Social cognition in women with borderline personality disorder based on an exhaustive analysis of the Movie for Assessment of Social Cognition (MASC) categories

A significant number of borderline personality disorder (BPD) symptoms are manifested in the interpersonal context. This can be explained by the difficulties in attributing the mental states of oneself and others, which constitutes social cognition. Errors in social cognition are interrelated with the affective, cognitive, impulsive, and interpersonal areas of the person with BPD. The aims of this study was to analyze social cognition in women with BPD compared with a control group and to analyze social cognition in BPD based on BPD symptoms and its severity. To assess social cognition, we used a full range of social cognition categories provided by the Movie for the Assessment of Social Cognition (MASC): correct theory of mind (ToM); attribution of mental states (thoughts, emotions, or intentions); errors of mentalization; types of ToM; and attribution of mental states through perceptive or cognitive cues and through hot or cold emotions. The MASC has high ecological validity and has been validated in Spanish. The sample comprised 79 women, including 47 women with BPD and 32 healthy women. Worse social cognition performance was observed in women with BPD. More severe borderline symptoms were related to worse functioning in the correct ToM and to errors of no mentalization. Involvement of the cognitive area in borderline symptoms was associated with worse functioning in correct ToM and worse social cognition in cognitive areas as well as with hypermentalization. This is the first study that uses all the MASC categories and considers BPD heterogeneity and its severity to study social cognition.

EXPRESS: Effects of age on behavioural and eye gaze on Theory of Mind using Movie for Social Cognition

Evidence has shown that older adults have lower accuracy in Theory-of-Mind (ToM) tasks compared to young adults, but we are still unclear whether the difficulty in decoding mental states in older adults stems from not looking at the critical areas, and more so from the ageing Asian population. Most ToM studies use static images or short vignettes to measure ToM but these stimuli are dissimilar to everyday social interactions. We investigated this question using a dynamic task that measured both accuracy and error types, and examined the links between accuracy and error types to eye gaze fixation at critical areas (e.g. eyes, mouth, body). A total of 82 participants (38 older, 44 young adults) completed the Movie for the Assessment of Social Cognition task on the eye tracker. Results showed that older adults had a lower overall accuracy with more errors in the ipo-ToM (under-mentalising) and no-ToM (lack of mentalisation) conditions compared to young adults. We analysed the eye gaze data using principal components analysis and found that increasing age and looking less at the face were related to lower MASC accuracy in our participants. Our findings suggest that ageing deficits in ToM are linked to a visual attention deficit specific to the perception of socially relevant nonverbal cues.

Mentalizing ability, mentalizing impairments, and anorexia nervosa: Validation of the Hebrew version of the Movie for the Assessment of Social Cognition (MASC)

The goal of this study was to validate the Hebrew version of the Movie for the Assessment of Social Cognition (MASC)-an ecological measure for assessing mentalizing ability-among patients with anorexia nervosa (AN) and healthy individuals. We examined the validity of the MASC's general mentalizing ability scale and of its mentalizing impairments subscales using validated measures of mentalizing ability (Reading the Mind in the Eyes test, Cambridge Mindreading Face-Voice Battery, and Reflective Function questionnaire) among female patients with AN (N = 35) and control participants (N = 42). ED symptoms were assessed via self-report questionnaires. The MASCHeb correlated with measures of mentalizing ability and was found to significantly differentiate patients with AN from controls. In addition to differing on general mental ability, the groups differed on hypomentalizing (but not hypermentalizing). Based on our findings, the MASCHeb proved to be an ecologically valid tool for assessing mentalizing ability and impairments among patients with AN. Moreover, our findings demonstrated the role played by general mentalizing ability in EDs and specifically pointed to the importance of hypomentalization in EDs. These findings have therapeutic implications, as outlined in the Discussion section.

Affective Empathy, Theory of Mind and Social Functioning in Patients With Focal Epilepsy

OBJECTIVE

Social cognition comprises basic and more complex functions, such as theory of mind (ToM) and affective empathy. Although everyday social interactions may be impaired if such higher-order social cognitive functions are compromised, associations between social functioning and social cognition in people with focal epilepsy (PWFE) are still poorly understood. We used a novel, naturalistic approach to investigate ToM in PWFE by applying the Movie for the Assessment of Social Cognition (MASC). Furthermore, we studied affective empathy, the relationship between social cognitive parameters and measures of social functioning, as well as between epilepsy focus and ToM.

METHODS

Thirty patients with either temporal (TLE) or frontal lobe epilepsy (FLE) were compared to 29 healthy control subjects (HC). In addition to the MASC, we applied questionnaire measures assessing empathy and everyday social functioning.

RESULTS

PWFE, especially with FLE, performed significantly worse than HC on the MASC. Perceived social integration and social activities, but not affective empathy, were reduced in PWFE. Regression analyses revealed associations between perceived social integration, clinical group status, affective empathy and ToM.

CONCLUSION

PWFE displayed ToM deficits during a naturalistic task, whereas affective empathy was unimpaired. FLE may be associated with especially compromised ToM performance. Social cognition and social functioning appear to be interrelated in PWFE, whose self-perceived levels of social integration and social activities are lower than those of HC. More research into the association between social cognition and social functioning in PWFE is needed, in order to develop tailored intervention programs for these patients.

Mammary analogue secretory carcinoma: A challenging case arising in a young man with radiation exposure

Mammary Analogue Secretory Carcinoma (MASC) is a recently described salivary gland tumor frequently sampled via fine-needle aspiration. The cytologic features of MASC are not entirely distinctive and can simulate acinic cell carcinoma, but the tumor harbors an ETV6 gene rearrangement resulting in an ETV6-NTRK3 fusion gene. We present a case of MASC arising in a 31 year old man with a history of multiple radio-embolization procedures.

Cytomorphological features of Mammary Analog secretory carcinoma of parotid gland: Report of 3 cases and review of literature

Mammary analog secretory carcinoma (MASC) of salivary gland is a recently described entity. Due to its rarity and cytomorphological overlap with other salivary gland tumors, it is often difficult to recognize on cytology. Here we describe three such cases with their histopathological correlation. All the three tumors arose in the parotid gland. They were misdiagnosed as mucoepidermoid carcinoma, acinic cell carcinoma and salivary duct adenocarcinoma, respectively. Final diagnosis of MASC was established on their follow-up histopathology and immunochemistry evaluation. Cytosmears of these tumors showed high cellularity with papillary architecture lying within fluid background rich in foamy macrophages. Nuclear atypia varied from minimal to marked with frequent mitosis and presence of necrosis. Cytoplasmic vacuolation was a consistent finding. Although the cytomorphological features of MASC are not specific, a diagnosis of MASC should be strongly considered in the presence of papillary architecture, prominent cytoplasmic vacuolations of the tumor cells and a background of cyst fluid. Immunohistochemistry on cell block may be done to confirm the diagnosis.

Mentalizing Errors in Patients with Schizophrenia Who Received Psychosocial Rehabilitation: a Case-Control Study

The main objective of this study was to evaluate the mentalizing performance of patients with schizophrenia who received daily psychosocial rehabilitation treatment compared with healthy controls. Differences in mentalizing performance between men and women, and the relationship between mentalizing deficits, cognitive impairment, symptoms, and global functioning of patients were also examined. A case-control study design was utilized (N = 95). Adults with schizophrenia were recruited from psychosocial rehabilitation clinics (n = 53) and healthy controls were recruited from the community (n = 42). Mentalizing was evaluated with the Movie for the Assessment of Social Cognition, an audiovisual measure with good ecological validity. Measures of cognitive functioning, symptoms, and global functioning were also administered. Patients exhibited significant mentalizing deficits. Specifically, patients made more undermentalizing errors and more no mentalizing errors compared with healthy controls. In patients and healthy controls, no differences were found between men and women in mentalizing abilities. In patients with schizophrenia, lower cognitive functioning (i.e., immediate and delayed verbal learning, verbal fluency, and processing speed) were associated with poorer mentalizing. In patients, processing speed explained 31% of the variance in total mentalizing errors and mentalizing deterioration was associated with poorer overall functioning. Psychosocial rehabilitation interventions in people with schizophrenia should consider mentalizing deficits (especially undermentalizing and no mentalizing difficulties) and their relationship with reduced processing speed in treatment delivery (e.g., direct and organized communication). Integration of treatments targeting mentalizing deficits in a psychosocial rehabilitation setting is recommended to improve functioning in schizophrenia.

Mind reading improvements in mentalization-based therapy training

The psychological strain of many psychiatric disorders arises from difficulties encountered in social interactions. Social withdrawal is often the first symptom of neuropsychiatric disorders. The authors explore the various options for training social cognition skills. Social cognition was assessed using the Movie for the Assessment of Social Cognition (MASC). After completion of mentalization-based therapy (MBT) training, MASC scores improved significantly in health care providers (p = .006, r = .57). Mentalizing (operationalized with reflective functioning [RF]) was assessed in the MBT group (Group A) and compared with RF in a control group (Group B). RF was significantly higher in Group A (RF = 4.35, SD = 1.19) than in Group B (RF = 3.43, SD = 1.70) (p = .0385; Cohen's d = 0.65). MBT might be a promising intervention in social cognition training. Mentalizing skills might be associated with attitude.

Social Cognition in Autism and Schizophrenia Spectrum Disorders: The Same but Different?

Social cognition impairment is a core shared phenotype in both schizophrenia spectrum disorders (SSD) and autism spectrum disorders (ASD). This study compares social cognition performance through four different instruments in a sample of 147 individuals with ASD or SSD and in healthy controls. We found that both clinical groups perform similarly to each other and worse than healthy controls in all social cognition tasks. Only performance on the Movie for the Assessment of Social Cognition (MASC) test was independent of age and intelligence. Proportionately, individuals in the control group made significantly more overmentalization errors than both patients group did and made fewer undermentalization errors than patients with SSD did. AUC analyses showed that the MASC was the instrument that best discriminated between the clinical and control groups. Multivariate analysis showed negative symptom severity as a potential mediator of the association between social cognition deficit and poor global functioning.

Nonsocial cognitive underpinnings of theory of mind in schizophrenia

Social cognition is a mediator between nonsocial cognition and functional outcome in schizophrenia. However, the relationship between specific nonsocial cognitive and social cognitive domains is less clear. The aim of this study was to investigate which specific nonsocial cognitive domains best predict theory of mind (ToM) performance in schizophrenia. We indexed ToM by a composite score of the video-based Movie for the Assessment of Social Cognition test (MASCtot) in a sample of 91 individuals with schizophrenia. Nonsocial cognition was measured with the nonsocial cognitive subtests of the MATRICS Consensus Cognitive Battery (MCCB) and the Wechsler Abbreviated Scale of Intelligence (WASI IQ). Bivariate and multiple regression analyses were applied. We found statistically significant bivariate associations between MASCtot and five nonsocial cognitive tests, measuring intelligence, speed of processing, verbal or visual memory, and non-verbal working memory. Together, they accounted for 17% of the variation in MASCtot, but none of the five tests made significant unique contributions to MASCtot in the regression analysis. Our results confirm that nonsocial cognition and ToM are associated, albeit distinct, constructs. The findings suggest that cognitive remediation must include social cognitive targets in order to achieve improved ToM and better functioning.

Primary Mammary-Analogue Secretory Carcinoma of the Lung: A Rare Entity With an Unusual Location

This is a case of a 55-year-old female with past medical history of tobacco smoking, hypertension, and lupus who presented with a left lung nodule, found on computed tomographic scan of the chest during workup for a recently diagnosed squamous cell carcinoma in a cervical lymph node. Resection of the lung nodule showed a 2.3-cm well-defined pale-tan mass, and histologic examination showed a well-circumscribed lesion with papillary, solid, and gland-like architectural patterns, with eosinophilic secretions, areas of comedonecrosis, and increased mitotic activity. Immunohistochemical stains showed the lesion to be positive for cytokeratin 7, S100 protein, and focally positive for mammaglobin. Fluorescence in situ hybridization studies confirmed rearrangement of the ETV6 gene at 12p13.2. To date, our case is the second reported case of a primary mammary-analogue secretory carcinoma arising in the lung, and the first to show evidence of tumor necrosis: an unusual feature in an unusual location.

Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT)

BACKGROUND

Mentalization-based treatment (MBT) is an evidence-based treatment for borderline personality disorder (BPD). Differences in treatment outcomes related to specific capacity of social cognition need further attention. This study aimed to investigate social cognition as a predictor of outcome.

METHOD

The study included 31 BPD patients who completed a test of social cognition (Movie for the Assessment of Social Cognition, MASC) before outpatient MBT. The MASC-scores indicated a person's theory of mind (ToM) and different error-types. During treatment repeated self-reports of alliance and clinical outcomes (symptoms, interpersonal problems, social functioning) were applied. Longitudinal analyses were based on Linear Mixed Models (n = 24).

RESULTS

The most frequent error-type was excessive ToM (hypermentalizing). Higher levels of excessive ToM were associated with greater improvement of alliance over time and good clinical outcomes. Insufficient ToM errors and low levels of accurate cognitive ToM responses were both associated with poorer improvement over time. The subgroup with frequent insufficient ToM errors had a larger total number of ToM errors. Insufficient ToM errors were associated with more childhood trauma, comorbid avoidant PD traits and/or PTSD, extensive prior treatment, and/or treatment irregularity.

CONCLUSION

This study demonstrates considerable variation of social cognitive capacity among BPD patients and good outcomes for patients with mainly ToM errors of hypermentalizing. It also indicates that poorly responding patients may represent a cohort with more complex problems of social cognition and insufficient mentalizing.

Secretory carcinoma of the major salivary gland: Provincial population-based analysis of clinical behavior and outcomes

BACKGROUND

Our aim was to identify the number of cases of secretory carcinoma (SC) of the major salivary gland in a population-based cohort and review its clinical behavior with long-term follow-up.

METHODS

All malignant salivary gland tumors (MSGTs) diagnosed between 1980 and 2014 were assessed for histological features compatible with SC and 140 were selected for further analysis.

RESULTS

Twenty two new cases of SC were identified, 19 of which were originally classified as acinic cell carcinoma, and 3 as adenocarcinoma, not otherwise specified (NOS). Lymph node involvement was less common in SC tumors (5%) than in the control group (11%). Disease recurrence was seen less frequently in SC (9%) than the control group (20%). Mean disease-free survival was 192 months for SC compared with 162 months for controls (P = 0.15).

CONCLUSION

The clinical course of SC is typically indolent with a low risk of relapse not significantly different from other low-grade MSGT.

Synchronous Parotid (Mammary Analog) Secretory Carcinoma and Acinic Cell Carcinoma: Report of a Case

Mammary analogue secretory carcinoma (MASC) is a recently described low-grade salivary gland malignancy with histologic, immunohistochemical and molecular similarities to secretory carcinoma of the breast, including a specific t(12;15)(p13;q25) resulting in an ETV6-NTRK3 gene fusion. Ultrasound and magnetic resonance imaging frequently document a macrocystic structure. The main differential diagnosis of secretory carcinoma is with low grade acinic cell carcinoma (AciCC). The two can be differentiated with immunohistochemical stains for S100, mammaglobin, carbonic anhydrase VI and DOG-1; the identification of the specific translocation can help to characterize non-typical cases. We report a unique case of synchronous MASC and AciCC presenting in a parotid gland and discuss the implications of the correct identification of the two tumors.

Clinicopathological characteristics and outcome of 31 patients with ETV6-NTRK3 fusion gene confirmed (mammary analogue) secretory carcinoma of salivary glands

OBJECTIVES

In 2010, a new subtype of salivary gland cancer (SGC), (mammary analogue) secretory carcinoma (SC), was defined, characterized by the ETV6-NTRK3 fusion gene. As clinical behavior and outcome data of this histological subtype tumor are still sparse, we aimed to describe the clinicopathological course and outcome of a series of translocation positive SC patients.

PATIENT AND METHODS

We re-evaluated the pathological diagnosis of a subset of SGCs, diagnosed in 4 of 8 Dutch head and neck centers. Subsequently, tumors with a morphological resemblance to SC were tested for the ETV6-NTRK3 fusion gene using RT-PCR. Furthermore, patients prospectively diagnosed with SC were included. The clinical characteristics and outcomes were retrieved from the patient files.

RESULTS

Thirty-one patients with ETV6-NTRK3 fusion gene positive SC were included. The median age was 49 years, 17 patients (55%) were male. Eighteen tumors (58%) arose in the parotid gland. One patient presented with lymph node metastasis. All patients underwent tumor resection and 4 patients had a neck dissection. Four patients had re-resection and 15 patients (48%) received postoperative radiotherapy. One patient developed a local recurrence, no regional recurrences or distant metastases were observed. After a median follow-up of 49 months the 5- and 10-year overall survival were 95%, the 5- and 10-year disease free survival were 89%.

CONCLUSION

The clinical course of SC is favorable with a low rate of locoregional recurrence and excellent survival. Given the low incidence of nodal metastases, elective neck treatment, i.e. surgery and/or radiotherapy, does not seem to be indicated.

A systematic review including an additional pediatric case report: Pediatric cases of mammary analogue secretory carcinoma

IMPORTANCE

Mammary Analogue Secretory Carcinoma (MASC) is a newly characterized salivary gland carcinoma resembling secretory carcinoma of the breast. Prior to being described, MASC was most commonly misdiagnosed as Acinic Cell Carcinoma. Though MASC is predominantly an adult neoplasm, cases have been reported in the pediatric population. Reporting and summarizing of known cases is imperative to understand the prognosis and clinical behavior of MASC.

OBJECTIVE

EVIDENCE REVIEW: Web of Science, Medline, EMBASE, and The Cochrane Library were searched for studies that included pediatric cases of MASC. Data on clinical presentation, diagnosis and management, and pathology were collected from all pediatric cases.

FINDINGS

CONCLUSIONS AND RELEVANCE: Since the first case of MASC in the pediatric population was described in 2011, only 12 cases, including this one, have been described in the literature. With this paucity of information, much remains unknown regarding this new pathologic diagnosis. The collection of clinical outcomes data of children with MASC is needed to better understand the behavior of this malignancy as well as determine optimal treatment regimens.

Clinicopathologic and molecular characterization of mammary analogue secretory carcinoma of salivary gland origin

BACKGROUND

Mammary analogue secretory carcinoma (MASC) is a newly recognized salivary gland tumor that harbors a characteristic balanced chromosomal translocation t (12; 15) (p13; q25) resulting in an ETV6-NTRK3 fusion gene.

METHODS

Retrospective study of 111 salivary gland carcinomas revealed 37 cases with secretory features and growth patterns resembling secretory carcinoma of breast. These 37 cases were originally diagnosed as acinic cell carcinoma, adenocarcinoma not otherwise specified and cystadenocarcinoma. Positive immunostaining for S-100 protein and mammaglobin, followed by detection of ETV6 gene rearrangement by FISH and/or ETV6-NTRK3 fusion transcript by RT-PCR were used to identify MASCs.

RESULTS

In the cohort of 37 salivary carcinomas with secretory features we have identified 10 cases of MASC. All 10 MASCs were positive for mammaglobin, S-100 protein and SOX10, while staining for DOG1 and p63 protein were mostly absent. In 7/10 cases, both FISH and RT-PCR were positive while three remaining cases showed break of ETV6 gene by FISH analysis and the RT-PCR was negative. Clinical follow-up data were obtained in 6 out of 10 patients with MASC. In 3 patients cervical lymph node metastases developed, one patient with high grade transformed MASC died with multiple distant bone metastases, and local recurrence was observed in three patients.

CONCLUSION

Our clinicopathological data are in keeping with previous studies; in most cases, MASC is a low-grade malignancy with overall favorable prognosis. In rare cases, however, MASC with high-grade transformation may behave aggressively, and these patients could benefit from targeted biological treatment using tyrosine kinase inhibitors.

Secretory carcinoma - impact of translocation and gene fusions on salivary gland tumor

Secretory carcinoma (SC), previously described as mammary analogue secretory carcinoma (MASC), is a recently described salivary gland tumor which morphologically resembles mammary secretory carcinoma. The first description of SC/MASC, reported by Skálová et al. in 2010, was as a rare salivary carcinoma imitating secretory carcinoma of the breast. SC/MASC is a unique salivary gland tumor with morphological overlap with acinic cell carcinoma (AciCC), mucoepidermoid carcinoma (MEC), and adenocarcinoma not otherwise specified (ADC-NOS). SC/MASC shares similar clinicopathological features with AciCC. As a critical difference between SC/MASC and AciCC, SC/MASC characteristically has the chromosomal translocation t(12;15)(p13;q25) which leads to a fusion gene between the ETV6 gene on chromosome 12 and the NTRK3 gene on chromosome 15. This genetic background is an important differential diagnostic finding for excluding other salivary gland tumors and may be a critical factor determining the prognosis for patients with SC/MASC. Research in recent years has provided a large body of new data on SC/MASC and suggests the possibility that the ETV6-NTRK3 translocation could be a therapeutic target. Here, we review the morphological and clinicopathological features of SC/MASC and discuss new directions for therapy.

ETV6 rearrangement in a case of mammary analogue secretory carcinoma of the skin

Mammary analog secretory carcinoma of salivary glands is a relatively recently recognized entity that harbors the ETV6-NTRK3 fusion transcript. To date, only rare cases of mammary analog secretory carcinoma of the skin have been reported. A 57-year-old man presented with a 6.0 cm cystic mass in the axilla, involving the dermis and superficial subcutis. Microscopically, the tumor exhibited nodular aggregation of tubular and microcystic structures embedded in the dense fibrotic and hyalinized stroma. Characteristic 'colloid-like' eosinophilic secretory material was present within intraluminal spaces. Tumor cells were largely characterized by vesicular nuclei with inconspicuous nucleoli and pink vacuolated cytoplasm. With respect to immunohistochemistry, tumor cells were intensely positive for AE1/AE3, Cam 5.2, and CK7, whereas Ber-EP4 and CEA were completely negative. A dual color break-apart fluorescence in situ hybridization probe identified rearrangement of the ETV6 gene locus on chromosome 12. The patient is alive with no evidence of recurrent disease or metastasis 3 years after the initial surgery. In conclusion, we report a rare example of mammary analog secretory carcinoma of the skin with ETV6 rearrangement. Awareness of this unique cutaneous tumor and subsequent reporting of additional cases is necessary for better characterization of its completely clinicopathologic spectrum.

Mammary analogue secretory carcinoma of the salivary glands: a diagnostic dilemma. Br J Oral Maxillofac Surg. 2017;55:290-292. [PMID: 27527989 DOI: 10.1016/j.bjoms.2016.07.029]

Mammary analogue secretory carcinoma (MASC) is a recently identified salivary gland neoplasm that can mimic other salivary gland tumours such as acinic cell carcinoma and cystadenocarcinoma. It is distinguished from these by differences in immunohistochemical profile and the identification of an ETV6-NTRK3 translocation (12;15)(p13;q25), which is also found in secretory carcinomas of the breast. Previous publications have suggested that MASC tumours have similar biological behaviour to acinic cell carcinoma. We report two cases of MASC that affected the upper lip, and showed an infiltrative and locally aggressive growth pattern that required several operations to ensure clearance of microscopic tumour cells.

A Case of Primary Mammary Analog Secretory Carcinoma (MASC) of the Thyroid Masquerading as Papillary Thyroid Carcinoma: Potentially More than a One Off

We present the second reported mammary analog secretory carcinoma (MASC) apparently arising in the thyroid and propose a potential close relationship to ETV6-NTRK3 fusion papillary thyroid carcinoma. The patient, a 36 year old woman, presented with a neck mass of 1 year's duration. Imaging studies showed a tumor involving most of the thyroid with enlarged regional lymph nodes. FNA biopsy yielded a diagnosis of "papillary thyroid carcinoma". Resection revealed a 4.5 cm infiltrative tumor. Final diagnosis was "papillary thyroid carcinoma (PTC) consistent with diffuse sclerosing variant" with positive lymph nodes (2+/4) and margins. Histologic features included mixed microcystic, solid, follicular and papillary architecture, prominent nucleoli, abundant nuclear grooves and rare nuclear pseudo-inclusions. Despite radioactive iodine, radiotherapy and multiagent chemotherapy, the patient progressed over 6 years with local recurrence and additional lymph node involvement finally developing widespread distant metastases. Prompted by the breast carcinoma-like histopathology of a metastasis, immunohistochemical staining was performed and revealed strong expression of GATA3 and mammaglobin with no reactivity for thyroglobulin or TTF-1. The original tumor was then tested and showed the same immunoprofile. RT-PCR confirmed the presence of an ETV6-NTRK3 fusion consistent with a diagnosis of MASC. Our patient's clinical, imaging and morphologic features remarkably mimicked papillary thyroid carcinoma. At the molecular level, the ETV6-NTRK3 fusion in this patient involved exons reported in the rare "papillary thyroid carcinoma" with this translocation. Given the immunophenotype of this case, it is possible that at least some ETV6-NTRK3 fusion positive PTC are actually MASC masquerading as papillary thyroid carcinoma.

Molecular analysis of a mammary analog secretory carcinoma in the upper lip: Novel search for genetic and epigenetic abnormalities in MASC

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Mammary analog secretory carcinoma (MASC) is a rare malignancy of the salivary glands characterized by ETV6–NTRK3 fusion gene.

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We diagnosed a case of MASC by molecular approaches (FISH, RT-PCR and sequencing).

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Furthermore, we searched novel genetic and epigenetic abnormalities in this MASC.

Introduction

Mammary analog secretory carcinoma (MASC) is a newly described rare malignancy of the salivary glands characterized by an ETS variant 6 (ETV6)–neurotrophic tyrosine kinase receptor type 3 (NTRK3) fusion gene (EN fusion gene).

Presentation of case

We present a case of MASC derived from the left upper lip in a 61-year-old woman. ETV6 rearrangement was detected by fluorescence in situ hybridization (FISH). The presence of EN fusion transcripts was verified by reverse-transcriptase polymerase chain reaction (RT-PCR) and sequencing of the PCR products. Accordingly, this tumor was diagnosed as MASC. Moreover, we performed mutation analysis of the 50 known cancer-related genes using next-generation sequencing. No mutation of cancer-related genes was identified here. Subsequently, the methylation status in promoter region of tumor-suppressor genes, RASSF1A and RARB2, was examined. Both genes have been reported to be methylated in malignant salivary gland tumors, but they were found to be unmethylated.

Discussion

Recent studies have demonstrated that distinct types of malignant salivary gland carcinomas are driven by specific, highly recurrent genetic alterations. Detection of molecular abnormalities could be powerful diagnostic tools in the field of salivary gland tumors in near future.

Conclusion

We experienced a rare malignant salivary gland carcinoma, MASC. We diagnosed this tumor by molecular approach and subsequently tried to identify novel molecular abnormalities. Although no novel molecular alteration except for EN fusion gene was identified, this result might represent the favorable prognosis of patients with MASC.

Anxiety in youth with and without autism spectrum disorder: examination of factorial equivalence

Although anxiety is frequently reported among children and adolescents with autism spectrum disorder (ASD), it has not been established that the manifest symptoms of anxiety in the context of ASD are the same as those seen in youth without ASD. This study sought to examine the metric and latent factor equivalence of anxiety as measured by the Multidimensional Anxiety Scale for Children, parent-report (MASC-P) and child-report (MASC-C), in youth with anxiety disorders and ASD with intact verbal ability (n=109, M(age)=11.67 years, 99 male) and a gender-matched comparison group of typically developing (TD) children and adolescents with anxiety disorders but without ASD (n=342, M(age)=11.25 years, 246 male). Multigroup factorial invariance (MFI) using structural equation modeling indicated equivalent latent factors in youth with and without ASD on the MASC-C (metric invariance). However, the item means and covariances along with the relations among the factor scores were different for the youth with ASD (i.e., lack of evidence for scalar or structural invariance). The MASC-P data did not fit the measure's established structure for either the ASD or TD group, and post-hoc exploratory factor analysis revealed a different factor structure in the ASD group. Findings suggest that the MASC-C may not measure identical constructs in anxious youth with and without ASD. Further research on the structure of the MASC in clinical samples is warranted.

Social Cognition in Borderline Personality Disorder: Evidence for Disturbed Recognition of the Emotions, Thoughts, and Intentions of others

Disturbed relatedness is a core feature of borderline personality disorder (BPD), and impaired social cognition or deficits in "mentalization" are hypothesized to underlie this feature. To date, only weak empirical evidence argues for impairment in the recognition of emotions, thoughts, or intentions in BPD. Data from facial emotion recognition research indicate that these abilities are altered in BPD only if tasks are complex. The present study aims to assess social cognitive abilities in BPD. Sixty-four women with BPD and 38 healthy controls watched the "Movie for the Assessment of Social Cognition" (MASC), a newly developed film displaying social interactions, and asking for an assessment of the intentions, emotions, and thoughts of the characters. In addition, participants completed an established but less ecologically valid measure of social cognition ("Reading the Mind in the Eyes"; RME). In the RME task, BPD patients did not display impairment in social cognition compared to healthy controls. By contrast, on the more sensitive MASC, women with BPD showed significantly impaired abilities in social cognition compared to healthy controls in their recognition of emotions, thoughts, and intentions. Comorbid PTSD, intrusions, and sexual trauma negatively predicted social cognitive abilities on the more sensitive MASC. Thus, our results suggest impaired social cognitive abilities in BPD. Especially for comorbid PTSD, intrusive symptoms, and history of sexual trauma predicted poor outcomes on social cognition tasks.