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Lo Y, Lester SC, Ellis IO, Lanjewar S, Laurini J, Patel A, Bhattarai A, Ustun B, Harmon B, Kleer CG, Ross D, Amin A, Wang Y, Bradley R, Turashvili G, Zeng J, Baum J, Singh K, Hakima L, Harigopal M, Komforti M, Shin SJ, Abbott SE, Jaffer S, Badve SS, Khoury T, D'Alfonso TM, Ginter PS, Collins V, Towne W, Gan Y, Nassar A, Sahin AA, Flieder A, Aldrees R, Ngo MH, Edema U, Sapna F, Schnitt SJ, Fineberg SA. Identification of Glandular (Acinar)/Tubule Formation in Invasive Carcinoma of the Breast: A Study to Determine Concordance Using the World Health Organization Definition. Arch Pathol Lab Med 2024:498575. [PMID: 38244086 DOI: 10.5858/arpa.2023-0163-oa] [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] [Accepted: 11/02/2023] [Indexed: 01/22/2024]
Abstract
CONTEXT.— The Nottingham Grading System (NGS) developed by Elston and Ellis is used to grade invasive breast cancer (IBC). Glandular (acinar)/tubule formation is a component of NGS. OBJECTIVE.— To investigate the ability of pathologists to identify individual structures that should be classified as glandular (acinar)/tubule formation. DESIGN.— A total of 58 hematoxylin-eosin photographic images of IBC with 1 structure circled were classified as tubules (41 cases) or nontubules (17 cases) by Professor Ellis. Images were sent as a PowerPoint (Microsoft) file to breast pathologists, who were provided with the World Health Organization definition of a tubule and asked to determine if a circled structure represented a tubule. RESULTS.— Among 35 pathologists, the κ statistic for assessing agreement in evaluating the 58 images was 0.324 (95% CI, 0.314-0.335). The median concordance rate between a participating pathologist and Professor Ellis was 94.1% for evaluating 17 nontubule cases and 53.7% for 41 tubule cases. A total of 41% of the tubule cases were classified correctly by less than 50% of pathologists. Structures classified as tubules by Professor Ellis but often not recognized as tubules by pathologists included glands with complex architecture, mucinous carcinoma, and the "inverted tubule" pattern of micropapillary carcinoma. A total of 80% of participants reported that they did not have clarity on what represented a tubule. CONCLUSIONS.— We identified structures that should be included as tubules but that were not readily identified by pathologists. Greater concordance for identification of tubules might be obtained by providing more detailed images and descriptions of the types of structures included as tubules.
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Affiliation(s)
- Yungtai Lo
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Susan C Lester
- the Department of Pathology, Brigham and Women's Hospital and the Dana-Farber/Harvard Cancer Center, Boston, Massachusetts (Lester, Aldrees, Ngo, Schnitt)
| | - Ian O Ellis
- the Department of Histopathology, University of Nottingham/Nottingham City Hospital, Nottingham, United Kingdom (Ellis)
| | - Sonali Lanjewar
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Javier Laurini
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ami Patel
- the Department of Pathology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York (Patel)
| | - Ava Bhattarai
- the Department of Pathology, Methodist University Hospital, Memphis, Tennessee (Bhattarai, Bradley)
| | - Berrin Ustun
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Bryan Harmon
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Celina G Kleer
- the Department of Pathology, University of Michigan, Ann Arbor (Kleer, Abbott)
| | - Dara Ross
- the Department of Pathology Memorial Sloan Kettering Cancer Center, New York, New York (Ross, D'Alfonso)
| | - Ali Amin
- the Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Amin, Wang, Singh)
| | - Yihong Wang
- the Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Amin, Wang, Singh)
| | - Robert Bradley
- the Department of Pathology, Methodist University Hospital, Memphis, Tennessee (Bhattarai, Bradley)
| | - Gulisa Turashvili
- the Department of Pathology, Emory University Hospital, Atlanta, Georgia (Turashvili, Badve)
| | - Jennifer Zeng
- the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Zeng, Collins)
| | - Jordan Baum
- the Department of Pathology, NYU Langone Hospital, Mineola, New York (Baum, Ginter, Flieder)
| | - Kamaljeet Singh
- the Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Amin, Wang, Singh)
| | - Laleh Hakima
- the Department of Pathology, University of North Carolina Hospitals, Chapel Hill (Hakima)
| | - Malini Harigopal
- the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Harigopal)
| | - Miglena Komforti
- the Department of Pathology, Mayo Clinic, Jacksonville, Florida (Komforti, Nassar)
| | - Sandra J Shin
- the Department of Pathology, Albany Medical College, Albany, New York (Shin)
| | - Sara E Abbott
- the Department of Pathology, University of Michigan, Ann Arbor (Kleer, Abbott)
| | - Shabnam Jaffer
- the Department of Pathology, Lenox Hill Hospital/Northwell Health, New York, New York (Jaffer)
| | - Sunil Shankar Badve
- the Department of Pathology, Emory University Hospital, Atlanta, Georgia (Turashvili, Badve)
| | - Thaer Khoury
- the Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York (Khoury)
| | - Timothy M D'Alfonso
- the Department of Pathology Memorial Sloan Kettering Cancer Center, New York, New York (Ross, D'Alfonso)
| | - Paula S Ginter
- the Department of Pathology, NYU Langone Hospital, Mineola, New York (Baum, Ginter, Flieder)
| | - Victoria Collins
- the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Zeng, Collins)
| | - William Towne
- the Department of Pathology, Columbia University/New York Presbyterian Hospital, New York, New York (Towne)
| | - Yujun Gan
- the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Gan)
| | - Aziza Nassar
- the Department of Pathology, Mayo Clinic, Jacksonville, Florida (Komforti, Nassar)
| | - Aysegul A Sahin
- the Department of Pathology, MD Anderson Cancer Center, Houston, Texas (Sahin)
| | - Andrea Flieder
- the Department of Pathology, NYU Langone Hospital, Mineola, New York (Baum, Ginter, Flieder)
| | - Rana Aldrees
- the Department of Pathology, Brigham and Women's Hospital and the Dana-Farber/Harvard Cancer Center, Boston, Massachusetts (Lester, Aldrees, Ngo, Schnitt)
| | - Marie-Helene Ngo
- the Department of Pathology, Brigham and Women's Hospital and the Dana-Farber/Harvard Cancer Center, Boston, Massachusetts (Lester, Aldrees, Ngo, Schnitt)
| | - Ukuemi Edema
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Fnu Sapna
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Stuart J Schnitt
- the Department of Pathology, Brigham and Women's Hospital and the Dana-Farber/Harvard Cancer Center, Boston, Massachusetts (Lester, Aldrees, Ngo, Schnitt)
| | - Susan A Fineberg
- From the Departments of Epidemiology and Population Health (Lo) and Pathology (Fineberg, Lanjewar, Laurini, Ustun, Harmon, Edema, Sapna), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Grabenstetter A, D'Alfonso TM. The Role of Novel Immunohistochemical Markers for Special Types of Breast Carcinoma. Adv Anat Pathol 2023; 30:374-379. [PMID: 37746900 DOI: 10.1097/pap.0000000000000415] [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: 09/26/2023]
Abstract
Some histologic special types of breast carcinoma harbor specific recurrent genetic alterations that are not seen in other types of breast carcinoma (no special type), namely adenoid cystic carcinoma, secretory carcinoma, and tall cell carcinoma with reversed polarity. These tumors have unique morphologic features, are triple-negative, that is, do not express hormone receptors or HER2, and are generally associated with a favorable prognosis. Adenoid cystic carcinoma, like its counterpart in other organs, shows a MYB-NFIB fusion gene that is the result of a recurrent t(6;9)(q22-23;p23-24) translocation. Other MYB alterations have been described that result in overexpression of MYB . Secretory carcinoma is characterized by an ETV6-NTRK3 gene fusion that is the result of recurrent (12;15);(p13;q25) translocation, which is also seen in mammary analog secretory carcinoma of the salivary gland. Tall cell carcinoma with reversed polarity shows IDH2 p.Arg172 hotspot mutations. Immunohistochemical antibodies have emerged that identify the underlying genetic alterations in these tumors and serve as useful diagnostic tools. This review will provide an update on the molecular features and diagnostic immunohistochemical markers that have become increasingly popular to aid in diagnosing these uncommon triple-negative breast tumors.
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Affiliation(s)
- Anne Grabenstetter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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Verdial FC, Mamtani A, Pawloski KR, Sevilimedu V, D'Alfonso TM, Zhang H, Gemignani ML, Barrio AV, Morrow M, Tadros AB. The Effect of Age on Outcomes After Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 2022; 29:3810-3819. [PMID: 35246810 PMCID: PMC10901180 DOI: 10.1245/s10434-022-11367-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Younger women (age ≤ 40 years) with breast cancer undergoing neoadjuvant chemotherapy (NAC) have higher rates of pathologic complete response (pCR); however, it is unknown whether axillary or breast downstaging rates differ by age. In this study, we compared pCR incidence and surgical downstaging rates of the breast and axilla post NAC, between patients aged ≤ 40, 41-60, and ≥ 61 years. METHODS We identified 1383 women with stage I-III breast cancer treated with NAC and subsequent surgery from November 2013 to December 2018. pCR and breast/axillary downstaging rates were assessed and compared across age groups. RESULTS Younger women were significantly more likely to have ductal histology, poorly differentiated tumors, and BRCA mutations; 35% of tumors were hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-), 36% were HER2-positive (HER2+), and 29% were triple negative (TN), with similar subtype distribution across age groups (p = 0.6). Overall, pCR rates did not differ by age, however among patients with TN tumors (n = 394), younger women had higher pCR rates (52% vs. 35% among those aged 41-60 years and 29% among those aged ≥61 years; p = 0.007) and were more likely to have tumors with high tumor-infiltrating lymphocyte (TIL) concentrations (p < 0.001). Downstaging to breast-conserving surgery (BCS) eligibility post NAC among initially BCS-ineligible patients was similar across age groups; younger women chose BCS less often (p < 0.001). Among cN1 patients (n = 813), 52% of women ≤40 years of age avoided axillary lymph node dissection (ALND) with NAC, versus 39% and 37% in the older groups (p < 0.001). CONCLUSIONS Younger women undergoing NAC for axillary downstaging were more likely to avoid ALND across all subtypes; however, overall pCR rates did not differ by age. Despite equivalent breast downstaging and BCS eligibility rates across age groups, younger women were less likely to undergo BCS.
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Affiliation(s)
- Francys C Verdial
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anita Mamtani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kate R Pawloski
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy M D'Alfonso
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hong Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Mantrala S, Ginter PS, Mitkar A, Joshi S, Prabhala H, Ramachandra V, Kini L, Idress R, D'Alfonso TM, Fineberg S, Jaffer S, Sattar AK, Chagpar AB, Wilson P, Singh K, Harigopal M, Koka D. Concordance in Breast Cancer Grading by Artificial Intelligence on Whole Slide Images Compares With a Multi-Institutional Cohort of Breast Pathologists. Arch Pathol Lab Med 2022; 146:1369-1377. [PMID: 35271701 DOI: 10.5858/arpa.2021-0299-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Breast carcinoma grade, as determined by the Nottingham Grading System (NGS), is an important criterion for determining prognosis. The NGS is based on 3 parameters: tubule formation (TF), nuclear pleomorphism (NP), and mitotic count (MC). The advent of digital pathology and artificial intelligence (AI) have increased interest in virtual microscopy using digital whole slide imaging (WSI) more broadly. OBJECTIVE.— To compare concordance in breast carcinoma grading between AI and a multi-institutional group of breast pathologists using digital WSI. DESIGN.— We have developed an automated NGS framework using deep learning. Six pathologists and AI independently reviewed a digitally scanned slide from 137 invasive carcinomas and assigned a grade based on scoring of the TF, NP, and MC. RESULTS.— Interobserver agreement for the pathologists and AI for overall grade was moderate (κ = 0.471). Agreement was good (κ = 0.681), moderate (κ = 0.442), and fair (κ = 0.368) for grades 1, 3, and 2, respectively. Observer pair concordance for AI and individual pathologists ranged from fair to good (κ = 0.313-0.606). Perfect agreement was observed in 25 cases (27.4%). Interobserver agreement for the individual components was best for TF (κ = 0.471 each) followed by NP (κ = 0.342) and was worst for MC (κ = 0.233). There were no observed differences in concordance amongst pathologists alone versus pathologists + AI. CONCLUSIONS.— Ours is the first study comparing concordance in breast carcinoma grading between a multi-institutional group of pathologists using virtual microscopy to a newly developed WSI AI methodology. Using explainable methods, AI demonstrated similar concordance to pathologists alone.
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Affiliation(s)
- Siddhartha Mantrala
- From Onward Assist, Ojas Medtech Incubator, CIE, IIIT Hyderabad Campus, Gachibowli, Telangana, India (Mantrala, Mitkari, Joshi, Prabhala, Ramachandra, Kini, Koka)
| | - Paula S Ginter
- The Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York (Ginter)
| | - Aditya Mitkar
- From Onward Assist, Ojas Medtech Incubator, CIE, IIIT Hyderabad Campus, Gachibowli, Telangana, India (Mantrala, Mitkari, Joshi, Prabhala, Ramachandra, Kini, Koka)
| | - Sripad Joshi
- From Onward Assist, Ojas Medtech Incubator, CIE, IIIT Hyderabad Campus, Gachibowli, Telangana, India (Mantrala, Mitkari, Joshi, Prabhala, Ramachandra, Kini, Koka)
| | - Harish Prabhala
- From Onward Assist, Ojas Medtech Incubator, CIE, IIIT Hyderabad Campus, Gachibowli, Telangana, India (Mantrala, Mitkari, Joshi, Prabhala, Ramachandra, Kini, Koka)
| | - Vikas Ramachandra
- From Onward Assist, Ojas Medtech Incubator, CIE, IIIT Hyderabad Campus, Gachibowli, Telangana, India (Mantrala, Mitkari, Joshi, Prabhala, Ramachandra, Kini, Koka)
| | - Lata Kini
- From Onward Assist, Ojas Medtech Incubator, CIE, IIIT Hyderabad Campus, Gachibowli, Telangana, India (Mantrala, Mitkari, Joshi, Prabhala, Ramachandra, Kini, Koka)
| | - Romana Idress
- The Department of Pathology and Laboratory Medicine (Idress), Aga Khan University, Karachi, Pakistan
| | - Timothy M D'Alfonso
- The Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (D'Alfonso)
| | - Susan Fineberg
- The Department of Pathology, Montefiore Medical Center, Bronx, New York (Fineberg)
| | - Shabnam Jaffer
- The Department of Pathology, Molecular and Cell Based Medicine, The Mount Sinai Hospital, New York, New York (Jaffer)
| | - Abida K Sattar
- The Department of Surgery (Sattar), Aga Khan University, Karachi, Pakistan
| | - Anees B Chagpar
- The Department of Surgery (Chagpar), Yale School of Medicine, New Haven, Connecticut
| | - Parker Wilson
- The Department of Pathology and Immunology, Washington University, St. Louis, Missouri (Wilson)
| | - Kamaljeet Singh
- The Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island (Singh)
| | - Malini Harigopal
- The Department of Pathology (Harigopal), Yale School of Medicine, New Haven, Connecticut
| | - Dinesh Koka
- From Onward Assist, Ojas Medtech Incubator, CIE, IIIT Hyderabad Campus, Gachibowli, Telangana, India (Mantrala, Mitkari, Joshi, Prabhala, Ramachandra, Kini, Koka)
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5
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Abstract
Papillary neoplasms of the breast are a heterogeneous group of tumors characterized by fibrovascular cores lined by epithelium, with or without myoepithelial cells. Papillary neoplasms include benign, atypical, and malignant tumors that show varying histopathologic features and clinical outcomes. Appropriate pathologic classification is crucial to guide clinical treatment. Classification of papillary neoplasms is largely based on morphology, with immunohistochemistry playing an ancillary role to establish diagnoses. Recent molecular studies have provided insight into the genomics of these lesions. This review summarizes the histologic, immunohistochemical, and molecular features of papillary neoplasms of the breast that are important for diagnosis and treatment.
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Affiliation(s)
- Dara S Ross
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, S-624, New York, NY 10065, USA
| | - Timothy M D'Alfonso
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, A-504, New York, NY 10065, USA.
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6
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Schwartz CJ, da Silva EM, Marra A, Gazzo AM, Selenica P, Rai VK, Mandelker D, Pareja F, Misyura M, D'Alfonso TM, Brogi E, Drullinsky P, Razavi P, Robson ME, Drago JZ, Wen HY, Zhang L, Weigelt B, Shia J, Reis-Filho JS, Zhang H. Morphological and genomic characteristics of breast cancers occurring in individuals with Lynch Syndrome. Clin Cancer Res 2021; 28:404-413. [PMID: 34667028 DOI: 10.1158/1078-0432.ccr-21-2027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/11/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Lynch syndrome (LS) is defined by germline pathogenic mutations involving DNA Mismatch Repair (MMR) genes and linked with the development of MMR-deficient (MMRd) colon and endometrial cancers. Whether breast cancers (BC) developing in context of LS are causally related to MMR deficiency (MMRd), remains controversial. Thus, we explored the morphological and genomic characteristics of BCs occurring in LS individuals. EXPERIMENTAL DESIGN A retrospective analysis of 20,110 cancer patients who underwent multigene panel genetic testing was performed to identify individuals with a likely pathogenic/pathogenic germline variant in MLH1, MSH2, MSH6 or PMS2 who developed BCs. The histological characteristics and immunohistochemical (IHC) assessment of BCs for MMR proteins and programmed death-ligand 1 (PD-L1) expression were assessed on cases with available materials. DNA samples from paired tumors and blood were sequenced with MSK-IMPACT ({greater than or equal to}468 key cancer genes). MSI status was assessed utilizing MSISensor. Mutational signatures were defined using SigMA. RESULTS 272 LS individuals were identified, 13 (5%) of whom had primary BCs. The majority of BCs (92%) were hormone receptor positive tumors. Five (42%) of 12 BCs displayed loss of MMR proteins by IHC. Four (36%) of 11 BCs subjected to tumor-normal sequencing showed dominant microsatellite instability mutational signatures, high tumor mutational burden and indeterminate (27%) or high MSISensor scores (9%). One patient with metastatic MMRd BC received anti-PD1 therapy and achieved a robust and durable response. CONCLUSIONS A subset of BCs developing in LS individuals are etiologically linked to MMRd and may benefit from anti-PD1/PD-L1 immunotherapy.
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Affiliation(s)
| | | | - Antonio Marra
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS
| | - Andrea M Gazzo
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Pier Selenica
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | | | - Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | | | - Edi Brogi
- Memorial Sloan Kettering Cancer Center
| | | | - Pedram Razavi
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Mark E Robson
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | | | | | - Liying Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | - Hong Zhang
- Pathology, Memorial Sloan Kettering Cancer Center
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7
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Zeng J, Edelweiss M, Ross DS, Xu B, Moo TA, Brogi E, D'Alfonso TM. Triple-Positive Breast Carcinoma: Histopathologic Features and Response to Neoadjuvant Chemotherapy. Arch Pathol Lab Med 2021; 145:728-735. [PMID: 33112958 DOI: 10.5858/arpa.2020-0293-oa] [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] [Accepted: 07/15/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— It is unclear whether HER2+ tumors expressing both estrogen receptor (ER) and progesterone receptor (PR), that is, triple-positive breast carcinomas (TPBCs), show unique morphologic and clinical features and response to neoadjuvant chemotherapy (NAC). OBJECTIVE.— To study the morphologic and immunohistochemical features of TPBCs from patients who underwent NAC. DESIGN.— We retrospectively reviewed core biopsy and post-NAC slides of 85 TPBCs. H-scores were calculated for ER and PR. HER2 slides and fluorescence in situ hybridization (FISH) reports were reviewed. Residual cancer burden was calculated for post-NAC specimens. RESULTS.— Eighty-one of the 85 tumors (95.3%) showed ductal histology, 3 (3.5%) were invasive lobular carcinomas, and 1 (1.2%) showed mixed ductal and lobular features. A subset showed mucinous (n = 7, 8.2%), apocrine (n = 5, 5.9%), and/or micropapillary (n = 4, 4.7%) differentiation. Fifty-four TPBCs (63.5%) showed high ER expression (H-score >200), including 27 (31.8%) with high expression of ER and PR. Fifty-two tumors (61.1%) showed HER2 3+ staining. Mean HER2/CEP17 ratio by FISH was 3.6 (range, 2-12.2) and mean HER2 signals per cell was 8 (range, 3.7-30.4). Pathologic complete response (pCR) rate was 35.3% (30 of 85). HER2 3+ staining was the only significant predictor of pCR on multivariate analysis (odds ratio = 9.215; 95% CI, 2.401-35.371; P < .001). The ER/PR expression did not correlate with response to therapy. CONCLUSIONS.— TPBCs are heterogeneous with some showing mucinous, lobular, or micropapillary differentiation. The pCR rate of TPBCs is similar to that reported for ER+/PR-/HER2+ tumors. HER2 overexpression by IHC was associated with significantly better response to therapy and may help select patients for treatment in the neoadjuvant setting.
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Affiliation(s)
- Jennifer Zeng
- From the Departments of Pathology (Zeng, Edelweiss, Ross, Xu, Brogi, D'Alfonso), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marcia Edelweiss
- From the Departments of Pathology (Zeng, Edelweiss, Ross, Xu, Brogi, D'Alfonso), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dara S Ross
- From the Departments of Pathology (Zeng, Edelweiss, Ross, Xu, Brogi, D'Alfonso), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bin Xu
- From the Departments of Pathology (Zeng, Edelweiss, Ross, Xu, Brogi, D'Alfonso), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tracy-Ann Moo
- Breast Surgical Oncology (Moo), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edi Brogi
- From the Departments of Pathology (Zeng, Edelweiss, Ross, Xu, Brogi, D'Alfonso), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy M D'Alfonso
- From the Departments of Pathology (Zeng, Edelweiss, Ross, Xu, Brogi, D'Alfonso), Memorial Sloan Kettering Cancer Center, New York, New York
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8
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Moo TA, Saccarelli CR, Sutton EJ, Sevilimedu V, Pawloski KR, D'Alfonso TM, Hughes MC, Gluskin JS, Bitencourt A, Morris EA, Tadros A, Morrow M, Gemignani ML, Sacchini V. Tumor-Nipple Distance of ≥ 1 cm Predicts Negative Nipple Pathology After Neoadjuvant Chemotherapy. Ann Surg Oncol 2021; 28:6024-6029. [PMID: 33866472 DOI: 10.1245/s10434-021-09902-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND As neoadjuvant chemotherapy (NAC) for breast cancer has become more widely used, so has nipple-sparing mastectomy. A common criterion for eligibility is a 1 cm tumor-to-nipple distance (TND), but its suitability after NAC is unclear. In this study, we examined factors predictive of negative nipple pathologic status (NS-) in women undergoing total mastectomy after NAC. METHODS Women with invasive breast cancer treated with NAC and total mastectomy from August 2014 to April 2018 at our institution were retrospectively identified. Following review of pre- and post-NAC magnetic resonance imaging (MRI) and mammograms, the association of clinicopathologic and imaging variables with NS- was examined and the accuracy of 1 cm TND on imaging for predicting NS- was determined. RESULTS Among 175 women undergoing 179 mastectomies, 74% of tumors were cT1-T2 and 67% were cN+ on pre-NAC staging; 10% (18/179) had invasive or in situ carcinoma in the nipple on final pathology. On multivariable analysis, after adjusting for age, grade, and tumor stage, three factors, namely number of positive nodes, pre-NAC nipple-areolar complex retraction, and decreasing TND, were significant predictors of nipple involvement (p < 0.05). The likelihood of NS- was higher with increasing TND on pre- and post-NAC imaging (p < 0.05). TND ≥ 1 cm predicted NS- in 97% and 95% of breasts on pre- and post-NAC imaging, respectively. CONCLUSIONS Increasing TND was associated with a higher likelihood of NS-. A TND ≥ 1 cm on pre- or post-NAC imaging is highly predictive of NS- and could be used to determine eligibility for nipple-sparing mastectomy after NAC.
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Affiliation(s)
- Tracy-Ann Moo
- Breast Service, Department of Surgery, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Carolina Rossi Saccarelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Imaging, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Elizabeth J Sutton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kate R Pawloski
- Breast Service, Department of Surgery, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy M D'Alfonso
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary C Hughes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jill S Gluskin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Almir Bitencourt
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audree Tadros
- Breast Service, Department of Surgery, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Virgilio Sacchini
- Breast Service, Department of Surgery, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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9
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Ho DJ, Yarlagadda DVK, D'Alfonso TM, Hanna MG, Grabenstetter A, Ntiamoah P, Brogi E, Tan LK, Fuchs TJ. Deep Multi-Magnification Networks for multi-class breast cancer image segmentation. Comput Med Imaging Graph 2021; 88:101866. [PMID: 33485058 PMCID: PMC7975990 DOI: 10.1016/j.compmedimag.2021.101866] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 01/17/2023]
Abstract
Pathologic analysis of surgical excision specimens for breast carcinoma is important to evaluate the completeness of surgical excision and has implications for future treatment. This analysis is performed manually by pathologists reviewing histologic slides prepared from formalin-fixed tissue. In this paper, we present Deep Multi-Magnification Network trained by partial annotation for automated multi-class tissue segmentation by a set of patches from multiple magnifications in digitized whole slide images. Our proposed architecture with multi-encoder, multi-decoder, and multi-concatenation outperforms other single and multi-magnification-based architectures by achieving the highest mean intersection-over-union, and can be used to facilitate pathologists' assessments of breast cancer.
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Affiliation(s)
- David Joon Ho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA.
| | - Dig V K Yarlagadda
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Timothy M D'Alfonso
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Anne Grabenstetter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Peter Ntiamoah
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Lee K Tan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Thomas J Fuchs
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA; Weill Cornell Graduate School for Medical Sciences, New York, NY 10065 USA
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10
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Hoda RS, Brogi E, D'Alfonso TM, Grabenstetter A, Giri D, Hanna MG, Kuba MG, Murray MP, Vallejo CE, Zhang H, Reis-Filho JS, Wen HY. Interobserver Variation of PD-L1 SP142 Immunohistochemistry Interpretation in Breast Carcinoma: A Study of 79 Cases Using Whole Slide Imaging. Arch Pathol Lab Med 2021; 145:1132-1137. [PMID: 33417715 DOI: 10.5858/arpa.2020-0451-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The Ventana programmed death ligand-1 (PD-L1) SP142 immunohistochemical assay (IHC) is approved by the US Food and Drug Administration as the companion diagnostic assay to identify patients with locally advanced or metastatic triple-negative breast cancer for immunotherapy with atezolizumab, a monoclonal antibody targeting PD-L1. OBJECTIVE.— To determine interobserver variability in PD-L1 SP142 IHC interpretation in invasive breast carcinoma. DESIGN.— The pathology database was interrogated for all patients diagnosed with primary invasive, locally recurrent, or metastatic breast carcinoma on which PD-L1 SP142 IHC was performed from November 2018 to June 2019 at our institution. A subset of cases was selected using a computerized random-number generator. PD-L1 IHC was evaluated in stromal tumor-infiltrating immune cells using the IMpassion130 trial criteria, with positive cases defined as immunoreactivity in immune cells 1% or more of the tumor area. IHC was interpreted on whole slide images by staff pathologists with breast pathology expertise. Interobserver variability was calculated using unweighted κ. RESULTS.— A total of 79 cases were assessed by 8 pathologists. Interobserver agreement was substantial (κ = 0.727). There was complete agreement among all 8 pathologists in 62% (49 of 79) of cases, 7 pathologists or more in 84% (66 of 79) of cases and 6 pathologists or more in 92% (73 of 79) of cases. In 4% (3 of 79) of cases, all of which were small biopsies, pathologists' interpretations were evenly split between scores of positive and negative. CONCLUSIONS.— The findings show substantial agreement in PD-L1 SP142 IHC assessment of breast carcinoma cases among 8 pathologists at a single institution. Further study is warranted to define the basis for discrepant results.
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Affiliation(s)
- Raza S Hoda
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York.,Hoda is currently located in the Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Edi Brogi
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy M D'Alfonso
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Grabenstetter
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dilip Giri
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew G Hanna
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - M Gabriela Kuba
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa P Murray
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christina E Vallejo
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hong Zhang
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jorge S Reis-Filho
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hannah Y Wen
- From the Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, New York
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11
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da Silva EM, Beca F, Sebastiao APM, Murray MP, Silveira C, Da Cruz Paula A, Pareja F, Wen HY, D'Alfonso TM, Edelweiss M, Weigelt B, Brogi E, Reis-Filho JS, Zhang H. Stromal MED12 exon 2 mutations in complex fibroadenomas of the breast. J Clin Pathol 2020; 75:133-136. [PMID: 33376197 PMCID: PMC8260148 DOI: 10.1136/jclinpath-2020-207062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022]
Abstract
Aims Here we explore the presence of mediator complex subunit 12 (MED12) exon 2 and telomerase reverse transcriptase (TERT) promoter hotspot mutations in complex fibroadenomas (CFAs) of the breast. Methods The stromal components from 18 CFAs were subjected to Sanger sequencing of MED12 exon 2 and the TERT promoter hotspot loci. The epithelial and stromal components of two MED12 mutated CFAs were subjected to laser capture microdissection, and Sanger sequencing of MED12 exon 2, TERT promoter and PIK3CA exons 9 and 20, separately. Results MED12 exon 2 mutations were identified in the stroma of 17% of CFAs. The analyses of epithelial and stromal components, microdissected separately, revealed that MED12 mutations were restricted to the stroma. No TERT promoter or PIK3CA mutations in exons 9 and 20 were detected in analysed CFAs. Conclusions Like conventional fibroadenomas, MED12 exon 2 mutations appear to be restricted to the stromal component of CFAs, supporting the notion that CFAs are stromal neoplasms.
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Affiliation(s)
- Edaise M da Silva
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francisco Beca
- Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Ana Paula Martins Sebastiao
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medical Pathology, Universidade Federal do Parana Setor de Ciencias da Saude, Curitiba, Brazil
| | - Melissa P Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Catarina Silveira
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,GenoMed SA, Institute of Molecular Medicine, University of Lisbon, Lisboa, Portugal
| | | | - Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hannah Y Wen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy M D'Alfonso
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marcia Edelweiss
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hong Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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12
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D'Alfonso TM, Pareja F, Da Cruz Paula A, Vahdatinia M, Gazzo A, Ferrando L, da Silva EM, Cheng E, Sclafani L, Chandarlapaty S, Zhang H, Hoda SA, Wen HY, Brogi E, Weigelt B, Reis-Filho JS. Whole-exome sequencing analysis of juvenile papillomatosis and coexisting breast carcinoma. J Pathol Clin Res 2020; 7:113-120. [PMID: 33263939 PMCID: PMC7869928 DOI: 10.1002/cjp2.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 12/18/2022]
Abstract
Juvenile papillomatosis (JP) of the breast is a rare benign mass‐forming lesion occurring in young women, which is histologically characterized by a constellation of proliferative changes and large cysts, giving it the gross appearance of Swiss cheese. A subset of patients with JP report a family history of breast carcinoma and/or coexisting or subsequent breast carcinoma. We performed whole‐exome sequencing of the hyperplastic epithelial component of three JPs, including one with coexisting ductal carcinoma in situ (DCIS) and invasive ductal carcinoma of no special type (IDC‐NST). JPs harbored clonal somatic PIK3CA hotspot mutations in two cases. In the JP with coexisting DCIS and IDC‐NST, these lesions were clonally related to the associated JP, sharing a clonal PIK3CA E542K somatic hotspot mutation. JP showed a paucity of copy number alterations, whereas the associated DCIS and IDC‐NST showed concurrent 1q gains/16q losses, hallmarks of estrogen receptor (ER)‐positive breast cancers. We observed JP to harbor a dominant aging‐related mutational signature, whereas coexisting DCIS and IDC‐NST showed greater exposure to an APOBEC signature. Taken together, our findings suggest that, at least in a subset of cases, JP might constitute the substrate from which DCIS and invasive breast carcinomas develop.
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Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arnaud Da Cruz Paula
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mahsa Vahdatinia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Gazzo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lorenzo Ferrando
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Edaise M da Silva
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Esther Cheng
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa Sclafani
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarat Chandarlapaty
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hong Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Syed A Hoda
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Hannah Y Wen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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13
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Grabenstetter A, Mohanty AS, Rana S, Zehir A, Brannon AR, D'Alfonso TM, DeLair DF, Tan LK, Ross DS. E-cadherin immunohistochemical expression in invasive lobular carcinoma of the breast: correlation with morphology and CDH1 somatic alterations. Hum Pathol 2020; 102:44-53. [PMID: 32599083 DOI: 10.1016/j.humpath.2020.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/05/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
E-cadherin (ECAD) immunohistochemical (IHC) expression is lost in ∼90% of invasive lobular carcinomas (ILCs) owing to genomic alterations of CDH1. We examined morphologic features and ECAD IHC expression in invasive breast carcinomas (BCs) with known CDH1 alterations. Between January 2014 and May 2018, 202 cases of BC with a CDH1 somatic alteration were identified. ECAD expression was lost in 77% (155/202) of cases and was retained in 23% (47/202) cases. Most (90%, 139/155) ECAD-negative cases were morphologically classified as ILC, while the remaining (10%, 16/155) were invasive mammary carcinoma with mixed ductal and lobular features (IMC). Of 47 cases with ECAD staining, 62% (29/47) were classified as ILC, 23% (11/47) were classified as IMC, and 15% (7/47) were classified as invasive ductal carcinoma (IDC). Of note, 51% (24/47) of ECAD-positive cases were initially diagnosed as IDC or IMC based on ECAD expression alone. For ECAD-negative BCs, 98% (152/155) of CDH1 alterations were truncating, and 2% (3/155) were variants of unknown significance (VUS). Truncating CDH1 alterations were identified in the majority of ECAD-positive BCs (72%, 34/47); however, VUS-type CDH1 alterations were more prevalent (28%, 13/47) in ECAD-positive BCs than in ECAD-negative BCs. Although 90% of ECAD-negative tumors were compatible with ILC in this study, 17% (29/168) of ILC cases were ECAD positive. In addition, CDH1 truncating alterations were seen in ECAD-positive ILC, supporting the notion of aberrant ECAD staining. Therefore, ECAD IHC expression must be interpreted in conjunction with morphology, and BC with classic histologic features of ILC should not be reclassified as IDC/IMC based solely on the status of ECAD IHC expression.
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Affiliation(s)
- Anne Grabenstetter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Abhinita S Mohanty
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Satshil Rana
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - A Rose Brannon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Timothy M D'Alfonso
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Deborah F DeLair
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Lee K Tan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Dara S Ross
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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14
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Pareja F, D'Alfonso TM. Neuroendocrine neoplasms of the breast: A review focused on the updated World Health Organization (WHO) 5th Edition morphologic classification. Breast J 2020; 26:1160-1167. [PMID: 32383258 DOI: 10.1111/tbj.13863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Abstract
Neuroendocrine breast neoplasms are uncommon invasive carcinomas that have historically been poorly defined due to various definitions of what constitutes a neuroendocrine carcinoma. The 5th Edition of the World Health Organization (WHO) Classification of Breast Tumors has moved to a dichotomous classification of neuroendocrine neoplasms in the breast in order to become standardized with classifications of other organ systems. Neuroendocrine breast neoplasms in the new edition are classified as "neuroendocrine tumor" and "neuroendocrine carcinoma." Key changes are exclusion of special histologic types (solid papillary carcinoma and hypercellular variant of mucinous carcinoma) and the inclusion of large cell neuroendocrine carcinoma. Neuroendocrine tumors are genetically heterogenous and harbor molecular alterations that differ from invasive carcinoma, no special type. Neuroendocrine carcinomas (high-grade) show some overlapping molecular alterations with their counterparts in other organ systems. Data regarding the prognostic significance of neuroendocrine differentiation are conflicting, and histologic grade and tumor stage remain the main prognostic parameters. Current management of neuroendocrine neoplasms is not different from other types of breast carcinoma. This review will provide an update to the current WHO classification of neuroendocrine breast neoplasms and describe pertinent clinical, histologic, and molecular features of these uncommon tumors.
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Affiliation(s)
- Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy M D'Alfonso
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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15
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Zhou ZN, Hayden J, D'Alfonso TM, Holcomb K. Elevated Serum βhCG in a 34-Year-Old Woman with Breast Cancer. J Appl Lab Med 2018; 3:314-318. [PMID: 33636937 DOI: 10.1373/jalm.2017.025288] [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: 10/30/2017] [Accepted: 01/03/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Zhen Ni Zhou
- Department of Obstetrics and Gynecology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Joshua Hayden
- Departments of Pathology and Laboratory Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Timothy M D'Alfonso
- Departments of Pathology and Laboratory Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
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16
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Karagiannis GS, Pastoriza JM, Wang Y, Harney AS, Entenberg D, Pignatelli J, Sharma VP, Xue EA, Cheng E, D'Alfonso TM, Jones JG, Anampa J, Rohan TE, Sparano JA, Condeelis JS, Oktay MH. Neoadjuvant chemotherapy induces breast cancer metastasis through a TMEM-mediated mechanism. Sci Transl Med 2018; 9:9/397/eaan0026. [PMID: 28679654 DOI: 10.1126/scitranslmed.aan0026] [Citation(s) in RCA: 318] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/13/2017] [Indexed: 12/11/2022]
Abstract
Breast cancer cells disseminate through TIE2/MENACalc/MENAINV-dependent cancer cell intravasation sites, called tumor microenvironment of metastasis (TMEM), which are clinically validated as prognostic markers of metastasis in breast cancer patients. Using fixed tissue and intravital imaging of a PyMT murine model and patient-derived xenografts, we show that chemotherapy increases the density and activity of TMEM sites and Mena expression and promotes distant metastasis. Moreover, in the residual breast cancers of patients treated with neoadjuvant paclitaxel after doxorubicin plus cyclophosphamide, TMEM score and its mechanistically connected MENAINV isoform expression pattern were both increased, suggesting that chemotherapy, despite decreasing tumor size, increases the risk of metastatic dissemination. Chemotherapy-induced TMEM activity and cancer cell dissemination were reversed by either administration of the TIE2 inhibitor rebastinib or knockdown of the MENA gene. Our results indicate that TMEM score increases and MENA isoform expression pattern changes with chemotherapy and can be used in predicting prometastatic changes in response to chemotherapy. Furthermore, inhibitors of TMEM function may improve clinical benefits of chemotherapy in the neoadjuvant setting or in metastatic disease.
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Affiliation(s)
- George S Karagiannis
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA. .,Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jessica M Pastoriza
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Yarong Wang
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Allison S Harney
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Department of Radiology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David Entenberg
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jeanine Pignatelli
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ved P Sharma
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Emily A Xue
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Esther Cheng
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Joan G Jones
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Department of Pathology, Montefiore Medical Center, Bronx, NY 10467, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jesus Anampa
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Joseph A Sparano
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - John S Condeelis
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA. .,Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Maja H Oktay
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA. .,Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.,Department of Pathology, Montefiore Medical Center, Bronx, NY 10467, USA
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17
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Ginter PS, D'Alfonso TM. Current Concepts in Diagnosis, Molecular Features, and Management of Lobular Carcinoma In Situ of the Breast With a Discussion of Morphologic Variants. Arch Pathol Lab Med 2017; 141:1668-1678. [DOI: 10.5858/arpa.2016-0421-ra] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Lobular carcinoma in situ (LCIS) refers to a neoplastic proliferation of cells that characteristically shows loss of E-cadherin expression and has long been regarded as a risk factor for invasive breast cancer. Long-term outcome studies and molecular data have also implicated LCIS as a nonobligate precursor to invasive carcinoma. In the past few decades, pleomorphic and florid LCIS have been recognized as morphologic variants of LCIS with more-aggressive histopathologic features, less-favorable biomarker profiles, and more-complex molecular features compared with classic LCIS. There is still a lack of consensus regarding certain aspects of managing patients with LCIS.Objectives.—To review recently published literature on LCIS and to provide an overview of the current morphologic classification of LCIS, recent molecular advances, and trends in patient management.Data Sources.—Sources included peer-reviewed, published journal articles in PubMed (US National Library of Medicine, Bethesda, Maryland) and published guidelines from the National Comprehensive Cancer Network (Fort Washington, Pennsylvania).Conclusions.—Lobular carcinoma in situ represents a marker for increased risk of breast cancer, as well as a nonobligate precursor to invasive carcinoma. Morphologic variants of LCIS—florid and pleomorphic LCIS—are genetically more-complex lesions and are more likely to be associated with invasive carcinoma. Further investigation into which molecular alterations in LCIS are associated with progression to invasive carcinoma is needed to help guide medical and surgical management.
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18
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Halteh P, Patel A, Eskreis-Winkler S, D'Alfonso TM. Schwannoma of the breast: A common tumor in an uncommon location. Breast J 2017; 24:206-207. [PMID: 28707768 DOI: 10.1111/tbj.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Pierre Halteh
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Ami Patel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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19
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Karagiannis GS, Pastoriza J, Pignatelli J, Wang Y, Harney AS, Entenberg D, Sharma VP, Xue E, Cheng E, D'Alfonso TM, Jones JG, Anampa J, Rohan TE, Sparano JA, Condeelis JS, Oktay MH. Abstract 3963: Neoadjuvant chemotherapy promotes prometastatic changes in the primary breast tumor microenvironment in mice and humans. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Chemotherapy induces influx of bone marrow-derived proangiogenic Tie2hi monocytes in primary tumors. Tie2hi perivascular macrophages specifically induce the prometastatic Mena isoforms in tumor cells and can assemble specialized microanatomical sites called “tumor microenvironment of metastasis” (TMEM), structures that may serve as doorways for intravasation of tumor cells in mammary tumors. Both TMEM and MenaINV are required for tumor cell intravasation and dissemination. Thus, we hypothesized that chemotherapy may increase the density of TMEM sites and MenaINV-expressing, intravasation-competent tumor cells, resulting in increased tumor cell invasion and metastasis. We studied these potential pro-metastatic effects of chemotherapy in a neoadjuvant setting (NAC) by either administering paclitaxel or a combination of doxorubicin and cyclophosphamide in several mammary carcinoma mouse and human breast cancer models. As expected, chemotherapy delayed tumor growth, yet it significantly increased the recruitment of TMEM-forming, perivascular Tie2hi/Vegfhi macrophages and TMEM density. Using high-resolution multiphoton intravital imaging in live tumor-bearing mice, we observed that paclitaxel also increased the activity of TMEM sites, visualized as endothelial cell tight-junction disruption around TMEM and subsequent intravasation of the migratory cancer cell subpopulation. Indeed, paclitaxel-treated mice have higher numbers of circulating tumor cells, single cell seeding in lungs and incidence and number of micrometastatic foci, all associated with increased TMEM activity, as demonstrated by high-resolution imaging techniques. Tie2 inhibitors reversed paclitaxel-induced pro-metastatic phenotypes without affecting the assembly of TMEM, indicating that Tie2-mediated signaling is required for paclitaxel-mediated cancer cell dissemination via TMEM. Paclitaxel also caused a significant increase in the expression of MenaINV at both the gene and protein levels. Furthermore, paclitaxel treatment in Mena-/- breast tumor-bearing mice resulted in failure to assemble TMEM and to increase circulating-tumor cells and cancer cell metastasis despite the fact that Tie2hi macrophages are attracted to perivascular niches as a result of paclitaxel treatment. This indicated that Mena is involved in the paclitaxel-mediated increase in cancer cell dissemination but not required for Tie2hi macrophage recruitment. These pre-clinical data are further supported by findings from a cohort (N=20) of breast cancer patients, who received pre-operative paclitaxel-based chemotherapy and demonstrated significant increases in TMEM density and MenaINV expression. Together, our data provide solid evidence that NAC leads to metastasis in rodents via TMEM/ MenaINV-mediated mechanisms, and to cancer cell dissemination in certain clinical scenarios in humans.
Citation Format: George S. Karagiannis, Jessica Pastoriza, Jeanine Pignatelli, Yarong Wang, Allison S. Harney, David Entenberg, Ved P. Sharma, Emily Xue, Esther Cheng, Timothy M. D'Alfonso, Joan G. Jones, Jesus Anampa, Thomas E. Rohan, Joseph A. Sparano, John S. Condeelis, Maja H. Oktay. Neoadjuvant chemotherapy promotes prometastatic changes in the primary breast tumor microenvironment in mice and humans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3963. doi:10.1158/1538-7445.AM2017-3963
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Affiliation(s)
| | | | | | - Yarong Wang
- 1Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - Emily Xue
- 1Albert Einstein College of Medicine, Bronx, NY
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20
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D'Alfonso TM, Subramaniyam S, Ginter PS, Mosquera JM, Croyle J, Liu YF, Rubin MA, Shin SJ. Characterization of CD34-deficient myofibroblastomas of the breast. Breast J 2017; 24:55-61. [DOI: 10.1111/tbj.12835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Timothy M. D'Alfonso
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
| | | | - Paula S. Ginter
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
- Institute for Precision Medicine of Weill Cornell and New York-Presbyterian Hospital; New York NY USA
| | - Jaclyn Croyle
- Institute for Precision Medicine of Weill Cornell and New York-Presbyterian Hospital; New York NY USA
| | - Yi-Fang Liu
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
| | - Mark A. Rubin
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
- Institute for Precision Medicine of Weill Cornell and New York-Presbyterian Hospital; New York NY USA
| | - Sandra J. Shin
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
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21
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Ginter PS, Ng J, Zhuo R, Swistel AJ, D'Alfonso TM. Exuberant Squamous Metaplasia with Calcification Following Intraoperative Radiotherapy for Breast Carcinoma: Report of an Unusual Case and Retrospective Review of Cases from a Single Institution. Breast J 2016; 23:267-274. [PMID: 27900811 DOI: 10.1111/tbj.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intraoperative radiotherapy (IORT) is a novel and increasingly utilized radiation technique in the treatment of breast carcinoma. There are few reports on the histologic changes seen in breast tissue from patients who have undergone IORT. We sought to evaluate the histologic changes observed in specimens received following IORT, as well as report an unusual case which prompted our study. A retrospective review of patients who received IORT and subsequently had breast tissue histologically evaluated at our institution was performed. Fifteen post-IORT specimens from 12 patients, including the patient from the reported case, were studied. We report a case of a 77-year-old woman found to have mammographic microcalcifications at the lumpectomy site 6 months following lumpectomy and IORT for ductal carcinoma in situ (DCIS). A stereotactic biopsy showed abundant desquamated anucleate squamous cells with calcification and keratin material associated with squamous metaplasia of ducts. Carcinoma was not present. The predominant findings in the post-IORT specimens were fat necrosis and scar (n = 5), recurrent invasive carcinoma (n = 5), surgical site changes (n = 3), abscess (n = 1), and exuberant squamous metaplasia with calcification (n = 1). Five of fifteen (33%) post-IORT specimens showed squamous metaplasia, all of which were collected within 6 months of IORT delivery. The morphologic changes observed after IORT are similar to those seen after external beam radiotherapy. Exuberant squamous metaplasia is an uncommon consequence of IORT; however, pathologists should be aware of this phenomenon and review a history of prior intraoperative radiation before raising concern for malignancy.
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Affiliation(s)
- Paula S Ginter
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - John Ng
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Rebecca Zhuo
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | | | - Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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22
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Abstract
Subareolar sclerosing duct hyperplasia (SSDH) remains to be fully characterized nearly 20 years after initial description. Thirty-five SSDH cases diagnosed over a 16-year period (January 2000 to December 2015) were reviewed. All patients were female (mean age = 59 years, range = 18-80) who had presented with a unilateral solitary lesion (left 22, right 13) with a mean size of 1.3 cm (range = 0.4-3.0 cm), and showed florid and papillary epithelial hyperplasia with dense sclerosis without involvement of nipple or areolar epidermis. Significant lesions concurrent within SSDH included low-grade adenosquamous carcinoma (n = 1), ductal carcinoma in situ (DCIS; n = 1), lobular carcinoma in situ (LCIS; n = 1), and atypical ductal hyperplasia (ADH; n = 13). No case of SSDH recurred in a mean follow-up of 44 months (range = 6-189). Subsequent significant lesions occurred in 6 patients: DCIS (n = 3; ipsilateral 2, contralateral 1), ipsilateral ADH (n = 2), and ipsilateral atypical lobular hyperplasia (n = 1). Long-term follow-up for patients with SSDH is indicated as DCIS can occur subsequently in either breast.
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Affiliation(s)
- Esther Cheng
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Timothy M D'Alfonso
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Maria Arafah
- 3 King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Rebecca Marrero Rolon
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Paula S Ginter
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Syed A Hoda
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
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23
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Ginter PS, Shin SJ, D'Alfonso TM. Small Glandular Proliferations of the Breast With Absent or Attenuated Myoepithelial Reactivity by Immunohistochemistry: A Review Focusing on the Differential Diagnosis and Interpretative Pitfalls. Arch Pathol Lab Med 2016; 140:651-64. [PMID: 27362570 DOI: 10.5858/arpa.2015-0289-sa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Small glandular proliferations of the breast encompass a variety of benign, atypical, and malignant lesions that show some overlapping morphologic features. Myoepithelial stains are frequently used in the workup of these lesions in order to rule out or establish a diagnosis of invasive carcinoma. Some benign lesions show absent or diminished myoepithelial staining, and may represent an interpretative pitfall, particularly in small core biopsy samples. OBJECTIVE -To review small glandular proliferations of the breast that show absent or diminished staining with myoepithelial immunohistochemical markers. DATA SOURCES -The study comprised a review of published literature and clinical case material. CONCLUSIONS -The interpretation of myoepithelial stains in small glandular proliferations of the breast can, on some occasions, represent a challenge in diagnosing these lesions. Recognition of the key histopathologic features and immunohistochemical staining patterns of the entities in the differential diagnosis is crucial in their workup.
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Affiliation(s)
- Paula S Ginter
- From the Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
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24
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Ginter PS, Babagbemi K, Weidner A, D'Alfonso TM. Intramammary Lymph Node with Gold Deposits Presenting as Mammographic Calcifications. Breast J 2015; 22:232-3. [DOI: 10.1111/tbj.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paula S. Ginter
- Department of Pathology and Laboratory Medicine Weill Cornell Medical College New York New York
| | - Kemi Babagbemi
- Department of Radiology Weill Cornell Medical College New York New York
| | - Anna‐Sophie Weidner
- Department of Pathology and Laboratory Medicine Weill Cornell Medical College New York New York
| | - Timothy M. D'Alfonso
- Department of Pathology and Laboratory Medicine Weill Cornell Medical College New York New York
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25
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Ginter PS, Shin SJ, Liu Y, Chen Z, D'Alfonso TM. Phosphohistone H3 expression correlates with manual mitotic counts and aids in identification of "hot spots" in fibroepithelial tumors of the breast. Hum Pathol 2015; 49:90-8. [PMID: 26826415 DOI: 10.1016/j.humpath.2015.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 07/15/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
Classification of mammary fibroepithelial tumors (FETs) relies on assessment of mitotic activity, among other histopathologic parameters. Routine hematoxylin and eosin (H&E) mitotic counts can be subjective and time consuming. Difficulty may arise in identifying "true" mitoses for a variety of reasons. Phosphorylation of histone H3 protein (PHH3) is correlated with mitotic chromatin condensation. The utility of PHH3 immunohistochemical staining to identify mitoses has been demonstrated in multiple organ systems. In this study, we examined the utility of PHH3 in assessing mitotic activity in FETs and compared PHH3- with H&E-determined mitotic counts. PHH3-stained mitoses were readily identifiable at ×10 magnification and allowed for rapid identification of mitotic "hot spots." Median mitotic counts/10 high-power fields for fibroadenoma, benign phyllodes tumor, borderline phyllodes tumor (BlnPT), and malignant phyllodes tumor (MPT) were 0, 0.5, 4.25, and 9, respectively on H&E, and 0, 0.75, 4.5, and 8, respectively for PHH3. Among all FETs, there was a strong positive correlation between H&E- and PHH3-determined mitotic counts (r=0.91, P<.001). Using PHH3, 2 cases would be reclassified, both from BlnPT to MPT. PHH3-determined counts correlated with H&E-determined counts in FETs. Using PHH3, a small number of cases were reclassified from BlnPT to MPT, for which treatment is similar. Although H&E-determined counts remain the criterion standard for assessing mitotic activity in FETs, PHH3 may be a useful adjunctive tool in some cases and is helpful in identifying mitotic hot spots.
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Affiliation(s)
- Paula S Ginter
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065.
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065
| | - Yifang Liu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065
| | - Zhengming Chen
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY 10065
| | - Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065
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26
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D'Alfonso TM, Ross DS, Liu YF, Shin SJ. Expression of p40 and laminin 332 in metaplastic spindle cell carcinoma of the breast compared with other malignant spindle cell tumours. J Clin Pathol 2015; 68:516-21. [PMID: 25795733 DOI: 10.1136/jclinpath-2015-202923] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/04/2015] [Indexed: 01/27/2023]
Abstract
AIMS To determine the use of p40 and laminin 332 (LN332) immunostains for diagnosing metaplastic carcinoma by studying the expression of these and other routine markers in spindle cell metaplastic carcinomas and other malignant spindle cell tumours. METHODS We identified cases of spindle cell metaplastic carcinoma (n=36) and other atypical/malignant spindle cell tumours, including 20 phyllodes tumours (14 borderline, six malignant) and 23 spindle cell sarcomas (three primary to breast). Immunohistochemical staining was performed for p40 and two LN332 chains, β3 (kalinin B1) and γ2 (lamC2). The expression of these markers was compared with p63 and cytokeratins. RESULTS p40 and p63 expression was seen in 21 of 36 (58.3%) and 33 of 36 (91.7%) metaplastic carcinomas, respectively. No phyllodes tumours showed stromal expression of p40 or p63. One of 23 (4.3%) sarcomas showed focal weak p63 staining. LamC2 and kalinin B1 expression was seen in 28 of 36 (77.8%) and 26 of 36 (72.2%) metaplastic carcinomas, respectively. LamC2 and kalinin B1 each showed positive stromal cell expression in two of 20 (10%) phyllodes tumours. No sarcomas showed staining with lamC2. Kalinin B1 staining was seen in 17 of 23 (73.9%) sarcomas, including two of three primary breast sarcomas. Cytokeratin expression was seen in 32 of 36 (88.9%) metaplastic carcinomas and diffuse staining was most often seen in 34βE12 and CK5. CONCLUSIONS The diagnostic value of relatively novel markers p40 and LN332 was found to be less than that of routinely used markers (p63 and cytokeratins). p40 proved to be a specific marker but lacked the sensitivity of p63, while LN332 showed staining in a significant proportion of phyllodes tumours and sarcomas.
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Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Dara S Ross
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Yi-Fang Liu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
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27
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Abstract
A case of a 53-year-old woman with the epithelioid variant of mammary myofibroblastoma, which was initially misinterpreted as invasive lobular carcinoma, is presented. A needle core biopsy of the 1.6 cm mass showed interlacing bundles of epithelioid myofibroblasts amid dense fibrous tissue associated with lobular carcinoma in situ of the classical type. Most epithelioid cells showed nuclear atypia, and a few exhibited signet-ring cytology. Immunoreactivity for estrogen and progesterone receptors further compounded the deception, and the neoplasm was misinterpreted as invasive lobular carcinoma. Excisional biopsy showed a circumscribed stromal tumor with foci suspicious for invasive lobular carcinoma. The latter was excluded by cytokeratin negativity throughout the tumor. The overall histopathological appearance and immunostaining pattern was confirmatory of myofibroblastoma. This case report emphasizes the potential for mistaking epithelioid myofibroblastoma for invasive lobular carcinoma--particularly in the setting of limited sampling, hormone-receptor immunoreactivity of the lesional cells, and synchronous lobular carcinoma in situ.
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Affiliation(s)
- Maria A Arafah
- College of Medicine, King Saud Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Syed A Hoda
- Weill Cornell Medical College, New York, NY, USA
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28
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Matrai C, D'Alfonso TM, Pharmer L, Drotman MB, Simmons RM, Shin SJ. Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases. Arch Pathol Lab Med 2015; 139:1137-42. [DOI: 10.5858/arpa.2014-0550-oa] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain.
Objective
To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management.
Design
Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed.
Results
Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001).
Conclusions
No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.
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Affiliation(s)
| | | | | | | | | | - Sandra J. Shin
- From the Departments of Pathology and Laboratory Medicine (Drs Matrai, D'Alfonso, and Shin), Breast Surgery (Drs Pharmer and Simmons), and Radiology-Division of Women's Imaging (Dr Drotman), Weill Cornell Medical College, New York, New York. Drs Matrai and D'Alfonso contributed equally to this study
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29
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D'Alfonso TM, Mosquera JM, MacDonald TY, Padilla J, Liu YF, Rubin MA, Shin SJ. MYB-NFIB gene fusion in adenoid cystic carcinoma of the breast with special focus paid to the solid variant with basaloid features. Hum Pathol 2014; 45:2270-80. [PMID: 25217885 DOI: 10.1016/j.humpath.2014.07.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 02/01/2023]
Abstract
Adenoid cystic carcinomas (ACCs) from various anatomical sites harbor a translocation t(6;9)(q22-23;p23-24), resulting in MYB-NFIB gene fusion. This gene fusion is not well studied in mammary ACCs, and there are no studies examining this abnormality in solid variant of ACC with basaloid features (SBACC), a high-grade variant thought to behave more aggressively than ACCs with conventional histologic growth. Our aim was to investigate the frequency of MYB-NFIB gene fusion in mammary ACCs with a focus paid to SBACC. MYB rearrangement and MYB-NFIB fusion were assessed by fluorescence in situ hybridization and reverse-transcription polymerase chain reaction, respectively. Histologic features and the presence of MYB rearrangement were correlated with clinical outcome. MYB rearrangement was present in 7 (22.6%) of 31 mammary ACCs (5/15 [33.3%] ACCs with conventional growth; 2/16 [12.5%] SBACCs). One patient with conventional ACC developed distant metastasis, and no patients had axillary lymph node involvement by ACC (mean follow-up, 34 months; range, 12-84 months). Two patients with SBACC had axillary lymph node involvement at initial surgery, and 2 additional patients experienced disease recurrence (1 local, 1 distant; mean follow-up, 50 months; range, 9-192 months). MYB-NFIB fusion status did not correlate with clinical outcome in studied patients. We confirm that MYB-NFIB gene fusion is observed in mammary ACCs and that a subset lacks this abnormality. This study is the first to confirm the presence of MYB rearrangement in SBACC. Additional validation with long-term follow-up is needed to determine the relationship, if any, between MYB-NFIB gene fusion and clinical outcome.
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Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065.
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065; Institute for Precision Medicine of Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY 10065
| | - Theresa Y MacDonald
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065
| | - Jessica Padilla
- Institute for Precision Medicine of Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY 10065
| | - Yi-Fang Liu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065
| | - Mark A Rubin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065; Institute for Precision Medicine of Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY 10065
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065
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30
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Abstract
AIMS Triple-negative breast cancer comprises a clinically aggressive group of invasive carcinomas. We examined a published gene expression screen of a panel of breast cancer cell lines to identify a potential triple-negative breast cancer-specific gene signature, and attempted to verify our findings by performing immunohistochemical analysis on tissue microarrays containing a large cohort of invasive breast carcinomas. METHODS The microarray dataset for a panel of human breast cancer cell lines was interrogated for triple-negative breast cancer-specific genes. Membranous immunohistochemical expression of the protein product of the AXL gene was assessed semiquantitatively in 569 invasive breast carcinomas grouped according to molecular subgroup by immunohistochemistry. RESULTS AXL was significantly upregulated in triple-negative/basal B cell lines compared with luminal or basal A cell lines. No significant difference was observed in the level of immunohistochemical expression of Axl protein between triple-negative breast cancers and other molecular subgroups (p=0.257). Axl expression was significantly associated with lymphovascular invasion (LVI) in all subgroups combined (p=0.033), and within the luminal A (p=0.002) and triple-negative breast cancer subgroups (p=0.026). CONCLUSIONS Despite preferential upregulation of AXL in triple-negative/basal B cell lines, analysis of Axl protein expression in a large series of patients' breast tumours revealed no association between Axl expression and triple-negative breast cancer or other subtype. The association of Axl expression with LVI supports previous work that implicates Axl as a promoter of invasiveness in breast cancer cell lines. Further studies are necessary to explore whether Axl expression of individual breast cancer tumours can be clinically useful.
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Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Jeffrey Hannah
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Zhengming Chen
- Department of Public Health, Weill Cornell Medical College, New York, USA
| | - Yifang Liu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Pengbo Zhou
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
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Rohan TE, Xue X, Lin HM, D'Alfonso TM, Ginter PS, Oktay MH, Robinson BD, Ginsberg M, Gertler FB, Glass AG, Sparano JA, Condeelis JS, Jones JG. Tumor microenvironment of metastasis and risk of distant metastasis of breast cancer. J Natl Cancer Inst 2014; 106:dju136. [PMID: 24895374 DOI: 10.1093/jnci/dju136] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Tumor microenvironment of metastasis (TMEM), consisting of direct contact between a macrophage, an endothelial cell, and a tumor cell, has been associated with metastasis in both rodent mammary tumors and human breast cancer. We prospectively examined the association between TMEM score and risk of distant metastasis and compared risk associated with TMEM score with that associated with IHC4. METHODS We conducted a case-control study nested within a cohort of 3760 patients with invasive ductal breast carcinoma diagnosed between 1980 and 2000 and followed through 2010. Case patients were women who developed a subsequent distant metastasis; control subjects were matched (1:1) on age at and calendar year of primary diagnosis. TMEM was assessed by triple immunostain and IHC4 by standard methods; slides were read by pathologists blinded to outcome. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusted for clinical variables. A Receiver Operating Characteristic analysis was performed, and the area under the curve was estimated. All statistical tests were two-sided. RESULTS TMEM score was associated with increased risk of distant metastasis in estrogen receptor (ER)(+)/human epidermal growth factor receptor (HER2)(-) tumors (multivariable OR high vs low tertile = 2.70; 95% CI = 1.39 to 5.26; P trend = .004), whereas IHC4 score had a borderline positive association (OR10 unit increase = 1.06; 95% CI = 1.00 to 1.13); the association for TMEM score persisted after adjustment for IHC4 score. The area under the curve for TMEM, adjusted for clinical variables, was 0.78. Neither TMEM score nor IHC4 score was independently associated with metastatic risk overall or in the triple negative or HER2(+) subgroups. CONCLUSIONS TMEM score predicted risk of distant metastasis in ER(+)/HER2(-) breast cancer independently of IHC4 score and classical clinicopathologic features.
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Affiliation(s)
- Thomas E Rohan
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ).
| | - Xiaonan Xue
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Hung-Mo Lin
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Timothy M D'Alfonso
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Paula S Ginter
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Maja H Oktay
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Brian D Robinson
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Mindy Ginsberg
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Frank B Gertler
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Andrew G Glass
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Joseph A Sparano
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - John S Condeelis
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
| | - Joan G Jones
- Affiliation of authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER, XX, MG); Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (H-ML); Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY (TMD'A, PSG, BDR); Department of Pathology, Montefiore Medical Center, Bronx, NY (MHO); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA (FBG); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (AGG); Department of Oncology, Montefiore Medical Center, Bronx, NY (JAS); Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY (JSC); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (JGJ)
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D'Alfonso TM, Scognamiglio T. Myofibroblastoma with chondroid metaplasia. Breast J 2013; 19:549-51. [PMID: 23834471 DOI: 10.1111/tbj.12163] [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: 10/26/2022]
Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, NY, New York
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D'Alfonso TM, Wang K, Chiu YL, Shin SJ. Pathologic Upgrade Rates on Subsequent Excision When Lobular Carcinoma In Situ Is the Primary Diagnosis in the Needle Core Biopsy With Special Attention to the Radiographic Target. Arch Pathol Lab Med 2013; 137:927-35. [DOI: 10.5858/arpa.2012-0297-oa] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Lobular carcinoma in situ (LCIS) as the primary pathologic diagnosis in a needle core biopsy is an infrequent finding, and the management of patients in this setting is controversial.
Objective.—To determine the rate of pathologic upgrade (defined as the presence of a clinically more-significant lesion in the subsequent excision) in patients with a primary pathologic diagnosis of LCIS in the needle core biopsy.
Design.—Patients with a primary diagnosis of LCIS in a needle core biopsy who underwent subsequent excision were identified. Core biopsies containing a concurrent high-risk lesion and cases with radiologic-pathologic discordance were excluded. The presence of selected microscopic features in the needle core biopsy was correlated with pathologic upgrade. Microscopic findings were correlated with the radiographic target in the needle core biopsy.
Results.—Sixty-one women with primary LCIS in their needle core biopsy showed a 10% pathologic upgrade rate. The percentage of cores involved by LCIS was significantly associated with pathologic upgrade (P= .04), whereas the remaining measured parameters were not. When LCIS represented the radiographic target, the pathologic upgrade rate was 18%, whereas when it was an incidental finding, the pathologic upgrade rate was 4%.
Conclusions.—It may be reasonable for patients with primary, yet incidental, LCIS on needle core biopsy to be managed in a nonsurgical fashion. Larger studies are needed to confirm our findings.
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Affiliation(s)
- Timothy M. D'Alfonso
- From the Departments of Pathology and Laboratory Medicine (Drs D'Alfonso and Shin and Ms Wang) and Public Health (Ms Chiu), Weill Cornell Medical College, New York, New York
| | - Karin Wang
- From the Departments of Pathology and Laboratory Medicine (Drs D'Alfonso and Shin and Ms Wang) and Public Health (Ms Chiu), Weill Cornell Medical College, New York, New York
| | - Ya-Lin Chiu
- From the Departments of Pathology and Laboratory Medicine (Drs D'Alfonso and Shin and Ms Wang) and Public Health (Ms Chiu), Weill Cornell Medical College, New York, New York
| | - Sandra J. Shin
- From the Departments of Pathology and Laboratory Medicine (Drs D'Alfonso and Shin and Ms Wang) and Public Health (Ms Chiu), Weill Cornell Medical College, New York, New York
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D'Alfonso TM, Ginter PS, Salvatore SP, Antonio LB, Hoda SA. Phylloides Tumor With Numerous Thanatosomes ("Death Bodies"): A Report of Two Cases and a Study of Thanatosomes in Breast Tumors. Int J Surg Pathol 2013; 22:337-42. [PMID: 23564701 DOI: 10.1177/1066896913482728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thanatosomes, a form of degenerative intracellular hyaline globules, have been described in various neoplastic and nonneoplastic disease processes in several organs. These structures are indicative of apoptotic cell death. Herein, we report 2 cases of malignant phylloides tumor, both of which showed numerous thanatosomes-to the point of dominating the histological appearance and masking the stromal element. Our subsequently conducted study showed that thanatosomes were present in 14 of 86 (16.3%) high-grade malignant breast tumors. The structures were identified in 5/25 (20%) malignant phylloides tumors, 4/19 (21.1%) metaplastic spindle cell carcinomas, 3/21 (14.3%) invasive carcinomas s/p neoadjuvant chemotherapy, and 2/21 (9.5%) poorly differentiated invasive ductal carcinomas. When present, thanatosomes were typically a rare and focal finding in most types of cases. In malignant phylloides tumors, the structures were relatively more numerous when present. Our study shows that although thanatosomes can be present in several types of malignant breast tumors, they are more common in malignant phylloides tumor. Only rarely, as evident from our 2 index cases, do thanatosomes cause diagnostic difficulty.
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Affiliation(s)
| | | | | | | | - Syed A Hoda
- Weill Cornell Medical College, New York, NY, USA
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Ginter PS, Robinson BD, D'Alfonso TM, Oktay MH, Gertler FB, Rohan TE, Condeelis JS, Jones JG. Abstract P6-02-04: TMEM (Tumor MicroEnvironment of Metastasis) in human breast cancer is a blood vessel associated intravasation microenvironment unrelated to lymphatics. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-02-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In breast cancer, both lymph node and distant metastasis represent dissemination of tumor cells from a primary site, but the mechanism of spread and the subsequent risk of mortality may not be the same. Historically, lymphatic spread has been documented both descriptively, as presence or absence of lymphovascular invasion (LVI), and as a formal part of TNM staging. Until recently, however, there has been no way to directly assess the risk of hematogenous dissemination by the primary tumor.
Observations from multiphoton-based intravital imaging of rodent models of breast cancer and the analysis of Mena function in tumor cells in vivo have characterized an intravasation microenvironment (ME) involved in the systemic dissemination of tumor cells from primary breast tumors. We have identified the corresponding structure in FFPE tissue and called it TMEM (Tumor MicroEnvironment of Metastasis). This microanatomic landmark is defined as the direct apposition of a Mena-overexpressing intravasation competent carcinoma cell, a perivascular macrophage, and an endothelial cell. In a case control study of 30 case-control pairs, where each matched pair differed only in their metastatic status – non-metastatic vs. metastatic – we found that the density of TMEM was significantly associated with development of systemic metastasis (p = 0.00006).
The relationship of hematogenous- and lymphatic-mediated tumor cell spread is not understood. Using the previously described cohort in which we showed that TMEM was associated with metastasis, the purpose of this study was to 1) assess intratumoral lymphatic density, 2) determine if TMEM- lymphatic structures associated with lymphatics exist, and 3) determine if TMEM- lymphatic structures correlate with systemic metastatic risk. Cases were stained with a triple immunostain identical to that used in our earlier study except that D2-40 (a lymphatic marker) was used, rather than CD31 (a blood vessel marker). The marker for macrophages (CD68) and invasive tumor cells (Mena) remained the same. Two pathologists, blinded to outcome, evaluated the presence or absence of intratumoral lymphatics and quantitated the number of TMEM-lymphatic structures per 10 high power (400x) fields in areas of highest intratumoral lymphatic density. A TMEM-lymphatic structure was defined as the direct apposition of a lymphatic (D2-40) endothelial cell with a macrophage and invasive tumor cell.
Intratumoral lymphatics were absent in a majority of tumors in each of the 2 groups (18 of 30 non-metastatic, 16 of 30 metastatic; p = 0.6). TMEM-lymphatic structures were rare and were equally present in the 2 groups (3 metastatic and 3 non-metastatic cases). Using the Wilcoxon (paired) signed-rank test, we found no significant difference in the density of these structures between the two groups (p = 0.4). Furthermore, TMEM-lymphatic structures did not correlate with the presence of lymph node metastases (p = 0.8). We conclude that lymphatic vessels do not participate in the TMEM assembly that has been associated with hematogenous metastasis. TMEM density assessment reflects a hematogenous intravasation ME and offers a novel approach to the assessment of metastatic risk.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-02-04.
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Affiliation(s)
- PS Ginter
- Weill Cornell Medical College, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Massachusetts Institute of Technology, Cambridge, MA
| | - BD Robinson
- Weill Cornell Medical College, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Massachusetts Institute of Technology, Cambridge, MA
| | - TM D'Alfonso
- Weill Cornell Medical College, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Massachusetts Institute of Technology, Cambridge, MA
| | - MH Oktay
- Weill Cornell Medical College, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Massachusetts Institute of Technology, Cambridge, MA
| | - FB Gertler
- Weill Cornell Medical College, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Massachusetts Institute of Technology, Cambridge, MA
| | - TE Rohan
- Weill Cornell Medical College, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Massachusetts Institute of Technology, Cambridge, MA
| | - JS Condeelis
- Weill Cornell Medical College, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Massachusetts Institute of Technology, Cambridge, MA
| | - JG Jones
- Weill Cornell Medical College, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Massachusetts Institute of Technology, Cambridge, MA
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Abstract
This article discusses the most common small glandular proliferations, namely sclerosing lesions (sclerosing adenosis and radial scar), tubular carcinoma, and epithelial displacement after needle core biopsy, as well as less common entities, such as low-grade adenosquamous carcinoma, microglandular adenosis, and syringomatous adenoma. Due to significant morphologic overlap, these entities are easily mistaken for one another. The similarities and differences among these lesions in their clinicopathologic features, radiologic findings, and immunohistochemical profiles are emphasizesd.
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Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital - Weill Cornell Medical College, New York, NY, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital - Weill Cornell Medical College, New York, NY, USA.
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Ginter PS, Robinson BD, D'Alfonso TM, Oktay MH, Jones JG. Abstract 1410: TMEM (Tumor MicroEnvironment of Metastasis) in human breast cancer is a blood vessel associated intravasation microenvironment unrelated to lymphatics. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Observations from intravital imaging (Wyckoff et al. Can Res 2007) and the analysis of Mena function in tumor cells in vivo (Roussos et al. JCS 2011) has characterized an intravasation microenvironment (ME) involved in the systemic dissemination of tumor cells from primary breast tumors. We have identified the corresponding structure in FFPE tissue and called it TMEM (Tumor MicroEnvironment of Metastasis). This microanatomic landmark is defined as the direct apposition of a Mena-overexpressing intravasation competent carcinoma cell, a perivascular macrophage, and an endothelial cell. In a case control study of 60 patients, where each matched pair differed only in their metastatic status - non-metastatic vs. metastatic - the density of TMEM was assessed and found to be significantly associated with development of systemic metastasis (p = 0.00006) (Robinson et al. Clin Can Res 2009). Although lymph node status is considered an important prognostic factor in breast cancer, the direct involvement of lymphatics in systemic tumor cell dissemination from primary tumors has not been demonstrated. In addition, the relationship of hematogenous- and lymphatic-mediated tumor cell spread is not understood. The purpose of this study was to 1) assess intratumoral lymphatic density in this same cohort, 2) determine if TMEM-like structures associated with lymphatics exist, and 3) determine if lymphaticTMEM-like structures correlate with systemic metastatic risk. Cases were stained with a triple immunostain identical to that used in the Robinson et al. study except that D2-40 (a lymphatic marker) was used, rather than CD31 (a blood vessel marker). The marker for macrophages (CD68) and invasive tumor cells (Mena) remained the same. Two pathologists, blinded to outcome, evaluated for the presence or absence of intratumoral lymphatics and quantitated the number of TMEM-like structures per 10 high power (400x) fields in areas of highest intratumoral lymphatic density. A TMEM-like structure was defined as the direct apposition of a lymphatic (D2-40) endothelial cell with a macrophage and invasive tumor cell. Intratumoral lymphatics were absent in a majority of tumors in each of the 2 groups (18 of 30 non-metastatic, 16 of 30 metastatic; p=0.6). TMEM-like structures were rare and were equally present in the 2 groups (3 metastatic and 3 non-metastatic cases). Using the Wilcoxon (paired) signed-rank test, we found no significant difference in the density of these structures between the two groups (p = 0.4). Furthermore, TMEM-like structures did not correlate with the presence of lymph node metastases (p=0.8). We conclude that lymphatic vessels do not participate in the TMEM assembly that has been associated with hematogenous metastasis. TMEM density assessment reflects a hematogenous intravasation ME and offers a novel approach to the assessment of metastatic risk.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1410. doi:1538-7445.AM2012-1410
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Carey SP, D'Alfonso TM, Shin SJ, Reinhart-King CA. Mechanobiology of tumor invasion: engineering meets oncology. Crit Rev Oncol Hematol 2011; 83:170-83. [PMID: 22178415 DOI: 10.1016/j.critrevonc.2011.11.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/14/2011] [Accepted: 11/16/2011] [Indexed: 12/21/2022] Open
Abstract
The physical sciences and engineering have introduced novel perspectives into the study of cancer through model systems, tools, and metrics that enable integration of basic science observations with clinical data. These methods have contributed to the identification of several overarching mechanisms that drive processes during cancer progression including tumor growth, angiogenesis, and metastasis. During tumor cell invasion - the first clinically observable step of metastasis - cells demonstrate diverse and evolving physical phenotypes that cannot typically be defined by any single molecular mechanism, and mechanobiology has been used to study the physical cell behaviors that comprise the "invasive phenotype". In this review, we discuss the continually evolving pathological characterization and in vitro mechanobiological characterization of tumor invasion, with emphasis on emerging physical biology and mechanobiology strategies that have contributed to a more robust mechanistic understanding of tumor cell invasion. These physical approaches may ultimately help to better predict and identify tumor metastasis.
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Affiliation(s)
- Shawn P Carey
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
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D'Alfonso TM, Shin SJ. Intramuscular lipoma arising within the pectoralis major muscle presenting as a radiographically detected breast mass. Arch Pathol Lab Med 2011; 135:1061-3. [PMID: 21810001 DOI: 10.5858/2010-0546-crr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lipomas are commonly encountered benign mesenchymal neoplasms composed of adipocytes that arise in the superficial subcutaneous tissues of the extremities and trunk. Occasionally, these tumors can originate from either within muscle (intramuscular) or between muscles (intermuscular). The former typically occurs within skeletal muscle of large muscles of an extremity, such as the thigh and shoulder. Intramuscular lipomas arising specifically from the pectoralis muscle are exceedingly rare. In this report, to our knowledge we describe the second case of an intramuscular lipoma arising within the pectoralis muscle. Similar to the first published report, our patient's tumor was clinically thought to be a breast mass. However, this example is unique in that it is the first of its kind to be found incidentally during screening ultrasound. Intramuscular lipomas are not routinely included in the radiologic differential diagnosis of a breast mass. However, when the tumor is posteriorly located and appears to involve the pectoralis muscle, the diagnostic possibility of intramuscular lipoma should be entertained.
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Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, New York, USA
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