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Arora A, Storr SJ, Reddy H, Lobo DN, Madhusudan S, Zaitoun AM. O085 CD10 expression in carcinomas of the pancreas, bile duct and ampulla. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction
Pancreatic cancer and cholangiocarcinoma including, cancer of ampulla of Vater, are very aggressive and have a dismal prognosis; hence improved methods of patient stratification are required.
Methods
We assessed the expression of CD10 in stromal and epithelial cells of two patient cohorts using immunohistochemistry on tissue microarrays. The first cohort was composed of 68 pancreatic adenocarcinomas and the second cohort was composed of 120 cancers of the bile duct and ampulla.
Results
In bile duct and ampullary carcinomas an association was observed between CD10 stromal expression and patient age (p =0.009). The CD10 stromal expression was associated with poor disease specific survival (DSS) (p =0.05). In multivariate Cox model for DSS, stromal CD10 expression (p = 0.037) was independently associated with poor outcome. In multivariate Cox model for disease free survival (DFS), CD10 stromal expression (p = 0.012), and nodal status (p = 0.025) were independently associated with poor outcome. In pancreatic cancer, no statistically significant association was observed between CD 10 stromal expression and clinicopathological variables such as tumour size (p = 0.099), T stage (p = 0.393), N stage (p = 0.860), Vascular invasion (p = 0.904), perineural invasion (p = 0.532) and grade (0.168). In multivariate Cox model for DSS, T stage (p = 0.042) was independently associated with poor outcome.
Conclusion
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
Take-home message
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
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Affiliation(s)
- A Arora
- Nottingham University Hospitals NHS Foundation Trust
| | - SJ Storr
- Nottingham University Hospitals NHS Foundation Trust
| | - H Reddy
- Nottingham University Hospitals NHS Foundation Trust
| | - DN Lobo
- Nottingham University Hospitals NHS Foundation Trust
| | - S Madhusudan
- Nottingham University Hospitals NHS Foundation Trust
| | - AM Zaitoun
- Nottingham University Hospitals NHS Foundation Trust
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Sharmin N, Zaitoun AM, Babaei-Jadidi R, Lobo DN, Nateri AS. O081 Investigating the FLYWCH1/ β-catenin signalling in pancreatic cancer. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction
β-catenin is a protein molecule of the E-cadherin/catenin adhesion complex that maintains epithelial cell-cell adhesion and intracellular signalling. The mutation and overexpression of β-catenin leads to cancer, including pancreatic ductal adenocarcinoma (PDAC). FLYWCH1 is a newly identified protein with zinc-finger type DNA-binding domain that interacts with nuclear β-catenin, leading to increased cell-cell and cell-matrix adhesion in cancer and stem cells. This study aimed to explore the roles of crosstalk between FLYWCH1 and Wnt/β-catenin signalling for the first time in pancreatic cancer cells.
Methods
We performed Western Blot analysis for the extraction of FLYWCH1/β-catenin, E-cadherin and GSK3-b in AsPc-1, PANC-1, and MIA PaCa-2 pancreatic cancer cell lines.
Recommended concentrations of antibodies were used for the detection of proteins of interest. Tubulin was used as a loading control. Fluorescent detection was used, and the density of detected proteins were measured.
Results
Our results demonstrate evidence of differential expression of FLYWCH1 in pancreatic cancer cells. PANC-1 had less expression of FLYWCH1, but expression was moderate in AsPC-1. E-cadherin, β catenin, and GSK3-b were also expressed. These data suggest that FLYWCH1 levels correlated with unphosphorylated β-catenin to suppress the transcriptional product via controlling the aberrant Wnt/β-catenin pathway while E-cadherin promoted the cell-cell attachment.
Conclusion
These results suggest that Wnt1/β-catenin activity is negatively correlated with FLYWCH1 expression in pancreatic cancer cells. Thus, FLYWCH1 could have tumour suppressive activities. Future studies are required to elucidate their therapeutic and biomarkers efficacy.
Take-home message
FLYWCH1 is a newly identified protein could control B-catenin expression which leads tumour suppression. Thus, FLYWCH1 would be a therapeutic target for pancreatic cancer treatment in the future.
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Affiliation(s)
- N Sharmin
- University of Nottingham, School of Medicine
| | - AM Zaitoun
- University of Nottingham, School of Medicine
| | | | - DN Lobo
- University of Nottingham, School of Medicine
| | - AS Nateri
- University of Nottingham, School of Medicine
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3
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Asanprakit W, Zaitoun AM, Lobo DN, Eremin O, Bennett AJ. O24 Predictive and prognostic roles of polymeric immunoglobuilin receptor in breast cancer. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Neoadjuvant chemotherapy (NAC) is used with increasing frequency as the primary treatment for breast cancer. Pathological complete response (pCR) which contributes to survival benefit is achieved in only 25–30% of patients with little benefit and significant morbidity in the remainder. Therefore, predicting the patients who are likely to achieve a pCR before commencing NAC is desirable. A pilot study using next generation RNA sequencing of 10 large and locally advanced breast cancer biopsy specimens demonstrated that the expression of polymeric immunoglobulin receptor (PIGR) was significantly increased in breast cancers with pCR. The predictive and prognostic roles of PIGR in breast cancer were expanded in the present study.
Method
PIGR mRNA expression was determined by RNA in situ hybridization assay in formalin-fixed paraffin-embedded (FFPE) specimens of pre-treatment breast cancer core biopsy from 46 women with breast cancer who received NAC. The expression of PIGR and its associations with pCR and overall survival was examined.
Results
PIGR mRNA expression was lower in breast cancer compared with normal breast tissue (median H score: 0 vs. 120, P < 0.0001). There was no statistically significant difference in the proportion of pCR in PIGR positive compared with PIGR negative tumours (22.2% vs. 32.1%, P = 0.466). Five-year overall survival of the patients with PIGR positive and negative tumours was 88.9% and 78.3%, respectively. However, overall survival was not significantly different (P = 0.406).
Conclusions
The expression of PIGR did not appear to be associated with pCR after NAC and did not correlate with overall survival in breast cancer patients.
Take-home Message
The expression of PIGR did not appear to be associated with pCR after NAC and did not correlate with overall survival in breast cancer patients.
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Affiliation(s)
- W Asanprakit
- FRAME Alternatives Laboratory, School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Department of Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - A M Zaitoun
- Department of Cellular Pathology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D N Lobo
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - O Eremin
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - A J Bennett
- FRAME Alternatives Laboratory, School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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Zaitoun AM, Elsayed DAF, Ramadan BM, Gaffar HAA. Assessment of the risk factors and functional outcome of delirium in acute stroke. Egypt J Neurol Psychiatry Neurosurg 2019. [DOI: 10.1186/s41983-019-0059-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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5
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Kasi M, Rashid S, Wallace SAJ, Sujendran V, Griffiths B, Butler A, Gibbs P, Sreedharan L, Zaitoun AM, Venkatachalapathy S, James MW, Aithal GP. Seeding of hepatocellular carcinoma into the stomach wall following endoscopic ultrasound and fine-needle aspiration biopsy. Oxf Med Case Reports 2018; 2018:omy039. [PMID: 30046450 PMCID: PMC6053806 DOI: 10.1093/omcr/omy039] [Citation(s) in RCA: 3] [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: 11/09/2017] [Revised: 04/26/2018] [Accepted: 06/01/2018] [Indexed: 01/10/2023] Open
Abstract
Delayed gastrointestinal metastasis is a rare complication of hepatocellular carcinoma (HCC). We present the case of a patient who presented with melaena and microcytic anaemia 6 years after receiving an orthotopic liver transplant for hepatitis B-induced HCC. Oesophagogastroduodenoscopy revealed a fungating gastric mass at the lesser curve and histology from biopsies confirmed metastatic recurrence of HCC in the stomach. The route of metastasis is likely due to iatrogenic seeding of tumour cells during pre-transplant endoscopic ultrasound (EUS) and fine needle aspiration (FNA) biopsy. Subsequent positron emission tomography and magnetic resonance imaging failed to reveal further metastatic disease and the patient was managed with a total gastrectomy. This is the first reported description in the literature of needle-track metastasis in the stomach due to liver EUS-FNA for HCC.
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Affiliation(s)
- M Kasi
- Nottingham Digestive Diseases Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Samin Rashid
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - S A J Wallace
- Division of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Vijayendran Sujendran
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Bill Griffiths
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Andrew Butler
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Paul Gibbs
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Loveena Sreedharan
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - A M Zaitoun
- Division of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Venkatachalapathy
- Nottingham Digestive Diseases Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M W James
- Nottingham Digestive Diseases Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - G P Aithal
- Nottingham Digestive Diseases Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Nottingham, UK
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Dhadda AS, Bessell EM, Scholefield J, Dickinson P, Zaitoun AM. Mandard tumour regression grade, perineural invasion, circumferential resection margin and post-chemoradiation nodal status strongly predict outcome in locally advanced rectal cancer treated with preoperative chemoradiotherapy. Clin Oncol (R Coll Radiol) 2014; 26:197-202. [PMID: 24485884 DOI: 10.1016/j.clon.2014.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 03/06/2012] [Revised: 11/21/2013] [Accepted: 11/26/2013] [Indexed: 02/06/2023]
Abstract
AIMS The pathology of tumours after chemo/radiotherapy for locally advanced rectal cancer can be difficult to interpret. The ypTNM staging does not accurately predict outcomes. Therefore, we developed a new prognostic index for this purpose. MATERIALS AND METHODS The Nottingham Rectal Cancer Prognostic Index (NRPI) is based on a study of 158 patients with locally advanced rectal cancer treated with preoperative chemo/radiotherapy at Nottingham University Hospital between April 2001 and December 2008. Patients were treated with radiotherapy to a dose of 50 Gy in 25 fractions over 5 weeks with/without concurrent capecitabine chemotherapy. Surgery was carried out after an interval of 6-10 weeks. Factors found to be significant on univariate analysis to predict for disease-free (DFS) and overall survival were further explored in multivariate analysis. The significant factors (Mandard tumour regression grade, perineural invasion, circumferential resection margin status and nodal status) were weighted to establish a score for the index. The median follow-up was 40 months (range 3-90 months). RESULTS On survival analysis, four distinct prognostic groups were found: Score 0 = excellent prognosis, 1-3 = good prognosis, 4-8 = moderate prognosis, 9-14 = poor prognosis. The NRPI significantly predicted both DFS and overall survival (P < 0.0001). DFS at 5 years was 95, 63, 25 and 0% for the four groups. On multivariate analysis the NRPI was found to be the strongest predictor of DFS including nodal and circumferential resection margin status (P < 0.0001). It was a stronger predictor of overall survival than the American Joint Committee on Cancer/Dukes staging (P < 0.0001). CONCLUSIONS The NRPI allocates patients into distinct prognostic categories. This seems to be a much stronger predictive factor than the American Joint Committee on Cancer/Dukes staging. This requires further validation, but seems to be a useful clinical index for future studies.
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Affiliation(s)
- A S Dhadda
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull, UK.
| | - E M Bessell
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Scholefield
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - P Dickinson
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A M Zaitoun
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Patel SR, Smith K, Letley DP, Cook KW, Memon AA, Ingram RJM, Staples E, Backert S, Zaitoun AM, Atherton JC, Robinson K. Helicobacter pylori downregulates expression of human β-defensin 1 in the gastric mucosa in a type IV secretion-dependent fashion. Cell Microbiol 2013; 15:2080-92. [PMID: 23870035 PMCID: PMC4028989 DOI: 10.1111/cmi.12174] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 05/23/2013] [Accepted: 07/15/2013] [Indexed: 02/06/2023]
Abstract
Helicobacter pylori establishes a chronic lifelong infection in the human gastric mucosa, which may lead to peptic ulcer disease or gastric adenocarcinoma. The human beta-defensins (hβDs) are antimicrobial peptides, hβD1 being constitutively expressed in the human stomach. We hypothesized that H. pylori may persist, in part, by downregulating gastric hβD1 expression. We measured hβD1 and hβD2 expression in vivo in relation to the presence, density and severity of H. pylori infection, investigated differential effects of H. pylori virulence factors, and studied underlying signalling mechanisms in vitro. Significantly lower hβD1 and higher hβD2 mRNA and protein concentrations were present in gastric biopsies from infected patients. Those patients with higher-level bacterial colonization and inflammation had significantly lower hβD1 expression, but there were no differences in hβD2. H. pylori infection of human gastric epithelial cell lines also downregulated hβD1. Using wild-type strains and isogenic mutants, we showed that a functionalcag pathogenicity island-encoded type IV secretion system induced this downregulation. Treatment with chemical inhibitors or siRNA revealed that H. pylori usurped NF-κB signalling to modulate hβD1 expression. These data indicate that H. pylori downregulates hβD1 expression via NF-κB signalling, and suggest that this may promote bacterial survival and persistence in the gastric niche.
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Affiliation(s)
- S R Patel
- Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, NG7 2RD, UK; Centre for Biomolecular Sciences, University of Nottingham, Nottingham, NG7 2RD, UK
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Abstract
Neurofibromas of the common bile duct are extremely rare. The lack of specific clinical or radiological features makes preoperative diagnosis in the absence of histology difficult. We report the case of a female patient who presented with obstructive jaundice and evidence of a common bile duct stricture on imaging. She underwent an exploratory laparotomy, and intraoperative frozen section confirmed clear margins and a benign lesion. Excision of the extrahepatic bile duct and A Rouxen-Y hepaticojejunostomy was performed. We discuss the clinical features and management of neurofibromas of the bile duct in light of the literature.
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Affiliation(s)
- A De Rosa
- Nottingham University Hospitals NHS Trust, UK
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9
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Awad S, Zaitoun AM, Lobo DN. Education and imaging. Hepatobiliary and pancreatic: Blocked metal biliary stent. J Gastroenterol Hepatol 2011; 26:1694. [PMID: 22011302 DOI: 10.1111/j.1440-1746.2011.06905.x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- S Awad
- Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom
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10
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Chowdhury AH, Zaitoun AM, Dunn WK, Brooks AJ, Lobo DN. Education and imaging. Gastrointestinal: Duodenal duplication cyst causing recurrent acute pancreatitis. J Gastroenterol Hepatol 2011; 26:785. [PMID: 21418306 DOI: 10.1111/j.1440-1746.2011.06620.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- A H Chowdhury
- Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
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11
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Dhadda AS, Dickinson P, Zaitoun AM, Gandhi N, Bessell EM. Prognostic importance of Mandard tumour regression grade following pre-operative chemo/radiotherapy for locally advanced rectal cancer. Eur J Cancer 2011; 47:1138-45. [PMID: 21220198 DOI: 10.1016/j.ejca.2010.12.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 12/01/2010] [Accepted: 12/07/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess the prognostic value of the Mandard tumour regression score (TRG) following pre-operative chemo/radiotherapy in patients with locally advanced rectal cancer. METHODS AND MATERIALS The study involved 158 patients with locally advanced rectal cancer treated with pre-operative long course chemo/radiotherapy at Nottingham University Hospital between April 2001 and December 2008. Patients were treated with radiotherapy to a dose of 50 Gy in 25 fractions over 5 weeks with or without concurrent capecitabine chemotherapy at a dose of 1650 mg/m(2)/day. Surgery was normally performed after an interval of 6-10 weeks. The response to pre-operative treatment was carefully graded by a single pathologist using the five point Mandard score. The median follow-up was 40 months (range 3-90 months). RESULTS Of the 158 patients 14% were TRG1, 41% were TRG2, 31% were TRG3, 13% were TRG4 and 1% were TRG5. The groups were combined into TRG1, TRG2 and TRG3-5 to simplify further analysis. The Mandard score was clearly related to both disease-free (p < 0.001) and overall survival (p = 0.012). On multivariate analysis perineural invasion, nodal status, TRG and circumferential resection margin status were the most powerful predictors of disease-free survival. CONCLUSIONS The Mandard tumour regression score is an independent prognostic factor and predicts for long-term outcome following pre-operative chemo/radiotherapy in rectal cancer.
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Affiliation(s)
- A S Dhadda
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Castle Road, Cottingham, Hull HU16 5JQ, UK.
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12
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Aloysius MM, Zaitoun AM, Awad S, Ilyas M, Rowlands BJ, Lobo DN. Mucins and CD56 as markers of tumour invasion and prognosis in periampullary cancer. Br J Surg 2010; 97:1269-78. [PMID: 20602499 DOI: 10.1002/bjs.7107] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study investigated the association of mucins and cluster of differentiation (CD) 56 with vascular and perineural invasion and survival in patients with periampullary cancer. METHODS Immunohistochemical staining was performed on formalin-fixed pancreatic tissue microarrays (cancer, chronic pancreatitis and normal pancreatic tissue) constructed from 126 pancreatic resections (cancer, 104; chronic pancreatitis, 22). Mucin (MUC) 1, MUC4 and MUC5AC expression was quantified using the immunohistochemical score (range 0-300), MUC3 expression was described as membranous or cytoplasmic, and expression of CD56, MUC2 and MUC6 as present or absent. RESULTS In cancers, vascular invasion correlated with overexpression (immunohistochemical score of 100 or more) of MUC1 (P = 0.003) and presence of MUC6 (P = 0.024), and perineural invasion correlated with overexpression of MUC5AC (P = 0.015). Reduced survival was observed with overexpression of MUC4 (P = 0.032) and MUC5AC (P = 0.048), membranous expression of MUC3 (P = 0.048), and presence of CD56 (P = 0.041). Perineural invasion also correlated with CD56 expression (P = 0.001). Overexpression of MUC4 and MUC5AC correlated with tumour recurrence (P = 0.001 and P = 0.034 respectively). Multivariable analysis identified membranous expression of MUC3 (P = 0.023), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.004) as independent predictors of poor survival. CONCLUSION Mucins and CD56 may be markers of prognosis in patients with periampullary cancer.
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Affiliation(s)
- M M Aloysius
- Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham NG7 2UH, UK
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13
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Dickinson PD, Zaitoun AM, Bessell EM, Dhadda AS. Rate of tumor regression as a prognostic factor following neoadjuvant chemoradiotherapy in locally advanced rectal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14030] [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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14
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Dhadda AS, Dickinson PD, Zaitoun AM, Bessell EM. Mandard tumor regression grade as a prognostic factor following preoperative chemotherapy/radiotherapy for locally advanced rectal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14024] [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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15
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Al-Attar A, Gossage L, Fareed KR, Shehata M, Mohammed M, Zaitoun AM, Soomro I, Lobo DN, Abbotts R, Chan S, Madhusudan S. Human apurinic/apyrimidinic endonuclease (APE1) is a prognostic factor in ovarian, gastro-oesophageal and pancreatico-biliary cancers. Br J Cancer 2010; 102:704-9. [PMID: 20087352 PMCID: PMC2837561 DOI: 10.1038/sj.bjc.6605541] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/09/2009] [Accepted: 12/16/2009] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Altered DNA repair may be associated with aggressive tumour biology and impact upon response to chemotherapy and radiotherapy. We investigated whether expression of human AP endonuclease (APE1), a key multifunctional protein involved in DNA BER, would impact on clinicopathological outcomes in ovarian, gastro-oesophageal, and pancreatico-biliary cancer. METHODS Formalin-fixed human ovarian, gastro-oesophageal, and pancreatico-biliary cancers were constructed into TMAs. Expression of APE1 was analysed by IHC and correlated to clinicopathological variables. RESULTS In ovarian cancer, nuclear APE1 expression was seen in 71.9% (97 out of 135) of tumours and correlated with tumour type (P=0.006), optimal debulking (P=0.009), and overall survival (P=0.05). In gastro-oesophageal cancers previously exposed to neoadjuvant chemotherapy, 34.8% (16 out of 46) of tumours were positive in the nucleus and this correlated with shorter overall survival (P=0.005), whereas cytoplasmic localisation correlated with tumour dedifferentiation (P=0.034). In pancreatico-biliary cancer, nuclear staining was seen in 44% (32 out of 72) of tumours. Absence of cytoplasmic staining was associated with perineural invasion (P=0.007), vascular invasion (P=0.05), and poorly differentiated tumours (P=0.068). A trend was noticed with advanced stage (P=0.077). CONCLUSIONS Positive clinicopathological correlations of APE1 expression suggest that APE1 is a potential drug target in ovarian, gastro-oesophageal, and pancreatico-biliary cancers.
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Affiliation(s)
- A Al-Attar
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Gossage
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - K R Fareed
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - M Shehata
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Mohammed
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - A M Zaitoun
- Department of Pathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - I Soomro
- Department of Pathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D N Lobo
- Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - R Abbotts
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - S Chan
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Madhusudan
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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Dhadda AS, Zaitoun AM, Bessell EM. Regression of rectal cancer with radiotherapy with or without concurrent capecitabine--optimising the timing of surgical resection. Clin Oncol (R Coll Radiol) 2008; 21:23-31. [PMID: 19027272 DOI: 10.1016/j.clon.2008.10.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 09/24/2008] [Accepted: 10/24/2008] [Indexed: 11/26/2022]
Abstract
AIMS To determine tumour regression (volume-halving time) obtained after chemo/radiotherapy, and thereby the ideal interval between the start of treatment and surgery in order to obtain a high rate of complete response. MATERIALS AND METHODS In total, 106 patients with cT3,4 rectal cancer who received preoperative radiotherapy alone or concurrently with capecitabine chemotherapy at Nottingham City Hospital, UK were studied. The rectal tumour volume visible on the computed tomography planning scan was compared with the residual pathological volume and the tumour volume-halving time calculated. The radiotherapy response was graded according to the Mandard system. RESULTS Fifty-three patients had radiotherapy alone, with 53 patients having concurrent chemoradiotherapy. The median tumour volume-halving time was found to be 14 days and not influenced by the addition of chemotherapy. The Mandard score, the interval from the start of treatment to surgery and the tumour volume-halving time were statistically associated with tumour regression. The median tumour volume in our series of 54 cm(3) would require an interval of 20 weeks after the start of treatment to surgery to regress to <0.1 cm(3) (10 volume-halving times; 140 days). CONCLUSIONS The initial tumour volume and median volume-halving time provide the best estimates for determining the optimum length of interval between the completion of preoperative chemo/radiotherapy and surgery in locally advanced rectal cancer.
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Affiliation(s)
- A S Dhadda
- Department of Clinical Oncology, Castle Hill Hospital, Cottingham, Hull, UK.
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17
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Robinson K, Kenefeck R, Pidgeon EL, Shakib S, Patel S, Polson RJ, Zaitoun AM, Atherton JC. Helicobacter pylori-induced peptic ulcer disease is associated with inadequate regulatory T cell responses. Gut 2008; 57:1375-85. [PMID: 18467372 DOI: 10.1136/gut.2007.137539] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Helicobacter pylori infection is the major cause of peptic ulceration and gastric adenocarcinoma. To address the hypothesis that the human acquired immune response to H. pylori influences pathogenesis, we characterised the gastric T helper (Th) and regulatory T cell (Treg) response of infected patients. METHODS The human gastric CD4(+) T cell response of 28 donors who were infected with H. pylori and 44 who were not infected was analysed using flow cytometry. The T cell associated mucosal cytokine response was analysed by real-time polymerase chain reaction assay of samples from 38 infected and 22 uninfected donors. Recombinant interleukin 10 (IL10) was added to co-cultures of H. pylori and AGS cells and its suppressive effects upon inflammatory responses were measured. RESULTS We found that the H. pylori-specific response consists of both T helper 1 and 2 subsets with high levels of IL10-secreting Tregs. People with peptic ulcer disease had a 2.4-fold reduced CD4(+)CD25(hi)IL10(+) Treg response (p = 0.05) but increased Th1 and Th2 responses (Th1: 3.2-fold, p = 0.038; Th2: 6.1-fold, p = 0.029) compared to those without ulcers. In vitro studies showed that IL10 inhibited IL8 expression and activation of nuclear factor kappa B induced by H. pylori in gastric epithelial cells, and enhanced H. pylori growth in a bacterial-cell co-culture model. CONCLUSIONS Together our data suggest that H. pylori induces a regulatory T cell response, possibly contributing to its peaceful coexistence with the human host, and that ulcers occur when this regulatory response is inadequate.
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Affiliation(s)
- K Robinson
- Institute of Infection, Immunity & Inflammation, University of Nottingham, Centre for Biomolecular Sciences, Nottingham, UK.
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Naik VS, Patil SB, Scholefield J, Kaye PV, James PD, Ilyas M, Zaitoun AM. Adenocarcinoma arising in a background of chronic atrophic pouchitis in an ileoanal pouch for ulcerative colitis. Histopathology 2008; 53:354-8. [DOI: 10.1111/j.1365-2559.2008.03094.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Edwards LJ, Atherton JC, Zaitoun AM, Constantinescu CS. A case of dysphagia with clinically isolated syndrome. Mult Scler 2008; 14:716-7. [PMID: 18424477 DOI: 10.1177/1352458507087325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Macafee DAL, Armstrong D, Hall RI, Dhingsa R, Zaitoun AM, Lobo DN. Pancreaticoduodenectomy with a "twist": the challenges of pancreatic resection in the presence of situs inversus totalis and situs ambiguus. Eur J Surg Oncol 2006; 33:524-7. [PMID: 17081721 DOI: 10.1016/j.ejso.2006.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 09/26/2006] [Indexed: 10/24/2022] Open
Affiliation(s)
- D A L Macafee
- Division of Gastrointestinal Surgery, Section of Surgery, E Floor, West Block, Nottingham University Hospitals, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Janes SEJ, Zaitoun AM, Catton JA, Aithal GP, Beckingham IJ. Brunner's gland hyperplasia at the ampulla of Vater. J Postgrad Med 2006; 52:38-40. [PMID: 16534163] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
Brunner's gland hyperplasia (BGH) is a diagnostic challenge where in the pathophysiology and natural history remain poorly understood. This Case Report describes BGH arising at the ampulla of Vater, causing abdominal pain and vomiting in a 46-year-old man. Owing to the inconclusive nature of imaging studies and suspicious intraoperative findings, a Whipple resection was performed without any complications. Histological analysis showed that the obstructing lesion was BGH, with no evidence of malignancy. This is only the second such case of its kind at the ampulla of Vater to be reported. In addition, we present the previously unreported endoscopic ultrasound findings. The subsequent literature review focuses on the pathophysiology, clinical presentation, diagnosis and management of BGH.
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Affiliation(s)
- S E J Janes
- Department of Surgery, Queens Medical Centre, Nottingham, United Kingdom.
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Abstract
We report on a 14-year-old girl with acute intestinal obstruction due to volvulus of the small bowel caused by a giant mesenteric lipoma. To the best of our knowledge, this presentation of a mesenteric lipoma is unknown in the previous paediatric literature.
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Affiliation(s)
- A Cherian
- Department of Paediatric Surgery, University Hospital Nottingham, Nottingham NG7 2UH, UK
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Wight CO, Zaitoun AM, Boulton-Jones JR, Dunkley C, Beckingham IJ, Ryder SD. Improving diagnostic yield of biliary brushings cytology for pancreatic cancer and cholangiocarcinoma. Cytopathology 2004; 15:87-92. [PMID: 15056168 DOI: 10.1046/j.0956-5507.2003.00097.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Biliary brushings are currently the best accepted method to obtain a cytological diagnosis of pancreatic cancer or cholangiocarcinoma. The technique has good specificity but poor sensitivity. Two dedicated pathologists reviewed 137 consecutive biliary brushings from 127 patients between February 1997 and February 2000. The ultimate diagnosis was determined by review of radiology, operative diagnosis and patient outcome. The sensitivity, specificity, positive predictive value and negative predictive value of the original results and the review results were calculated and compared. Additional diagnostic categories 'suspicious' and 'atypical possibly benign' were included on review. After review, the sensitivity improved from 49.4% to 89.0% and the specificity remained 100%. The use of the additional diagnostic category 'suspicious' increased the sensitivity to 90.4%, at the expense of a fall of the specificity to 66.7%. We conclude that review by two dedicated pathologists and additional diagnostic categories can improve the diagnostic accuracy of biliary brushings.
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Affiliation(s)
- C O Wight
- Department of Histopathology, Queen's Medical Centre, University Hospital NHS Trust, Nottingham, UK
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Nisar PJ, Zaitoun AM, Damera A, Hodi Z, Tierney GM, Beckingham IJ. Metastatic rectal adenocarcinoma to the liver associated with focal nodular hyperplasia. J Clin Pathol 2002; 55:967-9. [PMID: 12461070 PMCID: PMC1769820 DOI: 10.1136/jcp.55.12.967] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 45-year-old female patient underwent right hemihepatectomy for metastatic rectal adenocarcinoma. Preoperative imaging demonstrated an area of focal nodular hyperplasia (FNH) in segment VIII and metastatic carcinoma in segment VI of the liver. Gross and microscopic examination of the former lesion showed features typical of FNH with an intralesional metastatic adenocarcinoma. To the best of our knowledge, this is the first reported case of metastatic adenocarcinoma located within a lesion of FNH. The possibility of a pathogenetic association behind this occurrence is discussed.
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Affiliation(s)
- P J Nisar
- Section of Surgery, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Zaitoun AM, Al Mardini H, Awad S, Ukabam S, Makadisi S, Record CO. Quantitative assessment of fibrosis and steatosis in liver biopsies from patients with chronic hepatitis C. J Clin Pathol 2001; 54:461-5. [PMID: 11376020 PMCID: PMC1731453 DOI: 10.1136/jcp.54.6.461] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Hepatic fibrosis is one of the main consequences of liver disease. Both fibrosis and steatosis may be seen in some patients with chronic hepatitis C and alcoholic liver disease (ALD). AIMS To quantitate fibrosis and steatosis by stereological and morphometric techniques in patients with chronic hepatitis C and compare the results with a control group of patients with ALD. In addition, to correlate the quantitative features of fibrosis with the Ishak modified histological score. MATERIALS AND METHODS Needle liver biopsies from 86 patients with chronic hepatitis C and from 32 patients with alcoholic liver disease (disease controls) were analysed by stereological and morphometric analyses using the Prodit 5.2 system. Haematoxylin and eosin and Picro-Mallory stained sections were used. The area fractions (A(A)) of fibrosis, steatosis, parenchyma, and other structures (bile duct and central vein areas) were assessed by stereological method. The mean diameters of fat globules were determined by morphometric analysis. RESULTS Significant differences were found in the A(A) of fibrosis, including fibrosis within portal tract areas, between chronic hepatitis C patients and those with ALD (mean (SD): 19.14 (10.59) v 15.97 (12.51)). Portal and periportal (zone 1) fibrosis was significantly higher (p = 0.00004) in patients with chronic hepatitis C compared with the control group (mean (SD): 9.04 (6.37) v 3.59 (3.16)). Pericentral fibrosis (zone 3) occurred in both groups but was significantly more pronounced in patients with ALD. These results correlate well with the modified Ishak scoring system. However, in patients with cirrhosis (stage 6) with chronic hepatitis C the A(A) of fibrosis varied between 20% and 74%. The diameter of fat globules was significantly lower in patients with hepatitis C (p = 0.00002) than the ALD group (mean (SD): 14.44 (3.45) v 18.4 (3.32)). Microglobules were more frequent in patients with chronic hepatitis C than in patients with ALD. In patients with chronic hepatitis C, the fat globules had a zonal distribution in comparison with pan steatosis in ALD. CONCLUSION Quantitative, stereological techniques are simple and reliable for evaluating hepatic fibrosis and steatosis in chronic hepatitis C. They are most useful for assessing the origin, location, and the stage of fibrosis. Stereology and morphometry are recommended for the quantitation of fibrosis and steatosis, particularly for the evaluation of new treatment strategies in patients with chronic hepatitis C.
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Affiliation(s)
- A M Zaitoun
- Department of Histopathology, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH, UK.
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Zaitoun AM, Ebbs SR. Quantitative cytological assessment of Ki67 and AgNORs using computer-digitized image analysis of four clinicopathological breast lesions. Cytopathology 2000; 11:243-54. [PMID: 10983724 DOI: 10.1046/j.1365-2303.2000.00251.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Analysis of silver-stained proteins associated with nucleolar organiser regions (AgNORs) is proposed as a marker of cellular proliferation. This study describes the application of AgNORs and Ki67 in breast lesions. Sixty-one cases including fibroadenoma (FA), fibrocystic disease (FCD), ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were studied by image analysis to evaluate quantitative changes in AgNORs in both Ki67-positive, and Ki67-negative smears. The Ki67 index was assessed. Morphometric features of cell nuclei and AgNORs were determined by digitized computer image analysis (Prodit 5.2). The growth fraction was 5.08 for FA, 5.71 for FCD, 16.75 for DCIS and 23.26 for IC. The mean nuclear area was significantly higher in malignant cells than those of fibroadenoma and fibrocystic disease. In Ki67-positive cells the total area, long axis and number of AgNORs increased progressively across disease groups. Eccentricity of AgNORs and AgNORs: nuclear area ratios were significantly increased in malignant breast lesion in comparison with benign lesion in Ki67 positive cells. In Ki67 negative cells, the highest value of AgNORs was observed in DCIS. The AgNORs: nuclear area ratio demonstrated a statistically significant trend across the disease groups. This study demonstrates that the growth fraction, mean nuclear area and selected AgNORs features have potential for differentiating benign from malignant breast tumours.
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Affiliation(s)
- A M Zaitoun
- Department of Pathology, Mayday University Hospital, Surrey
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Zaitoun AM, McKee G, Coppen MJ, Thomas SM, Wilson PO. Completeness of excision and follow up cytology in patients treated with loop excision biopsy. J Clin Pathol 2000; 53:191-6. [PMID: 10823137 PMCID: PMC1731153 DOI: 10.1136/jcp.53.3.191] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To assess the relation between the grade and the status of follow up cytology, the completeness of loop excision biopsies with cervical intraepithelial neoplasia (CIN), and the findings at follow up cytology, as well as the differences between complete and incomplete exclusion, using the odds ratio. Treatment failure was assessed. METHODS 1600 women with CIN (290 CIN1, 304 CIN2, 1006 CIN3) were followed for a minimum of six months and a maximum of 10 years. A database was created and comparisons performed. The mean age of the patients was 37 years. RESULTS Excision was complete in over 84% of loops. Residual disease and recurrence of high grade dyskaryosis was more common in women with CIN 3 than CIN 2 or 1. No high grade dyskaryosis was seen in the fifth follow up smear in patients with CIN 1 and CIN 2. Residual, recurrent, and persistent disease was most common in patients with incompletely excised CIN at ectocervical and endocervical margins and deep margins of resection than in patients with completely excised CIN. The odds ratios were significantly higher in the women who had incomplete excision of CIN at ectocervical, endocervical, both ecto- and endocervical, and deep margins of resection compared with those with apparent complete excision of CIN lesions. One patient developed invasive squamous cell carcinoma 44 months after loop excision which showed CIN 3 invading endocervical crypts and extending to both ectocervical and endocervical margins of resection. CONCLUSIONS At long term follow up, patients with CIN who have residual disease are at increased risk of persistent disease and should therefore be followed up regularly with cytology and colposcopy. The findings support national policy of returning women with treated CIN of any grade to normal recall after five years except for cases of CIN3 where excision was incomplete or equivocal. In these cases follow up with annual smear for 10 years is recommended.
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Affiliation(s)
- A M Zaitoun
- Department of Pathology, Mayday University Hospital, Surrey, UK.
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Abstract
To evaluate the differential effects of portacaval shunting (PCS) on the morphological changes that occur in humans with portal-systemic encephalopathy, male rats underwent either PCS (13) or sham operations (10). Normal adult rats (6) were used as controls. All animals were killed 5 to 7 weeks after the surgery. The wet weight of the testes was obtained. Hematoxylin-eosin (HE)-stained sections at 5-micrometers thickness were used for stereological analysis using an image analysis system. Apoptosis was assessed quantitatively in HE and in in situ end-labeling (ISEL)-stained slides, while mitotic activity and mast cell numbers were assessed in 20 high-power fields. There was a significant reduction in the testicular mass (664 mg) in PCS rats in comparison with sham (2,199 mg) and control (1,937 mg) rats (P <.00001). The thickness of germinal epithelium was significantly reduced in PCS rats (64 micrometers) compared with sham (126 micrometers) and control groups (108 micrometers). The number of tubules per square millimeter and the mean curvature were significantly increased in PCS rats (P <.00001). There was a 112-fold increase in apoptosis in PCS rats (112) in comparison with the control and sham-operation groups (1.2 and 0.7, respectively). Mitosis was significantly reduced in the PCS group (P =.0089), but mast cells were unchanged. The results suggest that PCS in the absence of liver dysfunction produces testicular atrophy by reduction in mitosis, maturation arrest, and increased apoptosis of the germinal epithelium. PCS may therefore be responsible for gonadal atrophy that occurs with advanced liver disease in humans.
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Affiliation(s)
- A M Zaitoun
- Department of Pathology, Mayday University Hospital, Surrey, UK
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Abstract
AIM To assess the topographical relation between gastric glands, using the minimum spanning tree (MST), to derive both a model of neighbourhood and quantitative representation of the tissue's architecture, to assess the characteristic features of gastric atrophy, and to assess the grades of gastric atrophy. METHODS Haematoxylin and eosin stained sections from corporal and antral biopsy specimens (n = 139) from normal patients and from patients with nonatrophic gastritis and atrophic gastritis of grades 1, 2, and 3 (Sydney system) were assessed by image analysis system (Prodit 5.2) and 11 syntactic structure features were derived. These included both line and connectivity features. RESULTS Syntactic structure analysis was correlated with the semiquantitative grading system of gastric atrophy. The study showed significant reductions in the number of points and the length of MST in both body and antrum. The standard deviation of the length of MST was significantly increased in all grades of atrophy. The connectivity to two glands was the highest and most affected by the increased grade of atrophy. The reciprocal values of the Wiener, Randic, and Balaban indices showed significant changes in the volume of gland, abnormality in the shape of glands, and changes in irregularity and branching of the glands in both types of gastric mucosa. There was a complete separation in the MST, connectivity, and index values between low grade and high grade gastric atrophy. CONCLUSIONS (1) Gastric atrophy was characterised by loss of the gland, variation in the volume, reduction in the neighbourhood, irregularity in spacing, and abnormality in the shape of the glands. (2) Syntactic structure analysis significantly differentiated minor changes in gastric gland (low grade atrophy) from high grade atrophy of clinical significance. (3) Syntactic structure analysis is a simple, fast, and highly reproducible technique and appears a promising method for quantitative assessment of atrophy.
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Affiliation(s)
- A M Zaitoun
- Department of Pathology, Mayday University Hospital, Croydon, UK
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Abstract
The aims of this study were to compare the clinical with autopsy diagnoses, to evaluate the role of histological examination in the pathological diagnoses and to assess the new pathological diagnoses uncovered by autopsy. We aimed to obtain quantitative assessment of the sensitivity, specificity and accuracy of clinical diagnoses. The guidelines for postmortem reports by the Royal College of Pathologists (1993) were implemented for reports used in this study. These guidelines are similar in intent to those of the College of American Pathologists. Complete macroscopic and histological studies of 108 (53 females) autopsies were analysed. The mean age was 78.0+/-9.0 (SD) years (range 54-94 years). The interquartile range (25%ile 75%ile) was 72-84 years, with a median of 79.5 years. Seventy per cent of all causes of death were confirmed by macroscopical and histological examination. Sixty-one clinical diagnoses were inconsistent with the pathological findings. Histological examination contributed significantly to the final diagnosis in major (5%) and minor (6%) clinicopathological as well as new pathological findings (23%). The most common causes of death not suspected clinically were pulmonary embolism (23%), bronchopneumonia (22%), ischemic heart disease (13%) and malignancies (10%). The clinical sensitivity of antemortem diagnoses was 25% for peritonitis and 24% for pulmonary embolism. The overall clinical sensitivity was 54% and specificity 92%. The accuracy of positive diagnosis was 69% and accuracy of negative diagnosis 88%. Unexpected causes of death represented a third of all causes of death reported. Histological examination is an important tool in hospital autopsy audit. A quantitative approach can be used to assess the accuracy of postmortem clinical diagnoses, to identify the possible source of clinical diagnostic weakness, and provide data that may be of use for diagnostic precision in the more difficult clinical subjects.
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Affiliation(s)
- A M Zaitoun
- Department of Histopathology, Mayday University Hospital, Surrey, United Kingdom
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Abstract
1. The CoA and carnitine ester intermediates of mitochondrial beta-oxidation have not previously been quantified in liver disease, although there is some evidence that beta-oxidation is inhibited in alcoholic fatty liver. Mitochondria were isolated from needle liver biopsies from normal subjects, from patients with alcoholic fatty liver and patients with fatty liver of other aetiologies, incubated with 60 mumol/l [U-14C]hexadecanoate and the resultant CoA and carnitine esters were measured. 2. Although there was no significant difference in beta-oxidation flux between the patient groups, there was a significant rise in the proportion of 3-hydroxyacyl-CoA and 2-enoyl-CoA esters in patients with alcoholic fatty liver compared with normal subjects, and in patients with non-alcoholic fatty liver, suggesting an inhibition at the level of 3-hydroxyacyl-CoA dehydrogenase activity. 3. In alcoholic patients this difference could not be accounted for on the basis of the measured activity of short and long-chain 3-hydroxyacyl-CoA dehydrogenases, and it is suggested that either an inhibition of complex I activity or diminished amounts of ubiquinone are likely to be responsible for the observed accumulation of CoA and carnitine esters, which may contribute to the accumulation of triacylglycerols in alcoholic steatosis. In fatty liver of other aetiologies, short- and long-chain 3-hydroxyacyl-CoA dehydrogenase activities were decreased.
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Affiliation(s)
- S Eaton
- Department of Medicine, University of Newcastle upon Tyne, U.K
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Zaitoun AM, Booker MW, Coppen MJ. Isolated arteritis of the uterine cervix. J OBSTET GYNAECOL 1996. [DOI: 10.3109/01443619609030101] [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]
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Abstract
AIMS To determine the prevalence of lymphoid follicles in Helicobacter pylori positive and negative gastritis in antral and body type gastric mucosa in patients with non-ulcer dyspepsia (NUD), duodenal ulcer, or gastric ulcer; to correlate follicle presence with patient age; to evaluate the correlation between the prevalence of lymphoid follicles and active and inactive gastritis and its severity; and to assess the positive predictive value of lymphoid follicle prevalence with respect to H pylori infection. METHODS Gastric biopsy specimens, graded according to the Sydney system, from 337 patients were studied. RESULTS Lymphoid follicles occurred more often in antral mucosa (78%) than in body type mucosa (41%) and were observed in 85% of patients with H pylori positive gastritis. There was no significant difference between NUD and gastric and duodenal ulcer disease with regard to the presence of lymphoid follicles. The positive predictive value of the presence of lymphoid follicles in H pylori infection was 96%. Lymphoid follicles were more commonly observed in patients aged between 10 and 29 years. Lymphoid follicles were more frequently found in pangastritis of all subtypes than in antral gastritis and also in active gastritis than in inactive gastritis. The presence of lymphoid follicles correlated strongly with the degree and severity of gastritis. CONCLUSION Lymphoid follicles are a constant morphological feature of H pylori associated gastritis.
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Affiliation(s)
- A M Zaitoun
- Department of Histopathology, Al Qassimi Hospital, Sharjah, United Arab Emirates
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Affiliation(s)
- A M Zaitoun
- Department of Pathology, Mayday University Hospital, Thornton Heath, Surrey, UK
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Abstract
AIMS To determine the prevalence of Helicobacter pylori in five main nationality groups with gastric ulcer, duodenal ulcer, and non-ulcer dyspepsia; and to determine the histopathological types of gastritis and assess the graded variables of Helicobacter associated gastritis. METHODS Gastric antral and corpus biopsy specimens from 437 patients were examined for the prevalence of H pylori, 337 of which were classified and graded histologically according to the Sydney system. RESULTS The overall colonisation rate of H pylori was 90%, and there was no significant difference between groups of different ethnic origins. The colonisation rates were 99%, 89%, and 78% in patients with duodenal ulcer, non-ulcer dyspepsia, and gastric ulcer, respectively. Helicobacter associated gastritis was the most common form of chronic gastritis (87%). H pylori density was greater in the antrum than the body. Gastric atrophy in helicobacter associated gastritis was seen in 54% of the cases (43% grade I, 10% grade II, 1% grade III) and increased the older the patients. Atrophy of the corpus alone was very rare (1%). Atrophy and intestinal metaplasia were more prevalent in patients with gastric ulcer than duodenal ulcer. CONCLUSION The colonisation rate of H pylori was similar in the five groups studied and was almost invariably present in gastric biopsy specimens in patients with duodenal ulcer. H pylori associated gastritis was the most common form of gastritis. Atrophy was mainly of low grade and increased the older the patient.
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Affiliation(s)
- A M Zaitoun
- Department of Histopathology, Al Quassimi Hospital, Sharjah, UAE
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Abstract
AIMS To investigate a female patient with a tumour mass of the terminal ileum, to define the nature of the tumour, and to correlate its morphology and behaviour with similar types of tumours of the large intestine and stomach. METHODS Tissues obtained at colonoscopy, from hemicolectomy specimens, and from liver and peritoneal biopsy specimens were studied macroscopically, microscopically, histochemically, and immunohistochemically for epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), neuron specific enolase (NSE), and S100 protein. RESULTS Macroscopic examination showed a tumour of the terminal ileum protruding into the caecum. Microscopically the tumour showed two components, one adenoma with moderate dysplasia and the other carcinoid tumour. The adenomatous component stained positively for EMA and CEA and negatively for NSE. The carcinoid component stained positively for NSE and negatively for EMA and CEA. Histochemically the carcinoid area was argyrophil positive and argentaffin negative. Only the carcinoid had metastasised, to the liver, peritoneum, and the lymph nodes, at the time of diagnosis. CONCLUSION The morphological, histochemical, and immunohistochemical findings confirm the diagnosis of a composite adenoma-carcinoid tumour of the terminal ileum.
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Affiliation(s)
- N M Varghese
- Department of Gastroenterology, Mayday Healthcare NHS Trust, Surrey
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38
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Abstract
Gastric biopsy specimens from 283 patients with ulcer and non-ulcer dyspepsia attending five gastroenterology clinics in the northern region of the United Arab Emirates (UAE) were tested by the agar gel test (n = 115) or the ultra-rapid endoscopy room test (n = 168) for the presence of Helicobacter pylori urease. Results were compared with a histological technique using the Romanowsky type (Diff-3) stain for detecting H pylori in both antral and body type gastric mucosa. A sensitivity of 94% and specificity of 100% using the agar gel test compared with 87% sensitivity and 99.3% specificity for the ultra-rapid endoscopy room test. Grading of H pylori in gastric biopsy specimens showed that the higher the histological grade, the more likely that the urease test would be positive. Both forms of urease tests have high specificity for detecting H pylori in gastric biopsy specimens, although the urea agar test has a higher sensitivity than the ultra-rapid test. Low numbers of H pylori in gastric biopsy specimens are the most important determinant of a false negative urease test.
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Affiliation(s)
- A M Zaitoun
- Department of Pathology, Al Qassimi Hospital, Sharjah, UAE
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Abstract
A Romanowsky type (Diff-3) stain was used for identifying Helicobacter pylori in gastric biopsy specimens from 50 patients with ulcer and non-ulcer dyspepsia. Air dried smears were prepared from fresh biopsy tissue and histological sections were prepared from paraffin wax processed tissue. The Diff-3 technique is accomplished in five steps and takes about 30 seconds. Results using the Diff-3 stain correlated 100% with those using the Giemsa stain. The Diff-3 stain is reliable, simple, rapid, easy and clean, and smears prepared from fresh biopsy tissue can be examined and an immediate report given. The method is recommended for the identification of H pylori in smears prepared from fresh tissue as well as in sections prepared from processed tissue.
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Affiliation(s)
- A M Zaitoun
- Pathology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
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Zaitoun AM, Cobden I, al Mardini H, Record CO. Morphometric studies in rectal biopsy specimens from patients with ulcerative colitis: effect of oral 5 amino salicylic acid and rectal prednisolone treatment. Gut 1991; 32:183-7. [PMID: 1864539 PMCID: PMC1378805 DOI: 10.1136/gut.32.2.183] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [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: 12/29/2022]
Abstract
Morphometric measurements were performed on rectal biopsy specimens from 10 normal control subjects and 33 patients with a relapse of distal ulcerative colitis before and after treatment for four weeks in a double blind controlled trial with oral eudragit S coated 5 amino salicylic acid (n = 12) or rectal prednisolone enemas (n = 15). Measurements were assessed using a computer aided measuring system and a counting technique. When untreated patients were compared with the control group there were significant decreases in the area and height of the surface epithelium, in the area of crypt epithelium, and in the ratios of goblet cells to epithelial cells and of surface epithelium to lamina propria. The vascular and lamina propria areas and the number of intraepithelial polymorphs were increased. Treatment with 5 amino salicylic acid and corticosteroids resulted in similar morphological improvements: there was an increase in the area and height of the surface epithelium and the ratios of surface epithelium to lamina propria and of surface to crypt cell height. The ratio of goblet cells to epithelial cells also increased after treatment, while the numbers of polymorphs in the surface and crypt epithelium and lumen decreased. In conclusion, computerised morphometry is valuable for the assessment of the treatment of patients with ulcerative colitis and that in the doses used both treatments were of similar efficacy.
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Affiliation(s)
- A M Zaitoun
- Gastroenterology Unit, Royal Victoria Infirmary, Newcastle
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Aherne WA, Zaitoun AM, Lauder I, Hull DL. Cytokinetic changes in the thymus of tumour-bearing and of dexamethasone-treated mice. Cell Tissue Kinet 1980; 13:485-95. [PMID: 7459979 DOI: 10.1111/j.1365-2184.1980.tb00489.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Changes in the cell population kinetics of the Balb/c mouse thymus were studied (a) during the growth of a syngeneic transplantable sarcoma and (b) following intraperitoneal injection of dexamethasone. The weight of the thymus fell briefly after tumour transplantation, then recovered with overshoot and eventually declined profoundly. After dexamethasone injection the weight of the thymus fell to roughly one-third of its normal value in 36 hr. Similar cytokinetic changes were observed in both sets of experiments; thymic wasting was accompanied by a small increase in thymocyte cell cycle time, a prolongation of the S-phase of the cycle, a marked decrease in the thymocyte cell production rate and a marked reduction in the growth fraction of the thymocyte population in the superficial cortex. It is suggested that thymic atrophy in tumour bearing animals may be a stress phenomenon.
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Zaitoun AM. Cell population kinetics of the germinal centres of lymph nodes of BALB/c mice. J Anat 1980; 130:131-7. [PMID: 7364656 PMCID: PMC1233117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The cell population kinetics of the germinal centres of mesenteric, axillary and inguinal lymph nodes have been studied using 3H-TdR and stathmokinetic techniques. The FLM computed by the Gilbert program showed an ill-defined second peak. The durations of the cell cycle phases were similar in the three anatomical sites. The stathmokinetic data showed only slight variation in the KB and tC(a) values between the different groups of lymph nodes. The Im, IS, and IP values indicated that the number of proliferating cells of the germinal center was very high. When the results obtained with 3H-TdR were compared with those obtained stathmokinetically, good agreement was generally found.
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Zaitoun AM. Computer assisted stathmokinetic and FLM data analysis of cell cycle time in the germinal centre of the spleen: effect of prednisolone. Virchows Arch B Cell Pathol Incl Mol Pathol 1979; 31:7-13. [PMID: 42203 DOI: 10.1007/bf02889917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
The effects of dexamethasone on the cell kinetics of a rapidly growing syngeneic B cell malignant lymphoma in Balb/c mice have been studied. Growth curves, stathmokinetic studies and frequency of labelled mitoses (FLM) experiments were performed in groups of dexamethasone treated and control animals. These studies showed that tumour growth was arrested after 8 days treatment at which time the tumour weights were approximately half those of control animals. Dexamethasone increased the duration of the cell cycle with a particular increase in the duration of DNA synthesis. The results indicated that the effect on tumour growth could be attributed to a reduction in the growth fraction.
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Zaitoun AM, Lauder I, Aherne WA. Cell population kinetic profile of the mouse thymus, and the changes induced by prednisolone. Cell Tissue Kinet 1979; 12:191-201. [PMID: 427877 DOI: 10.1111/j.1365-2184.1979.tb00125.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The cell population kinetic parameters of the thymus in BALB/c mice have been estimated using stathmokinetic and [3H]TdR techniques in both control animals and animals treated with prednisolone. FLM data were analysed by computer using the Gilbert program. The study showed that prednisolone had an inhibitory effect mainly in the DNA synthesis phase and in G1. Stathmokinetic data also showed a decrease in the cell birth rate and an increase in the apparent cell cycle time (or potential doubling time) after treatment. The labelling index, the mitotic index and the growth fraction were also decreased. The study also shows a good agreement between the data obtained by stathmokinetic and [3H]TdR techniques.
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