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Krishnamurthy K, Stillman IE, Hecht JL, Vyas M. Defining the Nature and Clinicopathologic Significance of Mallory-Denk-like Inclusions in Ovarian Fibromas: A Potential Degenerative Phenomenon Associated With Torsion. Int J Gynecol Pathol 2024; 43:290-295. [PMID: 37562060 DOI: 10.1097/pgp.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Mallory-Denk bodies (MBD), described in alcoholic hepatitis, are composed of intermediate filaments admixed with other proteins. These cytoplasmic inclusions are irregularly shaped and eosinophilic as seen under the light microscope. MBD-like inclusions have rarely been described outside the hepatobiliary tree. Though rare, intracytoplasmic inclusions have been reported in ovarian fibromas. This study evaluates a series of torsed ovarian fibromas with intracytoplasmic inclusions resembling MDBs. Forty-three ovarian fibromas were retrieved from the pathology archives. The H&E slides were evaluated for the presence of MBD-like inclusions and histologic evidence of torsion. The cases with histologic features of torsion were included in the study group while the nontorsed fibromas formed the control group. Among the 15 cases of fibromas with torsion, MBD-like intracytoplasmic inclusions were seen in 5 cases, predominantly in the interface between necrotic areas and viable stroma. None of the cases from the control group showed any inclusions. There was no significant difference in the size of the fibroma or patient demographics between cases with and without inclusions. The inclusions were positive for cytokeratin and ubiquitin while being negative for per acidic Schiff and periodic acid-Schiff with diastase reaction, in the 3 cases selected for immunohistochemistry and special stains. Electron microscopy of the index case revealed a predominance of type 3 Mallory hyaline. This is the first report describing MDB-like inclusions in ovarian fibromas. These MDB-like inclusions appear to be limited to a fraction of ovarian fibromas that underwent torsion, suggesting that these inclusions likely result from subacute hypoxic damage to the cells.
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Hathaway CA, Townsend MK, Wang T, Vinci C, Jake-Schoffman DE, Hecht JL, Saeed-Vafa D, Moran Segura C, Nguyen JV, Conejo-Garcia JR, Fridley BL, Tworoger SS. Lifetime Exposure to Cigarette Smoke, B Cell Tumor Immune Infiltration, and Immunoglobulin Abundance in Ovarian Tumors. Cancer Epidemiol Biomarkers Prev 2024:741953. [PMID: 38517322 DOI: 10.1158/1055-9965.epi-23-1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/08/2024] [Accepted: 03/20/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Cigarette smoke exposure has been linked to systemic immune dysfunction, including for B cell and immunoglobulin (Ig) production, and poor outcomes in ovarian cancer patients. No study has evaluated the impact of smoke exposure across the lifecourse on B cell infiltration and Ig abundance in ovarian tumors. METHODS We measured markers of B and plasma cells and Ig isotypes using multiplex immunofluorescence on 395 ovarian cancer tumors in the Nurses' Health Study (NHS)/NHSII. We conducted beta-binomial analyses evaluating odds ratios (OR) and 95% confidence intervals (CI) for positivity of immune markers by cigarette exposure among cases and Cox proportional hazards models to evaluate hazard ratios (HR) and 95%CI for developing tumors with low ( RESULTS There were no associations between smoke exposure and B cell or IgM infiltration in ovarian tumors. Among cases, we observed higher odds of IgA+ among ever smokers (OR: 1.54, 95%CI: 1.14, 2.07) and ever smokers with no parental smoke exposure (OR: 2.03, 95%CI: 1.18, 3.49) versus never smokers. Women with parental cigarette smoke exposure versus not had higher risk of developing ovarian cancer with low IgG+ (HR: 1.51, 95%CI: 1.10, 2.09), while ever versus never smokers had a lower risk (HR: 0.74, 95%CI: 0.56,0.99). CONCLUSIONS Ever smoking was associated with increased odds of IgA in ovarian tumors. IMPACT IgA has been associated with improved ovarian cancer outcomes, suggesting that although smoking is associated with poor outcomes in ovarian cancer patients, it may lead to improved tumor immunogenicity.
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Affiliation(s)
| | | | - Tianyi Wang
- Moffitt Cancer Center, Tampa, FL, United States
| | | | | | | | | | | | | | | | | | - Shelley S Tworoger
- Oregon Health & Science University School of Medicine, Portland, OR, United States
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3
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Fitzgerald GD, Newton JM, Atasi L, Buniak CM, Burgos-Luna JM, Burnett BA, Carver AR, Cheng C, Conyers S, Davitt C, Deshmukh U, Donovan BM, Easter SR, Einerson BD, Fox KA, Habib AS, Harrison R, Hecht JL, Licon E, Nino JM, Munoz JL, Nieto-Calvache AJ, Polic A, Ramsey PS, Salmanian B, Shamshirsaz AA, Shamshirsaz AA, Shrivastava VK, Woolworth MB, Yurashevich M, Zuckerwise L, Shainker SA. Placenta accreta spectrum care infrastructure: an evidence-based review of needed resources supporting placenta accreta spectrum care. Am J Obstet Gynecol MFM 2024; 6:101229. [PMID: 37984691 DOI: 10.1016/j.ajogmf.2023.101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
The incidence of placenta accreta spectrum, the deeply adherent placenta with associated increased risk of maternal morbidity and mortality, has seen a significant rise in recent years. Therefore, there has been a rise in clinical and research focus on this complex diagnosis. There is international consensus that a multidisciplinary coordinated approach optimizes outcomes. The composition of the team will vary from center to center; however, central themes of complex surgical experts, specialists in prenatal diagnosis, critical care specialists, neonatology specialists, obstetrics anesthesiology specialists, blood bank specialists, and dedicated mental health experts are universal throughout. Regionalization of care is a growing trend for complex medical needs, but the location of care alone is just a starting point. The goal of this article is to provide an evidence-based framework for the crucial infrastructure needed to address the unique antepartum, delivery, and postpartum needs of the patient with placenta accreta spectrum. Rather than a clinical checklist, we describe the personnel, clinical unit characteristics, and breadth of contributing clinical roles that make up a team. Screening protocols, diagnostic imaging, surgical and potential need for critical care, and trauma-informed interaction are the basis for comprehensive care. The vision from the author group is that this publication provides a semblance of infrastructure standardization as a means to ensure proper preparation and readiness.
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Affiliation(s)
- Garrett D Fitzgerald
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI (Dr Fitzgerald).
| | - J M Newton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN (Dr Newton)
| | - Lamia Atasi
- Department of Obstetrics and Gynecology, Mercy Hospital, St. Louis, MO (Dr Atasi)
| | - Christina M Buniak
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Dr Buniak)
| | | | - Brian A Burnett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Dr Burnett)
| | - Alissa R Carver
- Department of Obstetrics and Gynecology, Wilmington Maternal-Fetal Medicine, Wilmington, NC (Dr Carver)
| | - CeCe Cheng
- Department of Obstetrics and Gynecology, Health Science Center at San Antonio, University of Texas, San Antonio, TX (Dr Cheng)
| | - Steffany Conyers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker)
| | - Caroline Davitt
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Davitt and Am Shamshiraz)
| | - Uma Deshmukh
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker)
| | - Bridget M Donovan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker); Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA (Drs Donovan and Shainker)
| | - Sara Rae Easter
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Dr Easter)
| | - Brett D Einerson
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT (Dr Einerson)
| | - Karin A Fox
- Baylor College of Medicine, Houston, TX (Dr Fox)
| | - Ashraf S Habib
- Duke University School of Medicine, Durham, NC (Dr Habib)
| | - Rachel Harrison
- Department of Obstetrics and Gynecology, Advocate Aurora Health, Chicago, IL (Dr Harrison)
| | - Jonathan L Hecht
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker)
| | - Ernesto Licon
- Miller Women's & Children's Hospital/Long Beach Memorial Medical Center, Orange, CA (Dr Licon)
| | - Julio Mateus Nino
- Department of Obstetrics and Gynecology, Atrium Health Wake Forest School of Medicine, Winston-Salem, NC (Dr Nino)
| | - Jessian L Munoz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX (Dr Munoz)
| | | | | | - Patrick S Ramsey
- University of Texas Health/University Health San Antonio, San Antonio, TX (Dr Ramsey)
| | - Bahram Salmanian
- Department of Obstetrics and Gynecology, University of Colorado Health Anschutz Medical Campus, Boulder, CO (Dr Salmanian)
| | | | - Amir A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Davitt and Am Shamshiraz)
| | - Vineet K Shrivastava
- Miller Women's and Children's Hospital/Long Beach Memorial Medical Center, Orange, CA (Dr Shrivastava)
| | | | - Mary Yurashevich
- Department of Anesthesiology, Duke Health, Durham, NC (Dr Yurashevich)
| | - Lisa Zuckerwise
- and Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN (Dr Zuckerwise)
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker); Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA (Drs Donovan and Shainker)
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4
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Sasamoto N, Stewart PA, Wang T, Thompson ZJ, Yoder SJ, Hecht JL, Cleveland JL, Conejo‐Garcia J, Fridley BL, Terry KL, Tworoger SS. Associations between prediagnostic aspirin use and ovarian tumor gene expression. Cancer Med 2023; 12:18405-18417. [PMID: 37525619 PMCID: PMC10523980 DOI: 10.1002/cam4.6386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/25/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Aspirin use has been associated with reduced ovarian cancer risk, yet the underlying biological mechanisms are not fully understood. To gain mechanistic insights, we assessed the association between prediagnosis low and regular-dose aspirin use and gene expression profiles in ovarian tumors. METHODS RNA sequencing was performed on high-grade serous, poorly differentiated, and high-grade endometrioid ovarian cancer tumors from the Nurses' Health Study (NHS), NHSII, and New England Case-Control Study (n = 92 cases for low, 153 cases for regular-dose aspirin). Linear regression identified differentially expressed genes associated with aspirin use, adjusted for birth decade and cohort. False discovery rates (FDR) were used to account for multiple testing and gene set enrichment analysis was used to identify biological pathways. RESULTS No individual genes were significantly differentially expressed in ovarian tumors in low or regular-dose aspirin users accounting for multiple comparisons. However, current versus never use of low-dose aspirin was associated with upregulation of immune pathways (e.g., allograft rejection, FDR = 5.8 × 10-10 ; interferon-gamma response, FDR = 2.0 × 10-4 ) and downregulation of estrogen response pathways (e.g., estrogen response late, FDR = 4.9 × 10-8 ). Ovarian tumors from current regular aspirin users versus never users were also associated with upregulation in interferon pathways (FDR <1.5 × 10-4 ) and downregulation of multiple extracellular matrix (ECM) architecture pathways (e.g., ECM organization, 4.7 × 10-8 ). CONCLUSION Our results suggest low and regular-dose aspirin may impair ovarian tumorigenesis in part via enhancing adaptive immune response and decreasing metastatic potential supporting the likely differential effects on ovarian carcinogenesis and progression by dose of aspirin.
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Affiliation(s)
- Naoko Sasamoto
- Department of Obstetrics and GynecologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Paul A. Stewart
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Tianyi Wang
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Zachary J. Thompson
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Sean J. Yoder
- Molecular Genomics Core FacilityH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Jonathan L. Hecht
- Department of PathologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - John L. Cleveland
- Department of Tumor BiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Jose Conejo‐Garcia
- Department of ImmunologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Brooke L. Fridley
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Kathryn L. Terry
- Department of Obstetrics and GynecologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Shelley S. Tworoger
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
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Achom M, Sadagopan A, Bao C, McBride F, Xu Q, Konda P, Tourdot RW, Li J, Nakhoul M, Gallant DS, Ahmed UA, O’Toole J, Freeman D, Mary Lee GS, Hecht JL, Kauffman EC, Einstein DJ, Choueiri TK, Zhang CZ, Viswanathan SR. A genetic basis for cancer sex differences revealed in Xp11 translocation renal cell carcinoma. bioRxiv 2023:2023.08.04.552029. [PMID: 37577497 PMCID: PMC10418269 DOI: 10.1101/2023.08.04.552029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Xp11 translocation renal cell carcinoma (tRCC) is a female-predominant kidney cancer driven by translocations between the TFE3 gene on chromosome Xp11.2 and partner genes located on either chrX or on autosomes. The rearrangement processes that underlie TFE3 fusions, and whether they are linked to the female sex bias of this cancer, are largely unexplored. Moreover, whether oncogenic TFE3 fusions arise from both the active and inactive X chromosomes in females remains unknown. Here we address these questions by haplotype-specific analyses of whole-genome sequences of 29 tRCC samples from 15 patients and by re-analysis of 145 published tRCC whole-exome sequences. We show that TFE3 fusions universally arise as reciprocal translocations with minimal DNA loss or insertion at paired break ends. Strikingly, we observe a near exact 2:1 female:male ratio in TFE3 fusions arising via X:autosomal translocation (but not via X inversion), which accounts for the female predominance of tRCC. This 2:1 ratio is at least partially attributable to oncogenic fusions involving the inactive X chromosome and is accompanied by partial re-activation of silenced chrX genes on the rearranged chromosome. Our results highlight how somatic alterations involving the X chromosome place unique constraints on tumor initiation and exemplify how genetic rearrangements of the sex chromosomes can underlie cancer sex differences.
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Affiliation(s)
- Mingkee Achom
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Data Science, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Medicine, Harvard Medical School; Boston, MA, USA
| | - Ananthan Sadagopan
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Chunyang Bao
- Department of Data Science, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA, USA
- Cancer Program, Broad Institute of MIT and Harvard; Cambridge, MA, USA
| | - Fiona McBride
- Department of Biomedical Informatics, Blavatnik Institute, Harvard Medical School; Boston, MA, USA
| | - Qingru Xu
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Data Science, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Prathyusha Konda
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Medicine, Harvard Medical School; Boston, MA, USA
| | - Richard W. Tourdot
- Department of Data Science, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Biomedical Informatics, Blavatnik Institute, Harvard Medical School; Boston, MA, USA
| | - Jiao Li
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Medicine, Harvard Medical School; Boston, MA, USA
| | - Maria Nakhoul
- Department of Informatics & Analytics, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Daniel S. Gallant
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Usman Ali Ahmed
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Jillian O’Toole
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Dory Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Gwo-Shu Mary Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Jonathan L. Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center; Boston, MA, USA
| | - Eric C Kauffman
- Department of Urology, Roswell Park Comprehensive Cancer Center; Buffalo, New York, USA
| | - David J Einstein
- Division of Medical Oncology, Beth Israel Deaconess Medical Center; Boston, MA, USA
| | - Toni K. Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Medicine, Harvard Medical School; Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital; Boston, MA, USA
| | - Cheng-Zhong Zhang
- Department of Data Science, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA, USA
- Cancer Program, Broad Institute of MIT and Harvard; Cambridge, MA, USA
| | - Srinivas R. Viswanathan
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Medicine, Harvard Medical School; Boston, MA, USA
- Cancer Program, Broad Institute of MIT and Harvard; Cambridge, MA, USA
- Department of Medicine, Brigham and Women’s Hospital; Boston, MA, USA
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6
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Carusi DA, Duzyj CM, Hecht JL, Butwick AJ, Barrett J, Holt R, O'Rinn SE, Afshar Y, Gilner JB, Newton JM, Shainker SA. Knowledge Gaps in Placenta Accreta Spectrum. Am J Perinatol 2023; 40:962-969. [PMID: 37336213 DOI: 10.1055/s-0043-1761635] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Since its first description early in the 20th Century, placenta accreta and its variants have changed substantially in incidence, risk factor profile, clinical presentation, diagnosis and management. While systematic use of diagnostic tools and a multidisciplinary team care approach has begun to improve patient outcomes, the condition's pathophysiology, epidemiology, and best practices for diagnosis and management remain poorly understood. The use of large databases with broadly accepted terminology and diagnostic criteria should accelerate research in this area. Future work should focus on non-traditional phenotypes, such as those without placenta previa-preventive strategies, and long term medical and emotional support for patients facing this diagnosis. KEY POINTS: · Placenta accreta spectrum research may be improved with standardized terminology and use of large databases.. · Placenta accreta prediction should move beyond ultrasound with the addition of biomarkers, and needs to extend to those without traditional risk factors.. · Future research should identify practices that can prevent future accreta development..
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Affiliation(s)
- Daniela A Carusi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christina M Duzyj
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Roxane Holt
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | | | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jennifer B Gilner
- Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, North Carolina
| | - J M Newton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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7
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Hathaway CA, Conejo-Garcia JR, Fridley BL, Rosner B, Saeed-Vafa D, Segura CM, Nguyen JV, Hecht JL, Sasamoto N, Terry KL, Tworoger SS, Townsend MK. Measurement of Ovarian Tumor Immune Profiles by Multiplex Immunohistochemistry: Implications for Epidemiologic Studies. Cancer Epidemiol Biomarkers Prev 2023; 32:848-853. [PMID: 36940177 PMCID: PMC10239319 DOI: 10.1158/1055-9965.epi-22-1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 03/16/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Despite the immunogenic nature of many ovarian tumors, treatment with immune checkpoint therapies has not led to substantial improvements in ovarian cancer survival. To advance population-level research on the ovarian tumor immune microenvironment, it is critical to understand methodologic issues related to measurement of immune cells on tissue microarrays (TMA) using multiplex immunofluorescence (mIF) assays. METHODS In two prospective cohorts, we collected formalin-fixed, paraffin-embedded ovarian tumors from 486 cases and created seven TMAs. We measured T cells, including several sub-populations, and immune checkpoint markers on the TMAs using two mIF panels. We used Spearman correlations, Fisher exact tests, and multivariable-adjusted beta-binomial models to evaluate factors related to immune cell measurements in TMA tumor cores. RESULTS Between-core correlations of intratumoral immune markers ranged from 0.52 to 0.72, with more common markers (e.g., CD3+, CD3+CD8+) having higher correlations. Correlations of immune cell markers between the whole core, tumor area, and stromal area were high (range 0.69-0.97). In multivariable-adjusted models, odds of T-cell positivity were lower in clear cell and mucinous versus type II tumors (ORs, 0.13-0.48) and, for several sub-populations, were lower in older tissue (sample age > 30 versus ≤ 10 years; OR, 0.11-0.32). CONCLUSIONS Overall, high correlations between cores for immune markers measured via mIF support the use of TMAs in studying ovarian tumor immune infiltration, although very old samples may have reduced antigenicity. IMPACT Future epidemiologic studies should evaluate differences in the tumor immune response by histotype and identify modifiable factors that may alter the tumor immune microenvironment.
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Affiliation(s)
| | | | - Brooke L. Fridley
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Bernard Rosner
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Daryoush Saeed-Vafa
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida, USA
- Advanced Analytical and Digital Laboratory, Moffitt Cancer Center, Tampa, Florida, USA
| | - Carlos Moran Segura
- Advanced Analytical and Digital Laboratory, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jonathan V. Nguyen
- Advanced Analytical and Digital Laboratory, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jonathan L. Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Naoko Sasamoto
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School; Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kathryn L. Terry
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School; Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Mary K. Townsend
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
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8
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Jauniaux E, Fox KA, Einerson B, Hussein AM, Hecht JL, Silver RM. Perinatal assessment of complex cesarean delivery: beyond placenta accreta spectrum. Am J Obstet Gynecol 2023:S0002-9378(23)00137-0. [PMID: 36868338 DOI: 10.1016/j.ajog.2023.02.021] [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: 11/07/2022] [Revised: 01/22/2023] [Accepted: 02/18/2023] [Indexed: 03/05/2023]
Abstract
Multiple cesarean deliveries are known to be associated with long-term postoperative consequences because of a permanent defect of the lower uterine segment wall and the development of thick pelvic adhesions. Patients with a history of multiple cesarean deliveries often present with large cesarean scar defects and are at heightened risk in subsequent pregnancies of cesarean scar ectopic pregnancy, uterine rupture, low-lying placenta or placenta previa, and placenta previa accreta. Moreover, large cesarean scar defects will lead to progressive dehiscence of the lower uterine segment with the inability to effectively reapproximate hysterotomy edge and repair at birth. Major remodeling of the lower uterine segment associated with true placenta accreta spectrum at birth, whereby the placenta becomes inseparable from the uterine wall, increases the rates of perinatal morbidity and mortality, especially when undiagnosed before delivery. Ultrasound imaging is currently not routinely used to evaluate the surgical risks of patients with a history of multiple cesarean deliveries, beyond the risk assessment of placenta accreta spectrum. Independent of accreta placentation, a placenta previa under a scarred, thinned partially disrupted lower uterine segment, covered by thick adhesions with the posterior wall of the bladder, poses a surgical risk and requires fine dissection and surgical expertise; however, data on the use of ultrasound to evaluate uterine remodeling and adhesions between the uterus and other pelvic organs are scarce. In particular, transvaginal sonography has been underused, including in patients with a high probability of placenta accreta spectrum at birth. Based on the best available knowledge, we discuss the role of ultrasound imaging in identifying the signs suggestive of major remodeling of the lower uterine segment and in mapping the changes in the uterine wall and pelvis, to enable the surgical team to prepare for all different types of complex cesarean deliveries. The need for postnatal confirmation of the prenatal ultrasound findings for all patients with a history of multiple cesarean deliveries, regardless of the diagnosis of placenta previa and placenta accreta spectrum, is discussed. We propose an ultrasound imaging protocol and a classification of the level of surgical difficulty at elective cesarean delivery to stimulate further research toward the validation of ultrasound signs by which these signs may be applied to improve surgical outcomes.
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Affiliation(s)
- Eric Jauniaux
- Faculty of Population Health Sciences, EGA Institute for Women's Health, University College London, London, United Kingdom.
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Brett Einerson
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Ahmed M Hussein
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT
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Kang E, Weir A, Meagher NS, Farrington K, Nelson GS, Ghatage P, Lee C, Riggan MJ, Bolithon A, Popovic G, Leung B, Tang K, Lambie N, Millstein J, Alsop J, Anglesio MS, Ataseven B, Barlow E, Beckmann MW, Berger J, Bisinotto C, Bösmüller H, Boros J, Brand AH, Brooks‐Wilson A, Brucker SY, Carney ME, Casablanca Y, Cazorla‐Jiménez A, Cohen PA, Conrads TP, Cook LS, Coulson P, Courtney‐Brooks M, Cramer DW, Crowe P, Cunningham JM, Cybulski C, Darcy KM, El‐Bahrawy MA, Elishaev E, Erber R, Farrell R, Fereday S, Fischer A, García MJ, Gayther SA, Gentry‐Maharaj A, Gilks CB, Grube M, Harnett PR, Harrington SP, Harter P, Hartmann A, Hecht JL, Heikaus S, Hein A, Heitz F, Hendley J, Hernandez BY, Polo SH, Heublein S, Hirasawa A, Høgdall E, Høgdall CK, Horlings HM, Huntsman DG, Huzarski T, Jewell A, Jimenez‐Linan M, Jones ME, Kaufmann SH, Kennedy CJ, Khabele D, Kommoss FKF, Kruitwagen RFPM, Lambrechts D, Le ND, Lener M, Lester J, Leung Y, Linder A, Loverix L, Lubiński J, Madan R, Maxwell GL, Modugno F, Neuhausen SL, Olawaiye A, Olbrecht S, Orsulic S, Palacios J, Pearce CL, Pike MC, Quinn CM, Mohan GR, Rodríguez‐Antona C, Ruebner M, Ryan A, Salfinger SG, Sasamoto N, Schildkraut JM, Schoemaker MJ, Shah M, Sharma R, Shvetsov YB, Singh N, Sonke GS, Steele L, Stewart CJR, Sundfeldt K, Swerdlow AJ, Talhouk A, Tan A, Taylor SE, Terry KL, Tołoczko A, Traficante N, Van de Vijver KK, van der Aa MA, Van Gorp T, Van Nieuwenhuysen E, van‐Wagensveld L, Vergote I, Vierkant RA, Wang C, Wilkens LR, Winham SJ, Wu AH, Benitez J, Berchuck A, Candido dos Reis FJ, DeFazio A, Fasching PA, Goode EL, Goodman MT, Gronwald J, Karlan BY, Kommoss S, Menon U, Sinn H, Staebler A, Brenton JD, Bowtell DD, Pharoah PDP, Ramus SJ, Köbel M. CCNE1 and survival of patients with tubo-ovarian high-grade serous carcinoma: An Ovarian Tumor Tissue Analysis consortium study. Cancer 2023; 129:697-713. [PMID: 36572991 PMCID: PMC10107112 DOI: 10.1002/cncr.34582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/14/2022] [Accepted: 09/30/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cyclin E1 (CCNE1) is a potential predictive marker and therapeutic target in tubo-ovarian high-grade serous carcinoma (HGSC). Smaller studies have revealed unfavorable associations for CCNE1 amplification and CCNE1 overexpression with survival, but to date no large-scale, histotype-specific validation has been performed. The hypothesis was that high-level amplification of CCNE1 and CCNE1 overexpression, as well as a combination of the two, are linked to shorter overall survival in HGSC. METHODS Within the Ovarian Tumor Tissue Analysis consortium, amplification status and protein level in 3029 HGSC cases and mRNA expression in 2419 samples were investigated. RESULTS High-level amplification (>8 copies by chromogenic in situ hybridization) was found in 8.6% of HGSC and overexpression (>60% with at least 5% demonstrating strong intensity by immunohistochemistry) was found in 22.4%. CCNE1 high-level amplification and overexpression both were linked to shorter overall survival in multivariate survival analysis adjusted for age and stage, with hazard stratification by study (hazard ratio [HR], 1.26; 95% CI, 1.08-1.47, p = .034, and HR, 1.18; 95% CI, 1.05-1.32, p = .015, respectively). This was also true for cases with combined high-level amplification/overexpression (HR, 1.26; 95% CI, 1.09-1.47, p = .033). CCNE1 mRNA expression was not associated with overall survival (HR, 1.00 per 1-SD increase; 95% CI, 0.94-1.06; p = .58). CCNE1 high-level amplification is mutually exclusive with the presence of germline BRCA1/2 pathogenic variants and shows an inverse association to RB1 loss. CONCLUSION This study provides large-scale validation that CCNE1 high-level amplification is associated with shorter survival, supporting its utility as a prognostic biomarker in HGSC.
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Affiliation(s)
- Eun‐Young Kang
- Department of Pathology and Laboratory MedicineUniversity of CalgaryFoothills Medical CenterCalgaryAlbertaCanada
| | - Ashley Weir
- School of Clinical MedicineUNSW Medicine and HealthUniversity of NSW SydneySydneyNew South WalesAustralia
- Adult Cancer ProgramLowy Cancer Research CentreUniversity of NSW SydneySydneyNew South WalesAustralia
- The Walter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
| | - Nicola S. Meagher
- School of Clinical MedicineUNSW Medicine and HealthUniversity of NSW SydneySydneyNew South WalesAustralia
- The Daffodil CentreThe University of SydneyA Joint Venture With Cancer Council NSWSydneyNew South WalesAustralia
| | - Kyo Farrington
- Department of Pathology and Laboratory MedicineUniversity of CalgaryFoothills Medical CenterCalgaryAlbertaCanada
| | - Gregg S. Nelson
- Department of OncologyDivision of Gynecologic OncologyCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Prafull Ghatage
- Department of OncologyDivision of Gynecologic OncologyCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Cheng‐Han Lee
- Department of Pathology and Laboratory MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Marjorie J. Riggan
- Department of Obstetrics and GynecologyDivision of Gynecologic OncologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Adelyn Bolithon
- Adult Cancer ProgramLowy Cancer Research CentreUniversity of NSW SydneySydneyNew South WalesAustralia
- School of Women's and Children's HealthFaculty of Medicine and HealthUniversity of NSW SydneySydneyNew South WalesAustralia
| | - Gordana Popovic
- Stats CentralMark Wainwright Analytical CentreUniversity of NSW SydneySydneyNew South WalesAustralia
| | - Betty Leung
- Prince of Wales Clinical SchoolUNSW Medicine and HealthUniversity of NSW SydneySydneyNew South WalesAustralia
| | - Katrina Tang
- Department of Anatomical PathologyPrince of Wales HospitalSydneyNew South WalesAustralia
| | - Neil Lambie
- Canterbury Health LaboratoriesChristchurchNew Zealand
| | - Joshua Millstein
- Division of BiostatisticsDepartment of Population and Public Health SciencesKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jennifer Alsop
- Department of OncologyCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUK
| | - Michael S. Anglesio
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- British Columbia's Gynecological Cancer Research Team (OVCARE)University of British ColumbiaBC Cancerand Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic OncologyEvangelische Kliniken Essen‐Mitte (KEM)EssenGermany
- Department of Obstetrics and GynecologyLudwig Maximilian University MunichMunichGermany
| | - Ellen Barlow
- Gynaecological Cancer CentreRoyal Hospital for WomenSydneyNew South WalesAustralia
| | - Matthias W. Beckmann
- Department of Gynecology and ObstetricsComprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐NurembergUniversity Hospital ErlangenErlangenGermany
| | - Jessica Berger
- Division of Gynecologic OncologyDepartment of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Christiani Bisinotto
- Department of Gynecology and ObstetricsRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Hans Bösmüller
- Institute of Pathology and NeuropathologyTuebingen University HospitalTuebingenGermany
| | - Jessica Boros
- Centre for Cancer ResearchThe Westmead Institute for Medical ResearchUniversity of SydneySydneyNew South WalesAustralia
- Department of Gynaecological OncologyWestmead HospitalSydneyNew South WalesAustralia
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
| | - Alison H. Brand
- Department of Gynaecological OncologyWestmead HospitalSydneyNew South WalesAustralia
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
| | - Angela Brooks‐Wilson
- Canada's Michael Smith Genome Sciences CentreBC CancerVancouverBritish ColumbiaCanada
| | - Sara Y. Brucker
- Department of Women's HealthTuebingen University HospitalTuebingenGermany
| | - Michael E. Carney
- Department of Obstetrics and GynecologyJohn A. Burns School of MedicineUniversity of HawaiiHonoluluHawaiiUSA
| | - Yovanni Casablanca
- Uniformed Services of the Health Sciences Gynecologic Cancer Center of ExcellenceBethesdaMarylandUSA
| | | | - Paul A. Cohen
- Department of Gynaecological OncologySt John of God Subiaco HospitalSubiacoWestern AustraliaAustralia
- Division of Obstetrics and GynaecologyMedical SchoolUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Thomas P. Conrads
- Women's Health Integrated Research CenterInova Health SystemFalls ChurchVirginiaUSA
| | - Linda S. Cook
- EpidemiologySchool of Public HealthUniversity of ColoradoAuroraColoradoUSA
- Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Penny Coulson
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Madeleine Courtney‐Brooks
- Division of Gynecologic OncologyDepartment of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Daniel W. Cramer
- Obstetrics and Gynecology Epidemiology CenterDepartment of Obstetrics and GynecologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Philip Crowe
- Prince of Wales Clinical SchoolUNSW Medicine and HealthUniversity of NSW SydneySydneyNew South WalesAustralia
- Department of SurgeryPrince of Wales Private HospitalRandwickNew South WalesAustralia
| | - Julie M. Cunningham
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Cezary Cybulski
- Department of Genetics and PathologyInternational Hereditary Cancer CenterPomeranian Medical UniversitySzczecinPoland
| | - Kathleen M. Darcy
- Gynecologic Cancer Center of ExcellenceDepartment of Gynecologic Surgery and ObstetricsUniformed Services University of the Health SciencesWalter Reed National Military Medical CenterBethesdaMarylandUSA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, IncBethesdaMarylandUSA
| | - Mona A. El‐Bahrawy
- Department of Metabolism, Digestion and ReproductionImperial College LondonHammersmith HospitalLondonUK
| | - Esther Elishaev
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Ramona Erber
- Institute of PathologyComprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐NurembergUniversity Hospital ErlangenErlangenGermany
| | - Rhonda Farrell
- Prince of Wales Private HospitalRandwickNew South WalesAustralia
| | - Sian Fereday
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneParkvilleVictoriaAustralia
| | - Anna Fischer
- Institute of Pathology and NeuropathologyTuebingen University HospitalTuebingenGermany
| | - María J. García
- Computational Oncology GroupStructural Biology ProgrammeSpanish National Cancer Research Centre (CNIO)MadridSpain
| | - Simon A. Gayther
- Center for Bioinformatics and Functional Genomics and the Cedars Sinai Genomics CoreCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | | | - C. Blake Gilks
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - AOCS Group
- Centre for Cancer ResearchThe Westmead Institute for Medical ResearchUniversity of SydneySydneyNew South WalesAustralia
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Marcel Grube
- Department of Women's HealthTuebingen University HospitalTuebingenGermany
| | - Paul R. Harnett
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNew South WalesAustralia
| | - Shariska Petersen Harrington
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Philipp Harter
- Department of Gynecology and Gynecologic OncologyEvangelische Kliniken Essen‐Mitte (KEM)EssenGermany
- Department of Gynecology and Gynecological OncologyHSK, Dr. Horst‐Schmidt KlinikWiesbadenWiesbadenGermany
| | - Arndt Hartmann
- Institute of PathologyComprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐NurembergUniversity Hospital ErlangenErlangenGermany
| | - Jonathan L. Hecht
- Department of PathologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Alexander Hein
- Department of Gynecology and ObstetricsComprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐NurembergUniversity Hospital ErlangenErlangenGermany
| | - Florian Heitz
- Department of Gynecology and Gynecologic OncologyEvangelische Kliniken Essen‐Mitte (KEM)EssenGermany
- Department of Gynecology and Gynecological OncologyHSK, Dr. Horst‐Schmidt KlinikWiesbadenWiesbadenGermany
- Center for PathologyEvangelische Kliniken Essen‐MitteEssenGermany
| | - Joy Hendley
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | | | | | - Sabine Heublein
- Department of Obstetrics and GynecologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Akira Hirasawa
- Department of Clinical Genomic MedicineGraduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Estrid Høgdall
- Department of PathologyHerlev HospitalUniversity of CopenhagenCopenhagenDenmark
| | - Claus K. Høgdall
- Department of GynaecologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Hugo M. Horlings
- Division of Molecular PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - David G. Huntsman
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Molecular OncologyBC Cancer Research CentreVancouverBritish ColumbiaCanada
| | - Tomasz Huzarski
- Department of Genetics and PathologyInternational Hereditary Cancer CenterPomeranian Medical UniversitySzczecinPoland
- Department of Genetics and PathologyUniversity of Zielona GoraZielona GoraPoland
| | - Andrea Jewell
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyThe University of Kansas Medical CenterKansas CityKansasUSA
| | | | - Michael E. Jones
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Scott H. Kaufmann
- Division of Oncology Research and Department of Molecular Pharmacology & Experimental TherapeuticsMayo ClinicRochesterMinnesotaUSA
| | - Catherine J. Kennedy
- Centre for Cancer ResearchThe Westmead Institute for Medical ResearchUniversity of SydneySydneyNew South WalesAustralia
- Department of Gynaecological OncologyWestmead HospitalSydneyNew South WalesAustralia
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
| | - Dineo Khabele
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWashington University in St. LouisSt. LouisMissouriUSA
| | | | - Roy F. P. M. Kruitwagen
- Department of Obstetrics and GynecologyMaastricht University Medical CentreMaastrichtThe Netherlands
- GROW – School for Oncology and ReproductionMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Diether Lambrechts
- Department of Human GeneticsLaboratory for Translational GeneticsKU LeuvenLeuvenBelgium
- VIB Center for Cancer BiologyVIBLeuvenBelgium
| | - Nhu D. Le
- Cancer Control ResearchBC Cancer AgencyVancouverBritish ColumbiaCanada
| | - Marcin Lener
- International Hereditary Cancer CenterDepartment of Genetics and PathologyPomeranian Medical University in SzczecinSzczecinPoland
| | - Jenny Lester
- David Geffen School of MedicineDepartment of Obstetrics and GynecologyUniversity of California at Los AngelesLos AngelesCaliforniaUSA
| | - Yee Leung
- Division of Obstetrics and GynaecologyFaculty of Health and Medical SciencesUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
- Department of Gynaecological OncologyKing Edward Memorial HospitalSubiacoWestern AustraliaAustralia
- Australia New Zealand Gynaecological Oncology GroupCamperdownAustralia
| | - Anna Linder
- Department of Obstetrics and GynecologyInst of Clinical Science, Sahlgrenska Center for Cancer ResearchUniversity of GothenburgGothenburgSweden
| | - Liselore Loverix
- Division of Gynecologic OncologyDepartment of Gynecology and ObstetricsLeuven Cancer InstituteLeuvenBelgium
| | - Jan Lubiński
- Department of Genetics and PathologyInternational Hereditary Cancer CenterPomeranian Medical UniversitySzczecinPoland
| | - Rashna Madan
- Department of Pathology and Laboratory MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | | | - Francesmary Modugno
- Division of Gynecologic OncologyDepartment of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPennsylvaniaUSA
- Women's Cancer Research CenterMagee‐Womens Research Institute and Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Susan L. Neuhausen
- Department of Population SciencesBeckman Research Institute of City of HopeDuarteCaliforniaUSA
| | - Alexander Olawaiye
- Division of Gynecologic OncologyDepartment of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Siel Olbrecht
- Division of Gynecologic OncologyDepartment of Gynecology and ObstetricsLeuven Cancer InstituteLeuvenBelgium
| | - Sandra Orsulic
- David Geffen School of MedicineDepartment of Obstetrics and GynecologyUniversity of California at Los AngelesLos AngelesCaliforniaUSA
| | - José Palacios
- Department of PathologyHospital Ramón y CajalInstituto Ramon y Cajal de Investigación Sanitaria (IRyCIS)CIBERONCUniversidad de AlcaláMadridSpain
| | - Celeste Leigh Pearce
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Malcolm C. Pike
- Department of Epidemiology and BiostatisticsMemorial Sloan‐Kettering Cancer CenterNew YorkNew YorkUSA
- Department of Population Health and Public Health SciencesKeck School of MedicineUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesCaliforniaUSA
| | - Carmel M. Quinn
- The Health Precincts BiobankUNSW Biospecimen ServicesMark Wainwright Analytical CentreUniversity of NSW SydneySydneyNew South WalesAustralia
| | - Ganendra Raj Mohan
- Department of Gynaecological OncologySt John of God Subiaco HospitalSubiacoWestern AustraliaAustralia
- Department of Gynaecological OncologyKing Edward Memorial HospitalSubiacoWestern AustraliaAustralia
| | - Cristina Rodríguez‐Antona
- Hereditary Endocrine Cancer GroupSpanish National Cancer Research Center (CNIO)MadridSpain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
| | - Matthias Ruebner
- Department of Gynecology and ObstetricsComprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐NurembergUniversity Hospital ErlangenErlangenGermany
| | - Andy Ryan
- MRC Clinical Trials UnitInstitute of Clinical Trials & MethodologyUniversity College LondonLondonUK
- Women's CancerInstitute for Women's HealthUniversity College LondonLondonUK
| | - Stuart G. Salfinger
- Department of Gynaecological OncologySt John of God Subiaco HospitalSubiacoWestern AustraliaAustralia
| | - Naoko Sasamoto
- Obstetrics and Gynecology Epidemiology CenterDepartment of Obstetrics and GynecologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Joellen M. Schildkraut
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | | | - Mitul Shah
- Department of OncologyCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUK
| | - Raghwa Sharma
- Tissue Pathology and Diagnostic OncologyWestmead HospitalSydneyNew South WalesAustralia
| | | | - Naveena Singh
- Department of PathologyBarts Health National Health Service TrustLondonUK
| | - Gabe S. Sonke
- Department of Medical OncologyThe Netherlands Cancer Institute ‐ Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Linda Steele
- Department of Population SciencesBeckman Research Institute of City of HopeDuarteCaliforniaUSA
| | - Colin J. R. Stewart
- School for Women's and Infants' HealthUniversity of Western AustraliaPerthAustralia
| | - Karin Sundfeldt
- Department of Obstetrics and GynecologyInst of Clinical Science, Sahlgrenska Center for Cancer ResearchUniversity of GothenburgGothenburgSweden
| | - Anthony J. Swerdlow
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
- Division of Breast Cancer ResearchThe Institute of Cancer ResearchLondonUK
| | - Aline Talhouk
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- British Columbia's Gynecological Cancer Research Team (OVCARE)University of British ColumbiaBC Cancerand Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Adeline Tan
- Division of Obstetrics and GynaecologyFaculty of Health and Medical SciencesUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
- Gynaepath WAClinipath (Sonic Healthcare)Osbourne ParkAustralia
| | - Sarah E. Taylor
- Division of Gynecologic OncologyDepartment of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Kathryn L. Terry
- Obstetrics and Gynecology Epidemiology CenterDepartment of Obstetrics and GynecologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Aleksandra Tołoczko
- Department of Genetics and PathologyPomeranian Medical UniversitySzczecinPoland
| | - Nadia Traficante
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneParkvilleVictoriaAustralia
| | - Koen K. Van de Vijver
- Department of PathologyGhent University HospitalCancer Research Institute Ghent (CRIG)GhentBelgium
- Department of PathologyAntwerp University HospitalAntwerpBelgium
| | - Maaike A. van der Aa
- Department of ResearchNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Toon Van Gorp
- Division of Gynecologic OncologyDepartment of Gynecology and ObstetricsLeuven Cancer InstituteLeuvenBelgium
| | - Els Van Nieuwenhuysen
- Division of Gynecologic OncologyDepartment of Gynecology and ObstetricsLeuven Cancer InstituteLeuvenBelgium
| | - Lilian van‐Wagensveld
- Department of Obstetrics and GynecologyMaastricht University Medical CentreMaastrichtThe Netherlands
- GROW – School for Oncology and ReproductionMaastricht University Medical CenterMaastrichtThe Netherlands
- Department of ResearchNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Ignace Vergote
- Division of Gynecologic OncologyDepartment of Gynecology and ObstetricsLeuven Cancer InstituteLeuvenBelgium
| | - Robert A. Vierkant
- Department of Quantitative Health SciencesDivision of Clinical Trials and BiostatisticsMayo ClinicRochesterMinnesotaUSA
| | - Chen Wang
- Department of Quantitative Health SciencesDivision of Computational BiologyMayo ClinicRochesterMinnesotaUSA
| | | | - Stacey J. Winham
- Department of Quantitative Health SciencesDivision of Computational BiologyMayo ClinicRochesterMinnesotaUSA
| | - Anna H. Wu
- Department of Population Health and Public Health SciencesKeck School of MedicineUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesCaliforniaUSA
| | - Javier Benitez
- Centre for Biomedical Network Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
- Human Genetics GroupSpanish National Cancer Research Centre (CNIO)MadridSpain
| | - Andrew Berchuck
- Department of Obstetrics and GynecologyDivision of Gynecologic OncologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | | | - Anna DeFazio
- The Daffodil CentreThe University of SydneyA Joint Venture With Cancer Council NSWSydneyNew South WalesAustralia
- Centre for Cancer ResearchThe Westmead Institute for Medical ResearchUniversity of SydneySydneyNew South WalesAustralia
- Department of Gynaecological OncologyWestmead HospitalSydneyNew South WalesAustralia
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
| | - Peter A. Fasching
- Department of Gynecology and ObstetricsComprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐NurembergUniversity Hospital ErlangenErlangenGermany
| | - Ellen L. Goode
- Department of Quantitative Health SciencesDivision of EpidemiologyMayo ClinicRochesterMinnesotaUSA
| | - Marc T. Goodman
- Cancer Prevention and Control ProgramCedars‐Sinai CancerCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Jacek Gronwald
- Department of Genetics and PathologyInternational Hereditary Cancer CenterPomeranian Medical UniversitySzczecinPoland
| | - Beth Y. Karlan
- David Geffen School of MedicineDepartment of Obstetrics and GynecologyUniversity of California at Los AngelesLos AngelesCaliforniaUSA
| | - Stefan Kommoss
- Department of Women's HealthTuebingen University HospitalTuebingenGermany
| | - Usha Menon
- MRC Clinical Trials UnitInstitute of Clinical Trials & MethodologyUniversity College LondonLondonUK
| | - Hans‐Peter Sinn
- Institute of PathologyHeidelberg University HospitalHeidelbergGermany
| | - Annette Staebler
- Institute of Pathology and NeuropathologyTuebingen University HospitalTuebingenGermany
| | - James D. Brenton
- Cancer Research UK Cambridge InstituteUniversity of CambridgeCambridgeUK
| | - David D. Bowtell
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneParkvilleVictoriaAustralia
| | - Paul D. P. Pharoah
- Department of OncologyCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUK
- Department of Public Health and Primary CareCentre for Cancer Genetic EpidemiologyUniversity of CambridgeCambridgeUK
| | - Susan J. Ramus
- School of Clinical MedicineUNSW Medicine and HealthUniversity of NSW SydneySydneyNew South WalesAustralia
- Adult Cancer ProgramLowy Cancer Research CentreUniversity of NSW SydneySydneyNew South WalesAustralia
| | - Martin Köbel
- Department of Pathology and Laboratory MedicineUniversity of CalgaryFoothills Medical CenterCalgaryAlbertaCanada
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Abbas-Aghababazadeh F, Sasamoto N, Townsend MK, Huang T, Terry KL, Vitonis AF, Elias KM, Poole EM, Hecht JL, Tworoger SS, Fridley BL. Predictors of residual disease after debulking surgery in advanced stage ovarian cancer. Front Oncol 2023; 13:1090092. [PMID: 36761962 PMCID: PMC9902593 DOI: 10.3389/fonc.2023.1090092] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
Objective Optimal debulking with no macroscopic residual disease strongly predicts ovarian cancer survival. The ability to predict likelihood of optimal debulking, which may be partially dependent on tumor biology, could inform clinical decision-making regarding use of neoadjuvant chemotherapy. Thus, we developed a prediction model including epidemiological factors and tumor markers of residual disease after primary debulking surgery. Methods Univariate analyses examined associations of 11 pre-diagnosis epidemiologic factors (n=593) and 24 tumor markers (n=204) with debulking status among incident, high-stage, epithelial ovarian cancer cases from the Nurses' Health Studies and New England Case Control study. We used Bayesian model averaging (BMA) to develop prediction models of optimal debulking with 5x5-fold cross-validation and calculated the area under the curve (AUC). Results Current aspirin use was associated with lower odds of optimal debulking compared to never use (OR=0.52, 95%CI=0.31-0.86) and two tissue markers, ADRB2 (OR=2.21, 95%CI=1.23-4.41) and FAP (OR=1.91, 95%CI=1.24-3.05) were associated with increased odds of optimal debulking. The BMA selected aspirin, parity, and menopausal status as the epidemiologic/clinical predictors with the posterior effect probability ≥20%. While the prediction model with epidemiologic/clinical predictors had low performance (average AUC=0.49), the model adding tissue biomarkers showed improved, but weak, performance (average AUC=0.62). Conclusions Addition of ovarian tumor tissue markers to our multivariable prediction models based on epidemiologic/clinical data slightly improved the model performance, suggesting debulking status may be in part driven by tumor characteristics. Larger studies are warranted to identify those at high risk of poor surgical outcomes informing personalized treatment.
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Affiliation(s)
- Farnoosh Abbas-Aghababazadeh
- Department of Biostatistics & Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,University Health Network, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Mary K. Townsend
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Tianyi Huang
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Kathryn L. Terry
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Allison F. Vitonis
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Kevin M. Elias
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Jonathan L. Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Brooke L. Fridley
- Department of Biostatistics & Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,*Correspondence: Brooke L. Fridley,
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11
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Burris HH, Gerson KD, Woodward A, Redhunt AM, Ledyard R, Brennan K, Baccarelli AA, Hecht JL, Collier ARY, Hacker MR. Cervical microRNA expression and spontaneous preterm birth. Am J Obstet Gynecol MFM 2023; 5:100783. [PMID: 36280145 PMCID: PMC9772144 DOI: 10.1016/j.ajogmf.2022.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Preterm birth remains a major public health issue affecting 10% of all pregnancies and increases risks of neonatal morbidity and mortality. Approximately 50% to 60% of preterm births are spontaneous, resulting from preterm premature rupture of membranes or preterm labor. The pathogenesis of spontaneous preterm birth is incompletely understood, and prediction of preterm birth remains elusive. Accurate prediction of preterm birth would reduce infant morbidity and mortality through targeted patient referral to hospitals equipped to care for preterm infants. Two previous studies have analyzed cervical microRNAs in association with spontaneous preterm birth and the length of gestation, but the extent to which microRNAs serve as predictive biomarkers remains unknown. OBJECTIVE This study aimed to examine associations between cervical microRNA expression and spontaneous preterm birth, with the specific goal of identifying a subset of microRNAs that predict spontaneous preterm birth. STUDY DESIGN We performed a prospective, nested, case-control study of 25 cases with spontaneous preterm birth and 49 term controls. Controls were matched to cases in a 2:1 ratio on the basis of age, parity, and self-identified race. Cervical swabs were collected at a mean gestational age of 17.1 (4.8) weeks of gestation, and microRNAs were analyzed using a quantitative polymerase chain reaction array. Normalized microRNA expression was compared between cases and controls, and a false discovery rate of 0.2 was applied to account for multiple comparisons. Histopathologic analysis of slides of cervical swab samples was performed to quantify leukocyte burden for adjustment in conditional regression models. We explored the use of Relief-based unsupervised identification of top microRNAs and support vector machines to predict spontaneous preterm birth. We performed microRNA enrichment analysis to explore potential biologic targets and pathways in which up-regulated microRNAs might be involved. RESULTS Of the 754 microRNAs on the polymerase chain reaction array, 346 were detected in ≥75% of participants' cervical swabs. Average cervical microRNA expression was significantly higher in cases of spontaneous preterm birth than in controls (P=.01). There were 95 significantly up-regulated individual microRNAs (>2-fold change) in cases of subsequent spontaneous preterm birth compared with term controls (P<.05; q<0.2). Notably, miR-143, miR-30e-3p, and miR-199b were all significantly up-regulated, which is consistent with the 1 previous study of cervical microRNA and spontaneous preterm birth. A Relief-based, novel variable (feature) selection machine learning approach had low-to-moderate prediction accuracy, with an area under the receiver operating curve of 0.71. Enrichment analysis revealed that identified microRNAs may modulate inflammatory cell signaling. CONCLUSION In this prospective nested case-control study of cervical microRNA expression and spontaneous preterm birth, we identified a global increase in microRNA expression and up-regulation of 95 distinct microRNAs in association with subsequent spontaneous preterm birth. Larger and more diverse studies are required to determine the ability of microRNAs to accurately predict spontaneous preterm birth, and mechanistic work to facilitate development of novel therapeutic interventions to prevent spontaneous preterm birth is warranted.
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Affiliation(s)
- Heather H Burris
- From the Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Burris and Ms Ledyard); Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Burris); Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA (Dr Burris).
| | - Kristin D Gerson
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Gerson); Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Gerson)
| | - Alexa Woodward
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Ms Woodward)
| | - Allyson M Redhunt
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Ms Redhunt and Drs Collier and Hacker); Tufts University School of Medicine, Boston, MA (Ms Redhunt)
| | - Rachel Ledyard
- From the Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Burris and Ms Ledyard)
| | - Kasey Brennan
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (Ms Brennan and Dr Baccarelli)
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (Ms Brennan and Dr Baccarelli)
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA (Dr Hecht); Department of Pathology, Harvard Medical School, Boston, MA (Dr Hecht)
| | - Ai-Ris Y Collier
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Ms Redhunt and Drs Collier and Hacker); Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA (Drs Collier and Hacker)
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Ms Redhunt and Drs Collier and Hacker); Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA (Drs Collier and Hacker); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (Dr Hacker)
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12
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Jauniaux E, Hecht JL, Hussein AM. Placenta percreta: the ghost of the accreta opera. Am J Obstet Gynecol 2022; 227:932. [PMID: 35835263 DOI: 10.1016/j.ajog.2022.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Eric Jauniaux
- Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London, 86-96 Chenies Mews, London WC1E 6HX, United Kingdom.
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Ahmed M Hussein
- Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt
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13
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Horgan R, Critchlow E, Wodoslawsky S, Rice S, Hecht JL, Al-Kouatly HB. Placental phenotype in non-immune hydrops fetalis with negative standard workup. Ultrasound Obstet Gynecol 2022; 60:702-703. [PMID: 35713291 DOI: 10.1002/uog.24970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Affiliation(s)
- R Horgan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - E Critchlow
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - S Wodoslawsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - S Rice
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - J L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - H B Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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14
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Levine D, Gupta SC, Kwan C, Brook A, Jorgensen EM, Kappler A, Hecht JL. The Sonographic Appearance of Endometrial Intraepithelial Neoplasia. J Ultrasound Med 2022; 41:1723-1737. [PMID: 34714549 DOI: 10.1002/jum.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To describe the sonographic findings of endometrial intraepithelial neoplasia (EIN), a precursor of endometrial cancer. METHODS Cases were found by word search of pathology database 1/2013 to 6/2019. One hundred and seventy-eight patients with ultrasound <1 year prior to biopsy were included. Medical records were searched for patient data. Two radiologists blindly classified images. Differences of opinion were decided by clinical report. Univariate and multivariate analyses were performed. RESULTS Median time between ultrasound and first sampling procedure was 49 days. Median age was 55 (range 28-85) years. Endometrial thickness ranged from 2 to 90 mm. Mean endometrial thickness was 13 ± 6 mm in the noncancer group and 16 ± 11 mm in the cancer group (P = .02). The endometrium was almost always heterogeneous 175/178 (98%). Cysts were almost always multiple (89/109, 82%) and >1 mm (72/109, 66%). Masses were most often >5 mm (56/105, 55%) and ill-defined (41/105, 39%). Vascularity was present in 93/178 examinations (52%) and always associated with cysts and/or mass. There were 92 cancers, 25 with invasion (including 4 with tumor extension into adenomyosis). In 47 cases, the endometrial-myometrial interface was graded as ill-defined, 39 of whom had hysterectomy. There was macroscopic cancer in 11, microscopic cancer in 4, and invasive carcinoma in 12 patients (P for invasive cancer versus other outcomes = .02). Depth of invasion was 5- >95%, with 6 cancers >50%. Multivariate analysis showed thickness, polyps, and type of bleeding as the best set of independent variables for cancer (area under the receiver operating characteristic (ROC) curve [AUC] = .75). Replacing type of bleeding with age or menopausal status had AUC of .73 and .74, respectively. CONCLUSIONS EIN has a variety of sonographic appearances with thickened endometrium with cysts and masses being common. Ill-definition of the endometrial-myometrial interface is a poor prognostic finding when seen in the absence of adenomyosis.
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Affiliation(s)
- Deborah Levine
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elisa M Jorgensen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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15
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Jauniaux E, Hecht JL, Elbarmelgy RA, Elbarmelgy RM, Thabet MM, Hussein AM. Searching for placenta percreta: a prospective cohort and systematic review of case reports. Am J Obstet Gynecol 2022; 226:837.e1-837.e13. [PMID: 34973177 DOI: 10.1016/j.ajog.2021.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 10/15/2021] [Revised: 12/04/2021] [Accepted: 12/12/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Placenta percreta is described as the most severe grade of placenta accreta spectrum and accounts for a quarter of all cases of placenta accreta spectrum reported in the literature. OBJECTIVE We investigated the hypothesis that placenta percreta, which has been described clinically as placental tissue invading through the full thickness of the uterus, is a heterogeneous category with most cases owing to primary or secondary uterine abnormality rather than an abnormally invasive form of placentation. STUDY DESIGN We have evaluated the agreement between the intraoperative findings using the International Federation of Gynecology and Obstetrics classification with the postoperative histopathology diagnosis in a prospective cohort of 101 consecutive singleton pregnancies presenting with a low-lying placenta or placenta previa, a history of at least 1 prior cesarean delivery and ultrasound signs suggestive of placenta accreta spectrum. Furthermore, a systematic literature review of case reports of placenta percreta, which included histopathologic findings and gross images, was performed. RESULTS Samples for histologic examination were available in 80 of 101 cases of the cohort, which were managed by hysterectomy or partial myometrial resection. Microscopic examination showed evidence of placenta accreta spectrum in 65 cases (creta, 9; increta, 56). Of 101 cases included in the cohort, 44 (43.5%) and 54 (53.5%) were graded as percreta by observer A and observer B, respectively. There was a moderate agreement between observers. Of note, 11 of 36 cases that showed no evidence of abnormal placental attachment at delivery and/or microscopic examination were classified as percreta by both observers. The systematic literature review identified 41 case reports of placenta percreta with microscopic images and presenting symptomatology, suggesting that most cases were the consequence of a uterine rupture. The microscopic descriptions were heterogeneous, and all descriptions demonstrated histology of placenta creta rather than percreta. CONCLUSION Our study supported the concept that placenta accreta is not an invasive disorder of placentation but the consequence of postoperative surgical remodeling or a preexisting uterine pathology and found no histologic evidence supporting the existence of a condition where the villous tissue penetrates the entire uterine wall, including the serosa and beyond.
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Affiliation(s)
- Eric Jauniaux
- Faculty of Population Health Sciences, EGA Institute for Women's Health, University College London, London, United Kingdom.
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Rasha A Elbarmelgy
- Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt
| | - Rana M Elbarmelgy
- Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt
| | - Mohamed M Thabet
- Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt
| | - Ahmed M Hussein
- Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt
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16
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Sasamoto N, Stewart PA, Wang T, Yoder SJ, Chellappan S, Hecht JL, Fridley BL, Terry KL, Tworoger SS. Lifetime ovulatory years and ovarian cancer gene expression profiles. J Ovarian Res 2022; 15:59. [PMID: 35562768 PMCID: PMC9102743 DOI: 10.1186/s13048-022-00995-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Greater ovulatory years is associated with increased ovarian cancer risk. Although ovulation leads to an acute pro-inflammatory local environment, how long-term exposure to ovulation impacts ovarian carcinogenesis is not fully understood. Thus, we examined the association between gene expression profiles of ovarian tumors and lifetime ovulatory years to enhance understanding of associated biological pathways. METHODS RNA sequencing data was generated on 234 invasive ovarian cancer tumors that were high-grade serous, poorly differentiated, or high-grade endometrioid from the Nurses' Health Study (NHS), NHSII, and the New England Case Control Study. We used linear regression to identify differentially expressed genes by estimated ovulatory years, adjusted for birth decade and cohort, overall and stratified by menopausal status at diagnosis. We used false discovery rates (FDR) to account for multiple testing. Gene set enrichment analysis (GSEA) with Cancer Hallmarks, KEGG, and Reactome databases was used to identify biological pathways associated with ovulatory years. RESULTS No individual genes were significantly differentially expressed by ovulatory years (FDR > 0.19). However, GSEA identified several pathways that were significantly associated with ovulatory years, including downregulation of pathways related to inflammation and proliferation (FDR < 1.0 × 10-5). Greater ovulatory years were more strongly associated with downregulation of genes related to proliferation (e.g., E2F targets, FDR = 1.53 × 10-24; G2M checkpoints, FDR = 3.50 × 10-22) among premenopausal versus postmenopausal women at diagnosis. The association of greater ovulatory years with downregulation of genes involved in inflammatory response such as interferon gamma response pathways (FDR = 7.81 × 10-17) was stronger in postmenopausal women. CONCLUSIONS Our results provide novel insight into the biological pathways that link ovulatory years to ovarian carcinogenesis, which may lead to development of targeted prevention strategies for ovarian cancer.
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Affiliation(s)
- Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
| | - Paul A Stewart
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Tianyi Wang
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sean J Yoder
- Molecular Genomics Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Srikumar Chellappan
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kathryn L Terry
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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17
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Salmanian B, Shainker SA, Hecht JL, Modest AM, Castro EC, Seaman RD, Meshinchiasl N, Hessami K, Brown A, Tounsi S, Shamshirsaz AA, Fox KA, Clark SL, Belfort MA, Shamshirsaz AA. The Society for Pediatric Pathology Task Force grading system for placenta accreta spectrum and its correlation with clinical outcomes. Am J Obstet Gynecol 2022; 226:720.e1-720.e6. [PMID: 35139335 DOI: 10.1016/j.ajog.2022.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/10/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The terminology and diagnostic criteria presently used by pathologists to report placenta accreta spectrum is inconsistent and does not reflect current knowledge of the pathogenesis of this disease. OBJECTIVE In 2020, the perinatal subcommittee of the Society for Pediatric Pathology Placenta Accreta Task Force proposed a new pathologic grading system for placenta accreta spectrum. We sought to correlate the clinical outcomes with the classification into each group in the new placenta accreta spectrum grading system. STUDY DESIGN The pathology reports of patients with histopathologic confirmation of placenta accreta spectrum were reviewed in 2 academic referral centers by placental pathologists. Pathologic grading was assigned based on the new grading system according to which placenta accreta spectrum is categorized into 5 groups depending on the depth of invasion, from grade p1 with no invasion into the uterine wall to grade p3E with invasion beyond the uterine wall to the adjacent organs. Patient characteristics and clinical outcomes were compared among these groups. A univariate analysis was performed, and a multivariate linear or binomial regression was employed when needed. RESULTS A total of 683 patients with placenta accreta spectrum were identified. Of those, 407 were included for histology review. There were 92 patients (23%) categorized into the grade p1 group, 74 (18%) in the grade p2 group, 84 (20%) in the grade p3A group, 121 (30%) in the grade p3D group, and 36 (9%) in the grade p3E group. There was a significant association between the pathology grading and the number of red blood cells transfused (β=1.14; 95% confidence interval, 0.48-1.79) and the postoperative complications including the rate of readmission (risk ratio, 1.93; 95% confidence interval, 1.26-2.94) and bladder injury (risk ratio, 1.81; 95% confidence interval, 1.23-2.68) after adjustment for antenatal diagnosis and other variables. The pathology grading was not associated with the estimated blood loss (P=.072). CONCLUSION The new pathology grading system accurately reflects maternal outcomes and complications of placenta accreta spectrum. We encourage the utilization of this new pathologic grading system because it is designed to omit discrepancies in placenta accreta spectrum reporting and to standardize communication.
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Affiliation(s)
- Bahram Salmanian
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Scott A Shainker
- Departments of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Anna M Modest
- Departments of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Eumenia C Castro
- Department of Pathology, Baylor College of Medicine, Houston, TX
| | - Rachel D Seaman
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | | | - Kamran Hessami
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Alec Brown
- Departments of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sarah Tounsi
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Amir A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Karin A Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Steven L Clark
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
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18
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Hecht JL, Janikova M, Choudhury R, Liu F, Canesin G, Janovicova L, Csizmadia E, Jorgensen EM, Esselen KM, Celec P, Swanson KD, Wegiel B. Labile Heme and Heme Oxygenase-1 Maintain Tumor-Permissive Niche for Endometriosis-Associated Ovarian Cancer. Cancers (Basel) 2022; 14:2242. [PMID: 35565370 PMCID: PMC9105072 DOI: 10.3390/cancers14092242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/12/2022] [Accepted: 04/26/2022] [Indexed: 01/12/2023] Open
Abstract
Endometriosis, a painful gynecological condition accompanied by inflammation in women of reproductive age, is associated with an increased risk of ovarian cancer. We evaluated the role of peritoneal heme accumulated during menstrual cycling, as well as peritoneal and lesional macrophage phenotype, in promoting an oncogenic microenvironment. We quantified the heme-degrading enzyme, heme oxygenase-1 (HO-1, encoded by Hmox1) in normal peritoneum, endometriotic lesions and endometriosis-associated ovarian cancer (EAOC) of clear cell type (OCCC). HO-1 was expressed primarily in macrophages and increased in endometrioma and OCCC tissues relative to endometriosis and controls. Further, we compared cytokine expression profiles in peritoneal macrophages (PM) and peripheral blood mononuclear cells (PBMC) in women with endometriosis versus controls as a measure of a tumor-promoting environment in the peritoneum. We found elevated levels of HO-1 along with IL-10 and the pro-inflammatory cytokines (IL-1β, IL-16, IFNγ) in PM but not in PBMC from endometriosis patients. Using LysM-Cre:Hmox1flfl conditional knockout mice, we show that a deficiency of HO-1 in macrophages led to the suppression of growth of ID8 ovarian tumors implanted into the peritoneum. The restriction of ID8 ovarian tumor growth was associated with an increased number of Mac3+ macrophage and B cells in LysM-Cre:Hmox1flfl mice compared to controls. Functional experiments in ovarian cancer cell lines show that HO-1 is induced by heme. Low levels of exogenous heme promoted ovarian cancer colony growth in soft agar. Higher doses of heme led to slower cancer cell colony growth in soft agar and the induction of HO-1. These data suggest that perturbation of heme metabolism within the endometriotic niche and in cancer cells themselves may be an important factor that influences tumor initiation and growth.
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Affiliation(s)
- Jonathan L. Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA;
| | - Monika Janikova
- Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (M.J.); (R.C.); (G.C.); (L.J.); (E.C.)
- Faculty of Medicine, Institute of Molecular Biomedicine, Comenius University in Bratislava, 814 99 Bratislava, Slovakia;
| | - Reeham Choudhury
- Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (M.J.); (R.C.); (G.C.); (L.J.); (E.C.)
| | - Fong Liu
- Department of OB/GYN, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA; (F.L.); (E.M.J.); (K.M.E.)
- Greater Baltimore Medical Center, 6569 Charles Street, Towson, MD 21204, USA
| | - Giacomo Canesin
- Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (M.J.); (R.C.); (G.C.); (L.J.); (E.C.)
- Vor Biopharma, 100 Cambridgepark Dr, Suite 400, Cambridge, MA 02140, USA
| | - Lubica Janovicova
- Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (M.J.); (R.C.); (G.C.); (L.J.); (E.C.)
- Faculty of Medicine, Institute of Molecular Biomedicine, Comenius University in Bratislava, 814 99 Bratislava, Slovakia;
| | - Eva Csizmadia
- Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (M.J.); (R.C.); (G.C.); (L.J.); (E.C.)
| | - Elisa M. Jorgensen
- Department of OB/GYN, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA; (F.L.); (E.M.J.); (K.M.E.)
| | - Katharine M. Esselen
- Department of OB/GYN, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA; (F.L.); (E.M.J.); (K.M.E.)
| | - Peter Celec
- Faculty of Medicine, Institute of Molecular Biomedicine, Comenius University in Bratislava, 814 99 Bratislava, Slovakia;
| | - Kenneth D. Swanson
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Barbara Wegiel
- Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (M.J.); (R.C.); (G.C.); (L.J.); (E.C.)
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Margulies SL, Dhingra I, Flores V, Hecht JL, Fadare O, Pal L, Parkash V. The Diagnostic Criteria for Chronic Endometritis: A Survey of Pathologists. Int J Gynecol Pathol 2021; 40:556-562. [PMID: 33323860 DOI: 10.1097/pgp.0000000000000737] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While acute endometritis is a reasonably well-defined entity of ascending infection and attendant active inflammation, chronic endometritis is less well defined. As part of a broad effort to define and refine the diagnostic criteria and management of the disease, we conducted a survey of pathologists to understand the variability in diagnostic criteria and implications of the diagnosis of nonspecific, nonobstetric chronic endometritis. Members of national and international professional pathology societies were surveyed utilizing anonymous electronic surveys designed to examine diagnostic criteria, etiological understanding and treatment implications of a pathologic diagnosis of nonspecific, nonobstetric chronic endometritis. There was substantial variability among pathologists in the diagnostic criteria used for making a diagnosis of nonspecific, nonobstetric chronic endometritis, with 28.5% of pathologists using the presence of a single plasma cell for making the diagnosis. There was additional variability in the use of special stains, reporting in the presence of coexisting lesions and the hormonal stage of the endometrium. There were no differences between generalists and specialists in the diagnostic criteria used, except the significantly greater likelihood of specialists making the diagnosis in gestational endometrium. The substantial variability in diagnostic criteria for nonspecific, nonobstetric chronic endometritis among pathologists, including among gynecologic pathologists, has the potential to confound the management of patients. Standardization of diagnostic criteria for chronic endometritis is essential to understand the implications of the diagnosis.
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20
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Wang N, Vuerich M, Kalbasi A, Graham JJ, Csizmadia E, Manickas-Hill ZJ, Woolley A, David C, Miller EM, Gorman K, Hecht JL, Shaefi S, Robson SC, Longhi MS. Limited TCR repertoire and ENTPD1 dysregulation mark late-stage COVID-19. iScience 2021; 24:103205. [PMID: 34608452 PMCID: PMC8482538 DOI: 10.1016/j.isci.2021.103205] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/06/2021] [Accepted: 09/28/2021] [Indexed: 01/12/2023] Open
Abstract
T cell exhaustion and dysfunction are hallmarks of severe COVID-19. To gain insights into the pathways underlying these alterations, we performed a comprehensive transcriptome analysis of peripheral-blood-mononuclear-cells (PBMCs), spleen, lung, kidney, liver, and heart obtained at autopsy from COVID-19 patients and matched controls, using the nCounter CAR-T-Characterization panel. We found substantial gene alterations in COVID-19-impacted organs, especially the lung where altered TCR repertoires are noted. Reduced TCR repertoires are also observed in PBMCs of severe COVID-19 patients. ENTPD1/CD39, an ectoenzyme defining exhausted T-cells, is upregulated in the lung, liver, spleen, and PBMCs of severe COVID-19 patients where expression positively correlates with markers of vasculopathy. Heightened ENTPD1/CD39 is paralleled by elevations in STAT-3 and HIF-1α transcription factors; and by markedly reduced CD39-antisense-RNA, a long-noncoding-RNA negatively regulating ENTPD1/CD39 at the post-transcriptional level. Limited TCR repertoire and aberrant regulation of ENTPD1/CD39 could have permissive roles in COVID-19 progression and indicate potential therapeutic targets to reverse disease. Transcriptome profiling of COVID-19 autoptic tissue and PBMC was carried out There is limited TCR repertoire in lung, kidney and PBMC of severe COVID-19 cases There are increased CD39 levels in PBMC of severe COVID-19 patients High HIF-1a and STAT-3 and low CD39-antisense might be linked with CD39 increase
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Affiliation(s)
- Na Wang
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, Shandong 250021, China.,School of Medicine, Shandong University, 44 Wenhuaxilu, Jinan, Shandong 250021, China
| | - Marta Vuerich
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Ahmadreza Kalbasi
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jonathon J Graham
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Eva Csizmadia
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | | | - Ann Woolley
- Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Clement David
- NanoString Technologies, 530 Fairview Avenue N, Seattle, WA 98109, USA
| | - Eric M Miller
- NanoString Technologies, 530 Fairview Avenue N, Seattle, WA 98109, USA
| | - Kara Gorman
- NanoString Technologies, 530 Fairview Avenue N, Seattle, WA 98109, USA
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Simon C Robson
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Maria Serena Longhi
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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21
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Einstein DJ, Arai S, Calagua C, Xie F, Voznesensky O, Capaldo BJ, Luffman C, Hecht JL, Balk SP, Sowalsky AG, Russo JW. Metastatic Castration-Resistant Prostate Cancer Remains Dependent on Oncogenic Drivers Found in Primary Tumors. JCO Precis Oncol 2021; 5:PO.21.00059. [PMID: 34568716 PMCID: PMC8457789 DOI: 10.1200/po.21.00059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/11/2021] [Accepted: 08/13/2021] [Indexed: 12/31/2022] Open
Abstract
Metastatic prostate cancer is initially sensitive to androgen receptor inhibition, but eventually becomes castration-resistant prostate cancer (mCRPC). Early use of more intensive therapies targeting androgen receptor and other oncogenic drivers in treatment-naïve primary prostate cancer (PC) may be more effective than that in advanced mCRPC. However, analysis of primary tumors may not reveal targetable metastatic drivers that are subclonal in the primary tumor or acquired at metastatic sites. METHODS PC samples spanning one patient's clinical course: diagnostic biopsies, pre- or post-enzalutamide metastatic biopsies, and rapid autopsy samples including a patient-derived xenograft (PDX) were analyzed by targeted exome sequencing followed by phylogenetic analysis. RESULTS Left- and right-lobe primary PC tumors appeared to diverge, with the right acquiring additional shared mutations and striking differences in copy number alterations that later appeared in metastatic samples during the treatment course and at autopsy, whereas the left base tumor maintained a quiet copy number alteration landscape and partitioned into a dead-end node. RB1 loss, a common finding in advanced castration-resistant disease, was identified throughout mCRPC samples, but not in the primary tumor. Significantly, a truncal EGFR-activating mutation (R108K) was identified in the primary tumor and was also found to be maintained in the mCRPC samples and in a PDX model. Furthermore, the PDX model remained sensitive to the EGFR inhibitor erlotinib, despite the presence of both RB1 and BRCA2 losses. CONCLUSION These findings indicate that truncal alterations identified in primary PC can drive advanced mCRPC, even in the presence of additional strong oncogenic drivers (ie, RB1 and BRCA2 loss), and suggest that earlier detection and targeting of these truncal alterations may be effective at halting disease progression.
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Affiliation(s)
- David J. Einstein
- Division of Medical Oncology and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Seiji Arai
- Division of Medical Oncology and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,Department of Urology, Gunma University Hospital, Maebashi, Japan
| | - Carla Calagua
- Division of Medical Oncology and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Fang Xie
- Division of Medical Oncology and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Olga Voznesensky
- Division of Medical Oncology and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Brian J. Capaldo
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD
| | - Christina Luffman
- Department of Pathology, University of Massachusetts Medical Center, Worcester, MA
| | - Jonathan L. Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Steven P. Balk
- Division of Medical Oncology and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adam G. Sowalsky
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD
| | - Joshua W. Russo
- Division of Medical Oncology and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,Joshua W. Russo, MD, PhD, Division of Medical Oncology and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, CLS 432, Boston, MA 02215; e-mail:
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22
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Jamaly S, Tsokos MG, Bhargava R, Brook OR, Hecht JL, Abdi R, Moulton VR, Satyam A, Tsokos GC. Complement activation and increased expression of Syk, mucin-1 and CaMK4 in kidneys of patients with COVID-19. Clin Immunol 2021; 229:108795. [PMID: 34252574 PMCID: PMC8270746 DOI: 10.1016/j.clim.2021.108795] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Acute and chronic kidney failure is common in hospitalized patients with COVID-19, yet the mechanism of injury and predisposing factors remain poorly understood. We investigated the role of complement activation by determining the levels of deposited complement components (C1q, C3, FH, C5b-9) and immunoglobulin along with the expression levels of the injury-associated molecules spleen tyrosine kinase (Syk), mucin-1 (MUC1) and calcium/calmodulin-dependent protein kinase IV (CaMK4) in the kidney tissues of people who succumbed to COVID-19. We report increased deposition of C1q, C3, C5b-9, total immunoglobulin, and high expression levels of Syk, MUC1 and CaMK4 in the kidneys of COVID-19 patients. Our study provides strong rationale for the expansion of trials involving the use of inhibitors of these molecules, in particular C1q, C3, Syk, MUC1 and CaMK4 to treat patients with COVID-19.
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Affiliation(s)
- Simin Jamaly
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Medical Biology, Faculty of Health Science, UiT Arctic University of Norway, N-9037 Tromsø, Norway
| | - Maria G Tsokos
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Rhea Bhargava
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Reza Abdi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Vaishali R Moulton
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Abhigyan Satyam
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
| | - George C Tsokos
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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23
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Sasamoto N, Wang T, Townsend MK, Hecht JL, Eliassen AH, Song M, Terry KL, Tworoger SS, Harris HR. Prospective Analyses of Lifestyle Factors Related to Energy Balance and Ovarian Cancer Risk by Infiltration of Tumor-Associated Macrophages. Cancer Epidemiol Biomarkers Prev 2021; 30:920-926. [PMID: 33653814 PMCID: PMC8102357 DOI: 10.1158/1055-9965.epi-20-1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lifestyle factors related to energy balance have been associated with ovarian cancer risk and influence the tumor immune microenvironment, including tumor-associated macrophages (TAM). However, no studies have assessed whether these factors differentially impact ovarian cancer risk by TAM densities. METHODS We conducted a prospective analysis in the Nurses' Health Studies to examine the associations of physical activity, sitting time, and a food-based empirical dietary inflammatory pattern (EDIP) score with invasive epithelial ovarian cancer risk by TAM density assessed by immunohistochemistry. We considered density of CD68 (marker of total TAMs) and CD163 (marker of pro-carcinogenic M2-type TAMs), and their ratios. We used multivariable Cox proportional hazards regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) of exposures with risk of ovarian tumors with high versus low TAMs, including analyses stratified by body mass index. RESULTS Analyses included 312 incident ovarian cancer cases with TAM measurements. Physical activity, sitting time, and EDIP score were not differentially associated with ovarian cancer risk by TAM densities (P heterogeneity > 0.05). Among overweight and obese women, higher EDIP score was associated with increased risk of CD163 low-density tumors (HR comparing extreme tertiles, 1.57; 95% CI, 0.88-2.80; P trend = 0.01), but not CD163 high-density tumors (comparable HR, 1.16; 95% CI, 0.73-1.86; P trend = 0.24), though this difference was not statistically significant (P heterogeneity = 0.22). CONCLUSIONS We did not observe differential associations between lifestyle factors and ovarian cancer risk by TAM densities. IMPACT Future investigations examining the interplay between other ovarian cancer risk factors and the tumor immune microenvironment may help provide insight into ovarian cancer etiology.
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Affiliation(s)
- Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Tianyi Wang
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Mary K Townsend
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kathryn L Terry
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Holly R Harris
- Division of Public Health Sciences, Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department in Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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24
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Satyam A, Tsokos MG, Brook OR, Hecht JL, Moulton VR, Tsokos GC. Activation of classical and alternative complement pathways in the pathogenesis of lung injury in COVID-19. Clin Immunol 2021; 226:108716. [PMID: 33774179 PMCID: PMC7989127 DOI: 10.1016/j.clim.2021.108716] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 01/04/2023]
Abstract
Lung inflammation and damage is prominent in people infected with SARS-Cov-2 and a major determinant of morbidity and mortality. We report the deposition of complement components in the lungs of people who succumbed to COVID-19 consistent with the activation of the classical and the alternative pathways. Our study provides strong rationale for the expansion of trials involving the use of complement inhibitors to treat patients with COVID-19.
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Affiliation(s)
- Abhigyan Satyam
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States,Corresponding author at: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Center for Life Science, CLS 944, 3 Blackfan Circle, Boston, MA 02115, United States
| | - Maria G. Tsokos
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Olga R. Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jonathan L. Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Vaishali R. Moulton
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - George C. Tsokos
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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25
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Ramia de Cap M, Jou D, Chen Y, Hecht JL, VanderLaan PA, Chen AL. Impact of a Modified HistoGel Method for Processing Endocervical Curettage Specimens on Diagnostic Yield. Am J Clin Pathol 2021; 155:141-147. [PMID: 33009570 DOI: 10.1093/ajcp/aqaa125] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Endocervical curettage (ECC) specimens may be limited by scant tissue. We evaluated whether a cellular concentration processing method could improve their diagnostic quality. METHODS Between October 2018 and June 2019, ECC specimens were assigned chronologically to one of two groups: nonconcentrated ECC (NECC) or concentrated ECC (CECC). NECC specimens underwent routine histologic processing. CECC specimens were processed using a published HistoGel-based cell block method. We reviewed diagnoses for ECCs, concurrent cervical biopsies and/or loop electrosurgical excision procedures (LEEPs), and preceding Papanicolaou (Pap) smears. We performed multivariate logistic regression analyses to evaluate the impact of processing method on ECC adequacy and discordance between Pap smear and worst tissue diagnoses. RESULTS NECC and CECC adequacy was 88.2% and 84.7% (P = .06). ECC adequacy was greater if concurrent biopsy/LEEP was performed (odds ratio [OR] = 1.76, P < .01). Discordance between Pap smear and worst tissue diagnoses was 9.5% and 13.3% (P = .04) for cases with NECC and CECC processing, although processing method was not significant in multivariate analysis (OR = 0.74, P = .11). Adequate ECC sampling and concurrent biopsy/LEEP were independently associated with concordance between Pap smear and worst tissue diagnosis (OR = 0.46, P < .01 and OR = 0.65, P = .02). CONCLUSIONS ECC processing method did not significantly affect either specimen adequacy (P = .06) or diagnostic discordance (P = .11) when controlled for other factors.
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Affiliation(s)
| | - David Jou
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Yigu Chen
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Athena L Chen
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
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26
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Shainker SA, Coleman B, Timor-Tritsch IE, Bhide A, Bromley B, Cahill AG, Gandhi M, Hecht JL, Johnson KM, Levine D, Mastrobattista J, Philips J, Platt LD, Shamshirsaz AA, Shipp TD, Silver RM, Simpson LL, Copel JA, Abuhamad A. Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum. Am J Obstet Gynecol 2021; 224:B2-B14. [PMID: 33386103 DOI: 10.1016/j.ajog.2020.09.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Placenta accreta spectrum includes the full range of abnormal placental attachment to the uterus or other structures, encompassing placenta accreta, placenta increta, placenta percreta, morbidly adherent placenta, and invasive placentation. The incidence of placenta accreta spectrum has increased in recent years, largely driven by increasing rates of cesarean delivery. Prenatal detection of placenta accreta spectrum is primarily made by ultrasound and is important to reduce maternal morbidity associated with the condition. Despite a large body of research on various placenta accreta spectrum ultrasound markers and their screening performance, inconsistencies in the literature persist. In response to the need for standardizing the definitions of placenta accreta spectrum markers and the approach to the ultrasound examination, the Society for Maternal-Fetal Medicine convened a task force with representatives from the American Institute of Ultrasound in Medicine, the American College of Obstetricians and Gynecologists, the American College of Radiology, the International Society of Ultrasound in Obstetrics and Gynecology, the Society for Radiologists in Ultrasound, the American Registry for Diagnostic Medical Sonography, and the Gottesfeld-Hohler Memorial Ultrasound Foundation. The goals of the task force were to assess placenta accreta spectrum sonographic markers on the basis of available data and expert consensus, provide a standardized approach to the prenatal ultrasound evaluation of the uterus and placenta in pregnancies at risk of placenta accreta spectrum, and identify research gaps in the field. This manuscript provides information on the Placenta Accreta Spectrum Task Force process and findings.
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27
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Aid M, Busman-Sahay K, Vidal SJ, Maliga Z, Bondoc S, Starke C, Terry M, Jacobson CA, Wrijil L, Ducat S, Brook OR, Miller AD, Porto M, Pellegrini KL, Pino M, Hoang TN, Chandrashekar A, Patel S, Stephenson K, Bosinger SE, Andersen H, Lewis MG, Hecht JL, Sorger PK, Martinot AJ, Estes JD, Barouch DH. Vascular Disease and Thrombosis in SARS-CoV-2-Infected Rhesus Macaques. Cell 2020; 183:1354-1366.e13. [PMID: 33065030 PMCID: PMC7546181 DOI: 10.1016/j.cell.2020.10.005] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has led to extensive morbidity and mortality throughout the world. Clinical features that drive SARS-CoV-2 pathogenesis in humans include inflammation and thrombosis, but the mechanistic details underlying these processes remain to be determined. In this study, we demonstrate endothelial disruption and vascular thrombosis in histopathologic sections of lungs from both humans and rhesus macaques infected with SARS-CoV-2. To define key molecular pathways associated with SARS-CoV-2 pathogenesis in macaques, we performed transcriptomic analyses of bronchoalveolar lavage and peripheral blood and proteomic analyses of serum. We observed macrophage infiltrates in lung and upregulation of macrophage, complement, platelet activation, thrombosis, and proinflammatory markers, including C-reactive protein, MX1, IL-6, IL-1, IL-8, TNFα, and NF-κB. These results suggest a model in which critical interactions between inflammatory and thrombosis pathways lead to SARS-CoV-2-induced vascular disease. Our findings suggest potential therapeutic targets for COVID-19.
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Affiliation(s)
- Malika Aid
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | | | - Samuel J Vidal
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Zoltan Maliga
- Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Stephen Bondoc
- Oregon Health & Sciences University, Beaverton, OR 97006, USA
| | - Carly Starke
- Oregon Health & Sciences University, Beaverton, OR 97006, USA
| | - Margaret Terry
- Oregon Health & Sciences University, Beaverton, OR 97006, USA
| | - Connor A Jacobson
- Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Linda Wrijil
- Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | - Sarah Ducat
- Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Andrew D Miller
- Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, NY 14853, USA
| | | | - Kathryn L Pellegrini
- Yerkes Genomics Core Laboratory, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Maria Pino
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Timothy N Hoang
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Abishek Chandrashekar
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Shivani Patel
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Kathryn Stephenson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Steven E Bosinger
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA; Yerkes Genomics Core Laboratory, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA; Department of Pathology & Laboratory Medicine, Emory School of Medicine, Emory University, Atlanta, GA 30329, USA
| | | | | | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Peter K Sorger
- Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Amanda J Martinot
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
| | - Jacob D Estes
- Oregon Health & Sciences University, Beaverton, OR 97006, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA.
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Venkatesh KK, Leviton A, Hecht JL, Joseph RM, Douglass LM, Frazier JA, Daniels JL, Fry RC, O’Shea TM, Kuban KC. Histologic chorioamnionitis and risk of neurodevelopmental impairment at age 10 years among extremely preterm infants born before 28 weeks of gestation. Am J Obstet Gynecol 2020; 223:745.e1-745.e10. [PMID: 32387324 DOI: 10.1016/j.ajog.2020.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/03/2020] [Accepted: 05/04/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Extremely preterm infants whose placenta had histologic evidence of chorioamnionitis have early brain dysfunction, but little is known about neurologic development at 10 years of age. OBJECTIVE We investigated the association between histologic chorioamnionitis and neurodevelopmental impairment at 10 years among children born <28 weeks' gestation (extremely preterm). STUDY DESIGN The multicenter Extremely Low Gestational Age Newborns study enrolled extremely preterm newborns from 2002 to 2004 at 14 hospitals in the United States. Chorioamnionitis was defined by histologic stage (early, moderate, and advanced) and grade (mild/moderate and severe) of chorionic plate and umbilical cord inflammation. The children were examined for cerebral palsy at 2 years and for autism spectrum disorder, cognitive impairment (intelligence quotient >2 standard deviations below the mean), and epilepsy at the age of 10 years by blinded evaluators using validated measures. Multivariable logistic regression with generalized estimating equations was used. RESULTS Among 805 placentas, 43% (347/805) had histologic chorioamnionitis by moderate or advanced maternal stage, 36% (286/805) by severe maternal grade, 18% (132/737) by moderate or advanced fetal stage, and 1% (10/737) by severe fetal grade. The frequencies of impairments were 11% (88/767) for cerebral palsy, 7% (56/773) for autism spectrum disorder, 15% (120/788) for cognitive impairment, and 7% (52/763) for epilepsy. After adjustment for maternal age, body mass index, race, insurance status, maternal education, tobacco use, infant sex, and multiple gestations, the adjusted odds ratio for the association between histologic chorioamnionitis and cerebral palsy years was increased with advanced maternal stage (adjusted odds ratio, 2.5; 95% confidence interval, 1.6-3.9), severe maternal grade (adjusted odds ratio, 2.0; 95% confidence interval, 1.2-3.4), moderate fetal stage (adjusted odds ratio, 2.20; 95% confidence interval, 2.1-2.2), and mild or moderate fetal grade (adjusted odds ratio, 1.5; 95% confidence interval, 1.0-2.2). Similarly, the adjusted odds ratio for the association between histologic chorioamnionitis and epilepsy was increased with advanced maternal stage (adjusted odds ratio, 1.5; 95% confidence interval, 1.3-1.6) and severe fetal grade (adjusted odds ratio, 5.9; 95% confidence interval, 1.9-17.8). In addition, the adjusted odds ratio for the association between histologic chorioamnionitis and autism spectrum disorder was increased with mild or moderate fetal grade (adjusted odds ratio, 1.7; 95% confidence interval, 1.0-2.9). Histologic chorioamnionitis was not associated with cognitive impairment. These findings held after adjustment for gestational age at delivery. In contrast to histologic chorioamnionitis, a clinical diagnosis of chorioamnionitis was not associated with neurodevelopmental impairment. CONCLUSION Histologic chorioamnionitis may be associated with some forms of neurodevelopmental impairment at 10 years of life among infants born <28 weeks' gestation.
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Jauniaux E, Hecht JL. Perinatal diagnosis of placenta accreta spectrum disorders in the twenty-first century: visual inspection at birth is not enough. BJOG 2020; 128:328. [PMID: 33052005 DOI: 10.1111/1471-0528.16513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
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Barnard ME, Trabert B, Hecht JL, Goode EL, Sasamoto N, Terry KL, Tworoger SS. Abstract A19: Aspirin use and ovarian cancer risk by lymphocyte infiltration. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.modpop19-a19] [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] Open
Abstract
Abstract
Introduction: There is growing evidence to support a modest inverse association between daily aspirin use and ovarian cancer risk. We previously hypothesized that this association may differ by immune cell infiltration. In our prior study evaluating heterogeneity by tumor-associated macrophage (TAM) infiltration, aspirin use was associated with lower risk of ovarian cancer with high protumorigenic M2-type TAM infiltration, but not low M2-type TAM infiltration. The goal of the present study was to evaluate the hypothesis that the association between aspirin use and ovarian cancer risk also differs by infiltration with tumor-infiltrating lymphocytes (TILs).
Methods: We included cases and matched controls from the Nurses’ Health Study (NHS), NHSII, and New England Case Control Study. Study participants self-reported aspirin use including regular use (≥1 x per week), duration of use, and number of tablets. A gynecologic pathologist (JLH), who was blinded to exposure status, reviewed hematoxylin and eosin stained tumor slides to quantify TILs for all cases (n=547). We used polytomous logistic regression, adjusted for ovarian cancer risk factors, to estimate odds ratios (OR) for aspirin use and ovarian cancer risk by TIL infiltration.
Results: Overall, recent aspirin use was associated with lower risk of ovarian cancer compared with no regular aspirin use (OR=0.65, 95%CI=0.47-0.89). Recent aspirin use was associated with a lower risk of ovarian cancer exhibiting TIL infiltration (OR=0.38, 95%CI=0.26-0.56) but not with TIL-negative cancers (OR=1.00, 95%CI=0.71-1.41; p-heterogeneity <0.001). We observed similar results for aspirin duration and tablets. For duration, comparing ≥10 years of aspirin use to <1 year we observed a significantly lower risk of ovarian cancer with TILs (OR=0.47, 95%CI=0.41-0.71; p-trend=0.004), but a nonsignificant reduction for ovarian cancer without TILs (OR=0.86, 95%CI=0.59-1.26; p-trend=0.72; p-heterogeneity=0.03). Comparing ≥6 tablets to <1 tablet per week, there was evidence of a lower risk of ovarian cancer with TILs (OR=0.47, 95%CI=0.30-0.75; p-trend=0.001) but not without TILs (OR=1.02, 95%CI=0.70-1.48; p-trend=0.84; p-heterogeneity=0.003).
Conclusions: Our results suggest that prediagnosis aspirin use may be an important modulator of immune cell infiltration in ovarian tumors, supporting an immunogenic mechanism for aspirin in ovarian carcinogenesis. Further work is under way to evaluate nonaspirin nonsteroidal anti-inflammatory drugs, and to consider which subsets of TAMs and TILs may be driving heterogeneity in the associations between anti-inflammatory drugs and ovarian cancer risk.
Citation Format: Mollie E. Barnard, Britton Trabert, Jonathan L. Hecht, Ellen L. Goode, Naoko Sasamoto, Kathryn L. Terry, Shelley S. Tworoger. Aspirin use and ovarian cancer risk by lymphocyte infiltration [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A19.
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Shainker SA, Silver RM, Modest AM, Hacker MR, Hecht JL, Salahuddin S, Dillon ST, Ciampa EJ, D'Alton ME, Otu HH, Abuhamad AZ, Einerson BD, Branch DW, Wylie BJ, Libermann TA, Karumanchi SA. Placenta accreta spectrum: biomarker discovery using plasma proteomics. Am J Obstet Gynecol 2020; 223:433.e1-433.e14. [PMID: 32199927 DOI: 10.1016/j.ajog.2020.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Many cases of placenta accreta spectrum are not diagnosed antenatally, despite identified risk factors and improved imaging methods. Identification of plasma protein biomarkers could further improve the antenatal diagnosis of placenta accreta spectrum . OBJECTIVE The purpose of this study was to determine if women with placenta accreta spectrum have a distinct plasma protein profile compared with control subjects. STUDY DESIGN We obtained plasma samples before delivery from 16 participants with placenta accreta spectrum and 10 control subjects with similar gestational ages (35.1 vs 35.5 weeks gestation, respectively). We analyzed plasma samples with an aptamer-based proteomics platform for alterations in 1305 unique proteins. Heat maps of the most differentially expressed proteins (T test, P<.01) were generated with matrix visualization and analysis software. Principal component analysis was performed with the use of all 1305 proteins and the top 21 dysregulated proteins. We then confirmed dysregulated proteins using enzyme-linked immunosorbent assay and report significant differences between placenta accreta spectrum and control cases (Wilcoxon-rank sum test, P<.05). RESULTS Many of the top 50 proteins that significantly dysregulated in participants with placenta accreta spectrum were inflammatory cytokines, factors that regulate vascular remodeling, and extracellular matrix proteins that regulate invasion. Placenta accreta spectrum, with the use of the top 21 proteins, distinctly separated the placenta accreta spectrum cases from control cases (P<.01). Using enzyme-linked immunosorbent assay, we confirmed 4 proteins that were dysregulated in placenta accreta spectrum compared with control cases: median antithrombin III concentrations (240.4 vs 150.3 mg/mL; P=.002), median plasminogen activator inhibitor 1 concentrations (4.1 vs 7.1 ng/mL; P<.001), soluble Tie2 (13.5 vs 10.4 ng/mL; P=.02), soluble vascular endothelial growth factor receptor 2 (9.0 vs 5.9 ng/mL; P=.003). CONCLUSION Participants with placenta accreta spectrum had a unique and distinct plasma protein signature.
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Shafrir AL, Babic A, Gates Kuliszewski M, Rice MS, Townsend MK, Hecht JL, Tworoger SS. Estrogen Receptor-β Expression of Ovarian Tumors and Its Association with Ovarian Cancer Risk Factors. Cancer Epidemiol Biomarkers Prev 2020; 29:2211-2219. [PMID: 32856599 DOI: 10.1158/1055-9965.epi-20-0618] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Differential associations between ovarian cancer risk factors and estrogen receptor-α (ERα) ovarian tumor expression have been noted; however, no research has assessed estrogen receptor-β (ERβ) expression. Thus, in exploratory analyses, we assessed the association of several factors with ovarian cancer risk by ERβ tumor status. METHODS We conducted a nested case-control study within the prospective Nurses' Health Study cohorts (NHS/NHSII), with exposures collected through biennial questionnaires. Paraffin-embedded tumor blocks were requested for cases diagnosed from 1976 to 2006 (NHS) and 1989 to 2005 (NHSII) and tissue microarrays were stained for nuclear ERβ (ERβ-nuc) and cytoplasmic ERβ (ERβ-cyto), with any staining considered positive (+). We obtained odds ratios (OR) and 95% confidence intervals (CI) using multivariate polytomous logistic regression. RESULTS We included 245 cases [43% ERβ-cyto (+) and 71% ERβ-nuc (+)] and 1,050 matched controls. An inverse association was observed between parity and risk of ERβ-nuc (+) (OR, parous vs. nulliparous: 0.46; 95% CI, 0.26-0.81), but not ERβ-nuc (-) tumors (OR, parous vs. nulliparous: 1.51; 95% CI, 0.45-5.04; P heterogeneity = 0.04). Conversely, parity was inversely associated with ERβ-cyto (-) tumors (OR, parous vs. nulliparous: 0.42; 95% CI, 0.23-0.78), but was not associated with ERβ-cyto (+) tumors (OR, parous vs. nulliparous: 1.08; 95% CI, 0.45-2.63; P heterogeneity = 0.05). Associations for other exposures, including hormone therapy, did not differ by ERβ-nuc or ERβ-cyto status. CONCLUSIONS Our results suggest that parity may influence ovarian cancer risk, in part, through alterations in ERβ localization within tumor cells. IMPACT Alterations in ERβ expression and localization appear to be important for ovarian cancer etiology. Future research should confirm our results and assess potential biologic mechanisms for the observed associations.
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Affiliation(s)
- Amy L Shafrir
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. .,Boston Center for Endometriosis, Brigham and Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | - Ana Babic
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Margaret Gates Kuliszewski
- Department of Epidemiology and Biostatistics, University of Albany SUNY School of Public Health, Albany, New York
| | - Megan S Rice
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mary K Townsend
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Sasamoto N, Townsend M, Abbas-Aghababazadeh F, Terry KL, Johnson JO, Hecht JL, Fridley BL, Tworoger SS. Abstract 34: Predictors of discordance between image-based and manual scoring of immunohistochemical stains in ovarian cancer tissue microarrays. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-34] [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
Digital image-based scoring of immunohistochemistry (IHC) staining allows faster, more objective and potentially more reproducible quantification of area stained or cell counts compared to manual scoring. However, predictors of discrepancies between these two assessment methods are not well understood. We examined clinical and pathological characteristics associated with discordance between image-based and manual scoring using ovarian cancer tissue microarrays (TMA) across a range of IHC stains. We evaluated 2,159 TMA cores from 681 ovarian cancer cases stained by four tissue cytoplasmic stains quantified as percentage of the tumor area stained (POSTN, CXCL14, ADH1B, COL11A1) and two immune cell markers quantified by cell count of infiltrating immune cells (CD68, CD163). The TMA slides were scored manually using semi-quantitative scoring by gynecologic pathologists as well as digitally using image-based Definiens automated platform. We used generalized linear mixed models with individual patients and TMAs included as random effects and stain as fixed effect to examine predictors of discordance, defined as absolute difference of ≥1SD in z-scores between image-based and manual scoring, overall and by each stain. The multi-level model included characteristics of the TMA, core, and tumor factors as predictors. Overall, TMA construction by automated robotic system (vs manual), smaller core size or area, borderline (vs invasive tumors), and having no geographic necrosis in the tumor were significantly associated with greater discordance between image-based and manual scoring. Interestingly, all these factors, except geographic necrosis, were differentially associated with discordance across the stains (p-interaction <0.05). Having multiple loci of geographic necrosis was associated with less discordance (OR=0.84, 95%CI=0.72-0.97). Invasive tumors compared to borderline tumors were less likely to be discordantly scored overall (OR=0.80, 95%CI=0.65-1.00) and for tissue cytoplasmic stains (OR range: 0.42-0.73), with associations in the opposite direction for immune cell markers (OR range: 1.21-2.37). Core areas in the lowest quartile vs all other cores were associated with greater discordance (OR=1.18, 95%CI=1.05-1.32), which was more notable for the tissue cytoplasmic stains (OR range: 1.18-2.00) compared to immune cell markers (OR range: 0.83-0.86). TMAs created by robot vs by hand had 64% higher odds of discordance (95%CI=1.20-2.25), which was more apparent when blank rows and columns were included on the TMA. Overall, TMA, core, and tumor level factors were related to discordance between image-based and manual scoring. Some stain types may be more susceptible to specific pre-analytic factors suggesting that reproducibility studies of manual vs image-based scoring should be conducted on a proportion of cases in large scale projects.
Citation Format: Naoko Sasamoto, Mary Townsend, Farnoosh Abbas-Aghababazadeh, Kathryn L. Terry, Joseph O. Johnson, Jonathan L. Hecht, Brooke L. Fridley, Shelley S. Tworoger. Predictors of discordance between image-based and manual scoring of immunohistochemical stains in ovarian cancer tissue microarrays [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 34.
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Gerson KD, Haviland MJ, Neo D, Hecht JL, Baccarelli AA, Brennan KJM, Dereix AE, Ralston SJ, Hacker MR, Burris HH. Pregnancy-associated changes in cervical noncoding RNA. Epigenomics 2020; 12:1013-1025. [PMID: 32808540 PMCID: PMC7546170 DOI: 10.2217/epi-2019-0231] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/20/2020] [Indexed: 12/16/2022] Open
Abstract
Aim: To identify pregnancy-associated changes in cervical noncoding RNA (ncRNA), including miRNA and long noncoding RNA (lncRNA), and their potential effects on biologic processes. Materials & methods: We enrolled 21 pregnant women with term deliveries (≥37 weeks' gestation) in a prospective cohort and collected cervical swabs before 28 weeks' gestation. We enrolled 21 nonpregnant controls. We analyzed miRNA, lncRNA and mRNA expression, applying a Bonferroni correction. Results: Five miRNA and three lncRNA were significantly differentially (>twofold change) expressed. Putative miRNA targets are enriched in genes mediating organogenesis, glucocorticoid signaling, cell adhesion and ncRNA machinery. Conclusion: Differential cervical ncRNA expression occurs in the setting of pregnancy. Gene ontology classification reveals biological pathways through which miRNA may play a biologic role in normal pregnancy physiology.
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Affiliation(s)
- Kristin D Gerson
- Department of Obstetrics & Gynecology, Maternal Child Health Research Center, Center for Research on Reproduction & Women's Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Miriam J Haviland
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Dayna Neo
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Andrea A Baccarelli
- Department of Environmental Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Kasey JM Brennan
- Department of Environmental Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Alexandra E Dereix
- Department of Environmental Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Steven J Ralston
- Department of Obstetrics & Gynecology, Pennsylvania Hospital, Philadelphia, PA 19107, USA
- Department of Obstetrics & Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michele R Hacker
- Department of Obstetrics & Gynecology, Maternal Child Health Research Center, Center for Research on Reproduction & Women's Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, Boston, MA 02115, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Heather H Burris
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Maternal Child Health Research Center, Center for Research on Reproduction & Women’s Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
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Lin DI, Hemmerich A, Edgerly C, Duncan D, Severson EA, Huang RSP, Ramkissoon SH, Connor YD, Shea M, Hecht JL, Ali SM, Vergilio JA, Ross JS, Elvin JA. Genomic profiling of BCOR-rearranged uterine sarcomas reveals novel gene fusion partners, frequent CDK4 amplification and CDKN2A loss. Gynecol Oncol 2020; 157:357-366. [PMID: 32156473 DOI: 10.1016/j.ygyno.2020.02.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/08/2020] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Genomic alterations of BCOR via ZC3H7B-BCOR fusion or BCOR internal tandem duplication (ITD) define a subset of endometrial stromal sarcoma (ESS). The goals of this study were to: 1) determine the molecular landscape of BCOR-rearranged ESS, 2) to identify novel BCOR fusion gene partners in ESS and their associated clinicopathological characteristics, and 3) to potentially unravel targetable genomic alterations in BCOR-mutated ESS. METHODS A retrospective database search of a CLIA-certified molecular laboratory was performed for uterine sarcomas that contained BCOR rearrangements or BCOR ITD. The cases were previously assayed by comprehensive genomic profiling via both DNA- and RNA-based targeted next generation sequencing during the course of clinical care. Clinicopathological and genomic data was centrally re-reviewed. RESULTS We identify largest cohort of BCOR-rearranged ESS to date (n = 40), which included 31 cases with canonical ZC3H7B-BCOR fusion as well as 8 cases with novel BCOR gene rearrangement partners, such as BCOR-L3MBTL2, EP300-BCOR, BCOR-NUTM2G, BCOR-RALGPS1, BCOR-MAP7D2, RGAG1-BCOR, ING3-BCOR, BCOR-NUGGC, KMT2D-BCOR, CREBBP-BCOR and 1 case with BCOR internal rearrangement. Re-review of cases with novel rearrangements demonstrated sarcomas with spindle, epithelioid or small round cell components and frequent myxoid stromal change. Comprehensive genomic profiling revealed high frequency of CDK4 and MDM2 amplification in 38% and 45% of BCOR-rearranged cases, respectively, and homozygous deletion of CDKN2A, which encodes an inhibitor of CDK4 in 28% of cases. Notably, CDK4 and MDM2 amplification was absent in all cases from 15 different ESS cases harboring BCOR ITD. CONCLUSIONS Alterations of CDK4 pathway members, for which targeted therapy is clinically available (i.e. palbociclib), via CDK4 amplification or CDKN2A loss, contributes to the pathogenesis of BCOR-rearranged uterine sarcomas, which may have therapeutic implications.
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Affiliation(s)
- Douglas I Lin
- Foundation Medicine Inc., Cambridge, MA, United States of America.
| | - Amanda Hemmerich
- Foundation Medicine Inc., Morrisville, NC, United States of America
| | - Claire Edgerly
- Foundation Medicine Inc., Morrisville, NC, United States of America
| | - Daniel Duncan
- Foundation Medicine Inc., Morrisville, NC, United States of America
| | - Eric A Severson
- Foundation Medicine Inc., Morrisville, NC, United States of America
| | | | - Shakti H Ramkissoon
- Foundation Medicine Inc., Morrisville, NC, United States of America; Wake Forest Comprehensive Cancer Center, Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Yamicia D Connor
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Meghan Shea
- Department of Internal Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Siraj M Ali
- Foundation Medicine Inc., Cambridge, MA, United States of America
| | - Jo-Anne Vergilio
- Foundation Medicine Inc., Cambridge, MA, United States of America
| | - Jeffrey S Ross
- Foundation Medicine Inc., Cambridge, MA, United States of America; Upstate Medical University, Syracuse, NY, United States of America
| | - Julia A Elvin
- Foundation Medicine Inc., Cambridge, MA, United States of America
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Hecht JL, Karumanchi SA, Shainker SA. Immune cell infiltrate at the utero-placental interface is altered in placenta accreta spectrum disorders. Arch Gynecol Obstet 2020; 301:499-507. [PMID: 32025844 DOI: 10.1007/s00404-020-05453-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 09/21/2019] [Accepted: 01/23/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To characterize the immune cell infiltrate associated with maternal vascular remodeling in 12 cases of cesarean hysterectomy from women with placenta accreta spectrum (PAS) disorder. METHODS Myometrial vessels were evaluated by hematoxylin and eosin and immunohistochemistry stains on tissue microarrays that included samples from the myometrium, deep to the implantation site. Vessels were quantified based on physiologic conversion and immune cell infiltrates. Placental bed biopsies from cases of repeat cesarean section, and decidual vessels from delivered non-PAS placentas were used as controls. RESULTS Immune cells, predominantly macrophages and T-cells, were present as a band along the placental-myometrial interface in PAS cases. However, within the myometrium, the infiltrate showed a perivascular accentuation. The infiltrates around and within vessel walls were composed of T-cells (CD3) and macrophages (CD68), with fewer NK (CD56), Treg (FoxP3) and rare B-cells (CD20). Plasma cells (CD138) were absent. The majority of vessels with immune cell infiltrates had undergone complete or partial physiologic conversion by trophoblast. However, a subset of unconverted vessels in the myometrium had a similar immune cell infiltration. Control blood vessels showed a similar pattern of leukocytes infiltration in the decidua and placental bed biopsies, but with a lower density. CONCLUSIONS Our findings suggest that myometrial vascular changes in PAS resemble the physiological changes of vessels noted in the implantation site of normal pregnancies. The presence of perivascular immune cell infiltrates in the absence of adjacent trophoblast suggests that the process may be initiated by paracrine effects rather than direct contact or endovascular growth of trophoblast.
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Affiliation(s)
- Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - S Ananth Karumanchi
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.,Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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Baniak N, Fadare O, Köbel M, DeCoteau J, Parkash V, Hecht JL, Hanley KZ, Gwin K, Zheng W, Quick CM, Jarboe EA, Liang SX, Kinloch M. Targeted Molecular and Immunohistochemical Analyses of Endometrial Clear Cell Carcinoma Show that POLE Mutations and DNA Mismatch Repair Protein Deficiencies Are Uncommon. Am J Surg Pathol 2020; 43:531-537. [PMID: 30585826 DOI: 10.1097/pas.0000000000001209] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Endometrial clear cell carcinoma (ECCC) is an uncommon histotype without unique identified molecular alterations. Recently, The Cancer Genome Atlas molecular subtypes have been reported in ECCC. ECCC cases were collected from 11 institutions with diagnoses confirmed by morphologic review and immunohistochemistry. DNA mismatch repair (MMR) proteins, p53 expression, and ARID1A expression was assessed by immunohistochemistry on tissue microarrays. Targeted next-generation sequencing was completed for POLE, TP53, KRAS, and PIK3CA. Pathogenicity of mutations was determined using MutationTaster and PolyPhen databases. For p53, immunohistochemistry and sequencing were complimentarily used to assess the p53 status. Of 57 cases, 46 were considered prototypical ECCC by morphology and immunohistochemical profile (Napsin A-positive and ER-negative). Three cases were excluded because of insufficient sample for complete immunohistochemical analysis, and 6 had failed sequencing, resulting in 37 cases. Of the 37 remaining cases, 6/37 (16%) had predicted pathogenic mutations in the exonuclease domain of POLE with an allelic frequency >10%; however, no hot-spot mutations were identified. No cases were MMR-deficient. The gene most commonly affected was TP53 (59%, 22/37), followed by KRAS (13%, 2/15) and PIK3CA (13%, 2/15). The current study is the largest molecular analysis of pure ECCC reported to date. When strict classification criteria are applied, MMR-deficient and POLE mutated subtypes are not represented. Further consensus on what represents a deleterious POLE mutations is needed. The findings support separately studying histologically/immunohistochemically defined ECCC to identify characteristic molecular alterations in future studies.
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Affiliation(s)
- Nick Baniak
- Department of Laboratory Medicine and Pathology, University of Saskatchewan, Saskatoon, SK
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego, San Diego, CA
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - John DeCoteau
- Department of Laboratory Medicine and Pathology, University of Saskatchewan, Saskatoon, SK
| | - Vinita Parkash
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Katja Gwin
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Charles M Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Elke A Jarboe
- University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, UT
| | - Sharon X Liang
- Department of Pathology and Laboratory Medicine, Hofstra-Northwell School of Medicine, Lake Success, NY
| | - Mary Kinloch
- Department of Laboratory Medicine and Pathology, University of Saskatchewan, Saskatoon, SK
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Lin DI, Allen JM, Hecht JL, Killian JK, Ngo NT, Edgerly C, Severson EA, Ali SM, Erlich RL, Ramkissoon SH, Vergilio JA, Ross JS, Elvin JA. SMARCA4 inactivation defines a subset of undifferentiated uterine sarcomas with rhabdoid and small cell features and germline mutation association. Mod Pathol 2019; 32:1675-1687. [PMID: 31190001 DOI: 10.1038/s41379-019-0303-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/28/2022]
Abstract
A rare subset of aggressive SMARCA4-deficient uterine sarcomas has been recently proposed, with only a limited number of cases having been previously described. Here, we identify 16 additional cases of SMARCA4-deficient uterine sarcoma from the database of a large, CLIA-certified and CAP-accredited, reference molecular laboratory, and we expand on their clinicopathological and genomic features. Median patient's age was 49 years (range 32-70). Most tumors were aggressive with distant metastasis. SMARCA4-deficient uterine sarcoma demonstrated predominantly rhabdoid or large epithelioid cells with abundant cytoplasm, but also had varying degrees of small cell and spindle cell morphology. Tumors were microsatellite stable and exhibited no other or only few co-occurring genomic alterations by comprehensive genomic profiling. We discovered one patient, who developed SMARCA4-deficient uterine sarcoma at the age of 55, had a germline SMARCA4 mutation, whose daughter had previously died of small cell carcinoma of the ovary, hypercalcemic type, at the age of 32. Our data support the notion that SMARCA4 inactivation is the driver oncogenic event of a morphologically and molecularly distinct form of uterine sarcoma. Identification of SMARCA4-deficient uterine sarcomas may be clinically important due to their aggressive behavior, germline association, and emerging targeted therapies.
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Affiliation(s)
- Douglas I Lin
- Foundation Medicine Inc., Cambridge, Massachusetts, USA.
| | | | | | | | - Nhu T Ngo
- Foundation Medicine Inc., Cambridge, Massachusetts, USA
| | | | | | - Siraj M Ali
- Foundation Medicine Inc., Cambridge, Massachusetts, USA
| | | | - Shakti H Ramkissoon
- Foundation Medicine, Morrisville, NC, USA.,Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Jeffrey S Ross
- Foundation Medicine Inc., Cambridge, Massachusetts, USA.,Upstate Medical University, Syracuse, NY, USA
| | - Julia A Elvin
- Foundation Medicine Inc., Cambridge, Massachusetts, USA
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Levine D, Patel MD, Suh-Burgmann EJ, Andreotti RF, Benacerraf BR, Benson CB, Brewster WR, Coleman BG, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow MM, Hur HC, Marnach ML, Pavlik E, Platt LD, Puscheck E, Smith-Bindman R, Brown DL. Simple Adnexal Cysts: SRU Consensus Conference Update on Follow-up and Reporting. Radiology 2019; 293:359-371. [DOI: 10.1148/radiol.2019191354] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
CASE A 31-year-old woman developed worsening pain and paresthesia in the neck, shoulder, and arm over a period of 6 years. Magnetic resonance imaging revealed a soft-tissue mass in the subscapular region, with likely involvement of the scapula and the subscapularis muscle. The mass was resected, and the final histologic diagnosis was desmoid-type fibromatosis. CONCLUSION Desmoid tumors with subscapularis muscle involvement are exceedingly rare. Although limited range of motion is the more common presentation for these tumors, this case demonstrates that desmoid tumors may present with primarily neurologic symptoms.
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Affiliation(s)
| | | | - Santiago A Lozano-Calderón
- Massachusetts General Hospital, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Weatherford RD, Mulla BM, Redhunt AM, Modest AM, Hacker MR, Hecht JL, Spiel MH, Shainker SA. 368: Hemorrhagic morbidity of invasive placentation with and without placenta previa. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gerson KD, Modest AM, Hecht JL, Young BC. Persistent amnion-chorion membrane separation. J Obstet Gynaecol Res 2018; 45:352-357. [PMID: 30411435 DOI: 10.1111/jog.13852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/02/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022]
Abstract
AIM Fetal membranes are composed of the amnion and chorion, which fuse during the early second trimester. Persistent separation confers increased risk of adverse perinatal outcomes. This study characterizes sonographic and placental findings associated with persistent amnion-chorion (AC) membrane separation. METHODS This is a case series of 23 patients carrying singleton pregnancies with persistent AC membrane separation after 16 weeks' gestation diagnosed by ultrasound from 2010 to 2016 at our institution. Twenty placentas were available for analysis. RESULTS Obstetrical complications occurred in 13 (56.5%) cases; two (8.7%) cases resulted in intrauterine fetal demise. Fetal malformations were reported in eight (34.8%) cases. Four (17.4%) neonates were small-for-gestational age (SGA; <10th percentile). Placental size measured ≤10th percentile for gestational age in eight (40%) cases. Placental cord insertion was marginal or velamentous in eight (34.8%) cases. Maternal and/or fetal placental perfusion abnormalities occurred in 11 (55%) cases. CONCLUSION AC membrane separation is associated with adverse obstetrical outcomes, placental abnormalities, including marginal and velamentous cord insertion, placental growth restriction and placental perfusion defects. This membrane complication is associated with increased incidence of fetal malformations in the absence of identifiable genetic etiologies.
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Affiliation(s)
- Kristin D Gerson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan L Hecht
- Department Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Brett C Young
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
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Barnard ME, Hecht JL, Rice MS, Gupta M, Harris HR, Eliassen AH, Rosner BA, Terry KL, Tworoger SS. Anti-Inflammatory Drug Use and Ovarian Cancer Risk by COX1/COX2 Expression and Infiltration of Tumor-Associated Macrophages. Cancer Epidemiol Biomarkers Prev 2018; 27:1509-1517. [PMID: 30377203 DOI: 10.1158/1055-9965.epi-18-0346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/16/2018] [Accepted: 08/20/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drug (NSAID) use may affect ovarian cancer risk via prostaglandin synthesis and tumor-associated macrophage (TAM) infiltration. We evaluated if associations between aspirin or non-aspirin NSAID use and ovarian cancer risk differed by tumor expression of prostaglandin-related (COX1, COX2) and TAM-related (CD68, CD163) markers. METHODS We evaluated cases and matched controls from the Nurses' Health Study (NHS), NHSII, and New England Case-Control Study (NECC). Cases with IHC data on COX1 and COX2 (n = 532) or CD68 and CD163 (n = 530) were included. We used polytomous logistic regression, adjusted for ovarian cancer risk factors, to estimate OR for NSAID use and ovarian cancer risk by marker level. RESULTS Recent aspirin use had a nonsignificant inverse association and recent non-aspirin NSAID use had no association with ovarian cancer risk. NSAID use was not differentially associated with ovarian cancer by COX1 or COX2 expression. However, recent aspirin use was associated with lower ovarian cancer risk for high [OR 0.54; 95% confidence interval (CI), 0.37-0.78], but not low (OR 1.50; 95% CI, 0.97-2.31), CD163 density (P heterogeneity < 0.001). Similar results were observed for aspirin duration and tablets and for recent non-aspirin NSAID use. Results were not clearly different by macrophage density defined by the less specific macrophage marker, CD68. CONCLUSIONS NSAID use was inversely associated with risk of ovarian cancer with high density CD163, a marker for M2-type, immunosuppressive macrophages. However, the relationship did not differ by prostaglandin synthesis markers. IMPACT Future research should explore prostaglandin-independent mechanisms for the association between NSAID use and ovarian cancer risk, including immune mechanisms.
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Affiliation(s)
- Mollie E Barnard
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Megan S Rice
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mamta Gupta
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathryn L Terry
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shelley S Tworoger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
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Ta RM, Hecht JL, Lin DI. Discordant loss of mismatch repair proteins in advanced endometrial endometrioid carcinoma compared to paired primary uterine tumors. Gynecol Oncol 2018; 151:401-406. [PMID: 30340772 DOI: 10.1016/j.ygyno.2018.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 05/21/2018] [Revised: 10/07/2018] [Accepted: 10/10/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE A subset of endometrial cancer is characterized by deficiencies in the mismatch repair (MMR) pathway. MMR testing is a well-established tool to screen for Lynch syndrome, but has also become a companion diagnostic test for immunotherapy. We compared the MMR status of primary and paired metastatic endometrial cancer to determine whether MMR deficiency can occur specifically in advanced endometrial cancer compared to primary tumor. METHODS Matched primary uterine and metastatic endometrioid adenocarcinoma from 2009 to 2018 at our institution were identified. PMS2 and MSH6 protein expression in metastatic and matched primary tumor was assessed using clinically validated immunohistochemistry methods for Lynch syndrome screening. MLH1 promoter hypermethylation and microsatellite instability (MSI) were performed in discordant cases. RESULTS 29 patients were identified with paired primary endometrial endometrioid adenocarcinoma and metastasis or recurrence after the original hysterectomy. Fourteen of 29 cases (48.2%, 14/29) were found to be MMR deficient at the metastatic or recurrent site. Two patients (6.9%, 2/29) showed discordant MMR status with PMS2 protein loss at the metastatic sites and intact expression in the primary uterine tumors. Both discordant cases exhibited abnormal subclonal loss at primary site and MLH1 promoter hypermethylation. High levels of microsatellite instability (MSI-H) was confirmed in one discordant metastatic site. CONCLUSION Advanced endometrial cancer can rarely (~7%) show somatic loss of MMR protein expression in recurrent or metastatic sites compared to matched paired primary tumor. MMR testing of recurrent or metastasis should be considered for guiding immunotherapy if primary uterine tumor exhibits abnormal subclonal MMR loss.
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Affiliation(s)
- Robert M Ta
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America
| | - Jonathan L Hecht
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America
| | - Douglas I Lin
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America.
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45
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Smith RS, Kenny CJ, Ganesh V, Jang A, Borges-Monroy R, Partlow JN, Hill RS, Shin T, Chen AY, Doan RN, Anttonen AK, Ignatius J, Medne L, Bönnemann CG, Hecht JL, Salonen O, Barkovich AJ, Poduri A, Wilke M, de Wit MCY, Mancini GMS, Sztriha L, Im K, Amrom D, Andermann E, Paetau R, Lehesjoki AE, Walsh CA, Lehtinen MK. Sodium Channel SCN3A (Na V1.3) Regulation of Human Cerebral Cortical Folding and Oral Motor Development. Neuron 2018; 99:905-913.e7. [PMID: 30146301 DOI: 10.1016/j.neuron.2018.07.052] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/05/2018] [Accepted: 07/30/2018] [Indexed: 12/29/2022]
Abstract
Channelopathies are disorders caused by abnormal ion channel function in differentiated excitable tissues. We discovered a unique neurodevelopmental channelopathy resulting from pathogenic variants in SCN3A, a gene encoding the voltage-gated sodium channel NaV1.3. Pathogenic NaV1.3 channels showed altered biophysical properties including increased persistent current. Remarkably, affected individuals showed disrupted folding (polymicrogyria) of the perisylvian cortex of the brain but did not typically exhibit epilepsy; they presented with prominent speech and oral motor dysfunction, implicating SCN3A in prenatal development of human cortical language areas. The development of this disorder parallels SCN3A expression, which we observed to be highest early in fetal cortical development in progenitor cells of the outer subventricular zone and cortical plate neurons and decreased postnatally, when SCN1A (NaV1.1) expression increased. Disrupted cerebral cortical folding and neuronal migration were recapitulated in ferrets expressing the mutant channel, underscoring the unexpected role of SCN3A in progenitor cells and migrating neurons.
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Affiliation(s)
- Richard S Smith
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Connor J Kenny
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Vijay Ganesh
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ahram Jang
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Rebeca Borges-Monroy
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jennifer N Partlow
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - R Sean Hill
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Taehwan Shin
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Allen Y Chen
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ryan N Doan
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Anna-Kaisa Anttonen
- The Folkhälsan Institute of Genetics, 00290 Helsinki, Finland; Medical and Clinical Genetics, Neuroscience Center and Research Programs Unit, Molecular Neurology, 00014, University of Helsinki, Helsinki, Finland
| | - Jaakko Ignatius
- Department of Clinical Genetics, Turku University Hospital, Turku, 20521, Finland
| | - Livija Medne
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Carsten G Bönnemann
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Oili Salonen
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, 00029 HUS, Helsinki, Finland
| | - A James Barkovich
- Benioff Children's Hospital, Departments of Radiology, Pediatrics, Neurology, and Neurological Surgery, University of California San Francisco, San Francisco, CA 94117, USA
| | - Annapurna Poduri
- Department of Neurology, Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Martina Wilke
- Department of Clinical Genetics, Erasmus MC Rotterdam 3015CN, Netherlands
| | - Marie Claire Y de Wit
- Neurogenetics Joint Clinic in Sophia Children's Hospital, Erasmus MC Rotterdam 3015CN, Netherlands
| | - Grazia M S Mancini
- Department of Clinical Genetics, Erasmus MC Rotterdam 3015CN, Netherlands
| | - Laszlo Sztriha
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Kiho Im
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Dina Amrom
- Neurogenetics Unit and Epilepsy Research Group, Montreal Neurological Institute and Hospital; and the Departments of Neurology & Neurosurgery and Human Genetics, McGill University, Montreal, QC H3A 2B4, Canada
| | - Eva Andermann
- Neurogenetics Unit and Epilepsy Research Group, Montreal Neurological Institute and Hospital; and the Departments of Neurology & Neurosurgery and Human Genetics, McGill University, Montreal, QC H3A 2B4, Canada
| | - Ritva Paetau
- Children's Hospital, University of Helsinki and Helsinki University Hospital, 00029 HUS, Helsinki, Finland
| | - Anna-Elina Lehesjoki
- The Folkhälsan Institute of Genetics, 00290 Helsinki, Finland; Medical and Clinical Genetics, Neuroscience Center and Research Programs Unit, Molecular Neurology, 00014, University of Helsinki, Helsinki, Finland
| | - Christopher A Walsh
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, and Howard Hughes Medical Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Maria K Lehtinen
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA.
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Burris HH, Just AC, Haviland MJ, Neo DT, Baccarelli AA, Dereix AE, Brennan KJ, Rodosthenous RS, Ralston SJ, Hecht JL, Hacker MR. Long noncoding RNA expression in the cervix mid-pregnancy is associated with the length of gestation at delivery. Epigenetics 2018; 13:742-750. [PMID: 30045669 DOI: 10.1080/15592294.2018.1503490] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/12/2022] Open
Abstract
Infants born preterm are at increased risk of multiple morbidities and mortality. Why some women deliver preterm remains poorly understood. Prior studies have shown that cervical microRNA expression and DNA methylation are associated with the length of gestation. However, no study has examined the role of long noncoding RNAs (lncRNAs) in the cervix during pregnancy. To determine whether expression of lncRNAs is associated with length of gestation at delivery, we analyzed RNA from cervical swabs obtained from 78 women during pregnancy (mean 15.5, SD 5.0, weeks of gestation) who were participating in the Spontaneous Prematurity and Epigenetics of the Cervix (SPEC) Study in Boston, MA, USA. We used a PCR-based platform and found that 9 lncRNAs were expressed in at least 50% of the participants. Of these, a doubling of the expression of TUG1, TINCR, and FALEC was associated with shorter lengths of gestation at delivery [2.8 (95% CI: 0.31, 5.2); 3.3 (0.22, 6.3); and 4.5 (7.3, 1.6) days shorter respectively]. Of the lncRNAs analyzed, none was statistically associated with preterm birth, but expression of FALEC was 2.6-fold higher in women who delivered preterm vs. term (P = 0.051). These findings demonstrate that lncRNAs can be measured in cervical samples obtained during pregnancy and are associated with subsequent length of gestation at delivery. Further, this study supports future work to replicate these findings in other cohorts and perform mechanistic studies to determine the role of lncRNAs in the cervix during pregnancy.
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Affiliation(s)
- Heather H Burris
- a Department of Neonatology, Beth Israel Deaconess Medical Center, Department of Pediatrics , Harvard Medical School , Boston , MA , USA.,b Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston , MA , USA.,c Department of Environmental Health , Harvard TH Chan School of Public Health , Boston , MA , USA.,d Department of Pediatrics , Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Allan C Just
- e Department of Environmental Medicine & Public Health , Icahn School of Medicine at Mount Sinai , NY , NY , USA
| | - Miriam J Haviland
- b Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston , MA , USA
| | - Dayna T Neo
- b Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston , MA , USA
| | - Andrea A Baccarelli
- f Department of Environmental Health Sciences , Columbia University Mailman School of Public Health , NY , NY , USA
| | - Alexandra E Dereix
- f Department of Environmental Health Sciences , Columbia University Mailman School of Public Health , NY , NY , USA
| | - Kasey J Brennan
- f Department of Environmental Health Sciences , Columbia University Mailman School of Public Health , NY , NY , USA
| | - Rodosthenis S Rodosthenous
- g Cardiology Division, Department of Medicine , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Steven J Ralston
- h Department of Obstetrics and Gynecology , Pennsylvania Hospital, University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Jonathan L Hecht
- i Department of Pathology, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston , MA , USA
| | - Michele R Hacker
- b Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston , MA , USA.,j Department of Epidemiology , Harvard TH Chan School of Public Health , Boston , MA , USA
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Martinot AJ, Abbink P, Afacan O, Prohl AK, Bronson R, Hecht JL, Borducchi EN, Larocca RA, Peterson RL, Rinaldi W, Ferguson M, Didier PJ, Weiss D, Lewis MG, De La Barrera RA, Yang E, Warfield SK, Barouch DH. Fetal Neuropathology in Zika Virus-Infected Pregnant Female Rhesus Monkeys. Cell 2018; 173:1111-1122.e10. [PMID: 29606355 DOI: 10.1016/j.cell.2018.03.019] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [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: 12/25/2017] [Revised: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 01/13/2023]
Abstract
The development of interventions to prevent congenital Zika syndrome (CZS) has been limited by the lack of an established nonhuman primate model. Here we show that infection of female rhesus monkeys early in pregnancy with Zika virus (ZIKV) recapitulates many features of CZS in humans. We infected 9 pregnant monkeys with ZIKV, 6 early in pregnancy (weeks 6-7 of gestation) and 3 later in pregnancy (weeks 12-14 of gestation), and compared findings with uninfected controls. 100% (6 of 6) of monkeys infected early in pregnancy exhibited prolonged maternal viremia and fetal neuropathology, including fetal loss, smaller brain size, and histopathologic brain lesions, including microcalcifications, hemorrhage, necrosis, vasculitis, gliosis, and apoptosis of neuroprogenitor cells. High-resolution MRI demonstrated concordant lesions indicative of deep gray matter injury. We also observed spinal, ocular, and neuromuscular pathology. Our data show that vascular compromise and neuroprogenitor cell dysfunction are hallmarks of CZS pathogenesis, suggesting novel strategies to prevent and to treat this disease.
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Affiliation(s)
- Amanda J Martinot
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Peter Abbink
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Onur Afacan
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Anna K Prohl
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Jonathan L Hecht
- Division of Anatomic Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Erica N Borducchi
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Rafael A Larocca
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Rebecca L Peterson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | | | - Peter J Didier
- Tulane National Primate Research Center, Tulane University, Covington, LA 70433, USA
| | | | | | | | - Edward Yang
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Simon K Warfield
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA.
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48
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Buitrago DH, Pinto D, Berkowitz SJ, Laham RJ, Hecht JL, Kent MS. Fatal Hemoptysis After Closure of Gastrobronchial Fistula Using an Amplatzer Vascular Device. Ann Thorac Surg 2018; 105:e71-e73. [DOI: 10.1016/j.athoracsur.2017.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/04/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
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49
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Fadare O, Roma AA, Desouki MM, Gwin K, Hanley KZ, Jarboe EA, Liang SX, Quick CM, Zheng W, Hecht JL, Parkash V, Wang XJ. The significance of L1CAM expression in clear cell carcinoma of the endometrium. Histopathology 2017; 72:532-538. [PMID: 28941294 DOI: 10.1111/his.13405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Oluwole Fadare
- Department of Pathology, University of California, San Diego, CA, USA
| | - Andres A Roma
- Department of Pathology, University of California, San Diego, CA, USA
| | - Mohamed M Desouki
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Katja Gwin
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Krisztina Z Hanley
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Elke A Jarboe
- Department of Pathology, ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sharon X Liang
- Department of Pathology and Laboratory Medicine, Hofstra-Northwell School of Medicine, Lake Success, NY, USA
| | - Charles M Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vinita Parkash
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Xuan J Wang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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50
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Harris HR, Rice MS, Shafrir AL, Poole EM, Gupta M, Hecht JL, Terry KL, Tworoger SS. Lifestyle and Reproductive Factors and Ovarian Cancer Risk by p53 and MAPK Expression. Cancer Epidemiol Biomarkers Prev 2017; 27:96-102. [PMID: 29133366 DOI: 10.1158/1055-9965.epi-17-0609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/13/2017] [Accepted: 10/09/2017] [Indexed: 11/16/2022] Open
Abstract
Background: One model of ovarian cancer development model divides tumors into two types. Type I tumors are characterized by KRAS and BRAF mutations, which can activate mitogen-activated protein kinase (MAPK). Type II tumors are characterized by tubal precursor lesions with p53 mutations. We evaluated the association between lifestyle and reproductive factors and risk of ovarian cancer defined by p53 and MAPK expression.Methods: Epithelial ovarian cancer cases (n = 274) and controls (n = 1,907) were identified from the Nurses' Health Study and Nurses' Health Study II prospective cohorts, and the population-based New England Case-Control study. Reproductive and lifestyle exposures were assessed by questionnaire/interview. We performed immunohistochemical assays for p53 and MAPK expression. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using polytomous logistic regression.Results: Parity was associated with a decreased risk of p53 wild-type tumors (OR = 0.31; 95% CI, 0.18-0.55), but not p53-mutant tumors (OR = 0.92; 95% CI, 0.54-1.59)(Pheterogeneity < 0.01). Family history of breast or ovarian cancer was associated with risk of MAPK-negative (OR = 2.06; 95% CI, 1.39-3.06), but not MAPK-positive tumors (OR = 0.74; 95% CI, 0.43-1.27; Pheterogeneity< 0.01). In cross-classified analyses, family history of breast or ovarian cancer was most strongly associated with p53-mutant/MAPK-negative tumors (OR = 2.33; 95% CI, 1.44-3.75). Differences by MAPK expression were also observed for estrogen plus progesterone hormone therapy use (Pheterogeneity = 0.03).Conclusions: These findings provide evidence that parity, family history, and estrogen plus progesterone hormone therapy use may be differentially associated with tumor subtypes defined by p53 and MAPK expression.Impact: In future studies, other immunohistochemical markers or gene expression profiles that more clearly define these subtypes should be considered. Cancer Epidemiol Biomarkers Prev; 27(1); 96-102. ©2017 AACR.
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Affiliation(s)
- Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. .,Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Megan S Rice
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amy L Shafrir
- Boston Center for Endometriosis, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth M Poole
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mamta Gupta
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shelley S Tworoger
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida
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