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Gubbiotti MA, Livolsi V, Montone KT. Update on Sinonasal Tract Malignancies. Arch Pathol Lab Med 2023:491557. [PMID: 36920001 DOI: 10.5858/arpa.2022-0447-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 03/16/2023]
Abstract
CONTEXT.— Sinonasal tract malignancies are rare cancers with frequent morphologic overlap. Given the similar histologic profiles seen in many of these entities, they often present a diagnostic challenge to the practicing pathologist. OBJECTIVE.— To provide a streamlined algorithm using histologic clues, immunohistochemical profiles, and molecular assays to aid in diagnosis of these lesions. DATA SOURCES.— Sources were the World Health Organization Tumor Classification, literature review, and institutional experience. CONCLUSIONS.— Although many sinonasal tract malignancies show similar histology, distinct immunohistochemical and molecular profiles can help parse out differences, thereby facilitating diagnosis for the pathologist.
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Affiliation(s)
- Maria A Gubbiotti
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Virginia Livolsi
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
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Gubbiotti MA, Montone K, Zhang P, Livolsi V, Baloch Z. A contemporary update on hyalinizing clear cell carcinoma: compilation of all in-house cases at our institution and a literature review spanning 2015-2020. Hum Pathol 2021; 111:45-51. [PMID: 33577927 DOI: 10.1016/j.humpath.2021.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
Tumors of the head and neck with clear cell features prompt a broad differential diagnosis. A relatively uncommon, but increasingly recognized, entity is hyalinizing clear cell carcinoma (HCCC). This neoplasm, first described in 1994, consists of clear cells arranged in nests or trabecule with a hyalinized stroma. These are low-grade neoplasms that only infrequently metastasize and rarely recur. They also often harbor a unique EWSR-ATF1 gene rearrangement. As the prognosis is excellent compared with other clear cell neoplasms, the correct diagnosis is key. Here we present all of the cases of HCCC in the past decade from our institution alongside a comprehensive literature review spanning 2015-2020 to further characterize this unusual malignancy.
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Affiliation(s)
- Maria A Gubbiotti
- Hospital of the University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Kathleen Montone
- Hospital of the University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Paul Zhang
- Hospital of the University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Virginia Livolsi
- Hospital of the University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Zubair Baloch
- Hospital of the University of Pennsylvania, Philadelphia, 19104, PA, USA.
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Weinstein GS, Cohen R, Lin A, O'Malley BW, Lukens J, Swisher‐McClure S, Shanti RM, Newman JG, Parhar HS, Tasche K, Brody RM, Chalian A, Cannady S, Palmer JN, Adappa ND, Kohanski MA, Bauml J, Aggarwal C, Montone K, Livolsi V, Baloch ZW, Jalaly JB, Cooper K, Rajasekaran K, Loevner L, Rassekh C. Penn Medicine Head and Neck Cancer Service Line COVID-19 management guidelines. Head Neck 2020; 42:1507-1515. [PMID: 32584447 PMCID: PMC7362039 DOI: 10.1002/hed.26318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS Creation of consensus document. RESULTS The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.
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Affiliation(s)
- Gregory S. Weinstein
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Roger Cohen
- Division of Medical Oncology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alexander Lin
- Department of Radiation OncologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Bert W. O'Malley
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John Lukens
- Department of Radiation OncologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Rabie M. Shanti
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Oral and Maxillofacial SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason G. Newman
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Harman S. Parhar
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kendall Tasche
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Robert M. Brody
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ara Chalian
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Steven Cannady
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - James N. Palmer
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Michael A. Kohanski
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Joshua Bauml
- Division of Medical Oncology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Charu Aggarwal
- Division of Medical Oncology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kathleen Montone
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Virginia Livolsi
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Zubair W. Baloch
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jalal B. Jalaly
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kumarasen Cooper
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Christopher Rassekh
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Swisher-McClure S, Lukens JN, Aggarwal C, Ahn P, Basu D, Bauml JM, Brody R, Chalian A, Cohen RB, Fotouhi-Ghiam A, Geiger G, Gershowitz J, Livolsi V, Mitra N, Montone K, Newman J, Ojerholm E, O'Malley B, Rajasekaran K, Tan E, Weinstein G, Lin A. A Phase 2 Trial of Alternative Volumes of Oropharyngeal Irradiation for De-intensification (AVOID): Omission of the Resected Primary Tumor Bed After Transoral Robotic Surgery for Human Papilloma Virus-Related Squamous Cell Carcinoma of the Oropharynx. Int J Radiat Oncol Biol Phys 2019; 106:725-732. [PMID: 31785337 DOI: 10.1016/j.ijrobp.2019.11.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE This trial tested the safety and efficacy of a novel, deintensified radiation therapy (RT) approach after initial surgical resection for patients with human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). METHODS AND MATERIALS This single-arm phase 2 prospective clinical trial enrolled 60 patients with stage pT1-pT2 N1-3 HPV-associated OPSCC treated with transoral robotic surgery (TORS) and selective neck dissection at a single institution between May 2014 and September 2017. Patients had favorable features at the primary site (negative surgical margins ≥2 mm, no perineural invasion, and no lymphovascular invasion) but required adjuvant therapy based on lymph node involvement. Surgeries were all performed at a high-volume head and neck cancer center with expertise in TORS. Patients received postoperative RT to at-risk areas in the involved neck (60-66 Gy) and uninvolved neck (54 Gy). The resected primary site was treated as an active avoidance structure in the treatment planning of postoperative RT. Concurrent chemotherapy was administered for patients with extranodal extension. RESULTS Median follow-up of the 60 patients enrolled was 2.4 years (range, 8.5-53.8 months). A single patient recurred at the primary site, for 2-year local control of 98.3%. One patient (1.7%) developed a regional neck recurrence, and 2 patients (3.3%) developed distant metastases. Measured 2-year local recurrence-free survival was 97.9% (95% confidence interval, 86.1%-99.7%). Overall survival was 100% at the time of analysis. The mean radiation dose to the primary site was 36.9 Gy (standard deviation, 10.3 Gy). Two patients (3.3%) experienced late soft tissue necrosis in the primary site surgical bed that resolved within 2 months. Feeding tube dependence rates were 0% during RT, 3.3% temporarily during follow-up, and 0% at last follow-up. CONCLUSIONS Deintensified postoperative RT that avoids the resected primary tumor site and targets only the at-risk neck after TORS for selected patients with HPV-associated OPSCC may be safe and is worthy of further study.
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Affiliation(s)
- Samuel Swisher-McClure
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charu Aggarwal
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter Ahn
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Devraj Basu
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua M Bauml
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Brody
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ara Chalian
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger B Cohen
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alireza Fotouhi-Ghiam
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Geoffrey Geiger
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jared Gershowitz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Virginia Livolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen Montone
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason Newman
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric Ojerholm
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bert O'Malley
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erik Tan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Weinstein
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Lubin D, Baraban E, Lisby A, Jalali-Farahani S, Zhang P, Livolsi V. Papillary Thyroid Carcinoma Emerging from Hashimoto Thyroiditis Demonstrates Increased PD-L1 Expression, Which Persists with Metastasis. Endocr Pathol 2018; 29:317-323. [PMID: 30121940 DOI: 10.1007/s12022-018-9540-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
There is evidence that programmed death-ligand 1 (PD-L1) is expressed by thyroid follicular epithelium in thyroiditis, but the role of PD-L1 in papillary thyroid carcinoma (PTC) is poorly understood. We aimed to determine whether (1) the presence of background chronic lymphocytic thyroiditis (CLT) or Hashimoto thyroiditis (HT) influenced the expression of PD-L1 in benign follicular epithelium or in PTC and (2) if PD-L1 expression in PTC persisted with lymph node metastasis. We performed immunohistochemistry (IHC) for PD-L1 on formalin-fixed paraffin-embedded tissues. We first studied five cases of unremarkable thyroid, five cases of CLT, and five cases of HT without carcinoma. We subsequently performed PD-L1 IHC on ten cases of PTC arising in normal thyroid, ten cases of PTC arising in CLT, and ten cases of PTC arising in HT. Whenever available, we evaluated corresponding synchronous lymph node metastases from all cases for PD-L1 expression. PD-L1 expression was increased (10-90%) in all five cases of HT, only minimal expressed (1-5%) in two of five cases of CLT, and not expressed in five cases of unremarkable thyroid. PTC arising in normal thyroid or CLT nearly uniformly lacked PD-L1 expression. In contrast, PTC arising in HT demonstrated significant PD-L1 expression, which persisted in corresponding lymph node metastases. Background non-neoplastic follicular epithelium in the HT cases also demonstrated PD-L1 expression. Thyroid follicular epithelium in HT demonstrates increased PD-L1 expression, and PTC arising in a background of HT shows increased PD-L1 expression, which is retained with metastasis.
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Affiliation(s)
- Daniel Lubin
- Department of Pathology, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Ezra Baraban
- Department of Pathology, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Amanda Lisby
- Department of Pathology, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sahar Jalali-Farahani
- Department of Pathology, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Paul Zhang
- Department of Pathology, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Virginia Livolsi
- Department of Pathology, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Hu Y, Zhang P, Montone K, Livolsi V. 67 An Institutional Experience With Mammary Analogue Secretory Carcinoma of the Salivary Gland. Am J Clin Pathol 2018. [DOI: 10.1093/ajcp/aqx116.066] [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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Ahn PH, Quon H, O'Malley BW, Weinstein G, Chalian A, Malloy K, Atkins JH, Sollecito T, Greenberg M, McNulty S, Lin A, Zhu TC, Finlay JC, Cengel K, Livolsi V, Feldman M, Mick R, Busch TM. Toxicities and early outcomes in a phase 1 trial of photodynamic therapy for premalignant and early stage head and neck tumors. Oral Oncol 2016; 55:37-42. [PMID: 26865261 DOI: 10.1016/j.oraloncology.2016.01.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 09/30/2015] [Revised: 01/17/2016] [Accepted: 01/20/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Management of early superficial lesions in the head and neck remains complex. We performed a phase 1 trial for high-grade premalignant and early superficial lesions of the head and neck using photodynamic therapy (PDT) with Levulan (ALA). MATERIALS AND METHODS Thirty-five subjects with high grade dysplasia, carcinoma in situ, or microinvasive (⩽1.5mm depth) squamous cell carcinoma were enrolled. Cohorts of 3-6 patients were given escalating intraoperative light doses of 50-200J/cm(2) 4-6h after oral administration of 60mg/kg ALA. Light at 629-635nm was delivered in a continuous (unfractionated) or fractionated (two-part) schema. RESULTS PDT was delivered to 30/35 subjects, with 29 evaluable. There was one death possibly due to the treatment. The regimen was otherwise tolerable, with a 52% rate of grade 3 mucositis which healed within several weeks. Other toxicities were generally grade 1 or 2, including odynophagia (one grade 4), voice alteration (one grade 3), and photosensitivity reactions. One patient developed grade 5 sepsis. With a median follow-up of 42months, 10 patients (34%) developed local recurrence; 4 of these received 50J/cm(2) and two each received 100, 150, and 200J/cm(2). Ten (34%) patients developed recurrence adjacent to the treated field. There was a 69% complete response rate at 3months. CONCLUSIONS ALA-PDT is well tolerated. Maximum Tolerated Dose appears to be higher than the highest dose used in this study. Longer followup is required to analyze effect of light dose on local recurrence. High marginal recurrence rates suggest use of larger treatment fields.
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Affiliation(s)
- Peter H Ahn
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
| | - Harry Quon
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States; Department of Radiation Oncology, Johns Hopkins University, 401 N. Broadway, Baltimore, MA 21231, United States
| | - Bert W O'Malley
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Gregory Weinstein
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Ara Chalian
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Kelly Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States; Department of Otolaryngology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, United States
| | - Joshua H Atkins
- Department of Anesthesiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Martin Greenberg
- Department of Oral Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Sally McNulty
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Jarod C Finlay
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Keith Cengel
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Virginia Livolsi
- Department of Pathology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Michael Feldman
- Department of Pathology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Rosemarie Mick
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
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Mehr C, Obstfeld A, Livolsi V, Furth E, Litzky L, Montone K, Schwartz L. Optimizing Specimen Distribution for Residency Training in a Subspecialty-Based Surgical Pathology Rotation in a Tertiary-Care Academic Center. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.102] [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: 11/13/2022] Open
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Haggerty AF, Mantia-Smaldone G, Siegelman E, Livolsi V, Tanyi J. Surgical diagnosis of stage I fallopian tube cancer in anti-Yo antibody paraneoplastic cerebellar degeneration. J OBSTET GYNAECOL 2014; 35:100-1. [PMID: 24960213 DOI: 10.3109/01443615.2014.930095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A F Haggerty
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology , Philadelphia, Pennsylvania , USA
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Livolsi V, McNicol AM. Introduction to the jubilee issue in Endocrine Pathology. Endocr Pathol 2014; 25:1. [PMID: 24557992 DOI: 10.1007/s12022-014-9300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Virginia Livolsi
- Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA,
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Canberk S, Griffin AC, Goyal A, Wang H, Montone K, Livolsi V, Baloch Z. Oncocytic follicular nodules of the thyroid with or without chronic lymphocytic thyroiditis: An institutional experience. Cytojournal 2013; 10:2. [PMID: 23599721 PMCID: PMC3623453 DOI: 10.4103/1742-6413.106686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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] [Received: 12/14/2012] [Accepted: 01/24/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Oncocytic follicular (OF) cells can be a prominent component of fine needle aspiration (FNA) specimens from neoplasms (adenomas and carcinomas) and nodules arising in multinodular goiter and chronic lymphocytic thyroiditis (CLT). Because OF cells can be present in non-neoplastic and neoplastic thyroid lesions it can be challenging to differentiate between these two in FNA specimens. The aims of this study were to determine the risk of malignancy in cases diagnosed as either oncocytic follicular neoplasm (OFN) or hyperplastic/adenomatoid nodule with OF on FNA and to identify clinicopathologic features that may help in predicting malignancy in such cases, especially the presence or absence of CLT. DESIGN We retrospectively searched the computerized laboratory information system at our institution between 1998 and 2009 for thyroid US guided FNA specimens in which the term "oncocytic/oncocytes" was mentioned in the final cytopathologic diagnosis. A total of 340 cases were selected for this study. The following data points were collected: Patient demographics, site of thyroid biopsy, size of lesion, FNA diagnosis, histopathologic follow-up and presence of CLT. Surgical pathology follow-up (SPFU) was available in 269 (79%) cases. RESULTS Two hundred and sixty patients were females and 80 males (average age 53 years). The lesion size was <3.0 cm in 241 (71%) and ≥ 3.0 cm in 99 (29%) cases. Cytologic diagnoses included: Follicular neoplasm with oncocytic features (FNOF) 321 and suggestive of FNOF 19 cases; a secondary cytologic diagnosis of CLT was made in 20 cases. SPFU was available in 269 (79%) cases; it was benign in 213 (213/267 = 79%) and malignant in 56 (56/269 = 21%) cases. The background thyroid showed CLT in 67 (25%) cases; 24% (48/196) neoplasms occurred with versus 76% (147/196) without CLT. The rate of malignancy was lower in nodules measuring less than 3.0 cm as compared to those equal or greater than 3.0 cm in size (17% vs. 28% respectively). The presence of CLT did not significantly alter the rate of malignancy in both FNA and surgical pathology specimens. CONCLUSIONS Based on this study, nodule size and not CLT appears to be an important clinicopathologic features in the management of thyroid FNA specimens diagnosed as OFN.
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Affiliation(s)
- Sule Canberk
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, Pennsylvania, 19104, USA
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Rassekh C, Shires C, Livolsi V, Loevner L, Grady S, O'Malley B. Chondroid Chordoma: Is It Really a Chondrosarcoma and Does It Matter? Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312060] [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: 10/28/2022]
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13
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Wang CCC, Friedman L, Kennedy GC, Wang H, Kebebew E, Steward DL, Zeiger MA, Westra WH, Wang Y, Khanafshar E, Fellegara G, Rosai J, Livolsi V, Lanman RB. A large multicenter correlation study of thyroid nodule cytopathology and histopathology. Thyroid 2011; 21:243-51. [PMID: 21190442 PMCID: PMC3698689 DOI: 10.1089/thy.2010.0243] [Citation(s) in RCA: 249] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) biopsies are the cornerstone of preoperative evaluation of thyroid nodules, but FNA diagnostic performance has varied across different studies. In the course of collecting thyroid FNA specimens for the development of a molecular diagnostic test, local cytology and both local and expert panel surgical pathology results were reviewed. METHODS Prospective FNAs were collected at 21 clinical sites. Banked FNAs were collected from two academic centers. Cytology and corresponding local and expert panel surgical pathology results were compared to each other and to a meta-review of 11 recently published U.S.-based thyroid FNA studies. RESULTS FNA diagnostic performance was comparable between the study specimens and the meta-review. Histopathology malignancy rates for prospective clinic FNAs were 34% for cytology indeterminate cases and 98% for cytology malignant cases, comparable to the figures found in the meta-review (34% and 97%, respectively). However, histopathology malignancy rates were higher for cytology benign cases in the prospective clinic FNA subcohort (11%) than in the meta-review (6%, with meta-review rates of 10% at community sites and 2% at academic centers, p < 0.0001). Resection rates for prospective clinic FNAs were also comparable to the meta-review for both cytology indeterminate cases (62% vs. 59%, respectively) and cytology malignant cases (82% vs. 81%, respectively). Surgical pathology categorical disagreement (benign vs. malignant diagnosis) was higher between local pathology and a consensus of the two expert panelists (11%) than between the two expert panelists both pre- (8%) and postconferral (3%). CONCLUSIONS Although recent guidelines for FNA biopsy and interpretation have been published, the rates of false-positive and false-negative results remain a challenge. Two-thirds of cytology indeterminate cases were benign postoperatively and may decrease with the development of an accurate molecular diagnostic test. High disagreement rates between local and expert panel histopathology diagnosis suggests that central review for surgical diagnoses should be used when developing diagnostic tests based on resected thyroid specimens.
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Affiliation(s)
- Chung-Che Charles Wang
- Department of Medical and Clinical Affairs, Veracyte, Inc., South San Francisco, California 94080, USA.
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14
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Berman AT, Litzky L, Livolsi V, Singhal S, Kucharczuk JC, Cooper JD, Friedberg JR, Evans TL, Stevenson JP, Metz JM, Hahn SM, Rengan R. Adjuvant radiotherapy for completely resected stage 2 thymoma. Cancer 2011; 117:3502-8. [DOI: 10.1002/cncr.25851] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/20/2010] [Accepted: 09/21/2010] [Indexed: 11/06/2022]
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15
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Abstract
Chordomas are rare neoplasms of notochord derivation that arise along the craniospinal axis. Their incidence along the cervical spine and close proximity to the thyroid can pose diagnostic pitfalls. We report a case of a paraspinal mass juxtaposed adjacent to the thyroid with intranuclear inclusions of papillary carcinoma, abundant eosinophilic cytoplasm of an oncocytic lesion, and pleomorphism of anaplastic carcinoma that expressed thyroglobulin and emulated a malignant thyroid neoplasm. However, subsequent histological examination revealed a chordoma with perithyroidal soft-tissue invasion. This case highlights the significance of including chordoma in the differential diagnosis of a thyroid neoplasm and interpreting thyroglobulin reactivity warily, because its inadvertent tracking during fine-needle aspirates (FNAs) can produce false positive staining of nonthyroidal cells.
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Affiliation(s)
- Anjali Saqi
- Department of Pathology, New York Presbyterian Hospital, Columbia-Presbyterian Medial Center, New York, 10032, USA.
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16
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Dohán O, Baloch Z, Bánrévi Z, Livolsi V, Carrasco N. Rapid communication: predominant intracellular overexpression of the Na(+)/I(-) symporter (NIS) in a large sampling of thyroid cancer cases. J Clin Endocrinol Metab 2001; 86:2697-700. [PMID: 11397873 DOI: 10.1210/jcem.86.6.7746] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Here we report the analysis of the Na(+)/I(-) symporter (NIS) protein expression in 57 thyroid cancer samples by immunohistochemistry with high-affinity anti-NIS Abs. As many as 70% of these samples exhibited increased NIS expression with respect to the normal surrounding thyroid tissue. Most significantly, NIS was located in these samples either in both the plasma membrane and intracellular compartments simultaneously, or exclusively in intracellular compartments. This suggests that NIS is clearly expressed or even overexpressed in most thyroid cancer cells, but malignant transformation in some of these cells interferes either with the proper targeting of NIS to the plasma membrane, or with the mechanisms that retain NIS in the plasma membrane after it has been targeted. The results further indicate that, in addition to indicating NIS expression in cases where it is absent (approximately 30%), improvements in (131)I radioablation therapy might result from promoting targeting of NIS to the plasma membrane in the majority (approximately 70%) of thyroid cancers.
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Affiliation(s)
- O Dohán
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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17
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Kossev P, Livolsi V. Lymphoid lesions of the thyroid: review in light of the revised European-American lymphoma classification and upcoming World Health Organization classification. Thyroid 1999; 9:1273-80. [PMID: 10646671 DOI: 10.1089/thy.1999.9.1273] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Thyroid lymphomas are rare diseases and almost always rise in the background of chronic lymphocytic thyroiditis (Hashimoto's thyroiditis). Large cell lymphoma is an aggressive disease and usually is not a significant diagnostic challenge from the pathological point of view. Small cell lymphoma, however, can sometimes be difficult to distinguish from chronic lymphocytic thyroiditis. In the past, most thyroid lymphomas were considered to be of follicle center cell origin. Today, after the introduction of the mucosa-associated lymphoid tissue (MALT) and the extranodal lymphoid tissue (ELT) concepts, most of the lymphomas in the extranodal sites are thought to originate from the marginal zone of the lymphoid follicles. The distinction between the different types of lymphomas has significant impact on the patient's prognosis, treatment, and follow-up. It is imperative that clinicians (endocrinologists and surgeons) and pathologists are aware of these types of lymphomas in order for the most appropriate diagnostic procedures to be selected, specific staging principles to be applied, and appropriate disease-specific treatment to be implemented. It is also important that terms such as "lesion of uncertain malignant potential" as defined by ancillary studies be understood.
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Affiliation(s)
- P Kossev
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
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18
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Merz JF, Sankar P, Taube SE, Livolsi V. Use of human tissues in research: clarifying clinician and researcher roles and information flows. J Investig Med 1997; 45:252-7. [PMID: 9249997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J F Merz
- Center for Bioethics, Department of Health and Human Services, Rockville, MD, USA
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19
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Abstract
Drug-induced abortive retroviral infection has been reported to induce both T-cell and B-cell immunity in vivo. We sought to analyze if replication-incompetent retroviruses could induce the development of similarly protective in vivo immune responses in a more desirable fashion. To evaluate retroviral transduction vaccination (genetic infection), a plasmid encoding human CD4 in a retroviral vector was transfected into the pA317 amphotropic retroviral packaging system. The resulting replication defective retrovirus was used to transduce BALB/c mice prior to tumor challenge with human CD4. Immunization elicited specific humoral and cellular anti-human CD4 responses. We evaluated anti-cell responses using a tumor model system. We observed that BALB/c mice challenged with SP2/0 lymphoma cells develop lethal tumors and die within 7 weeks of challenge. Cloned SP2/0 cells stably transfected with the human cell-surface antigen CD4 also develop tumors in naive mice and succumb to the tumors in a similar manner to SP2/0 inoculated animals. In contrast, CD4 retrovirus-transduced animals, when challenged with the CD4-expressing SP2/0 cells, demonstrated a low incidence of tumors and significantly enhanced survival compared to the mice immunized similarly with human CD8 retrovirus. These results establish an in vivo tumor challenge system with relevance to the development of protective in vivo immune responses, and indicate that genetic infection is a useful technique for inducing protective immunity.
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Affiliation(s)
- W V Williams
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia
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20
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Abstract
This report is to make the general scientific community aware of availability of human tissues through this network. During the short period of its existence, this network has developed useful procedures for distributing human tumor tissue in a rapid, scientifically useful, cost-effective manner to investigators to whom this tissue would not otherwise be available. The growth in the number of specimens being distributed matches the previous experience of each of the member institutions in internal distribution activities. It is expected that the availability of tissue will lead to new research initiatives and grant applications. This Network has been established as a model which can in the future be expanded to meet the needs of the scientific community at large. The National Cancer Institute encourages investigators engaging in cancer research who have need of human tissues to submit their requests to the Cooperative Human Tissue Network.
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21
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Abstract
To determine the characteristic appearance of polycystic ovaries on magnetic resonance (MR) images, seven women with polycystic ovarian disease (PCOD) underwent MR examination of the pelvis. These MR images were compared with sonograms. Histologic material was available in two patients. Six of the seven women had characteristic, small peripheral cysts, best seen on T2-weighted MR images; these cysts were seen sonographically in only one case. The centers of nine of 14 ovaries were of low intensity with all MR pulse sequences; this low intensity corresponded with low echogenicity in six cases. Histologically, these areas correlated with hypertrophic cellular stroma. Coexisting central teratomas were seen in three ovaries. The ability of MR to display the findings of PCOD better than ultrasound and its ability to demonstrate coexisting pathologic conditions are valuable in imaging the female pelvis.
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22
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Lytton B, Collins JT, Weiss RM, Schiff M, McGuire EJ, Livolsi V. Results of biopsy after early stage prostatic cancer treatment by implantation of 125I seeds. J Urol 1979; 121:306-9. [PMID: 430623 DOI: 10.1016/s0022-5347(17)56764-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We have treated 77 patients for clinically early stage carcinoma of the prostate, 9 stage A2, 63 stage B and 5 stage C, with direct implantation of 125I seeds into the prostate and pelvic lymphadenectomy. It is estimated that a minimum dose of 15,000 rad but a maximum dose of 35,000 rad is delivered to the prostate over several months. Of the 77 patients 14 (18 per cent) had metastatic disease in the pelvic lymph nodes. In 22 cases perineal needle biopsy was done 12 to 18 months after treatment and in 3 cases a second biopsy was performed after 2 to 3 years. Persistent tumor was present in 11 biopsies. Cytological changes were observed in 8 of these, primarily cytoplasmic vacuolation and nuclear pyknosis. There seemed to be no relationship between grade and stage of disease and histological evidence of persistence of tumor after radiation. One patient with persistent tumor in the postoperative biopsy has shown progression of disease after 2 years and another with a negative biopsy has a bony metastasis. The remaining 10 patients with persistent tumor have shown no sign of progression of disease during a 2 to 4-year interval.
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