1
|
Oon ML, Syn NL, Tan CL, Tan KB, Ng SB. Bridging bytes and biopsies: A comparative analysis of ChatGPT and histopathologists in pathology diagnosis and collaborative potential. Histopathology 2024; 84:601-613. [PMID: 38032062 DOI: 10.1111/his.15100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/03/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND AIMS ChatGPT is a powerful artificial intelligence (AI) chatbot developed by the OpenAI research laboratory which is capable of analysing human input and generating human-like responses. Early research into the potential application of ChatGPT in healthcare has focused mainly on clinical and administrative functions. The diagnostic ability and utility of ChatGPT in histopathology is not well defined. We benchmarked the performance of ChatGPT against pathologists in diagnostic histopathology, and evaluated the collaborative potential between pathologists and ChatGPT to deliver more accurate diagnoses. METHODS AND RESULTS In Part 1 of the study, pathologists and ChatGPT were subjected to a series of questions encompassing common diagnostic conundrums in histopathology. For Part 2, pathologists reviewed a series of challenging virtual slides and provided their diagnoses before and after consultation with ChatGPT. We found that ChatGPT performed worse than pathologists in reaching the correct diagnosis. Consultation with ChatGPT provided limited help and information generated from ChatGPT is dependent on the prompts provided by the pathologists and is not always correct. Finally, we surveyed pathologists who rated the diagnostic accuracy of ChatGPT poorly, but found it useful as an advanced search engine. CONCLUSIONS The use of ChatGPT4 as a diagnostic tool in histopathology is limited by its inherent shortcomings. Judicious evaluation of the information and histopathology diagnosis generated from ChatGPT4 is essential and cannot replace the acuity and judgement of a pathologist. However, future advances in generative AI may expand its role in the field of histopathology.
Collapse
Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Nicholas L Syn
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Char Loo Tan
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Kong-Bing Tan
- Department of Pathology, National University Hospital, Singapore, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siok-Bian Ng
- Department of Pathology, National University Hospital, Singapore, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| |
Collapse
|
2
|
Oon ML, Wu B, Chan HLE, Petersson F. Ocular Crystal-Storing Histiocytosis with Co-existing MALT Lymphoma-A Rare Case with Cytologic and Heretofore Not Reported Findings on Frozen Section. Head Neck Pathol 2023; 17:1034-1041. [PMID: 37792236 PMCID: PMC10739693 DOI: 10.1007/s12105-023-01581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Crystal-storing histiocytosis (CSH) is a rare disorder which most commonly occurs in the setting of concurrent lymphoproliferative disease. Morphologically, it consists of aggregates of histiocytes containing eosinophilic crystalline material, which in most cases is composed of aggregated abnormal light chains. METHODS Using histomorphology, immunohistochemistry and in situ hybridization, the authors characterize a rare case of orbital CSH associated with extranodal marginal zone (MALT) lymphoma and report for the first time the frozen section features of CSH. RESULTS The frozen section featured plump histiocytes with ample weakly basophilic to grayish cytoplasm with a microvacuolated appearance and focal stippling. These features stand in contrast with the formalin-fixed, paraffin embedded histomorphological appearance of aggregates of plump histiocytes with densely eosinophilic crystalline cytoplasmic material. CONCLUSION CSH is a challenging diagnosis to make on frozen section. The artifacts that preclude its recognition, as well as differential diagnoses of this entity in the head and neck are discussed.
Collapse
Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Bingcheng Wu
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Hian Lee Esther Chan
- Department of Haematology-Oncology, National University Cancer Institute, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Fredrik Petersson
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| |
Collapse
|
3
|
Lim CK, Zhong Y, Hopkins R, Sin WX, Au BV, Narayanan S, Huang CH, Lee CYC, Oon ML, Chowdhury A, Wong B, Yeap F, Villegas M, Pompon J, Ng PPL, Ng SB, Quah TC, Tan PL, Chin KC, Connolly JE. Natural killer cell memory precedes HLH in monozygotic twins discordant for chronic active Epstein-Barr virus disease. Blood 2023; 141:2151-2155. [PMID: 36877914 DOI: 10.1182/blood.2022018309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/24/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Severe mosquito bite allergy (SMBA) is a manifestation of chronic active Epstein-Barr virus (CAEBV) infection defined by necrotic ulceration of the stings. CAEBV with SMBA has a high mortality rate as most patients eventually develop fulminant and refractory hemophagocytic lymphohistiocytosis (HLH). However, how self-resolving SMBA escalates to systemic lethal HLH remains unclear. Through comprehensive immune profiling of a SMBA patient with CAEBV and her healthy monozygotic twin, we found that both twins were seropositive for EBV but showed high discordance in their circulating natural killer (NK) cells. The patient's EBV-infected NK cells displayed memory-like properties, including low CD16, high CD226 and induction of enhanced IFNγ production by IL-2 or IL-12. Her leukocytes also produced high levels of IL-2 and IL-12 when stimulated with salivary gland extract (SGE) specifically from A. albopictus mosquitoes, connected again with hyperproduction of IFNγ by her NK cells. Strikingly, pharmacological inhibition of STAT3 suppressed the NK memory-associated cytokine axis of IFNγ, IL-2 and IL-12 that is generated by A. albopictus SGE stimulation. Altogether, this study shows that NK memory is promoted during CAEBV with SMBA by repeated cytokine restimulation leading up to lethal HLH, and proposes STAT3 as a therapeutic target to halt its progression.
Collapse
Affiliation(s)
- Chrissie K Lim
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | - Youjia Zhong
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Richard Hopkins
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | - Wei-Xiang Sin
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | - Bijin Veonice Au
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | - Sriram Narayanan
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | - Chiung-Hui Huang
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Colin Y C Lee
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | - Ming Liang Oon
- Department of Pathology, National University Hospital, Singapore
| | - Avisha Chowdhury
- Department of Emerging Infectious Diseases, Duke-NUS Medical School, National University of Singapore, Singapore
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON, Canada
| | - Benjamin Wong
- Department of Emerging Infectious Diseases, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Frances Yeap
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mariflor Villegas
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Julien Pompon
- Department of Emerging Infectious Diseases, Duke-NUS Medical School, National University of Singapore, Singapore
- MIVEGEC, University of Montpellier, IRD, CNRS, Montpellier, France
| | | | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Thuan Chong Quah
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poh-Lin Tan
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keh-Chuang Chin
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John E Connolly
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
- Department of Microbiology and Immunology, National University of Singapore, Singapore
- Institute of Biomedical Studies, Baylor University, Waco, TX
- Parker Institute for Cancer Immunotherapy, San Francisco, CA
| |
Collapse
|
4
|
Oon ML, Lum J, Lau KW, Nga ME. Gastric endocrine cell hyperplasia after neoadjuvant therapy for poorly cohesive carcinoma: a diagnostic pitfall. Pathology 2023. [DOI: 10.1016/j.pathol.2022.12.228] [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: 01/28/2023]
|
5
|
Oon ML, Low SYY, Kuick CH, Goh JY, Chang KTE, McLendon RE, Tan CL. An Unusual Ganglioglioma with Pseudopapillary Features and PRKAR2B-BRAF Fusion. J Neuropathol Exp Neurol 2021; 80:1000-1003. [PMID: 34599823 DOI: 10.1093/jnen/nlab099] [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: 11/13/2022] Open
Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Health System, Singapore, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore.,Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Chik Hong Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jian Yuan Goh
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Roger E McLendon
- Department of Pathology, Duke University Medical Centre, Durham, NC, USA
| | - Char Loo Tan
- Department of Pathology, National University Health System, Singapore, Singapore.,Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
6
|
Lau S, Oon ML, Wu BC, Cheng AJL. Metastatic mucinous adenocarcinoma arising from chronic fistula-in-ano. Jpn J Clin Oncol 2021; 51:1687-1688. [PMID: 34254130 DOI: 10.1093/jjco/hyab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/27/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Samuel Lau
- Department of Diagnostic Imaging, National University Health System
| | - Ming Liang Oon
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Bing Cheng Wu
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Amanda J L Cheng
- Department of Diagnostic Imaging, National University Health System
| |
Collapse
|
7
|
Chuang XE, Chan DYS, Oon ML, Wang S, Chia CLK. Inflammatory myofibroblastic tumour causing intestinal obstruction in a patient with neurofibromatosis type 1. Ann R Coll Surg Engl 2021; 103:e53-e55. [PMID: 33559560 PMCID: PMC9773897 DOI: 10.1308/rcsann.2020.7003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Inflammatory myofibroblastic tumours (IMTs) are rare tumours with unpredictable biological behaviour ranging from benign to locally invasive and rarely, distant metastasis. While neurofibromatosis type 1 (NF1) may manifest with gastrointestinal soft tissue tumours, this is the first report in the literature that describes an IMT occurring in a NF1 patient who presented with intestinal obstruction. Our patient presented with intestinal obstruction secondary to an obstructing terminal ileum mesenteric tumour. En bloc bowel resection was performed, with histology revealing an IMT and an adjacent neurofibroma. The resection margins were clear and the patient was free of recurrence at six months.
Collapse
Affiliation(s)
| | - DYS Chan
- Khoo Teck Puat Hospital, Singapore
| | - ML Oon
- National University Hospital, Singapore
| | - S Wang
- National University Hospital, Singapore
| | - CLK Chia
- Khoo Teck Puat Hospital, Singapore
| |
Collapse
|
8
|
Oon ML, Lim JQ, Lee B, Leong SM, Soon GST, Wong ZW, Lim EH, Li Z, Yeoh AEJ, Chen S, Ban KHK, Chung TH, Tan SY, Chuang SS, Kato S, Nakamura S, Takahashi E, Ho YH, Khoury JD, Au-Yeung RKH, Cheng CL, Lim ST, Chng WJ, Tripodo C, Rotzschke O, Ong CK, Ng SB. T-Cell Lymphoma Clonality by Copy Number Variation Analysis of T-Cell Receptor Genes. Cancers (Basel) 2021; 13:cancers13020340. [PMID: 33477749 PMCID: PMC7832336 DOI: 10.3390/cancers13020340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary T-cells defend the human body from pathogenic invasion via specific recognition by T-cell receptors (TCRs). The TCR genes undergo recombination (rearrangement) in a myriad of possible ways to generate different TCRs that can recognize a wide diversity of foreign antigens. However, in patients with T-cell lymphoma (TCL), a particular T-cell becomes malignant and proliferates, resulting in a population of genetically identical cells with same TCR rearrangement pattern. To help diagnose patients with TCL, a polymerase chain reaction (PCR)-based assay is currently used to determine if neoplastic cells in patient samples are of T-cell origin and bear identical (monoclonal) TCR rearrangement pattern. Herein, we report the application of a novel segmentation and copy number computation algorithm to accurately identify different TCR rearrangement patterns using data from the whole genome sequencing of patient materials. Our approach may improve the diagnostic accuracy of TCLs and can be similarly applied to the diagnosis of B-cell lymphomas. Abstract T-cell lymphomas arise from a single neoplastic clone and exhibit identical patterns of deletions in T-cell receptor (TCR) genes. Whole genome sequencing (WGS) data represent a treasure trove of information for the development of novel clinical applications. However, the use of WGS to identify clonal T-cell proliferations has not been systematically studied. In this study, based on WGS data, we identified monoclonal rearrangements (MRs) of T-cell receptors (TCR) genes using a novel segmentation algorithm and copy number computation. We evaluated the feasibility of this technique as a marker of T-cell clonality using T-cell lymphomas (TCL, n = 44) and extranodal NK/T-cell lymphomas (ENKTLs, n = 20), and identified 98% of TCLs with one or more TCR gene MRs, against 91% detected using PCR. TCR MRs were absent in all ENKTLs and NK cell lines. Sensitivity-wise, this platform is sufficiently competent, with MRs detected in the majority of samples with tumor content under 25% and it can also distinguish monoallelic from biallelic MRs. Understanding the copy number landscape of TCR using WGS data may engender new diagnostic applications in hematolymphoid pathology, which can be readily adapted to the analysis of B-cell receptor loci for B-cell clonality determination.
Collapse
Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
| | - Jing Quan Lim
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore 169610, Singapore;
- Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Bernett Lee
- Singapore Immunology Network (SIgN), A*STAR (Agency for Science, Technology and Research), Singapore 138632, Singapore; (B.L.); (O.R.)
| | - Sai Mun Leong
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
| | - Gwyneth Shook-Ting Soon
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
| | - Zi Wei Wong
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
| | - Evelyn Huizi Lim
- Viva-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.H.L.); (Z.L.); (A.E.J.Y.)
| | - Zhenhua Li
- Viva-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.H.L.); (Z.L.); (A.E.J.Y.)
| | - Allen Eng Juh Yeoh
- Viva-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.H.L.); (Z.L.); (A.E.J.Y.)
- VIVA—University Children’s Cancer Centre, Khoo Teck Puat–National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore 119074, Singapore
| | - Shangying Chen
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore; (S.C.); (K.H.K.B.)
| | - Kenneth Hon Kim Ban
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore; (S.C.); (K.H.K.B.)
| | - Tae-Hoon Chung
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore; (T.-H.C.); (W.-J.C.)
| | - Soo-Yong Tan
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Seiichi Kato
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya 466-8560, Japan; (S.K.); (S.N.)
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya 464-0021, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya 466-8560, Japan; (S.K.); (S.N.)
| | - Emiko Takahashi
- Department of Pathology, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
| | - Yong-Howe Ho
- Department of Pathology, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Joseph D. Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Rex K. H. Au-Yeung
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China;
| | - Chee-Leong Cheng
- Department of Pathology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Soon-Thye Lim
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore;
| | - Wee-Joo Chng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore; (T.-H.C.); (W.-J.C.)
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore 119074, Singapore
| | - Claudio Tripodo
- Tumor Immunology Unit, University of Palermo School of Medicine, 90134 Palermo, Italy;
| | - Olaf Rotzschke
- Singapore Immunology Network (SIgN), A*STAR (Agency for Science, Technology and Research), Singapore 138632, Singapore; (B.L.); (O.R.)
| | - Choon Kiat Ong
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore 169610, Singapore;
- Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore
- Genome Institute of Singapore, A*STAR (Agency for Science, Technology and Research), Singapore 138632, Singapore
- Correspondence: (C.K.O.); (S.-B.N.); Tel.: +65-6436-8269 (C.K.O.); +65-6772-4709 (S-B.N.)
| | - Siok-Bian Ng
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore; (T.-H.C.); (W.-J.C.)
- Correspondence: (C.K.O.); (S.-B.N.); Tel.: +65-6436-8269 (C.K.O.); +65-6772-4709 (S-B.N.)
| |
Collapse
|
9
|
Oon ML, Hendriansyah L, Pratiseyo PD, Wahjoepramono E, Goh JY, Kuick CH, Chang KTE, Perry A, Tan CL. The Multifaceted Appearance of Supratentorial Ependymoma with ZFTA-MAML2 Fusion. Free Neuropathol 2021; 2:2-24. [PMID: 37284641 PMCID: PMC10209857 DOI: 10.17879/freeneuropathology-2021-3397] [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] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/11/2021] [Indexed: 06/08/2023]
Abstract
Ependymomas are glial neoplasms with a wide morphological spectrum. The majority of supratentorial ependymomas are known to harbor ZFTA fusions, most commonly to RELA. We present an unusual case of a 9-year-old boy with a supratentorial ependymoma harboring a noncanonical ZFTA-MAML2 fusion. This case had unusual histomorphological features lacking typical findings of ependymoma and bearing resemblance to a primitive neoplasm with focal, previously undescribed myogenic differentiation. We discuss the diagnostic pitfalls in this case and briefly review the histological features of ependymoma with noncanonical gene fusions. Our report underscores the importance of molecular testing in such cases to arrive at the correct diagnosis. Supratentorial ependymomas with noncanonical fusions are rare, and more studies are necessary for better risk stratification and identification of potential treatment targets.
Collapse
Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Health System, SingaporeSingapore
| | - Lutfi Hendriansyah
- Department of Neurosurgery, Siloam Hospital Lippo Village Karawaci, TangerangIndonesia
| | | | - Eka Wahjoepramono
- Department of Neurosurgery, Siloam Hospital Lippo Village Karawaci, TangerangIndonesia
| | - Jian Yuan Goh
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, SingaporeSingapore
| | - Chik Hong Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, SingaporeSingapore
| | - Kenneth TE Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, SingaporeSingapore
- Duke-NUS Medical School, SingaporeSingapore
| | - Arie Perry
- Departments of Pathology and Neurological Surgery, University of California, San Francisco, CaliforniaUSA
| | - Char Loo Tan
- Department of Pathology, National University Health System, SingaporeSingapore
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, SingaporeSingapore
| |
Collapse
|
10
|
Oon ML, Hoppe MM, Fan S, Phyu T, Phuong HM, Tan SY, Hue SSS, Wang S, Poon LM, Chan HLE, Lee J, Chee YL, Chng WJ, de Mel S, Liu X, Jeyasekharan AD, Ng SB. The contribution of MYC and PLK1 expression to proliferative capacity in diffuse large B-cell lymphoma. Leuk Lymphoma 2019; 60:3214-3224. [PMID: 31259656 DOI: 10.1080/10428194.2019.1633629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
Polo-like kinase-1 (PLK1) regulates the MYC-dependent kinome in aggressive B-cell lymphoma. However, the role of PLK1 and MYC toward proliferation in diffuse large B-cell lymphoma (DLBCL) is unknown. We use multiplexed fluorescent immunohistochemistry (fIHC) to evaluate the co-localization of MYC, PLK1 and Ki67 to study their association with proliferation in DLBCL. The majority (98%, 95% CI 95-100%) of MYC/PLK1-double positive tumor cells expressed Ki67, underscoring the key role of the MYC/PLK1 circuit in proliferation. However, only 38% (95% CI 23-40%) and 51% (95% CI 46-51%) of Ki67-positive cells expressed MYC and PLK1, respectively. Notably, 40% (95% CI 26-43%) of Ki67-positive cells are MYC- and PLK-negative. A stronger correlation exists between PLK1 and Ki67 expression (R = 0.74, p < .001) than with MYC and Ki67 expression (R = 0.52, p < .001). Overall, the results indicate that PLK1 has a higher association than MYC in DLBCL proliferation and there are mechanisms besides MYC and PLK1 influencing DLBCL proliferation.
Collapse
Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Michal M Hoppe
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Shuangyi Fan
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - The Phyu
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hoang M Phuong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Soo-Yong Tan
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- A*STAR, Advanced Molecular Pathology Laboratory, Institute of Molecular and Cell Biology, Singapore, Singapore
| | - Susan Swee-Shan Hue
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
- A*STAR, Advanced Molecular Pathology Laboratory, Institute of Molecular and Cell Biology, Singapore, Singapore
| | - Shi Wang
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Li M Poon
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore, Singapore
| | - Hian L E Chan
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore, Singapore
| | - Joanne Lee
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore, Singapore
| | - Yen L Chee
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore, Singapore
| | - Wee-Joo Chng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore, Singapore
| | - Sanjay de Mel
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore, Singapore
| | - Xin Liu
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore, Singapore
| | - Anand D Jeyasekharan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore, Singapore
| | - Siok-Bian Ng
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
11
|
Oon ML, Soon G, Poon LM, Wang S. Development of monomorphic B-cell plasmacytoma post-transplant lymphoproliferative disorder in a patient with previous autologous stem cell transplant. Pathology 2019; 51:644-646. [PMID: 31470993 DOI: 10.1016/j.pathol.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Gwyneth Soon
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Li Mei Poon
- Department of Haematology-Oncology, National University Hospital, National University Health System, Singapore
| | - Shi Wang
- Department of Pathology, National University Hospital, National University Health System, Singapore.
| |
Collapse
|