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Karmally S, Pancholy B, Lau R, Raparia K, Pursnani S. IgG4-related disease: Coronary arteritis masquerading as coronary "masses". J Cardiovasc Comput Tomogr 2022; 16:e29-e30. [PMID: 35027285 DOI: 10.1016/j.jcct.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Richard Lau
- Kaiser Permanente, Santa Clara, California, USA.
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Raparia K, Raj R. Tissue Continues to Be the Issue: Role of Histopathology in the Context of Recent Updates in the Radiologic Classification of Interstitial Lung Diseases. Arch Pathol Lab Med 2019; 143:30-33. [PMID: 30785335 DOI: 10.5858/arpa.2018-0134-ra] [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: 11/06/2022]
Abstract
CONTEXT.— High-resolution computed tomography (HRCT) imaging has an increasingly important role in clinical decision-making in patients with interstitial lung diseases. The recent Fleischner Society white paper on the diagnostic criteria for idiopathic pulmonary fibrosis highlights the advances in our understanding of HRCT imaging in interstitial lung diseases. OBJECTIVE.— To discuss the evidence and recommendations outlined in the white paper as it pertains to the radiologic diagnosis of interstitial lung disease, specifically highlighting the current limitations of HRCT in confidently predicting histopathologic findings. DATA SOURCES.— The recent Fleischner Society white paper and other studies pertaining to the role of HRCT in predicting histopathology in interstitial lung diseases are reviewed. CONCLUSIONS.— High-resolution computed tomography is highly predictive of a usual interstitial pneumonia (UIP) pattern on histopathology when the HRCT shows a typical UIP pattern on a "confident" read by the radiologist. A probable UIP pattern is also very predictive of a UIP pattern on histopathology, and histopathologic confirmation is not needed for most patients demonstrating this pattern in the appropriate clinical setting. A UIP pattern may be seen in a substantial proportion of patients with an "indeterminate UIP" pattern on HRCT and in many patients for whom the HRCT suggests an alternative diagnosis; histopathologic confirmation should be considered in patients demonstrating these patterns whenever feasible.
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Affiliation(s)
- Kirtee Raparia
- From the Department of Pathology, Kaiser Permanente Santa Clara, Santa Clara, California (Dr Raparia); and the Department of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, California (Dr Raj)
| | - Rishi Raj
- From the Department of Pathology, Kaiser Permanente Santa Clara, Santa Clara, California (Dr Raparia); and the Department of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, California (Dr Raj)
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Xie P, Kondeti VK, Lin S, Haruna Y, Raparia K, Kanwar YS. Withdrawal: Role of extracellular matrix renal tubulo-interstitial nephritis antigen (TINag) in cell survival utilizing integrin αvβ3/focal adhesion kinase (FAK)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B-serine/threonine kinase (AKT) signaling pathway. J Biol Chem 2019; 294:10379. [PMID: 31253687 DOI: 10.1074/jbc.w119.009585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Monroig-Bosque PDC, Morales-Rosado JA, Roden AC, Churg A, Barrios R, Cagle P, Ge Y, Allen TC, Smith ML, Larsen BT, Sholl LM, Beasley MB, Borczuk A, Raparia K, Ayala A, Tazelaar HD, Miller R, Kalhor N, Moran CA, Ro JY. Micropapillary adenocarcinoma of lung: Morphological criteria and diagnostic reproducibility among pulmonary pathologists. Ann Diagn Pathol 2019; 41:43-50. [PMID: 31132651 DOI: 10.1016/j.anndiagpath.2019.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 12/21/2022]
Abstract
CONTEXT Invasive micropapillary adenocarcinoma (MPC) is an aggressive variant of lung adenocarcinoma, frequently manifesting with advanced stage lymph node metastasis and decreased survival. OBJECTIVE Identification of this morphology is important, as it is strongly correlated with poor prognosis regardless of the amount of MPC component. To date, no study has investigated the morphological criteria used to objectively diagnose it. DESIGN Herein, we selected 30 cases of potential MPC of lung, and distributed 2 digital images per case among 15 pulmonary pathology experts. Reviewers were requested to diagnostically interpret, assign the percentage of MPC component, and record the morphological features they identified. The noted features included: columnar cells, elongated slender cell nests, extensive stromal retraction, lumen formation with internal epithelial tufting, epithelial signet ring-like forms, intracytoplasmic vacuolization, multiple nests in the same alveolar space, back-to-back lacunar spaces, epithelial nest anastomosis, marked pleomorphism, peripherally oriented nuclei, randomly distributed nuclei, small/medium/large tumor nest size, fibrovascular cores, and spread through air-spaces (STAS). RESULTS Cluster analysis revealed three subgroups with the following diagnoses: "MPC", "combined papillary and MPC", and "others". The subgroups correlated with the reported median percentage of MPC. Intracytoplasmic vacuolization, epithelial nest anastomosis/confluence, multiple nests in the same alveolar space, and small/medium tumor nest size were the most common criteria identified in the cases diagnosed as MPC. Peripherally oriented nuclei and epithelial signet ring-like forms were frequently identified in both the "MPC" and "combined papillary and MPC" groups. CONCLUSIONS Our study provides objective diagnostic criteria to diagnose MPC of lung.
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Affiliation(s)
- Paloma Del C Monroig-Bosque
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | | | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andrew Churg
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Roberto Barrios
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Philip Cagle
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Yimin Ge
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Timothy C Allen
- Department of Pathology, The University of Mississippi Medical Center, MS, USA
| | - Maxwell L Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Brandon T Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Lynette M Sholl
- Department of Pathology, Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary B Beasley
- Department of Anatomic Pathology, The Mount Sinai Hospital, New York, NY, USA
| | - Alain Borczuk
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - Kirtee Raparia
- Kaiser Permanente, Santa Clara Medical Center and Medical Offices, Santa Clara, CA, USA
| | - Alberto Ayala
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | | | - Ross Miller
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Neda Kalhor
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cesar A Moran
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA; Health Sciences Research Department, Mayo Clinic, Rochester, MN, USA
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA.
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Raparia K. Current Issues in Surgical, Hematologic, and Cytologic Pathology. Arch Pathol Lab Med 2018; 142:1509-1510. [PMID: 30500274 DOI: 10.5858/arpa.2018-0383-ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kirtee Raparia
- From the Department of Pathology, Kaiser Santa Clara Medical Center, Santa Clara, California
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Behdad A, Zhou XY, Gao J, Raparia K, Dittman D, Green SJ, Qi C, Betz B, Bryar P, Chen Q, Chen YH. High Frequency of MYD88 L265P Mutation in Primary Ocular Adnexal Marginal Zone Lymphoma and Its Clinicopathologic Correlation: A Study From a Single Institution. Arch Pathol Lab Med 2018; 143:483-493. [PMID: 30444439 DOI: 10.5858/arpa.2018-0092-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The pathogenesis of primary ocular adnexal marginal zone lymphoma (POAMZL) remains unclear. The reported associations with Chlamydia psittaci infection and MYD88 mutations are highly variable. OBJECTIVE.— To examine MYD88 L265P mutation in ocular marginal zone lymphomas and correlate with clinicopathologic features and Chlamydia infection. DESIGN.— Presence of MYD88 L265P mutation and Chlamydia infection in lymphoma was analyzed by using sensitive polymerase chain reaction (PCR) methods. RESULTS.— The MYD88 L265P mutation was identified in 8 of 22 POAMZLs (36%), including 2 of 3 cases in which PCR failed to detect clonal IGH gene rearrangement; none of the 4 secondary marginal zone lymphomas were positive. Test results for Chlamydia were negative in all cases. Patients with and without the MYD88 mutation had similar clinicopathologic features. CONCLUSIONS.— The MYD88 mutational analysis provides important information in diagnostic workup of POAMZL. The frequent MYD88 mutation suggests a critical role of this aberration in the pathogenesis of POAMZL and may serve as a therapeutic target for patients with progressive disease.
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Affiliation(s)
- Amir Behdad
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - Xiao Yi Zhou
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - Juehua Gao
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - Kirtee Raparia
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - David Dittman
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - Stefan J Green
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - Chao Qi
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - Bryan Betz
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - Paul Bryar
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - Qing Chen
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
| | - Yi-Hua Chen
- From the Departments of Pathology (Drs Behdad, Gao, and Raparia; Mr Dittman; Drs Qi, Q Chen, and Y-H Chen) and Ophthalmology (Dr Bryar), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wayne State University School of Medicine, Detroit, Michigan (Dr Zhou); Research Resources Center, University of Illinois at Chicago, Chicago (Dr Green); Department of Pathology, University of Michigan, Ann Arbor (Dr Betz). Dr Zhou is currently at the Department of Ophthalmology, Bascom-Palmer Eye Institute, Miami, Florida. Dr Raparia is currently at the Department of Pathology, Kaiser Permanente, Santa Clara, California
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Chae YK, Davis AA, Raparia K, Agte S, Pan A, Mohindra N, Villaflor V, Giles F. Association of Tumor Mutational Burden With DNA Repair Mutations and Response to Anti-PD-1/PD-L1 Therapy in Non-Small-Cell Lung Cancer. Clin Lung Cancer 2018; 20:88-96.e6. [PMID: 30425022 DOI: 10.1016/j.cllc.2018.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [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: 02/24/2018] [Revised: 08/20/2018] [Accepted: 09/15/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To examine clinical predictors of tumor mutational burden (TMB), to explore the association between TMB and DNA repair mutations, and to analyze TMB as a biomarker for response to immune checkpoint blockade in non-small-cell lung cancer. PATIENTS AND METHODS TMB scores were determined retrospectively for 72 consecutive patients at our institution with next-generation sequencing comprehensive genomic profiling testing by Foundation Medicine. TMB scores were correlated with a number of clinical variables and presence of DNA repair mutations. Thirty-four patients were treated with anti-programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1) therapies, and survival analyses based on TMB score were performed. In addition, tissue immunohistochemical analysis was performed for a subset of patients. RESULTS History of smoking, but not other clinical variables, including prior treatment lines, stage of disease, and number of metastatic sites, predicted higher TMB score. Higher TMB score was significantly associated with greater number of DNA repair mutations. In the subset of patients treated with immune checkpoint blockade, higher TMB score significantly predicted overall survival, but not progression-free survival (hazard ratio = 0.10, P = .003; hazard ratio 1.1, P = .84, respectively). In a small subset of patients, PD-1/PD-L1 staining did not independently predict progression-free survival or overall survival. CONCLUSION Tissue TMB was significantly associated with smoking history and number of DNA repair mutations. TMB is a promising biomarker for response to anti-PD-1/PD-L1 therapy, with higher TMB score predicting longer overall survival.
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Affiliation(s)
- Young Kwang Chae
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.
| | - Andrew A Davis
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kirtee Raparia
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sarita Agte
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Alan Pan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nisha Mohindra
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Victoria Villaflor
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Francis Giles
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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Abstract
CONTEXT.— Rhinoscleroma is a rare, chronic, infectious granulomatous process involving the upper respiratory tract caused by gram-negative bacilli, Klebsiella rhinoscleromatis. The site most commonly affected is the nasopharynx; however, lesions in various other locations have been described. OBJECTIVE.— To review the literature for all the reported cases of rhinoscleroma in the past 5 years. DATA SOURCES.— Published cases of rhinoscleroma from a PubMed (National Center for Biotechnology Information, Bethesda, Maryland) search were reviewed. CONCLUSIONS.— Rhinoscleroma in nonendemic regions is extremely rare; however, with increased travel, immigration, and globalization, it is imperative to recognize this entity because the symptoms can be devastating and in some cases fatal. Although nasopharynx is the common site of involvement, unusual sites such as the trachea can be involved in rare cases. Rhinoscleroma can be managed effectively with a combination of antibiotics and surgical debridement and repair; however, recurrence rates do remain high.
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Affiliation(s)
- Brandon Umphress
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Umphress); and the Department of Pathology, Kaiser Permanente Santa Clara, California (Dr Raparia)
| | - Kirtee Raparia
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Umphress); and the Department of Pathology, Kaiser Permanente Santa Clara, California (Dr Raparia)
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Bhattacharyya S, Wang W, Qin W, Cheng K, Coulup S, Chavez S, Jiang S, Raparia K, De Almeida LMV, Stehlik C, Tamaki Z, Yin H, Varga J. TLR4-dependent fibroblast activation drives persistent organ fibrosis in skin and lung. JCI Insight 2018; 3:98850. [PMID: 29997297 DOI: 10.1172/jci.insight.98850] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/23/2018] [Indexed: 01/01/2023] Open
Abstract
Persistent fibrosis in multiple organs is the hallmark of systemic sclerosis (SSc). Recent genetic and genomic studies implicate TLRs and their damage-associated molecular pattern (DAMP) endogenous ligands in fibrosis. To test the hypothesis that TLR4 and its coreceptor myeloid differentiation 2 (MD2) drive fibrosis persistence, we measured MD2/TLR4 signaling in tissues from patients with fibrotic SSc, and we examined the impact of MD2 targeting using a potentially novel small molecule. Levels of MD2 and TLR4, and a TLR4-responsive gene signature, were enhanced in SSc skin biopsies. We developed a small molecule that selectively blocks MD2, which is uniquely required for TLR4 signaling. Targeting MD2/TLR4 abrogated inducible and constitutive myofibroblast transformation and matrix remodeling in fibroblast monolayers, as well as in 3-D scleroderma skin equivalents and human skin explants. Moreover, the selective TLR4 inhibitor prevented organ fibrosis in several preclinical disease models and mouse strains, and it reversed preexisting fibrosis. Fibroblast-specific deletion of TLR4 in mice afforded substantial protection from skin and lung fibrosis. By comparing experimentally generated fibroblast TLR4 gene signatures with SSc skin biopsy gene expression datasets, we identified a subset of SSc patients displaying an activated TLR4 signature. Together, results from these human and mouse studies implicate MD2/TLR4-dependent fibroblast activation as a key driver of persistent organ fibrosis. The results suggest that SSc patients with high TLR4 activity might show optimal therapeutic response to selective inhibitors of MD2/TLR4 complex formation.
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Affiliation(s)
- Swati Bhattacharyya
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Wenxia Wang
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Wenyi Qin
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kui Cheng
- Department of Chemistry and Biochemistry and the BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA
| | - Sara Coulup
- Department of Chemistry and Biochemistry and the BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA
| | - Sherry Chavez
- Department of Chemistry and Biochemistry and the BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA
| | - Shuangshang Jiang
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
| | - Kirtee Raparia
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | | | - Christian Stehlik
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Zenshiro Tamaki
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hang Yin
- Department of Chemistry and Biochemistry and the BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA.,School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
| | - John Varga
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Illinois, USA
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Guo Y, Song HY, Raparia K, Vassilopoulos A. Abstract 4356: SIRT2-deacetylase activity is a potential predictive and prognostic marker in lung cancer patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4356] [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
Background: SIRT2 has been described as a tumor suppressor, whereas our previous study using an LSL-KRASG12D mouse model showed that Sirt2 loss induced lung tumorigenesis in vivo through increased KRAS acetylation (K147) and activity. However, there is limited information about the clinical significance of SIRT2 expression and/or activity in lung cancer patients.
Purpose: The aim of this study was to investigate the associations between SIRT2 levels and activity with clinical-pathological characteristics and patient outcomes in lung cancer.
Materials and Methods: SIRT2 expression and activity was analyzed using a tissue microarray of 162 resected lung cancer samples from Northwestern Memorial Hospital. To assess SIRT2 expression, we used an antibody against SIRT2 for immunohistochemistry. To assess SIRT2 activity, we evaluated acetylated levels of two specific deacetylation targets, α-tubulin (K40) and KRAS (K147). For all tested markers, staining intensity of each tissue sample was scored as 0 (no signal), + 1 (weak), + 2 (distinct), + 3 (strong). The percentage of each positive staining was categorized as A (<25%), B (25~50%), C (>50%). Following statistical analysis, it was determined whether SIRT2 expression and activity were associated with several clinical parameters or outcomes. p < 0.05 was assumed statistically significant.
Results: Acetylated α-tubulin and acetylated KRAS in lung tumor samples were significantly correlated with each other (p<0.05), but not with SIRT2 expression. Of note, acetylated α-tubulin was significantly associated with TTF1 expression (p<0.05), staging (p<0.005), pleural metastasis (p<0.005), surgery (p<0.001), and chemotherapy (p<0.005). Acetylated KRAS had significant associations with surgery (p<0.005), lymph nodal status (p<0.05) and pleural metastasis (p<0.05). Kaplan-Meier analysis further indicated that both TTF1 and acetylated α-tubulin were independent predictors of patient survival (p=0.005 and p=0.028, respectively).
Conclusions: Our data implicated that SIRT2 deacetylation activity, but not SIRT2 expression levels, could represent an optimal predictive and prognostic factor in lung cancer. Based on this finding, strategies to increase SIRT2 activity might be favorable in clinical treatment protocols for lung cancer.
Citation Format: Yang Guo, Ha Yong Song, Kirtee Raparia, Athanassios Vassilopoulos. SIRT2-deacetylase activity is a potential predictive and prognostic marker in lung cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4356.
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Affiliation(s)
- Yang Guo
- Northwestern University, Chicago, IL
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Funkhouser WK, Hayes DN, Moore DT, Funkhouser WK, Fine JP, Jo H, Nikolaishvilli-Feinberg N, Eeva M, Grilley-Olson JE, Banks PM, Graziano P, Boswell EL, Elmberger G, Raparia K, Hart CF, Sholl LM, Nolan NJ, Fritchie KJ, Pouagare E, Allen TC, Volmar KE, Biddinger PW, Kleven DT, Papez MJ, Spencer DV, Rekhtman N, Mino-Kenudson M, Hariri L, Driver B, Cagle PT. Interpathologist Diagnostic Agreement for Non-Small Cell Lung Carcinomas Using Current and Recent Classifications. Arch Pathol Lab Med 2018; 142:1537-1548. [PMID: 29708428 DOI: 10.5858/arpa.2017-0481-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT.— Measurement of interpathologist diagnostic agreement (IPDA) should allow pathologists to improve current diagnostic criteria and disease classifications. OBJECTIVES.— To determine how IPDA for pathologists' diagnoses of non-small cell lung carcinoma (NSCLC) is affected by the addition of a set of mucin and immunohistochemical (IHC) stains to hematoxylin-eosin (H&E) alone, by recent NSCLC reclassifications, by simplification of these classifications, and by pathologists' practice location, pulmonary pathology expertise, practice duration, and lung carcinoma case exposure. DESIGN.— We used a Web-based survey to present core images of 54 NSCLC cases to 22 practicing pathologists for diagnosis, initially as H&E only, then as H&E plus mucin and 4 IHC stains. Each case was diagnosed according to published 2004, 2011, and 2015 NSCLC classifications. Cohen's kappa was calculated for the 231 pathologist pairs as a measure of IPDA. RESULTS.— Twenty-two pathologists diagnosed 54 NSCLC cases by using 4 published classifications. IPDA is significantly higher for H&E/mucin/IHC diagnoses than for H&E-only diagnoses. IPDA for H&E/mucin/IHC diagnoses is highest with the 2015 classification. IPDA is estimated higher after collapse of stated diagnoses into subhead or dichotomized classes. IPDA for H&E/mucin/IHC diagnoses with the 2015 World Health Organization classification is similar for community and academic pathologists, and is higher when pathologists have pulmonary pathology expertise, have more than 6 years of practice experience, or diagnose more than 100 new lung carcinoma cases per year. CONCLUSIONS.— Higher IPDA is associated with use of mucin and IHC stains, with the 2015 NSCLC classification, and with pathologists' pulmonary pathology expertise, practice duration, and frequency of lung carcinoma cases.
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Affiliation(s)
- William K Funkhouser
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - D Neil Hayes
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Dominic T Moore
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - W Keith Funkhouser
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Jason P Fine
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - HeeJoon Jo
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Nana Nikolaishvilli-Feinberg
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Mervi Eeva
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Juneko E Grilley-Olson
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Peter M Banks
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Paolo Graziano
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Elizabeth L Boswell
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Goran Elmberger
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Kirtee Raparia
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Craig F Hart
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Lynette M Sholl
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Norris J Nolan
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Karen J Fritchie
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Ersie Pouagare
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Timothy C Allen
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Keith E Volmar
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Paul W Biddinger
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Daniel T Kleven
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Michael J Papez
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Deborah V Spencer
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Natasha Rekhtman
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Mari Mino-Kenudson
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Lida Hariri
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Brandon Driver
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
| | - Philip T Cagle
- From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson
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12
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Zhou XY, Lu X, Raparia K, Chen YH. Isolated orbital mass as the primary presentation of a triple-hit lymphoma transformed from a systemic follicular lymphoma. Am J Ophthalmol Case Rep 2018; 10:156-158. [PMID: 29780927 PMCID: PMC5956659 DOI: 10.1016/j.ajoc.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Triple-hit lymphoma is a highly aggressive B-cell lymphoma. We report a case of triple-hit lymphoma transformed from systemic follicular lymphoma (FL) after 9-year remission and presented primarily as an isolated orbital mass without systemic symptoms or lymphadenopathy. Observations A 58-year-old female presented with intermittent vertical binocular diplopia, left upper eyelid swelling and pain and was found to have a 2.9 cm orbital mass. Histological section revealed a CD10-positive large B-cell lymphoma, consistent with transformation of FL. Fluorescent in situ hybridization (FISH) analysis demonstrated rearrangements involving C-MYC, BCL-2 and BCL-6 genes, indicating a high grade, triple-hit lymphoma. Conclusions and importance Triple-hit lymphoma transformed from a low-grade lymphoma may initially present as an isolated orbital mass without systemic evidence of transformation. Early recognition of double or triple-hit lymphomas is important since these patients require aggressive chemotherapy.
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Affiliation(s)
- Xiao Yi Zhou
- Wayne State University School of Medicine, 540 E. Canfield Ave., Detroit, MI 48201, USA
| | - Xinyan Lu
- Department of Pathology, Northwestern Memorial Hospital, 251 E. Huron, Chicago, IL 60611, USA
| | - Kirtee Raparia
- Department of Pathology, Northwestern Memorial Hospital, 251 E. Huron, Chicago, IL 60611, USA
- Department of Ophthalmology, Northwestern Memorial Hospital, 251 E. Huron, Chicago, IL 60611, USA
| | - Yi-Hua Chen
- Department of Pathology, Northwestern Memorial Hospital, 251 E. Huron, Chicago, IL 60611, USA
- Corresponding author. Department of Pathology, Northwestern Memorial Hospital, 251 E Huron, Chicago, IL 60611, USA.
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13
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Akamata K, Wei J, Bhattacharyya M, Cheresh P, Bonner MY, Arbiser JL, Raparia K, Gupta MP, Kamp DW, Varga J. SIRT3 is attenuated in systemic sclerosis skin and lungs, and its pharmacologic activation mitigates organ fibrosis. Oncotarget 2018; 7:69321-69336. [PMID: 27732568 PMCID: PMC5342480 DOI: 10.18632/oncotarget.12504] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/29/2016] [Indexed: 12/19/2022] Open
Abstract
Constitutive fibroblast activation is responsible for organ fibrosis in fibrotic disorders including systemic sclerosis (SSc), but the underlying mechanisms are not fully understood, and effective therapies are lacking. We investigated the expression of the mitochondrial deacetylase sirtuin 3 (SIRT3) and its modulation by hexafluoro, a novel fluorinated synthetic honokiol analogue, in the context of fibrosis. We find that augmenting cellular SIRT3 by forced expression in normal lung and skin fibroblasts, or by hexafluoro treatment, blocked intracellular TGF-ß signaling and fibrotic responses, and mitigated the activated phenotype of SSc fibroblasts. Moreover, hexafluoro attenuated mitochondrial and cytosolic reactive oxygen species (ROS) accumulation in TGF-β-treated fibroblasts. Remarkably, we found that the expression of SIRT3 was significantly reduced in SSc skin biopsies and explanted fibroblasts, and was suppressed by TGF-β treatment in normal fibroblasts. Moreover, tissue levels of acetylated MnSOD, a sensitive marker of reduced SIRT3 activity, were dramatically enhanced in lesional skin and lung biopsies from SSc patients. Mice treated with hexafluoro showed substantial attenuation of bleomycin-induced fibrosis in the lung and skin. Our findings reveal a cell-autonomous function for SIRT3 in modulating fibrotic responses, and demonstrate the ability of a novel pharmacological SIRT3 agonist to attenuate fibrosis in vitro and in vivo. In light of the impaired expression and activity of SIRT3 associated with organ fibrosis in SSc, pharmacological approaches for augmenting SIRT3 might have therapeutic potential.
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Affiliation(s)
- Kaname Akamata
- Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jun Wei
- Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mitra Bhattacharyya
- Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Cheresh
- Division of Pulmonary & Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Y Bonner
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jack L Arbiser
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta Veterans Administration Medical Center and Winship Cancer, Atlanta, GA, USA
| | - Kirtee Raparia
- Department of Pathology, Northwestern University, Chicago, IL, USA
| | - Mahesh P Gupta
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - David W Kamp
- Division of Pulmonary & Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA
| | - John Varga
- Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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14
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Miller R, Allen TC, Barrios RJ, Beasley MB, Burke L, Cagle PT, Capelozzi VL, Ge Y, Hariri LP, Kerr KM, Khoor A, Larsen BT, Mark EJ, Matsubara O, Mehrad M, Mino-Kenudson M, Raparia K, Roden AC, Russell P, Schneider F, Sholl LM, Smith ML. Hypersensitivity Pneumonitis A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2018; 142:120-126. [DOI: 10.5858/arpa.2017-0138-sa] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ross Miller
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Timothy Craig Allen
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Roberto J. Barrios
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Mary Beth Beasley
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Louise Burke
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Philip T. Cagle
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Vera Luiza Capelozzi
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Yimin Ge
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Lida P. Hariri
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Keith M. Kerr
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Andras Khoor
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Brandon T. Larsen
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Eugene J. Mark
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Osamu Matsubara
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Mitra Mehrad
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Mari Mino-Kenudson
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Kirtee Raparia
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Anja Christiane Roden
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Prudence Russell
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Frank Schneider
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Lynette M. Sholl
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Maxwell Lawrence Smith
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
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15
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Affiliation(s)
| | | | - Gökhan M Mutlu
- 3 Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Ankit Bharat
- 1 Department of Medicine.,4 Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
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16
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Capelozzi VL, Allen TC, Beasley MB, Cagle PT, Guinee D, Hariri LP, Husain AN, Jain D, Lantuejoul S, Larsen BT, Miller R, Mino-Kenudson M, Mehrad M, Raparia K, Roden A, Schneider F, Sholl LM, Smith ML. Molecular and Immune Biomarkers in Acute Respiratory Distress Syndrome: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2017; 141:1719-1727. [DOI: 10.5858/arpa.2017-0115-sa] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a multifactorial syndrome with high morbidity and mortality rates, characterized by deficiency in gas exchange and lung mechanics that lead to hypoxemia, dyspnea, and respiratory failure. Histologically, ARDS is characterized by an acute, exudative phase, combining diffuse alveolar damage and noncardiogenic edema, followed by a later fibroproliferative phase. Despite an enhanced understanding of ARDS pathogenesis, the capacity to predict the development of ARDS and to risk-stratify patients with the disease remains limited. Biomarkers may help to identify patients at the greatest risk of developing ARDS, to evaluate response to therapy, to predict outcome, and to improve clinical trials. The ARDS pathogenesis is presented in this article, as well as concepts and information on biomarkers that are currently used clinically or are available for laboratory use by academic and practicing pathologists and the developing and validating of new assays, focusing on the assays' major biologic roles in lung injury and/or repair and to ultimately suggest innovative, therapeutic approaches.
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17
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Chae YK, Arya A, Chiec L, Shah H, Rosenberg A, Patel S, Raparia K, Choi J, Wainwright DA, Villaflor V, Cristofanilli M, Giles F. Challenges and future of biomarker tests in the era of precision oncology: Can we rely on immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH) to select the optimal patients for matched therapy? Oncotarget 2017; 8:100863-100898. [PMID: 29246028 PMCID: PMC5725070 DOI: 10.18632/oncotarget.19809] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/13/2016] [Accepted: 04/11/2017] [Indexed: 12/22/2022] Open
Abstract
Molecular techniques have improved our understanding of the pathogenesis of cancer development. These techniques have also fueled the rational development of targeted drugs for patient populations stratified by their genetic characteristics. These novel methods have changed the classic paradigm of diagnostic pathology; among them are IHC, FISH, polymerase chain reaction (PCR) and microarray technology. IHC and FISH detection methods for human epidermal growth factor receptor-2 (HER2), epidermal growth factor receptor (EGFR) and programmed death ligand-1 (PD-L1) were recently approved by the Food and Drug Administration (FDA) as routine clinical practice for cancer patients. Here, we discuss general challenges related to the predictive power of these molecular biomarkers for targeted therapy in cancer medicine. We will also discuss the prospects of utilizing new biomarkers for fibroblast growth factor receptor (FGFR) and hepatocyte growth factor receptor (cMET/MET) targeted therapies for developing new and robust predictive biomarkers in oncology.
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Affiliation(s)
- Young Kwang Chae
- Developmental Therapeutics Program of the Division of Hematology Oncology, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ayush Arya
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Lauren Chiec
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Hiral Shah
- Developmental Therapeutics Program of the Division of Hematology Oncology, Chicago, IL, USA
| | - Ari Rosenberg
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Sandip Patel
- University of California San Diego, San Diego, CA, USA
| | - Kirtee Raparia
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jaehyuk Choi
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Derek A Wainwright
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Victoria Villaflor
- Developmental Therapeutics Program of the Division of Hematology Oncology, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Massimo Cristofanilli
- Developmental Therapeutics Program of the Division of Hematology Oncology, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Francis Giles
- Developmental Therapeutics Program of the Division of Hematology Oncology, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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18
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Poropatich K, Hernandez D, Fontanarosa J, Brown K, Woloschak G, Paintal A, Raparia K, Samant S. Peritumoral cuffing by T-cell tumor-infiltrating lymphocytes distinguishes HPV-related oropharyngeal squamous cell carcinoma from oral cavity squamous cell carcinoma. J Oral Pathol Med 2017. [PMID: 28632936 DOI: 10.1111/jop.12605] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND It is unclear why human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) has improved clinical behavior compared to HPV-negative HNSCC. We sought to better characterize the immune microenvironment of tongue cancers by examining the CD3 and CD8 TIL pattern in HPV-positive and HPV-negative tumors. METHODS Histologic sections from 40 oral tongue and oropharyngeal cases were analyzed (n=21 HPV DNA-positive, n=19 HPV DNA-negative). CD3 and CD8 T-cell immunostaining were performed on whole-slide sections to quantify tumor-infiltrating lymphocyte (TIL) density and assess its morphology. RESULTS A subset of cases (HPV-positive) displayed a unique TIL pattern consisting of circumferential peritumoral population T cells, which was absent in the HPV-negative cases. The presence of peritumoral cuffing was strongly predictive of improved recurrence-free survival compared to cases that lacked this morphologic pattern of immune infiltrate. Four HPV-positive cases lacked the pattern, including two cases with disease recurrence. CONCLUSIONS For the first time, we show an architectural pattern of immune infiltrate in HNSCC is seen exclusively in HPV-positive patients with improved recurrence-free survival and suggests an organized host immunological response contributes to disease control.
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Affiliation(s)
- Kate Poropatich
- Department of Pathology, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - David Hernandez
- Department of Otolaryngology, Feinberg Medical School, Northwestern University, Chicago, IL, USA
| | - Joel Fontanarosa
- Department of Otolaryngology, Feinberg Medical School, Northwestern University, Chicago, IL, USA
| | - Koshonna Brown
- Department of Radiation Oncology, Feinberg Medical School, Northwestern University, Chicago, IL, USA
| | - Gayle Woloschak
- Department of Radiation Oncology, Feinberg Medical School, Northwestern University, Chicago, IL, USA
| | - Ajit Paintal
- Department of Pathology, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Kirtee Raparia
- Department of Pathology, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA.,Robert H Lurie Comprehensive Cancer Center, Department of Medicine-Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandeep Samant
- Department of Otolaryngology, Feinberg Medical School, Northwestern University, Chicago, IL, USA.,Robert H Lurie Comprehensive Cancer Center, Department of Medicine-Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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19
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Thunnissen E, Allen TC, Adam J, Aisner DL, Beasley MB, Borczuk AC, Cagle PT, Capelozzi VL, Cooper W, Hariri LP, Kern I, Lantuejoul S, Miller R, Mino-Kenudson M, Radonic T, Raparia K, Rekhtman N, Roy-Chowdhuri S, Russell P, Schneider F, Sholl LM, Tsao MS, Vivero M, Yatabe Y. Immunohistochemistry of Pulmonary Biomarkers: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2017; 142:408-419. [PMID: 28686497 DOI: 10.5858/arpa.2017-0106-sa] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The use of immunohistochemistry for the determination of pulmonary carcinoma biomarkers is a well-established and powerful technique. Immunohistochemisty is readily available in pathology laboratories, is relatively easy to perform and assess, can provide clinically meaningful results very quickly, and is relatively inexpensive. Pulmonary predictive biomarkers provide results essential for timely and accurate therapeutic decision making; for patients with metastatic non-small cell lung cancer, predictive immunohistochemistry includes ALK and programmed death ligand-1 (PD-L1) (ROS1, EGFR in Europe) testing. Handling along proper methodologic lines is needed to ensure patients receive the most accurate and representative test outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yasushi Yatabe
- From the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands (Drs Thunnissen and Radonic); the Department of Pathology, The University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Gustave Roussy, Villejuif, France (Dr Adam); the Department of Pathology, University of Colorado, Aurora (Dr Aisner); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell University Medical Center, New York, New York (Dr Borczuk); the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Cagle and Miller); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of Pathology, Royal Prince Alfred Hospital, Sydney, Australia (Dr Cooper); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, University Clinic Golnik, Golnik, Slovenia (Dr Kern); the Department of Pathology, INSERM U578, CHU A Michallon, Centre Léon Bérard, Lyon, Université Joseph Fourier INSERM U 823, Institut A. Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, The University Of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, St. Vincent's Pathology, Fitzroy, Australia (Ms Russell); the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr Schneider); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Drs Sholl and Vivero); the Department of Pathology, University of Toronto, University Health Network, Toronto, Ontario, Canada (Dr Tsao); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe)
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20
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Jain D, Allen TC, Aisner DL, Beasley MB, Cagle PT, Capelozzi VL, Hariri LP, Lantuejoul S, Miller R, Mino-Kenudson M, Monaco SE, Moreira A, Raparia K, Rekhtman N, Roden AC, Roy-Chowdhuri S, da Cunha Santos G, Thunnissen E, Troncone G, Vivero M. Rapid On-Site Evaluation of Endobronchial Ultrasound–Guided Transbronchial Needle Aspirations for the Diagnosis of Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2017. [DOI: 10.5858/arpa.2017-0114-sa] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool in the field of diagnostic respiratory cytology. Rapid on-site evaluation (ROSE) of EBUS-TBNA not only has the potential to improve diagnostic yield of the procedure but also to triage samples for predictive molecular testing to guide personalized treatments for lung cancer.
Objective.—
To provide an overview of the current status of the literature regarding ROSE of EBUS-TBNA in the diagnosis of lung cancer.
Data Sources.—
An electronic literature search in PubMed and Google databases was performed using the following key words: cytology, lung cancer, on-site evaluation, rapid on-site evaluation, and ROSE EBUS-TBNA. Only articles published in English were included in this review.
Conclusions.—
Rapid on-site evaluation can ensure that the targeted lesion is being sampled and can enable appropriate specimen triage. If available, it should be used with EBUS-TBNA in the diagnosis of lung cancer because it can minimize repeat procedures for additional desired testing (ie, molecular studies). Some studies have shown that ROSE does not adversely affect the number of aspirations, total procedure time of EBUS-TBNA, or the rate of postprocedure complications; it is also helpful in providing a preliminary diagnosis that can reduce the number of additional invasive procedures, such as mediastinoscopy. As EBUS technology continues to evolve, our knowledge of the role of ROSE in EBUS-TBNA for the diagnosis of lung cancer will also continue to grow and evolve.
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21
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Poropatich K, Dittmann D, Chen YH, Raparia K, Wolniak K, Gao J. A Small Case Series of Intravascular Large B-Cell Lymphoma with Unexpected Findings: Subset of Cases with Concomitant Extravascular Central Nervous System (CNS) Involvement Mimicking Primary CNS Lymphoma. J Pathol Transl Med 2017; 51:284-291. [PMID: 28415157 PMCID: PMC5445203 DOI: 10.4132/jptm.2017.02.16] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 12/22/2022] Open
Abstract
Background Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal lymphoma with growth mainly in the lumina of vessels. We studied a small series of IVLBCL and focused on its central nervous system (CNS) involvement. Methods Searching the medical records of Northwestern Memorial Hospital, we identified five cases of IVLBCL from January 2007 to January 2015. Clinical information, hematoxylin and eosin stained histologic slides and immunohistochemistry studies were reviewed for all cases. Polymerase chain reaction (PCR) analysis for the immunoglobulin (Ig) heavy and light chain gene rearrangement was performed on all five cases. Results Three of the five cases of IVLBCL were autopsies. Patients’ age ranged from 56 to 84. CNS involvement was present in two cases—in both patients, the CNS involvement showed an extravascular pattern with confluent sheet-like formation. PCR analysis confirmed that in one case the systemic intravascular and CNS extravascular components were clonally identical. Conclusions In a small case series of IVLBCL, we observed that CNS involvement by IVLBCL often has an extravascular morphology, but is clonally identical to the intravascular counterpart by PCR analysis. As IVLBCL can have a rapidly progressing poor outcome, it should be kept in the differential diagnoses for patients presenting with lymphoma of the CNS. The presence of extravascular growth patterns in the CNS should not exclude IVLBCL as a diagnosis.
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Affiliation(s)
- Kate Poropatich
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dave Dittmann
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yi-Hua Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kirtee Raparia
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristy Wolniak
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Juehua Gao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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22
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Fernandez R, Chiu S, Raparia K, Garcha P, Farver C, Budev M, Tambur AR, DeCamp MM, Budinger S, Perlman H, Mohanakumar T, Bharat A. Humoral Human Lung Allograft Rejection by Tissue-Restricted Non-HLA Antibodies. Ann Thorac Surg 2017; 102:e339-41. [PMID: 27645977 DOI: 10.1016/j.athoracsur.2016.03.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/11/2016] [Accepted: 03/14/2016] [Indexed: 02/08/2023]
Abstract
A third of lung recipients have preexisting antibodies against nonhuman leukocyte self-antigens (nHAbs) present in the lung tissue. These nHAbs also form de novo in about 70% of patients within 3 years after transplantation. Both preexisting and de novo nHAbs can cause murine lung allograft dysfunction. However, their role in human transplantation remains unclear. We report hyperacute rejection after right lung transplant in a recipient with preexisting nHAbs. The recipient of the left lung from the same donor had an uneventful initial course, but de novo nHAbs developed at 3 weeks, leading to acute humoral rejection. Both patients were successfully treated with antibody-directed therapies.
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Affiliation(s)
- Ramiro Fernandez
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen Chiu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kirtee Raparia
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Marie Budev
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - Anat R Tambur
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Malcolm M DeCamp
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Scott Budinger
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Harris Perlman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - T Mohanakumar
- Washington University School of Medicine, Saint Louis, Missouri
| | - Ankit Bharat
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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23
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Abstract
Thrombus associated with peripherally inserted central catheterization is not uncommon. Treatment is typically conservative; however, more aggressive therapies can be considered in patients with tenuous medical condition. The authors present a patient with metastatic hepatocellular carcinoma masquerading as peripherally inserted central catheter-associated intra-atrial thrombus, subsequently removed via vacuum-assisted mechanical thrombectomy.
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Affiliation(s)
- Samir Abboud
- Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois, USA.
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24
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Roden AC, Aisner DL, Allen TC, Aubry MC, Barrios RJ, Beasley MB, Cagle PT, Capelozzi VL, Dacic S, Ge Y, Hariri LP, Lantuejoul S, Miller RA, Mino-Kenudson M, Moreira AL, Raparia K, Rekhtman N, Sholl L, Smith ML, Tsao MS, Vivero M, Yatabe Y, Yi ES. Diagnosis of Acute Cellular Rejection and Antibody-Mediated Rejection on Lung Transplant Biopsies: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2016; 141:437-444. [DOI: 10.5858/arpa.2016-0459-sa] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
The diagnosis and grading of acute cellular and antibody-mediated rejection (AMR) in lung allograft biopsies is important because rejection can lead to acute graft dysfunction and/or failure and may contribute to chronic graft failure. While acute cellular rejection is well defined histologically, no reproducible specific features of AMR are currently identified. Therefore, a combination of clinical features, serology, histopathology, and immunologic findings is suggested for the diagnosis of AMR.
Objective.—
To describe the perspective of members of the Pulmonary Pathology Society (PPS) on the workup of lung allograft transbronchial biopsy and the diagnosis of acute cellular rejection and AMR in lung transplant.
Data Sources.—
Reports by the International Society for Heart and Lung Transplantation (ISHLT), experience of members of PPS who routinely review lung allograft biopsies, and search of literature database (PubMed).
Conclusions.—
Acute cellular rejection should be assessed and graded according to the 2007 working formulation of the ISHLT. As currently no specific features are known for AMR in lung allografts, the triple test (clinical allograft dysfunction, donor-specific antibodies, pathologic findings) should be used for its diagnosis. C4d staining might be performed when morphologic, clinical, and/or serologic features suggestive of AMR are identified.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eunhee S. Yi
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota (Drs Roden, Aubry, and Yi); the Department of Pathology, University of Colorado, Denver (Dr Aisner); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology and Genomic Medicine, Methodist Hospital, Houston, Texas (Drs Barrios, Cagle, Ge,
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25
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Mehta C, Raparia K, Bharat A. Fatty Tumor Compressing the Heart. JAMA Surg 2016; 151:1081-1082. [PMID: 27652588 DOI: 10.1001/jamasurg.2016.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher Mehta
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kirtee Raparia
- Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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26
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Sirajuddin A, Raparia K, Lewis VA, Franks TJ, Dhand S, Galvin JR, White CS. Primary Pulmonary Lymphoid Lesions: Radiologic and Pathologic Findings. Radiographics 2016; 36:53-70. [PMID: 26761531 DOI: 10.1148/rg.2016140339] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The pulmonary lymphoid system is complex and is composed of two compartments: the pulmonary lymphatics and the bronchus-associated lymphoid tissue (BALT). Additional important cells that function in the pulmonary lymphoid system include dendritic cells, Langherhans cells, macrophages, and plasma cells. An appreciation of the normal lymphoid anatomy of the lung as well as its immunology is helpful in understanding the radiologic and pathologic findings of the primary pulmonary lymphoid lesions. Primary lymphoid lesions of the lung arise from the BALT and are uncommon. However, they are increasingly recognized within the growing number of posttransplant patients as well as other patients who are receiving immunosuppressive therapies. Primary lymphoid lesions encompass a wide range of benign and malignant lesions. Benign lymphoid lesions of the lung include reactive lymphoid hyperplasia, follicular bronchiolitis, lymphoid interstitial pneumonia, and nodular lymphoid hyperplasia. Malignant lymphoid lesions of the lung include low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), other non-Hodgkin lymphomas, and Hodgkin lymphoma. Last, a miscellaneous group of primary lymphoid lesions includes lymphomatoid granulomatosis, posttransplant lymphoproliferative disorders, acquired immunodeficiency syndrome (AIDS)-related lymphoma, and intravascular lymphoma/lymphomatosis. These lesions are best evaluated with multidetector chest computed tomography. The radiologic findings of the primary lymphoid lesions are often nonspecific and are best interpreted in correlation with clinical data and pathologic findings. The purpose of this article is to review pulmonary lymphoid anatomy as well as the most common primary pulmonary lymphoid disorders.
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Affiliation(s)
- Arlene Sirajuddin
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Kirtee Raparia
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Vanessa A Lewis
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Teri J Franks
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Sabeen Dhand
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Jeffrey R Galvin
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Charles S White
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
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27
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Raparia K, Aisner DL, Allen TC, Beasley MB, Borczuk A, Cagle PT, Capelozzi V, Dacic S, Hariri LP, Kerr KM, Lantuejoul S, Mino-Kenudson M, Rekhtman N, Roden AC, Roy-Chowdhuri S, Sholl L, Smith ML, Thunnissen E, Tsao MS, Yatabe Y. Transbronchial Lung Cryobiopsy for Interstitial Lung Disease Diagnosis: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2016; 140:1281-1284. [PMID: 27441784 DOI: 10.5858/arpa.2016-0258-sa] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transbronchial lung cryobiopsy involves using a cryoprobe rather than forceps to obtain a bronchoscopic biopsy. Recent studies have shown that transbronchial cryobiopsy provides a larger specimen than conventional transbronchial forceps biopsy, and that the interobserver agreement in the interpretation of cryobiopsy specimens is comparable to that of a surgical lung biopsy. This is encouraging, and transbronchial lung cryobiopsy clearly has a role in the workup and diagnosis of interstitial lung diseases. However, very few patients who have been studied underwent both transbronchial lung cryobiopsy and surgical lung biopsy, and the available data suggest that the diagnostic accuracy of cryobiopsy may not be similar to that of surgical lung biopsy. Further study is needed before transbronchial lung biopsy can be recommended as a replacement for surgical lung biopsy.
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Bhattacharyya S, Wang W, Morales-Nebreda L, Feng G, Wu M, Zhou X, Lafyatis R, Lee J, Hinchcliff M, Feghali-Bostwick C, Lakota K, Budinger GRS, Raparia K, Tamaki Z, Varga J. Tenascin-C drives persistence of organ fibrosis. Nat Commun 2016; 7:11703. [PMID: 27256716 PMCID: PMC4895803 DOI: 10.1038/ncomms11703] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 04/20/2016] [Indexed: 02/07/2023] Open
Abstract
The factors responsible for maintaining persistent organ fibrosis in systemic sclerosis (SSc) are not known but emerging evidence implicates toll-like receptors (TLRs) in the pathogenesis of SSc. Here we show the expression, mechanism of action and pathogenic role of endogenous TLR activators in skin from patients with SSc, skin fibroblasts, and in mouse models of organ fibrosis. Levels of tenascin-C are elevated in SSc skin biopsy samples, and serum and SSc fibroblasts, and in fibrotic skin tissues from mice. Exogenous tenascin-C stimulates collagen gene expression and myofibroblast transformation via TLR4 signalling. Mice lacking tenascin-C show attenuation of skin and lung fibrosis, and accelerated fibrosis resolution. These results identify tenascin-C as an endogenous danger signal that is upregulated in SSc and drives TLR4-dependent fibroblast activation, and by its persistence impedes fibrosis resolution. Disrupting this fibrosis amplification loop might be a viable strategy for the treatment of SSc.
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Affiliation(s)
- Swati Bhattacharyya
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Wenxia Wang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | | | - Gang Feng
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Minghua Wu
- University of Texas Medical School at Houston, Houston, Texas 77030, USA
| | - Xiaodong Zhou
- University of Texas Medical School at Houston, Houston, Texas 77030, USA
| | - Robert Lafyatis
- Boston University School of Medicine, Boston, Massachusetts 02215, USA
| | - Jungwha Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Monique Hinchcliff
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | | | - Katja Lakota
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - G. R. Scott Budinger
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Kirtee Raparia
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Zenshiro Tamaki
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - John Varga
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Sholl LM, Aisner DL, Allen TC, Beasley MB, Cagle PT, Capelozzi VL, Dacic S, Hariri LP, Kerr KM, Lantuejoul S, Mino-Kenudson M, Raparia K, Rekhtman N, Roy-Chowdhuri S, Thunnissen E, Tsao M, Vivero M, Yatabe Y. Liquid Biopsy in Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2016; 140:825-9. [PMID: 27195432 DOI: 10.5858/arpa.2016-0163-sa] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Liquid biopsy has received extensive media coverage and has been called the holy grail of cancer detection. Attempts at circulating tumor cell and genetic material capture have been progressing for several years, and recent financially and technically feasible improvements of cell capture devices, plasma isolation techniques, and highly sensitive polymerase chain reaction- and sequencing-based methods have advanced the possibility of liquid biopsy of solid tumors. Although practical use of circulating RNA-based testing has been hindered by the need to fractionate blood to enrich for RNAs, the detection of circulating tumor cells has profited from advances in cell capture technology. In fact, the US Food and Drug Administration has approved one circulating tumor cell selection platform, the CellSearch System. Although the use of liquid biopsy in a patient population with a genomically defined solid tumor may potentially be clinically useful, it currently does not supersede conventional pretreatment tissue diagnosis of lung cancer. Liquid biopsy has not been validated for lung cancer diagnosis, and its lower sensitivity could lead to significant diagnostic delay if liquid biopsy were to be used in lieu of tissue biopsy. Ultimately, notwithstanding the enthusiasm encompassing liquid biopsy, its clinical utility remains unproven.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yasushi Yatabe
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Drs Sholl and Vivero); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, The University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell Medical College, New York, New York, and the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle); the Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil (Dr Capelozzi); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, Aberdeen University Medical School and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom (Dr Kerr); the Department of Biopathology, Centre Léon Bérard, Lyon, France, and J Fourier University-INSERM U 823-Institut A Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, VU Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); the Department of Pathology, University Health Network/Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada (Dr Tsao); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe)
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Roy-Chowdhuri S, Aisner DL, Allen TC, Beasley MB, Borczuk A, Cagle PT, Capelozzi V, Dacic S, da Cunha Santos G, Hariri LP, Kerr KM, Lantuejoul S, Mino-Kenudson M, Moreira A, Raparia K, Rekhtman N, Sholl L, Thunnissen E, Tsao MS, Vivero M, Yatabe Y. Biomarker Testing in Lung Carcinoma Cytology Specimens: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2016; 140:1267-1272. [PMID: 27081878 DOI: 10.5858/arpa.2016-0091-sa] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The advent of targeted therapy in lung cancer has heralded a paradigm shift in the practice of cytopathology with the need for accurately subtyping lung carcinoma, as well as providing adequate material for molecular studies, to help guide clinical and therapeutic decisions. The variety and versatility of cytologic-specimen preparations offer significant advantages to molecular testing; however, they frequently remain underused. Therefore, evaluating the utility and adequacy of cytologic specimens is critical, not only from a lung cancer diagnosis standpoint but also for the myriad ancillary studies that are necessary to provide appropriate clinical management. A large fraction of lung cancers are diagnosed by aspiration or exfoliative cytology specimens, and thus, optimizing strategies to triage and best use the tissue for diagnosis and biomarker studies forms a critical component of lung cancer management. This review focuses on the opportunities and challenges of using cytologic specimens for molecular diagnosis of lung cancer and the role of cytopathology in the molecular era.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yasushi Yatabe
- From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell Medical College, New York (Drs Borczuk and Cagle); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle); the Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil (Dr Capelozzi); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, University Health Network, Princess Margaret Cancer Centre, and the University of Toronto, Toronto, Ontario, Canada (Drs da Cunha Santos and Tsao); the Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, Aberdeen University Medical School, and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom (Dr Kerr); the Department of Biopathology, Centre Léon Bérard, Lyon, and J Fourier University, Institut National de la Santé et de la Recherche Médicale-Institut Albert Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, New York University, New York (Dr Moreira); the Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York (Dr Rekhtman); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston (Drs Sholl and Vivero); the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe)
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Chae YK, Pan A, Davis AA, Raparia K, Mohindra NA, Matsangou M, Giles FJ. Biomarkers for PD-1/PD-L1 Blockade Therapy in Non-Small-cell Lung Cancer: Is PD-L1 Expression a Good Marker for Patient Selection? Clin Lung Cancer 2016; 17:350-361. [PMID: 27137346 DOI: 10.1016/j.cllc.2016.03.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [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: 12/09/2015] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 12/14/2022]
Abstract
Immunotherapy has emerged as a promising treatment modality in cancer therapy. With improved understanding of how to tip the balance of immune homeostasis, novel therapeutics targeting immune checkpoints have been developed, with durable responses observed in multiple solid tumors, including melanoma, renal cell carcinoma, and non-small-cell lung cancer. Clinical trials have reported favorable responses using programmed cell death-1 protein receptor (PD-1)/programmed cell death-1 protein ligand (PD-L1) blockade as monotherapy and most impressively in combinatorial trials with cytotoxic T-lymphocyte antigen-4 protein blockade. Nonetheless, a clinical benefit has not been observed in all patients. Therefore, identifying the ideal biomarkers for patient selection would be of great value in optimizing and personalizing immunotherapy. The utility of PD-L1 expression as a biomarker has varied in different clinical trials and immunohistochemistry assays. In addition, the response to immune checkpoint inhibition has been complicated by PD-L1 expression as a marker influenced by the dynamic tumor microenvironment. No consensus has yet been reached on whether PD-L1 expression is an ideal marker for patient selection. Recent research has shown promise for alternative markers, including T-cell immunohistochemistry, other immunologic markers, T-cell receptor clonality, and somatic mutational burden. However, additional studies are needed to assess the value of these as practical predictive biomarkers for patient selection and treatment response.
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Affiliation(s)
- Young Kwang Chae
- Developmental Therapeutics Program of the Division of Hematology Oncology, Department of Medicine, Northwestern Medicine Developmental Therapeutics Institute, Northwestern University, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Alan Pan
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew A Davis
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kirtee Raparia
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nisha A Mohindra
- Developmental Therapeutics Program of the Division of Hematology Oncology, Department of Medicine, Northwestern Medicine Developmental Therapeutics Institute, Northwestern University, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maria Matsangou
- Developmental Therapeutics Program of the Division of Hematology Oncology, Department of Medicine, Northwestern Medicine Developmental Therapeutics Institute, Northwestern University, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Francis J Giles
- Developmental Therapeutics Program of the Division of Hematology Oncology, Department of Medicine, Northwestern Medicine Developmental Therapeutics Institute, Northwestern University, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
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Sholl LM, Aisner DL, Allen TC, Beasley MB, Borczuk AC, Cagle PT, Capelozzi V, Dacic S, Hariri L, Kerr KM, Lantuejoul S, Mino-Kenudson M, Raparia K, Rekhtman N, Roy-Chowdhuri S, Thunnissen E, Tsao MS, Yatabe Y. Programmed Death Ligand-1 Immunohistochemistry— A New Challenge for Pathologists: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2016; 140:341-4. [DOI: 10.5858/arpa.2015-0506-sa] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The binding of programmed death ligand-1 and ligand-2 (PD-L1 and PD-L2) to PD-1 blocks T-cell–mediated immune response to tumor. Antibodies that target programmed death receptor-1 (PD-1) will block the ligand-receptor interface, thereby allowing T cells to attack the tumor and increase antitumor immune response. In clinical trials, PD-1 inhibitors have been associated with an approximately 20% overall response rate in unselected patients with non–small cell lung cancer, with sustained tumor response in a subset of patients treated by these immune checkpoint inhibitors. Facing a proliferation of PD-L1 immunohistochemistry clones, staining platforms, and scoring criteria, the pathologist must decide on the feasibility of introducing a newly approved companion diagnostic assay that may require purchase not only of a specific antibody kit but of a particular staining platform. Given the likely reality that clinical practice may, in the near future, demand access to 4 different PD-L1 antibodies coupled with different immunohistochemistry platforms, laboratories will be challenged with deciding among this variety of testing methods, each with its own potential benefits. Another immediate challenge to PD-L1 testing in lung cancer patients is that of access to adequate tumor tissue, given that non–small cell lung cancer samples are often extremely limited in size. With PD-L1 testing it has become clear that the historically used US regulatory approach of one assay–one drug will not be sustainable. One evolving concept is that of complementary diagnostics, a novel regulatory pathway initiated by the US Food and Drug Administration, which is distinct from companion diagnostics in that it may present additional flexibility. Although pathologists need to face the practical reality that oncologists will be asking regularly for the PD-L1 immunohistochemistry status of their patients' tumors, we should also keep in mind that there may be room for improvement of biomarkers for immunotherapy response. The field is rich with opportunities for investigation into biomarkers of immunotherapy response, particularly in the form of collaborative, multidisciplinary studies that incorporate oncologists, pathologists, and basic scientists. Pathologists must take the lead in the rational incorporation of these biomarkers into clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yasushi Yatabe
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Sholl)
- the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner)
- the Department of Pathology, The University of Texas Medical Branch, Galveston (Dr Allen)
- the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley)
- the Department of Pathology, Weill Cornell Medical College, New York, New York (Drs Borczuk and Cagle)
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Sholl LM, Andea A, Bridge JA, Cheng L, Davies MA, Ehteshami M, Gangadhar TC, Kamel-Reid S, Lazar A, Raparia K, Siroy A, Watson KL. Template for Reporting Results of Biomarker Testing of Specimens From Patients With Melanoma. Arch Pathol Lab Med 2015; 140:355-7. [PMID: 26340412 DOI: 10.5858/arpa.2015-0278-cp] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Kimberly L Watson
- From the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl);,the Department of Pathology, University of Michigan Hospitals, Ann Arbor (Dr Andea);,the Department of Pathology, University of Nebraska Medical Center, Omaha (Dr Bridge);,the Department of Pathology, Indiana University, Indianapolis (Dr Cheng);,the Departments of Melanoma Medical Oncology and Systems Biology (Dr Davies).,Pathology (Drs Lazar and Siroy), and Translational Molecular Pathology (Dr Lazar).,The University of Texas MD Anderson Cancer Center, Houston, Texas; Newport Coast Pathology Inc, Newport Beach, California (Dr Ehteshami);,the Department of Medicine and the Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia (Dr Gangadhar);,the Department of Pathology, The University Health Network/Princess Margaret Cancer Center, Toronto, Ontario, Canada (Dr Kamel-Reid);,the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Raparia); and Cancer Registry Consultant, Sioux Falls, South Dakota (Ms Watson).,and Cancer Registry Consultant, Sioux Falls, South Dakota (Ms Watson)
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Paintal A, Raparia K, Nayar R. Cytomorphologic findings of malignant mesothelioma in FNA biopsies and touch preps of core biopsies. Diagn Cytopathol 2015; 44:14-9. [PMID: 26303316 DOI: 10.1002/dc.23337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/02/2015] [Accepted: 08/05/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Given the lack of recent literature regarding the aspiration cytology of immunohistochemically confirmed malignant mesothelioma (MM), we were interested in reviewing the experience of our institution and establishing useful morphologic criteria. METHODS Seventeen aspiration and touch preparation specimens with a diagnosis of MM obtained between 2002-2013 were reviewed along with 20 cases of adenocarcinoma and 16 cases of squamous cell carcinoma. The utility of a number of morphologic features was evaluated. RESULTS In most cases of MM, a consistent pattern emerged. Aspirates and touch preps were cellular with irregularly shaped 2 and 3 dimensional clusters. The individual cells were predominantly angulated and had dense cytoplasm with eccentric nuclei. In every case, a minority of tumor cells contained prominent microvacuoles. The chromatin pattern tended to be fine with small nucleoli. While most cases were cytologically monotonous, five cases displayed striking pleomorphism and three cases contained occasional large atypical cells. Two cases contained metachromatic background material. Features which were most useful in discriminating MM from adenocarcinoma were angulated cell shape(P = 0.0002), dense cytoplasm(P = 0.0001), and cytoplasmic microvacuoles(P = 0.0001). In our material, cases of squamous cell carcinoma were often difficult to distinguish from MM. Useful discriminatory features present in squamous cell carcinoma included ink dot nuclei(P = 0.0003), a "dirty" cystic, necrotic background (P = 0.0027) and tumor balls with peripheral spindling(P = 0.0041). CONCLUSION Most cases of MM have a consistent appearance in core biopsy touch preps and FNAs. Distinguishing MM from adenocarcinoma and squamous cell carcinoma can be facilitated by evaluating a few key morphologic features.
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Affiliation(s)
- Ajit Paintal
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kirtee Raparia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ritu Nayar
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Katzen JB, Raparia K, Agrawal R, Patel JD, Rademaker A, Varga J, Dematte JE. Early stage lung cancer detection in systemic sclerosis does not portend survival benefit: a cross sectional study. PLoS One 2015; 10:e0117829. [PMID: 25689302 PMCID: PMC4331488 DOI: 10.1371/journal.pone.0117829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/31/2014] [Indexed: 01/15/2023] Open
Abstract
Background Systemic Sclerosis (SSc) is a rare connective tissue disorder associated with an increased risk of malignancy including lung cancer. Methods A single center review of all cases of lung cancer in patients with SSc was conducted. Clinical, radiographic, and detailed pathologic data was collected. Risk factors were compared with our center’s SSc Registry. Cancer characteristics were compared with the National Cancer Institute SEER Cancer Statistics (NCI SEER) data. Results 17 cases were identified; the majority were females (82%) with the lung cancers diagnosed after the onset of SSc (88%). Tobacco use was identified in 65% of cases. Serologic testing showed 50% of cases were Scl-70 positive. Twelve cases had radiographic evidence of SSc lung involvement, however only 6 had restrictive physiology on pulmonary function testing. Thirteen cases had pulmonary nodules preceding lung cancer. Thirteen of the cancers were adenocarcinoma. Ten underwent molecular mutational profiling: 2/8 had KRAS mutation and 1/10 had EGFR mutation. More of the non-small cell lung cancers were diagnosed at localized disease (56%) than in the NCI SEER database. However, 5 years survival among the stage I cases was 25% versus an expected survival of 54%. Conclusions The high proportion of adenocarcinomas seen in our study is different from that reported in the literature. Lung cancers were diagnosed at an early stage, likely due to our center’s practice of radiographic screening for SSc associated lung involvement, however this did not confer a survival advantage. A high proportion of patients who developed lung cancer had interstitial lung disease.
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Affiliation(s)
- Jeremy B. Katzen
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | - Kirtee Raparia
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Rishi Agrawal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jyoti D. Patel
- Department of Medicine, Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Alfred Rademaker
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University, Chicago, Illinois, United States of America
| | - John Varga
- Department of Medicine, Division of Rheumatology and Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jane E. Dematte
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Raparia K, Villa C, Raj R, Cagle PT. Peripheral lung adenocarcinomas with KRAS mutations are more likely to invade visceral pleura. Arch Pathol Lab Med 2014; 139:189-93. [PMID: 24694341 DOI: 10.5858/arpa.2013-0759-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Kirsten-RAS (KRAS) mutations play an important role in the carcinogenesis of a subset of lung adenocarcinomas and are associated with poorer prognosis. OBJECTIVE To investigate the relationship of KRAS mutation status to the histologic subtype of adenocarcinoma according to the recent classification, patient demographics, tumor size, predominant histologic subtype, nodal status, and visceral pleural invasion, in an attempt to uncover the reason for the worse prognosis associated with KRAS mutation. DESIGN A total of 187 consecutive resected lung adenocarcinomas from our institution from 2008 to 2011 that were diagnosed according to the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification and screened for KRAS mutations were included in the study. RESULTS A total of 32% of the adenocarcinomas harbored the KRAS mutation. The median age in the KRAS mutation group was 69 years (range, 43-86 years), and male to female ratio was 1:2.3. The proportion of heavy smokers was significantly higher in tumors with KRAS mutation compared with wild type (83% versus 62%; P = .01). A total of 27% of tumors with KRAS mutation had pleural invasion versus 11% of tumors without KRAS mutation (P = .009). A total of 59 tumor samples were positive for KRAS mutation (25 for G12C, 14 for G12A, 8 for G12V, 7 for G12D, 3 for G12S, and 1 for G12T), and only 3 tumors harbored codon 13 mutations (G13C). Two tumors had double mutations. CONCLUSIONS KRAS mutations are more common in heavy smokers, and lung adenocarcinomas with KRAS mutation are more likely to invade the visceral pleura. Increased frequency of visceral pleural invasion may explain in part the worse prognosis associated with KRAS mutations.
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Affiliation(s)
- Kirtee Raparia
- From the Departments of Pathology (Drs Raparia and Villa), and Pulmonary and Critical Care (Dr Raj), Northwestern University, Chicago, Illinois; and the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle)
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Villa C, Cagle PT, Johnson M, Patel JD, Yeldandi AV, Raj R, DeCamp MM, Raparia K. Correlation of EGFR mutation status with predominant histologic subtype of adenocarcinoma according to the new lung adenocarcinoma classification of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society. Arch Pathol Lab Med 2014; 138:1353-7. [PMID: 24571650 DOI: 10.5858/arpa.2013-0376-oa] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Epidermal growth factor receptor (EGFR) mutations have been identified as predictors of response to EGFR tyrosine kinase inhibitors in non-small cell lung cancer. OBJECTIVE To investigate the relationship of EGFR mutation status to the histologic subtype of adenocarcinoma according to the new International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification. DESIGN We screened EGFR mutation in 200 consecutive lung adenocarcinoma resection specimens diagnosed between 2008 and 2011. RESULTS Among 200 lung adenocarcinomas, EGFR mutations were identified in 41 tumors (20.5%). The mean age in the EGFR-mutant group was 64.8 years and this group consisted of 78% females and 22% males. Most patients with EGFR-positive lung cancers were never-smokers (51%) as compared to 8% with EGFR-negative cancers (P < .001). The most common mutations identified in our population were deletions in exon 19 (22 patients) and L858R in exon 21 (12 patients). Five patients had double mutations. The predominant pattern of adenocarcinoma was lepidic (44%) in EGFR-mutant lung cancers as compared to 69% with acinar pattern in EGFR wild-type lung cancers (P < .001). Of 22 minimally invasive adenocarcinomas, 8 (36%) had EGFR mutations, accounting for 20% of adenocarcinomas with EGFR mutations (P < .05). CONCLUSIONS Based on the new IASLC/ATS/ERS classification, the predominant subtype of adenocarcinoma was lepidic (44%) in EGFR-mutant lung cancers (P < .001). However, histologic subtype should not be used to exclude patients from tyrosine kinase inhibitor therapy, since EGFR mutations are found in lung adenocarcinomas of other subtypes.
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Affiliation(s)
- Celina Villa
- From the Department of Pathology (Drs Villa, Yeldandi, and Raparia), the Division of Medical Oncology, and Robert H. Lurie Comprehensive Cancer Center (Drs Johnson and Patel), the Division of Pulmonary, and Critical Care Medicine (Dr Raj); and the Division of Thoracic Surgery, and Robert H. Lurie Comprehensive Cancer Center (Dr DeCamp), Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Department of Pathology & Genomic Medicine, The Methodist Hospital, Houston, Texas (Dr Cagle)
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Amirian ES, Scheurer ME, Wrensch M, Olson SH, Lai R, Lachance D, Armstrong G, Zhou R, Wiemels J, Lau C, Claus E, Barnholtz-Sloan J, Il'yasova D, Schildkraut J, Houlston R, Shete S, Bernstein J, Jenkins R, Davis F, Merrell R, Johansen C, Sadetzki S, Melin B, Bondy M, Dardis C, Dembowska-Baginska B, Swieszkowska E, Drogosiewicz M, Polnik MP, Filipek I, Grudzinska M, Grajkowska W, Perek D, Flores K, Crawford J, Piccioni D, Lemus H, Lindsay S, Kesari S, Bricker P, Fonkem E, Ebue E, Song J, Harris F, Thawani N, DiPatre PL, Newell-Rogers MK, Fonkem E, Gittleman H, Kruchko C, Ostrom Q, Chen Y, Farah P, Ondracek A, Wolinsky Y, Barnholtz-Sloan J, Griffin J, Tobin R, Newell-Rogers MK, Ebwe E, Fonkem E, Johnson D, Leeper H, Uhm J, Lee A, Back M, Gzell C, Kastelan M, Wheeler H, Ostrom Q, Kruchko C, Gittleman H, Chen Y, Ondracek A, Farah P, Wolinsky Y, Barnholtz-Sloan J, Lopez E, Sepulveda C, Diego-Perez J, Betanzos Y, de Leon AP, Prabhu V, Perry E, Melian E, Barton K, Lee J, Anderson D, Urgoiti GR, Singh A, Tsang RY, Nordal R, Lim G, Chan J, Starreveld Y, de Robles P, Biagioni B, Hamilton M, Easaw J, Senerchia A, Eleuterio S, Souza E, Cappellano A, Seixas T, Cavalheiro S, Saba N, Torres-Carranza A, Canales-Martinez LC, Perez-Cardenas S, Miranda-Maldonado I, Barbosa-Quintana O, de Leon AMP, Umemura Y, Ronan L, van Zanten SV, Jansen M, van Vuurden D, Vandertop P, Kaspers GJ, Wallach J, LaSala P, Kalnicki S, Garg M, Wong TT, Ho DM, Chang KP, Yen SH, Guo WY, Chang FC, Liang ML, Chen HHS, Chen YW, Pan DHC, Chung WY, Yoo H, Jung KW, Lee SH, Shin SH, Ha J, Won YJ, Yoon H, Offor O, Helenowski I, Bhandari R, Raparia K, Marymont M, DeCamp M, de Hoyos A, Chandler J, Bendok B, Chmura S, Mehta M. EPIDEMIOLOLGY. Neuro Oncol 2013; 15:iii32-iii36. [PMCID: PMC3823890 DOI: 10.1093/neuonc/not175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
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Yoon H, Helenowski I, Bhandari R, Raparia K, Marymont M, DeCamp M, de Hoyos A, Chandler J, Bendok B, Mehta M. Predictive Factors for Brain Metastases and Relapse and Prognostic Factors for Survival in Stage III-IV Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Paintal A, Raparia K, Zakowski MF, Nayar R. The diagnosis of malignant mesothelioma in effusion cytology. Cancer Cytopathol 2013; 121:703-7. [DOI: 10.1002/cncy.21342] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 06/28/2013] [Accepted: 07/12/2013] [Indexed: 01/07/2023]
Affiliation(s)
- Ajit Paintal
- Northwestern University; Feinberg School of Medicine; Chicago Illinois
| | - Kirtee Raparia
- Northwestern University; Feinberg School of Medicine; Chicago Illinois
| | - Maureen F. Zakowski
- Memorial Sloan-Kettering Cancer Center; New York New York
- Weill Cornell Medical College; New York New York
| | - Ritu Nayar
- Northwestern University; Feinberg School of Medicine; Chicago Illinois
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Raparia K, Villa C, DeCamp MM, Patel JD, Mehta MP. Molecular profiling in non-small cell lung cancer: a step toward personalized medicine. Arch Pathol Lab Med 2013; 137:481-91. [PMID: 23544937 DOI: 10.5858/arpa.2012-0287-ra] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Lung carcinoma is the result of sequential accumulation of genetic and epigenetic changes. Lung adenocarcinoma is a heterogeneous disease with diverse somatic mutations, and several of them include the so-called driver mutations, which may serve as "druggable" therapeutic targets. Thus, development of personalized approaches for the treatment of non-small cell lung carcinoma (NSCLC) mandates that pathologists make a precise histologic classification inclusive of routine molecular analysis of such tumors. OBJECTIVE To address the molecular mechanisms underlying NSCLC and how this knowledge reflects the multidisciplinary approach in the diagnosis and management of these patients. We will also summarize the current available and investigational personalized therapies for patients with resectable early-stage, unresectable locally advanced, and metastatic NSCLC. DATA SOURCES Peer-reviewed published literature and personal experience. CONCLUSIONS There are multiple mechanisms involved in the pathogenesis of lung cancer, which operate in parallel and involve pathways of activation and inhibition of various cellular events. Further research is essential to characterize the histologic and mutational profiles of lung carcinomas, which will ultimately translate into improved and more personalized therapeutic management of patients with lung cancer.
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Affiliation(s)
- Kirtee Raparia
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Raparia K, Lin JW, Donovan D, Vrabec JT, Zhai QJ, Ayala AA, Ro JY. Chondroblastoma-like chondroma of soft tissue: report of the first case in the base of skull. Ann Diagn Pathol 2013; 17:298-301. [PMID: 22743240 DOI: 10.1016/j.anndiagpath.2012.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 05/15/2012] [Indexed: 11/16/2022]
Abstract
Chondroblastoma-like chondroma (CLC) of soft tissue is a rare benign neoplasm that usually involves the soft tissues of the hand. This report describes the first case of CLC of soft tissue arising in the base of the skull. A 33-year-old man was seen with a slow growing mass in the right parotid region of his face. The noncontrast computed tomographic scans showed an 8.5-cm mass with calcifications involving the right masticator space and extending through the bone into the middle cranial fossa. The radiologic differential diagnosis included osteosarcoma, leiomyosarcoma, chondrosarcoma, and giant cell tumor. During surgery, the large lateral skull base tumor appeared to involve the middle and infratemporal fossae and eroded the surrounding bone. Although the tumor was removed piecemeal, total excision was performed. On microscopic examination, the tumor displayed lobules of mature hyaline cartilage with numerous chondroblasts, coarse calcifications including chicken wire calcifications, and scattered osteoclasts. No atypia, mitoses, necrosis, or osteoid formation was seen. The tumor was diagnosed as chondroma with chondroblastoma features of the soft tissue. His postoperative clinical course was uneventful; however, after 7 months, he had a local recurrence identified on follow-up magnetic resonance imaging. He underwent repeat surgical excision of the tumor, which showed similar histology as the previous excision. This large skull based tumor eroding the bone, which clinically and radiologically mimicked a malignant process, was an unusual presentation of a benign cartilaginous neoplasm. Pathologists should be aware that CLC may occur in the base of the skull and this lesion should be differentiated from the other benign or malignant tumors arising in this area. These lesions have a potential for local recurrence; hence, a close follow-up is recommended.
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Affiliation(s)
- Kirtee Raparia
- Department of Pathology, Northwestern University, Chicago, IL, USA
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Abstract
CONTEXT Nodular, intercapillary glomerulosclerotic lesions resembling Kimmelstiel-Wilson nodules commonly observed in diabetic nephropathy can also be seen in patients without any clinical history or evidence of diabetes. OBJECTIVES To discuss the pathobiology of lesions reminiscent of diabetes nephropathy, including light-chain deposition disease, amyloidosis, immunotactoid nephropathy, the membranoproliferative form of glomerulonephritis, and idiopathic nodular glomerulosclerosis, and how to differentiate them from diabetic nephropathy. DATA SOURCES Published literature and authors' personal experience. CONCLUSIONS The well-formed, intercapillary, nodular mesangial lesions, along with thickened glomerular basement membranes and tubular basement membranes, and hyaline arteriolosclerosis are virtually pathognomic of diabetic nephropathy. However, the pathologist must exclude lesions reminiscent of diabetic nephropathy by performing special stains on histologic sections, immunofluorescence, and electron microscopic studies.
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Affiliation(s)
- Kirtee Raparia
- Department of Pathology, Northwestern University Medical School, Chicago, IL 60611, USA
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Abstract
CONTEXT Diagnosis and classification of lymphomas are based on the morphologic, immunologic, and genetic features that the lesional cells share with their normal B and T lymphocyte counterparts. Primary pulmonary lymphomas account for 0.3% of primary lung neoplasms and less than 0.5% of all lymphomas. OBJECTIVE To describe and summarize the clinical and histopathologic features of the primary pulmonary lymphoma and secondary involvement of the lung by lymphoma. DATA SOURCES Peer-reviewed published literature and personal experience. CONCLUSIONS Diagnosis of clonal lymphoid proliferations in the lung has evolved owing to the greater utility of molecular and flow cytometric analysis of tissue. Further studies are needed to best define the clinical and prognostic features, as well as search for targeted therapy for these patients with rare neoplasms.
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Affiliation(s)
- Josette William
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
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Matkowskyj KA, Rao MS, Raparia K. Transcription factor E3 protein-positive perivascular epithelioid cell tumor of the appendix presenting as acute appendicitis: a case report and review of the literature. Arch Pathol Lab Med 2013; 137:434-7. [PMID: 23451753 DOI: 10.5858/arpa.2012-0103-cr] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) are a group of mesenchymal tumors that coexpress melanocytic and smooth muscle markers; their exact origin remains unknown. This group includes renal angiomyolipoma, clear cell sugar tumor, and lymphangioleiomyomatosis, although the term perivascular epithelioid cell tumors is currently used for lesions that exhibit a similar morphologic and immunohistochemical profile throughout the human body. Recently, a distinct subset of PEComas has been shown to harbor transcription factor E3 gene (TFE3) fusions. We report, for the first time, a unique case of TFE3-positive PEComa presenting as acute appendicitis in a 24-year-old woman. Microscopically, the tumor was composed of benign-appearing epithelioid cells with clear and eosinophilic cytoplasm, and arranged in nested and alveolar patterns. Immunohistochemical studies showed diffuse strong positivity for neuron-specific enolase, TFE3, and progesterone receptor and focal strong positivity for human melanoma black-45 (HMB-45) and melanocyte differentiation antigen (Melan-A) in the tumor cells. Although rare, PEComa should be included in the differential diagnosis of mesenchymal tumors of the appendix.
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Affiliation(s)
- Kristina A Matkowskyj
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Raparia K. Anatomic winds of change blow in from Chicago: topics from faculty at Feinberg School of Medicine, Northwestern University, and Northwestern Memorial Hospital. Arch Pathol Lab Med 2013; 137:312-3. [PMID: 23451742 DOI: 10.5858/arpa.2012-0431-ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kirtee Raparia
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago,IL 60611, USA.
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Raparia K, Molina CP, Quiroga-Garza G, Weilbaecher D, Ayala AG, Ro JY. Inflammatory aortic aneurysm: possible manifestation of IgG4-related sclerosing disease. Int J Clin Exp Pathol 2013; 6:469-475. [PMID: 23411750 PMCID: PMC3563203] [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] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 01/11/2013] [Indexed: 06/01/2023]
Abstract
In this study, we investigate the hypothesis that IgG4-related autoimmune reaction is involved in the formation of inflammatory aortic aneurysms (IAA). We obtained 23 cases of IAA and 11 cases of atherosclerotic aortic aneurysms (AAA) as control group. We evaluated the expression of IgG4 in both IAA study cases and AAA control cases. In addition, immunohistochemical expression of C-Kit, CD21, CD34, S-100 protein, SMA, vimentin, p53, beta-catenin, and ALK-1, and EBV-LMP1 expression by in situ hybridization were performed only in IAA cases. Of the 23 patients, 20 were males and 3 were females (M: F ratio 6.7:1); age ranged from 43 to 81 years (average 64.3 years). Histologically, all 23 cases of IAA formed a mass that displayed inflammatory myofibroblastic tumor-like features. All lesions stained strongly and diffusely for vimentin and SMA (100%); 17 stained strongly and focally for CD34 (74%); and all were negative for C-Kit, CD21, S-100 protein, p53, beta-catenin, EBV-LMP1, and ALK-1. The numbers of infiltrating IgG4-positive plasma cells in IAA cases exceed that of AAA cases. Score 3 (>50 plasma cells/one 40X field) of IgG4-positive plasma cells was only seen in IAA cases (13/23, 57%), whereas none of the 11 cases of AAA showed score 3 IgG4-positive plasma cells (P=0.0018, Fischer's exact test). Our findings suggest that IAA may be an aortic manifestation of the IgG4-related sclerosing disease. The high number of positive plasma cells, >50 plasma cells/one 40X field is more specific for the IAA than for AAA; however, lesser number can be seen in both IAA and AAA patients.
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Affiliation(s)
- Kirtee Raparia
- Departments of Pathology, Northwestern UniversityChicago, IL
| | | | | | | | | | - Jae Y Ro
- Departments of Pathology, The Methodist HospitalHouston, TX
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Xie P, Kondeti VK, Lin S, Haruna Y, Raparia K, Kanwar YS. Role of extracellular matrix renal tubulo-interstitial nephritis antigen (TINag) in cell survival utilizing integrin (alpha)vbeta3/focal adhesion kinase (FAK)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B-serine/threonine kinase (AKT) signaling pathway. J Biol Chem 2011; 286:34131-46. [PMID: 21795690 PMCID: PMC3190785 DOI: 10.1074/jbc.m111.241778] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 03/20/2011] [Revised: 07/19/2011] [Indexed: 11/06/2022] Open
Abstract
Tubulo-interstitial nephritis antigen (TINag) is an extracellular matrix protein expressed in tubular basement membranes. Combined mutations in TINag and nephrocystin-1 genes lead to nephronophthisis with reduced cell survival. Because certain extracellular matrix proteins are known to modulate cell survival, studies were initiated in Lewis rats lacking TINag to assess if they are more susceptible to cisplatin-induced injury. Cisplatin induced a higher degree of tubular cell damage and apoptosis in regions where TINag is expressed in a parental Wistar strain. This was accompanied by an accentuated increase in serum creatinine and Kim-1 RNA and renal expression of Bax, p53, and its nuclear accumulation, mtDNA fragmentation, and a decrease of Bcl-2. Cisplatin induced fulminant apoptosis of HK-2 cells with increased caspase3/7 activity, mtDNA fragmentation, and a reduced cell survival. These effects were partially reversed in cells maintained on TINag substratum. Far Western/solid phase assays established TINag binding with integrin αvβ3 comparable with vitronectin. Transfection of cells with αv-siRNA accentuated cisplatin-induced apoptosis, aberrant translocation of cytochrome c and Bax, and reduced cell survival. The αv-siRNA decreased expression of integrin-recruited focal adhesion kinase (FAK) and p-FAK, while increasing the expression of p53 and p-p53. Similarly, p-AKT was reduced although ILK was unaffected. Inhibition of PI3K had similar adverse cellular effects. These effects were ameliorated in cells on TINag substratum. In vivo, a higher degree of decrease in the expression of p-FAK and pAKT was observed in Lewis rats following cisplatin treatment. These in vivo and in vitro studies demonstrate an essential role of TINag in cellular survival to maintain proper tubular homeostasis utilizing integrin αvβ3 and downstream effectors.
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Affiliation(s)
- Ping Xie
- From the Departments of Pathology and Medicine, Northwestern University, Chicago, Illinois 60611
| | - Vinay K. Kondeti
- From the Departments of Pathology and Medicine, Northwestern University, Chicago, Illinois 60611
| | - Sun Lin
- the Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011, China, and
| | - Yoshisuke Haruna
- the Department of Medicine, Kawasaki Medical School, Kurashiki, Okayama 7010192, Japan
| | - Kirtee Raparia
- From the Departments of Pathology and Medicine, Northwestern University, Chicago, Illinois 60611
| | - Yashpal S. Kanwar
- From the Departments of Pathology and Medicine, Northwestern University, Chicago, Illinois 60611
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Sun L, Kondeti VK, Xie P, Raparia K, Kanwar YS. Epac1-mediated, high glucose-induced renal proximal tubular cells hypertrophy via the Akt/p21 pathway. Am J Pathol 2011; 179:1706-18. [PMID: 21854750 DOI: 10.1016/j.ajpath.2011.06.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 05/30/2011] [Accepted: 06/08/2011] [Indexed: 11/17/2022]
Abstract
The mechanisms involved in tubular hypertrophy in diabetic nephropathy are unclear. We investigated the role of exchange protein activated by cAMP 1(Epac1), which activates Rap-family G proteins in cellular hypertrophy. Epac1 is expressed in heart, renal tubules, and in the HK-2 cell line. In diabetic mice, increased Epac1 expression was observed, and under high glucose ambience (HGA), HK-2 cells also exhibited increased Epac1 expression. We isolated a 1614-bp DNA fragment upstream of the initiation codon of Epac1 gene, inclusive of glucose response elements (GREs). HK-2 or COS7 cells transfected with the Epac1 promoter revealed a dose-dependent increase in its activity under HGA. Mutations in GRE motifs resulted in decreased promoter activity. HK-2 cells exhibited a hypertrophic response and increased protein synthesis under HGA, which was reduced by Epac1-siRNA or -mutants, whereas the use of a protein kinase A inhibitor had minimal effect. Epac1 transfection led to cellular hypertrophy and increased protein synthesis, which was accentuated by HGA. HGA increased the proportion of cells in the G0/G1 cell-cycle phase, and the expression of pAkt and the cyclin-dependent kinase inhibitors p21 and p27 was increased while the activity of cyclin-dependent kinase 4 decreased. These effects were reversed following transfection of cells with Epac1-siRNA or -mutants. These data suggest that HGA increases GRE-dependent Epac1 transcription, leading to cell cycle arrest and instigation of cellular hypertrophy.
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Affiliation(s)
- Lin Sun
- Departments of Pathology and Medicine, Northwestern University, Chicago, Illinois 60611, USA
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Nayak B, Kondeti VK, Xie P, Lin S, Viswakarma N, Raparia K, Kanwar YS. Transcriptional and post-translational modulation of myo-inositol oxygenase by high glucose and related pathobiological stresses. J Biol Chem 2011; 286:27594-611. [PMID: 21652700 DOI: 10.1074/jbc.m110.217141] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Renal-specific oxidoreductase/myo-inositol oxygenase (RSOR/MIOX) catabolizes myo-inositol and is implicated in the pathogenesis of diabetic nephropathy. How high glucose (HG) ambience up-regulates its expression and enzyme activity was investigated. MIOX up-regulation was associated with an increase in enzyme activity, which was reduced to basal levels with phosphatase treatment. Using phosphothreonine, protein kinase A (PKA), and PKC substrate antibodies, analyses of kidney lysates of diabetic animals and LLC-PK1/HK-2 cells subjected to HG ambience indicated MIOX to be a phosphoprotein. Kinase phosphorylated recombinant RSOR/MIOX proteins had increased activity confined to exons 2-5. Mutants with substituted phosphorylation sites had a minimal increase in activity. Treatment of cells with PKC, PKA, and PDK1 kinase activators increased activity, whereas inhibitors reduced it. Inhibitors also reduced the phosphorylation and activity of MIOX induced by HG. Besides HG, exposure of cells to oxidants H(2)O(2) and methylglyoxal up-regulated MIOX expression and its phosphorylation and activity, whereas antioxidants N-acetylcysteine, β-naphthoflavone, and tertiary butyl hydroquinone reduced MIOX expression. Treatment with HG or oxidants or overexpression of MIOX induced nuclear translocation of redox-sensitive transcription factor Nrf2, which binds to antioxidant response elements of various promoters. Promoter analyses revealed an increase in luciferase activity with HG and oxidants. Analyses of antioxidant response elements and carbohydrate response elements revealed an accentuation of DNA-protein interactions with oxidants and under HG ambience. ChIP-PCR and immunofluorescence studies revealed nuclear translocation of carbohydrate response element-binding protein. These findings suggest that phosphorylation of RSOR/MIOX enhances its activity, which is augmented by HG via transcriptional/translational events that are also modulated by diabetes-related pathobiological stresses.
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Affiliation(s)
- Baibaswata Nayak
- Department of Pathology, Northwestern University, Chicago, Illinois 60611, USA
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