nerve is seldom seen. In this report the authors describe the even rarer case of metastatic renal cell carcinoma mimicking a schwannoma in a dorsal root ganglion. Cases from the literature show the rarity of this finding and its late clinical appearance. Given that survival in patients with metastatic carcinoma continues to increase, dorsal root ganglion metastasis may become more common over time.
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Affiliation(s)
- Jason K. Wasserman
- 1Division of Anatomical Pathology, Pathology and Laboratory Medicine, University of Ottawa; and
| | | | - Rafael Glikstein
- 3Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kien T. Mai
- 1Division of Anatomical Pathology, Pathology and Laboratory Medicine, University of Ottawa; and
| | - Gerard H. Jansen
- 1Division of Anatomical Pathology, Pathology and Laboratory Medicine, University of Ottawa; and
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18
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Wasserman JK, Perry JJ, Sivilotti ML, Sutherland J, Worster A, Émond M, Jin AY, Oczkowski WJ, Sahlas DJ, Murray H, MacKey A, Verreault S, Wells GA, Dowlatshahi D, Stotts G, Stiell IG, Sharma M. Computed Tomography Identifies Patients at High Risk for Stroke After Transient Ischemic Attack/Nondisabling Stroke. Stroke 2015; 46:114-9. [DOI: 10.1161/strokeaha.114.006768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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
Background and Purpose—
Ischemia on computed tomography (CT) is associated with subsequent stroke after transient ischemic attack. This study assessed CT findings of acute ischemia, chronic ischemia, or microangiopathy for predicting subsequent stroke after transient ischemic attack.
Methods—
This prospective cohort study enrolled patients with transient ischemic attack or nondisabling stroke that had CT scanning within 24 hours. Primary outcome was subsequent stroke within 90 days. Secondary outcomes were stroke at ≤2 or >2 days. CT findings were classified as ischemia present or absent and acute or chronic or microangiopathy. Analysis used Fisher exact test and multivariate logistic regression.
Results—
A total of 2028 patients were included; 814 had ischemic changes on CT. Subsequent stroke rate was 3.4% at 90 days and 1.5% at ≤2 days. Stroke risk was greater if baseline CT showed acute ischemia alone (10.6%;
P
=0.002), acute+chronic ischemia (17.4%;
P
=0.007), acute ischemia+microangiopathy (17.6%;
P
=0.019), or acute+chronic ischemia+microangiopathy (25.0%;
P
=0.029). Logistic regression found acute ischemia alone (odds ratio [OR], 2.61; 95% confidence interval [CI[, 1.22–5.57), acute+chronic ischemia (OR, 5.35; 95% CI, 1.71–16.70), acute ischemia+microangiopathy (OR, 4.90; 95% CI, 1.33–18.07), or acute+chronic ischemia+microangiopathy (OR, 8.04; 95% CI, 1.52–42.63) was associated with a greater risk at 90 days, whereas acute+chronic ischemia (OR, 10.78; 95% CI, 2.93–36.68), acute ischemia+microangiopathy (OR, 8.90; 95% CI, 1.90–41.60), and acute+chronic ischemia+microangiopathy (OR, 23.66; 95% CI, 4.34–129.03) had greater risk at ≤2 days. Only acute ischemia (OR, 2.70; 95% CI, 1.01–7.18;
P
=0.047) was associated with a greater risk at >2 days.
Conclusions—
In patients with transient ischemic attack/nondisabling stroke, CT evidence of acute ischemia alone or acute ischemia with chronic ischemia or microangiopathy was associated with increased subsequent stroke risk within 90 days.
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Affiliation(s)
- Jason K. Wasserman
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Jeffrey J. Perry
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Marco L.A. Sivilotti
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Jane Sutherland
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Andrew Worster
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Marcel Émond
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Albert Y. Jin
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Wieslaw J. Oczkowski
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Demetrios J. Sahlas
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Heather Murray
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Ariane MacKey
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Steve Verreault
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - George A. Wells
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Dar Dowlatshahi
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Grant Stotts
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Ian G. Stiell
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Mukul Sharma
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
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19
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Chakraborty S, Alhazzaa M, Wasserman JK, Sun YY, Stotts G, Hogan MJ, Demchuk A, Aviv RI, Dowlatshahi D. Dynamic characterization of the CT angiographic 'spot sign'. PLoS One 2014; 9:e90431. [PMID: 24594897 PMCID: PMC3940908 DOI: 10.1371/journal.pone.0090431] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 12/10/2013] [Accepted: 01/30/2014] [Indexed: 11/24/2022] Open
Abstract
Background and purpose Standard (static) CT angiography is used to identify the intracerebral hemorrhage (ICH) spot sign. We used dynamic CT-angiography to describe spot sign characteristics and measurement parameters over 60-seconds of image acquisition. Methods We prospectively identified consecutive patients presenting with acute ICH within 4.5 hours of symptom onset, and collected whole brain dynamic CT-angiography (dCTA). Spot parameters (earliest appearance, duration, maximum Hounsfield unit (HU), time to maximum HU, time to spot diagnostic definition, spot volume and hematoma volumes) were measured using volumetric analysis software. Result We enrolled 34 patients: three were excluded due to secondary causes of ICH. Of the remaining 31 patients there were 18 females (58%) with median age 70 (range 47–86) and baseline hematoma volume 33 ml (range 0.7–103 ml). Positive dCTA spot sign was present in 13 patients (42%) visualized as an expanding 3-dimensional structure temporally evolving its morphology over the scan period. Median time to spot appearance was 21 s (range 15–35 seconds). This method allowed tracking of spots evolution until the end of venous phase (active extravasation) with median duration of 39 s (range 25–45 seconds). The average density and time to maximum density was 204HU and 30.8 s (range 23–31 s) respectively. Median time to spot diagnosis was 20.8 s using either 100 or 120HU definitions. Conclusion Dynamic CTA allows a 3-dimensional assessment of spot sign formation during acute ICH, and captured higher spot sign prevalence than previously reported. This is the first study to describe and quantify spot sign characteristics using dCTA; these can be used in ongoing and upcoming ICH studies.
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Affiliation(s)
- Santanu Chakraborty
- Division of Neuroradiology, Department of Medical Imaging, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada
- * E-mail:
| | - Mohammed Alhazzaa
- Department of Medicine, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada
- Department of Neurology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Jason K. Wasserman
- Department of Pathology, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada
| | - Yang Yang Sun
- Department of Medicine, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada
| | - Grant Stotts
- Department of Medicine, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada
| | - Mathew J. Hogan
- Department of Medicine, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada
| | - Andrew Demchuk
- Department of Clinical Neurosciences, Foothills Medical Centre, Calgary Health Region, Calgary, Alberta, Canada
| | - Richard I. Aviv
- Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada
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20
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Dowlatshahi D, Wasserman JK, Momoli F, Petrcich W, Stotts G, Hogan M, Sharma M, Aviv RI, Demchuk AM, Chakraborty S. Evolution of Computed Tomography Angiography Spot Sign Is Consistent With a Site of Active Hemorrhage in Acute Intracerebral Hemorrhage. Stroke 2014; 45:277-80. [DOI: 10.1161/strokeaha.113.003387] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [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
Background and Purpose—
CT angiography spot sign predicts hematoma expansion in patients with acute intracerebral hemorrhage (ICH). The spot sign may represent a site of active extravasation, a locus of arrested hemorrhage forming fibrin globes, or represent associated epiphenomena such as hypertensive microaneurysms. We sought to describe the evolution of spot signs over 60 seconds in acute ICH using dynamic CT angiography and determine whether they grow and diffuse into the hematoma as would be expected with active extravasation.
Methods—
We prospectively identified consecutive patients presenting with spontaneous ICH <6 hours from symptom onset that completed dynamic CT angiography imaging over a 60-second acquisition protocol. We determined spot positivity, quantified spot volumes, and then used repeated-measures ANOVA to assess changes in spot volume over time.
Results—
We collected data on 35 patients; 13 of 35 (37%) patients were spot-positive. Spot-positive patients had larger median ICH volume compared with spot-negative patients (median 10.7 versus 49.2 mL;
P
=0.007). Maximal spot sign volumes ranged from 0.02 to 2.8 mL (median 0.17 mL). Spot sign volumes increased significantly with time (
P
<0.001) and seemed to disperse into the hematoma in all cases. Three of 13 (23%) spot-positive patients presented with 2 distinct spot signs, but the remaining patients either had only 1 spot sign or different contiguous components of an irregularly shaped spot sign.
Conclusions—
In this dynamic CT angiography study of ICH, spot signs evolve consistent with sites of active extravasation.
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Affiliation(s)
- Dar Dowlatshahi
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
| | - Jason K. Wasserman
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
| | - Franco Momoli
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
| | - William Petrcich
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
| | - Grant Stotts
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
| | - Matthew Hogan
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
| | - Mukul Sharma
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
| | - Richard I. Aviv
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
| | - Andrew M. Demchuk
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
| | - Santanu Chakraborty
- From the Departments of Medicine–Neurology (D.D., G.S., M.H.), Pathology and Laboratory Medicine (J.K.W.), Epidemiology and Community Medicine (D.D., F.M.), Clinical Epidemiology (F.M.), Methods Centre (F.M., W.P.), and Medical Imaging–Neuroradiology (S.C.), University of Ottawa, CHEO Research Institute (F.M.) and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.); Department
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Dowlatshahi D, Wasserman JK, Butcher KS, Bernbaum ML, Cwinn AA, Giulivi A, Lang E, Poon MC, Tomchishen-Pope J, Sharma M, Coutts SB. Stroke prenotification is associated with shorter treatment times for warfarin-associated intracerebral hemorrhage. Cerebrovasc Dis 2013; 36:383-7. [PMID: 24248034 DOI: 10.1159/000355500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/05/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Warfarin-associated intracerebral hemorrhage (WAICH) is a devastating disease with increasing incidence. In this setting, treatment with prothrombin complex concentrates (PCC) is essential to correct coagulopathy. Yet despite the availability of coagulopathy correction strategies, significant treatment delays can occur in emergency departments (EDs), which may be overcome using stroke prenotification strategies. To explore this, we compared arrival-to-treatment times with PCC for WAICH between two different stroke response systems that used the same international normalized ratio (INR) correction protocol. METHODS We established a registry of consecutive patients presenting with WAICH and treated with PCC presenting to two Canadian tertiary-care academic stroke centers: one with a stroke prenotification system, and one with a traditional ED assessment, treatment and referral system. In this comparative cohort design, we defined the WAICH diagnosis time as the earliest time point where both INR and CT were available. We compared median times from arrival to treatment, as well as arrival to diagnosis, and diagnosis to treatment. RESULTS Between 2008 and 2010, we collected data from 123 consecutive patients with intracranial hemorrhage who received PCC for INR correction (79 from ED referral, and 44 prenotification). Onset-to-arrival times, demographics, Glasgow Coma Scale scores, and baseline INR were similar between the two systems. Arrival-to-treatment times were significantly shorter in the prenotification system as compared to the traditional ED referral system (135 vs. 267 min; p = 0.001), which was driven by both decreased arrival-to-diagnosis time (49 vs. 117 min; p = 0.006), as well as decreased diagnosis-to-treatment time (56 vs. 112 min; p < 0.001). Arrival-to-scan times and arrival-to-INR times were similarly shorter in the prenotification system (68 vs. 118 min and 20.5 vs. 47 min, respectively). CONCLUSION Stroke prenotification was associated with shorter arrival-to-treatment times for emergent INR correction in patients with WAICH, which was driven by both faster diagnosis and treatment. Our results are consistent with those seen in ischemic stroke, suggesting that prenotification systems present an opportunity to optimize acute intracerebral hemorrhage therapy.
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Affiliation(s)
- Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont., Canada
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Dowlatshahi D, Butcher KS, Asdaghi N, Nahirniak S, Bernbaum ML, Giulivi A, Wasserman JK, Poon MC, Coutts SB. Poor prognosis in warfarin-associated intracranial hemorrhage despite anticoagulation reversal. Stroke 2012; 43:1812-7. [PMID: 22556194 DOI: 10.1161/strokeaha.112.652065] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Anticoagulant-associated intracranial hemorrhage (aaICH) presents with larger hematoma volumes, higher risk of hematoma expansion, and worse outcome than spontaneous intracranial hemorrhage. Prothrombin complex concentrates (PCCs) are indicated for urgent reversal of anticoagulation after aaICH. Given the lack of randomized controlled trial evidence of efficacy, and the potential for thrombotic complications, we aimed to determine outcomes in patients with aaICH treated with PCC. METHODS We conducted a prospective multicenter registry of patients treated with PCC for aaICH in Canada. Patients were identified by local blood banks after the release of PCC. A chart review abstracted clinical, imaging, and laboratory data, including thrombotic events after therapy. Hematoma volumes were measured on brain CT scans and primary outcomes were modified Rankin Scale at discharge and in-hospital mortality. RESULTS Between 2008 and 2010, 141 patients received PCC for aaICH (71 intraparenchymal hemorrhages). The median age was 78 years (interquartile range, 14), 59.6% were male, and median Glasgow Coma Scale was 14. Median international normalized ratio was 2.6 (interquartile range, 2.0) and median parenchymal hematoma volume was 15.8 mL (interquartile range, 31.8). Median post-PCC therapy international normalized ratio was 1.4: 79.5% of patients had international normalized ratio correction (<1.5) within 1 hour of PCC therapy. Patients with intraparenchymal hemorrhage had an in-hospital mortality rate of 42.3% with median modified Rankin Scale of 5. Significant hematoma expansion occurred in 45.5%. There were 3 confirmed thrombotic complications within 7 days of PCC therapy. CONCLUSIONS PCC therapy rapidly corrected international normalized ratio in the majority of patients, yet mortality and morbidity rates remained high. Rapid international normalized ratio correction alone may not be sufficient to alter prognosis after aaICH.
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Affiliation(s)
- Dar Dowlatshahi
- Department of Medicine, Division of Neurology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital Civic Campus, Room C2182, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9.
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Wasserman JK, Jimenez-Rivera C, Doja A. Refractory head movements secondary to Sandifer syndrome treated with enteral feeding. Mov Disord 2010; 25:1754-5. [DOI: 10.1002/mds.23161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wasserman JK, Koeberle PD. Development and characterization of a hemorrhagic rat model of central post-stroke pain. Neuroscience 2009; 161:173-83. [PMID: 19324079 DOI: 10.1016/j.neuroscience.2009.03.042] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 03/03/2009] [Accepted: 03/05/2009] [Indexed: 12/29/2022]
Abstract
Stroke is the leading cause of disability in the industrialized world and it is estimated that up to 8% of stroke victims suffer from some form of central post-stroke pain (CPSP). Thalamic syndrome is form of central pain that typically results from stroke in the thalamus. In the present study, we describe the development and characterization of a rat model of thalamic CPSP. This model is based on a hemorrhagic stroke lesion in the ventral posterolateral nucleus of the thalamus, one of the reported causes of thalamic syndrome in humans. Behavioral analysis showed that animals displayed hyperesthesia in response to mechanical pinch stimulation, with sensitivity localized to the hind limb. This response appeared within 7 days of the intra-thalamic hemorrhage. Animals also showed increased thermal sensitivity in the contralateral hind limb. Histopathology indicated the presence of activated microglia adjacent to the core of hemorrhagic lesions in the thalamus. Neutrophils were confined to the hemorrhage core, indicating that they entered in the initial bleed. By 7 days, bands of activated microglia and astrocytes separated the hematoma from surviving neurons at the edge of the lesion. We did not observe any terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) positive neurons beyond the immediate hematoma at 1, 3, or 7 days after hemorrhage. Surviving neurons were located in the vicinity of activated microglia and astrocytes at the outer edge of the hematoma. Thus, thalamic hemorrhage produces a confined lesion that destroys the tissue within the initial bleed, with little or no neuron death beyond the hemorrhage core. Surviving neurons surrounded by activated glial cells likely contribute to neuropathic pain in this model. This thalamic hemorrhage model is useful for studying the neuropathology and physiology of thalamic syndrome, and developing therapeutics for central post-stroke pain.
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Affiliation(s)
- J K Wasserman
- University of Toronto, Division of Anatomy, MSB 1186, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8
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Wasserman JK, Yang H, Schlichter LC. Glial responses, neuron death and lesion resolution after intracerebral hemorrhage in young vs. aged rats. Eur J Neurosci 2009; 28:1316-28. [PMID: 18973558 DOI: 10.1111/j.1460-9568.2008.06442.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Intracerebral hemorrhage (ICH) usually affects older humans but almost no experimental studies have assessed aged animals. We address how aging alters inflammation, neuron death and lesion resolution after a hemorrhage in the rat striatum. In the normal aged brain, microglia displayed a 'dystrophic' phenotype, with shorter cellular processes and large gaps between adjacent cells, and there was more astrocyte reactivity. The ICH injury was monitored as hematoma volume and number of dying neurons at 1 and 3 days, and the volume of the residual lesion, ventricles and lost tissue at 28 days. Inflammation at 1 and 3 days was assessed from densities of microglia with resting vs. activated morphologies, or expressing the lysosomal marker ED1. Despite an initial delay in neuron death in aged animals, by 28 days, there was no difference in neuron density or volume of tissue lost. However, lesion resolution was impaired in aged animals and there was less compensatory ventricular expansion. At 1 day after ICH, there were fewer activated microglia/macrophages in the aged brain, but by 3 days there were more of these cells at the edge of the hematoma and in the surrounding parenchyma. In both age groups a glial limitans had developed by 3 days, but astrocyte reactivity and the spread of activated microglia/macrophages into the surrounding parenchyma was greater in the aged. These findings have important implications for efforts to reduce secondary injury after ICH and to develop anti-inflammatory therapies to treat ICH in aged humans.
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Affiliation(s)
- Jason K Wasserman
- Toronto Western Research Institute, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada
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Wasserman JK, Schlichter LC. Minocycline protects the blood-brain barrier and reduces edema following intracerebral hemorrhage in the rat. Exp Neurol 2007; 207:227-37. [PMID: 17698063 DOI: 10.1016/j.expneurol.2007.06.025] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 06/19/2007] [Accepted: 06/22/2007] [Indexed: 11/20/2022]
Abstract
Intracerebral hemorrhage (ICH) results from rupture of a blood vessel in the brain. After ICH, the blood-brain barrier (BBB) surrounding the hematoma is disrupted, leading to cerebral edema. In both animals and humans, edema coincides with inflammation, which is characterized by production of pro-inflammatory cytokines, activation of resident brain microglia and migration of peripheral immune cells into the brain. Accordingly, inflammation is an attractive target for reducing edema following ICH. In the present study, BBB damage was assessed by quantifying intact microvessels surrounding the hematoma, monitoring extravasation of IgG and measuring brain water content 3 days after ICH induced by collagenase injection into the rat striatum. In the injured brain, the water content increased in both ipsilateral and contralateral hemispheres compared with the normal brain. Quantitative real-time RT-PCR revealed an up-regulation of inflammatory genes associated with BBB damage; IL1beta, TNFalpha and most notably, MMP-12. Immunostaining showed MMP-12 in damaged microvessels and their subsequent loss from tissue surrounding the hematoma. MMP-12 was also observed for the first time in neurons. Dual-antibody labeling demonstrated that neutrophils were the predominant source of TNFalpha protein. Intraperitoneal injection of the tetracycline derivative, minocycline, beginning 6 h after ICH ameliorated the damage by reducing microvessel loss, extravasation of plasma proteins and edema; decreasing TNFalpha and MMP-12 expression; and reducing the numbers of TNFalpha-positive cells and neutrophils in the brain. Thus, minocycline, administered at a clinically relevant time, appears to target the inflammatory processes involved in edema development after ICH.
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Affiliation(s)
- Jason K Wasserman
- Toronto Western Research Institute, University Health Network, Toronto Ontario, Canada M5T 2S8
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Wasserman JK, Schlichter LC. Neuron death and inflammation in a rat model of intracerebral hemorrhage: Effects of delayed minocycline treatment. Brain Res 2007; 1136:208-18. [PMID: 17223087 DOI: 10.1016/j.brainres.2006.12.035] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [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: 11/03/2006] [Revised: 12/07/2006] [Accepted: 12/09/2006] [Indexed: 10/23/2022]
Abstract
After intracerebral hemorrhage (ICH), blood entry is followed by neuron death and an inflammatory response, but development of pharmacological therapies has been hampered by an inadequate understanding of the spatial and temporal relationship between neuron death and inflammation. Using a rat model of ICH, we first investigated these relationships at 6 h, and 1, 3 and 7 days. At the edge of the hematoma, no degenerating neurons were observed at 6 h; however, dying neurons were present between 1 and 3 days, with peak neuron death occurring at 1 day. This is apparently the first report of ongoing neuron death at the edge of the hematoma during a time window that is appropriate for human therapy. Neuron death was limited to the edge of the hematoma, with no degenerating neurons in the striatum surrounding the hematoma, despite robust and prolonged microglia activation. Importantly, neuron loss at the edge of the hematoma was spatially and temporally associated with accumulation and activation of microglia/macrophages. We then tested the hypothesis that treatment with the tetracycline derivative, minocycline, after the hematoma had reached a maximal size, will reduce inflammation and neuron damage. Minocycline injection (45 mg/kg i.v. at 6 h, and i.p. at 24, 48 and 72 h) failed to reduce neuron loss outside the hematoma or striatal tissue loss (assessed at 7 days), despite reducing the number of neutrophils and activated microglia/macrophages. Thus, minocycline does not appear to target the mechanisms responsible for cell death in this model of ICH.
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Affiliation(s)
- Jason K Wasserman
- Toronto Western Research Institute, University Health Network, Canada
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