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Yang SR, Jayakumaran G, Benhamida J, Febres Aldana CA, Fanaroff R, Chang J, Gedvilaite E, Villafania LB, Sauter JL, Offin M, Zauderer MG, Ladanyi M. Diffuse pleural mesotheliomas with genomic near-haploidization: a newly recognized subset with distinct clinical, histologic, and molecular features. Clin Cancer Res 2024:743086. [PMID: 38630790 DOI: 10.1158/1078-0432.ccr-24-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/13/2024] [Accepted: 04/16/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Diffuse pleural mesotheliomas (DPMs) with genomic near-haploidization (GNH) represent a novel subtype first recognized by the TCGA project; however, its clinicopathologic and molecular features remain poorly defined. EXPERIMENTAL DESIGN We analyzed clinical genomic profiling data from 290 patients with DPM using the MSK-IMPACT assay. Allele-specific copy number analysis was performed using the FACETS algorithm. RESULTS 210 patients were evaluable for LOH analysis using FACETS. In this cohort, GNH was detected in 10 cases (4.8%). Compared to non-GNH tumors, GNH DPMs were associated with younger age and less frequent self-reported history of occupational asbestos exposure. Histologically, GNH DPMs were enriched in biphasic subtype (80% vs. 14.5%) and showed abundant tumor infiltrating lymphocytes (TILs). Genomic analysis revealed a higher frequency of TP53 alterations, while SETDB1 mutations were present in nearly all and only in this subset. The clinicopathologic and molecular findings were further validated in a separate cohort. Despite the younger age, patients with GNH DPMs had a shorter overall survival (10.9 vs. 25.4 months, p=0.004); the poor prognostic impact of GNH remained significant after controlling for biphasic histology. Out of three patients with GNH DPMs who received immune checkpoint blockade (ICB), two achieved a clinician assessed partial response. CONCLUSIONS GNH defines an aggressive subtype of mainly biphasic DPMs in younger patients with recurrent alterations in SETDB1 and TP53. The enrichment in biphasic histology and TILs, together with our preliminary ICB response data and anecdotal clinical trial data, suggests that further evaluation of immunotherapy may be warranted in this subset.
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Affiliation(s)
- Soo-Ryum Yang
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | - Jamal Benhamida
- Memorial Sloan Kettering Cancer Center, New York City, United States
| | | | - Rachel Fanaroff
- University of Maryland Medical Center, Baltimore, MD, United States
| | - Jason Chang
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Erika Gedvilaite
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | | | - Michael Offin
- Memorial Sloan Kettering Cancer Center, Hillsdale, NJ, United States
| | | | - Marc Ladanyi
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Febres-Aldana CA, Fanaroff R, Offin M, Zauderer MG, Sauter JL, Yang SR, Ladanyi M. Diffuse Pleural Mesothelioma: Advances in Molecular Pathogenesis, Diagnosis, and Treatment. Annu Rev Pathol 2024; 19:11-42. [PMID: 37722697 DOI: 10.1146/annurev-pathol-042420-092719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Diffuse pleural mesothelioma (DPM) is a highly aggressive malignant neoplasm arising from the mesothelial cells lining the pleural surfaces. While DPM is a well-recognized disease linked to asbestos exposure, recent advances have expanded our understanding of molecular pathogenesis and transformed our clinical practice. This comprehensive review explores the current concepts and emerging trends in DPM, including risk factors, pathobiology, histologic subtyping, and therapeutic management, with an emphasis on a multidisciplinary approach to this complex disease.
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Affiliation(s)
- Christopher A Febres-Aldana
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
| | - Rachel Fanaroff
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
| | - Michael Offin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marjorie G Zauderer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer L Sauter
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
| | - Soo-Ryum Yang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
| | - Marc Ladanyi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
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3
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Chapoval SP, Gao H, Fanaroff R, Keegan AD. Plexin B1 controls Treg numbers, limits allergic airway inflammation, and regulates mucins. Front Immunol 2024; 14:1297354. [PMID: 38259471 PMCID: PMC10801081 DOI: 10.3389/fimmu.2023.1297354] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
We investigated the effect of global Plexin B1 deficiency on allergic airway responses to house dust mite (HDM) or ovalbumin (OVA). In the HDM model, there were higher Th2 cytokine levels in the BALF of Plexin B1 knock-out (KO) mice compared to wild type (WT), and tissue inflammation and mucus production were modestly enhanced. In the OVA model, Plexin B1 deficiency led to increases in lung inflammation, mucus production, and lung Th2 cytokines accompanied by dysregulated mucin gene expression without affecting anti-OVA IgE/IgG1 levels. Spleen cells from Plexin B1 KO mice proliferated more robustly than WT cells in vitro to a variety of stimuli. Plexin B1 KO CD4+ T cells from spleens expressed higher levels of Ki-67 and CD69 compared to WT cells. Spleen cells from naïve Plexin B1 KO mice secreted increased amounts of IL-4 and IL-6 when pulsed in vitro with OVA whereas in vivo OVA-primed spleen cells produced IL-4/IL-5 when subjected to in vitro OVA restimulation. The upregulated allergic inflammatory response in Plexin B1 KO mice was associated with a lower number of Tregs in the lung tissues. Moreover, these mice displayed lower numbers of Treg cells in the lymphoid tissues at the baseline. These results demonstrate a previously unrecognized link between Plexin B1, Treg cells, and mucus in allergic lung inflammation.
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Affiliation(s)
- Svetlana P. Chapoval
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, United States
- Program in Oncology at the Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Hongjuan Gao
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rachel Fanaroff
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Achsah D. Keegan
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, United States
- Program in Oncology at the Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
- Veteran Affairs (VA) Maryland Health Care System, Baltimore Veteran Affairs (VA) Medical Center, Baltimore, MD, United States
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Paik PK, Fan PD, Qeriqi B, Namakydoust A, Daly B, Ahn L, Kim R, Plodkowski A, Ni A, Chang J, Fanaroff R, Ladanyi M, de Stanchina E, Rudin CM. Targeting NFE2L2/KEAP1 Mutations in Advanced NSCLC With the TORC1/2 Inhibitor TAK-228. J Thorac Oncol 2023; 18:516-526. [PMID: 36240971 PMCID: PMC10500888 DOI: 10.1016/j.jtho.2022.09.225] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 03/17/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Increased insight into the mutational landscape of squamous cell lung cancers (LUSCs) in the past decade has not translated into effective targeted therapies for patients with this disease. NRF2, encoded by NFE2L2, and its upstream regulator, KEAP1, control key aspects of redox balance and are frequently mutated in NSCLCs. METHODS Here, we describe the specific potent activity of TAK-228, a TORC1/2 inhibitor, in NSCLC models harboring NRF2-activating alterations and results of a phase 2 clinical trial of TAK-228 in patients with advanced NSCLC harboring NRF2-activating alterations including three cohorts (NFE2L2-mutated LUSC, KEAP1-mutated LUSC, KRAS/NFE2L2- or KEAP1-mutated NSCLC). RESULTS TAK-228 was most efficacious in a LUSC cohort with NFE2L2 alterations; the overall response rate was 25% and median progression-free survival was 8.9 months. Additional data suggest that concurrent inhibition of glutaminase with the glutaminase inhibitor CB-839 might overcome metabolic resistance to therapy in these patients. CONCLUSIONS TAK-228 has single-agent activity in patients with NRF2-activated LUSC. This study reframes oncogenic alterations as biologically relevant based on their downstream effects on metabolism. This trial represents, to the best of our knowledge, the first successful attempt at metabolically targeting NSCLC and identifies a promising targeted therapy for patients with LUSC, who are bereft of genotype-directed therapies.
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Affiliation(s)
- Paul K Paik
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Pang-Dian Fan
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Current Affiliation, Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | | | - Azadeh Namakydoust
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bobby Daly
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Linda Ahn
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rachel Kim
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ai Ni
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jason Chang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rachel Fanaroff
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Charles M Rudin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
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5
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Burke AP, Hardy N, Fanaroff R, Legesse T. Sarcomatoid Mesothelioma with Bland Histologic Features: A Potential Pitfall in Diagnosis. AJSP Rev Rep 2022; 27:87-93. [PMID: 37538296 PMCID: PMC10398945 DOI: 10.1097/pcr.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Sarcomatoid mesotheliomas can be challenging to diagnose on small biopsy specimens, where limited material may preclude definitive assessment of invasion and lesional cells can have relatively bland cytology with no mesothelial marker expression. We report a case of a patient who presented with a pleural effusion and had subsequent pleural biopsy that showed a bland, uniform spindle cell proliferation in a mildly myxoid background. There was little if any collagen; no chest wall, soft tissue, or fat; and mesothelial markers were negative. The cells were positive for pancytokeratin and GATA3 by immunohistochemistry, and in situ hybridization showed a "negative" result for homozygous loss of CDKN2A; however, there was partial (heterozygous) loss of one allele. A diagnosis of atypical spindle cell proliferation was made based on these findings. Several months later, the patient had a repeat pleural biopsy that showed spindled cells with more pleomorphism, areas of invasion into the chest wall, and the same partial loss of CDKN2A, consistent with a sarcomatoid mesothelioma. This case underscores the challenges present on small biopsy specimens, the fact that sarcomatoid mesotheliomas can be relatively bland appearing with focal pleomorphism, and that heterozygous loss of CDKN2A should be considered a positive result indicative of a neoplastic process.
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Affiliation(s)
| | - Naomi Hardy
- University of Maryland Medical Center. 22 S. Greene St., Baltimore, MD 21201
| | - Rachel Fanaroff
- University of Maryland Medical Center, 22 S. Greene St., Baltimore MD 21201
| | - Teklu Legesse
- University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201
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6
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Fink MY, Qi X, Shirey KA, Fanaroff R, Chapoval S, Viscardi RM, Vogel SN, Keegan AD. Mice Expressing Cosegregating Single Nucleotide Polymorphisms (D298G and N397I) in TLR4 Have Enhanced Responses to House Dust Mite Allergen. J Immunol 2022; 208:2085-2097. [PMID: 35396219 PMCID: PMC9176710 DOI: 10.4049/jimmunol.2100926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/28/2022] [Indexed: 12/13/2022]
Abstract
Asthma is a common and ubiquitous chronic respiratory disease that is associated with airway inflammation and hyperreactivity resulting in airway obstruction. It is now accepted that asthma is controlled by a combination of host genetics and environment in a rather complex fashion; however, the link between sensing of the environment and development and exacerbation of allergic lung inflammation is unclear. Human populations expressing cosegregating D299G and T399I polymorphisms in the TLR4 gene are associated with a decreased risk for asthma in adults along with hyporesponsiveness to inhaled LPS, the TLR4 ligand. However, these data do not account for other human genetic or environmental factors. Using a novel mouse strain that expresses homologous human TLR4 polymorphisms (TLR4-single nucleotide polymorphism [SNP]), we directly tested the effect of these TLR4 polymorphisms on in vivo responses to allergens using two models of induction. We report that intact TLR4 is required for allergic inflammation when using the OVA and LPS model of induction, as cellular and pathological benchmarks were diminished in both TLR4-SNP and TLR4-deficent mice. However, in the more clinically relevant model using house dust mite extract for induction, responses were enhanced in the TLR4-SNP mice, as evidenced by greater levels of eosinophilic inflammation, Th2 cytokine production, and house dust mite-specific IgG1 production compared with wild-type mice; however, mucus production and airway hyperreactivity were not affected. These results suggest that the TLR4 polymorphic variants (genes) interact differently with the allergic stimulation (environment).
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Affiliation(s)
- Marc Y Fink
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD
| | - Xiulan Qi
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD
| | - Kari Ann Shirey
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD
| | - Rachel Fanaroff
- Department of Anatomical Pathology, University of Maryland Medical Center, Baltimore, MD
| | - Svetlana Chapoval
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD
| | - Rose M Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD; and
| | - Stefanie N Vogel
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD
| | - Achsah D Keegan
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD; .,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD.,Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD
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7
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Richard K, Piepenbrink KH, Shirey KA, Gopalakrishnan A, Nallar S, Prantner DJ, Perkins DJ, Lai W, Vlk A, Toshchakov VY, Feng C, Fanaroff R, Medvedev AE, Blanco JCG, Vogel SN. A mouse model of human TLR4 D299G/T399I SNPs reveals mechanisms of altered LPS and pathogen responses. J Exp Med 2021; 218:211550. [PMID: 33216117 PMCID: PMC7685774 DOI: 10.1084/jem.20200675] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/01/2020] [Accepted: 10/09/2020] [Indexed: 12/12/2022] Open
Abstract
Two cosegregating single-nucleotide polymorphisms (SNPs) in human TLR4, an A896G transition at SNP rs4986790 (D299G) and a C1196T transition at SNP rs4986791 (T399I), have been associated with LPS hyporesponsiveness and differential susceptibility to many infectious or inflammatory diseases. However, many studies failed to confirm these associations, and transfection experiments resulted in conflicting conclusions about the impact of these SNPs on TLR4 signaling. Using advanced protein modeling from crystallographic data of human and murine TLR4, we identified homologous substitutions of these SNPs in murine Tlr4, engineered a knock-in strain expressing the D298G and N397I TLR4 SNPs homozygously, and characterized in vivo and in vitro responses to TLR4 ligands and infections in which TLR4 is implicated. Our data provide new insights into cellular and molecular mechanisms by which these SNPs decrease the TLR4 signaling efficiency and offer an experimental approach to confirm or refute human data possibly confounded by variables unrelated to the direct effects of the SNPs on TLR4 functionality.
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Affiliation(s)
- Katharina Richard
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
| | - Kurt H Piepenbrink
- Department of Food Science and Technology, Department of Biochemistry, University of Nebraska, Lincoln, NE
| | - Kari Ann Shirey
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
| | - Archana Gopalakrishnan
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
| | - Shreeram Nallar
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
| | - Daniel J Prantner
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
| | - Darren J Perkins
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
| | - Wendy Lai
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
| | - Alexandra Vlk
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
| | - Vladimir Y Toshchakov
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
| | - Chiguang Feng
- Center for Vaccine Development, University of Maryland, School of Medicine, Baltimore, MD
| | - Rachel Fanaroff
- Department of Anatomical Pathology, University of Maryland Medical Center, Baltimore, MD
| | - Andrei E Medvedev
- Department of Immunology, University of Connecticut Health Center, Farmington, CT
| | | | - Stefanie N Vogel
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD
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Bhat P, Khurana S, Fanaroff R, Adams SM, Rabinowitz RP. Rice body formation due to Haemophilus parainfluenza-associated chronic arthropathy. IDCases 2020; 23:e01030. [PMID: 33384928 PMCID: PMC7770526 DOI: 10.1016/j.idcr.2020.e01030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 11/18/2022] Open
Abstract
A 68-year-old woman with a medical history significant for psoriatic arthritis was found to have an enlarged, painful lump on her left hip 15 months after intramedullary rod placement for a left subtrochanteric femur fracture sustained in a fall. Histopathological findings showed rice body formation (RBF) with concurrent H. parainfluenza. RBF is a relatively rare arthropathy of a subset of chronic inflammatory disease such as rheumatoid arthritis or tuberculous arthropathy. RBF associated with psoriatic arthritis or orthopedic hardware placement has been reported in a handful of cases in the literature but there has not been any definitive evidence for RBF as a result of Haemophilus parainfluenza infections and is a rather unusual characteristic of this case.
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Affiliation(s)
- Pavan Bhat
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA
- Corresponding author.
| | - Sahiba Khurana
- Department of Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA
| | - Rachel Fanaroff
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Scott M. Adams
- Orthopaedic Associates of Central Maryland, Catonsville, MD, USA
| | - Ronald P. Rabinowitz
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Section of Infectious Diseases, Baltimore, MD, USA
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Huang Y, Nasir S, Challa SR, Peng CCH, Stashek K, Fanaroff R, Hu S. Gastric AA amyloidosis secondary to chronic infection presenting with hematemesis: a case report. Clin J Gastroenterol 2020; 13:1070-1073. [PMID: 32852723 DOI: 10.1007/s12328-020-01211-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022]
Abstract
AA amyloidosis, previously known as secondary amyloidosis, has been associated with multiple chronic inflammatory conditions, including various autoimmune diseases and rarely chronic infection. Hereby, we present a case of AA amyloidosis secondary to chronic infection which initially presented with nausea and hematemesis. Endoscopic biopsies revealed diffuse AA amyloid deposition in the stomach, but not the esophagus. AA Amyloidosis presumably compromised gastric motility, promoted reflux related esophageal ulcers and erosions, and caused his cardiac and renal insufficiency. Therefore, endoscopic biopsies could be practical investigation to identify AA amyloidosis in the setting of chronic inflammatory diseases, especially with multi-organ involvement.
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Affiliation(s)
- Yuting Huang
- University of Maryland Medical Center Midtown Campus, 827 Linden Ave, Baltimore, 21201, USA
| | - Salahuddin Nasir
- American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda
| | | | - Carol Chiung-Hui Peng
- University of Maryland Medical Center Midtown Campus, 827 Linden Ave, Baltimore, 21201, USA
| | - Kristen Stashek
- University of Maryland School of Medicine, Baltimore, 21201, USA
| | - Rachel Fanaroff
- University of Maryland School of Medicine, Baltimore, 21201, USA
| | - Shien Hu
- University of Maryland School of Medicine, Baltimore, 21201, USA.
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10
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Hu JY, Fanaroff R, Jeudy J. Porcelain Heart: A Case of Diffuse Myocardial Calcification. Radiol Cardiothorac Imaging 2020; 2:e190204. [PMID: 33778584 DOI: 10.1148/ryct.2020190204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/30/2019] [Accepted: 01/27/2020] [Indexed: 11/11/2022]
Abstract
The pathophysiology of myocardial calcifications is variable and may have potentially fatal consequences if undiagnosed and untreated.
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Affiliation(s)
- Jiun-Yiing Hu
- Departments of Diagnostic Radiology & Nuclear Medicine (J.J.) and Pathology (R.F.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; and the University of Maryland School of Medicine (J.Y.H., J.J.).,J.Y.H. (e-mail: )
| | - Rachel Fanaroff
- Departments of Diagnostic Radiology & Nuclear Medicine (J.J.) and Pathology (R.F.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; and the University of Maryland School of Medicine (J.Y.H., J.J.).,J.Y.H. (e-mail: )
| | - Jean Jeudy
- Departments of Diagnostic Radiology & Nuclear Medicine (J.J.) and Pathology (R.F.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; and the University of Maryland School of Medicine (J.Y.H., J.J.).,J.Y.H. (e-mail: )
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11
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Fanaroff R, Goldberg E, Papadimitriou JC, Twaddell WS, Daly B, Drachenberg CB. Emphysematous gastritis due to Sarcina ventriculi infection in a diabetic liver-kidney transplant recipient. Autops Case Rep 2020; 10:e2020164. [PMID: 33344282 PMCID: PMC7703457 DOI: 10.4322/acr.2020.164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Emphysematous gastritis (EG) is a rare and potentially lethal process caused by invasive, gas-producing bacteria leading to inflammation and gas dissection of the stomach. The most common etiologic agents are Clostridium infections, but other organisms, including enterobacteria, staphylococcus, and fungi have also been identified. We report the first case of EG due to Sarcina ventriculi in a solid organ transplant recipient, who presented with epigastric pain and vomiting. The patient had a history of type 1 diabetes mellitus (DM) with recurrent episodes of ketoacidosis and systemic diabetic complications, including severe gastroparesis. CT scan studies demonstrated EG with venous air, and endoscopy showed severe gastritis and ulcerations. In the gastric biopsies, abundant Sarcina ventriculi were noted in areas of mucosal/submucosal necrosis. Antibiotic treatment was instituted at admission, and subsequent endoscopy demonstrated the disappearance of Sarcina, with some improvement of the gastric inflammation; however, the patient developed septic shock with multiorgan failure and expired. This case highlights the need to consider other infectious etiologies in transplant patients, in addition to the well-known opportunistic infections.
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Affiliation(s)
- Rachel Fanaroff
- University of Maryland School of Medicine, Department of Pathology. Baltimore, MD, USA
| | - Eric Goldberg
- University of Maryland School of Medicine, Department of Medicine. Baltimore, MD, USA
| | - John C Papadimitriou
- University of Maryland School of Medicine, Department of Pathology. Baltimore, MD, USA
| | - William S Twaddell
- University of Maryland School of Medicine, Department of Pathology. Baltimore, MD, USA
| | - Barry Daly
- University of Maryland School of Medicine, Diagnostic Radiology and Nuclear Medicine. Baltimore, MD, USA
| | - Cinthia B Drachenberg
- University of Maryland School of Medicine, Department of Pathology. Baltimore, MD, USA
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12
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Adashek M, Chan AS, Heath J, Fanaroff R, Kallen ME, Friedberg JS, Culligan M, Khashab T, Miller KD. Prognostic value of tumor infiltrating lymphocytes in epithelioid malignant pleural mesothelioma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20064 Background: Malignant Mesothelioma (MM) is an aggressive malignancy with survival of 4-12 mo. without treatment and 10% 5-year survival. The response of patients with MM to immunotherapy has increased interest in the tumor immune microenvironment. The purpose of this study was to determine if tumor infiltrating lymphocytes (TIL) are correlated with survival in epithelioid MM. Methods: Immunohistochemistry was performed on specimens from 27 patients with epithelioid mesothelioma using CD4, CD8, and CD68 antibodies. Infiltrate density was scored (0-3+) by pathologist estimate in intratumoral and adjacent tumoral tissue. ANOVA and regression analysis were performed. Overall survival (OS) for the entire group and time to progression (TTP) for nine patients with known time from surgery until tumor recurrence were also studied as a surgical resection subgroup (SRG). Results: For the small SRG the relationship between (TTP) and TIL score of CD8 at the edge of the tumor was significant (F[2,6]=5.64, P=.042) however TIL score of intratumoral CD8 cell infiltrates and TTP did not demonstrate statistical significance. The relationship between OS with CD8 infiltrate at the tumor edge, for the entire group, approached significance at (F [3,22]=2.93, P=0.056). TTP and OS and the TIL score of CD4, CD68 at both tumor center and tumor edge did not demonstrate statistical significance. Conclusions: CD8+ lymphocytes are an important component of host immune defense against cancer. We found that in epithelioid MM the cellular infiltrate of CD8 lymphocytes at the edge of the tumor (but not with intratumoral CD8) was associated with longer time to recurrence. TTP and OS were not associated with CD4 and CD68 within or at the tumor edge. The role of CD8 T-cells and the quantitative difference between CD8 at the edge of tumor and intratumoral CD8 should be further investigated in order to optimize immunotherapy.
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Affiliation(s)
| | - Abigail Sy Chan
- Sinai Hospital of Baltimore, Department of Internal Medicine, Baltimore, MD
| | - Johnathan Heath
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA, Baltimore, MD
| | - Rachel Fanaroff
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Michael E Kallen
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA, Baltimore, MD
| | | | - Melissa Culligan
- University of Maryland Marlene & Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Tamara Khashab
- University of Maryland Marlene & Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Kenneth David Miller
- University of Maryland Marlene & Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
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