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Cai F, Dai P, Jiang J, Lee AY, Emerson J, Taylor MS, Kang M, Kwong K, Clark H, Wong S, Smith S, Fernandez M, Luu V, Timbol Z, Berglund LJ, Culican S, Campbell D, Smith A, Schifter M, Lin MW. Treatment and monitoring of an immunobullous disease cohort in a single centre in Sydney Australia. Australas J Dermatol 2021; 62:e437-e440. [PMID: 34250600 DOI: 10.1111/ajd.13659] [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: 12/27/2020] [Accepted: 05/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Fenfen Cai
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Pei Dai
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Jocelyn Jiang
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical and Sydney Dental Schools of the Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Adrian Ys Lee
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical and Sydney Dental Schools of the Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Jonathan Emerson
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical and Sydney Dental Schools of the Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Mark S Taylor
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical and Sydney Dental Schools of the Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Michelle Kang
- Department of Oral Medicine, Oral Pathology and Special Needs Dentistry, Westmead Hospital, Westmead, NSW, Australia
| | - Kenelm Kwong
- Department of Oral Medicine, Oral Pathology and Special Needs Dentistry, Westmead Hospital, Westmead, NSW, Australia
| | - Hadleigh Clark
- Department of Oral Medicine, Oral Pathology and Special Needs Dentistry, Westmead Hospital, Westmead, NSW, Australia
| | - Sue Wong
- Flow Cytometry Unit, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Sandy Smith
- Flow Cytometry Unit, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Marian Fernandez
- Flow Cytometry Unit, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Vincent Luu
- Flow Cytometry Unit, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Zarah Timbol
- Flow Cytometry Unit, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Lucinda J Berglund
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical and Sydney Dental Schools of the Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW, Australia.,Flow Cytometry Unit, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Suzanne Culican
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - David Campbell
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Annika Smith
- Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia
| | - Mark Schifter
- Sydney Medical and Sydney Dental Schools of the Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW, Australia.,Department of Oral Medicine, Oral Pathology and Special Needs Dentistry, Westmead Hospital, Westmead, NSW, Australia
| | - Ming-Wei Lin
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical and Sydney Dental Schools of the Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW, Australia.,Flow Cytometry Unit, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
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van der Poorten DK, McLeod D, Ahlenstiel G, Read S, Kwok A, Santhakumar C, Bassan M, Culican S, Campbell D, Wong SWJ, Evans L, Jideh B, Kane A, Katelaris CH, Keat K, Ko Y, Lee JA, Limaye S, Lin MW, Murad A, Rafferty M, Suan D, Swaminathan S, Riminton SD, Toong C, Berglund LJ. Gastric Cancer Screening in Common Variable Immunodeficiency. J Clin Immunol 2018; 38:768-777. [PMID: 30219982 DOI: 10.1007/s10875-018-0546-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/06/2018] [Indexed: 12/22/2022]
Abstract
Individuals with common variable immunodeficiency (CVID) have an increased risk of gastric cancer, and gastrointestinal lymphoma, yet screening for premalignant gastric lesions is rarely offered routinely to these patients. Proposed screening protocols are not widely accepted and are based on gastric cancer risk factors that are not applicable to all CVID patients. Fifty-two CVID patients were recruited for screening gastroscopy irrespective of symptoms or blood results and were compared to 40 controls presenting for gastroscopy for other clinical indications. Overall, 34% of CVID patients had intestinal metaplasia (IM), atrophic gastritis or moderate to severe non-atrophic gastritis, which can increase the risk of gastric cancer, compared to 7.5% of controls (p < 0.01). Focal nodular lymphoid hyperplasia, a precursor lesion for gastrointestinal lymphoma, was seen in eight CVID patients (16%), one of whom was diagnosed with gastrointestinal lymphoma on the same endoscopy. High-risk gastric pathology was associated with increased time since diagnosis of CVID, smoking, Helicobacter pylori, a low-serum pepsinogen I concentration, and diarrhea, but not pepsinogen I/II ratio, iron studies, vitamin B12 levels or upper gastrointestinal symptoms. There was a lower rate of detection of IM when fewer biopsies were taken, and IM and gastric atrophy were rarely predicted by the endoscopist macroscopically, highlighting the need for standardized biopsy protocols. The prevalence of premalignant gastric lesions in patients with CVID highlights the need for routine gastric screening. We propose a novel gastric screening protocol to detect early premalignant lesions and reduce the risk of gastric cancer and gastric lymphoma in these patients.
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Affiliation(s)
- David K van der Poorten
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Duncan McLeod
- Department of Anatomical Pathology, Westmead Hospital, Sydney, NSW, Australia.,NSW Health Pathology, Sydney, NSW, Australia
| | - Golo Ahlenstiel
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.,Blacktown Clinical School, School of Medicine, Western Sydney University, Penrith, NSW, Australia.,Department of Gastroenterology and Hepatology, Blacktown Hospital, Blacktown, NSW, Australia.,Storr Liver Centre, Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Scott Read
- Storr Liver Centre, Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Avelyn Kwok
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Cositha Santhakumar
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Milan Bassan
- Department of Gastroenterology and Hepatology, Liverpool hospital, Sydney, NSW, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | | | | | - Louise Evans
- Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,Department of Immunology, Liverpool Hospital, Sydney, NSW, Australia
| | - Bilel Jideh
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia
| | - Alisa Kane
- Department of Immunology, Liverpool Hospital, Sydney, NSW, Australia
| | - Constance H Katelaris
- Department of Immunology, Campbelltown Hospital, Campbelltown, NSW, Australia.,Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Karuna Keat
- Department of Immunology, Campbelltown Hospital, Campbelltown, NSW, Australia.,Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Yanna Ko
- Department of Immunology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Jessie A Lee
- Department of Immunology, Liverpool Hospital, Sydney, NSW, Australia
| | - Sandhya Limaye
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.,Department of Immunology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Ming Wei Lin
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.,Departments of Immunology and Immunopathology, Westmead Hospital, Hawkesbury Rd, Westmead, Sydney, NSW, 2145, Australia
| | - Ari Murad
- Department of Immunology, Liverpool Hospital, Sydney, NSW, Australia
| | - Martina Rafferty
- Department of Immunology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Dan Suan
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.,Departments of Immunology and Immunopathology, Westmead Hospital, Hawkesbury Rd, Westmead, Sydney, NSW, 2145, Australia.,Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Sanjay Swaminathan
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.,Departments of Immunology and Immunopathology, Westmead Hospital, Hawkesbury Rd, Westmead, Sydney, NSW, 2145, Australia
| | - Sean D Riminton
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.,Department of Immunology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Catherine Toong
- NSW Health Pathology, Sydney, NSW, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,Department of Immunology, Liverpool Hospital, Sydney, NSW, Australia.,Department of Immunology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Lucinda J Berglund
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia. .,NSW Health Pathology, Sydney, NSW, Australia. .,Departments of Immunology and Immunopathology, Westmead Hospital, Hawkesbury Rd, Westmead, Sydney, NSW, 2145, Australia.
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Lin MW, Silvestrini RA, Culican S, Campbell D, Fulcher DA. A dual-fixed neutrophil substrate improves interpretation of antineutrophil cytoplasmic antibodies by indirect immunofluorescence. Am J Clin Pathol 2014; 142:325-30. [PMID: 25125622 DOI: 10.1309/ajcpg02fgqvausiu] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To determine whether the addition of a formalin-fixed neutrophil substrate could improve interpretation and prediction of autoantigenic specificity in antineutrophil cytoplasmic antibody (ANCA) testing. METHODS Routine diagnostic samples sent for ANCA testing were analyzed prospectively on a dual substrate of both ethanol- and formalin-fixed neutrophils. Positive samples on ethanol-fixed neutrophils were deemed "typical" if formalin-fixed neutrophils also stained, and "atypical" if not. Indirect immunofluorescence (IIF) results were correlated with antimyeloperoxidase (MPO) and anti-proteinase 3 (PR3) results with an enzyme-linked immunosorbent assay (ELISA). RESULTS Of 1,426 samples, 201 from unique patients were ANCA-positive (200 on IIF, 1 on ELISA alone). Thirty-two (45%) of 71 typical ANCA staining patterns were positive for either an anti-MPO or anti-PR3 antibodies, whereas only one (0.8%) of 129 atypical patterns was ELISA-positive, in a patient without systemic vasculitis. Only one (3%) of 34 ELISA-positive samples had a negative IIF-ANCA (1/1,426 patients, 0.07%), and this patient did not have vasculitis. CONCLUSIONS Concomitant staining on formalin fixation of IIF-positive ethanol-fixed ANCA samples improves the interpretation of ANCA testing and is predictive of vasculitis autoantigens MPO and PR3.
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Affiliation(s)
- Ming-Wei Lin
- Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Westmead, Australia
- Discipline of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Roger A. Silvestrini
- Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Westmead, Australia
| | - Suzanne Culican
- Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Westmead, Australia
| | - David Campbell
- Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Westmead, Australia
| | - David A. Fulcher
- Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Westmead, Australia
- Discipline of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
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