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Kouroukli O, Bravou V, Giannitsas K, Tzelepi V. Tissue-Based Diagnostic Biomarkers of Aggressive Variant Prostate Cancer: A Narrative Review. Cancers (Basel) 2024; 16:805. [PMID: 38398199 PMCID: PMC10887410 DOI: 10.3390/cancers16040805] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Prostate cancer (PC) is a common malignancy among elderly men, characterized by great heterogeneity in its clinical course, ranging from an indolent to a highly aggressive disease. The aggressive variant of prostate cancer (AVPC) clinically shows an atypical pattern of disease progression, similar to that of small cell PC (SCPC), and also shares the chemo-responsiveness of SCPC. The term AVPC does not describe a specific histologic subtype of PC but rather the group of tumors that, irrespective of morphology, show an aggressive clinical course, dictated by androgen receptor (AR) indifference. AR indifference represents an adaptive response to androgen deprivation therapy (ADT), driven by epithelial plasticity, an inherent ability of tumor cells to adapt to their environment by changing their phenotypic characteristics in a bi-directional way. The molecular profile of AVPC entails combined alterations in the tumor suppressor genes retinoblastoma protein 1 (RB1), tumor protein 53 (TP53), and phosphatase and tensin homolog (PTEN). The understanding of the biologic heterogeneity of castration-resistant PC (CRPC) and the need to identify the subset of patients that would potentially benefit from specific therapies necessitate the development of prognostic and predictive biomarkers. This review aims to discuss the possible pathophysiologic mechanisms of AVPC development and the potential use of emerging tissue-based biomarkers in clinical practice.
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Affiliation(s)
- Olga Kouroukli
- Department of Pathology, Evaggelismos General Hospital, 10676 Athens, Greece
| | - Vasiliki Bravou
- Department of Anatomy-Histology-Embryology, School of Medicine, University of Patras, 26504 Patras, Greece;
| | | | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, 26504 Patras, Greece
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2
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Spinos T, Goutas D, Driva TS, Zografos E, Gakiopoulou C, Agrogiannis G, Zolota V, Tzelepi V, Manolis I, Koniaris E, Ioannou M, Lazaris AC. The Immunohistochemical Expression of REV-7 in Various Human Cancer Pathology Specimens: A Systematic Review. Cureus 2024; 16:e52542. [PMID: 38371007 PMCID: PMC10874486 DOI: 10.7759/cureus.52542] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
The purpose of this systematic review is to summarize all existing evidence, regarding the immunohistochemical expression of REV-7 in different human cancer pathology specimens. Moreover, the association of REV-7 expression with disease severity (clinical course), patients' survival, prognosis, and response to various treatments, such as chemotherapy and irradiation, was investigated. Three databases (PubMed, Scopus, and Cochrane) were systematically screened, from inception to September 2, 2023, as suggested by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Only studies using immunohistochemical staining for REV-7 in paraffin-embedded cancer tissues were included. Nine studies met the inclusion criteria and were included in the final qualitative synthesis. All nine studies were retrospective and non-comparative ones. Selected studies reported immunohistochemical expression of REV-7 in different types of cancer, including testicular cancer, ovarian cancer, esophagus squamous cell carcinoma, prostate cancer, colorectal cancer, diffuse large B-cell lymphoma, breast cancer, lung cancer, and skin cancer. High REV-7 expression was associated with faster disease progression, resistance to available treatment options, and worse prognosis in the majority of included studies. These results indicate that immunohistochemical staining of REV-7 protein could potentially be used as a predictive tissue marker in certain cases. Promising results, arising from REV-7 inactivation experiments, render REV-7 targeting a potential therapeutic strategy for future cancer management, especially in the cases of chemoresistant or radioresistant disease.
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Affiliation(s)
- Theodoros Spinos
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Goutas
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - Tatiana S Driva
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - Eleni Zografos
- Department of Clinical Therapeutics, Oncology Unit, Alexandra General Hospital, Athens, GRC
| | - Charikleia Gakiopoulou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - George Agrogiannis
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - Vasiliki Zolota
- Department of Pathology, University Hospital of Patras, Patras, GRC
| | - Vasiliki Tzelepi
- Department of Pathology, University Hospital of Patras, Patras, GRC
| | - Ioannis Manolis
- Department of Pathology, Hippokration General Hospital, Athens, GRC
| | | | - Maria Ioannou
- Department of Pathology, University of Thessaly, Larissa, GRC
| | - Andreas C Lazaris
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
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3
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Papakonstantinou E, Pappa I, Androutsopoulos G, Adonakis G, Maroulis I, Tzelepi V. Comprehensive Analysis of DNA Methyltransferases Expression in Primary and Relapsed Ovarian Carcinoma. Cancers (Basel) 2023; 15:4950. [PMID: 37894317 PMCID: PMC10605797 DOI: 10.3390/cancers15204950] [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] [Received: 08/14/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Despite recent advances in epithelial ovarian carcinoma (EOC) treatment, its recurrence and mortality rates have not improved significantly. DNA hypermethylation has generally been associated with an ominous prognosis and chemotherapy resistance, but the role of DNA methyltransferases (DNMTs) in EOC remains to be investigated. METHODS In the current study, we systematically retrieved gene expression data from patients with EOC and studied the immunohistochemical expression of DNMTs in 108 primary and 26 relapsed tumors. RESULTS Our results showed that the DNMT1, DNMT3A, DNMT3B and DNMT3L RNA levels were higher and the DNMT2 level was lower in tumors compared to non-neoplastic tissue, and DNMT3A and DNMT2 expression decreased from Stage-II to Stage-IV carcinomas. The proteomic data also suggested that the DNMT1 and DNMT3A levels were increased in the tumors. Similarly, the DNMT1, DNMT3A and DNMT3L protein levels were overexpressed and DNMT2 expression was reduced in high-grade carcinomas compared to non-neoplastic tissue and low-grade tumors. Moreover, DNMT1 and DNMT3L were increased in relapsed tumors compared to their primaries. The DNMT3A, DNMT1 and DNMT3B mRNA levels were correlated with overall survival. CONCLUSIONS Our study demonstrates that DNMT1 and DNMT3L are upregulated in primary high-grade EOC and further increase in relapses, whereas DNMT3A is upregulated only in the earlier stages of cancer progression. DNMT2 downregulation highlights the presumed tumor-suppressor activity of this gene in ovarian carcinoma.
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Affiliation(s)
- Efthymia Papakonstantinou
- Department of Obstetrics and Gynecology, School of Medicine, University of Patras, 26504 Patras, Greece; (E.P.); (G.A.)
| | - Ioanna Pappa
- Multidimensional Data Analysis and Knowledge Management Laboratory, Computer Engineering and Informatics Department, School of Engineering, University of Patras, 26504 Patras, Greece;
| | - Georgios Androutsopoulos
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Medical School, University of Patras, 26504 Patras, Greece;
| | - Georgios Adonakis
- Department of Obstetrics and Gynecology, School of Medicine, University of Patras, 26504 Patras, Greece; (E.P.); (G.A.)
| | - Ioannis Maroulis
- Department of General Surgery, School of Medicine, University of Patras, 26504 Patras, Greece;
| | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, 26504 Patras, Greece
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4
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Tzelepi V, Gika H, Begou O, Timotheadou E. The Contribution of Lipidomics in Ovarian Cancer Management: A Systematic Review. Int J Mol Sci 2023; 24:13961. [PMID: 37762264 PMCID: PMC10531399 DOI: 10.3390/ijms241813961] [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] [Received: 07/29/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Lipidomics is a comprehensive study of all lipid components in living cells, serum, plasma, or tissues, with the aim of discovering diagnostic, prognostic, and predictive biomarkers for diseases such as malignant tumors. This systematic review evaluates studies, applying lipidomics to the diagnosis, prognosis, prediction, and differentiation of malignant and benign ovarian tumors. A literature search was performed in PubMed, Science Direct, and SciFinder. Only publications written in English after 2012 were included. Relevant citations were identified from the reference lists of primary included studies and were also included in our list. All studies included referred to the application of lipidomics in serum/plasma samples from human cases of OC, some of which also included tumor tissue samples. In some of the included studies, metabolome analysis was also performed, in which other metabolites were identified in addition to lipids. Qualitative data were assessed, and the risk of bias was determined using the ROBINS-I tool. A total of twenty-nine studies were included, fifteen of which applied non-targeted lipidomics, seven applied targeted lipidomics, and seven were reviews relevant to our objectives. Most studies focused on the potential application of lipidomics in the diagnosis of OC and showed that phospholipids and sphingolipids change most significantly during disease development. In conclusion, this systematic review highlights the potential contribution of lipids as biomarkers in OC management.
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Affiliation(s)
- Vasiliki Tzelepi
- Department of Oncology, “Papageorgiou” General Hospital, 56429 Thessaloniki, Greece;
| | - Helen Gika
- Biomic_Auth, Bioanalysis and Omics Lab, Centre for Interdisciplinary Research of Aristotle University of Thessaloniki, Innovation Area of Thessaloniki, 57001 Thermi, Greece; (H.G.); (O.B.)
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Olga Begou
- Biomic_Auth, Bioanalysis and Omics Lab, Centre for Interdisciplinary Research of Aristotle University of Thessaloniki, Innovation Area of Thessaloniki, 57001 Thermi, Greece; (H.G.); (O.B.)
- Department of Chemistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Eleni Timotheadou
- Department of Oncology, “Papageorgiou” General Hospital, 56429 Thessaloniki, Greece;
- Department of Medical Oncology, Aristotle University of Thessaloniki School of Medicine, 54124 Thessaloniki, Greece
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5
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Logotheti S, Papadaki E, Zolota V, Logothetis C, Vrahatis AG, Soundararajan R, Tzelepi V. Lineage Plasticity and Stemness Phenotypes in Prostate Cancer: Harnessing the Power of Integrated "Omics" Approaches to Explore Measurable Metrics. Cancers (Basel) 2023; 15:4357. [PMID: 37686633 PMCID: PMC10486655 DOI: 10.3390/cancers15174357] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Prostate cancer (PCa), the most frequent and second most lethal cancer type in men in developed countries, is a highly heterogeneous disease. PCa heterogeneity, therapy resistance, stemness, and lethal progression have been attributed to lineage plasticity, which refers to the ability of neoplastic cells to undergo phenotypic changes under microenvironmental pressures by switching between developmental cell states. What remains to be elucidated is how to identify measurements of lineage plasticity, how to implement them to inform preclinical and clinical research, and, further, how to classify patients and inform therapeutic strategies in the clinic. Recent research has highlighted the crucial role of next-generation sequencing technologies in identifying potential biomarkers associated with lineage plasticity. Here, we review the genomic, transcriptomic, and epigenetic events that have been described in PCa and highlight those with significance for lineage plasticity. We further focus on their relevance in PCa research and their benefits in PCa patient classification. Finally, we explore ways in which bioinformatic analyses can be used to determine lineage plasticity based on large omics analyses and algorithms that can shed light on upstream and downstream events. Most importantly, an integrated multiomics approach may soon allow for the identification of a lineage plasticity signature, which would revolutionize the molecular classification of PCa patients.
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Affiliation(s)
- Souzana Logotheti
- Department of Pathology, University of Patras, 26504 Patras, Greece; (S.L.); (E.P.); (V.Z.)
| | - Eugenia Papadaki
- Department of Pathology, University of Patras, 26504 Patras, Greece; (S.L.); (E.P.); (V.Z.)
- Department of Informatics, Ionian University, 49100 Corfu, Greece;
| | - Vasiliki Zolota
- Department of Pathology, University of Patras, 26504 Patras, Greece; (S.L.); (E.P.); (V.Z.)
| | - Christopher Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | | | - Rama Soundararajan
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vasiliki Tzelepi
- Department of Pathology, University of Patras, 26504 Patras, Greece; (S.L.); (E.P.); (V.Z.)
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6
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Bota EC, Koumoundourou D, Ravazoula P, Zolota V, Psachoulia C, Kardari M, Karampitsakos T, Tzouvelekis A, Tzelepi V, Sampsonas F. A comprehensive analysis of GATA3 expression in carcinomas of various origins with emphasis on lung carcinomas. Monaldi Arch Chest Dis 2023. [PMID: 37667882 DOI: 10.4081/monaldi.2023.2641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/27/2023] [Indexed: 09/06/2023] Open
Abstract
GATA3 is a transcription factor involved in embryogenesis of multiple human tissues and in maintaining cell differentiation and tissue homeostasis in the adult organism. GATA3 is also involved in carcinogenesis and regarded as a sensitive marker for urothelial and breast carcinomas, albeit expression in carcinomas of non-breast/urothelial origin has been frequently reported. We sought to examine the extent and intensity of GATA3 expression in various carcinomas, mainly lung, urothelial, and breast and various other primary sites. Patients with breast carcinoma (N=40), carcinoma of the urinary bladder/renal pelvis (N=40), lung carcinoma (N=110) and various other origins (N=45) were included in the study. One hundred and sixty-five patients had a primary tumor diagnosis, and 70 cases had a metastatic tumor diagnosis. Our results showed that GATA3 expression was significantly more common in carcinomas of the breast, urinary bladder and renal pelvis compared to all other origins. All primary and 93% of metastatic urinary bladder carcinomas and 94% of the primary and 80% of metastatic breast carcinomas expressed GATA3. Expression was lower in non-urothelial histology of urinary primaries and in triple negative breast carcinomas. Focal staining, mostly faint, was seen in 5.6% of the primary lung adenocarcinomas and 35% of the primary lung squamous cell carcinomas. More extensive and intense staining was seen in 3.7% of the primary lung adenocarcinomas and 12% of the primary lung squamous cell carcinomas. Expression, mostly focal was also seen in 30% of the metastatic lung carcinomas. Finally, high expression was seen in 12.5% of the other tumors (one metastatic pancreatic carcinoma, one metastatic salivary gland adenocarcinoma NOS, one metastatic squamous cell carcinoma of the skin, one primary uterine cervix serous carcinoma, and one squamous cell carcinoma of the head and neck) and focal expression was present in another 22% of them. No ideal cut-off for positivity for GATA3 staining could be identified. In conclusion our study shows that GATA3 staining has two caveats in its use: the first is that non classical histologies of urothelial carcinomas and TNBC may be negative for the marker and secondly carcinomas of various origins may show (although rarely) intense positivity.
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Affiliation(s)
| | | | | | - Vasiliki Zolota
- Department of Pathology and Cytopathology, University Hospital of Patras; Department of Pathology, University of Patras.
| | | | - Maria Kardari
- Department of Pathology and Cytopathology, University Hospital of Patras.
| | | | | | - Vasiliki Tzelepi
- Department of Pathology and Cytopathology, University Hospital of Patras; Department of Pathology, University of Patras.
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7
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Chlorogiannis DD, Verras GI, Tzelepi V, Chlorogiannis A, Apostolos A, Kotis K, Anagnostopoulos CN, Antzoulas A, Davakis S, Vailas M, Schizas D, Mulita F. Tissue classification and diagnosis of colorectal cancer histopathology images using deep learning algorithms. Is the time ripe for clinical practice implementation? Prz Gastroenterol 2023; 18:353-367. [PMID: 38572457 PMCID: PMC10985751 DOI: 10.5114/pg.2023.130337] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/20/2023] [Indexed: 04/05/2024]
Abstract
Colorectal cancer is one of the most prevalent types of cancer, with histopathologic examination of biopsied tissue samples remaining the gold standard for diagnosis. During the past years, artificial intelligence (AI) has steadily found its way into the field of medicine and pathology, especially with the introduction of whole slide imaging (WSI). The main outcome of interest was the composite balanced accuracy (ACC) as well as the F1 score. The average reported ACC from the collected studies was 95.8 ±3.8%. Reported F1 scores reached as high as 0.975, with an average of 89.7 ±9.8%, indicating that existing deep learning algorithms can achieve in silico distinction between malignant and benign. Overall, the available state-of-the-art algorithms are non-inferior to pathologists for image analysis and classification tasks. However, due to their inherent uniqueness in their training and lack of widely accepted external validation datasets, their generalization potential is still limited.
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Affiliation(s)
| | | | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | | | - Anastasios Apostolos
- First Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | - Konstantinos Kotis
- Intelligent Systems Lab, Department of Cultural Technology and Communication, University of the Aegean, Mytilene, Greece
| | | | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Spyridon Davakis
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Michail Vailas
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Dimitrios Schizas
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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8
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Grypari IM, Tzelepi V, Gyftopoulos K. DNA Damage Repair Pathways in Prostate Cancer: A Narrative Review of Molecular Mechanisms, Emerging Biomarkers and Therapeutic Targets in Precision Oncology. Int J Mol Sci 2023; 24:11418. [PMID: 37511177 PMCID: PMC10380086 DOI: 10.3390/ijms241411418] [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] [Received: 05/28/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Prostate cancer (PCa) has a distinct molecular signature, including characteristic chromosomal translocations, gene deletions and defective DNA damage repair mechanisms. One crucial pathway involved is homologous recombination deficiency (HRD) and it is found in almost 20% of metastatic castrate-resistant PCa (mCRPC). Inherited/germline mutations are associated with a hereditary predisposition to early PCa development and aggressive behavior. BRCA2, ATM and CHECK2 are the most frequently HRD-mutated genes. BRCA2-mutated tumors have unfavorable clinical and pathological characteristics, such as intraductal carcinoma. PARP inhibitors, due to the induction of synthetic lethality, have been therapeutically approved for mCRPC with HRD alterations. Mutations are detected in metastatic tissue, while a liquid biopsy is utilized during follow-up, recognizing acquired resistance mechanisms. The mismatch repair (MMR) pathway is another DNA repair mechanism implicated in carcinogenesis, although only 5% of metastatic PCa is affected. It is associated with aggressive disease. PD-1 inhibitors have been used in MMR-deficient tumors; thus, the MMR status should be tested in all metastatic PCa cases. A surrogate marker of defective DNA repair mechanisms is the tumor mutational burden. PDL-1 expression and intratumoral lymphocytes have ambivalent predictive value. Few experimental molecules have been so far proposed as potential biomarkers. Future research may further elucidate the role of DNA damage pathways in PCa, revealing new therapeutic targets and predictive biomarkers.
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Affiliation(s)
- Ioanna-Maria Grypari
- Cytology Department, Aretaieion University Hospital, National Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Kostis Gyftopoulos
- Department of Anatomy, School of Medicine, University of Patras, 26504 Patras, Greece
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9
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Logotheti S, Vundavilli H, Papadaki E, Zhao Y, Estecio MR, Soundararajan R, Shepherd P, Dong J, Hoang A, Guo S, Navone N, Tzelepi V, Logothetis C, Lu Y, Vrahatis A, Wang W, Aparicio A. Abstract 142: Candidate measures of lineage plasticity in aggressive phenotypes of prostate cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-142] [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: 04/07/2023]
Abstract
Abstract
Lineage plasticity in cancer reflects the property of neoplastic cells to adapt to external pressures by switching between different developmental pathways. While some prostate cancers appear “constrained” to a luminal epithelial lineage despite progression on androgen signaling inhibitors, others exhibit a “lineage-promiscuous” phenotype under the pressures of these therapies. However, a clinically applicable marker that quantifies lineage plasticity has yet to be developed. To address this knowledge gap, we applied single-cell genomics and bulk epigenetic profiling to two patient derived xenografts (PDXs) derived before and after chemotherapy from the castration-resistant prostate tumor of a 42-year-old with a PSA 486, Gleason 5+4, cT4N1M1b PCa, who succumbed to his disease within 21 months of diagnosis. We reasoned that the two PDXs, MDA PCa 177-B (AR negative, basal transcriptional profile) and MDA PCa 189-1 (AR positive, luminal transcriptional profile), should share the property of lineage plasticity and serve to define candidate measurable signatures of this property. Targeted and single-cell DNA sequencing showed that the two models share 66.8% of their annotated mutations, 71.5% of copy number variations, and a common ancestor in their phylogeny, confirming their common clonal origin. Single-cell RNA sequencing revealed the presence of a cluster of cells shared by both PDXs that contained a highly mixed program, similar to a “high-plasticity cell state” (HPCS) previously implicated in the emergence and maintenance of cellular heterogeneity in genetically engineered mouse models of lung cancer (Marjanovic et al PMID: 32707077). H3K27ac, H3K27me3 and H3K4me3 chromatin immunoprecipitation followed by sequencing and reduced representation bisulfite sequencing performed in triplicates revealed chromatin profiles shared by both PDX models, and being absent from normal prostate specimens in publicly available datasets. In conclusion, our data supports the hypothesis that the property of lineage plasticity can be reflected in a biomarker signature and used as a measurable metric. Ongoing are evaluation of the candidate signatures in publicly available datasets representative of the spectrum of the disease in patient samples, and assessment of the effects of systemic therapies (including epigenetic modulators) on the property of lineage plasticity in clinical and co-clinical samples.
Citation Format: Souzana Logotheti, Haswanth Vundavilli, Eugenia Papadaki, Yuehui Zhao, Marcos Roberto Estecio, Rama Soundararajan, Peter Shepherd, Jiabin Dong, Anh Hoang, Shuai Guo, Nora Navone, Vasiliki Tzelepi, Christopher Logothetis, Yue Lu, Aristidis Vrahatis, Wenyi Wang, Ana Aparicio. Candidate measures of lineage plasticity in aggressive phenotypes of prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 142.
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Affiliation(s)
- Souzana Logotheti
- 1Department of Genitourinary Medical Oncology, UT MD Anderson Cancer Center, Houston, TX
| | - Haswanth Vundavilli
- 2Department of Bioinformatics and Computational Biology, UT MD Anderson Cancer Center, Houston, TX
| | | | - Yuehui Zhao
- 2Department of Bioinformatics and Computational Biology, UT MD Anderson Cancer Center, Houston, TX
| | - Marcos Roberto Estecio
- 4Department of Epigenetics and Molecular Carcinogenesis, UT MD Anderson Cancer, Houston, TX
| | - Rama Soundararajan
- 5Department of Translational Molecular Pathology, UT MD Anderson Cancer Center, Houston, TX
| | - Peter Shepherd
- 1Department of Genitourinary Medical Oncology, UT MD Anderson Cancer Center, Houston, TX
| | - Jiabin Dong
- 1Department of Genitourinary Medical Oncology, UT MD Anderson Cancer Center, Houston, TX
| | - Anh Hoang
- 1Department of Genitourinary Medical Oncology, UT MD Anderson Cancer Center, Houston, TX
| | - Shuai Guo
- 2Department of Bioinformatics and Computational Biology, UT MD Anderson Cancer Center, Houston, TX
| | - Nora Navone
- 1Department of Genitourinary Medical Oncology, UT MD Anderson Cancer Center, Houston, TX
| | - Vasiliki Tzelepi
- 6University of Patras, School of Medicine, Department of Pathology, Patras, Greece
| | - Christopher Logothetis
- 1Department of Genitourinary Medical Oncology, UT MD Anderson Cancer Center, Houston, TX
| | - Yue Lu
- 7Department of Epigenetics and Molecular Carcinogenesis, UT MD Anderson Cancer Center, Houston, TX
| | | | - Wenyi Wang
- 2Department of Bioinformatics and Computational Biology, UT MD Anderson Cancer Center, Houston, TX
| | - Ana Aparicio
- 1Department of Genitourinary Medical Oncology, UT MD Anderson Cancer Center, Houston, TX
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10
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Tsaturyan A, Adamou C, Pantazis L, Kalogeropoulou C, Tzelepi V, Apostolopoulos D, Pagonis K, Peteinaris A, Natsos A, Vrettos T, Al-Aown A, Liatsikos E, Kallidonis P. The effect of percutaneous tract dilation technique on renal parenchymal trauma: An experimental in vivo study on a porcine model. Urol Ann 2023; 15:191-196. [PMID: 37304519 PMCID: PMC10252767 DOI: 10.4103/ua.ua_25_22] [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: 02/04/2022] [Accepted: 09/28/2022] [Indexed: 06/13/2023] Open
Abstract
Purpose The purpose of this study was to evaluate renal parenchymal trauma of two-step dilation compared to the conventional Amplatz gradual dilation during percutaneous nephrolithotomy on a porcine model. Materials and Methods A nonpapillary percutaneous access tract was established under fluoroscopic guidance in both kidneys of four female pigs. On the right kidney of each pig, gradual dilation was performed using an Amplatz dilator set with a gradual dilation to 30 Fr, whereas on the left, a two-step dilation was utilized using only 16 Fr and 30 Fr dilators. Two of the animals were euthanized immediately after the procedure and the remaining two 1 month later. The pigs that were kept alive underwent a contrast-enhanced computed tomography immediately, 15, and 30 days postoperatively. A dimercaptosuccinic acid (DMSA) scintigraphy and single-photon emission computed tomography-computed tomography (CT) were also performed after the last CT and afterward, the pigs were sacrificed. All kidneys were harvested for pathohistological examination. Results The follow-up radiologic imaging showed similar parenchymal damage caused by the compared dilation techniques and an expected reduction in scar size in the later scans. No scar was identified by DMSA in any kidney. Gross and microscopic examinations conducted both on the kidneys that were harvested immediately after the procedure and the ones from the animals that were left to heal, revealed no significant differences in tissue damage, grade of fibrosis, or inflammation depending on the dilation method. Conclusions Our study showed no inferior outcomes caused by two-step dilation compared to gradual dilation regarding renal parenchymal damage following a nonpapillary puncture. In fact, postoperative imaging findings suggested a trend toward better healing and less scar tissue when the two-step method was used.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
| | | | - Lampros Pantazis
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
| | | | - Vasiliki Tzelepi
- Department of Pathology and ICU University Hospital of Patras, Patras, Greece
| | | | | | - Angelis Peteinaris
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
| | - Anastasios Natsos
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU University Hospital of Patras, Patras, Greece
| | - Abdulrahman Al-Aown
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Evangelos Liatsikos
- Department of Urology and ICU University Hospital of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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11
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Grypari IM, Pappa I, Papastergiou T, Zolota V, Bravou V, Melachrinou M, Megalooikonomou V, Tzelepi V. Elucidating the role of PRMTs in prostate cancer using open access databases and a patient cohort dataset. Histol Histopathol 2023; 38:287-302. [PMID: 36082942 DOI: 10.14670/hh-18-513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Protein arginine methylation is an understudied epigenetic mechanism catalyzed by enzymes known as Protein Methyltransferases of Arginine (PRMTs), while the opposite reaction is performed by Jumonji domain- containing protein 6 (JMJD6). There is increasing evidence that PRMTs are deregulated in prostate cancer (PCa). In this study, the expression of two PRMT members, PRMT2 and PRMT7 as well as JMJD6, a demethylase, was analyzed in PCa. Initially, we retrieved data from The Cancer Genome Atlas (TCGA) project and the Gene Expression Omnibus (GEO) database to explore the differential expression of various PRMT family members in patients with PCa and then applied immunohistochemistry in a patient cohort across the spectrum of PCa, including non-neoplastic prostate tissue and lymph node metastatic foci. The results from the TCGA analysis revealed that PRMT7, PRMT6 and PRMT3 expression increased while PRMT2, PRMT9 and JMJD6 levels decreased in the tumor compared to non-neoplastic prostate. Results from the GEO datasets were similar, albeit not identical with the TCGA results, with PRMT7 and PRMT3 being upregulated and PRMT2 and JMJD6 being downregulated in the tumor compared to non-neoplastic tissue in some of them. In addition, PRMT7 levels decreased with stage and grade progression in the TCGA analysis. In the patient cohort, both PRMTs and JMJD6 were overexpressed in PCa compared to non-neoplastic tissue, and nuclear PRMT2 and JMJD6 were upregulated in lymph node metastasis, too. PRMT7 and JMJD6 expression were upregulated with the progression of stage and JMJD6 was also increased with the elevation of grade. After androgen ablation therapy, nuclear expression of PRMT7 and JMJD6 were elevated compared to untreated tumors. PRMT2, PRMT7 and JMD6 were also correlated with markers of EMT and cell cycle regulators. Finally, our findings indicate that PRMTs and JMJD6 are involved in prostate cancer progression and revealed a potential interplay of PRMTs with EMT mediators, underscoring the need for therapeutic targeting of arginine methylation in prostate cancer.
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Affiliation(s)
- Ioanna Maria Grypari
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Ioanna Pappa
- Multidimensional Data Analysis and Knowledge Management Laboratory, Computer Engineering and Informatics Department, School of Engineering, University of Patras, Patras, Greece
| | - Thomas Papastergiou
- Multidimensional Data Analysis and Knowledge Management Laboratory, Computer Engineering and Informatics Department, School of Engineering, University of Patras, Patras, Greece
| | - Vasiliki Zolota
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Vasiliki Bravou
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Patras, Patras, Greece
| | - Maria Melachrinou
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Vasileios Megalooikonomou
- Multidimensional Data Analysis and Knowledge Management Laboratory, Computer Engineering and Informatics Department, School of Engineering, University of Patras, Patras, Greece
| | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece.
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12
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Tzelepi V. Prostate Cancer: Pathophysiology, Pathology and Therapy. Cancers (Basel) 2022; 15:cancers15010281. [PMID: 36612276 PMCID: PMC9818719 DOI: 10.3390/cancers15010281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Prostate cancer (PCa) is a major health care challenge in the developed world, being the most common type of cancer in men in the USA [...].
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Affiliation(s)
- Vasiliki Tzelepi
- Department of Pathology, University of Patras, 26504 Patras, Greece;
- Department of Histopathology and Cytology, University Hospital of Patras, 26504 Patras, Greece
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13
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Geramoutsou C, Nikou S, Karavias D, Arbi M, Tavlas P, Tzelepi V, Lygerou Z, Maroulis I, Bravou V. Focal adhesion proteins in hepatocellular carcinoma: RSU1 a novel tumour suppressor with prognostic significance. Pathol Res Pract 2022; 235:153950. [DOI: 10.1016/j.prp.2022.153950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022]
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14
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Soundararajan R, Viscuse P, Pilie P, Liu J, Logotheti S, Laberiano Fernández C, Lorenzini D, Hoang A, Lu W, Soto LMS, Wistuba II, Xu M, Song X, Shepherd PDA, Navone NM, Tidwell RSS, Lozano G, Logothetis C, Zhang J, Long JP, Estecio MR, Tzelepi V, Aparicio AM. Genotype-to-Phenotype Associations in the Aggressive Variant Prostate Cancer Molecular Profile (AVPC-m) Components. Cancers (Basel) 2022; 14:3233. [PMID: 35805010 PMCID: PMC9265062 DOI: 10.3390/cancers14133233] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023] Open
Abstract
The aggressive variant prostate cancer molecular profile (AVPC-m), composed of combined defects in TP53, RB1 and PTEN, characterizes a subset of prostate cancers linked to androgen indifference and platinum sensitivity. To contribute to the optimization of the AVPC-m assessment for inclusion in prospective clinical trials, we investigated the status of the AVPC-m components in 28 patient tumor-derived xenografts (PDXs) developed at MDACC. We subjected single formalin-fixed, paraffin-embedded (FFPE) blocks from each PDX to immunohistochemistry (IHC), targeted next-generation genomic sequencing (NGS) and Clariom-S Affymetrix human microarray expression profiling. Standard validated IHC assays and a 10% labeling index cutoff resulted in high reproducibility across three separate laboratories and three independent readers for all tumor suppressors, as well as strong correlations with loss-of-function transcriptional scores (LOF-TS). Adding intensity assessment to labeling indices strengthened the association between IHC results and LOF-TS for TP53 and RB1, but not for PTEN. For TP53, genomic alterations determined by NGS had slightly higher agreement scores with LOF-TS than aberrant IHC, while for RB1 and PTEN, NGS and IHC determinations resulted in similar agreement scores with LOF-TS. Nonetheless, our results indicate that the AVPC-m components can be assessed reproducibly by IHC using various widely available standardized assays.
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Affiliation(s)
- Rama Soundararajan
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.L.F.); (W.L.); (L.M.S.S.); (I.I.W.)
| | - Paul Viscuse
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (P.V.); (P.P.); (S.L.); (A.H.); (P.D.A.S.); (N.M.N.); (C.L.)
| | - Patrick Pilie
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (P.V.); (P.P.); (S.L.); (A.H.); (P.D.A.S.); (N.M.N.); (C.L.)
| | - Jingjing Liu
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (J.L.); (M.X.); (X.S.); (J.Z.)
| | - Souzana Logotheti
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (P.V.); (P.P.); (S.L.); (A.H.); (P.D.A.S.); (N.M.N.); (C.L.)
| | - Caddie Laberiano Fernández
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.L.F.); (W.L.); (L.M.S.S.); (I.I.W.)
| | - Daniele Lorenzini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Instituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Anh Hoang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (P.V.); (P.P.); (S.L.); (A.H.); (P.D.A.S.); (N.M.N.); (C.L.)
| | - Wei Lu
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.L.F.); (W.L.); (L.M.S.S.); (I.I.W.)
| | - Luisa Maren Solis Soto
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.L.F.); (W.L.); (L.M.S.S.); (I.I.W.)
| | - Ignacio I. Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.L.F.); (W.L.); (L.M.S.S.); (I.I.W.)
| | - Mingchu Xu
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (J.L.); (M.X.); (X.S.); (J.Z.)
| | - Xingzhi Song
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (J.L.); (M.X.); (X.S.); (J.Z.)
| | - Peter D. A. Shepherd
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (P.V.); (P.P.); (S.L.); (A.H.); (P.D.A.S.); (N.M.N.); (C.L.)
| | - Nora M. Navone
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (P.V.); (P.P.); (S.L.); (A.H.); (P.D.A.S.); (N.M.N.); (C.L.)
| | - Rebecca S. S. Tidwell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA; (R.S.S.T.); (J.P.L.)
| | - Guillermina Lozano
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Christopher Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (P.V.); (P.P.); (S.L.); (A.H.); (P.D.A.S.); (N.M.N.); (C.L.)
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (J.L.); (M.X.); (X.S.); (J.Z.)
| | - James P. Long
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA; (R.S.S.T.); (J.P.L.)
| | - Marcos R. Estecio
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Vasiliki Tzelepi
- Department of Pathology, University of Patras, 26504 Patras, Greece;
| | - Ana M. Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (P.V.); (P.P.); (S.L.); (A.H.); (P.D.A.S.); (N.M.N.); (C.L.)
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15
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Adamou C, Tsaturyan A, Kalogeropoulou C, Tzelepi V, Apostolopoulos D, Vretos T, Pagonis K, Peteinaris A, Liatsikos E, Kallidonis P. Comparison of renal parenchymal trauma after standard, mini and ultra-mini percutaneous tract dilation in porcine models. World J Urol 2022; 40:2083-2089. [PMID: 35751669 DOI: 10.1007/s00345-022-04069-1] [Citation(s) in RCA: 1] [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] [Received: 01/14/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate whether reducing tract dilation diameter in PCNL (percutaneous nephrolithotomy) procedures results in minimizing of renal trauma of the percutaneous tract. METHODS A percutaneous renal access tract was established bilaterally to 11 pigs. Two pigs were euthanized immediately after the experiment, while nine pigs were sacrificed 1 month later. The percutaneous accesses were dilated up to 30Fr, 22Fr or 12Fr. The animals underwent a contrast-enhanced computer tomography immediately after the procedure and 30 days later. DMSA-scintigraphy with SPECT-CT was also performed. The kidneys of all animals were harvested for histological evaluation. The volume of scar tissue and the percentage of renal volume replaced by scar tissue were calculated. RESULTS Immediate post-procedural CT-scans revealed a significant difference in defect diameter among the three modalities. However, the scar volume calculated on CT-images and histopathology showed a significant difference only when 30Fr dilation was compared to 12Fr dilation. The percentage of scar volume was negligible in all cases, but there was still a statistical difference between 30 and 12Fr dilation. Dilation up to 22Fr revealed no statistical differences compared to the other two modalities. DMSA-scintigraphy showed no scar tissue in any case. CONCLUSION Dilation up to 30Fr may cause a significantly larger scar tissue on renal parenchyma compared to 12Fr dilation as it was shown on CT-images and microscopic evaluation, but based on the DMSA/SPECT-CT this difference seems to be insignificant to the renal function. The scar tissue caused by 22Fr dilation seemed to have no significant difference from the other modalities.
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Affiliation(s)
| | - Arman Tsaturyan
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | - Vasiliki Tzelepi
- Department of Pathology, University Hospital of Patras, Patras, Greece
| | | | - Theofanis Vretos
- Department of Anesthesiology and Intensive Care, University Hospital of Patras, Patras, Greece
| | | | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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16
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Destouni M, Lazaris AC, Tzelepi V. Cribriform Patterned Lesions in the Prostate Gland with Emphasis on Differential Diagnosis and Clinical Significance. Cancers (Basel) 2022; 14:cancers14133041. [PMID: 35804812 PMCID: PMC9264941 DOI: 10.3390/cancers14133041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary A cribriform structure is defined as a continuous proliferation of cells with intermingled lumina. Various entities may have a cribriform morphology within the prostate gland, ranging from normal, to benign, to borderline and even to malignant lesions. This review summarizes the morphologic features of entities that have a cribriform morphology within the prostate gland, with an emphasis on their differential diagnosis, molecular profile and clinical significance. The basic aim is to assist the pathologist with challenging and controversial cases and inform the clinician on the clinical implications of cribriform morphology. Abstract Cribriform glandular formations are characterized by a continuous proliferation of cells with intermingled lumina and can constitute a major or minor part of physiologic (normal central zone glands), benign (clear cell cribriform hyperplasia and basal cell hyperplasia), premalignant (high-grade prostatic intraepithelial neoplasia), borderline (atypical intraductal cribriform proliferation) or clearly malignant (intraductal, acinar, ductal and basal cell carcinoma) lesions. Each displays a different clinical course and variability in clinical management and prognosis. The aim of this review is to summarize the current knowledge regarding the morphological features, differential diagnosis, molecular profile and clinical significance of the cribriform-patterned entities of the prostate gland. Areas of controversy regarding their management, i.e., the grading of Intaductal Carcinoma, will also be discussed. Understanding the distinct nature of each cribriform lesion leads to the correct diagnosis and ensures accuracy in clinical decision-making, prognosis prediction and personalized risk stratification of patients.
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Affiliation(s)
- Maria Destouni
- Department of Cytopathology, Hippokrateion General Hospital of Athens, 11527 Athens, Greece;
| | - Andreas C. Lazaris
- First Department of Pathology, School of Medicine, The National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, 26504 Patras, Greece
- Correspondence:
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17
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Lygeros S, Danielidi A, Tzelepi V, Grafanaki K. An Unusual Polypoid Septal Mucosal Melanoma: Overview and Diagnostic Pitfalls. Cureus 2021; 13:e20819. [PMID: 35141076 PMCID: PMC8802658 DOI: 10.7759/cureus.20819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 11/05/2022] Open
Abstract
Sinonasal mucosa is an area of high melanocyte density compared to other mucosa-lined sites. Sinonasal mucosal melanomas (SNMM) most commonly arise from the nasal cavity and the paranasal sinuses. Due to their obscure anatomic location and lack of early symptomatology, SNMM are often diagnosed in an advanced stage. The majority of patients who present with symptoms complain of unilateral nasal dysfunction, such as obstruction and epistaxis. We hereby report a case of an 86-year-old female, who presented with a three-year history of progressive right-sided nasal obstruction and recurrent epistaxis. Posterior rhinoscopy and endoscopy revealed a polypoid, fleshy lesion whose coloration varied from mildly pigmented to amelanotic. Inverted sinonasal papilloma was included in the differential diagnosis due to MRI findings. Post-resection histopathology indicated a mucosal melanoma. Typically, amelanotic lesions are rare, more difficult to diagnose and associated with worse prognosis due to both their aggressiveness and delayed diagnosis.
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18
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Dimitrakopoulos FID, Antonacopoulou AG, Kottorou AE, Kalofonou M, Panagopoulos N, Dougenis D, Makatsoris T, Tzelepi V, Koutras A, Kalofonos HP. Genetic Variations of CD40 and LTβR Genes Are Associated With Increased Susceptibility and Clinical Outcome of Non-Small-Cell Carcinoma Patients. Front Oncol 2021; 11:721577. [PMID: 34604057 PMCID: PMC8484958 DOI: 10.3389/fonc.2021.721577] [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: 06/07/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Immune system-related receptors CD40 (tumor necrosis factor receptor superfamily member 5), BAFFR (tumor necrosis factor receptor superfamily member 13C), and LTβR (tumor necrosis factor receptor superfamily member 3) play a pivotal role in non-small-cell lung cancer (NSCLC). To further evaluate their role in NSCLC, CD40 rs1883832 (T>C), BAFFR rs7290134 (A>G), and LTβR rs10849448 (A>G) single-nucleotide polymorphisms (SNPs) were investigated regarding their impact in risk and clinical outcome of NSCLC patients. Methods The three selected SNPs were evaluated in 229 NSCLC patients and 299 healthy controls, while CD40, BAFFR, and LTβR protein expression was assessed by immunohistochemistry in 96 tumor specimens from NSCLC patients. Results In total, CD40 rs1883832 was associated with NSCLC risk, with the T allele, after adjusting for cofactors, being related to increased risk (p = 0.007; OR 1.701). Moreover, the CT genotype was associated with increased risk (p = 0.024; OR 1.606) and poorer 5-year overall survival (OS) after adjusting for cofactors (p = 0.001, HR 1.829), while CC was associated with higher CD40 expression in tumorous cells (p = 0.040) and in stromal cells (p = 0.036). In addition, AA homozygotes for the LTβR rs10849448 had increased risk for NSCLC in multivariate analysis (p = 0.008; OR, 2.106) and higher LTβR membranous expression (p = 0.035). Although BAFFR rs7290134 was associated with BAFFR membranous expression (p = 0.039), BAFFR rs7290134 was not associated with neither the disease risk nor the prognosis of NSCLC patients. Conclusions In conclusion, CD40 rs1883832 and LTβR rs10849448 seem to be associated with increased risk for NSCLC, while CD40 rs1883832 is also associated with OS of patients with NSCLC.
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Affiliation(s)
- Foteinos-Ioannis D Dimitrakopoulos
- Division of Oncology, Department of Medicine, University of Patras, Patras, Greece.,Molecular Oncology Laboratory, Division of Oncology, Department of Medicine, University of Patras, Patras, Greece
| | - Anna G Antonacopoulou
- Molecular Oncology Laboratory, Division of Oncology, Department of Medicine, University of Patras, Patras, Greece
| | - Anastasia E Kottorou
- Molecular Oncology Laboratory, Division of Oncology, Department of Medicine, University of Patras, Patras, Greece
| | - Melpomeni Kalofonou
- Centre for Bio-Inspired Technology, Institute of Biomedical Engineering, Imperial College London, London, United Kingdom
| | | | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, University of Patras, Patras, Greece
| | - Thomas Makatsoris
- Division of Oncology, Department of Medicine, University of Patras, Patras, Greece
| | | | - Angelos Koutras
- Division of Oncology, Department of Medicine, University of Patras, Patras, Greece
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19
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Grypari IM, Logotheti S, Zolota V, Troncoso P, Efstathiou E, Bravou V, Melachrinou M, Logothetis C, Tzelepi V. The protein arginine methyltransferases (PRMTs) PRMT1 and CARM1 as candidate epigenetic drivers in prostate cancer progression. Medicine (Baltimore) 2021; 100:e27094. [PMID: 34516499 PMCID: PMC8428700 DOI: 10.1097/md.0000000000027094] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/13/2021] [Indexed: 01/05/2023] Open
Abstract
Epigenetic changes are implicated in prostate cancer (PCa) progression and resistance to therapy. Arginine residue methylation is an understudied histone post-translational modification that is increasingly associated with cancer progression and is catalyzed by enzymes called protein arginine methyltransferases (PRMTs). The molecular consequences of aberrant expression of PRMTs in PCa and the relationship between PRMTs and PCa progression are largely unknown. Using immunohistochemistry, we examined the expression of PRMT1 and CARM1, two of the best-studied PRMTs, in 288 patients across the spectrum of PCa and correlated them with markers of androgen receptor (AR) signaling, and milestones of carcinogenesis. Our findings indicate that PRMT1 and CARM1 are upregulated early in PCa progression, and that CARM1 is further upregulated after therapy. In addition, a correlation of CARM1 with AR post-translational modifications was noted in the setting of therapy resistance, highlighting CARM1 as one of the adaptation mechanisms of PCa cells in an androgen-depleted environment. Finally, CARM1 correlated with markers of cell cycle regulation, and both CARM1 and PRMT1 correlated with markers of epithelial-to-mesenchymal transition signaling. Taken together these findings indicate that an epigenetic network drives PCa progression through enhancement of milestone pathways including AR signaling, the cell cycle, and epithelial-to-mesenchymal transition.
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Affiliation(s)
- Ioanna Maria Grypari
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Souzana Logotheti
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Vasiliki Zolota
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eleni Efstathiou
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center
| | - Vasiliki Bravou
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Patras, Patras, Greece
| | - Maria Melachrinou
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Christopher Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center
| | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
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Stravodimou A, Tzelepi V, Balasis S, Georgiou S, Papadaki H, Mouzaki A, Melachrinou M, Kourea EP. PD-L1 Expression, T-lymphocyte Subpopulations and Langerhans Cells in Cutaneous Squamous Cell Carcinoma and Precursor Lesions. Anticancer Res 2021; 41:3439-3448. [PMID: 34230139 DOI: 10.21873/anticanres.15131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The role of immune cells and PD-L1 in cutaneous squamous carcinogenesis is unclear. This study examines T-cell populations, Langerhans cells (LCs) and PD-L1 in invasive squamous cell carcinoma (inSCC), adjacent precursors and normal skin (NS) to investigate their participation in tumorigenesis. MATERIALS AND METHODS Cases of cutaneous inSCC with adjacent precursors (n=125) were selected. In situ SCC (isSCC) and actinic keratosis (AK) were observed in 53 and 123 cases, respectively, whereas NS was present in 123 lesions. Immunohistochemistry was performed for CD3, CD8, Foxp3, CD1a and PD-L1. RESULTS T-cells, LCs and PD-L1 gradually increase during the evolution from AK to isSCC and inSCC, with statistical significance between all lesions, except for CD3+ and CD8+ cells between isSCC and inSCC. Epithelial PD-L1 expression correlates with tumor diameter and thickness. CONCLUSION The progressive increase of T-cells, LCs and PD-L1 in cutaneous squamous carcinogenesis provides rationale for immunotherapy and identification of predictive biomarkers.
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Affiliation(s)
- Aristea Stravodimou
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Stavros Balasis
- Department of Orthopaedics, University of Patras Hospital, Patras, Greece
| | - Sophia Georgiou
- Department of Dermatology, School of Medicine, University of Patras, Patras, Greece
| | - Helen Papadaki
- Department of Anatomy, School of Medicine, University of Patras, Patras, Greece
| | - Athanasia Mouzaki
- Division of Hematology, Department of Internal Medicine, School of Medicine, University of Patras, Patras, Greece
| | - Maria Melachrinou
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece
| | - Eleni P Kourea
- Department of Pathology, School of Medicine, University of Patras, Patras, Greece;
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21
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Zolota V, Tzelepi V, Piperigkou Z, Kourea H, Papakonstantinou E, Argentou MI, Karamanos NK. Epigenetic Alterations in Triple-Negative Breast Cancer-The Critical Role of Extracellular Matrix. Cancers (Basel) 2021; 13:cancers13040713. [PMID: 33572395 PMCID: PMC7916242 DOI: 10.3390/cancers13040713] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 01/15/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/11/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is an aggressive subgroup of breast cancer characterized by genomic complexity and therapeutic options limited to only standard chemotherapy. Although it has been suggested that stratifying TNBC patients by pathway-specific molecular alterations may predict benefit from specific therapeutic agents, application in routine clinical practice has not yet been established. There is a growing body of the literature supporting that epigenetic modifications comprised by DNA methylation, chromatin remodeling and non-coding RNAs play a fundamental role in TNBC pathogenesis. Extracellular matrix (ECM) is a highly dynamic 3D network of macromolecules with structural and cellular regulatory roles. Alterations in the expression of ECM components result in uncontrolled matrix remodeling, thus affecting its ability to regulate vital functions of cancer cells, including proliferation, migration, adhesion, invasion and epithelial-to-mesenchymal transition (EMT). Recent molecular data highlight the major role of tumor microenvironment and ECM alterations in TNBC and approaches for targeting tumor microenvironment have recently been recognized as potential therapeutic strategies. Notably, many of the ECM/EMT modifications in cancer are largely driven by epigenetic events, highlighting the pleiotropic effects of the epigenetic network in TNBC. This article presents and critically discusses the current knowledge on the epigenetic alterations correlated with TNBC pathogenesis, with emphasis on those associated with ECM/EMT modifications, their prognostic and predictive value and their use as therapeutic targets.
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Affiliation(s)
- Vasiliki Zolota
- Department of Pathology, School of Medicine, University of Patras, 26504 Rion, Greece; (V.T.); (H.K.)
- Correspondence: ; Tel.: +30-0693613366
| | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, 26504 Rion, Greece; (V.T.); (H.K.)
| | - Zoi Piperigkou
- Biochemistry, Biochemical Analysis & Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, 26110 Patras, Greece; (Z.P.); (N.K.K.)
- Foundation for Research and Technology-Hellas (FORTH)/Institute of Chemical Engineering Sciences (ICE-HT), 26110 Patras, Greece
| | - Helen Kourea
- Department of Pathology, School of Medicine, University of Patras, 26504 Rion, Greece; (V.T.); (H.K.)
| | - Efthymia Papakonstantinou
- Department of Gynecology and Obstetrics School of Medicine, University of Patras, 26504 Rion, Greece;
| | - Maria-Ioanna Argentou
- Department of Surgery, School of Medicine, University of Patras, 26504 Rion, Greece;
| | - Nikos K. Karamanos
- Biochemistry, Biochemical Analysis & Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, 26110 Patras, Greece; (Z.P.); (N.K.K.)
- Foundation for Research and Technology-Hellas (FORTH)/Institute of Chemical Engineering Sciences (ICE-HT), 26110 Patras, Greece
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Bosgana P, Nikou S, Dimitrakopoulos FI, Logotheti S, Tzelepi V, Kalophonos C, Bravou V, Kourea E, Sampsonas F, Zolota V. H3K4 Methylation Status and Lysine Specific Methyltransferase KMT2C Expression Correlate with Prognosis in Lung Adenocarcinoma. Curr Mol Pharmacol 2020; 14:1028-1036. [PMID: 32867667 DOI: 10.2174/1874467213999200831130739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/20/2019] [Accepted: 02/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Genetic events cannot account for the complexity of human carcinogenesis alone. Mutations of epigenetic regulators and aberrations of their expression patterns have been detected in various human malignancies. Methylation of histone H3 at lysine 4 (H3K4me), is an evolutionarily conserved histone modification that marks regions of active transcription and regulates cell growth, migration, and invasion. The MLL/KMT2 family of histone methyltransferases specifically methylate histone H3 at lysine 4. OBJECTIVE The aim of this study was to explore the role of KMT2C/MLL3 as well as key histone modification activating markers, such as H3K4me2 and H3K4me3 in a cohort of surgically resected human lung adenocarcinomas in an effort to reveal possible biomarkers for lung adenocarcinoma diagnosis and prognosis and potential therapeutic targets. METHOD The immunohistochemical expression of KMT2C/MLL3, H3K4me2 and H3K4me3 was analyzed in formalin fixed paraffin embedded tissue from 96 patients with lung adenocarcinoma. Results were associated with clinicopathologic parameters and patient's prognosis. RESULTS Nuclear expression of KMT2C/MLL3 in epithelial cells was independently associated with shorter overall survival. Cytoplasmic H3K4me2 expression was associated withT stage and nuclear H3K4me2 expression was associated with female gender and patients' prognosis. The latter association persisted after multivariate analysis. No association was found between H3K4me3 expression and clinicopathological data or disease outcome in our cohort of patients. CONCLUSION These results suggest that the pattern of histone modifications and KMT2C/MLL3 expression can be used as an independent prognostic factor in lung adenocarcinoma, revealing that chromatin remodeling is criticallyinvolved in cancer progression.
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Affiliation(s)
- Pinelopi Bosgana
- Department of Pathology, Medical School, University of Patras, Patras. Greece
| | - Sophia Nikou
- Department of Anatomy, Embryology and Histology, Medical School, University of Patras, Patras. Greece
| | | | - Souzana Logotheti
- Department of Pathology, Medical School, University of Patras, Patras. Greece
| | - Vasiliki Tzelepi
- Department of Pathology, Medical School, University of Patras, Patras. Greece
| | - Charalambos Kalophonos
- Division of Oncology, Department of Medicine, Medical School, University of Patras, Patras. Greece
| | - Vasiliki Bravou
- Department of Anatomy, Embryology and Histology, Medical School, University of Patras, Patras. Greece
| | - Eleni Kourea
- Department of Pathology, Medical School, University of Patras, Patras. Greece
| | - Fotios Sampsonas
- Department of Pulmunology, Medical School, University of Patras, Patras. Greece
| | - Vassiliki Zolota
- Department of Pathology, Medical School, University of Patras, Patras. Greece
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Grypari IM, Logotheti S, Lazaris AC, Kallidonis P, Fokaefs E, Melachrinou M, Zolota V, Tzelepi V. Isolated Intraductal Carcinoma of the Prostate in Prostatectomy Specimens: Report of 2 Cases and Review of the Literature. Int J Surg Pathol 2020; 28:918-924. [PMID: 32456482 DOI: 10.1177/1066896920920357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraductal carcinoma of the prostate (IDCp) is a distinct neoplastic entity, and although recognized for some time, it was included for the first time in the histologic classification of prostate cancer in the 2016 publication of World Health Organization. IDCp represents an intraductal or intra-acinar proliferation of malignant cells, with preservation of the basal cell layer. Even though IDCp is usually accompanied by a high-grade invasive component, low-grade invasive carcinoma can rarely be seen adjacent to the lesion. Even rarer is the incidence of isolated IDCp in needle biopsies, while a few such cases have been reported in prostatectomy specimens. We report 2 cases with isolated IDCp without any invasive component. A review of the literature is performed including the diagnostic challenges of IDCp and its morphologic mimics, immunohistochemical markers, molecular aspects, and prognostic implications. Even though it is not yet clear whether IDCp represents an intraductal spread of invasive cancer or a precursor of invasive carcinoma, the existence of isolated IDCp reinforces the idea that, at least in some of the cases, IDCp is a precancerous lesion. Further molecular studies need to be performed in order to clarify its pathogenesis.
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Tzelepi V, Logotheti S, Efstathiou E, Troncoso P, Aparicio A, Sakellakis M, Hoang A, Perimenis P, Melachrinou M, Logothetis C, Zolota V. Epigenetics and prostate cancer: defining the timing of DNA methyltransferase deregulation during prostate cancer progression. Pathology 2019; 52:218-227. [PMID: 31864524 DOI: 10.1016/j.pathol.2019.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 07/10/2019] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 01/31/2023]
Abstract
DNA methyltransferases (DNMTs) regulate gene expression by methylating cytosine residues within CpG dinucleotides. Aberrant methylation patterns have been shown in a variety of human tumours including prostate cancer. However, the expression of DNMTs in clinical samples across the spectrum of prostate cancer progression has not been studied before. Tissue microarrays were constructed from the prostatectomy specimens of 309 patients across the spectrum of prostate cancer progression: hormone-naïve low-grade prostate cancer (n=49), hormone-naïve high-grade prostate cancer (n=151), hormonally treated high-grade prostate cancer (n=65), and castrate-resistant prostate cancer (CRPC) including neuroendocrine carcinoma (n=44). Adjacent non-neoplastic parenchyma was also available in 100 patients. In 71 patients with high-grade carcinoma and lymph node metastasis, tissue from the metastasis was also available for analysis. Immunohistochemical staining was performed with antibodies against DNMT1, DNMT2, DNMT3A, DNMT3B, and DNMT3L. Our results showed that DNMT1 and DNMT3L were upregulated early in prostate cancer progression, whereas DNMT2 was upregulated as a response to androgen ablation. DNMT1, DNMT3A, and DNMT3B were higher in the late stages of prostate cancer progression, i.e., the emergence of castrate resistance and androgen-independent growth. Lastly, DNMT1, DNMT2, and DNMT3L were upregulated in lymph node metastases compared to primary carcinomas. Our results highlight a cascade of epigenetic events in prostate cancer progression.
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Affiliation(s)
- Vasiliki Tzelepi
- Department of Pathology, Medical School, University of Patras, Greece.
| | - Souzana Logotheti
- Department of Pathology, Medical School, University of Patras, Greece
| | - Eleni Efstathiou
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, USA
| | - Ana Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Minas Sakellakis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Anh Hoang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Petros Perimenis
- Department of Urology, Medical School, University of Patras, Greece
| | - Maria Melachrinou
- Department of Pathology, Medical School, University of Patras, Greece
| | - Christopher Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Vasiliki Zolota
- Department of Pathology, Medical School, University of Patras, Greece
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Dimtrakopoulos FID, Kottorou AE, Antonacopoulou AG, Nikolakopoulos A, Panagopoulos N, Kalofonou M, Dougenis D, Koutras A, Makatsoris T, Tzelepi V, Kalofonos H. Association of BAFFR expression in CAFs with overall survival and response to platinum-based chemotherapy in NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8537 Background: Β-cell activating factor receptor (BAFFR) is a surface receptor, which leads to activation of the Nuclear Factor-kappaB (NF-κB) alternative pathway, a pathway with an important role in non-small cell lung cancer (NSCLC). In addition, cancer associated fibroblasts (CAFs) are major players of the tumor microenvironment promoting NSCLC. The aim of this study was to assess the possible associations of BAFFR expression in CAFs with response to first-line chemotherapy doublet and clinical outcome of NSCLC patients. Methods: Immunohistochemical analysis of BAFFR expression on CAFs was performed on tumor and tumor-adjacent formalin fixed and paraffin embedded tissue samples from 124 operated patients with NSCLC. Patients were under follow-up for at least 60 months, while response to chemotherapy was evaluated in patients who relapsed during this period. Results: BAFFR expression, which was noted exclusively in the cytoplasm of CAFs, was associated with OS only in patients with no infiltration of regional lymph nodes. Higher expression levels of BAFFR in CAFs were related to worse 2-, 3- and 5-year survival (P = 0.015, P = 0.027 and P = 0.040, respectively). This finding persisted after multivariate analysis with age, gender, histological subtype, histological differentiation and disease stage as coefficients (P = 0.009; HR, 2.734; 95% CI, 1.283-5.828). In addition, response to first line chemotherapy was associated with BAFFR expression in CAFs (P = 0.025). Patients who progressed had lower BAFFR levels. Furthermore, BAFFR expression in CAFs was associated with patients’ age. In particular, older patients had higher expression of BAFFR compared to patients younger than 55 years (P = 0.010). Additionally, carcinomas with better differentiation had lower expression of BAFFR in CAFs (P = 0.005). Finally, BAFFR expression in CAFs was related to development of metastatic disease (P = 0.033) and particularly in liver (P = 0,017) and in bones (P = 0.003). Conclusions: The present findings suggest that the expression of BAFFR in CAFs may be a useful biomarker with prognostic and predictive value, representing possibly an unknown biological relation, which merits further investigation.
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Affiliation(s)
| | - Anastasia E Kottorou
- Clinical and Molecular Oncology Laboratory, Medical School, University of Patras, Patras, Greece
| | - Anna G Antonacopoulou
- Clinical and Molecular Oncology Laboratory, Medical School, University of Patras, Patras, Greece
| | | | - Nikolaos Panagopoulos
- Department of Cardiothoracic Surgery, Medical School, University of Patras, Rion, Greece
| | - Melpomeni Kalofonou
- Institute of Biomedical Engineering, Imperial College London, London, United Kingdom
| | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, Medical School, University of Patras, Patras, Greece
| | - Angelos Koutras
- Department of Oncology, University Hospital of Patras, Patras, Greece
| | | | - Vasiliki Tzelepi
- Department of Histopathology, University of Patras, Patra, Greece
| | - Haralabos Kalofonos
- On behalf of the Hellenic Society of Medical Oncology (HeSMO, http://www.hesmo.gr/en), Athina, Greece
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Dimitrakopoulos FI, Antonacopoulou A, Kottorou A, Tzelepi V, Panagopoulos N, Kalofonou M, Dougenis D, Koutras A, Makatsoris T, Kalofonos H. Genetic variation of lymphotoxin beta receptor (LTβR) rs10849448 (A/G) is associated with risk for lung cancer and metastatic spread to adrenals. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz073.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Dimitrakopoulos FI, Antonacopoulou A, Kottorou A, Marousi S, Koukourikou I, Scopa C, Dougenis D, Tzelepi V, Kalofonos H. Association of the rs1883832 variant of CD40 with NSCLC risk and overall survival. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Leivaditis V, Koletsis E, Spiliotopoulos K, Grapatsas K, Tzelepi V, Dougenis D. A rare case of giant cell lung carcinoma with intracardiac extension via the pulmonary vein and thrombus formation. J Surg Case Rep 2018; 2018:rjy144. [PMID: 29977517 PMCID: PMC6016651 DOI: 10.1093/jscr/rjy144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/25/2018] [Accepted: 06/07/2018] [Indexed: 12/18/2022] Open
Abstract
A 61-year-old man presented with dyspnea, left thoracic pain and productive cough. Chest computed tomography demonstrated a solid mass of the left upper lobe, 2.9 × 1.8 cm2 in size, which had irregular borders and appeared to infiltrate and totally occlude the upper left pulmonary vein extending up to the left atrium (LA) with thrombus formation. The patient underwent median sternotomy and left pneumonectomy, combined with LA thrombus resection under cardiopulmonary bypass (CPB) with bicaval cannulation. The LA was partially resected and the intracavitary thrombus was completely removed. The surgical margins were free of tumor cells. Episodes of embolism were not observed during surgery. The patient was successfully weaned from CPB. The postoperative course was uncomplicated. Pathological examination of the resected specimen revealed giant cell carcinoma.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany.,Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
| | - Efstatios Koletsis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
| | | | - Konstantinos Grapatsas
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Vasiliki Tzelepi
- Department of Pathology, University Hospital of Patras, Patras, Greece
| | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
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Antonacopoulou A, Kottorou A, Tzelepi V, Dimitrakopoulos F, Makatsoris T, Koutras A, Kalofonos H. PO-513 The alternative NF-κB pathway in colorectal cancer. from genetic polymorphisms through mRNA to protein levels. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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Antonacopoulou AG, Kottorou AE, Tzelepi V, Dimtrakopoulos FID, Makatsoris T, Koutras A, Kalofonos H. The alternative NF-κB pathway in colorectal cancer: From genetic polymorphisms through mRNA to protein levels. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anna G Antonacopoulou
- Clinical and Molecular Oncology Laboratory, Medical School, University of Patras, Patras, Greece
| | - Anastasia E Kottorou
- Clinical and Molecular Oncology Laboratory, Medical School, University of Patras, Patras, Greece
| | | | | | | | - Angelos Koutras
- Department of Oncology, University Hospital of Patras, Patras, Greece
| | - Haralabos Kalofonos
- Division of Medical Oncology, University Hospital of Patras, Rio-Patras, Greece
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Dimitrakopoulos FI, Tzelepi V, Kottorou A, Antonacopoulou A, Koutras A, Makatsoris T, Kalofonos H. Clinical significance of the expression of membrane receptors of the alternative nuclear factor-kappaB pathway in non-small cell lung cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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32
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Kourea HP, Nikolaou M, Tzelepi V, Adonakis G, Kardamakis D, Tsapanos V, Scopa CD, Kalofonos C, Decavalas G. Expression of phosphorylated Akt, mTOR and MAPK in type I endometrial carcinoma: clinical significance. Anticancer Res 2015; 35:2321-2331. [PMID: 25862896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM The Akt/mTOR and MAPK pathways are frequently activated in various tumor types but data on endometrial carcinoma are limited. The aim of the present study was to investigate the clinical significance of the expression of phosphorylated MAPK, Akt and mTOR (p-MAPK, p-Akt, p-mTOR) in type I endometrial carcinoma. MATERIALS AND METHODS The study comprised of 103 formalin-fixed paraffin-embedded (FFPE) type I endometrial carcino ma cases, retrospectively retrieved and assessed by immuno histochemistry for p-MAPK, p-Akt and p-mTOR expression. The expression of these proteins was also studied in non-neoplastic endometrial tissue adjacent to the tumor. RESULTS The expression patterns of these molecules differed between malignant and non-tumorous tissue specimens. The immuno reactivity for p-Akt was exclusively detected in the neoplastic tissues. Expression levels of p-MAPK were higher in tumors compared to non-neoplastic endometrium (p<0.001), while p-mTOR was found to be over-expressed in non-neo plastic endometrium compared to carcinomas (p=0.001). Expression of p-Akt was correlated with p-MAPK protein levels (p=0.022, r=0.229). On the other hand, no association was found with clinicopathological parameters and with disease-free (DFS) or overall survival (OS) of the patients. CONCLUSION Our findings support the de-regulation of the PI3K/Akt/mTOR and MAPK signaling pathways in type I endometrial carcinomas suggesting involvement of these pivotal pathways in endometrial carcinogenesis.
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Affiliation(s)
- Helen P Kourea
- Department of Pathology, University Hospital, University of Patras School of Medicine, Patras, Greece
| | - Marinos Nikolaou
- Department of Obstetrics-Gynecology, University Hospital, University of Patras School of Medicine, Patras, Greece
| | - Vasiliki Tzelepi
- Department of Pathology, University Hospital, University of Patras School of Medicine, Patras, Greece
| | - Georgios Adonakis
- Department of Obstetrics-Gynecology, University Hospital, University of Patras School of Medicine, Patras, Greece
| | - Dimitrios Kardamakis
- Department of Radiation Oncology and Stereotactic Radiotherapy, University Hospital, University of Patras School of Medicine, Patras, Greece
| | - Vasilios Tsapanos
- Department of Obstetrics-Gynecology, University Hospital, University of Patras School of Medicine, Patras, Greece
| | - Chrisoula D Scopa
- Department of Pathology, University Hospital, University of Patras School of Medicine, Patras, Greece
| | - Charalambos Kalofonos
- Department of Oncology, University Hospital, University of Patras School of Medicine, Patras, Greece
| | - Georgios Decavalas
- Department of Obstetrics-Gynecology, University Hospital, University of Patras School of Medicine, Patras, Greece
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Nikolaou M, Kourea HP, Tzelepi V, Adonakis G, Scopa CD, Tsapanos V, Kardamakis D, Kalofonos C, Decavalas G. The prognostic role of preoperative serum CA 125 levels in patients with endometrial carcinoma. J BUON 2014; 19:198-202. [PMID: 24659664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Previous studies have shown that elevated preoperative serum CA 125 levels strongly correlate with various clinical and pathological variables and prognosis of patients with endometrial carcinoma (EC). The aim of the present study was to evaluate the clinical significance of preoperative serum CA 125 levels in patients with EC. METHODS A retrospective study of all EC patients treated at our institution between 1995 and 2010 with available follow-up was conducted. The preoperative serum level of CA 125 was measured in 99 patients and evaluated in relation to various clinical and pathological variables and outcome. We used the cut-off level of 20 U/ml for CA 125 on chi-square test for categorical variables. Survival analysis was performed with the use of Kaplan Meier method, the log rank test and Cox proportional hazards regression analysis. RESULTS In the early stages of disease the mean values of CA 125 were 35 U/ml (SD±70) for stages IA-IB and 21 U/ml (SD±29) for stage IC (Mann-Whitney test for continuous variables). In advanced stages of disease (III-IV), the values of preoperative serum CA 125 levels were statistically increased, with mean value 54 U/ml (SD±44), in comparison to stages IA-IB (p=0.02) and IC (p=0.007). According to the multivariate analysis, elevated preoperative serum CA 125 level (p=0.043) and histological tumor type (p=0.004) were independent prognostic factors for disease free survival (DFS) and overall survival (OS) of patients with EC. CONCLUSION The current study suggests that measurement of preoperative serum CA 125 is a useful clinical tool in the prognosis of patients with EC.
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Affiliation(s)
- Marinos Nikolaou
- Department of Obstetrics-Gynecology, University of Patras, Medical School, Patras, Greece
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Aparicio A, Tzelepi V, Araujo JC, Guo CC, Liang S, Troncoso P, Logothetis CJ, Navone NM, Maity SN. Neuroendocrine prostate cancer xenografts with large-cell and small-cell features derived from a single patient's tumor: morphological, immunohistochemical, and gene expression profiles. Prostate 2011; 71:846-56. [PMID: 21456067 PMCID: PMC3883511 DOI: 10.1002/pros.21301] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/26/2010] [Indexed: 01/24/2023]
Abstract
BACKGROUND Small-cell carcinoma (SCC) of the prostate is an AR-negative variant of prostate cancer found at progression in 10-20% of castrate-resistant disease. Its finding predicts a distinct clinical course and a poor prognosis. Large-cell neuroendocrine carcinoma (LCNEC) is a much rarer variant that behaves similarly to SCC. The biological mechanisms that drive these disease variants are poorly understood. METHODS Eight tumor fragments from the salvage pelvic exenteration specimen of a patient with castrate-resistant prostate carcinoma were subcutaneously implanted into 6- to 8-week-old male CB17 SCID mice. Serial tissue sections and tissue microarrays of the resulting MDA PCa 144 xenograft lines were used for histopathologic and immunohistochemical characterization of the xenografts and their tissue of origin. RNA from two representative xenograft sublines was used for gene-expression profiling. RESULTS All eight fragments formed tumors: four of the MDA PCa 144 xenograft sublines had morphologic characteristics of SCC and four, of LCNEC. All retained high fidelity to their parent tumor tissue, which remained stable through serial passages. Morphological transitions in the specimen of origin suggested LCNEC represents an intermediate step between adenocarcinoma and SCC. Over 2,500 genes were differentially expressed between the SCC (MDA PCa 144-13) and the LCNEC (MDA PCa 144-4) sublines and enriched in "Nervous System Development" Gene Ontology subtree. CONCLUSION The eight xenograft models described represent the spectrum of neuroendocrine carcinomas in prostate cancer and will be valuable preclinical tools to study the pathogenesis of and therapy targets for this increasingly recognized subset of lethal prostate cancer.
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MESH Headings
- Aged
- Animals
- Antineoplastic Agents/therapeutic use
- Carcinoma, Large Cell/drug therapy
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/radiotherapy
- Carcinoma, Neuroendocrine/drug therapy
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/radiotherapy
- Carcinoma, Small Cell/drug therapy
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/radiotherapy
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Humans
- Male
- Mice
- Mice, SCID
- Prostate-Specific Antigen
- Prostatic Neoplasms/drug therapy
- Prostatic Neoplasms/pathology
- Prostatic Neoplasms/radiotherapy
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Ana Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
- Correspondence to: Department of Genitourinary Medical Oncology, Unit 1374, 1515 Holcombe Boulevard, Houston, TX 77030-4009. Tel: 713-563-6969; Fax: 713-745-1625;
| | - Vasiliki Tzelepi
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - John C. Araujo
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Charles C. Guo
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Shoudan Liang
- Department of Bioinformatics and Computational Biology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Patricia Troncoso
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Christopher J. Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Nora M. Navone
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Sankar N. Maity
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Tzelepi V, Efstathiou E, Troncoso P, Pettaway CA, Hoang A, Logothetis C, Pagliaro LC. Modulation of candidate therapy targets in regionally advanced prostate cancer by androgen ablation and docetaxel. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sampsonas E, Kaparianos A, Tzelepi V, Zolota V, Karkoulias K, Tsiamita M, Mastronikolis N, Spiropoulos K. Miliary pattern due to occupational lung disease in a patient with laryngeal cancer. Eur Rev Med Pharmacol Sci 2010; 14:43-45. [PMID: 20184088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Inhalation of metal dusts and fumes can induce a wide range of respiratory disorders, including granulomatosis, chemical pneumonitis and pulmonary interstitial disease. Laryngeal cancer is the most common cancer of the upper aerodigestive tract. We present a patient with occupational lung disease whose chest CT showed miliary nodular pattern, with concurrent laryngeal cancer who had been engaged in type printing for 22 years. Histology of the laryngeal lession showed squamous cell laryngeal cancer. Histology of the nodules showed a foreign body granulomatous response with several foreign body cells, most probably due to exposure to numerous inorganic (lanthanides, elements such us La, Ce, Nd, Sm, EU, Tb, Lu) and organic particles (such us acrylates, epoxy- and urethane-acrylates).
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Affiliation(s)
- E Sampsonas
- Department of Internal Medicine, Division of Pneumology, University Hospital of Rio, Patras, Greece
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Tzelepi V, Zolota V, Mavromati E. Fetus amorphous acardious: report of a rare case and differential diagnosis from placental teratoma with review of the literature. Eur Rev Med Pharmacol Sci 2007; 11:419-422. [PMID: 18306911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Fetus amorphous acardious is a rare fetal malformation, lacking a functional heart and bearing no resemblance to human embryos. The main differential diagnosis is with placental teratoma and is based on the degree of skeletal organization and umbilical cord formation. A 27-year old woman delivered a healthy newborn at 37 weeks' gestation. An amorphous mass, covered with healthy looking skin, was connected to the placenta with a short pendicle. X-ray examination of the mass revealed the presence of vertebral column associated with ribs and pelvic bones. Histopathologic examination demonstrated the presence of spinal tube inside the vertebral column. Microscopy of the pedicle was consistent with umbilical cord. Various other tissues were also discovered, such as adipose tissue, gastric and large.
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Affiliation(s)
- V Tzelepi
- Department of Pathology, Medical School, University of Patras, Greece 12 Agias Anastasias str., 26225, Patras, Greece.
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Tzelepi V, Zolota V, Batistatou A, Fokaefs E. Solitary fibrous tumor of the urinary bladder: report of a case with long-term follow-up and review of the literature. Eur Rev Med Pharmacol Sci 2007; 11:101-6. [PMID: 17552139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Solitary fibrous tumor (SFT) is a neoplasm typically arising in the pleura. Yet, extrapleural cases have been described and are a common cause of diagnostic pitfalls, especially when met in unusual sites. We report the clinical and pathological features of a case of SFT arising in a rather unusual site, the urinary bladder, the seventh reported to date in the English literature and the first with long term follow-up. Differential diagnosis from other spindle cell neoplasms of the bladder can be problematic. Prognosis of this neoplasm is obscure and long-term follow-up is required for all cases of solitary fibrous tumor. Solitary fibrous tumor is a rare mesenchymal tumor of the urinary bladder, but should always be considered in the differential diagnosis of spindle cell neoplasms encountered in the lower genital tract.
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Affiliation(s)
- V Tzelepi
- Department of Pathology, Medical School, University of Patras, Greece.
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Vassiliou V, Charoulis N, Tzelepi V, Salakou S, Zolota V, Dougenis D, Kardamakis D. CLC070 ORAL The role of adjuvant radiotherapy in the management of thymic tumors. Lung Cancer 2007. [DOI: 10.1016/s0169-5002(07)70070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kourea H, Tzelepi V, Savvopoulos C, Apostolakis E, Dougenis D, Scopa C. CLC063 POSTER Multiple peripheral oncocytic carcinoid tumors of the lung positive for thyroglobulin (TG). Lung Cancer 2007. [DOI: 10.1016/s0169-5002(07)70063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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