The Cancer Screening and Survivorship Program at Roswell Park Comprehensive Cancer Center

Roswell Park Comprehensive Cancer Center (Roswell) is the only NCI-designated cancer center in New York State outside of the New York City metropolitan area. The Cancer Screening and Survivorship Program combines cancer screening services with survivorship care in a freestanding centralized clinic with providers also dispersed to see survivors in other clinical areas. The aims of the program are to provide comprehensive, patient-centered care to cancer survivors and their families and caregivers by addressing symptoms, supporting wellness, prevention and quality of life, and engaging community primary care providers in a shared-care model. The clinic is led by an onco-generalist, defined as an internal medicine trained physician serving cancer survivor's medical issues from all cancer disease sites. Roswell's Cancer Screening and Survivorship Program growth and development is guided by ongoing research related to patient needs and barriers to care, overall quality of life, health promotion and prevention, as well as education and training to build a more robust cancer survivorship workforce. The cancer center leadership has identified the expansion of cancer survivorship paired with community outreach and engagement, PCP outreach and education, and comprehensive cancer screening services as one of the key strategic areas of growth over the next decade. With the investment in our long-term strategic plan, we expect to continue to grow and serve a broader community of cancer survivors and further our research related to the structure and outcomes of our programmatic activities. IMPLICATIONS FOR CANCER SURVIVORS: This program provides robust whole-person care for cancer survivors and provides an example of successful infrastructure for cancer survivorship.

Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study

PURPOSE

Cancer patients experience significant distress and burden of decision-making throughout treatment and beyond. These stressors can interfere with their ability to make reasoned and timely decisions about their care and lead to low physical and social functioning and poor survival. This pilot study examined the impact of offering Problem-Solving Skills Training (PSST) to adult cancer survivors to help them and their caregivers cope more successfully with post-treatment decision-making burden and distress.

PATIENTS AND METHODS

Fifty patients who completed their definitive treatment for colorectal, breast or prostate cancer within the last 6 months and reported distress (level > 2 on the National Comprehensive Cancer Network distress thermometer) were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions. Patients were invited to include a supportive other (n = 17). Patient and caregiver assessments at baseline (T1), end of intervention or 3 months (T2), and at 6 months (T3) focused on problem-solving skills, anxiety/depression, quality of life and healthcare utilization. We compared outcomes by study arm and interviewed participants about PSST burden and skill maintenance.

RESULTS

Trial participation rate was 60%; 76% of the participants successfully completed PSST training. PSST patients reported reduction in anxiety/depression, improvement in QoL (p < 0.05) and lower use of hospital and emergency department services compared to CAU patients (p = 0.04).

CONCLUSIONS

The evidence from this pilot study indicates that a remotely delivered PSST is a feasible and potentially effective strategy to improve mood and self-management in cancer survivors in community oncology settings.

Abstract PO-253: Overcoming barriers to colorectal cancer screening for underserved patients: Lessons from the COVID-19 pandemic

Introduction This patient navigation initiative works to address cancer health disparities by improving education and access to screening and cancer care. This initiative includes partnerships with local Federally Qualified Health Centers (FQHCs) and primary care physicians (PCPs), primarily focused on increasing colorectal cancer (CRC) screening rates among underserved populations in Western New York (WNY) who may have low health literacy. Grounded in health services research, we aimed to improve clinical care by implementing evidence-based guidelines into practice by working directly with underserved communities in our area to improve CRC screening rates at an urban FQHC. Methods Throughout the COVID-19 pandemic, our navigators pivoted to a hybrid schedule with remote access to health systems, splitting time between our cancer center and remotely at home until allowed back on-site to work at the FQHC. Colonoscopy halted in NY between March and June 2020, resulting in scheduling challenges due to significant backlogs of cancelled procedures during the shutdown and regional hold on elective procedures. Endoscopists across WNY had reduced capacity for postponed procedures, leading to the prioritization of scheduling for symptomatic patients. Therefore, navigators focused screening efforts on widely disseminating stool-based tests to patients due for average-risk CRC screening and prioritizing patients with positive screening results to coordinate colonoscopy appointments. Results Between April 2020 through March 2021, our pre-pandemic goal was to educate 550 patients and screen 300 patients. During this timeframe, navigators provided screening education to 632 patients and screened 232 patients despite significant challenges presented by the COVID-19 pandemic. With many colonoscopy procedures being cancelled and/or rescheduled, stool-based tests were widely available and became a more common choice for patients. To date, since April 2020, navigators have educated 807 patients and have navigated 306 patients to complete CRC screening. Of those 306 patients, 234 chose to complete at-home stool-based testing. In 2020, CRC screening rates remained over 50%, exceeding national FQHC targets. This was achieved through targeted patient outreach, education, and navigation, despite significant challenges with the shutdown and the COVID-19 pandemic. Conclusions Stool-based tests paired with targeted outreach and education were an efficient tool for CRC screening during this challenging time. Navigators regularly cross-check records to be sure results are received by ordering physicians and properly coded for accurate data reporting. This is especially important for positive test results and timely follow up, which may lead to improved health outcomes. Moving forward, this paired approach may be an effective strategy for improving screening rates among hard-to-reach patient populations and patients facing substantial barriers to accessing routine medical care.

Citation Format: Kathryn M. Glaser, Christina Crabtree-Ide, Alyssa McNulty, Ellis Gomez, Nicole Donofrio, Tessa Flores, Mary E. Reid. Overcoming barriers to colorectal cancer screening for underserved patients: Lessons from the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-253.

Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC

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Background: Cancer patients experience significant distress throughout treatment and especially during transition back to normal life with greater burden on socially disadvantaged patients and those with medical comorbidities. Patient stressors can interfere with their ability to make reasoned and timely decisions about survivorship care and lead to poor quality of life and low physical and social functioning. This pilot effectiveness-implementation study examined the impact and feasibility of offering the Bright IDEAS system of Problem-Solving Skills Training (PSST) to adult cancer survivors to help them and their caregivers cope more successfully with decision making and distress. Methods: Patients with breast (21), prostate (9) or colorectal (20) cancer who completed their definitive cancer treatment within the last 6 months and had their cancer survivorship visit were recruited from two regional cancer centers and affiliated community oncology clinics. Patients with an NCCN distress level > 2 were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions provided by a trained therapist in person or remotely. Patients were invited but not required to include a supportive other (n = 17). Patient and caregiver assessments at baseline (T1), end of intervention/3 months (T2), and 3 months post intervention/6 months (T3) focused on problem-solving skills (SPSI-25), distress (HADS) and quality of life (FACT). We also collected healthcare utilization data. We compared outcome changes T1-T2 and T1-T3, by study arm, using t-tests. Multivariate regression analysis identified subgroups of patients with positive and negative responses to skills training. Results: Average age of the participants was 63 years (45 to 87) with racial and ethnic distributions representative of the local population (88% white). Two thirds were women (n = 32), one third of the patients were recruited and received therapy fully remotely due to COVID-19-related protocol changes. Patients who received PSST reported a reduction in dysfunctional problem-solving style and improvement in constructive style while problem-solving skills of CAU patients trended in the opposite direction. Patients in the PSST arm also reported significant reduction in anxiety and depression and improvement in cancer-specific quality of life (p < 0.05) that was sustained at 6 months. Patients in the PSST arm reported lower use of hospital and ED services compared to CAU patients (p = 0.07). Better improvement in outcomes was driven by lower problem-solving skills at baseline. Conclusions: Despite the logistical complexity of running a clinical trial during quarantine, patients and caregivers in the PSST arm demonstrated meaningful improvement in distress and quality of life. The evidence from this pilot study will help guide development of a future multi-site randomized clinical trial of the effect of PSST on cancer survivorship care and outcomes. Clinical trial information: NCT03567850.

Feasibility of fully remote administration of problem-solving skills training (PSST) to adult cancer survivors in community settings

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Background: Cancer survivors experience significant stress throughout cancer treatment and especially during transition back to normal life. These stressors are particularly severe for rural or socially disadvantaged patients with limited access to care. Improving their problem-solving skills is known to help patients make reasoned and timely decisions about survivorship care that reduce stress and enhance quality of life, physical and social functioning, and overall cancer prognosis. This pilot implementation study examined barriers to and facilitators of providing Problem-Solving Skills Training (PSST) to adult cancer survivors and their caregivers in community settings. Methods: Patients (n = 50) who completed their definitive cancer treatment and cancer survivorship visit within the previous 6 months were recruited from two regional cancer centers and affiliated community cancer clinics. Patients with NCCN distress level >2 were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions using the Bright IDEAS system of teaching problem solving. Training was offered by a trained therapist in person at the patient’s preferred location or remotely. Patients were invited but not required to include a supportive other (SO). Patient outcomes were assessed at baseline (T1), the end of the intervention/3 months (T2), and 3 months post intervention/6 months (T3). We examined patient and caregiver preferences for mode of communication and therapy, barriers to PSST participation, and adherence rates. An independent consultant interviewed patients and caregivers about factors that promote or inhibit intervention sustainability and its wider adaptation and usefulness. Results: Average age of the participants was 63 years (45-87) with gender, racial and ethnic distributions representative of the local population (64% women, 88% white). Women were 80% less likely to include a SO than men. Among the third of the patients recruited fully remotely, 50% preferred receiving consent materials via regular mail and 18% preferred electronic communication. Among the two patients lost to follow-up before PSST completion and one patient who withdrew despite reporting significant distress, none had a SO in the study. Seventy-six percent of the PSST patients completed the training (defined as > 6 sessions). After study completion, all patients and caregivers reported high satisfaction with Bright IDEAS and high probability of continuing to use the skills learned. Conclusions: Despite significant distress and numerous reported social challenges, patients and caregivers in the PSST arm demonstrated high adherence, skill retention and overall satisfaction. Future research should be tailored to accommodate the preferred type of communication and recruitment approaches of the targeted population and emphasize the positive role of informal caregivers. Clinical trial information: NCT03567850.

Abstract B105: Providing colorectal cancer screening interventions at Federally Qualified Health Centers (FQHCs): Addressing the issues of language, culture, and health literacy through culturally tailored education and navigation

Background: Colorectal cancer (CRC) screening is effective in preventing and detecting cancer at an early stage, yet CRC continues to be the second leading cause of cancer death, and populations served by Federally Qualified Health Centers (FQHCs) are screened at lower rates (39%) than the national average (67%), with the lowest screening rates recent immigrants (34%). Time constraints impede providers from discussing CRC screening; insufficient access to screening facilities and patients' fear regarding colonoscopy preparation and procedure are just some of the challenges CHCs face. These issues are only compounded by significant language and cultural barriers.

Methods: This quality improvement (QI) initiative measured CRC screening rates from August 2016 to April 2018 at an urban FQHC providing primary care services to diverse, low-income, and predominantly non-English speaking population with two clinic locations (intervention and control site). The patient navigator assigned to the intervention site provided both provider and patient education, developed culturally tailored patient education materials (visual), assisted in scheduling and coordinating services (transportation, interpreters, obtaining prep solution for colonoscopy) and distributed fecal immunochemical testing (FIT) for those refusing or ineligible for a colonoscopy. Our rationale for the project, supported by preliminary data, was that FQHC providers want to increase screening rates, particularly in non-English speaking patients, but need tools and support to implement change.

Results: Between August 2016 and April 2018, the intervention site increased from 32% to 59% of eligible patients screened for CRC, with the most notable change in the non-English speaking patients, primarily Burmese, Nepali and Spanish speaking. The change in CRC screening rates at the intervention from baseline is highly significant (p &lt; 0.001), although the change from baseline in control site is also significant (p=0.020), but only in the second year. One year post intervention, there was a 24% increase in odds of participating in screening for a person at the intervention center compared to the control center. By April 2018, this effect increased significantly and the odds of participating in CRC screening are 86% higher for a person at the intervention center compared to the control center. In August 2018, intervention efforts will expand to the control site, piloting a culturally tailored educational video targeting the predominantly African American population served at the site.

Conclusions: Specialized and tailored education plus navigation are effective in increasing CRC screening rates at FQHCs, particularly in non-English speaking populations. Understanding how different populations think about CRC screening informs navigation strategies on how to better promote screening in diverse populations and develop more targeted interventions.

Citation Format: Kathryn M. Glaser, Tessa Flores, Miranda Lynch, Jessie Mossop, Alyssa Abrams, Carolyn Johnson, Deborah O. Erwin, Mary Reid. Providing colorectal cancer screening interventions at Federally Qualified Health Centers (FQHCs): Addressing the issues of language, culture, and health literacy through culturally tailored education and navigation [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B105.

Building a comprehensive cancer survivorship program

There is a significant increase in the number of people surviving cancer as a result of improved detection and better treatments. In the United States (US) alone, these numbers are estimated to reach 20 million by 2026 [Miller et al (2016) CA Cancer J Clin 66(4) 271–289)]; [Bluethmann et al (2016) Cancer Epidemiol Biomarkers Prev 25(7) 1029–1036]. Living through cancer treatment represents a life-changing event, often including residual and long-term emotional, physical, psychological and spiritual sequelae. Survivorship programming must encompass the clinical management of medical issues, local support services for patients and their caregivers, protocols for communicating with community primary care providers (PCPs) and education for all clinicians in the survivorship continuum on the issues impacting survivors. This article will discuss a range of issues that should be addressed when developing a comprehensive, multi-disciplinary cancer survivorship care.

Laser-induced breakdown spectroscopy determination of toxic metals in fresh fish

A method based on laser induced breakdown spectroscopy (LIBS) for monitoring lead and copper accumulation in edible fish, particularly "tilapia del Nilo" (Oreochromis niloticus) is presented. The capability of this analytical method is compared with results obtained by atomic absorption spectrometry. Detection limits by LIBS are 25 parts per million (ppm) for Pb and 100 ppm for Cu, values that are below the maximum permissible levels of some international standards. Application of LIBS detection allows the development of portable instruments for contamination control of edible fish.

Genetic and morphological variability in South American rodent Oecomys (Sigmodontinae, Rodentia): evidence for a complex of species

The rodent genus Oecomys (Sigmodontinae) comprises ~16 species that inhabit tropical and subtropical forests in Central America and South America. In this study specimens of Oecomys paricola Thomas, 1904 from Belém and Marajó island, northern Brazil, were investigated using cytogenetic, molecular and morphological analyses. Three karyotypes were found, two from Belém (2n = 68, fundamental number (FN) = 72 and 2n = 70, FN = 76) and a third from Marajó island (2n = 70, FN = 72). No molecular or morphological differences were found between the individuals with differing cytotypes from Belém, but differences were evident between the individuals from Belém and Marajó island. Specimens from Belém city region may represent two cryptic species because two different karyotypes are present in the absence of significant differences in morphology and molecular characteristics. The Marajó island and Belém populations may represent distinct species that have been separated for some time, and are in the process of morphological and molecular differentiation as a consequence of reproductive isolation at the geographic and chromosomal levels. Thus, the results suggest that O. paricola may be a complex of species.

Sustained leukaemic phenotype after inactivation of BCR-ABLp190 in mice

Pharmacological inactivation of cancer genes or products is being used as a strategy for therapy in oncology. To investigate the potential role of BCR-ABLp190 cessation in leukaemia development, we generated mice carrying a tetracycline-repressible BCR-ABLp190 transgene. These mice were morphologically normal at birth, and developed leukaemias. Disease was characterized by the presence of B-cell blasts co-expressing myeloid markers, reminiscent of the human counterpart. BCR-ABLp190 activation can initiate leukaemia in both young and adult mice. Transitory expression of BCR-ABLp190 is enough to develop leukaemia. Suppression of the BCR-ABLp190 transgene in leukaemic CombitTA-p190 mice did not rescue the malignant phenotype, indicating that BCR-ABLp190 is not required to maintain the disease in mice. Similar results were obtained by inactivation of BCR-ABLp190 with STI571 (Gleevec; Novartis, East Hanover, NJ, USA) in leukaemic CombitTA-p190 mice. However, gradual suppression of BCR-ABLp190 in leukaemic CombitTA-p190 mice identified a minimum level of BCR-ABLp190 expression necessary to revert the specific block in B-cell differentiation in the leukaemic cells. Overall, the findings indicate that BCR-ABLp190 appears to cause epigenetic and/or genetic changes in tumour-maintaining cells that render them insensitive to BCR-ABLp190 inactivation.

SLUG (SNAI2) overexpression in embryonic development

The Snail-related zinc-finger transcription factor, SLUG (SNAI2), is critical for the normal development of neural crest-derived cells and loss-of-function SLUG mutations have been proven to cause piebaldism and Waardenburg syndrome type 2 in a dose-dependent fashion. However, little is known about the consequences of SLUG overexpression in embryonic development. We report SLUG duplication in a child with a unique de novo 8q11.2-->q13.3 duplication associated with tetralogy of Fallot, submucous cleft palate, renal anomalies, hypotonia and developmental delay. To investigate the effects of Slug overexpression on development, we analyzed mice carrying a Slug transgene. These mice were morphologically normal at birth, inferring that Slug overexpression is not sufficient to cause overt morphogenetic defects. In the adult mice, there was a 20% incidence of sudden death, cardiomegaly and cardiac failure associated with incipient mesenchymal tumorigenesis. These findings, while not directly implicating Slug in congenital and acquired heart disease, raise the possibility that Slug overexpression may contribute to specific cardiac phenotypes and cancer development.

Structure and environmental relationships of insectivorous bat assemblages in tropical Australian savannas

Abstract  Patterns in the composition of assemblages of microbat species sampled during the late dry season (the 'build-up') in north Australian savannas were assessed against a range of environmental factors as well as four a priori defined habitat types (riparian, escarpments, coastal and woodlands). Distinct species assemblages were most strongly associated with topographic and climatic variables. There were also limited associations with vegetation structure, fire and local roost potential but no associations with insects or water availability. Total species diversity at sample sites was associated with distance to rivers and rainfall. In general, species assemblages were not clearly defined and the number of significant environmental associations was relatively few. We compare these associations with those reported for bat assemblages elsewhere in Australia.

A comparison of three survey methods for collecting bat echolocation calls and species-accumulation rates from nightly Anabat recordings

Bat surveys are frequently undertaken using ultrasonic detectors to determine the species present in an area on the basis of the identity of echolocation calls. We compared three techniques for using the Anabat II detector: the detector pointed along tracks (flyways) versus the detector pointed across tracks (non-flyways); recording output to audio cassette (analogue) versus direct recording to computer (digital); and active hand-held recording versus static automatic recording. In addition, we derived a species-accumulation curve from all-night Anabat recordings in the wet–dry tropics of the Northern Territory. We found no significant difference between flyway and non-flyway recordings; significantly more calls were identified from digital recordings; and significantly more species were detected using hand-held than static recordings. Species-accumulation analysis suggests that the minimum time required to achieve a satisfactory (80%) inventory of bat species at a site is during the three-hour period immediately after sunset. We use our findings to make recommendations for the design of bat surveys using the Anabat II detector.

Abnormalities on 1q and 7q are associated with poor outcome in sporadic Burkitt's lymphoma. A cytogenetic and comparative genomic hybridization study

Comparative genomic hybridization (CGH) studies have demonstrated a high incidence of chromosomal imbalances in non-Hodgkin's lymphoma. However, the information on the genomic imbalances in Burkitt's Lymphoma (BL) is scanty. Conventional cytogenetics was performed in 34 cases, and long-distance PCR for t(8;14) was performed in 18 cases. A total of 170 changes were present with a median of four changes per case (range 1-22). Gains of chromosomal material (143) were more frequent than amplifications (5) or losses (22). The most frequent aberrations were gains on chromosomes 12q (26%), Xq (22%), 22q (20%), 20q (17%) and 9q (15%). Losses predominantly involved chromosomes 13q (17%) and 4q (9%). High-level amplifications were present in the regions 1q23-31 (three cases), 6p12-p25 and 8p22-p23. Upon comparing BL vs Burkitt's cell leukemia (BCL), the latter had more changes (mean 4.3 +/- 2.2) than BL (mean 2.7 +/- 3.2). In addition, BCL cases showed more frequently gains on 8q, 9q, 14q, 20q, and 20q, 9q, 8q and 14q, as well as losses on 13q and 4q. Concerning outcome, the presence of abnormalities on 1q (ascertained either by cytogenetics or by CGH), and imbalances on 7q (P=0.01) were associated with a short survival.

[Clinical descriptive study of 40 patients with carcinoma of the nasopharynx in advanced stage in an area of low epidemiological risk]

The nasopharyngeal carcinoma in Spain, low risk geographical area, is a rare tumor. This is the cause why there few papers about it in our country. We have carried out a muestral descriptive statistical study. We have selected among all the patients diagnosed of nasopharyngeal carcinoma a big group who, have been treated with induction chemotherapy followed by radiotherapy with or without surgery, they presented very complete clinical histories in the Departments of E.N.T., Oncology and Radiotherapy that allowed us to compare all the picked up data and this increased, without doubt, the reliability of them. The results obtained in the different examined variables of our patients are the same that those we found in literature. The nasopharyngeal carcinoma is a tumor that usually affects young patients, of both sexes, without previous consumption of alcohol and tobacco and they are diagnosed in advanced stages. The rhinologic symptoms are the most frequent ones but the cervical nodes are the usual cause for consulting a doctor with a long diagnostic interval. There is a prevalence in the undifferentiated tumors showed by histology.

Novel genomic imbalances in B-cell splenic marginal zone lymphomas revealed by comparative genomic hybridization and cytogenetics

Splenic marginal zone lymphoma (SMZL) has recently been recognized in the World Health Organization classification of hematological diseases as distinct type of non-Hodgkin's lymphoma. In contrast to the well-established chromosomal changes associated with other B-cell non-Hodgkin's lymphoma, few genetic alterations have been found associated with SMZL. The aim of our study was to analyze by comparative genomic hybridization (CGH) the chromosomal imbalances in 29 patients with SMZL and to correlate these findings with clinical and biological characteristics and patient outcome. In 21 cases, cytogenetic studies were simultaneously performed. Most of the patients (83%) displayed genomic imbalances. A total of 111 DNA copy number changes were detected with a median of four abnormalities per case (range, 1 to 12). Gains (n = 92) were more frequent than losses (n = 16), while three high-level amplifications (3q26-q29, 5p11-p15, and 17q22-q25) were observed. The most frequent gains involved 3q (31%), 5q (28%), 12q and 20q (24% each), 9q (21%), and 4q (17%). Losses were observed in 7q (14%) and 17p (10%). SMZL patients with genetic losses had a shorter survival than the remaining SMZL patients (P < 0.05). In summary, chromosomal imbalances in regions 3q, 4q, 5q, 7q, 9q, 12q, and 20q have been detected by CGH in SMZL. Patients with SMZL displaying genetic losses by CGH had a short survival.

Survival of intrastriatal xenografts of ventral mesencephalic dopamine neurons from MHC-deficient mice to adult rats

Previous studies of neural xenografts have used immunosuppressive agents to prevent graft rejection. In the present study we have examined the survival of mouse dopamine neurons lacking either MHC class I or MHC class II molecules transplanted into rat brains and the host immune and inflammatory responses against the xenografts. Survival of neural grafts was immunocytochemically determined at 4 days, 2 weeks, and 6 weeks after transplantation by counting tyrosine hydroxylase (TH)-positive cells in the graft areas. In addition, the host immune and inflammatory responses against neural xenografts were evaluated by semiquantitatively rating MHC class I and class II antigen expression, accumulation of macrophages and activated microglia, and infiltration of CD4- and CD8-positive T-lymphocytes. For the negative controls, the mean number of TH-positive cells in rats that received wild-type mouse tissue progressively decreased at various time periods following transplantation. In contrast, intrastriatal grafting of either MHC class I or MHC class II antigen-depleted neural xenografts resulted in a prolonged survival and were comparable to cyclosporin A-treated rats that had received wild-type mouse tissue. These results indicate that genetically modified donor tissue lacking MHC molecules can be used to prevent neural xenograft rejection.

Liposarcoma initiated by FUS/TLS-CHOP: the FUS/TLS domain plays a critical role in the pathogenesis of liposarcoma

The most common chromosomal translocation in liposarcomas, t(12;16)(q13;p11), creates the FUS/TLS-CHOP fusion gene. We previously developed a mouse model of liposarcoma by expressing FUS-CHOP in murine mesenchymal stem cells. In order to understand how FUS-CHOP can initiate liposarcoma, we have now generated transgenic mice expressing altered forms of the FUS-CHOP protein. Transgenic mice expressing high levels of CHOP, which lacks the FUS domain, do not develop any tumor despite its tumorigenicity in vitro and widespread activity of the EF1alpha promoter. These animals consistently show the accumulation of a glycoprotein material within the terminally differentiated adipocytes, a characteristic figure of liposarcomas associated with FUS-CHOP. On the contrary, transgenic mice expressing the altered form of FUS-CHOP created by the in frame fusion of the FUS domain to the carboxy end of CHOP (CHOP-FUS) developed liposarcomas. No tumors of other tissues were found in these transgenic mice despite widespread activity of the EF1alpha promoter. The characteristics of the liposarcomas arising in the CHOP-FUS mice were very similar to those previously observed in our FUS-CHOP transgenic mice indicating that the FUS domain is required not only for transformation but also influences the phenotype of the tumor cells. These results provide evidence that the FUS domain of FUS-CHOP plays a specific and critical role in the pathogenesis of liposarcoma.

The chimeric FUS/TLS-CHOP fusion protein specifically induces liposarcomas in transgenic mice

The characteristic t(12;16)(q13;p11) chromosomal translocation, which leads to gene fusion that encodes the FUS-CHOP chimeric protein, is associated with human liposarcomas. The altered expression of FUS-CHOP has been implicated in a characteristic subgroup of human liposarcomas. We have introduced the FUS-CHOP transgene into the mouse genome in which the expression of the transgene is successfully driven by the elongation factor 1alpha (EF1alpha) promoter to all tissues. The consequent overexpression of FUS-CHOP results in most of the symptoms of human liposarcomas, including the presence of lipoblasts with round nuclei, accumulation of intracellular lipid, induction of adipocyte-specific genes and a concordant block in the differentiation program. We have demonstrated that liposarcomas in the FUS-CHOP transgenic mice express high levels of the adipocyte regulatory protein PPARgamma, whereas it is not expressed in embryonic fibroblasts from these animals following induction to differentiation toward the adipocyte lineage, indicating that the in vitro system does not really reflect the in vivo situation and the developmental defect is downstream of PPARgamma expression. No tumors of other tissues were found in these transgenic mice despite widespread activity of the EF1alpha promoter. This establishes FUS-CHOP overexpression as a key determinant of human liposarcomas and provide the first in vivo evidence for a link between a fusion gene created by a chromosomal translocation and a solid tumor.

A primitive hematopoietic cell is the target for the leukemic transformation in human philadelphia-positive acute lymphoblastic leukemia

BCR-ABL is a chimeric oncogene generated by translocation of sequences from the chromosomal counterpart (c-ABL gene) on chromosome 9 into the BCR gene on chromosome 22. Alternative chimeric proteins, BCR-ABL(p190) and BCR-ABL(p210), are produced that are characteristic of chronic myelogenous leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(1)-ALL). In CML, the transformation occurs at the level of pluripotent stem cells. However, Ph(1)-ALL is thought to affect progenitor cells with lymphoid differentiation. Here we demonstrate that the cell capable of initiating human Ph(1)-ALL in non-obese diabetic mice with severe combined immunodeficiency disease (NOD/SCID), termed SCID leukemia-initiating cell (SL-IC), possesses the differentiative and proliferative capacities and the potential for self-renewal expected of a leukemic stem cell. The SL-ICs from all Ph(1)-ALL analyzed, regardless of the heterogeneity in maturation characteristics of the leukemic blasts, were exclusively CD34(+ )CD38(-), which is similar to the cell-surface phenotype of normal SCID-repopulating cells. This indicates that normal primitive cells, rather than committed progenitor cells, are the target for leukemic transformation in Ph(1)-ALL.

Allogeneic peripheral blood cell transplantation for hypereosinophilic syndrome with myelofibrosis

Patients with hypereosinophilic syndrome (HES) display a very heterogeneous clinical picture ranging from asymptomatic cases to very aggressive forms. We report a 38-year-old woman with progressive HES who developed severe myelofibrosis and was treated by allogeneic stem cell transplantation, using peripheral blood (PBSCT) instead of bone marrow as the source of progenitor cells, after conditioning with cytoxan and busulphan. To the best of our knowledge, this is the first case of HES with myelofibrosis treated with PBSCT. The patient remains alive 8 months post-PBSCT, and bone marrow fibrosis has significantly decreased following transplantation. Bone Marrow Transplantation (2000) 25, 217-218.

Increased number of chromosomal imbalances and high-level DNA amplifications in mantle cell lymphoma are associated with blastoid variants

Mantle cell lymphomas (MCLs) are characterized by 11q13 chromosomal translocations and cyclin D1 overexpression. The secondary genetic and molecular events involved in the progression of these tumors are not well known. In this study, we have analyzed 45 MCLs (32 typical and 13 blastoid variants) by comparative genomic hybridization (CGH). To identify the possible genes included in the abnormal chromosome regions, selected cases were analyzed for P53, P16(INK4a), RB, C-MYC, N-MYC, BCL2, BCL6, CDK4, and BMI-1 gene alterations. The most frequent imbalances detected by CGH were gains of chromosomes 3q (49%), 7p (27%), 8q (22%), 12q (20%), 18q (18%), and 9q34 (16%) and losses of chromosomes 13 (44%), 6q (27%), 1p (24%), 11q14-q23 (22%), 10p14-p15 (18%), 17p (16%), and 9p (16%). High-level DNA amplifications were identified in 11 different regions of the genome, predominantly in 3q27-q29 (13%), 18q23 (9%), and Xq28 (7%). The CGH analysis allowed the identification of regional consensus areas in most of the frequently involved chromosomes. Chromosome gains (P =. 02) and losses (P =.01) and DNA amplifications (P =.015) were significantly higher in blastoid variants. The significant differences between blastoid and typical tumors were gains of 3q, 7p, and 12q, and losses of 17p. CGH losses of 17p correlated with P53 gene deletions and mutations. Similarly, gains of 12q and high-level DNA amplifications of 10p12-p13 were associated with CDK4 and BMI-1 gene amplifications, respectively. One of 2 cases with 8q24 amplification showed C-MYC amplification by Southern blot. Alterations in 2p, 3q, 13, and 18q were not associated with N-MYC, BCL6, RB, or BCL2 alterations, respectively, suggesting that other genes may be the targets of these genetic abnormalities in MCLs. Increased number of gains (0 v 1-4 v >4 gains per case) (P =.002), gains of 3q (P =.02), gains of 12q (P =.03), and losses of 9p (P =. 003) were significantly associated with a shorter survival of the patients. These results indicate that an increased number of chromosome imbalances are associated with blastoid variants of MCLs and may have prognostic significance.

A marginal zone pattern may be found in different varieties of non-Hodgkin's lymphoma: the morphology and immunohistology of splenic involvement by B-cell lymphomas simulating splenic marginal zone lymphoma

AIMS

Splenic marginal zone lymphoma (SMZL) is characterized by a micronodular infiltrate of the splenic white pulp, centred on pre-existing follicles, with a peripheral rim of 'marginal' zone B-cells, always accompanied by a variable degree of red pulp infiltration. These histological features can be closely mimicked by a variety of other small B-cell lymphomas when they involve the spleen, which makes recognition of SMZL difficult. We therefore have compared the histopathological and immunohistochemical features of other non-Hodgkin's lymphoma (NHL) types with those of SMZL.

METHODS AND RESULTS

We selected cases of splenic involvement by different types of B-cell lymphoma, including mantle cell lymphoma (MCL), follicular lymphoma (FL), immunocytoma (IM) and lymphocytic lymphoma (B-CLL). A micronodular pattern and marginal zone differentiation were both found to be frequently present in FL and MCL, and with lesser frequency in IM and B-CLL. The main morphological feature useful for differential diagnosis was the cytological composition of the white pulp tumoral nodules. SMZL is distinguished by characteristic dimorphic cytology, different from the monomorphic cytology of MCL, and the distinctive mixture of centroblasts and centrocytes which is the rule in FL. B-CLL could also be identified on the basis of the polymorphic cytology including small lymphocytes and prolymphocytes, whereas cases diagnosed as IM show prominent plasmacytic differentiation, lacking the features of the other lymphoma types. Immunohistochemistry was particularly useful for the differential diagnosis. Thus the recognition of MCL was facilitated by the identification of cyclin D1 and CD43 reactivity, while FL could be recognized by the lack of IgD expression or the distinctive pattern of Ki67 staining found in SMZL. B-CLL cells were CD23+, CD43+.

CONCLUSION

The results of this study provide morphological and immunohistological information useful in the recognition of the different varieties of NHLs when involving the spleen and the differential diagnosis of SMZL.

W2H: WWW interface to the GCG sequence analysis package

MOTIVATION

The user-friendly, graphical X-windows interface (WPI) to the GCG sequence analysis package can often not be used due to the lack of an X-server on PC or Macintosh computers. Because Web browsers like Netscape are much more common on those platforms, we decided to develop W2H, a WWW interface to the GCG Sequence Analysis Software Package with nearly the same functionality as the X-windows interface WPI.

RESULTS

The new WWW interface (W2H) to the GCG Sequence Analysis Software Package (Wisconsin Package) supports modern Web technologies, like client-pull method, or embedded scripting language, and provides a reasonable platform independence. The interface is quite comprehensive with advanced features like sequence selector, search set builder, enzyme chooser, access to sequence databases, uploading client files to the GCG server or displaying and manipulating graphical outputs in addition to GCG analysis programs. W2H also manages secure access to both GCG server and user data. For special environments, like workshops, conferences and company intranets, there is a special mode (Intranet mode) with less security constraints. The behaviour of W2H is mostly controlled by meta-data files describing the applications and giving a base for dynamic creation of HTML documents. This paper presents mainly the development approaches used, and architectural design aspects of W2H.

AVAILABILITY

W2H is available by ftp://ftp.ebi.ac. uk/pub/software/unix/w2h or ftp://genome.dkfz-heidelberg.de/pub/w2h

CONTACT

m.senger@ebi.ac.uk

IARC Database of p53 gene mutations in human tumors and cell lines: updated compilation, revised formats and new visualisation tools

Since 1989, about 570 different p53 mutations have been identified in more than 8000 human cancers. A database of these mutations was initiated by M. Hollstein and C. C. Harris in 1990. This database originally consisted of a list of somatic point mutations in the p 53 gene of human tumors and cell lines, compiled from the published literature and made available in a standard electronic form. The database is maintained at the International Agency for Research on Cancer (IARC) and updated versions are released twice a year (January and July). The current version (July 1997) contains records on 6800 published mutations and will surpass the 8000 mark in the January 1998 release. The database now contains information on somatic and germline mutations in a new format to facilitate data retrieval. In addition, new tools are constructed to improve data analysis, such as a Mutation Viewer Java applet developed at the European Bioinformatics Institute (EBI) to visualise the location and impact of mutations on p53 protein structure. The database is available in different electronic formats at IARC (http://www.iarc. fr/p53/homepage.htm ) or from the EBI server (http://www.ebi.ac.uk ). The IARC p53 website also provides reports on database analysis and links with other p53 sites as well as with related databases. In this report, we describe the criteria for inclusion of data, the revised format and the new visualisation tools. We also briefly discuss the relevance of p 53 mutations to clinical and biological questions.

Immune thrombocytopenic purpura secondary to endometriosis

In this paper, we describe a patient with immune thrombocytopenic purpura (ITP) secondary to endometriosis. To our knowledge, this is the first reported case presenting such an association. Surgical eradication of the endometriosis was the only effective treatment for the thrombocytopenia. The pathogenic connection between both disorders seems to be an altered immune function.

[Kukuchi's disease of the neck: report of two cases]

Kikuchi's disease is an unusual disease, described in 1972, that is characterized by lymph node enlargement and fever. Cervical lymph nodes are affected so often that the ear, nose and throat specialist should be aware of this entity during differential diagnosis. Two cases treated in our service are reported and the literature is reviewed.

Pilomatrixoma: a description of two cases diagnosed by fine-needle aspiration

The present work reports on the findings obtained by fine-needle aspiration of two pilomatrixomas located on the upper limbs whose diagnosis was confirmed histologically. In both cases, the cytology disclosed a proliferation of small round basaloid cells that were dispersed and grouped in clusters together with squamous cells and abundant multinucleate giant cells. The differential diagnosis with other neoplasms is discussed.

Evaluation of cellular proliferation in human biopsy samples of lymphoid tissue according to the expression of AgNORs

The proportions of cells with a high expression of AgNORs, as directly assessed under the light microscope, and those of Ki-67-immunoreactive cells were divided into three categories (low, < 25%; intermediate, 25-50%; high, > 50%) and compared to a series of 41 human biopsy samples of lymphoid tissue. Irrespective of histological features a strong correlation was found between both variables (contingency coefficient = 0.8; P < 0.001). It is concluded that direct evaluation of cells with a high expression of AgNORs may serve as an index of proliferative activity in biopsy samples of lymphoid tissue.

Expression of argyrophilic nucleolar organizer regions (AgNORs) can be used to assess cellular proliferation as shown in rat thymic sections

Silver-stained nucleolar organizer regions (AgNORs) were studied in thymic sections from 4- and 30-day-old rats. By direct examination under the light microscope cells with a low or high content of AgNORs (type I and type II cells, respectively) were identified and their relative numbers calculated. The mean area of AgNORs per cell was calculated for each type of cell and age group. Additionally, the proportion of cells labelled with bromodeoxyuridine was calculated in sections from the same animals. Visual identification of type I and type II cells was confirmed by a significant (p < 0.01) difference in the mean AgNOR area in both types of cell. Both the proportion of cells with a high expression of AgNORs (type II cells) and that of bromodeoxyuridine-labelled cells were significantly greater (p < 0.01) in 4-day-old rats than in 30-day-old rats. A significant correlation was found between both variables (R2 = 0.45; p = 0.002), the relation being best between both variables and age (R2 = 0.91; p = < 0.001). These data offer support for an easy interpretation of the AgNOR reaction in which the proportion of cells with a high expression of AgNORs can be used as an index of proliferative activity in a tissue sample.

[Mucinous adenocarcinoma of the urachus. Apropos of a case]

This report present one case of mucinous adenocarcinoma of the urachus, a very uncommon tumour with eccentric clinical behaviour. It includes a brief description of both its macro and microscopic appearance, establishing the differential diagnosis both with adenocarcinoma of the vesical dome and the metastatic tumours which can affect the bladder. Also, there is a brief comment on the main anatomo-clinical characteristics of these tumours.

The anxiety/defense test battery: influence of gender and ritanserin treatment on antipredator defensive behavior

The anxiety/defense test battery has been developed to measure defensive reactions in laboratory rats to both direct exposure to, and stimuli associated with, a natural predator, the domestic cat. The present investigation confirmed earlier findings with each test providing a distinct behavioral profile following exposure to predator stimuli. In addition, the data showed a consistent gender difference in a number of these behavioral measures, indicating that females are more defensive than males. These effects included reliability higher levels of cat avoidance and crouching, with lower levels of transits, lying and drinking for cat-exposed females. Similarly, females exposed to a cat odor stimulus showed a reliably higher level of stretch attend and flat back approach behaviors (risk assessment) towards the stimulus block. The 5-HT2 antagonist, ritanserin, failed to provide significant indication of anxiolytic activity, and had minimal influence on antipredator defensive behavior. An important exception to this profile was a reliable decrease in stretch attend behavior to a cat odor stimulus in females but not males. Overall, these findings suggest a complex relationship between gender, antipredator defensive behavior, and anxiolytic drug treatment.

Masson's vegetant intravascular hemangioendothelioma. Fine needle aspiration cytology, histology and immunohistochemistry of a case

Masson's vegetant hemangioendothelioma is a benign intravascular tumor, sometimes confused with such malignant vascular tumors as angiosarcoma, whose clinical appearance is nonspecific and whose diagnosis can only be established through microscopic examination. The fine needle aspiration (FNA) cytologic findings together with the histologic and immunohistochemical findings of such a tumor in a 22-year-old man are presented. Cytologically, the material obtained by FNA consisted of two distinct populations of cells. One type of cell had large nuclei (sometimes displaced towards the periphery), finely granular chromatin, prominent nucleoli and abundant globular cytoplasm. The second type of cell had spindle-shaped or oval nuclei, granular chromatin and scanty eosinophilic cytoplasm. Although these findings may permit the cytologic recognition of this entity, the aspirate in this case was interpreted as showing a vascular mesenchymal tumor of probable malignancy. Histologic examination of the excised tumor, aided by immunoperoxidase studies for factor VIII antigen that revealed the endothelial nature of the proliferating cells, established the correct diagnosis.