1
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Shah RB, Cai Q, Aron M, Berney DM, Cheville JC, Deng FM, Epstein J, Fine SW, Genega EM, Hirsch MS, Humphrey PA, Gordetsky J, Kristiansen G, Kunju LP, Magi-Galluzzi C, Gupta N, Netto GJ, Osunkoya AO, Robinson BD, Trpkov K, True LD, Troncoso P, Varma M, Wheeler T, Williamson SR, Wu A, Zhou M. Diagnosis of "cribriform" prostatic adenocarcinoma: an interobserver reproducibility study among urologic pathologists with recommendations. Am J Cancer Res 2021; 11:3990-4001. [PMID: 34522463 PMCID: PMC8414383] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023] Open
Abstract
Accurate diagnosis of cribriform Gleason pattern 4 (CrP4) prostate adenocarcinoma (PCa) is important due to its independent association with adverse clinical outcomes and as a growing body of evidence suggests that it impacts clinical decision making in PCa management. To identify reproducible features for diagnosis of CrP4, we assessed interobserver agreement among 27 experienced urologic pathologists of 60 digital images from 44 radical prostatectomies (RP) that represented a broad spectrum of potential CrP4. The following morphologic features were correlated with the consensus diagnosis (defined as 75% agreement) for each image: partial vs. transluminal glandular bridging, intraglandular stroma, <12 vs. ≥12 lumina, well vs. poorly formed lumina, mucin (mucinous fibroplasia, extravasation, or extracellular pool), size (compared to benign glands and number of lumina), number of attachments with gland border by tumor cells forming a "glomeruloid-like" pattern, a clear luminal space along the periphery of gland occupying <50% of glandular circumference, central nerve, dense (cell mass occupying >50% of luminal space) vs. loose, and regular vs. irregular contour. Interobserver reproducibility for the overall diagnostic agreement was fair (k=0.40). Large CrP4 had better agreement (k=0.49) compared to small CrP4 (k=0.40). Transluminal bridging, dense cellular proliferation, a clear luminal space along the periphery of gland occupying <50% of gland circumference, lack of intraglandular mucin, and lack of contact between the majority of intraglandular cells with stroma were significantly associated with consensus for CrP4. In contrast, partial bridging, majority of intraglandular cells in contact with stroma, mucinous fibroplasia, only one attachment to the gland border by tumor cells forming a "glomeruloid-like" pattern, and a clear luminal space along the periphery of gland accounting for >50% of the glandular circumference were associated with consensus against CrP4. In summary, we identified reproducible morphological features for and against CrP4 diagnosis, which could be used to refine and standardize the diagnostic criteria for CrP4.
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Affiliation(s)
- Rajal B Shah
- Department of Pathology, The University of Texas Southwestern Medical CenterDallas, TX, USA
| | - Qi Cai
- Department of Pathology, The University of Texas Southwestern Medical CenterDallas, TX, USA
| | - Manju Aron
- Department of Pathology, University of Southern CaliforniaLos Angeles, CA, USA
| | - Daniel M Berney
- Department of Cellular Pathology, Bartshealth NHS Trust and Barts Cancer Institute, Queen Mary University of LondonUnited Kingdom
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo ClinicRochester, MN, USA
| | - Fang-Ming Deng
- Department of Pathology, New York University Medical CenterNew York, NY, USA
| | - Jonathan Epstein
- Department of Pathology, Urology, Oncology, The Johns Hopkins Medical InstitutionsBaltimore, MD, USA
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer CenterNew York, NY, USA
| | | | - Michelle S Hirsch
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Peter A Humphrey
- Department of Pathology, Yale School of MedicineNew Haven, CT, USA
| | - Jennifer Gordetsky
- Department of Pathology, Microbiology and Immunology, Urology, Vanderbilt University Medical CenterNashville, TN, USA
| | - Glen Kristiansen
- Institute of Pathology of The University Hospital BonnBonn, Germany
| | - Lakshmi P Kunju
- Department of Pathology at Michigan Medicine, University of Michigan Medical SchoolAnn Arbor, MI, USA
| | | | - Nilesh Gupta
- Department of Pathology, Henry Ford Health SystemDetroit, MI, USA
| | - George J Netto
- Department of Pathology, University of Alabama at BirminghamBirmingham, AL, USA
| | - Adeboye O Osunkoya
- Department of Pathology and Urology, Emory University School of MedicineAtlanta, GA, USA
| | - Brian D Robinson
- Department of Pathology, Weill Cornell MedicineNew York, NY, USA
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of CalgaryCalgary, AB, Canada
| | - Lawrence D True
- Department of Laboratory Medicine and Pathology, University of Washington School of MedicineSeattle, Washington, USA
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Murali Varma
- Department of Cellular Pathology, University Hospital of WalesCardiff, Wales, United Kingdom
| | - Thomas Wheeler
- Department of Pathology & Immunology, Baylor College of MedicineHouston, TX, USA
| | - Sean R Williamson
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland ClinicCleveland, OH, USA
| | - Angela Wu
- Department of Pathology at Michigan Medicine, University of Michigan Medical SchoolAnn Arbor, MI, USA
| | - Ming Zhou
- Department of Pathology, Tufts Medical CenterBoston, MA, USA
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2
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Compérat E, Amin MB, Epstein JI, Hansel DE, Paner G, Al-Ahmadie H, True L, Bayder D, Bivalacqua T, Brimo F, Cheng L, Cheville J, Dalbagni G, Falzarano S, Gordetsky J, Guo C, Gupta S, Hes O, Iyer G, Kaushal S, Kunju L, Magi-Galluzzi C, Matoso A, McKenney J, Netto GJ, Osunkoya AO, Pan CC, Pivovarcikova K, Raspollini MR, Reis H, Rosenberg J, Roupret M, Shah RB, Shariat SF, Trpkov K, Weyerer V, Zhou M, Reuter V. The Genitourinary Pathology Society Update on Classification of Variant Histologies, T1 Substaging, Molecular Taxonomy, and Immunotherapy and PD-L1 Testing Implications of Urothelial Cancers. Adv Anat Pathol 2021; 28:196-208. [PMID: 34128484 DOI: 10.1097/pap.0000000000000309] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/13/2022]
Abstract
The Genitourinary Pathology Society (GUPS) undertook a critical review of the recent advances in bladder cancer focusing on important topics of high interest for the practicing surgical pathologist and urologist. This review represents the second of 2 manuscripts ensuing from this effort. Herein, we address the effective reporting of bladder cancer, focusing particularly on newly published data since the last 2016 World Health Organization (WHO) classification. In addition, this review focuses on the importance of reporting bladder cancer with divergent differentiation and variant (subtypes of urothelial carcinoma) histologies and the potential impact on patient care. We provide new recommendations for reporting pT1 staging in diagnostic pathology. Furthermore, we explore molecular evolution and classification, emphasizing aspects that impact the understanding of important concepts relevant to reporting and management of patients.
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Affiliation(s)
- Eva Compérat
- Department of Pathology, Medical University Vienna, Vienna General Hospital
- Department of Pathology, Hôpital Tenon, Sorbonne University
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science, Memphis
- Department of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Jonathan I Epstein
- Departments of Pathology
- Urology
- Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Donna E Hansel
- Department of Pathology & Laboratory Medicine, Oregon Health Science University, OR
| | - Gladell Paner
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Larry True
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington, DC
| | - Dilek Bayder
- Department of Pathology, Koc Univiversity School of Medicine, Istanbul, Turkey
| | | | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Sara Falzarano
- Department of Pathology and Laboratory Medicine, University of South Florida, Gainesville, FL
| | - Jennifer Gordetsky
- Departments of Pathology, Microbiology, and Immunology
- Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Charles Guo
- Department of Pathology, MD Anderson Cancer Center, Houston
| | - Sounak Gupta
- Department of Pathology, Mayo Clinic, Rochester, MN
| | - Ondrej Hes
- Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
| | | | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Lakshmi Kunju
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI
| | | | | | - Jesse McKenney
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - George J Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL
| | - Adeboye O Osunkoya
- Departments of Pathology
- Urology, Emory University School of Medicine, Atlanta, GA
| | - Chin Chen Pan
- Department of Pathology, Taipei Veterans General Hospital, Tapeh, Taiwan
| | - Kristina Pivovarcikova
- Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
| | - Maria R Raspollini
- Department of Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy
| | - Henning Reis
- Department of Pathology, West German Cancer Center/University Hospital Essen, University of Duisburg-Essen, Duisburg
| | | | - Morgan Roupret
- Department of Urology, APHP Sorbonne University, Paris, France
| | - Rajal B Shah
- Departments of Pathology
- Urology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Veronika Weyerer
- Department of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, MA
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3
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Amin MB, Comperat E, Epstein JI, True LD, Hansel D, Paner GP, Al-Ahmadie H, Baydar D, Bivalacqua T, Brimo F, Cheng L, Cheville J, Dalbagni G, Falzarano S, Gordetsky J, Guo CC, Gupta S, Hes O, Iyer G, Kaushal S, Kunju L, Magi-Galluzzi C, Matoso A, Netto G, Osunkoya AO, Pan CC, Pivovarcikova K, Raspollini MR, Reis H, Rosenberg J, Roupret M, Shah RB, Shariat S, Trpkov K, Weyerer V, Zhou M, McKenney J, Reuter VE. The Genitourinary Pathology Society Update on Classification and Grading of Flat and Papillary Urothelial Neoplasia With New Reporting Recommendations and Approach to Lesions With Mixed and Early Patterns of Neoplasia. Adv Anat Pathol 2021; 28:179-195. [PMID: 34128483 DOI: 10.1097/pap.0000000000000308] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/15/2022]
Abstract
The Genitourinary Pathology Society (GUPS) undertook a critical review of the recent advances in bladder neoplasia with a focus on issues relevant to the practicing surgical pathologist for the understanding and effective reporting of bladder cancer, emphasizing particularly on the newly accumulated evidence post-2016 World Health Organization (WHO) classification. The work is presented in 2 manuscripts. Here, in the first, we revisit the nomenclature and classification system used for grading flat and papillary urothelial lesions centering on clinical relevance, and on dilemmas related to application in routine reporting. As patients of noninvasive bladder cancer frequently undergo cystoscopy and biopsy in their typically prolonged clinical course and for surveillance of disease, we discuss morphologies presented in these scenarios which may not have readily applicable diagnostic terms in the WHO classification. The topic of inverted patterns in urothelial neoplasia, particularly when prominent or exclusive, and beyond inverted papilloma has not been addressed formally in the WHO classification. Herein we provide a through review and suggest guidelines for when and how to report such lesions. In promulgating these GUPS recommendations, we aim to provide clarity on the clinical application of these not so uncommon diagnostically challenging situations encountered in routine practice, while also importantly advocating consistent terminology which would inform future work.
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Affiliation(s)
- Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science, Memphis
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Eva Comperat
- Department of Pathology, Vienna General Hospital
- Medical University Department of Pathology, Hôpital Tenon, Sorbonne University
| | - Jonathan I Epstein
- Departments of Pathology
- Urology
- Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lawrence D True
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Donna Hansel
- Department of Pathology, Oregon Health Science University, OR
| | | | - Hikmat Al-Ahmadie
- Departments of Pathology
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dilek Baydar
- Department of Pathology, Koc University School of Medicine, Istanbul, Turkey
| | | | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | | | | | - Jennifer Gordetsky
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center
| | - Sounak Gupta
- Department of Pathology, Mayo Clinic, Rochester, MN
| | - Ondra Hes
- Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
| | | | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Lakshmi Kunju
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | | | - Andres Matoso
- Departments of Pathology
- Urology
- Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - George Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL
| | - Adeboye O Osunkoya
- Departments of Pathology and Laboratory Medicine
- Urology, Emory University School of Medicine, Atlanta, GA
| | - Chin Chen Pan
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kristina Pivovarcikova
- Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
| | - Maria R Raspollini
- Department of Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy
| | - Henning Reis
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, Essen
| | | | - Morgan Roupret
- GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Rajal B Shah
- Departments of Pathology
- Urology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shahrokh Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Veronika Weyerer
- Department of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, MA
| | - Jesse McKenney
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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4
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Fonseca RB, Straub Hogan MM, Kapp ME, Cate F, Coogan A, Arora S, Gordetsky J, Smelser WW, Clark PE, Cates J, Giannico GA. Diagnostic renal mass biopsy is associated with individual categories of PADUA and RENAL nephrometry scores: Analysis of diagnostic and concordance rates with surgical resection. Urol Oncol 2021; 39:371.e7-371.e15. [PMID: 33773915 DOI: 10.1016/j.urolonc.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/06/2021] [Accepted: 02/22/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Renal mass biopsy (RMB) is a safe and accurate method for diagnosis and clinical management of renal masses. However, the non-diagnostic rate is a limiting factor. We tested the hypothesis that imaging characteristics and anatomic complexity of the mass may impact RMB diagnostic outcome using the preoperative aspects and dimensions used for an anatomical (PADUA) classification and radius-exophytic/endophytic-nearness-anterior/posterior-location (RENAL) score. MATERIAL AND METHODS Single institution, retrospective study of 490 renal masses from 443 patients collected from 2001 to 2018. Outcome measurements include (1) diagnostic and concordance rates amongst RMB types and RMB with surgical resection specimens; (2) association between diagnostic RMB and anatomical complexity of renal masses. The analysis was conducted in unselected masses and small renal masses (SRMs). RESULTS RMB was performed by fine needle aspiration (FNA), core needle biopsy (CNB), or both (FNA+CNB). Non-diagnostic rate was significantly higher for FNA compared to CNB and FNA+CNB in both unselected and SRMs. Subset analysis in the FNA+CNB group showed similar diagnostic rates for FNA and CNB. In unselected masses, specificity for FNA, CNB, and FNA+CNB was 100%. Sensitivity was higher for CNB (90.1%, P = 0.002) and FNA+CNB (96.3%, P = 0.004) compared to FNA (66.7%). For unselected masses, endophytic growth predicted a non-diagnostic CNB. R.E.N.A.L location entirely between the polar lines (central) and entirely above the upper polar line predicted a diagnostic CNB. Sonography-guidance predicted a diagnostic FNA. For SRMs, non-diagnostic CNB was associated with endophytic growth, while diagnostic CNB was associated with renal sinus invasion and operator experience. More cystic masses were sampled by FNA, but diagnostic results were similar for FNA and CNB. CONCLUSIONS Endophytic growth consistently predicted a non-diagnostic CNB in unselected and SRMs, whereas sonography-guidance predicted a diagnostic FNA. Cystic masses could be adequately sampled by FNA.
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Affiliation(s)
- Ricardo B Fonseca
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences; Nashville, TN
| | - Melissa M Straub Hogan
- Vanderbilt University Medical Center, Department of Pathology, Immunology, and Microbiology; Nashville, TN
| | - Meghan E Kapp
- Vanderbilt University Medical Center, Department of Pathology, Immunology, and Microbiology; Nashville, TN
| | | | - Alice Coogan
- Vanderbilt University Medical Center, Department of Pathology, Immunology, and Microbiology; Nashville, TN
| | - Sandeep Arora
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences; Nashville, TN
| | - Jennifer Gordetsky
- Vanderbilt University Medical Center, Department of Pathology, Immunology, and Microbiology; Nashville, TN
| | - Woodson W Smelser
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Peter E Clark
- Department of Urology, Urologic Oncology Levine Cancer Institute Atrium Health, Charlotte, NC
| | - Justin Cates
- Vanderbilt University Medical Center, Department of Pathology, Immunology, and Microbiology; Nashville, TN
| | - Giovanna A Giannico
- Vanderbilt University Medical Center, Department of Pathology, Immunology, and Microbiology; Nashville, TN.
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5
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Boi SK, Orlandella RM, Gibson JT, Turbitt WJ, Wald G, Thomas L, Buchta Rosean C, Norris KE, Bing M, Bertrand L, Gross BP, Makkouk A, Starenki D, Farag KI, Sorge RE, Brown JA, Gordetsky J, Yasin H, Garje R, Nandagopal L, Weiner GJ, Lubaroff DM, Arend RC, Li P, Zakharia Y, Yang E, Salem AK, Nepple K, Marquez-Lago TT, Norian LA. Obesity diminishes response to PD-1-based immunotherapies in renal cancer. J Immunother Cancer 2020; 8:e000725. [PMID: 33427691 PMCID: PMC7757487 DOI: 10.1136/jitc-2020-000725] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity is a major risk factor for renal cancer, yet our understanding of its effects on antitumor immunity and immunotherapy outcomes remains incomplete. Deciphering these associations is critical, given the growing clinical use of immune checkpoint inhibitors for metastatic disease and mounting evidence for an obesity paradox in the context of cancer immunotherapies, wherein obese patients with cancer have improved outcomes. METHODS We investigated associations between host obesity and anti-programmed cell death (PD-1)-based outcomes in both renal cell carcinoma (RCC) subjects and orthotopic murine renal tumors. Overall survival (OS) and progression-free survival (PFS) were determined for advanced RCC subjects receiving standard of care anti-PD-1 who had ≥6 months of follow-up from treatment initiation (n=73). Renal tumor tissues were collected from treatment-naive subjects categorized as obese (body mass index, 'BMI' ≥30 kg/m2) or non-obese (BMI <30 kg/m2) undergoing partial or full nephrectomy (n=19) then used to evaluate the frequency and phenotype of intratumoral CD8+ T cells, including PD-1 status, by flow cytometry. In mice, antitumor immunity and excised renal tumor weights were evaluated ±administration of a combinatorial anti-PD-1 therapy. For a subset of murine renal tumors, immunophenotyping was performed by flow cytometry and immunogenetic profiles were evaluated via nanoString. RESULTS With obesity, RCC patients receiving anti-PD-1 administration exhibited shorter PFS (p=0.0448) and OS (p=0.0288). Treatment-naive renal cancer subjects had decreased frequencies of tumor-infiltrating PD-1highCD8+ T cells, a finding recapitulated in our murine model. Following anti-PD-1-based immunotherapy, both lean and obese mice possessed distinct populations of treatment responders versus non-responders; however, obesity reduced the frequency of treatment responders (73% lean vs 44% obese). Tumors from lean and obese treatment responders displayed similar immunogenetic profiles, robust infiltration by PD-1int interferon (IFN)γ+CD8+ T cells and reduced myeloid-derived suppressor cells (MDSC), yielding favorable CD44+CD8+ T cell to MDSC ratios. Neutralizing interleukin (IL)-1β in obese mice improved treatment response rates to 58% and reduced MDSC accumulation in tumors. CONCLUSIONS We find that obesity is associated with diminished efficacy of anti-PD-1-based therapies in renal cancer, due in part to increased inflammatory IL-1β levels, highlighting the need for continued study of this critical issue.
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Affiliation(s)
- Shannon K Boi
- Graduate Biomedical Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rachael M Orlandella
- Graduate Biomedical Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Justin Tyler Gibson
- Graduate Biomedical Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William James Turbitt
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gal Wald
- Department of Urology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Lewis Thomas
- Department of Urology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Claire Buchta Rosean
- Department of Urology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Katlyn E Norris
- Honors Undergraduate Research Program, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Megan Bing
- Department of Urology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Laura Bertrand
- Department of Urology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Brett P Gross
- Interdisciplinary Program in Immunology, The University of Iowa, Iowa City, Iowa, USA
| | - Amani Makkouk
- Interdisciplinary Program in Immunology, The University of Iowa, Iowa City, Iowa, USA
| | - Dmytro Starenki
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Kristine I Farag
- Science and Technology Honors Program, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert E Sorge
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James A Brown
- Department of Urology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
| | - Jennifer Gordetsky
- Departments of Pathology and Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hesham Yasin
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Rohan Garje
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
- Genitourinary Oncology Program, Division of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Lakshminarayanan Nandagopal
- Division of Hematology and Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
- The University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
| | - George J Weiner
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
- Department of Internal Medicine, Division of General Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - David M Lubaroff
- Department of Urology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
| | - Rebecca C Arend
- The University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Peng Li
- Department of Biostatistics, The University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Yousef Zakharia
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
- Genitourinary Oncology Program, Division of Hematology, Oncology and Blood and Marrow Transplantation, The University of Iowa, Iowa City, Iowa, USA
| | - Eddy Yang
- The University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
- Department of Radiation Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Aliasger K Salem
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
- Division of Pharmaceutics and Translational Therapeutics, University of Iowa College of Pharmacy, Iowa City, Iowa, USA
| | - Kenneth Nepple
- Department of Urology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
| | - Tatiana T Marquez-Lago
- Department of Genetics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lyse A Norian
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- The University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
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6
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Brinkley G, Nam H, Shim E, Kirkman R, Kundu A, Karki S, Heidarian Y, Tennessen JM, Liu J, Locasale JW, Guo T, Wei S, Gordetsky J, Johnson-Pais TL, Absher D, Rakheja D, Challa AK, Sudarshan S. Teleological role of L-2-hydroxyglutarate dehydrogenase in the kidney. Dis Model Mech 2020; 13:dmm045898. [PMID: 32928875 PMCID: PMC7710027 DOI: 10.1242/dmm.045898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
L-2-hydroxyglutarate (L-2HG) is an oncometabolite found elevated in renal tumors. However, this molecule might have physiological roles that extend beyond its association with cancer, as L-2HG levels are elevated in response to hypoxia and during Drosophila larval development. L-2HG is known to be metabolized by L-2HG dehydrogenase (L2HGDH), and loss of L2HGDH leads to elevated L-2HG levels. Despite L2HGDH being highly expressed in the kidney, its role in renal metabolism has not been explored. Here, we report our findings utilizing a novel CRISPR/Cas9 murine knockout model, with a specific focus on the role of L2HGDH in the kidney. Histologically, L2hgdh knockout kidneys have no demonstrable histologic abnormalities. However, GC-MS metabolomics demonstrates significantly reduced levels of the TCA cycle intermediate succinate in multiple tissues. Isotope labeling studies with [U-13C] glucose demonstrate that restoration of L2HGDH in renal cancer cells (which lowers L-2HG) leads to enhanced incorporation of label into TCA cycle intermediates. Subsequent biochemical studies demonstrate that L-2HG can inhibit the TCA cycle enzyme α-ketoglutarate dehydrogenase. Bioinformatic analysis of mRNA expression data from renal tumors demonstrates that L2HGDH is co-expressed with genes encoding TCA cycle enzymes as well as the gene encoding the transcription factor PGC-1α, which is known to regulate mitochondrial metabolism. Restoration of PGC-1α in renal tumor cells results in increased L2HGDH expression with a concomitant reduction in L-2HG levels. Collectively, our analyses provide new insight into the physiological role of L2HGDH as well as mechanisms that promote L-2HG accumulation in disease states.
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Affiliation(s)
- Garrett Brinkley
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Hyeyoung Nam
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Eunhee Shim
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Richard Kirkman
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Anirban Kundu
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Suman Karki
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Yasaman Heidarian
- Department of Biology, Indiana University, Bloomington, IN 47405, USA
| | - Jason M Tennessen
- Department of Biology, Indiana University, Bloomington, IN 47405, USA
| | - Juan Liu
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27710, USA
| | - Jason W Locasale
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27710, USA
| | - Tao Guo
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Shi Wei
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Jennifer Gordetsky
- Departments of Pathology and Urology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Devin Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, AL 35806, USA
| | - Dinesh Rakheja
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Anil K Challa
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sunil Sudarshan
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Birmingham VA Medical Center, Birmingham, AL 35233, USA
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7
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Colvin SD, Cason DE, Galgano SJ, Triche BL, Gordetsky J, Rais-Bahrami S, Porter KK. Fusion of high B-value diffusion-weighted and T2-weighted MR images increases sensitivity for identification of extraprostatic disease in prostate cancer. Clin Imaging 2020; 68:202-209. [PMID: 32892105 DOI: 10.1016/j.clinimag.2020.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate whether fusion of high b-value diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) increases radiologists' ability to detect pathologic features responsible for upstaging in prostate cancer patients prior to radical prostatectomy (RP). BASIC PROCEDURES This was a retrospective study including 103 patients who underwent RP and a prostate MRI performed at 3T. High b-value DWI and T2WI were fused and interpreted by three radiologists with different degrees of experience. Prior to and after fusion, readers answered questionnaires about cancer presence, extraprostatic extension (EPE), seminal vesicle (SV) invasion, lymph node (LN) involvement, and reader confidence. Pathology reports served as the reference standard. MAIN FINDINGS High b-value DWI-T2WI fusion increased sensitivity for detection of EPE from 65.6% to 77.4% (p < 0.05), SV invasion from 40.5% to 48.8% (p < 0.05), and LN metastasis by 23.8% to 44.4% (p < 0.05). Readers' confidence significantly improved with the use of fusion imaging. Across all readers, confidence of cancer detection increased by 12.5% (p < 0.05), EPE by 14.7% (p < 0.05), SV invasion by 8.1% (p < 0.05), and LN metastasis by 2.5% (p < 0.05) using Wilcoxon signed rank test. PRINCIPAL CONCLUSIONS Fusion overlay of high b-value DWI and T2WI increases sensitivity for detection of extraprostatic disease resulting in upstaging at the time of RP.
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Affiliation(s)
- Stephanie D Colvin
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Daniel E Cason
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Benjamin L Triche
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Soroush Rais-Bahrami
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
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8
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Kawahara T, Teramoto Y, Li Y, Ishiguro H, Gordetsky J, Yang Z, Miyamoto H. Impact of Vasectomy on the Development and Progression of Prostate Cancer: Preclinical Evidence. Cancers (Basel) 2020; 12:E2295. [PMID: 32824199 PMCID: PMC7464827 DOI: 10.3390/cancers12082295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022] Open
Abstract
Some observational studies have implied a link between vasectomy and an elevated risk of prostate cancer. We investigated the impact of vasectomy on prostate cancer outgrowth, mainly using preclinical models. Neoplastic changes in the prostate were compared in transgenic TRAMP mice that underwent vasectomy vs. sham surgery performed at 4 weeks of age. One of the molecules identified by DNA microarray (i.e., ZKSCAN3) was then assessed in radical prostatectomy specimens and human prostate cancer lines. At 24 weeks, gross tumor (p = 0.089) and poorly differentiated adenocarcinoma (p = 0.036) occurred more often in vasectomized mice. Vasectomy significantly induced ZKSCAN3 expression in prostate tissues from C57BL/6 mice and prostate cancers from TRAMP mice. Immunohistochemistry showed increased ZKSCAN3 expression in adenocarcinoma vs. prostatic intraepithelial neoplasia (PIN), PIN vs. non-neoplastic prostate, Grade Group ≥3 vs. ≤2 tumors, pT3 vs. pT2 tumors, pN1 vs. pN0 tumors, and prostate cancer from patients with a history of vasectomy. Additionally, strong (2+/3+) ZKSCAN3 expression (p = 0.002), as an independent prognosticator, or vasectomy (p = 0.072) was associated with the risk of tumor recurrence. In prostate cancer lines, ZKSCAN3 silencing resulted in significant decreases in cell proliferation/migration/invasion. These findings suggest that there might be an association between vasectomy and the development and progression of prostate cancer, with up-regulation of ZKSCAN3 expression as a potential underlying mechanism.
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Affiliation(s)
- Takashi Kawahara
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yuki Teramoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Yi Li
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
| | - Hitoshi Ishiguro
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Kanagawa Institute of Industrial Science and Technology, Kawasaki 210-0821, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Jennifer Gordetsky
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, USA
- Departments of Pathology and Urology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Zhiming Yang
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
| | - Hiroshi Miyamoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, USA
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9
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Gordetsky J, Spieker AJ, Pena MDCR, Kamanda S, Anderson MR, Cheville J, Boorjian S, Frank I, Granada CP, Comperat E, Hirsch MS, Iczkowski KA, Imblum B, Schwartz L, Giannico GA, Rais-Bahrami S. Squamous Cell Carcinoma of the Bladder Is Not Associated With High-risk HPV. Urology 2020; 144:158-163. [PMID: 32681917 DOI: 10.1016/j.urology.2020.06.065] [Citation(s) in RCA: 1] [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: 05/12/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the clinical features, pathologic features, and prevalence of human papilloma virus (HPV) in squamous cell carcinoma (SCC) of the bladder. SCC of the bladder is known to be associated with conditions that cause chronic inflammation/irritation. The literature is inconsistent regarding the association of HPV with pure SCC of the bladder. METHODS A multi-institutional study identified cases of SCC of the bladder. Pure squamous histology and the absence of urothelial carcinoma in situ were required for inclusion. Clinical and pathologic features were collected, and tissues were evaluated for high-risk HPV using p16 immunohistochemistry and in situ hybridization. RESULTS We identified 207 cases of SCC of the bladder. Risk factors for bladder cancer included smoking (133/207, 64%) and chronic bladder irritation (83/207, 40%). The majority (155/207, 75%) of patients had > pT2 disease. Mean tumor size was 5.6 ± 3.0 cm and 36/207 (17%) patients had lymph node positive disease. p16 immunohistochemistry was positive in 52/204 (25%) cases but high-risk HPV was identified with in situ hybridization in only 1 (0.5%) case. Tumor size, stage, number of lymph nodes removed, number of positive lymph nodes, lymphovascular invasion, perineural invasion, and positive margins each were associated with cancer-specific mortality when adjusted for demographic factors. A multivariate analysis of variable importance further revealed sex and race as important factors in predicting cancer-specific mortality. CONCLUSION SCC of the bladder is an aggressive histologic subtype. Although bladder SCC can express p16, it is not typically associated with high-risk HPV, although rare cases can occur.
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Affiliation(s)
- Jennifer Gordetsky
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN; Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | | | - Sonia Kamanda
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Michele R Anderson
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Eva Comperat
- Department of Pathology, Tenon Hospital, Sorbonne University, Paris, France
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | - Brittney Imblum
- Department of Pathology, University of Pennsylvania, Philadelphia, PA
| | - Lauren Schwartz
- Department of Pathology, University of Pennsylvania, Philadelphia, PA
| | - Giovanna A Giannico
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL
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10
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Gordetsky J, Kim C, Miller RF, Mehrad M. Non-necrotizing granulomatous pneumonitis and chronic pleuritis in soldiers deployed to Southwest Asia. Histopathology 2020; 77:453-459. [PMID: 32379353 DOI: 10.1111/his.14135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/29/2020] [Indexed: 01/09/2023]
Abstract
AIMS Reports of respiratory illnesses among soldiers returning from Southwest Asia have been described. During deployment to Southwest Asia, soldiers are exposed to various respiratory hazards, including dust storms, smoke from burn pits and industrial air pollutants. A few studies have reported increased rates of constrictive bronchiolitis and asthma in these patients. We sought to expand upon the pathological findings in this cohort. METHODS AND RESULTS Lung biopsies from veterans of Southwest Asia were identified and re-reviewed. All patients had undergone pulmonary function tests and chest high-resolution CT imaging with no significant findings. Overall, 59 patients with a history of inhalational exposure to at least one of the following were identified: smoke from burn pit, dust storm and sulphur plant fire. Samples included video-assisted thoracoscopic lung biopsies (57 of 59, 96.6%) and cryobiopsies (two of 59, 3.4%). Patients were predominantly male (54 of 59, 91.5%) with an age range of 24-55 years (mean and median = 35). Non-necrotising, poorly formed granulomas were identified in 22 cases (22 of 59, 37.2%). The granulomas were mainly bronchiolocentric and were associated with chronic lymphoplasmacytic bronchiolitis, similar to hypersensitivity pneumonitis (HP). Pleural reaction in the form of focal chronic lymphocytic pleuritis and/or focal pleural adhesions were seen in 43 of 57 (75.4%) biopsies. CONCLUSIONS To our knowledge, this is the first study to report pleural reaction as well as features of HP in this population, suggesting that pleural reaction and HP may be part of the spectrum of Southwest Asia deployment-related lung diseases.
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Affiliation(s)
- Jennifer Gordetsky
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christine Kim
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert F Miller
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mitra Mehrad
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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Rodriguez Pena MDC, Gordetsky J, Greipp PT, Wei S, Martignoni G, Netto GJ, Harada S, Prieto Granada CN. Rare MDM2 amplification in a fat-predominant angiomyolipoma. Virchows Arch 2020; 477:661-666. [PMID: 32409886 DOI: 10.1007/s00428-020-02813-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/23/2020] [Accepted: 04/05/2020] [Indexed: 12/14/2022]
Abstract
Angiomyolipomas (AMLs) are triphasic tumors (smooth muscle, vascular and adipocytic components) with myomelanocytic differentiation, arising most commonly in the kidneys, which can show predominant epithelioid morphology and fat-predominant or fat-poor variants. Fat-predominant AMLs can show areas of hypercellularity and lipoblast-like cells, and these features can mimic well-differentiated liposarcoma (WDLS). To date, only one documented metastatic epithelioid AML showed unequivocal MDM2 amplification by fluorescence in situ hybridization. We describe our findings in a series of 35 AMLs including epithelioid, fat-poor, and fat-predominant variants, following interrogation of the MDM2 locus by FISH and CISH assays. MDM2 amplification was detected in 1 fat-predominant AML. Our findings demonstrate that rare MDM2 amplifications can occur in AMLs. We favor that this finding likely represents a "molecular bystander" event since these tumors are mainly driven by aberrations in the TSC1/TSC2 genes. Nevertheless, the presence of MDM2 amplification in a fat-predominant AML could present a potential diagnostic pitfall, particularly when confronted with the differential diagnosis of fat-predominant AML and WDLS in limited material from the retroperitoneum.
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Affiliation(s)
| | - Jennifer Gordetsky
- Pathology Department, Vanderbilt University Medical Center, Nashville, TN, USA
- Urology Department, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Shi Wei
- Pathology Department, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Guido Martignoni
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
- Department of Pathology, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - George J Netto
- Pathology Department, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shuko Harada
- Pathology Department, University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Coiner BL, Giannico GA, Gordetsky J. Paratesticular Cyst with Benign Epithelial Proliferation Arising from a Mesonephric Duct Remnant. Urology 2020; 141:e30-e31. [PMID: 32315691 DOI: 10.1016/j.urology.2020.04.012] [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] [Received: 03/16/2020] [Accepted: 04/05/2020] [Indexed: 11/17/2022]
Abstract
A 65-year-old male presented with a cystic scrotal mass that fluctuated in size. The cyst was associated with aberrant epididymal tissue and was found to have benign epithelial proliferations, with immunohistochemistry supporting a mesonephric origin (GATA3, CD10, and WT1 positive). Clinical presentation, imaging, and pathologic findings are described.
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Affiliation(s)
| | | | - Jennifer Gordetsky
- Department of Pathology, Vanderbilt University, Nashville, TN; Department of Urology, Vanderbilt University, Nashville, TN.
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13
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Phillips J, Bloom J, Yarlagadda V, Schultz L, Gordetsky J, Tanno FY, Chambo JL, Almeida MQ, Fragoso MC, Srougi M, Srougi V, Rais-Bahrami S. Internal validation and decision curve analysis of a preoperative nomogram predicting a postoperative complication in pheochromocytoma surgery: An international study. Int J Urol 2020; 27:463-468. [PMID: 32236993 DOI: 10.1111/iju.14221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/28/2019] [Accepted: 02/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop a preoperative nomogram that would predict the risk of a postoperative complication for pheochromocytoma patients undergoing adrenalectomy using an international database. METHODS We retrospectively analyzed preoperative variables and postoperative outcomes in patients who underwent adrenalectomy for pheochromocytoma in three institutions from 2000 to 2017. Internal validation of a generated nomogram was carried out with receiver operating characteristics, calibration plots, and decision curve analyses. RESULTS A total of 153 patients who had undergone 166 adrenalectomies were included in the study. Overall, post-adrenalectomy complications were seen in 30% of patients, whereas 9.6% of patients sustained a Clavien ≥3a complication. Independent predictors of a complication were a history of hypertension, body mass index, tumor size, and Charlson Comorbidity Index score. On internal validation, the multivariable model generated a nomogram that predicted a postoperative complication or clinically hemodynamic event with an area under the curve of 0.86, showed good calibration and had an overall net benefit. CONCLUSIONS An internally validated nomogram combining body mass index, Charlson Comorbidity Index score and tumor size can predict the probability of a post-adrenalectomy complication in those with and without hypertension. The model, the first of its kind in pheochromocytoma surgery, identifies patients at risk of a postoperative complication at the time of their presentation with pheochromocytoma.
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Affiliation(s)
- John Phillips
- Department of Urology, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
| | - Jonathan Bloom
- Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Vidhush Yarlagadda
- Departments of, Department of, Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Luciana Schultz
- and, Department of, Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer Gordetsky
- Departments of, Department of, Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,and, Department of, Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Fabio Y Tanno
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Jose L Chambo
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Madson Q Almeida
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria Cbv Fragoso
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Victor Srougi
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Soroush Rais-Bahrami
- Departments of, Department of, Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, Alabama, USA
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14
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Fang AM, Rosen J, Saidian A, Bae S, Tanno FY, Chambo JL, Bloom J, Gordetsky J, Srougi V, Phillips J, Rais-Bahrami S. Perioperative outcomes of laparoscopic, robotic, and open approaches to pheochromocytoma. J Robot Surg 2020; 14:849-854. [PMID: 32112185 DOI: 10.1007/s11701-020-01056-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/15/2020] [Indexed: 01/20/2023]
Abstract
While multiple studies have demonstrated that minimally invasive surgical (MIS) techniques are a safe and efficacious approach to adrenalectomy for pheochromocytomas (PC), these studies have only been small comparative studies. The aim of this multi-institutional study is to compare perioperative outcomes between open and MIS, stratified by robotic and conventional laparoscopic, techniques in the surgical management of PC. We retrospectively evaluated patients who underwent adrenalectomy for PCs from 2000 to 2017 at three different institutions. Clinical, perioperative, and pathologic parameters were analyzed using t test, Chi square, and Fisher exact statistical measures. Of the 156 adrenalectomy cases performed, 26 (16.7%) were with an open approach and 130 (83.3%) using MIS techniques. Of the MIS procedures, 41 (31.5%) were performed robotically and 89 (68.5%) performed laparoscopically without robotic assistance. Demographic and clinical parameters were similar between the open and MIS groups. Patients, who underwent MIS procedure had a lower complication rate (p = 0.04), shorter hospitalization (p = 0.02), shorter operative time (p < 0.001), and less blood loss (p = 0.002) than those who underwent open surgical resection. Conventional laparoscopic and robotic operative approaches resulted in similar complication rates, length of hospitalization, and blood loss. Our study is one of the largest cohorts comparing the perioperative outcomes between conventional laparoscopic and robotic adrenalectomies in patients with PC. Our results support that MIS techniques have potentially lower morbidity compared to open techniques, while laparoscopic and robotic approaches have similar perioperative outcomes.
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Affiliation(s)
- Andrew M Fang
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35233, USA
| | - Jennifer Rosen
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35233, USA
| | - Ava Saidian
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35233, USA
| | - Sejong Bae
- Division of Preventative Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fabio Y Tanno
- Department of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Jose L Chambo
- Department of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Jonathan Bloom
- Department of Urology, New York Medical College, Valhalla, NY, USA
| | - Jennifer Gordetsky
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35233, USA
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pathology, Vanderbilt University, Nashville, TN, USA
| | - Victor Srougi
- Department of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - John Phillips
- Department of Urology, New York Medical College, Valhalla, NY, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35233, USA.
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
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15
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Ellenburg JL, Kolettis P, Drwiega JC, Posey AM, Goldberg M, Mehrad M, Giannico G, Gordetsky J. Formalin Versus Bouin Solution for Testis Biopsies: Which Is the Better Fixative? Clin Pathol 2020; 13:2632010X19897262. [PMID: 31922127 PMCID: PMC6940599 DOI: 10.1177/2632010x19897262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022]
Abstract
Purpose: Some resources recommended Bouin solution for the fixation of testis biopsy
specimens. We compared the histologic quality of rat testicular tissue using
buffered formalin and Bouin solution as fixatives. Methods: We prospectively compared the histologic quality of rat testicular tissue
fixed in Bouin solution versus formalin. Testicular tissue was harvested
post-mortem from six rats. Each testis was removed and sectioned in half;
one half was fixed in formalin and one half in Bouin solution. Testicular
tissue histology (nuclear membrane detail, nuclear granularity, cytoplasmic
granularity, cytoplasmic membrane detail, and basement membrane detail) was
graded as high quality (2) or low quality (1). Sloughing of cells into the
lumens of the seminiferous tubules was graded on a 0-3 scale (0=none,
1=mild, 2=moderate, 3=extensive). Results: All slides regardless of fixative were of appropriate quality for the
histologic evaluation of spermatogenesis. The average sloughing score for
formalin cases was 1.4 and for Bouin cases 1.6. Formalin fixed tissue was
found to have high quality nuclear membrane detail (2), nuclear granularity
(1.9), and basement membrane detail (2). Cytoplasmic granularity was of
lesser but adequate quality (1.4). Cytoplasmic membrane detail was poor,
(1). Tissue fixed with Bouin solution had high quality basement membrane
detail (2) and adequate cytoplasmic granularity (1.5), nuclear membrane
detail (1.3) and nuclear granularity (1.4). Cytoplasmic membrane detail was
poor (1). Conclusion: Compared to Bouin solution, formalin fixation of rat testicular tissue
produced adequate histology for the evaluation of spermatogenesis and may be
superior to Bouin solution for certain cytologic features.
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Affiliation(s)
- James L Ellenburg
- Department of Urology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter Kolettis
- Department of Urology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph C Drwiega
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna M Posey
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew Goldberg
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mitra Mehrad
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Giovanna Giannico
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Gordetsky
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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16
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Ghatalia P, Gordetsky J, Kuo F, Dulaimi E, Cai KQ, Devarajan K, Bae S, Naik G, Chan TA, Uzzo R, Hakimi AA, Sonpavde G, Plimack E. Correction to: Prognostic impact of immune gene expression signature and tumor infiltrating immune cells in localized clear cell renal cell carcinoma. J Immunother Cancer 2019; 7:273. [PMID: 31640776 PMCID: PMC6806554 DOI: 10.1186/s40425-019-0735-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following publication of the original article [1], the author reported that the current funding section "Kidney Cancer Association Young Investigator Grant provided funding for this project" should be replaced with "Kidney Cancer Association Young Investigator Grant and Bucks County Board provided funding for this project."
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Affiliation(s)
- Pooja Ghatalia
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Jennifer Gordetsky
- University of Alabama at Birmingham, 1802 6th Ave S, Birmingham, AL, 35233, USA
| | - Fengshen Kuo
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Essel Dulaimi
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Kathy Q Cai
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Karthik Devarajan
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Sejong Bae
- University of Alabama at Birmingham, 1802 6th Ave S, Birmingham, AL, 35233, USA
| | - Gurudatta Naik
- University of Alabama at Birmingham, 1802 6th Ave S, Birmingham, AL, 35233, USA
| | - Timothy A Chan
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Robert Uzzo
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - A Ari Hakimi
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Guru Sonpavde
- University of Alabama at Birmingham, 1802 6th Ave S, Birmingham, AL, 35233, USA.,Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Elizabeth Plimack
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
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Morlote DM, Harada S, Batista D, Gordetsky J, Rais-Bahrami S. Clear cell papillary renal cell carcinoma: molecular profile and virtual karyotype. Hum Pathol 2019; 91:52-60. [DOI: 10.1016/j.humpath.2019.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 02/01/2023]
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18
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Fasciano D, Eich ML, Del Carmen Rodriguez Pena M, Rais-Bahrami S, Gordetsky J. Focused Submission of Tissue for Radical Prostatectomy Following Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion-Targeted Biopsy. Int J Surg Pathol 2019; 28:44-50. [PMID: 31342804 DOI: 10.1177/1066896919865026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prostate cancer can be difficult to appreciate grossly and therefore partial sampling of the gland can lead to incorrect grading, staging, or margin status. However, submitting the entire prostate is more time consuming and costly. We investigated the use of magnetic resonance imaging/ultrasound-targeted biopsy for the selective submission of prostatectomy specimens. We performed a retrospective review for patients with cancer on targeted prostate biopsy who underwent subsequent radical prostatectomy. Prostatectomy specimens were submitted in their entirety and assessed for Grade Group, extraprostatic extension (EPE), margins, and number of blocks. For Targeted-Grossing (TG) assessment, apex margin, bladder neck margin, seminal vesicles, and vas deferens sections were included. For the remainder of the prostate, only sections from areas shown to be positive for cancer on targeted biopsy were included in the analysis. With total tissue submission, EPE was found in 39/81 (48.1%) cases and positive margins in 19/81 (23.5%) cases. The TG method required significantly fewer blocks: 15.8 ± 5.9 versus 44.9 ± 11.9 (P < .0001). The TG method would have diagnosed the correct stage in 73/81 (90.1%) cases, Grade Group in 74/81 (91.4%) cases, and margin status in 79/81 (97.5%) cases. EPE was missed completely by the TG method in 7 cases (P = .008), of which 5/7 (71.4%) had focal EPE. There was no significant difference in stage (P = .24), Grade Group (P = .95), or margin status (P = .16) between the 2 methods. Grossing utilizing selective tissue submission from areas found to be positive for prostate cancer on magnetic resonance imaging/ultrasound-targeted prostate biopsy remains inferior to complete submission of tissue for radical prostatectomy specimens.
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Ghatalia P, Gordetsky J, Kuo F, Dulaimi E, Cai KQ, Devarajan K, Bae S, Naik G, Chan TA, Uzzo R, Hakimi AA, Sonpavde G, Plimack E. Prognostic impact of immune gene expression signature and tumor infiltrating immune cells in localized clear cell renal cell carcinoma. J Immunother Cancer 2019; 7:139. [PMID: 31138299 PMCID: PMC6540413 DOI: 10.1186/s40425-019-0621-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background The tumor immune microenvironment has become the focus of research in clear cell renal cell carcinoma (ccRCC) due to its important role in immune surveillance post nephrectomy. This study investigates the correlation of tumor infiltrating immune cell characteristics with rates of recurrence following surgery in localized ccRCC. Methods We morphologically identified and scored tumor infiltrating lymphocytes (TILs) in hematoxylin and eosin (H&E) stained slides of patients with localized ccRCC (stage ≥T1b excluding stage IV). The University of Alabama at Birmingham (UAB) dataset (n = 159) was used to discover and the Fox Chase Cancer Center (FCCC) dataset (n = 198) was used to validate the results of morphologic immune cell analysis. We then performed gene expression analysis using the Immune Profile panel by NanoString in the UAB cohort and identified immune cells and pathways associated with recurrence, followed by validation in the Cancer Genome Atlas (TCGA) ccRCC dataset. Infiltrating immune cell types were identified by gene expression deconvolution. Results The presence of TILs identified by morphology correlated with higher T cell, Th1, CD8+ T and Treg gene signatures. Recurrence was associated with lower T cells and higher neutrophils. Higher Teffector (Teff)/Treg ratio correlated with lower rate of recurrence and was validated in the TCGA dataset. Genes associated with adaptive immune response were downregulated in tumors that recurred. Unsupervised hierarchical clustering identified a subset of patients with over-expression of adaptive response genes including CD8, CD3, GZMA/B, PRF1, IDO1, CTLA4, PDL1, ICOS and TIGIT. These patients had higher morphologic lymphocyte infiltration and T cell gene expression. Higher levels of TILs identified by morphology correlated with higher rates of recurrence in our discovery dataset but not in our validation set. Conclusions Recurrence of ccRCC following surgery was associated with lower T cell infiltrate, lower adaptive immune response and higher neutrophil gene expression. Presence of higher Teff/Treg ratio correlated with lower recurrence. Electronic supplementary material The online version of this article (10.1186/s40425-019-0621-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pooja Ghatalia
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Jennifer Gordetsky
- University of Alabama at Birmingham, 1802 6th Ave S, Birmingham, AL, 35233, USA
| | - Fengshen Kuo
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Essel Dulaimi
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Kathy Q Cai
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Karthik Devarajan
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Sejong Bae
- University of Alabama at Birmingham, 1802 6th Ave S, Birmingham, AL, 35233, USA
| | - Gurudatta Naik
- University of Alabama at Birmingham, 1802 6th Ave S, Birmingham, AL, 35233, USA
| | - Timothy A Chan
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Robert Uzzo
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - A Ari Hakimi
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Guru Sonpavde
- University of Alabama at Birmingham, 1802 6th Ave S, Birmingham, AL, 35233, USA.,Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Elizabeth Plimack
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
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20
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Glaser ZA, Gordetsky J, Bae S, Nix J, Porter KK, Rais-Bahrami S. Validation of MSKCC pre-prostatectomy nomogram in men who undergo MRI-targeted prostate biopsy prior to radical prostatectomy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.14] [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: 11/20/2022] Open
Abstract
14 Background: The Memorial Sloan Kettering Cancer Center (MSKCC) Pre-Prostatectomy nomogram is a widely used resource using clinical factors to predict the likelihood of adverse pathology at radical prostatectomy. The increasing adoption of magnetic resonance imaging (MRI) and MRI-targeted biopsy (TB) permits optimized detection of clinically-significant cancer over systematic biopsy sampling alone. We aim to validate the prognostic utility of the MSKCC Pre-Prostatectomy nomogram with TB pathology results. Methods: Men who underwent systematic extended-sextant prostate biopsy (SB) followed by MRI TB who later underwent radical prostatectomy at our institution were included. Patient information was entered into the MSKCC Pre-Prostatectomy nomogram using five biopsy reporting schemes (SB alone, TB alone reported each of two ways (individual core (IC) technique or aggregate cores (AG) technique combining cores from a single MRI targeted lesion), and SB with TB combined with TB reported by both IC and AG methods. The likelihood of extracapsular extension (EPE), lymph node involvement (LNI), and seminal vesicle invasion (SVI) as predicted by the nomogram for each biopsy reporting schema were compared to radical prostatectomy pathology. Results: We identified 63 men from January 2014 to November 2017. On ROC analysis, IC-TB, AG-TB, SB plus IC-TB, and SB plus AG-TB exhibited similar, if not improved, AUC compared to SB alone in predicting EPE (0.671, 0.674, 0.658, and 0.6613 versus 0.6085). For LNI, superior AUC was observed for AG-TB (0.647) compared to IC-TB (0.571) and SB alone (0.524) Equivocal SVI prediction was observed for SB plus IC-TB compared to SB alone (0.727 versus 0.733). Conclusions: Using TB pathology results either alone or combined with SB pathology results for the MSKCC Pre-Prostatectomy nomogram appears comparable, if not improved, in prognosticating adverse pathologic features on radical prostatectomy compared to using SB core data alone from which the nomogram was developed.
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Affiliation(s)
| | | | - Sejong Bae
- University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey Nix
- University of Alabama at Birmingham, Birmingham, AL
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21
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Esposito RA, Gordetsky J, Rais-Bahrami S, Gunn AJ. Multiple, Bilateral Renal Oncocytomas: An Uncommon Condition Managed with Percutaneous Cryoablation. The Arab Journal of Interventional Radiology 2019. [DOI: 10.4103/ajir.ajir_31_18] [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: 11/04/2022] Open
Abstract
Multiple, bilateral renal oncocytomas are uncommon, and the management of this condition is poorly described. Here, we report a case of multiple, bilateral, biopsy-proven renal oncocytomas that were successfully managed using percutaneous cryoablation. This procedure may serve as a less invasive treatment for patients with multiple, bilateral renal oncocytomas when compared to radical or partial nephrectomy.
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Affiliation(s)
- Robert A. Esposito
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Andrew J. Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Chakravarthi BVSK, Chandrashekar DS, Hodigere Balasubramanya SA, Robinson AD, Carskadon S, Rao U, Gordetsky J, Manne U, Netto GJ, Sudarshan S, Palanisamy N, Varambally S. Wnt receptor Frizzled 8 is a target of ERG in prostate cancer. Prostate 2018; 78:1311-1320. [PMID: 30051493 DOI: 10.1002/pros.23704] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 05/31/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022]
Abstract
Prostate cancer (PCa) is one of the most frequently diagnosed cancers among men. Many molecular changes have been detailed during PCa progression. The gene encoding the transcription factor ERG shows recurrent rearrangement, resulting in the overexpression of ERG in the majority of prostate cancers. Overexpression of ERG plays a critical role in prostate oncogenesis and development of metastatic disease. Among the downstream effectors of ERG, Frizzled family member FZD4 has been shown to be a target of ERG. Frizzled-8 (FZD8) has been shown to be involved in PCa bone metastasis. In the present study, we show that the expression of FZD8 is directly correlated with ERG expression in PCa. Furthermore, we show that ERG directly targets and activates FZD8 by binding to its promoter. This activation is specific to ETS transcription factor ERG and not ETV1. We propose that ERG overexpression in PCa leads to induction of Frizzled family member FZD8, which is known to activate the Wnt pathway. Taken together, these findings uncover a novel mechanism for PCa metastasis, and indicate that FZD8 may represent a potential therapeutic target for PCa.
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Affiliation(s)
- Balabhadrapatruni V S K Chakravarthi
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Darshan S Chandrashekar
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sai Akshaya Hodigere Balasubramanya
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alyncia D Robinson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shannon Carskadon
- Vattikuti Urology Institute, Department of Urology, Henry Ford Health System, Detroit, Michigan
| | - Uttam Rao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Upender Manne
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - George J Netto
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sunil Sudarshan
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nallasivam Palanisamy
- Vattikuti Urology Institute, Department of Urology, Henry Ford Health System, Detroit, Michigan
| | - Sooryanarayana Varambally
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
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Chakravarthi BVSK, Rodriguez Pena MDC, Agarwal S, Chandrashekar DS, Hodigere Balasubramanya SA, Jabboure FJ, Matoso A, Bivalacqua TJ, Rezaei K, Chaux A, Grizzle WE, Sonpavde G, Gordetsky J, Netto GJ, Varambally S. A Role for De Novo Purine Metabolic Enzyme PAICS in Bladder Cancer Progression. Neoplasia 2018; 20:894-904. [PMID: 30121007 PMCID: PMC6098199 DOI: 10.1016/j.neo.2018.07.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 04/03/2018] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/15/2022] Open
Abstract
Genomic and transcriptome sequencing of bladder cancer (BLCA) has identified multiple molecular alterations during cancer progression. Many of these identified genetic and epigenetic changes play a role in the progression of this disease. Studies have identified molecular subtypes in muscle-invasive bladder cancer (MIBC) with different sensitivities to frontline therapy suggesting the heterogeneity in these tumors and the importance of molecular characterization of MIBC to provide effective treatment. Specifically, it has become increasingly evident, as demonstrated by The Cancer Genome Atlas project, that metabolic enzymes are commonly dysregulated in BLCA. Elevated expression of multiple metabolic enzymes is due to the increased demand from rapidly proliferating BLCA cells requiring extensive nucleotide synthesis. Cancer cells utilize the de novo purine and pyrimidine biosynthetic pathway as a source of their nucleotide needs. In this study, we show that phosphoribosyl aminoimidazole succinocarboxamide synthetase (PAICS), an enzyme involved in de novo purine biosynthetic pathway, is significantly overexpressed in BLCA. Immunohistochemical staining of paraffin-embedded tissue sections showed that PAICS is overexpressed in MIBC. Furthermore, we found that tumor suppressor miR-128 negatively regulated PAICS expression by binding to its 3′-untranslated region. We also found that PAICS induces EMT by positively regulating SNAI1 and by a reduction in E-cadherin expression. Additionally, our in vitro functional studies and in vivo chicken chorioallantoic membrane assay show that PAICS plays a critical role in BLCA cell proliferation, invasion, and tumor growth. Collectively, our data suggest that targeting PAICS may provide a therapeutic option in BLCA.
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Affiliation(s)
- Balabhadrapatruni V S K Chakravarthi
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Sumit Agarwal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Andres Matoso
- Department of Pathology, Urology and Oncology, Johns Hopkins University, Baltimore, MD, USA; The Johns Hopkins University Greenberg Bladder Cancer Institute and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Johns Hopkins University Greenberg Bladder Cancer Institute and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Alcides Chaux
- Department of Scientific Research, Norte University, Asunción, Paraguay
| | - William E Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Guru Sonpavde
- Department of Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George J Netto
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sooryanarayana Varambally
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Informatics Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
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Ghatalia P, Devarajan K, Gordetsky J, Dulaimi E, Bae S, Naik G, Sonpavde G, Plimack E. Abstract 3141: Immune gene expression and prognosis in localized clear cell (cc) renal cell carcinoma (RCC). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We previously reported that increased infiltration of immune cells (lymphocytes, plasma cells, macrophages, neutrophils) in localized ccRCC is associated with recurrence. In these tumors we now study the immune gene expression to identify a signature to predict recurrence.
Methods: We identified pts with ccRCC with >T1b tumor who underwent nephrectomy for whom we had annotation for objective tumor recurrence and a minimum follow-up of 2 years. All histologic slides were examined and tumor section with the highest amount of intratumoral immune infiltration were selected from each tumor for gene expression profiling. Total mRNA isolated from the macrodissected FFPE tumor underwent gene expression profiling for 770 genes in the Immune Profile Panel by NanoString Technologies. Digital raw counts of mRNA abundance were normalized using positive controls as well as 16 housekeeping genes. The mean signals were used to calculate fold change in gene expression between recurrers and non-recurrers, and a p-value <0.05 using empirical Bayes methods was considered significant. Cox regression was also conducted to correlate gene expression with time to recurrence.
Results: Of 132 patients (pts), 24 (18%) had recurrence and 108 did not. The median age of pts was 59 years and 57 were female. The median time to recurrence was 25.7 months. Fifty pts had low immune infiltration score and 82 pts had high infiltration based on previously conducted morphologic assessment. Only 4 genes (IL8, NCAM1, ARG2, PPBP) had >1.5 times increased mean expression in recurrers vs non-recurrers (p<0.05). Only 5 genes (CX3CL1, HLA-G, VCAM1, IL17RB, CXCL14) had >1.5 times decreased mean expression in recurrers vs non-recurrers (p<0.05). Overexpression of the following immunoregulatory genes was associated with a shorter time to recurrence: TGFB1, STAT3, NFATC4, B7-H3, ADORA2A, OX-40L, IL10, RUNX1, LILRA4, MARCO, CR1, FCER2, IL2RA (HR 1.5-3.6, p<0.05). When compared to pts with low lymphocyte infiltration, pts with high lymphocyte infiltration overexpressed T cell (CD3E, CD5), cytotoxic T cell (CD8B, SLAMF6, IL2RB, GZMK, TCF7, CTSW, EBI3), Th1 (CD38, CXCR3, CXCR6, IL16), Th2 (ITK) and Tregs (IL2RB, IRF4, TIGIT) genes (FDR p<0.01).
Conclusions: Specific immune related somatic genes were differentially expressed based on recurrence and time to recurrence in patients with localized ccRCC undergoing surgery. With further validation, these genes warrant functional validation since they may represent therapeutic targets in the perioperative setting. The results also highlight the heterogeneity of immune cell infiltration.
Citation Format: Pooja Ghatalia, Karthik Devarajan, Jennifer Gordetsky, Essel Dulaimi, Sejong Bae, Gurudatta Naik, Guru Sonpavde, Elizabeth Plimack. Immune gene expression and prognosis in localized clear cell (cc) renal cell carcinoma (RCC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3141.
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Affiliation(s)
| | | | | | | | - Sejong Bae
- 2University of Alabama at Birmingham, Birmingham, AL
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Gunn A, Mullenbach B, Poundstone M, Klimkowski S, Gordetsky J, Rais-Bahrami S. 4:03 PM Abstract No. 309 Transarterial embolization of renal cell carcinoma as an adjunctive therapy prior to cryoablation: a propensity score matching analysis. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Ullman D, Dorn D, Rais-Bahrami S, Gordetsky J. Clinical Utility and Biologic Implications of Phosphatase and Tensin Homolog (PTEN) and ETS-related Gene (ERG) in Prostate Cancer. Urology 2017; 113:59-70. [PMID: 29225123 DOI: 10.1016/j.urology.2017.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 12/13/2022]
Abstract
Phosphatase and tensin homolog (PTEN) and ETS-related gene (ERG) mutations are commonly found in prostate cancer. Although mouse studies have demonstrated that PTEN and ERG cooperatively interact during tumorigenesis, human studies examining these genes have been inconclusive. A systematic PubMed search including original articles assessing the pathogenesis of PTEN and ERG in prostate cancer was performed. Studies examining ERG's prognostic significance have conflicting results. Studies examining PTEN and ERG simultaneously found these genes are likely to occur together, but cooperative tumorigenesis functions have not been conclusively established. PTEN mutations are associated with a range of prognostic features. However, the practical clinical utility of this information remains to be determined.
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Affiliation(s)
- David Ullman
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - David Dorn
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL; Department of Urology, University of Alabama at Birmingham, Birmingham, AL.
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Batra N, Gordetsky J, Kelly D, Dangle PP. Case: Pediatric paratesticular soft tissue perineurinoma - A rare entity. Can Urol Assoc J 2017; 12:E40-E41. [PMID: 29173268 DOI: 10.5489/cuaj.4883] [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: 11/19/2022]
Abstract
Soft tissue perineuriomas are rare but benign tumours that are composed of peripheral nerve sheath and are most commonly located in the extremity. Diagnosis is confirmed by the immunohistochemical and ultrastructural features of the tumour. Paratesticular location is extremely rare; so far, only one case is reported. Herein, we report a second case of perineurioma in a 16-year-old male in the paratesticular region.
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Affiliation(s)
- Neha Batra
- The University of Alabama at Birmingham Medical School; Birmingham, AL, United States
| | | | - David Kelly
- Children's Of Alabama, University of Alabama; Birmingham, AL, United States
| | - Pankaj P Dangle
- Children's Of Alabama, University of Alabama; Birmingham, AL, United States
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Abstract
Although rare, secondary tumors of the bladder can present a diagnostic dilemma to pathologists considering a differential diagnosis of primary bladder cancer. We investigated the clinicopathologic and imaging characteristics of metastatic tumors to the bladder. We retrospectively reviewed the surgical pathology databases from 2 sites from 2013 to 2016, identifying 66 cases of secondary bladder tumors. Clinical, pathologic, and imaging findings were reviewed. Mean age at diagnosis was 63 years (range = 25-87). Females had a significantly higher proportion (44/66, 66.7%) of secondary bladder tumors compared with males (22/66, 33.3%; P = .007). In total, 56/66 (84.8%) patients had a clinical history of an in situ or invasive malignancy in another organ, and 54/66 (81.8%) patients had imaging supporting a metastatic tumor. Only 2/66 (3.0%) patients had a prior history of urothelial carcinoma. In total, 4/66 (6.1%) cases (all females) were originally misdiagnosed as primary bladder malignancies and were corrected after clinicoradiologic correlation. Overall, colorectal origin was most common (15/66, 22.7%), followed by cervical and ovarian primaries (10/66, 15.2% each). Cervical and ovarian origins predominated in the female cohort (10/44, 22.7% each), followed by endometrial (8/44, 18.2%). Colorectal and prostate primaries were the most common among males (10/22, 45.5%, and 7/22, 31.8%, respectively). Secondary bladder tumors can mimic urothelial carcinomas. In our cohort, gynecological, colorectal, and prostatic origins were most common. Clinical history, imaging, and immunohistochemical studies can be useful in avoiding this diagnostic pitfall.
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Affiliation(s)
| | - Samuel Borak
- 1 University of Alabama at Birmingham, AL, USA.,2 Community Pathology Practice Program, Montgomery, AL, USA
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Chakravarthi BVSK, Chandrashekar DS, Agarwal S, Balasubramanya SAH, Pathi SS, Goswami MT, Jing X, Wang R, Mehra R, Asangani IA, Chinnaiyan AM, Manne U, Sonpavde G, Netto GJ, Gordetsky J, Varambally S. miR-34a Regulates Expression of the Stathmin-1 Oncoprotein and Prostate Cancer Progression. Mol Cancer Res 2017; 16:1125-1137. [PMID: 29025958 DOI: 10.1158/1541-7786.mcr-17-0230] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/24/2017] [Accepted: 10/09/2017] [Indexed: 12/27/2022]
Abstract
In aggressive prostate cancers, the oncoprotein STMN1 (also known as stathmin 1 and oncoprotein 18) is often overexpressed. STMN1 is involved in various cellular processes, including cell proliferation, motility, and tumor metastasis. Here, it was found that the expression of STMN1 RNA and protein is elevated in metastatic prostate cancers. Knockdown of STMN1 resulted in reduced proliferation and invasion of cells and tumor growth and metastasis in vivo Furthermore, miR-34a downregulated STMN1 by directly binding to its 3'-UTR. Overexpression of miR-34a in prostate cancer cells reduced proliferation and colony formation, suggesting that it is a tumor suppressor. The transcriptional corepressor C-terminal binding protein 1 (CtBP1) negatively regulated expression of miR-34a. Furthermore, gene expression profiling of STMN1-modulated prostate cancer cells revealed molecular alterations, including elevated expression of growth differentiation factor 15 (GDF15), which is involved in cancer progression and potentially in STMN1-mediated oncogenesis. Thus, in prostate cancer, CtBP1-regulated miR-34a modulates STMN1 expression and is involved in cancer progression through the CtBP1\miR-34a\STMN1\GDF15 axis.Implications: The CtBP1\miR-34a\STMN1\GDF15 axis is a potential therapeutic target for treatment of aggressive prostate cancer. Mol Cancer Res; 16(7); 1125-37. ©2017 AACR.
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Affiliation(s)
- Balabhadrapatruni V S K Chakravarthi
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sumit Agarwal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Satya S Pathi
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Moloy T Goswami
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Xiaojun Jing
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Rui Wang
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Rohit Mehra
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan.,Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Irfan A Asangani
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan.,Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan.,Department of Urology, University of Michigan, Ann Arbor, Michigan.,Howard Hughes Medical Institute, University of Michigan, Ann Arbor, Michigan
| | - Upender Manne
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Guru Sonpavde
- Department of Medical Oncology, GU section, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - George J Netto
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sooryanarayana Varambally
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama. .,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
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Gordetsky J, Collingwood R, Lai WS, Del Carmen Rodriquez Pena M, Rais-Bahrami S. Second Opinion Expert Pathology Review in Bladder Cancer: Implications for Patient Care. Int J Surg Pathol 2017; 26:12-17. [DOI: 10.1177/1066896917730903] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. To review bladder specimens referred to our facility for secondary review to determine the frequency and degree of changes in pathological diagnoses, which could affect patient care. Methods. A retrospective review of 246 bladder specimens sent to our pathology department for second opinion pathological review was performed. All consultation specimens were reviewed by a single genitourinary (GU)-subspecialized surgical pathologist. Any changes in the pathological grade, stage, or histological tumor type were noted as well as patient demographic data. Statistical analysis was performed to determine the frequency and type of discrepancies in diagnoses and determine any associations with patient demographic parameters. Results. Secondary pathology consultation of 246 bladder specimens from 233 patients were reviewed and compared with the primary diagnosis. The diagnosis was altered in 91/246 cases (37.0%). The number of cases reviewed per patient and specimen type was not associated with a change in diagnosis ( P = .19; P = .1). Of the cases with a change in diagnosis, 8 (8.8%) changed malignancy status, 46 (50.5%) changed stage, 16 (17.6%) changed tumor type (ie, change from urothelial carcinoma to prostate adenocarcinoma), 16 (17.6%) changed histological variant subtype, and 14 (15.4%) changed grade. There was no association noted between age, gender, or race and changes in diagnosis ( P = .53; P = .41; P = .70). Conclusions. Secondary pathology review with a GU-subspecialized surgical pathologist can change the stage, grade, or histological subtype on bladder biopsy and tumor resection specimens in more than one-third of cases. Age and gender were not associated with the frequency of change in diagnosis on consultation review.
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Gordetsky J, Rais-Bahrami S, Epstein JI. Pathological Findings in Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion-guided Biopsy: Relation to Prostate Cancer Focal Therapy. Urology 2017; 105:18-23. [DOI: 10.1016/j.urology.2017.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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32
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Tian W, Dorn D, Wei S, Sanders RD, Matoso A, Shah RB, Gordetsky J. GATA3 expression in benign prostate glands with radiation atypia: a diagnostic pitfall. Histopathology 2017; 71:150-155. [DOI: 10.1111/his.13214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Wei Tian
- Department of Pathology; Miraca Life Sciences; Irving TX USA
| | - David Dorn
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Shi Wei
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Ronald D Sanders
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Andres Matoso
- Department of Pathology; Johns Hopkins Hospital; Baltimore MD USA
| | - Rajal B Shah
- Department of Pathology; Miraca Life Sciences; Irving TX USA
| | - Jennifer Gordetsky
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
- Department of Urology; University of Alabama at Birmingham; Birmingham AL USA
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Lai WS, Clemmensen T, Saidian A, Rais-Bahrami S, Gordetsky J. MP22-13 CLINICAL AND PATHOLOGIC CHARACTERISTICS OF EARLY ONSET RENAL CELL CARCINOMA. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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McCleskey BC, Epstein JI, Albany C, Hashemi-Sadraei N, Idrees MT, Jorns JM, Lu DY, Matoso A, Rais-Bahrami S, Schwartz LE, Ulbright TM, Gordetsky J. The Significance of Lymphovascular Invasion of the Spermatic Cord in the Absence of Cord Soft Tissue Invasion. Arch Pathol Lab Med 2017; 141:824-829. [DOI: 10.5858/arpa.2016-0226-oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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
Context.—
Testicular germ cell tumors with lymphovascular invasion (LVI) are staged pT2, and those with spermatic cord involvement are staged pT3.
Objective.—
To study the clinical significance of LVI within the spermatic cord without direct involvement of the cord soft tissues.
Design.—
A retrospective, multi-institutional review was performed on testicular GCTs with spermatic cord LVI in the absence of cord soft tissue invasion.
Results.—
Forty-four germ cell tumors had LVI in the spermatic cord without soft tissue invasion; 37 of 44 patients (84%) had nonseminomatous germ cell tumors (NSGCT), and 7 (16%) had pure seminomas. Patients with NSGCTs and spermatic cord LVI had worse clinical outcomes compared with patients with pure seminoma and spermatic cord LVI (P = .008). We then compared patients with NSGCTs and spermatic cord LVI (n = 37) to patients with NSGCTs and LVI limited to the testis (n = 32). A significantly greater percentage of patients with LVI in the spermatic cord presented with advanced clinical stage (76% versus 50%; P = .01). There was no statistically significant difference in disease recurrence/progression or death between patients with spermatic cord LVI and patients with LVI limited to the testis (P = .40; P = .50). There was no significant difference in the presence of embryonal dominant histology (P = .30) or rete testis invasion (P = .50) between the 2 groups. More hilar soft tissue invasion was seen in patients with LVI present in the spermatic cord (P = .004).
Conclusions.—
In patients with NSGCTs, LVI in the spermatic cord, without soft tissue invasion, is associated with worse clinical stage at presentation compared with patients with LVI confined to the testis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jennifer Gordetsky
- From the Departments of Pathology (Drs McCleskey and Gordetsky), Urology (Drs Rais-Bahrami and Gordetsky), and Radiology (Dr Rais-Bahrami), University of Alabama, Birmingham; the Department of Pathology, University of Michigan, Ann Arbor (Dr Jorns); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (Dr Lu); the Department o
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35
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Zarzour JG, Milner D, Valentin R, Jackson BE, Gordetsky J, West J, Rais-Bahrami S, Morgan DE. Quantitative iodine content threshold for discrimination of renal cell carcinomas using rapid kV-switching dual-energy CT. Abdom Radiol (NY) 2017; 42:727-734. [PMID: 27847998 DOI: 10.1007/s00261-016-0967-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Determine iodine content threshold discriminating papillary renal cell carcinomas (pRCC) from complex cysts (CCs) using rapid kV-switching dual-energy CT (rsDECT). MATERIALS AND METHODS IRB-approved retrospective study of 72 consecutive patients with pathologic diagnosis of renal cell carcinoma, who underwent rsDECT from 2011 to 2015. Controls included consecutive patients with CC during same period. Iodine content of each pRCC (n = 27) was measured on rsDECT workstation for arterial (n = 15) or nephrographic phase (n = 12), and compared to iodine content for clear cell renal cell carcinomas (ccRCC, n = 46) and complex cysts (n = 54). An optimal iodine content threshold was estimated using logistic regressions and Youden's J based on maximum specificity and sensitivity. RESULTS Iodine threshold of 1.28 mg/cc was optimal to discriminate between pRCCs and CCs for nephrographic phase (sens 1.0, spec 0.96, PPV 0.92, and NPV 1.0, AUC 0.997, acc 0.97, p < 0.0001). Iodine threshold of 1.22 mg/cc was the optimal cutoff value to discriminate between pRCCs and CCs in the arterial phase (sens 0.67, spec 0.97, PPV 0.91, NPV 0.85, AUC 0.76, and acc 0.84, p = 0.006). The optimal threshold to discriminate between ccRCCs and pRCCs was 1.85 mg/cc in the arterial phase (sens 0.87, spec 0.92, PPV 0.87, NPV 0.92, p < 0001) and 2.71 mg/cc in the nephrographic phase (sens 1.0, spec 1.0, PPV 1.0, NPV 1.0, p < 0.0001). CONCLUSIONS Quantitative iodine values on rsDECT discriminate between papillary RCC and complex cysts, and between papillary RCC and clear cell RCC, the former addressing an important clinical challenge particularly when an unenhanced series has not been performed. These rsDECT thresholds differ from values derived from dual-source DECT technology.
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Affiliation(s)
- Jessica G Zarzour
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA.
| | - Desmin Milner
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA
| | - Roberto Valentin
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA
| | - Bradford E Jackson
- Department of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janelle West
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA
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Sweeney MK, Rais-Bahrami S, Gordetsky J. Inverted urothelial papilloma: A review of diagnostic pitfalls and clinical management. Can Urol Assoc J 2017; 11:66-69. [PMID: 28443149 DOI: 10.5489/cuaj.4136] [Citation(s) in RCA: 9] [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: 11/19/2022]
Abstract
Inverted urothelial papilloma (IUP) is a rare, non-invasive endophytic lesion that accounts for 1-2% of urothelial tumours. On cystoscopy, IUP appears as a pedunculated/papillary mass with a smooth surface. On microscopy, IUP has an endophytic growth pattern with the bulk of the tumour covered by a superficial layer of urothelium, which can be hyperplastic or attenuated. The cytology should be bland, with uniform, spindled cells arranged in anastomosing trabeculae and cords with peripheral palisading of basaloid cells. Exophytic papillae and mitotic activity should be absent or focal. Pseudoglandular spaces and squamous metaplasia may also be present. There are distinct molecular differences between IUP and urothelial carcinoma (UC). IUP rarely has mutations of FGFR3, homozygous loss of 9p21, or gain of chromosomes 3, 7, and 17, whereas these mutations are frequently seen in UC. In addition, IUP is much less likely to have TERT mutations compared to UC. Immunohistochemistry can also be helpful in distinguishing the two entities as IUP is typically negative for CK20 and has a low Ki-67 proliferation index. Positivity for p53 may be seen in a minority of IUP. IUP can recur and be seen in association with UC. Distinguishing IUP from UC can be difficult due to the similarity between the two entities both on cystoscopy and histology, as up to 25% of UCs will also have inverted growth. Given the morphologic variants of IUP and UC, it is possible for a diagnostic error to occur, which can significantly impact patient management.
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Affiliation(s)
| | | | - Jennifer Gordetsky
- Department of Urology.,Department of Pathology; University of Alabama at Birmingham, Birmingham, AL, United States
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37
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Kates M, Ball MW, Chappidi MR, Baras AS, Gordetsky J, Sopko NA, Brant A, Pierorazio PM, Epstein JI, Schoenberg MP, Bivalacqua TJ. Accuracy of urethral frozen section during radical cystectomy for bladder cancer. Urol Oncol 2016; 34:532.e1-532.e6. [DOI: 10.1016/j.urolonc.2016.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
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38
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Dulaney C, Rais-Bahrami S, Della Manna D, Gordetsky J, Nix J, Yang E. Clinical and Radiographic Correlates of Canonical Cancer Pathway Deregulation in Malignant Intraprostatic Lesions. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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39
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Necchi A, Eigl BJ, Yang ESH, Bae S, Chandrashekar D, Chen D, Naik G, Mehta A, Giannatempo P, Colecchia M, Gordetsky J, Wei S, Cooper T, Varambally S, Sonpavde G. Gene Expression Profiling of Advanced Penile Squamous Cell Carcinoma Receiving Cisplatin-based Chemotherapy Improves Prognostication and Identifies Potential Therapeutic Targets. Eur Urol Focus 2016; 4:733-736. [PMID: 28753783 DOI: 10.1016/j.euf.2016.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/27/2016] [Accepted: 08/07/2016] [Indexed: 10/21/2022]
Abstract
In men with advanced penile squamous cell carcinoma receiving first-line chemotherapy, visceral metastases (VM) and Eastern Cooperative Oncology Group performance status ≥1 are poor prognostic factors for overall survival (OS). We hypothesized that tumor gene expression profiling may enhance prognostic stratification and identify potential therapeutic targets. In this retrospective study, RNA extracted from macrodissected tumors underwent profiling for the expression of 738 genes using NanoString. Univariate and multivariate analyses assessed the association of genes, VM, and performance status with OS. Tumors were available from 25 men who received first-line cisplatin-based chemotherapy. In univariate analysis, upregulated MAML2 (p=0.004), KITLG (p≤0.0001), and JAK1 (p=0.029) genes were associated with poor OS, and upregulated FANCA was associated with better OS (p=0.024). In stepwise multivariate analyses, VM (hazard ratio=12.75, p=0.0001) and MAML2 (hazard ratio=10.411, p=0.003) were associated with poor OS. The presence of none, one, and both of these poor risk factors was associated with significantly different median OS of 18.4 mo, 7.2 mo, and 2.1 mo, respectively. Unsupervised clustering demonstrated two major molecular subtypes with trend for different survivals (p=0.052). Validation of results is necessary. PATIENT SUMMARY: The expression of the MAML2 gene in penile cancers from men receiving first-line cisplatin-based chemotherapy predicted overall survival independent of clinical factors.
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Affiliation(s)
- Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Eddy Shih-Hsin Yang
- Department of Radiation Oncology, University of Alabama, Birmingham (UAB), Birmingham, AL, USA
| | - Sejong Bae
- Department of Medicine, Division of Preventive Medicine, Biostatistics and Bioinformatics Shared Facility, UAB Comprehensive Cancer Center, Birmingham, AL, USA
| | | | - Dongquan Chen
- Department of Medicine, Division of Preventive Medicine, Biostatistics and Bioinformatics Shared Facility, UAB Comprehensive Cancer Center, Birmingham, AL, USA
| | - Gurudatta Naik
- Department of Medicine, Section of Oncology, UAB School of Medicine, Birmingham, AL, USA
| | - Amitkumar Mehta
- Department of Medicine, Section of Oncology, UAB School of Medicine, Birmingham, AL, USA
| | | | | | | | - Shi Wei
- Department of Pathology, UAB School of Medicine, Birmingham, AL, USA
| | - Tiffiny Cooper
- Department of Radiation Oncology, University of Alabama, Birmingham (UAB), Birmingham, AL, USA
| | | | - Guru Sonpavde
- Department of Medicine, Section of Oncology, UAB School of Medicine, Birmingham, AL, USA.
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Gordetsky J, Gibson B, Stevens TM, Ellenburg JL, Grizzle W, Rais-Bahrami S. Occult Metastases in Pelvic Lymphadenectomy Specimens From Patients With Urothelial Carcinoma of the Bladder. Urology 2016; 94:161-6. [PMID: 27184604 PMCID: PMC10830253 DOI: 10.1016/j.urology.2016.03.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/17/2016] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify occult metastases within lymph nodes (LNs) reported as negative by routine histologic evaluation. In patients with high-grade, muscle-invasive urothelial carcinoma (UC) of the bladder, pelvic lymphadenectomy during radical cystectomy demonstrates a survival advantage, increasing with the number of LNs removed, even if negative for metastatic disease. This finding may potentially be explained by the presence of occult metastases. MATERIALS AND METHODS Radical cystectomy specimens with high-grade UC invading the perivesical tissue and negative LNs (pT3N0) between 2000 and 2014 were reviewed. Five levels were cut for each LN block. Two sections were cut per level: 1 stained for hematoxylin and eosin and 1 for AE1/AE3. Micrometastases were defined as tumor deposits >0.2 mm but <2 mm. Isolated tumor cells were defined as ≤0.2 mm. Medical records and survival data were reviewed. RESULTS We identified 21 cases, consisting of 370 lymph nodes. Six of 21 patients (29%) had occult metastases, including 5 occult metastatic UC and 1 occult metastatic prostate adenocarcinoma. There were 10 positive LNs; 2 macrometastases, 2 micrometastases, and 6 with ITCs. Two of 6 patients (33%) had lymphovascular invasion identified in the primary tumor. Kaplan-Meier analysis showed no significant difference in overall survival between the group of patients who remained N0 versus those upstaged due to discovery of occult metastases (P-value = .42). CONCLUSION In patients with pT3 UC undergoing cystectomy, we demonstrated the presence of occult metastases in 29% of patients. The high percentage of occult metastases present in these cases possibly explains the proven survival advantage of removing "negative" LNs. This finding might also have implications in the histologic evaluation of LNs.
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Affiliation(s)
- Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL; Department of Urology, University of Alabama at Birmingham, Birmingham, AL.
| | - Briana Gibson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Todd M Stevens
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - J Luke Ellenburg
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - William Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
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41
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Gordetsky J, Gennaro KH, Selph JP, Rais-Bahrami S. Nephrogenic Adenoma: Clinical Features, Management, and Diagnostic Pitfalls. Urology 2016; 95:29-33. [PMID: 27138263 DOI: 10.1016/j.urology.2016.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To review the diagnosis and management of nephrogenic adenoma (NA), an uncommon benign lesion found in the urinary tract. This lesion arises from a proliferation of implanted renal tubular cells. Although more common in adults, it can occur in all ages. NAs can recur and cause significant morbidity in patients. NAs are also a potential diagnostic pitfall as they can clinically and histologically mimic malignancy in the urinary tract. MATERIALS AND METHODS We performed an Institutional Board Review approved search of our surgical pathology database from 2005 to 2015 for cases of NA. A retrospective chart review was performed with a focus on the clinical, pathologic, and radiographic findings in these patients. RESULTS We identified 32 cases of NA in 31 patients. Lesions were most common in Caucasian males (male-to-female ratio of 2:1) with an average age at diagnosis of 55 years (range 25-77). Bladder was the most common site of occurrence (81.2%), followed by ureter (9.4%), urethra (6.3%), and intrarenal collecting system (3.1%). Most patients (72%) were symptomatic and presented with hematuria (41%), lower urinary tract symptoms (28%), pelvic or flank pain (6%), hydronephrosis (19%), or urinary incontinence (13%). NA was asymptomatic and identified incidentally in 9 (28%) patients. One patient (3%) had a renal transplant and 8 (26%) patients had diabetes mellitus. Twenty-six (84%) patients were managed with endoscopic resection of their tumors. CONCLUSION NAs are benign lesions that may cause significant morbidity and mimic malignant tumors. There should be increased suspicion in patients with predisposing factors.
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Affiliation(s)
- Jennifer Gordetsky
- University of Alabama at Birmingham, Department of Pathology, Birmingham, AL; University of Alabama at Birmingham, Department of Urology, Birmingham, AL.
| | - Kyle H Gennaro
- University of Alabama, School of Medicine, Birmingham, AL
| | - John P Selph
- University of Alabama at Birmingham, Department of Urology, Birmingham, AL
| | - Soroush Rais-Bahrami
- University of Alabama at Birmingham, Department of Urology, Birmingham, AL; University of Alabama at Birmingham, Department of Radiology, Birmingham, AL
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Abstract
Background Despite significant changes in the clinical and histologic diagnosis of prostate cancer, the Gleason grading system remains one of the most powerful prognostic predictors in prostate cancer. The correct diagnosis and grading of prostate cancer is crucial for a patient’s prognosis and therapeutic options. However, this system has undergone significant revisions and continues to have deficiencies that can potentially impact patient care. Main Body We describe the current state of grading prostate cancer, focusing on the current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma. We also explore the limitations of the current Gleason grading system and present a validated alternative to the Gleason score. The new grading system initially described in 2013 in a study from Johns Hopkins Hospital and then validated in a multi-institutional study, includes five distinct Grade Groups based on the modified Gleason score groups. Grade Group 1 = Gleason score ≤6, Grade Group 2 = Gleason score 3 + 4 = 7, Grade Group 3 = Gleason score 4 + 3 = 7, Grade Group 4 = Gleason score 8, Grade Group 5 = Gleason scores 9 and 10. Conclusion As this new grading system is simpler and more accurately reflects prostate cancer biology, it is recommended by the World Health Organization (WHO) to be used in conjunction with Gleason grading.
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Affiliation(s)
- Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA. .,Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jonathan Epstein
- Department of Pathology, The Johns Hopkins Hospital, The Weinberg Building Room 2242. 401 North Broadway St., Baltimore, MD, 21231, USA. .,Department of Urology, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Ghatalia P, Gordetsky J, Bae S, Watkins SM, Sudarshan S, Naik G, Sonpavde G. Association of a combined panel of tumor infiltrating lymphocytes, plasma cells, and macrophages with recurrence of localized clear cell (cc) renal cell carcinoma (RCC) undergoing surgery. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.502] [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: 11/20/2022] Open
Abstract
502 Background: Tumor infiltrating Programmed-Death (PD)-1 and FoxP3-expressing lymphocytes and macrophages appear to be associated with higher risk of recurrence in patients (pts) with ccRCC undergoing surgery for localized disease. We aimed to combine the presence of morphologically identified lymphocytes, plasma cells and macrophages into a readily available composite immune cell panel and to evaluate its association with tumor recurrence. Methods: We identified pts with ccRCC who underwent nephrectomy at UAB for whom we had annotation for objective tumor recurrence and a minimum follow-up of 2 years. Central pathology review was conducted by a single urologic oncology certified pathologist to capture pathologic variables (stage, grade, necrosis, histologic components, cystic changes) and immune cell (lymphocyte/plasma cell/macrophage) infiltration. Logistic regression (univariate and multivariate) analyses were conducted to evaluate the association of these variables with tumor recurrence. Results: Of the 159 identified and evaluable pts, 33 (20.7%) recurred and 126 did not. On univariate analyses, sarcomatoid/rhabdoid histologic components, lymphocyte/plasma cell infiltration, necrosis, pathological T stage and histologic grade were all statistically significantly associated with a risk of recurrence (p < 0.05). On multivariate analysis, in addition to pathologic stage (p = 0.0018), only the combination of higher lymphocyte/plasma cell and macrophage infiltration (p = 0.0347) was independently associated with recurrence; patients were 8.7 times more likely to recur (95% CI: 1.66, 45.28). Conclusions: A readily available and widely applicable composite panel of morphologically identified lymphocytes, plasma cells and macrophages infiltrating the tumor predicts recurrence of pts with localized ccRCC undergoing surgery, after controlling for clinical and pathologic prognostic factors. Our hypothesis-generating data require validation and further interrogation of specific markers expressed on immune cells may refine an immune panel that confers prognostic impact.
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Affiliation(s)
| | | | - Sejong Bae
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Sunil Sudarshan
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | | | - Guru Sonpavde
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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Gordetsky J, Joseph DB. Cloacal Exstrophy: A History of Gender Reassignment. Urology 2015; 86:1087-9. [PMID: 26375849 DOI: 10.1016/j.urology.2015.06.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/03/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jennifer Gordetsky
- Department of Pathology, The University of Alabama, Birmingham, AL; Department of Urology, The University of Alabama, Birmingham, AL.
| | - David B Joseph
- Department of Urology, The University of Alabama, Birmingham, AL
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Gaston SM, Grizzle WE, Kittles R, Hayek J, Kolettis PN, Rais-Bahrami S, Nix J, Gordetsky J, Adams GW, Kearney GP. Abstract SY29-02: The use of innovative prostate biopsy tissue print techniques for molecular genomic, epigenomic and gene expression studies. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-sy29-02] [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
Cancer health disparities can arise from research studies that use biospecimens that are not representative of the populations affected by the disease. In biorepositories at research oriented hospitals that support molecular biomarker research, an under-representation of important clinical subpopulations can result from practices that govern conventional biorepository collection of discarded tissues from surgical specimens. In prostate cancer biorepositories, most of the frozen samples are obtained from radical prostatectomy (RP) specimens. However, tissue collections based on RP specimens do not include patients who are diagnosed with relatively advanced disease and treated with first-line hormonal and/or radiation therapy rather than surgery; African Americans are more likely than European Americans to be diagnosed with this type of advanced prostate cancer. Moreover, RP collections have a limited representation of patient groups that preferentially choose non-surgical treatment for organ confined prostate cancer; such a preference for non-surgical treatment has been observed for African American prostate cancer patients in many areas of the US. Our collaborative group utilizes innovative prostate biopsy tissue print techniques to obtain a more complete representation of the men who are being evaluated for prostate cancer, including the patients with a biopsy diagnosis of “no cancer” and prostate cancer patients who chose active surveillance or non-surgical treatment rather than radical prostatectomy. Prostate biopsy tissue prints consist of nitrocellulose blots collected from each of the fresh tissue cores as it is transferred from the biopsy needle. This nitrocellulose blotting step is simple, inexpensive and results in no compromise of the biopsy tissue for surgical pathology. We have used snap-frozen tissue prints as the source of prostate tissues for multiple biomarker studies, including array-based and sequence-based profiling techniques that require high quality DNA and RNA. Because prostate biopsy tissue prints are easily collected in an outpatient office setting, this approach has allowed us to expand the Birmingham Area Prostate Cancer Biorepository (BAPrCAR) to include a multi-center urology practice that serves large numbers of African Americans and performs prostate biopsies on over 2000 patients per year. Prostate biopsy tissue prints have also been important in our studies of molecular marker correlations of magnetic resonance image (MRI) defined criteria of prostate cancer suspicion; our goal is to optimize the use of MRI/ultrasound guided biopsies for both African American and European American patients who are considering active surveillance. We have successfully used prostate biopsy tissue print samples to characterize multiple molecular biomarkers in parallel, including ancestry informative SNPs, mRNA and miRNA transcripts, genomic mutations and DNA methylation-marker patterns. In summary, our experience demonstrates that biopsy tissue print techniques provide an innovative, practical approach to overcoming disparities in prostate cancer research by significantly expanding patient representation in the frozen biorepository collections used for molecular biomarker discovery and translational studies.
Citation Format: Sandra M. Gaston, William E. Grizzle, Rick Kittles, Jihad Hayek, Peter N. Kolettis, Soroush Rais-Bahrami, Jeffrey Nix, Jennifer Gordetsky, George W. Adams, Gary P. Kearney. The use of innovative prostate biopsy tissue print techniques for molecular genomic, epigenomic and gene expression studies. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr SY29-02. doi:10.1158/1538-7445.AM2015-SY29-02
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Affiliation(s)
| | | | - Rick Kittles
- 3University of Arizona College of Medicine, Tuscon, AZ
| | | | | | | | - Jeffrey Nix
- 2University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Gary P. Kearney
- 6New England Baptist Hospital, Harvard Medical School, Boston, MA
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McIntosh ER, Harada S, Drwiega J, Brandwein-Gensler MS, Gordetsky J. Frozen section: guiding the hands of surgeons? Ann Diagn Pathol 2015; 19:326-9. [PMID: 26320052 DOI: 10.1016/j.anndiagpath.2015.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/25/2015] [Accepted: 07/10/2015] [Indexed: 11/16/2022]
Abstract
Frozen section (FS) analysis is a powerful tool that can provide a rapid diagnosis, directing operative management. However, FSs can also be misused. We consider an FS to be "inappropriate" when it does not influence operative management or immediate patient care. Not only can inappropriate FSs compromise diagnostic material, they can impact turnaround time of other FSs. We evaluated the utilization of FSs at our institution and assessed influence on intraoperative management. Frozen sections performed at the University of Alabama at Birmingham Hospital in 2013 were stratified by surgical subspecialty. Operative, clinical, and pathology notes were reviewed to determine the rationale for sending each FS and to determine impact on intraoperative management. Cases lacking operative notes were excluded. A total of 4104 FSs were performed in 1896 cases. Surgical subspecialties included cardiothoracic, otolaryngology, breast, surgical oncology, gynecology, gastrointestinal, hepatobiliary, urology, transplant, and orthopedics. 42.5% of FSs evaluated margin status, 34.8% confirmed or excluded malignancy, 9.5% were for tumor classification, 6.7% assessed adequacy for diagnosis, 1.9% were to confirm or exclude infection, 2.8% were for transplant, and 1.8% were for lymphoma workup. Twelve percent (491/4104) of FSs did not influence operative management. This was most common among cardiothoracic surgeries (34%). No inappropriate FSs were sent for any transplant surgeries. Otolaryngology used the most FSs and had less than 1% that were inappropriate. Most FSs influence operative management. The rationale for sending an FS and its influence on operative management was subspecialty dependent. Interdepartmental discussions of FS utilization might be helpful in the elimination of unnecessary FSs.
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Affiliation(s)
| | - Shuko Harada
- Department of Pathology, The University of Alabama, Birmingham, AL
| | - Joseph Drwiega
- Department of Pathology, The University of Alabama, Birmingham, AL
| | | | - Jennifer Gordetsky
- Department of Pathology, The University of Alabama, Birmingham, AL; Department of Urology, The University of Alabama, Birmingham, AL.
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47
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Mehta AN, Yang ESH, Necchi A, Giannatempo P, Colecchia M, Eigl BJ, Chen D, Bae S, Naik G, Gordetsky J, Wei S, Cooper T, Sonpavde G. Gene expression profiling to improve prognostic stratification of men with advanced penile squamous cell cancer (PSCC) receiving first-line systemic therapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Eddy Shih-Hsin Yang
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Andrea Necchi
- Istituto Nazionale Tumori of Milan, Milano, MI, Italy
| | | | | | | | - Dongquan Chen
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Sejong Bae
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Shi Wei
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Tiffiny Cooper
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Guru Sonpavde
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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Gordetsky J, Joseph D. FRI-04 CLOACAL EXSTROPHY: A HISTORY OF GENDER REASSIGNMENT. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gorin M, Rowe S, Gordetsky J, Ball M, Pierorazio P, Epstein J, Javadi M, Allaf M. MP35-16 PILOT STUDY EVALUATING
99M
TC-SESTAMIBI SPECT/CT FOR THE DIFFERENTIATION OF ONCOCYTOMA FROM RENAL CELL CARCINOMA. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gordetsky J, Gorin MA, Canner J, Ball MW, Pierorazio PM, Allaf ME, Epstein JI. Frozen section during partial nephrectomy: does it predict positive margins? BJU Int 2015; 116:868-72. [DOI: 10.1111/bju.13011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer Gordetsky
- Departments of Pathology and Urology; The University of Alabama; Birmingham AL USA
| | - Michael A. Gorin
- Department of Urology; The Johns Hopkins Hospital; Baltimore MD USA
| | - Joe Canner
- Department of Surgery; Center for Surgical Trials and Outcomes Research; The Johns Hopkins Hospital; Baltimore MD USA
| | - Mark W. Ball
- Department of Urology; The Johns Hopkins Hospital; Baltimore MD USA
| | | | - Mohamad E. Allaf
- Department of Urology; The Johns Hopkins Hospital; Baltimore MD USA
| | - Jonathan I. Epstein
- Department of Urology; The Johns Hopkins Hospital; Baltimore MD USA
- Department of Pathology; The Johns Hopkins Hospital; Baltimore MD USA
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