Comparison between two types of needles for Endoscopic Ultrasound (EUS)-guided fine aspiration biopsy of pancreatic and upper gastrointestinal masses

BACKGROUND

EUS-guided fine-needle aspiration (FNA) has long been the main method for sampling pancreatic lesions. Recently, the method of fine-needle biopsy (FNB) was introduced in practice, allowing for the acquisition of tissue cores while aspirating the lesion. We hereby report our experience with a new FNB needle compared with the standard FNA needle.

METHODS

Retrospective data from our department were collected on patients who underwent FNB using the Acquire EUS-FNB needle (Boston Scientific, Massachusetts) and FNA using the EchoTip Ultra EUS-FNA Needle (Cook Medical, Indiana) between January 2017 and February 2018. The cases were reviewed independently by two cytopathologists and evaluated for the presence of cell block or core tissue material, adequacy for potential ancillary testing, and number of passes.

RESULTS

The number of passes ranged from 1 to 16, with a mean of 5.52 ± 3.74 in the FNA group, and from 1 to 6, with a mean of 2.74 ± 1.11 passes in the FNB group (P < .0001). Tissue cores were present in 87.23% of the FNB needle samples. A cell block was adequate in 36.36% of cases using the FNA needle. The diagnostic yield as well as the adequacy for ancillary testing were significantly different between the two groups (P = .0001). The tumor size, location and patients' demographics were not statistically significant between the two groups.

CONCLUSION

Compared with the conventional needle, the new FNB needle was associated with a lower number of passes and a better yield for histological material.

The chemopreventive effect of withaferin A on spontaneous and inflammation-associated colon carcinogenesis models

Chemopreventive effects and associated mechanisms of withaferin A (WA) against intestinal and colon carcinogenesis remain unknown. We investigated the chemopreventive effect of WA on transgenic adenomatous polyposis coli (APCMin/+) mouse and chemically induced azoxymethane/dextran sodium sulfate (AOM/DSS) models of intestinal and colon carcinogenesis. Oral WA administration (4 and 3 mg/kg) inhibited tumor initiation and progression of intestinal polyps formation in APCMin/+ mice and colon carcinogenesis in the AOM/DSS mouse model. WA-administered mice showed a significant reduction in both number [duodenum, 33% (P > 0.05); jejunum, 32% (P < 0.025); ileum, 43% ( P < 0.001); and colon 59% (P < 0.01] and size of polyps in APCMin/+ mice compared with the respective controls. Similarly, tumor multiplicity was significantly reduced (P < 0.05) in the colon of WA-administered AOM/DSS mice. Pathological analysis showed reduced adenomas and tissue inflammation in WA-administered mouse models. Molecular studies suggested that WA inhibited the expression of inflammatory (interluekin-6, tumor necrosis factor-alpha and cyclooxygenase-2), pro-survival (pAKT, Notch1 and NF-κB) markers in APCMin/+ and AOM/DSS models. The results suggest that WA is a potent agent for preventing colon carcinogenesis and further investigation is required to show clinical utility of the agent.

Enhancement of gut barrier function by microbial metabolite, urolithin A via AhR-Nrf2 dependent pathways in IBD

Inflammatory bowel diseases (IBD) consisting of Crohn’s and ulcerative colitis are resultant of dysregulation of the immune system leading to intestinal inflammation and microbial dysbiosis. Numerous studies in recent years highlighted the pivotal role of gut microbiota and their metabolites in host physiological processes including in IBD. Urolithin A (UroA) is a microbial metabolite derived from polyphenolics (e.g., ellagitannins/ellagic acid) of pomegranate and berries. We also synthesized a potent structural analogue of UroA (UAS03) and tested their efficacies in preventing and treating colitis in pre-clinical models. Our studies showed that UroA/UAS03 significantly enhance gut barrier function in addition to blocking unwarranted inflammation. We demonstrate that UroA and UAS03 exert their barrier functions through activation of aryl hydrocarbon receptor (AhR)- nuclear factor erythroid 2–related factor 2 (Nrf2)-dependent pathways to upregulate epithelial tight junction proteins. In addition, treatment with these compounds attenuated colitis in pre-clinical models by remedying barrier dysfunction and blocking increased inflammatory mediators such as IL-6, TNF-α and IL-1β. UroA/UAS03 failed to induce tight junction proteins and protect against 2,4,6-Trinitrobenzenesulfonic acid (TNBS)-induced colitis in AhR−/− and Nrf2−/− mice suggesting an obligatory requirement of AhR and Nrf2 pathways for UroA/UAS03 mediated beneficial activities. Overall, the results highlight how microbial metabolites provide two-pronged beneficial activities at gut epithelium by enhancing barrier functions and reducing systemic and local inflammation to protect from colonic diseases.

miR-301a expression: Diagnostic and prognostic marker for prostate cancer

BACKGROUND

Prostate-specific antigen screening for prostate cancer (CaP) remains controversial. This study establishes the role of microRNA 301a (miR-301a) as a supplemental biomarker that can distinguish between patients with benign prostate hyperplasia and clinically significant CaP. We evaluate the ability of miR-301a to predict the adverse pathology of CaP.

METHODS

In the first cohort, serum and prostate tumor samples were obtained from thirteen patients with Benign prostate hyperplasia (BPH), twelve patients with Gleason 6, and sixteen patients with Gleason 7 prostate adenocarcinoma. In the second cohort, 40 prostatectomy cases were selected (BPH:12, Gleason 6:12 and Gleason 7:16). MiRNA was extracted from serum and tumor samples. Quantitative reverse transcription-polymerase chain reaction was performed for detection of miR-301a. To understand the molecular role of miR-301a, we performed cell viability, Western blots, promoter analysis, overexpression, and silencing studies in BPH and DU-145 cell lines.

RESULTS

MiR-301a demonstrated a significantly higher expression in both serum and tumor tissue in patients with CaP when compared to patients with BPH (P = 0.011 and 0.013 for serum and tissue expression, respectively). Expression of miR-301a in prostatectomy specimens correlated with increased Gleason score. We demonstrated that miR-301a inhibited the pro-apoptotic function of RUNX3, and activated ROCK1-mediated pro-survival signal in CaP. Silencing miR-301a initiated the pro-apoptotic function of RUNX3 by inhibiting ROCK1 expression in CaP cells.

CONCLUSIONS

Expression of miR-301a could be a valuable adjunct tool for stratifying patients with elevated prostate-specific antigen, as well as those diagnosed with CaP. Including the miR-301a as an additional variable in MSKCC post-prostatectomy nomogram improved its ability in facilitating clinical decision-making.

Abstract 3930: Chemoprevention of metastatic colon cancer by a novel small molecule

Introduction: Colon cancer is a one of the leading cause of death in both men and women. Metastatic colon cancer is responsible for mortality due to resistance to conventional therapies. Our group has previously reported that activation of AKT and Notch1 plays an important role in metastasis of colon cancer cells. As Notch1 and AKT regulates cell proliferation and are upstream of epithelial to mesenchymal transition (EMT) cascade, it seems interesting to explore their inhibition for pharmacological intervention. In the present study we identified a sesquiterpene molecule, Verrucarin J (VJ), that inhibited Notch1 expression and downregulated AKT mediated EMT transition in colon cancer cells.

Methods: The anticancer effect of VJ was assessed on both colon cancer cells and stably AKT overexpressing colon cells by cell proliferation, apoptosis and Western blot analysis. For xenograft studies, pCMV/HCT-116 or AKT/HCT-116 cells (1.5 × 106) in a 50-μl final volume of phosphate-buffered saline (PBS) were injected subcutaneously into separate flanks of the mice. Also effects of VJ were determined in mouse model of colorectal cancer i.e. APC min+/_ mice. Statistical analysis was done by unpaired Student's t-test and one way ANOVA,*p≤0.05, **p≤0.01, ***p≤0.001.

Results: Molecular analysis of VJ treatment on colon cancer cells revealed that it inhibited colon cancer growth by down regulating AKT and Notch1 signaling. Western blot analysis revealed that VJ inhibits AKT/NF-κβ/ Bcl2- signaling axis in colon cancer cells. VJ also Inhibited migration and invasion of colon cancer cells that corresponds with downregulation of mesenchymal marker expression. In addition, VJ treatment induces apoptosis in colon cancer cells as well as AKT overexpressing cells. Intraperitoneal administration of VJ in pCMV/HCT116 and AKT/HCT-116 xenograft mice revealed decrease in tumor volume in comparison with control mice. We also examined the in vivo efficacy of VJ in ApcMin/+ mouse model. Treatment of ApcMin/+ with VJ (0.5 mg/kg/IP/twice a week) over 12 weeks significantly reduced the number of intestinal polyps (distal 84%; Middle 63% and Proximal 2%) as compared vehicle treated mice. In addition, we also observed 50% reduction in number of colon tumors in VJ treated mice.

Conclusion: In conclusion, our studies suggest that VJ inhibits both AKT and Notch1 signaling and induces apoptosis in colon cancer cells. In vivo studies revealed significant reduction in tumor formation in mice models of colon cancer. Hence VJ could be a viable therapeutic agent for treating patients with metastatic colon cancer.

Citation Format: Deeksha Pal, Balaji Chandrasekaran, Ashish Tyagi, Becca Von Baby, Houda Alatassi, Murali Ankem, Chendil Damodaran. Chemoprevention of metastatic colon cancer by a novel small molecule [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3930.

Abstract 3097: Chemo prevention effect of Withaferin A, a natural compound, on mouse models of colorectal carcinogenesis

Introduction: Colorectal cancer (CRC) is the most common cancer and one of the leading causes of cancer-related deaths in United States as well as worldwide. Development of sporadic CRC takes an average of 15-20 years, so establishing preventive measures are possible. We are interested in a dietary compound, Withaferin-A (WA), which possesses both chemotherapeutic and chemopreventive properties. WA's effect was studied on both colitis-mediated colon and spontaneous-intestinal carcinogenesis mouse models.

Methods: In the present study, two animal models of colon cancer were used to study the chemo- preventive effect of WA. In intestinal tumorigenesis model C57BL/6-ApcMin/+ , mice at six weeks of age were orally fed with the vehicle or WA (4mg/kg body weight of mice) for five days per week for 12-14 weeks. The other model used was AOM/DSS (Azoxymethane/dextran sulfate sodium), which induces gut inflammation and tumorigenesis. Intraperitoneal injection of AOM (8mg/kg) was followed by three cycles of DSS. WA (3mg/kg body weight of mice) was administered five times per week for 8-10 weeks. After completion of the studies, the tumor tissues were subjected to histopathological and molecular analysis. An unpaired Student's t-test was used for statistical analysis.

Results: Oral administration of WA to ApcMin/+ mice leads to a significant decrease in the number of intestinal polyps and colon tumors (colon: 42%, p=0.025), proximal: 53%, p=0.0063, middle: 27.84%, p= 0.28, distal: 32.8, p= 0.001) when compared to vehicle-treated mice. Similarly, in AOM/DSS, oral administration of WA reduced polyp multiplicity by 40% (p= 0.02) compared to vehicle-treated controls. Moreover, the treatment group of both colon cancer models showed inhibition of pro-survival signaling markers (Notch1, pAKT and NFκB) as well as a decrease in proliferative markers.

Conclusion: Our results suggest that WA effectively suppresses intestinal polyp development and colitis-mediated colon carcinogenesis, suggesting a preventive and therapeutic role in colon cancer models. These findings warrant further investigation to develop novel strategies to achieve maximum benefit of dietary agents for cancer chemoprevention.

Citation Format: Deeksha Pal, Balaji Chandrasekaran, Becca Von Baby, Houda Alatassi, Murali Ankem, Chendil Damodaran. Chemo prevention effect of Withaferin A, a natural compound, on mouse models of colorectal carcinogenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3097.

Abstract 4810: Targeting androgen receptor in combination with cisplatin: Effective treatment strategy for muscle invasive bladder cancer

Background: Bladder cancer is one of the major causes of cancer death in US and worldwide. Cisplatin is a key component of chemotherapeutic regimens employed in the treatment of advanced bladder cancer. The role of androgen and androgen receptor (AR) signaling in bladder cancer remains uncharacterized.

Aim: The aim of the study is to delineate the role of AR in bladder cancer and to determine whether combination of AR inhibitor, enzalutamide (Enz) and cisplatin-based therapies effectively inhibit the growth of muscle invasive bladder cancer (MIBC).

Methods: AR expression was determined in 75 human bladder cancer specimens and in a panel of bladder cancer cell lines. Cells grown in charcoal stripped media supplemented with dihydrotestosterone (DHT) were treated with cisplatin, enzalutamide (AR inhibitor), or a combination of both. Cellular/phenotypic analysis including MTT assay, apoptotic assay, migration as well as invasion assays and molecular analysis including western blotting, real time PCR analysis were performed. Isobologram analysis for the combination was performed and analyzed with CompuSyn. Experiments were repeated in triplicates and analyzed with unpaired Student's t-test and one way ANOVA *p≤0.05, **p≤0.01, ***p≤0.001.

Results: AR expression was seen in around 40% of bladder cancer patients. Inhibition of AR signaling by enzalutamide effectively inhibited the growth of AR+ MIBC cells. Interestingly, enzalutamide in combination with cisplatin (Enz + Cis) synergistically inhibited the proliferation of MIBC cells, TCCSUP (CI: 0.42, 1.25 + 5 μM) and J82 (CI: 0.79, 2.5 + 5 μM) at low concentrations of enzalutamide and cisplatin resp.. The molecular studies revealed the induction of DNA damage markers (pATM, pATR, pChk1, pHis) and enhanced expression of the pro-apoptotic genes (Bax, caspases-3 and PARP) in Enz+Cis treated AR+ MIBC cells. In addition, we demonstrated abrogation of invasive and migratory potential with Enz+Cis treatment, by downregulation of the mesenchymal markers (N-cadherin, slug, β-catenin, and vimentin) in both cell lines. Our studies suggest combination of Enz + Cis may be effective in patients with AR+ MIBC.

Conclusion: Combination of cisplatin and AR inhibition effectively inhibit bladder tumor growth and migration, and hold promise as synergetic therapies for AR+ bladder cancer patients.

Citation Format: Ashish Tyagi, Balaji Chandersekaran, Samarpit Rai, Houda Alatassi, Ahmed Q. Haddad, Murali K. Ankem, Chendil Damodaran. Targeting androgen receptor in combination with cisplatin: Effective treatment strategy for muscle invasive bladder cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4810.

Oral administration of withaferin A inhibits carcinogenesis of prostate in TRAMP model

We previously reported that withaferin A (WA), a natural compound, deters prostate cancer by inhibiting AKT while inducing apoptosis. In the current study, we examined its chemopreventive efficacy against carcinogenesis in the prostate using the transgenic adenocarcinoma of mouse prostate (TRAMP) model. Two distinct sets of experiments were conducted. To determine whether WA delays tumor progression, it was given before cancer onset, at week 6, and until week 44. To determine its effect after the onset of prostate cancer, it was given from weeks 12 to 35. In both strategies, oral administration of WA effectively suppressed tumor burden when compared to vehicle-treated animals. No toxicity was seen in treated animals at gross pathological examination. Western blot analysis and immunohistochemistry of tumor sections revealed that in TRAMP controls, AKT and pAKT were highly expressed while nuclear FOXO3a and Par-4 were downregulated. On the contrary, treated mice showed inhibition of AKT signaling and activation of FOX03a-Par-4-induced cell death. They also displayed inhibition of mesenchymal markers such as β-catenin, vimentin, and snail as well as upregulation of E-cadherin. Because expressions of the angiogenic markers factor VIII and retic were downregulated, an anti-angiogenic role of WA is suggested. Overall, our results suggest that WA could be a promising anti-cancer agent that effectively inhibits carcinogenesis of the prostate.

Withaferin-A suppress AKT induced tumor growth in colorectal cancer cells

The oncogenic activation of AKT gene has emerged as a key determinant of the aggressiveness of colorectal cancer (CRC); hence, research has focused on targeting AKT signaling for the treatment of advanced stages of CRC. In this study, we explored the anti-tumorigenic effects of withaferin A (WA) on CRC cells overexpressing AKT in preclinical (in vitro and in vivo) models. Our results indicated that WA, a natural compound, resulted in significant inhibition of AKT activity and led to the inhibition of cell proliferation, migration and invasion by downregulating the epithelial to mesenchymal transition (EMT) markers in CRC cells overexpressing AKT. The oral administration of WA significantly suppressed AKT-induced aggressive tumor growth in a xenograft model. Molecular analysis revealed that the decreased expression of AKT and its downstream pro-survival signaling molecules may be responsible for tumor inhibition. Further, significant inhibition of some important EMT markers, i.e., Snail, Slug, β-catenin and vimentin, was observed in WA-treated human CRC cells overexpressing AKT. Significant inhibition of micro-vessel formation and the length of vessels were evident in WA-treated tumors, which correlated with a low expression of the angiogenic marker RETIC. In conclusion, the present study emphasizes the crucial role of AKT activation in inducing cell proliferation, angiogenesis and EMT in CRC cells and suggests that WA may overcome AKT-induced cell proliferation and tumor growth in CRC.

Multipurpose tenofovir disoproxil fumarate electrospun fibers for the prevention of HIV-1 and HSV-2 infections in vitro

Sexually transmitted infections affect hundreds of millions of people worldwide. Both human immunodeficiency virus (HIV-1 and -2) and herpes simplex virus-2 (HSV-2) remain incurable, urging the development of new prevention strategies. While current prophylactic technologies are dependent on strict user adherence to achieve efficacy, there is a dearth of delivery vehicles that provide discreet and convenient administration, combined with prolonged-delivery of active agents. To address these needs, we created electrospun fibers (EFs) comprised of FDA-approved polymers, poly(lactic-co-glycolic acid) (PLGA) and poly(DL-lactide-co-ε-caprolactone) (PLCL), to provide sustained-release and in vitro protection against HIV-1 and HSV-2. PLGA and PLCL EFs, incorporating the antiretroviral, tenofovir disoproxil fumarate (TDF), exhibited sustained-release for up to 4 weeks, and provided complete in vitro protection against HSV-2 and HIV-1 for 24h and 1 wk, respectively, based on the doses tested. In vitro cell culture and EpiVaginal tissue tests confirmed the safety of fibers in vaginal and cervical cells, highlighting the potential of PLGA and PLCL EFs as multipurpose next-generation drug delivery vehicles.

Abstract 2903: 1-Methoxyphaseollidin: Novel gamma secretase inhibitor targeting notch-1 signaling in breast cancer stem cells

We recently showed that two different ALDH+ and CD44+/CD24-/low breast cancer stem cells (BSCSs) exhibited stem cell characteristics that include self-renewal, extensive proliferation, the ability to form non-adherent spherical clusters, chemotherapy resistance and high Notch1 expression. We have identified a compound compound: 6-(3-methylbut-2-enyl) coumestrol (Pso) and treatment with Pso resulted in growth inhibition and an EMT phenotype in both BCSCs and BC cells. Oral Pso administration at physiologically achievable doses (25 mg/kg/BW) suppressed the growth of BCSCs and BC xenografts without toxicity. In the current studies, we identified several novel Pso-derived analogs that may be more potent than the parent compound. One such compound, 1-methoxyphaseollidin (1MP), obtained via three main functional group changes: (i) translocation of the isoprenyl moiety from the phenyl ring fused to the pyran ring (as in Pso) to the phenyl ring adjacent to the furan ring, (ii) removal of the carbonyl group from the pyran ring, and (iii) introduction of a methoxy group at the 1-position, inhibited Notch1 activity and growth of both BSCS and BC cells at nM concentration (IC50: 300nM), which is 100 times more potently than Pso in cell culture models. Molecular studies suggest that 1MP inhibits Notch signaling pathways (Hes1, Hey1 and Presenilin) in both BCSC and BC cells. Further, downregulation of AKT signaling (pAKT (S473), p65 and BCl-2 were seen in 1MP treated cells. Docking studies suggest that 1MP binds outside of the catalytic unit of γ-secretase and induces a conformational change, resulting in Notch1 inhibition in both BCSCs and BC cells. More importantly, administration of 1MP significantly inhibited the growth of BCSC and BC tumors without causing gastrointestinal toxicity in tumor-bearing mice. H&E staining suggests that 1MP treated tumors show infiltrate to margins are less as compared to vehicle treated mice’s. We believe targeting notch1 signaling and optimizing 1MP could be an effective therapeutic strategy for treating breast cancer.

Note: This abstract was not presented at the meeting.

Citation Format: Venkatesh Kolluru, Deeksha Pal, Becca Baby, Houda Alatassi, Arun Kumar Sharma, Murali Ankem, Chendil Damodaran. 1-Methoxyphaseollidin: Novel gamma secretase inhibitor targeting notch-1 signaling in breast cancer stem cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2903. doi:10.1158/1538-7445.AM2017-2903

Inhibition of autophagy prevents cadmium-induced prostate carcinogenesis

BACKGROUND

Cadmium, an established carcinogen, is a risk factor for prostate cancer. Induction of autophagy is a prerequisite for cadmium-induced transformation and metastasis. The ability of Psoralidin (Pso), a non-toxic, orally bioavailable compound to inhibit cadmium-induced autophagy to prevent prostate cancer was investigated.

METHODS

Psoralidin was studied using cadmium-transformed prostate epithelial cells (CTPE), which exhibit high proliferative, invasive and colony forming abilities. Gene and protein expression were evaluated by qPCR, western blot, immunohistochemistry and immunofluorescence. Xenograft models were used to study the chemopreventive effects in vivo.

RESULTS

Cadmium-transformed prostate epithelial cells were treated with Pso resulting in growth inhibition, without causing toxicity to normal prostate epithelial cells (RWPE-1). Psoralidin-treatment of CTPE cells inhibited the expression of Placenta Specific 8, a lysosomal protein essential for autophagosome and autolysosome fusion, which resulted in growth inhibition. Additionally, Pso treatment caused decreased expression of pro-survival signalling proteins, NFκB and Bcl2, and increased expression of apoptotic genes. In vivo, Pso effectively suppressed CTPE xenografts growth, without any observable toxicity. Tumours from Pso-treated animals showed decreased autophagic morphology, mesenchymal markers expression and increased epithelial protein expression.

CONCLUSIONS

These results confirm that inhibition of autophagy by Pso plays an important role in the chemoprevention of cadmium-induced prostate carcinogenesis.

Sellar and Suprasellar Anaplastic Hemangiopericytoma in a 34-Year Old Man

Central nervous system hemangiopericytomas are rare, representing <1% of all primary central nervous system tumors. Hemangiopericytomas of the sellar region are exceptionally rare. Here we present a case of a sellar/suprasellar anaplastic hemangiopericytoma.The patient is a 34 year old man with a history of a resected pituitary tumor, diagnosed as a pituitary adenoma per the patient, who presented with bitemporal hemianopsia. Radiology revealed a 3.7 cm enhancing sellar/suprasellar mass with local mass effect, consistent with a pituitary adenoma. On resection, the mass was diagnosed as anaplastic hemangiopericytoma, WHO grade III. The patient experienced residual tumor with two further resections before expiring of a pulmonary embolus seven months later.There are only 10 previously documented cases of sellar/suprasellar hemangiopericytoma in the English-speaking world literature. This is the third case of anaplastic hemangiopericytoma in this region. These cases should be recorded until meaningful conclusions about therapy and prognosis can be established.

Targeting aberrant expression of Notch-1 in ALDH+ cancer stem cells in breast cancer

We have previously reported that high aldehyde dehydrogenase (ALDH) enzyme activity in breast cancer cells results in breast cancer stem cell (BCSC) properties by upregualting Notch-1 and epithelial mesenchymal markers. This results in chemoresistance in breast cancer. Here, we examined the functional and clinical significance of ALDH expression by measuring the ALDH levels in breast cancer tissues by immunohistochemistry. There was a significantly higher ALDH expression in higher grade breast cancer tumor tissues (Grade- II and III) versus normal breast tissues. Injection of BCSC (ALDH⁺ and CD44⁺ /CD22^- ) cells resulted in aggressive tumor growth in athymic mice versus ALDH^- cells. The ALDH⁺ and CD44⁺ /CD22^- tumors grow rapidly and are larger than ALDH^- tumors which were slow growing and smaller. Molecularly, ALDH⁺ tumors expressed higher expression of Notch-1 and EMT markers than ALDH^- tumors. Oral administration of the naturally occurring Psoralidin (Pso, 25 mg/kg of body weight) significantly inhibited the growth in ALDH⁺ and ALDH^- tumors as well. Psoralidin inhibited Notch-1 mediated EMT activation in ALDH⁺ and ALDH^- tumors-this confirms our in vitro findings. Our results suggest that Notch-1 could be an attractive target and inhibition of Notch-1 by Psoralidin may prevent pathogenesis of breast cancer as well as metastasis. © 2016 Wiley Periodicals, Inc.

miR-301a expression: A prognostic marker for prostate cancer

PURPOSE

The diagnosis and treatment of prostate cancer (CaP) continues to be challenging, as prostate-specific antigen (PSA) appears to be overly sensitive and biopsy is the only reliable method for confirmation. Hence, the goal of the study is to identify a biomarker that could distinguish malignant cancer from benign prostatic hyperplasia (BPH) during the early diagnosis of the disease.

MATERIALS AND METHODS

A total of 75 formalin fixed paraffin embedded (FFPE) with matching controls, 4 paired metastatic tumors, 6 fresh tumor tissues and BPH (13 cases) with their clinical diagnosis were selected for this study. Prostate cancer cell lines and normal prostate epithelial cell lines were obtained from ATCC and subjected to phenotypic analysis.

RESULTS

We observed significant differential expression of miR-301a in CaP samples in comparison to BPH and adjacent benign samples. The overexpression of miR-301a activates the invasion/migration of CaP cells. In contrast, silencing miR-301a expression inhibited the colony-forming ability, adhesion, invasion and migration of CaP cells. Similarly, the overexpression of miR-301a increased cell motility in normal RWPE-1 prostate epithelial cells. Our results suggest that miR-301a is differentially expressed between BPH and CaP specimens and that the expression of miR-301a correlates with biochemical recurrence and/or metastasis in CaP patients.

CONCLUSIONS

The expression of miR-301a could be a potential marker for metastasis in CaP patients. Detecting miR-301a expression during diagnosis will avoid wait and watch timelines, thus preventing morbidity.

Rosai-Dorfman Disease of the Gastrointestinal Tract: Report of a Case and Review of the Literature

Rosai-Dorfman disease (RDD) is a rare, acquired disease of unknown etiology that affects primarily children and young adults. It is characterized by a proliferation of distinctive histiocytes in the lymph nodes and/or extranodal sites. Involvement of the gastrointestinal tract is rare. We report a case of RDD in a 60-year-old woman who presented with hematochezia and was found to have RDD of the rectum presenting as a rectal mass. This report highlights the current pathogenetic mechanisms, immunohistochemical markers, and the gastrointestinal manifestations of RDD.

Abstract 5253: Oral administration of Withaferin-A effectively suppresses prostate carcinogenesis in PTEN-Knockout mice

Androgen ablation therapy alone or in combination with radiation therapy is the mainstay for prostate cancer (CaP), which is initially effective in de-bulking the tumor volume, however, eventually these patients will progress to a castration-resistant prostate cancer (CRPC), which requires more aggressive chemotherapies. Treating CRPC with second generation androgen -ablation based therapies like enzalutamide and abiraterone exhibit only a short window of therapeutic benefit resulting in chemoresistance. Hence, there is an immediate need for identification of novel targets to eradicate CRPC effectively. We and others have reported targeting AKT activation could efficiently suppress the growth of CRPC cells; in fact a number of clinical trials have shown some promise that AKT could be an attractive target for CRPC. In fact, clinical studies from our lab have suggested that AKT activation predominantly occurs in Gleason stage specific manner suggesting identification of novel drugs to inhibit AKT activation is imperative. Our earlier finding suggests that Withaferin-A (WA), an herbal molecule effectively inhibits the growth of CRPC cells by downregulating AKT activation and its downstream pro-survival events. Present study investigated whether oral administration of WA may inhibit tumor development in Pten conditional knockout mice [(Pten-loxp/loxp:PB-Cre4+) (Pten-KO)] which will be a unique and appropriate preclinical model to study the AKT driven prostate tumor. Oral administration of WA for 45 weeks effectively prevented the tumor growth without any significant signs of toxicity to organs in Pten-KO mice. Vehicle and WA (5mg/kg body weight) were orally given up to 45 weeks. Gross pathological studies suggested a significant inhibition of growth and micro metastasis in WA-treated mice as compared to the vehicle treated mice. On microscopic examination of the prostatic tissue, we found that the WA-treated tumors showed more necrosis than the control group and some of the tumors were more differentiated than the controls in the same group. All the organs were completely submitted for histological evaluation. None of the WA-treated mice organs showed any metastatic lesion on the other hand, we found discrete metastasis to lungs in the control tumors. Our ongoing immunohistochemistry analysis may corroborate our in vitro findings that down regulation of AKT and epithelial-to-mesenchymal transition (EMT) markers such as β-catenin, snail, and vimentin in WA treated tumors as compared to the control mice. Overall, these results provide important scientific evidence in support of AKT signaling as a target to inhibit CRPC as well as metastatic CRPC.

Citation Format: Chendil Damodaran, Suman Suman, Trinath P. Das, Houda Alatassi, Murali K. Ankem. Oral administration of Withaferin-A effectively suppresses prostate carcinogenesis in PTEN-Knockout mice. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 5253.

Activation of AKT negatively regulates the pro-apoptotic function of death-associated protein kinase 3 (DAPK3) in prostate cancer

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This is the first study that demonstrates the inverse correlation of AKT activation and down-regulation of tumor suppressor protein, DAPK-3, in CaP cell lines as well as human prostate tumor tissues that correlate with disease progression.

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Either silencing AKT or overexpressing DAPK-3 induces apoptosis in Castration Resistant Prostate Cancer cells.

The activation of AKT governs many signaling pathways and promotes cell growth and inhibits apoptosis in human malignancies including prostate cancer (CaP). Here, we investigated the molecular association between AKT activation and the function of death-associated protein kinase 3 (DAPK3) in CaP. An inverse correlation of pAKT and DAPK3 expression was seen in a panel of CaP cell lines. Inhibition of AKT by wortmannin/LY294002 or overexpression of DAPK3 reverts the proliferative function of AKT in CaP cells. On the other hand, ectopic expression of AKT inhibited DAPK3 function and induced proliferation of CaP cells. In addition, AKT over-expressed tumors exhibit aggressive growth when compared to control vector in xenograft models. The immunohistochemistry results revealed a down-regulation of DAPK3 expression in AKT over-expressed tumors as compared to control tumors. Finally, we examined the expression pattern of AKT and DAPK3 in human CaP specimens – the expected gradual increase and nuclear localization of pAKT was seen in higher Gleason score samples versus benign hyperplasia (BPH). On the contrary, reduced expression of DAPK3 was seen in higher Gleason stages versus BPH. This suggests that inhibition of DAPK3 may be a contributing factor to the carcinogenesis of the prostate. Understanding the mechanism by which AKT negatively regulates DAPK3 function may suggest whether DAPK3 can be a therapeutic target for CaP.

Cytomorphologic findings and differential diagnosis of pulmonary papillary adenoma: A case report and literature review

Pulmonary papillary adenoma is a rare tumor of the lung. Some authors refer to it as papillary adenoma of type II pneumocytes. It demonstrates benign behavior, although some references suggest that this tumor may rarely exhibit invasive characteristics. We report a case of pulmonary papilloma adenoma of the lung diagnosed by fine-needle aspiration biopsy and transbronchial biopsy. The patient is a 78-year-old woman, who presented to an outside facility with complaint of confusion after a missed episode of dialysis. On further workup, she was found to have a 3.8 cm irregular mass in the upper lobe of her right lung as visualized on chest CT. Fine-needle aspiration and a concurrent forceps-assisted transbronchial biopsy of the mass were performed. On microscopical examination, tumor cells formed small cohesive papillary fronds. On cytological evaluation, tumor cells were uniform medium-sized epithelial cells with moderate cytoplasm, fine chromatin, and inconspicuous nucleoli. The biopsies showed papillary arrangement of epithelial cells in a background of mild fibrosis and chronic inflammation. There was no piling up of cells and the nuclei were uniform with bland appearance. No mitoses were appreciated, and Ki-67 activity was low. The clinical decision was for observation. The patient suffered no complications after the procedures during 26 months of follow-up. We hereby present this case with a review of the literature. Diagn. Cytopathol. 2016;44:543-547. © 2016 Wiley Periodicals, Inc.

Abstract 3067: Expression of miR-301a regulates metastasis and act as a lethal marker for prostate cancer

Prostate Specific Antigen (PSA) screening contributes as a biomarker for diagnosis of prostate cancer; however, PSA screening has been considered an over diagnosis in some cases. This has lead to the identification of novel invasive markers which could eventually differentiate patients with lethal prostate cancer from those with indolent disease. Emerging evidences suggest that a small set of microRNAs (miRNA) are linked to prostate cancer pathogenesis leading to castration resistant prostate cancer (CRPC).

In our studies of genome wide miRNA profiling, we have found that miR-301a is highly expressed in prostate cancer (CaP) cell lines as compared to normal prostate epithelial cells. While analyzing CaP samples, we found higher expression of miR-301a at specific stages. Interestingly, the miR-301a induction varies from 10 to 250 fold in aggressive tumors which clearly correlate with metastases. To confirm these findings, we utilized metastatic lesions from transgenic mice model of Trans Adenocarcinoma of Mouse Prostate (TRAMP) tissues, where higher levels of miR301a expression were observed in prostate tumors in comparison with normal prostate. Further, micro dissecting the tumors (metastasis) from lung showed ∼15 fold induction of miR301a expression compared to the normal lung components. Silencing specifically miR-301a resulted in the inhibition of proliferation, colony forming abilities, invasion, and migration and cell adhesion properties in CaP cell lines. Our molecular studies also suggest that miR-301 regulates Rho GTPases family proteins and transcriptionally activates Epithelial-Mesenchymal-Transition (EMT) markers like slug and β-catenin.

Our ongoing studies may not only reveal whether miR-301 regulates Rho-associated kinases (ROCK) but also the potential role of EMT in CaP. Furthermore, we intend to perform a case control study by screening an additional 100 CaP cases besides indolent controls. As mentioned earlier, besides revealing the functional role in CaP pathogenesis, results from these findings will also suggest whether miR-301 expression distinguishes lethal CaP from indolent disease.

Citation Format: Trinath P. Das, Suman Suman, Arokya Ms PapuJohn, Akhila Ankhem, Sandhya R. Rao, Jamie C. Messer, Houda Alatassi, Murali M. Ankhem, Chendil Damodaran. Expression of miR-301a regulates metastasis and act as a lethal marker for prostate cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3067. doi:10.1158/1538-7445.AM2015-3067

Abstract 1968: Activation of AKT negatively regulates the pro-apoptotic function of death-associated protein kinase 3 (DAPK3) in prostate cancer

Activation of AKT plays a central role by inducing pro-survival signaling pathways, promotes cell growth and inhibits apoptosis in human malignancies including prostate cancer. Higher expression of pAKT is correlated with aggressiveness of the prostate cancer. Published evidences suggest that inhibition of survival kinases may utilize the current therapeutic modalities to sensitize the prostate cancer cells more significantly. Indeed, numbers of small molecules or peptides are being developed to inhibit either AKT or its upstream kinase PI3K to inhibit the growth of human malignances. Death-associated protein kinase 3 (DAPK3), a serine/threonine kinase governs many signaling pathways including induction of apoptosis.

This lead the way to focus our research on small molecules which can inhibit AKT activation and induce DAPK mediated apoptosis in CaP cell lines. To begin with, we identified a small molecule which binds to AKT kinase domain with a predicted affinity of ∼11.0 Kcal/mol. The amino acid residues of AKT-1 within 4 Å of the best docking site of this small molecule, 6-dimethyl, dihydro pyranone (6ddp), includes ARG-4, SER-7, LEU-156, GLY-157, LYS-158, GLY-159, PHE-161, VAL-164, LYS -179, GLU-191, HIS-194, GLU-234, ASP-274, MET-281, ASP-292, GLY-294,LEU-295, and PHE-438. The hydroxyl group of 6ddp likely forms a hydrogen bond with the nitrogen on the side chain of HIS-194. 6ddp inhibited pAKT (ser473) expression which concomitantly induced DAPK1 expression resulting in the growth inhibition of CaP cell lines. Similar results were obtained when a pharmacological inhibitor of AKT was used which resulted in DAPK induced apoptosis of CaP cells. Subsequently, we examined the DAPK3 activation in prostate cancer samples, which significantly showed a higher expression in normal prostate samples. On the contrary, reduced expression with low level was observed with the progression of disease. Currently, our study focuses on the kinase and phosphatase interaction network by mass spectrometric analysis of protein complexes. Understanding the mechanism of DAPK3 mediated AKT inhibition, may strengthen the therapeutic window for prostate cancer without causing much or any toxicity

Citation Format: Trinath P. Das, Arokya MS Papu John, Ram V. Roy, Sandhya R. Rao, Houda Alatassi, Chendil Damodaran, Murali M. Ankhem. Activation of AKT negatively regulates the pro-apoptotic function of death-associated protein kinase 3 (DAPK3) in prostate cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1968. doi:10.1158/1538-7445.AM2015-1968

Impact of immediate evaluation of touch imprint cytology from computed tomography guided core needle biopsies of mass lesions: Single institution experience

BACKGROUND

Computed tomography (CT) guided core needle biopsy (CT-guided CNB) is a minimally invasive, safe and effective manner of tissue sampling in many organs. The aim of our study is to determine the impact of on-site evaluation of touch imprint cytology (TIC) to minimize the number of passes required to obtain adequate tissue for diagnosis.

DESIGN

A retrospective review of all CT-guided CNBs performed during 4 year period, where pathologists were present for on-site TIC evaluation. Each case was evaluated for the number of passes required before TIC was interpreted as adequate for diagnosis.

RESULTS

A total of 140 CT-guided CNBs were included in the study (liver, lung, kidney, sacral, paraspinal, omental, splenic and adrenal masses). Of the 140 cases, 109 were diagnosed as malignant, 28 as benign and three insufficient. In 106 cases (75.7%), the biopsies were determined adequate by TIC on the first pass, 19 cases (13%) on the second pass and 7 cases (5%) on the third pass. Only in 5 cases (3.6%), more than three passes were required before diagnostic material was obtained. Three cases (2.14%) were interpreted as inadequate both on TIC and on the final diagnosis. Of the biopsies deemed adequate on the first pass, 71% resulted in either termination of the procedure, or only one additional pass was obtained. In five cases, based on the TIC evaluation, a portion of the sample was sent for either flow cytometric analysis or cytogenetic studies.

CONCLUSIONS

In the majority of cases, adequate material was obtained in the first pass of CT-guided CNB and once this was obtained, either no additional passes, or one additional pass was performed. This study demonstrates the utility of on-site evaluation in minimizing the number of passes required for obtaining adequate diagnostic material and for proper specimen triage for ancillary studies, which in turn decreases the risk to the patient and costs. However, tumor exhaustion in the tissue as a result of TIC is an important pitfall of the procedure, which occurred in 9 (8.2%) of our malignant cases.

Parainfluenza virus-3-induced cytopathic effects on lung tissue and bronchoalveolar lavage fluid in a bone marrow transplant recipient: a case report

Parainfluenza virus type 3(PIV-3) commonly causes respiratory tract infections in hematopoietic stem cell transplant (HSCT) patients. The majority of PIV-3 infections develop in patients who have undergone stem cell transplantation from unrelated donors. From these patients, bronchoalveolar lavage (BAL) fluid and/or lung biopsies are often collected and sent for evaluation of infectious processes. However, cytologic findings associated with a PIV-3 infection in BAL fluid have not been reported in the literature. We describe BAL cytology and lung biopsy findings in a patient who received an HSCT from a related donor and subsequently developed a PIV-3 infection. This patient was noted to have scattered reticular-nodular opacities in both lungs on computed tomogram scan and underwent transbronchial biopsy and BAL of the left lower lobe. Examination of the BAL fluid revealed scattered multinucleated giant cells intermixed with inflammatory cells. The lung biopsy showed organizing pneumonia associated with several multinucleated respiratory epithelial cells containing rare intracytoplasmic inclusions. Gram, periodic acid Schiff, Gomori methenamine silver, and acid fast stains on the biopsy specimen failed to reveal microorganisms. A sample of the BAL fluid sent for respiratory viral culture grew PIV-3. These findings suggest that the presence of giant cells in transplant patients with organizing pneumonia should raise suspicion of a PIV-3 infection.

Tumor-associated primo vascular system is derived from xenograft, not host

The primo vascular system (PVS), which is composed of very small primo-vessels (PV) and primo-nodes (PN), has recently emerged as a third component of circulatory system. Here, we report the presence of a tumor derived PVS in murine xenografts of human histiocytic lymphoma (U937) in close proximity to the tumor. Within this system, PNs are small (~500-600 μM diameter) membranous sac-like structures which contain numerous small cells which can be demonstrated by DAPI staining. Hematoxylin and Eosin (H&E) staining of the peri-tumoral PVS shows the presence of loose structures lined by fibroblasts but filled with dense fibers, cells, lacunae and nerve-like structures. The origin and type of cells within the PVS was characterized by immunostaining with antibodies for CD68, CD45 and lysozyme. The results of these studies reveal that the PVS of the xenograft originates from the human U937 tumor cells. qRT-PCR analysis of mRNA isolated from PVS cells reveals a striking predominance of human, rather than mouse, sequences. Of particular interest, human stem cell specific transcription factors were overexpressed, most notably KLF4, an upstream regulator of NANOG which maintains the pluripotent and undifferentiated state of stem cells. These results suggest that the cells present within the PVS are derived from the human xenograft and suggests that the primo-vessels associated with the xenografted tumor may provide a safe haven for a select population of cancer stem cells. Further understanding of the biological properties of these cells may allow the development of new anti-cancer interventions.

Renal cell carcinoma with extensive oncocytic features

Oncocytic features are a hallmark of renal oncocytoma, but can be seen in other renal tumors such as clear cell renal cell carcinoma with granular cells and eosinophilic variant of chromophobe cell tumors. Up to 5% of renal neoplasms are ultimately diagnosed as unclassified renal cell carcinoma with oncocytic features accounting for a significant number of these tumors. Also a recent morphological variant of mucinous tubular and spindle cell carcinoma with oncocytic changes has been described, adding another challenge. Here we report an unusual case of unclassified renal cell carcinoma with extensive oncocytic changes and we discuss the differential diagnosis.

Signet ring cell carcinoma of the gallbladder in a 22-year-old man: a case report and review of the literature

Primary carcinoma of the gallbladder is an uncommon malignancy with a variable incidence among different geographic locales and ethnic groups. Women are affected generally 3 times as often as men. Choleliths are a significant risk factor. Other risk factors include abnormal union of the choledochopancreatic ducts, obesity, multiparity, chronic infection with certain bacteria, and genetics. The signet ring cell subtype of adenocarcinoma is a rare entity. The behavior of this subtype is not well described in the literature. The authors present a case of signet ring cell carcinoma of the gallbladder, unusual in their case because of the patient's young age, male gender, African American ethnicity, and lack of choleliths or any other risk factors. They review the literature in English to characterize this rare subtype.

Unusual Presentation of Benign Cystic Brenner Tumor With Exuberant Psammomatous Calcifications

Transitional cell tumors of the ovary comprise about 1% to 2% of all ovarian neoplasms. Most of these tumors are benign Brenner tumors and account for about 5% of benign surface epithelial—stromal tumors. Spicules of calcifications are found in the stroma of about 50% of benign Brenner tumors. Although diagnostic challenges might occur more frequently with either of the borderline or malignant Brenner tumors, this problem is not that common when diagnosing a benign Brenner tumor. This study reports a case of benign Brenner tumor with exuberant dystrophic calcifications that obscured most of the epithelium and posed a diagnostic challenge in differentiating it from the more common malignant counterparts such as serous carcinoma and specifically psammocarcinoma.

Epithelioid angiomyolipoma of the liver with striking giant cell component: fine-needle aspiration biopsy findings of a rare neoplasm

Angiomyolipoma (AML) is a uncommon benign neoplasm of the liver with cyto- and histologic features similar to the more commonly encountered renal AML. Tumors composed predominantly of epithelioid cells have been referred to as epithelioid AML. Because most liver lesions are first evaluated by fine-needle aspiration biopsy (FNAB), it is important to distinguish this variant of AML from more common hepatic neoplasms such as hepatocellular carcinoma (HCC) or metastatic tumors. Rare reports of epithelioid AML of the liver diagnosed by FNAB are in the literature. Here, we describe the cytologic findings of a unique case of epithelioid AML with numerous giant cells.

Biotin-rich intranuclear inclusions: have you checked your immunohistochemical controls?

Intranuclear biotin interacts with avidin-biotin-complex used for viral immunoperoxidase detection giving false-positive results.

Tubal gestation and schistosomiasis: a case report

BACKGROUND

Schistosomal infections of the female reproductive tract are common in countries where the parasite is endemic. Serious complications, such as ectopic pregnancy and infertility, may arise in patients with gynecologic schistosomiasis.

CASE

A primiparous, African woman presented with vaginal bleeding and was found to have an ectopic pregnancy. Laparoscopy revealed distorted pelvic anatomy due to dense adhesions. Pathologic examination confirmed an ectopic pregnancy and identified Schistosoma haematobium ova in the patient's fallopian tube. Urine examination was confirmatory, and the patient was treated and referred for fertility counseling.

CONCLUSION

Clinicians should consider schistosomiasis as a possible etiology for gynecologic complaints, including serious complications such as ectopic pregnancy and infertility, in patients from endemic regions.