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Roelofs KA, Juniat V, O'Rouke M, Ledbetter L, Hubschman S, Hardy T, Lee J, Baugh S, Pullarkat ST, Selva D, Goldberg RA, Rootman DB. Radiologic Features of Well-circumscribed Orbital Tumors With Histopathologic Correlation: A Multi-center Study. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00313. [PMID: 38215460 DOI: 10.1097/iop.0000000000002584] [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: 01/14/2024]
Abstract
PURPOSE To delineate specific imaging characteristics of solitary fibrous tumors, schwannomas, cavernous venous malformations, and well-circumscribed orbital lymphoma. METHODS Patients undergoing excisional biopsy of solitary fibrous tumor, schwannomas, cavernous venous malformations, or well-circumscribed orbital lymphoma with preoperative MRIs available for review were identified at 3 academic centers in the United States and Australia. An exploratory statistical analysis was performed to identify important radiologic features, which were subsequently included in a random forest model. Histopathologic correlates were evaluated in representative cases. RESULTS A total of 91 cases were included with a mean age of 52.9 ± 17.2 years. Nearly all solitary fibrous tumors were located in the anterior or mid orbit (87.5%) and they more commonly demonstrated intralesional heterogeneity on T2-weighted imaging (45.5%) (p < 0.01). Compared with the other tumors, schwannomas tended to be intraconal (66.7%) and were often in the mid or posterior orbit (83.4%) (p < 0.01). Cavernous venous malformations characteristically demonstrated progressive contrast enhancement (93.9%; p < 0.01). Most lesions in all 4 groups were hypointense on T1-weighted imaging (80%-100%; p = 0.14) and only well-circumscribed orbital lymphoma tended to also be hypointense on T2 (81.8%) (p < 0.01). Finally, cases of lymphoma had significantly lower apparent diffusion coefficient ratios (0.9 ± 0.2) (p < 0.001), while the other 3 groups were not significantly different from one another (cavernous venous malformations: 1.8 ± 0.4; schwannomas: 1.8 ± 0.5; and solitary fibrous tumor: 1.6 ± 0.6) (p = 0.739). CONCLUSIONS Key features that aid in the differentiation of these 4 tumors from one another include T2 intensity and homogeneity, early contrast-enhancement pattern, and ADC ratio.
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Affiliation(s)
- Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Valerie Juniat
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael O'Rouke
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Luke Ledbetter
- Department of Radiology, University of California, Los Angeles, California, U.S.A
| | - Sasha Hubschman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Thomas Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Jean Lee
- Department of Medical Imaging, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Sheeja T Pullarkat
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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Nassif C, Crabtree M, Pullarkat ST. Isolated Asymptomatic Colonic Plasmacytoma Presenting as a Polyp at Screening Colonoscopy. ACG Case Rep J 2023; 10:e01069. [PMID: 37312758 PMCID: PMC10259640 DOI: 10.14309/crj.0000000000001069] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
Isolated extramedullary plasmacytomas (IEMPs) are rare. Extramedullary plasmacytomas (EMPs) are uncommon and mostly occur in the nasopharynx or upper respiratory tract. EMP involvement of the gastrointestinal tract occurs in approximately 10% of cases, more often in the small bowel than the colon. Less than 40 cases of colonic IEMP have been reported. Asymptomatic colonic IEMPs are extremely rare with few reported cases. We present a 57-year-old asymptomatic man with a colonic IEMP found during screening colonoscopy. A sigmoid colon polyp was removed and diagnosed as a plasmacytoma. Further investigation revealed it to be an isolated lesion.
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Affiliation(s)
| | - Matthew Crabtree
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Sheeja T. Pullarkat
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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3
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Dillon AB, Budoff G, McCannel CA, Tsui E, Pullarkat ST, Schwartz SD. Ocular Toxoplasmosis: No Stranger to the Masquerade Ball. Journal of VitreoRetinal Diseases 2022; 6:391-398. [PMID: 37006900 PMCID: PMC9954925 DOI: 10.1177/24741264211056769] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This article illustrates multiple atypical manifestations of ocular toxoplasmosis masquerading as acute retinal necrosis and vitreoretinal lymphoma. Methods: Two case presentations are discussed, and the body of pertinent literature is reviewed and discussed. Results: In these cases, an extensive workup and attention to history lead to the correct diagnosis and management. Conclusions: Aggressive cases of ocular toxoplasmosis may present in a variety of phenotypes that may mimic other vision- and potentially life-threatening conditions, particularly in a milieu of inadequate endogenous and exogenous antimicrobial defenses.
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Affiliation(s)
- Alexander B. Dillon
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Greg Budoff
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Colin A. McCannel
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Edmund Tsui
- Uveitis Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | | | - Steven D. Schwartz
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Chen W, Dabaja B, Daly ME, Gordon LI, Hansen N, Herrera AF, Hochberg EP, Johnston PB, Kaminski MS, Kelsey CR, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, Metzger M, Morgan D, Mulroney C, Pullarkat ST, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Torka P, Winter JN, Yahalom J, Yang JC, Burns JL, Campbell M, Sundar H. NCCN Guidelines® Insights: Hodgkin Lymphoma, Version 2.2022. J Natl Compr Canc Netw 2022; 20:322-334. [PMID: 35390768 DOI: 10.6004/jnccn.2022.0021] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hodgkin lymphoma (HL) is an uncommon malignancy of B-cell origin. Classical HL (cHL) and nodular lymphocyte-predominant HL are the 2 main types of HL. The cure rates for HL have increased so markedly with the advent of modern treatment options that overriding treatment considerations often relate to long-term toxicity. These NCCN Guidelines Insights discuss the recent updates to the NCCN Guidelines for HL focusing on (1) radiation therapy dose constraints in the management of patients with HL, and (2) the management of advanced-stage and relapsed or refractory cHL.
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Affiliation(s)
| | | | - Weiyun Z Ai
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Weina Chen
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | - Ryan C Lynch
- Fred Hutchinson Cancer Research Center/University of Washington
| | - Kami Maddocks
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Monika Metzger
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | | | - Randa Tao
- Huntsman Cancer Institute at the University of Utah
| | | | - Jane N Winter
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Joanna C Yang
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; and
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Lee CM, Asilnejad B, Cohen LM, Roelofs KA, Rootman DB, Khanlou N, Pullarkat ST. Solitary Extramedullary Plasmacytoma of the Lacrimal Sac With Associated Crystal-Storing Histiocytosis. Ophthalmic Plast Reconstr Surg 2022; 38:102-107. [PMID: 34406151 DOI: 10.1097/iop.0000000000002028] [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] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a rare case of crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma of the lacrimal sac and to review literature on the 2 entities to summarize important diagnostic, management, and prognostic considerations. METHODS A case report of the ophthalmologic presentation, pathology workup, and oncologic management is presented. Literature search with focus on lesions occurring in ophthalmic sites and management guidelines from expert panels and working groups. RESULTS Crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma arose within the lacrimal sac of a previously healthy middle-aged woman and presented as a painless nodule with epiphora. The biopsy tissue showed sheets of crystal-filled histiocytes, interspersed with monoclonal plasma cells and rarely demonstrated plasma cell phagocytosis. Imaging and laboratory studies confirmed the localized nature. CONCLUSIONS Crystal-storing histiocytosis is an uncommon entity in which crystals, most commonly arising from altered immunoglobulins, aggregate within histiocytes and form symptomatic mass lesions. It has been reported in ophthalmic regions in patients with a concurrent lymphoproliferative or plasma cell disorder and can rarely predate a malignancy. The current case is notable because crystal-storing histiocytosis occurs with a localized process, solitary extramedullary plasmacytoma, and presents in an unusual site, the lacrimal sac. Tissue biopsy with multimodal pathological evaluation is necessary to make the diagnosis. Ophthalmologists should recognize that crystal-storing histiocytosis is commonly associated with a hematologic malignancy and, when appropriate, refer the patient for oncologic management. Surveillance may be indicated in cases with no established etiology. Solitary extramedullary plasmacytoma should also be monitored, as a proportion of cases progress to multiple myeloma.
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Affiliation(s)
- Christine M Lee
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brenda Asilnejad
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Negar Khanlou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sheeja T Pullarkat
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Ku NK, Pullarkat ST, Kim YS, Cheng L, O'Malley D. Use of CD42b immunohistochemical stain for the detection of Histoplasma. Ann Diagn Pathol 2018; 32:47-50. [PMID: 29414398 DOI: 10.1016/j.anndiagpath.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 11/18/2022]
Abstract
In pathologic specimen, Histoplasma capsulatum can frequently be identified by morphology and special stains such as GMS and PAS. Incidentally, we noted unusual staining of the platelet associated marker CD42b/GP1b expressed on the surface of fungal organisms. Evaluation of additional cases demonstrated that a majority of histoplasmosis cases (15/18 cases; 83%) showed positive staining with CD42b/GP1b, comparable to GMS stain results. Other platelet associated markers such as Factor VIII and CD61 showed no or rare expression (1/18 cases with Factor VIII). Studies have shown that 14-3-3 proteins bind directly to cytoplasmic domain of CD42b/GP1b. Significant homology is seen between fungal and human 14-3-3 proteins which may represent a molecular basis for our observation. Our study demonstrated that CD42b/GP1b staining by immunohistochemistry can aid in detection of Histoplasma organisms. Further studies with organisms with similar morphologic features such as Blastomyces and Leishmania may demonstrate a diagnostic utility in speciating organisms.
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Affiliation(s)
- Nam K Ku
- Department of Pathology, University of California, Davis, Sacramento, CA, United States.
| | - Sheeja T Pullarkat
- Department of Pathology, University of California, Los Angeles, Los Angeles, CA, United States.
| | - Young S Kim
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, United States.
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, United States.
| | - Dennis O'Malley
- Neogenomics, Aliso Viejo, CA, United States; Department of Hematopathology, M.D. Anderson Cancer Center, Houston, TX, United States.
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7
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Agerbæk MØ, Pereira MA, Clausen TM, Pehrson C, Oo HZ, Spliid C, Rich JR, Fung V, Nkrumah F, Neequaye J, Biggar RJ, Reynolds SJ, Tosato G, Pullarkat ST, Ayers LW, Theander TG, Daugaard M, Bhatia K, Nielsen MA, Mbulaiteye SM, Salanti A. Burkitt lymphoma expresses oncofetal chondroitin sulfate without being a reservoir for placental malaria sequestration. Int J Cancer 2017; 140:1597-1608. [PMID: 27997697 PMCID: PMC5318225 DOI: 10.1002/ijc.30575] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/02/2016] [Indexed: 12/22/2022]
Abstract
Burkitt lymphoma (BL) is a malignant disease, which is frequently found in areas with holoendemic Plasmodium falciparum malaria. We have previously found that the VAR2CSA protein is present on malaria-infected erythrocytes and facilitates a highly specific binding to the placenta. ofCS is absent in other non-malignant tissues and thus VAR2CSA generally facilitates parasite sequestration and accumulation in pregnant women. In this study, we show that the specific receptor for VAR2CSA, the oncofetal chondroitin sulfate (ofCS), is likewise present in BL tissue and cell lines. We therefore explored whether ofCS in BL could act as anchor site for VAR2CSA-expressing infected erythrocytes. In contrast to the placenta, we found no evidence of in vivo sequestering of infected erythrocytes in the BL tissue. Furthermore, we found VAR2CSA-specific antibody titers in children with endemic BL to be lower than in control children from the same malaria endemic region. The abundant presence of ofCS in BL tissue and the absence of ofCS in non-malignant tissue encouraged us to examine whether recombinant VAR2CSA could be used to target BL. We confirmed the binding of VAR2CSA to BL-derived cells and showed that a VAR2CSA drug conjugate efficiently killed the BL-derived cell lines in vitro. These results identify ofCS as a novel therapeutic BL target and highlight how VAR2CSA could be used as a tool for the discovery of novel approaches for directing BL therapy.
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Affiliation(s)
- Mette Ø. Agerbæk
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marina A. Pereira
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas M. Clausen
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - Caroline Pehrson
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Htoo Zarni Oo
- Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - Charlotte Spliid
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Janet Neequaye
- Department of Child Health, Korle Bu University Teaching Hospital, Accra, Ghana
| | - Robert J. Biggar
- Institute of Health and Biotechnology, Queensland University of Technology, Brisbane, Australia
| | - Steven J. Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Giovanna Tosato
- Laboratory of Cellular Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sheeja T. Pullarkat
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles
| | - Leona W. Ayers
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Thor G. Theander
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mads Daugaard
- Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Morten A. Nielsen
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ali Salanti
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
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Arcega RS, Feinstein AJ, Bhuta S, Blackwell KE, Rao NP, Pullarkat ST. An unusual initial presentation of mantle cell lymphoma arising from the lymphoid stroma of warthin tumor. Diagn Pathol 2015; 10:209. [PMID: 26634829 PMCID: PMC4669604 DOI: 10.1186/s13000-015-0444-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 10/16/2015] [Accepted: 11/28/2015] [Indexed: 02/07/2023] Open
Abstract
Background Warthin tumors presenting concomitantly with a lymphoma is vanishingly rare with only 15 reported cases in English literature. Herein, we report an unusual initial presentation of a mantle cell lymphoma involving the lymphoid stroma of a Warthin tumor. Case presentation A seventy-seven year old otherwise healthy gentleman with a 50-pack year smoking history presents with a slowly enlarging left cheek mass. CT scan of the neck demonstrated a left parotid gland tumor measuring 3.4 cm in greatest dimension. He underwent a left superficial parotidectomy, with subsequent histopathologic examination revealing a Warthin tumor with extensive expansion of the lymphoid stroma. Flow cytometric, immunohistochemical, and cytogenetic studies of the stromal component of the tumor confirmed the presence of a mantle cell lymphoma. Clinical staging demonstrated stage IVa disease, and was considered to be at low to intermediate risk due to the slow growth of the parotid lesion. The patient is undergoing close follow up with repeat PET-CT scans at six months. Conclusion To the best of our knowledge, this is the first well documented collision tumor between mantle cell lymphoma and a Warthin tumor. This case also brings to light the significance of thorough evaluation of the lymphoid component of Warthin tumor.
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Affiliation(s)
- Ramir S Arcega
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA.
| | - Aaron J Feinstein
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, USA.
| | - Sunita Bhuta
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA.
| | - Keith E Blackwell
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, USA.
| | - Nagesh P Rao
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA.
| | - Sheeja T Pullarkat
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA.
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Lum EL, Schaenman JM, DeNicola M, Reddy UG, Shen JI, Pullarkat ST. A case report of CMV lymphadenitis in an adult kidney transplant recipient. Transplant Proc 2015; 47:141-5. [PMID: 25645793 DOI: 10.1016/j.transproceed.2014.09.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
Abstract
Cytomegalovirus (CMV) infection following kidney transplantation is associated with increased morbidity and mortality. In this case report we describe a case of a 23-year-old woman with an unusual presentation of diffuse CMV lymphadenitis following kidney transplantation that did not respond to gangiclovir therapy. This case highlights the atypical presentation of CMV disease in a kidney transplant recipient, the importance of CMV hypergammaglobulin in the treatment of CMV infection post kidney transplantation, and the difficulties in transitioning care from pediatric to adult transplant programs.
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Affiliation(s)
- E L Lum
- UCLA David Geffen School of Medicine Department of Medicine, Division of Nephrology, Kidney Transplant, Los Angeles, Califonia, USA.
| | - J M Schaenman
- UCLA David Geffen School of Medicine Department of Medicine, Infectious Diseases, Los Angeles, Califonia, USA
| | - M DeNicola
- UCLA David Geffen School of Medicine Department of Pathology, Los Angeles, Califonia, USA
| | - U G Reddy
- UCLA David Geffen School of Medicine Department of Medicine, Division of Nephrology, Kidney Transplant, Los Angeles, Califonia, USA
| | - J I Shen
- UCLA Harbor Department of Medicine, Division of Nephrology, Los Angeles, Califonia, USA
| | - S T Pullarkat
- UCLA David Geffen School of Medicine Department of Pathology, Los Angeles, Califonia, USA
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10
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Tirado CA, Shabsovich D, Yeh L, Pullarkat ST, Yang L, Kallen M, Rao N. A (1;19) translocation involving TCF3-PBX1 fusion within the context of a hyperdiploid karyotype in adult B-ALL: a case report and review of the literature. Biomark Res 2015; 3:4. [PMID: 25729575 PMCID: PMC4344763 DOI: 10.1186/s40364-015-0029-0] [Citation(s) in RCA: 6] [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: 12/18/2014] [Revised: 01/23/2015] [Accepted: 01/30/2015] [Indexed: 01/26/2023] Open
Abstract
Background The t(1;19)(q23;p13), which can result in the TCF3-PBX1 chimeric gene, is one of the most frequent translocations in B-acute lymphoblastic leukemia (B-ALL) and is observed in both adult and pediatric populations at an overall frequency of 6%. It can occur in a balanced or unbalanced form and as a sole abnormality is associated with an intermediate prognosis. Additionally, this translocation is observed in the context of hyperdiploid B-ALL, in which case it is associated with a poor prognosis. However, due to different translocation partner genes at chromosomes 1 and 19, distinct subtypes of hyperdiploid B-ALL with t(1;19)/der(19)t(1;19) are recognized based on the presence or absence of the TCF3-PBX1 fusion gene, but the cytogenetic and etiologic differences between the two remain understudied. Findings We report a case of an adult with a history of relapsed precursor B-ALL whose conventional cytogenetics showed an abnormal female karyotype with both hyperdiploidy and a t(1;19)(q23;p13). Fluorescence in situ hybridization (FISH) on previously G-banded metaphases using the LSI TCF3/PBX1 Dual Color, Dual Fusion Translocation Probe confirmed the presence of the TCF3-PBX1 gene fusion. Conclusions This particular pattern with a TCF3-PBX1 fusion within the context of a hyperdiploid karyotype is seen in B-ALL and is usually associated with a poor outcome. This case is one of only a few cases with both hyperdiploidy and a confirmed TCF3-PBX1 fusion, demonstrating the importance of using FISH for proper molecular classification of these cases in order to distinguish them from those with hyperdiploidy but no TCF3-PBX1 fusion gene. Such molecular studies may provide insight into the precise differences between TCF3-PBX1 positive and negative hyperdiploid B-ALL bearing the t(1;19)(q23;p13).
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Affiliation(s)
- Carlos A Tirado
- Department of Pathology and Laboratory Medicine, David Geffen UCLA School of Medicine, Los Angeles, CA 90024 USA
| | - David Shabsovich
- Department of Pathology and Laboratory Medicine, David Geffen UCLA School of Medicine, Los Angeles, CA 90024 USA
| | - Lei Yeh
- Department of Pathology and Laboratory Medicine, David Geffen UCLA School of Medicine, Los Angeles, CA 90024 USA
| | - Sheeja T Pullarkat
- Department of Pathology and Laboratory Medicine, David Geffen UCLA School of Medicine, Los Angeles, CA 90024 USA
| | - Lynn Yang
- Department of Pathology and Laboratory Medicine, David Geffen UCLA School of Medicine, Los Angeles, CA 90024 USA
| | - Michael Kallen
- Department of Pathology and Laboratory Medicine, David Geffen UCLA School of Medicine, Los Angeles, CA 90024 USA
| | - Nagesh Rao
- Department of Pathology and Laboratory Medicine, David Geffen UCLA School of Medicine, Los Angeles, CA 90024 USA
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11
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Wu W, Doan N, Said J, Karunasiri D, Pullarkat ST. Strong expression of chemokine receptor CCR9 in diffuse large B-cell lymphoma and follicular lymphoma strongly correlates with gastrointestinal involvement. Hum Pathol 2014; 45:1451-8. [PMID: 24828696 DOI: 10.1016/j.humpath.2014.02.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 11/18/2013] [Revised: 02/18/2014] [Accepted: 02/28/2014] [Indexed: 11/30/2022]
Abstract
The gastrointestinal (GI) tract is the most common site of extranodal B-cell lymphomas. However, it is unclear how neoplastic lymphoid cells preferentially home there. We hypothesize that expression of the GI-homing chemokine receptor CCR9 may account for the dissemination of B-cell lymphomas to the GI tract. To test our hypothesis, we compared the expression of CCR9 using immunohistochemistry on GI versus nodal diffuse large B-cell lymphoma and follicular lymphoma. We found that 27 (66%) of 41, 12 (29%) of 41, and 2 (5%) of 41 of GI lymphoma cases demonstrated 3+, 2+, and 1+ CCR9 staining, respectively. In contrast, 2 (5%) of 39, 5 (13%) of 39, 8 (20.5%) of 39, and 24 (61.5%) of 39 nodal-restricted lymphoma cases demonstrated 3+, 2+, 1+, and 0+ CCR9 staining (P < .0001). This was observed for both diffuse large B-cell lymphoma (P < .001) and follicular lymphoma (P < .001). We also compared the expression of CCR9 on nodal B-cell lymphomas with involvement of the GI tract with those restricted to the lymph node. We found that 10 (62%) of 16, 3 (19%) of 16, and 3 (19%) of 16 nodal lymphomas with GI involvement showed 3+, 2+, and 1+ CCR9 staining, respectively. In contrast, 2 (5%) of 39, 5 (13%) of 39, 8 (20.5%) of 39, and 24 (61.5%) of 39 nodal lymphomas without GI involvement demonstrated 3+, 2+, 1+, and 0+ CCR9 staining, respectively (P < .001). Our finding that CCR9 expression is elevated in the nodal lymphomas of patients with GI involvement suggests the potential clinical utility of chemokine receptor status, as assessed by immunohistochemistry, to potentially predict GI dissemination and progression to higher stage in patients who initially present with limited nodal-restricted disease.
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Affiliation(s)
- Winnie Wu
- Department of Pathology, University of California Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, CA, 90095-1732, USA
| | - Ngan Doan
- Department of Pathology, University of California Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, CA, 90095-1732, USA
| | - Jonathan Said
- Department of Pathology, University of California Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, CA, 90095-1732, USA
| | - Deepthi Karunasiri
- Department of Pathology, Olive-View Medical Center, Sylmar, CA, 91342-1495, USA
| | - Sheeja T Pullarkat
- Department of Pathology, University of California Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, CA, 90095-1732, USA.
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12
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Pullarkat ST, Pullarkat V, Lagoo A, Brynes R, Weiss LM, Bedell V, Chen W, Huang Q, Gaal K, Weisenburger DD, Kim YS. Characterization of bone marrow mast cells in acute myeloid leukemia with t(8;21) (q22;q22); RUNX1-RUNX1T1. Leuk Res 2013; 37:1572-5. [DOI: 10.1016/j.leukres.2013.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
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13
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Kantarci S, Cherukuri DP, Rao NP, Pullarkat ST. A Novel BCL2 Gene Rearrangement, t(5;18)(q31;q21), in Follicular Lymphoma. Cancer Genet 2013. [DOI: 10.1016/j.cancergen.2013.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Mbulaiteye SM, Pullarkat ST, Nathwani BN, Weiss LM, Rao N, Emmanuel B, Lynch CF, Hernandez B, Neppalli V, Hawes D, Cockburn MG, Kim A, Williams M, Altekruse S, Bhatia K, Goodman MT, Cozen W. Epstein-Barr virus patterns in US Burkitt lymphoma tumors from the SEER residual tissue repository during 1979-2009. APMIS 2013; 122:5-15. [PMID: 23607450 DOI: 10.1111/apm.12078] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 02/18/2013] [Indexed: 11/28/2022]
Abstract
Burkitt lymphoma (BL) occurs at all ages, but the patterns of Epstein-Barr virus (EBV) positivity in relation to human immunodeficiency virus (HIV), immunoprofiles and age have not been fully explored. BL tissues from residual tissue repositories, and two academic centers in the United States were examined by expert hematopathologists for morphology, immunohistochemistry, MYC rearrangement, EBV-encoded RNA (EBER), and diagnosed according to the 2008 WHO lymphoma classification. Analysis was done using frequency tables, Chi-squared statistics, and Student's t-test. Of 117 cases examined, 91 were confirmed as BL. The age distribution was 26%, 15%, 19%, and 29% for 0-19, 20-34, 35-59, 60+ years, and missing in 11%. MYC rearrangement was found in 89% and EBER positivity in 29% of 82 cases with results. EBER positivity varied with age (from 13% in age group 0-19 to 55% in age group 20-34, and fell to 25% in age group 60+ years, p = 0.08); with race (56% in Blacks/Hispanics vs 21% in Whites/Asians/Pacific Islanders, p = 0.006); and by HIV status (64% in HIV positive vs 22% in HIV negative cases, p = 0.03). EBER positivity was demonstrated in about one-third of tumors and it was strongly associated with race and HIV status, and marginally with age-group.
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Affiliation(s)
- Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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15
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Wong AK, Kerkoutian S, Said J, Rashidi H, Pullarkat ST. Risk of lymphoma in patients receiving antitumor necrosis factor therapy: a meta-analysis of published randomized controlled studies. Clin Rheumatol 2011; 31:631-6. [PMID: 22147207 DOI: 10.1007/s10067-011-1895-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [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: 05/04/2011] [Revised: 11/01/2011] [Accepted: 11/04/2011] [Indexed: 12/19/2022]
Abstract
The 2008 edition of the WHO Classification of Tumours of Haematopoietic and Lymphoid tissues recognizes a new diagnostic entity termed "other iatrogenic immunodeficiency-associated lymphoproliferative disorders" highlighting lymphomas arising in patients treated with immunosuppressive agents for autoimmune disorders. The role of antitumor necrosis factor alpha therapy (anti-TNFα) and lymphoma risk in rheumatoid arthritis (RA) patients remains unclear; therefore, the goal of our study was to determine whether anti-TNFα therapy is associated with iatrogenic lymphomas. A meta-analysis of all randomized controlled clinical trials published (2000-2009) in RA patients receiving anti-TNFα therapy was performed. Fourteen studies fulfilled all search criteria and included 2,306 control patients and 5,179 patients treated with anti-TNFα therapy, namely etanercept, adalumimab, and infliximab. Clinical information including the number of patients, age, gender, lymphoma rates, and follow-up time was recorded. The overall rate and rate differences were analyzed using the DerSimonian and Laird method. Of the control group, four (4/2,306, 0.17%) patients developed hematolymphoid neoplasms. Eleven (11/5,179, 0.21%) patients receiving anti-TNFα therapy developed lymphomas. The adjusted overall rates are 0.36 lymphomas per 1,000 person-years in patients who did not receive anti-TNFα therapy versus 1.65 lymphomas per 1,000 person-years in patients who received anti-TNFα therapy. The corresponding 95% confidence interval for this rate difference is (-0.214, 2.79). The adjusted rate difference is 1.29 lymphomas per 1,000 person-years (95% CI, -0.21, 2.8; p value = 0.093). The corresponding p value is p = 0.0928. There is a suggestion of increased lymphomas in the treated group, with the predominant subset being B-cell lymphomas. Since the outcome of lymphoma is rare, it does not reach statistical significance of p < 0.05.
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Affiliation(s)
- Anna K Wong
- Department of Pathology and Laboratory Medicine, UCSD School of Medicine, San Diego, CA, USA
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16
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Acree SC, Pullarkat ST, Quismorio FP, Mian SR, Brynes RK. Adult Leukemic Synovitis Is Associated With Leukemia of Monocytic Differentiation. J Clin Rheumatol 2011; 17:130-4. [DOI: 10.1097/rhu.0b013e318214befe] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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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17
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Alexanian S, Wong AK, Said J, Aoyama C, Park A, Pullarkat ST. Intravascular extranodal NK/T-cell lymphoma, nasal type, presenting as acute abdomen. J Hematop 2010. [DOI: 10.1007/s12308-010-0076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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18
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Ho T, Sedarat F, Rao N, Pullarkat ST. Diagnostic confusion resulting from CD56 expression by cutaneous myeloid sarcoma. Rare Tumors 2009; 1:e51. [PMID: 21139930 PMCID: PMC2994451 DOI: 10.4081/rt.2009.e51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/04/2009] [Indexed: 11/23/2022] Open
Abstract
Myeloid sarcomas are tumor masses composed of aggregates of malignant myeloid precursors in extramedullary sites including the skin. We report a case of myeloid sarcoma in a patient who presented with an ear lobe mass and facial nerve paralysis. Expression of CD56 by the malignant cells led to an initial misdiagnosis as Merkel cell tumor. Comprehensive pathological evaluation confirmed the diagnosis of myeloid sarcoma with aberrant expression of CD56 and carrying the translocation t(8;21) (q22;q22). Aberrant antigen expression by cutaneous myeloid sarcomas can cause diagnostic confusion with other cutaneous neoplasms. This is especially relevant when myeloid sarcoma is the sole manifestation of acute myeloid leukemia.
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Affiliation(s)
- Thanh Ho
- Department of Pathology and Laboratory Medicine and
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19
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Pullarkat ST, Danley K, Bernstein L, Brynes RK, Cozen W. High lifetime incidence of adult acute lymphoblastic leukemia among Hispanics in California. Cancer Epidemiol Biomarkers Prev 2009; 18:611-5. [PMID: 19208664 DOI: 10.1158/1055-9965.epi-07-2949] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The higher incidence of acute lymphoblastic leukemia (ALL) among Hispanic children relative to that in other racial/ethnic groups is well-known. We evaluated the incidence patterns of ALL in adults. METHODS We analyzed the incidence patterns of ALL (International Classification of Diseases for Oncology 3 codes 9835-9837) among all patients diagnosed from 1988 to 2004 in California using data from the California Cancer Registry to determine whether adult Hispanics also had higher incidence rates of ALL compared with non-Hispanic Whites (Whites). Age-adjusted incidence rates (AAIR), incidence rate ratios (IRR), and 5-year survival rates were obtained using SEER*Stat. AAIRs of other leukemia subtypes and IRRs relative to non-Hispanic Whites were also examined as references for ALL. RESULTS AAIRs of ALL in Hispanic males and females ages 20 to 54 years were higher compared with those in White males and females (IRR, 1.99; 95% confidence interval, 1.74-2.28 and IRR, 1.91; 95% confidence interval, 1.60-2.25, respectively). A higher AAIR of ALL was also observed among older (55+ years) Hispanic females (IRR, 1.84; 95% confidence interval, 1.52-2.21), but not in males (IRR, 1.07; 95% confidence interval, 0.84-1.34). Among Hispanics, low socioeconomic status was associated with a higher AAIR compared with high/middle socioeconomic status (IRR, 1.33; 95% confidence interval, 1.04-1.70). The respective 5-year survival rates among ALL patients were 38% and 30% for Whites and Hispanics ages 20 to 54 years, and 8% and 12% for patients 55 years of age or older. Compared with other racial/ethnic groups, Hispanics did not have an increased IRR of the other major leukemia subtypes. CONCLUSION Hispanics experience a higher incidence of ALL throughout life, but not other subtypes.
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Affiliation(s)
- Sheeja T Pullarkat
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1732, USA.
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20
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Pullarkat ST, Pullarkat V, Kroft SH, Wilson CS, Ahsanuddin AN, Mann KP, Thein M, Grody WW, Brynes RK. Systemic mastocytosis associated with t(8;21)(q22;q22) acute myeloid leukemia. J Hematop 2009; 2:27-33. [PMID: 19669220 PMCID: PMC2713498 DOI: 10.1007/s12308-009-0023-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [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: 10/16/2008] [Accepted: 01/15/2009] [Indexed: 11/29/2022] Open
Abstract
Although KIT mutations are present in 20–25% of cases of t(8;21)(q22;q22) acute myeloid leukemia (AML), concurrent development of systemic mastocytosis (SM) is exceedingly rare. We examined the clinicopathologic features of SM associated with t(8;21)(q22;q22) AML in ten patients (six from our institutions and four from published literature) with t(8;21) AML and SM. In the majority of these cases, a definitive diagnosis of SM was made after chemotherapy, when the mast cell infiltrates were prominent. Deletion 9q was an additional cytogenetic abnormality in four cases. Four of the ten patients failed to achieve remission after standard chemotherapy and seven of the ten patients have died of AML. In the two patients who achieved durable remission after allogeneic hematopoietic stem cell transplant, recipient-derived neoplastic bone marrow mast cells persisted despite leukemic remission. SM associated with t(8;21) AML carries a dismal prognosis; therefore, detection of concurrent SM at diagnosis of t(8;21) AML has important prognostic implications.
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Affiliation(s)
- Sheeja T Pullarkat
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS, A7-149, Los Angeles, CA, 90095-1732, USA,
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21
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Hu D, Pullarkat ST, Shackley B, Wang MB. Kimura's Disease: An Inflammatory Disorder Mimicking a Parotid Mass. Laryngoscope 2009. [DOI: 10.1002/lary.20413] [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]
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22
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Pullarkat ST, Vardiman JW, Slovak ML, Rao DS, Rao NP, Bedell V, Said JW. Megakaryocytic blast crisis as a presenting manifestation of chronic myeloid leukemia. Leuk Res 2008; 32:1770-5. [DOI: 10.1016/j.leukres.2008.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 02/28/2008] [Accepted: 02/28/2008] [Indexed: 11/26/2022]
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23
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Silva AHD, Pullarkat ST, Yong WH, Vinters HV. Primary central nervous system lymphoma: a review of 21 cases. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.706.20] [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: 11/11/2022]
Affiliation(s)
| | - Sheeja T. Pullarkat
- Department of Pathology and Laboratory Medicine ‐ Division of HematopathologyUniversity of California ‐ Los AngelesLos AngelesCA
| | - Willian H. Yong
- Department of Pathology and Laboratory Medicine ‐ Division of Neuropathology
| | - Harry V. Vinters
- Department of Pathology and Laboratory Medicine ‐ Division of Neuropathology
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24
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Pullarkat VA, Bueso-Ramos C, Lai R, Kroft S, Wilson CS, Pullarkat ST, Bu X, Thein M, Lee M, Brynes RK. Systemic mastocytosis with associated clonal hematological non-mast-cell lineage disease: analysis of clinicopathologic features and activating c-kit mutations. Am J Hematol 2003; 73:12-7. [PMID: 12701114 DOI: 10.1002/ajh.10322] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The majority of patients with systemic mastocytosis with associated clonal, hematological non-mast cell lineage disease (SM-AHNMD) have a myeloid stem cell malignancy including myelodysplastic syndromes (MDS), myelodysplastic/myeloproliferative disorders, acute myeloid leukemia (AML), or chronic myeloproliferative disease. The clinicopathologic features of SM-AHNMD have not been fully characterized. We describe seven cases of this entity: 3 with MDS, 3 with AML, and 1 with chronic myelomonocytic leukemia. In the majority of cases, SM was diagnosed concurrently with the myeloid malignancy and aberrant mast cell morphology was observed. The commonly described c-kit enzymatic site mutation Asp816Val was detected only in 2 cases, while 3 patients carried the Asp816His mutation. Among the 3 cases with AML, 2 patients carried the translocation t(8;21). On the basis of our results and other reported cases, there appears to be a specific association between SM and AML with t(8;21). Concurrent occurrence of SM may define a subset of patients with de novo AML and other myeloid malignancies who have an adverse prognosis. As clinically effective tyrosine kinase inhibitors that inhibit enzymatic-type c-kit mutations are being developed, detection of mast cell proliferation associated with myeloid malignancy may have important therapeutic implications.
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MESH Headings
- Adult
- Aged
- Anemia, Refractory, with Excess of Blasts/genetics
- Anemia, Refractory, with Excess of Blasts/pathology
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 5
- Chromosomes, Human, Pair 8
- Female
- Gene Deletion
- Hematologic Diseases/genetics
- Hematologic Diseases/pathology
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myelomonocytic, Chronic/genetics
- Leukemia, Myelomonocytic, Chronic/pathology
- Male
- Mast Cells/pathology
- Mastocytosis, Systemic/genetics
- Mastocytosis, Systemic/pathology
- Middle Aged
- Mutation
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/pathology
- Proto-Oncogene Proteins c-kit/genetics
- Translocation, Genetic
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Affiliation(s)
- Vinod A Pullarkat
- Division of Hematology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
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25
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Pullarkat ST, Stoehlmacher J, Ghaderi V, Xiong YP, Ingles SA, Sherrod A, Warren R, Tsao-Wei D, Groshen S, Lenz HJ. Thymidylate synthase gene polymorphism determines response and toxicity of 5-FU chemotherapy. Pharmacogenomics J 2002; 1:65-70. [PMID: 11913730 DOI: 10.1038/sj.tpj.6500012] [Citation(s) in RCA: 384] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Thymidylate synthase (TS) catalyses the conversion of deoxy-uridylate to deoxy-thymidylate and is essential for DNA synthesis. The human TS gene promoter is polymorphic, having either double or triple tandem repeats of a 28-bp sequence. Here we determined the significance of this polymorphism in humans and its prediction for clinical outcome of patients with metastatic colorectal cancer treated with 5-fluorouracil. The TS mRNA level was analyzed using RT-PCR. Individuals homozygous for the triple repeat variant (L/L) had 3.6 times higher TS mRNA levels compared to those homozygous for the double repeat variant (S/S) in tumor tissue (P = 0.004). We tested 50 patients with disseminated colorectal cancer who received 5-FU treatment to determine whether this TS polymorphism will predict clinical outcome. We found individuals with S/S genotype had a response rate of 50% (4/8) when compared to 9% (2/22) in those with L/L and 15% (3/20) in those with S/L genotype (P = 0.041). Patients with L/L had less severe side effects to 5-FU (P = 0.008). The data suggest that genotyping for the TS polymorphism may have the potential to identify patients more likely to respond to 5-FU based chemotherapy.
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Affiliation(s)
- S T Pullarkat
- University of Southern California/Norris Comprehensive Cancer Center, Los Angeles 90033, USA
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26
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Abstract
Mast cell disease (MCD), a proliferation of mast cells (MC), is occasionally associated with hematologic malignancies. Neoplastic MC have activating c-kit mutations. c-kit is a receptor tyrosine kinase required for the development, proliferation, and survival of MC. Interaction of c-kit with its ligand stem cell factor induces dimerization, receptor phosphorylation, and signal transduction. The most common c-kit mutation detected in neoplastic MCD is Asp816Val, which results in ligand-independent autophosphorylation of the receptor leading to MC proliferation. We describe the rare occurrence of MCD associated with acute myeloid leukemia, report a novel c-kit mutation Asp816 His, and discuss the pathogenesis of MCD associated with hematologic malignancies.
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Affiliation(s)
- V A Pullarkat
- Division of Hematology, University of Southern California School of Medicine, Los Angeles, California 90033-0804, USA.
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