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Gross AR, Kehinde T, Morais L, Hutchison M, Grise J, Mohamed N, Badami V, Ahmed H, Zdilla MJ, Vos JA, Gross AG, Leonard R. A novel gelatinized barium sulfate injection method for assessment of bronchoalveolar lavage parameters. Clin Respir J 2024; 18:e13721. [PMID: 38286743 PMCID: PMC10784628 DOI: 10.1111/crj.13721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/17/2023] [Accepted: 11/04/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Bronchoalveolar lavage (BAL) is frequently used in pulmonary medicine though it requires further optimization. Practical obstacles such as patient safety and procedural limitation have to date precluded large, controlled trials aimed at standardization of BAL procedure. Indeed, BAL guidelines are based on observational data. Innovative research methods are necessary to advance the clinical practice of BAL. METHODS In our study, we evaluated the effect of injecting a gelatinized barium solution into different lobes and segments of cadaveric lungs. As the technique requires an irreversible injection into lung airspaces, it is not suitable for in vivo purposes. We measured the volume returned from BAL as well as the distribution of BAL injection via dissection. Segmental anatomic orientation was compared to a radiologist's impression of plain film radiographs taken of injected lungs. RESULTS Mean injected volume distributions were greatest in the upper lobes and lowest in the lower lobes; mean ratios of injected volume distribution to lung lobe volume also followed this trend. Cannulated bronchi orders favored lower branches in the upper lobe and higher branches in the lower lobes. Segmental anatomy varied by the lung lobe injected and was most varied in the lower lobes. CONCLUSION This novel gelatinized-barium injection technique provides a minimally complex method to yield clinically meaningful feedback on the performance of BAL. The technique is also adaptable to study of procedural parameters in the context of variable lung anatomies and pathologies.
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Affiliation(s)
- Alexander R. Gross
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM)West Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Temitope Kehinde
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM)West Virginia University School of MedicineMorgantownWest VirginiaUSA
| | | | - Marshall Hutchison
- Department of RadiologyWest Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Joy Grise
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM)West Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Nada Mohamed
- Department of Pulmonary and Critical Care MedicineWest Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Varun Badami
- Department of Pulmonary and Critical Care MedicineWest Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Haroon Ahmed
- Department of Pulmonary and Critical Care MedicineWest Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Matthew J. Zdilla
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM)West Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Jeffrey A. Vos
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM)West Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Austin G. Gross
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM)West Virginia University School of MedicineMorgantownWest VirginiaUSA
| | - Rachel Leonard
- Department of Pulmonary and Critical Care MedicineWest Virginia University School of MedicineMorgantownWest VirginiaUSA
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Zdilla MJ, Gross AR, Hajarat T, Vos JA. Bilateral Virchow nodes: an unusual finding of pulmonary small-cell neuroendocrine carcinoma metastasis. Autops Case Rep 2023; 13:e2023455. [PMID: 38034518 PMCID: PMC10688261 DOI: 10.4322/acr.2023.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/02/2023] [Indexed: 12/02/2023]
Abstract
An enlarged left-sided supraclavicular node is a signal node for cancer metastasis. In such a case, the enlarged lymph node is often referred to as a Virchow node. The left-sided nature of the node is due to the drainage of the thoracic duct. So, the enlargement of a Virchow node is typically associated with malignancies, including gastrointestinal, pulmonary, and genitourinary carcinomas, in addition to lymphomas. This report documents a particularly unusual finding: bilateral Virchow nodes, representing metastasis of small-cell neuroendocrine carcinoma.
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Affiliation(s)
- Matthew J. Zdilla
- West Virginia University School of Medicine, Department of Pathology, Anatomy, and Laboratory Medicine, Morgantown, West Virginia, USA
| | - Alexander R. Gross
- West Virginia University School of Medicine, Department of Pathology, Anatomy, and Laboratory Medicine, Morgantown, West Virginia, USA
| | - Tara Hajarat
- West Virginia University School of Medicine, Department of Pathology, Anatomy, and Laboratory Medicine, Morgantown, West Virginia, USA
| | - Jeffrey A. Vos
- West Virginia University School of Medicine, Department of Pathology, Anatomy, and Laboratory Medicine, Morgantown, West Virginia, USA
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3
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Jelic TM, Estalilla OC, Vos JA, Harvey G, Stricker CJ, Adelanwa AO, Khalid AA, Plata MJ. Flow Cytometric Enumeration of Peripheral Blood CD34 + Cells Predicts Bone Marrow Pathology in Patients with Less Than 1% Blasts by Manual Count. J Blood Med 2023; 14:519-535. [PMID: 37753388 PMCID: PMC10519426 DOI: 10.2147/jbm.s417432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
Background and Aims Significance of absolute number of CD34+ cells in the peripheral blood of patients with less than 1% myeloblasts by manual differential count is unknown and our aim is to study its relevance in clinical practice. Methods We studied 138 peripheral bloods flow cytometric analyses in patients with less than 1% myeloblasts by manual differential, when CD34+ events were present in the gate that encompassed lymphocytes, monocytes, stem cells, and blasts. Results The average absolute number of CD34+cells in the peripheral blood was 11 CD34+cells/µL ranging from less than 1 cell/µL to 147 cells/µL. The average absolute number of CD34+ cells in patients with an abnormal expansive process involving bone marrow (metastases, myelodysplasia, granulomas, marrow infections) or if bone marrow biopsy not performed, presumed expansive marrow process was 25 cells/µL, and in patients without an expansive marrow process (or presumed negative) was 4 cells/µL (P<0.00007). Cutoff 12 CD34+ cells/μL had 93% positive predictive value for bone marrow involvement by an expansive process and 78% negative predictive value. Conclusion Flow cytometric testing of the peripheral blood is extremely sensitive method for enumerating CD34+ cells and can detect fewer than one CD34+ cell/µL. The absolute number of CD34+ cells in the peripheral blood is a useful parameter in determining marrow involvement by an expansive process and may provide guidance with respect to the necessity for bone marrow biopsy.
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Affiliation(s)
- Tomislav M Jelic
- Department of Pathology and Laboratory Medicine, Charleston Area Medical Center, Charleston, WV, USA
| | - Oscar C Estalilla
- Department of Pathology and Laboratory Medicine, Charleston Area Medical Center, Charleston, WV, USA
| | - Jeffrey A Vos
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Gary Harvey
- Department of Pathology and Laboratory Medicine, Charleston Area Medical Center, Charleston, WV, USA
| | - Caitlin J Stricker
- Department of Pathology and Laboratory Medicine, Charleston Area Medical Center, Charleston, WV, USA
| | - Ayodele O Adelanwa
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Ahmed A Khalid
- Cancer Center, Charleston Area Medical Center, Charleston, WV, USA
| | - Milton J Plata
- Department of Pathology and Laboratory Medicine, Charleston Area Medical Center, Charleston, WV, USA
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Patel R, Marano G, Joseph J, Chung J, Plata A, Vos JA. 18 F-fludeoxyglucose positron emission computed tomography ( 18 F-FDG-PET/CT) versus 68 Ga-DOTATATE-PET/CT in patients with head and neck cancer: Comparisons and implications for treatment. Head Neck 2023; 45:347-354. [PMID: 36591637 DOI: 10.1002/hed.27243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/22/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Tumor-specific molecular imaging in head and neck squamous cell carcinoma (HNSCC) is not well established. Somatostatin receptors (SSTRs) are found in solid tumors, including HNSCC. 68 Ga-DOTATATE, a commercially available radionuclide that binds SSTRs, may have utility in imaging HNSCC. METHODS Patients with HNSCC received pretreatment imaging with 18 F-FDG-PET/CT and 68 Ga-DOTATATE. Imaging was compared for concordance. When available, surgical resection specimens were compared to pretreatment imaging findings. Historic HNSCC tumor specimens were assessed for both SSTR and p16/human papilloma virus (HPV) expression. RESULTS Twenty patients were imaged. Fifteen had oropharyngeal cancer. Primary tumor site was concordant between imaging modalities for all patients. One of 45 lymph nodes was discordant. Retrospective specimen review showed a significant correlation with SSTR expression and HPV/p16 expression. No adverse events occurred. CONCLUSIONS 68 Ga-DOTATATE imaging is safe and effective in HNSCC. SSTR expression may be increased in HPV-mediated tumors. Targeted therapies to SSTR should be explored.
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Affiliation(s)
- Rusha Patel
- Department of Otolaryngology, Oklahoma University, Oklahoma City, Oklahoma, United States
| | - Gary Marano
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Joe Joseph
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffson Chung
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Andrew Plata
- Department of Pathology, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffrey A Vos
- Department of Pathology, West Virginia University, Morgantown, West Virginia, USA
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Sasi R, Senft J, Spruill M, Barua S, Dougaparsad S, Vos JA, Perrotta PL. A treatment-refractory aggressive MDS-MLD with multiple highly complex chromosome 5 intrachromosomal rearrangements: a case report. Mol Cytogenet 2022; 15:51. [PMID: 36474285 PMCID: PMC9727891 DOI: 10.1186/s13039-022-00630-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A patient with a myelodysplastic neoplasm exhibited a karyotype with multiple complex chromosome 5 rearrangements. This patient appeared to have a catastrophic cytogenetic event that manifested as a treatment-refractory aggressive form of disease, which lead to patient demise within one year. Both the clinical presentation and disease course were unusual based on the medical history and morphologic findings. Such cases of myelodysplastic syndrome with multilineage dysplasia (MDS-MLD) with complex abnormalities are not reported in the literature. CASE PRESENTATION The patient was a 62-year-old female who presented with pancytopenia and dyspnea. The morphologic appearance of the peripheral blood smear and bone marrow biopsy, along with flow cytometric findings, favored the diagnosis of MDS-MLD unclassifiable. Myelodysplastic syndrome (MDS) with multilineage dysplasia (MDS-MLD), is an MDS characterized by one or more cytopenias and dysplastic changes in two or more of the myeloid lineages (i.e., erythroid, granulocytic, and megakaryocytic). The bone marrow, in particular, showed prominent dysplasia, including the presence of atypical megakaryocytes with small hypolobated morphology reminiscent of those typically seen in MDS with isolated 5q deletion. Cytogenetic analysis, including interphase and metaphase FISH, karyotype and SNP chromosomal microarray were performed, as well as DNA sequencing studies. Cytogenetic analysis showed a very complex karyotype featuring multiple 5q intrachromosomal rearrangements including a pericentric inversion with multiple interspersed deletions and monosomy 7. FISH studies showed a partial deletion of the PDGFRβ gene, and SNP chromosomal microarray and targeted panel-based sequencing identified biallelic loss of function of the TP53 gene. Based on the pathologic findings, the patient was treated for MDS but did not respond to either lenalidomide or azacitidine. CONCLUSION The genetic changes described, in particular, the complex intrachromosomal rearrangements of chromosome 5, suggest the occurrence of a sudden catastrophic event that led to an aggressive course in the patient's disease. Conventional karyotyping, metaphase and interphase FISH, SNP chromosomal microarray and NGS helped to identify the complex genetic changes seen in this case. This highlights the importance of utilizing a multimodality approach to fully characterize complex chromosomal events that may significantly impact disease progression, treatment and survival.
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Affiliation(s)
- Ramakrishnan Sasi
- grid.268154.c0000 0001 2156 6140Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506 USA
| | - Jamie Senft
- grid.268154.c0000 0001 2156 6140Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506 USA
| | - Michelle Spruill
- grid.268154.c0000 0001 2156 6140Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506 USA
| | - Subit Barua
- grid.268154.c0000 0001 2156 6140Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506 USA
| | | | - Jeffrey A. Vos
- grid.490496.6Essentia Health – St. Mary’s Medical Center, Duluth, MN 55805 USA
| | - Peter L. Perrotta
- grid.268154.c0000 0001 2156 6140Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506 USA
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Baloda V, Wheeler SE, Murray DL, Kohlhagen MC, Vos JA, Yatsenko SA, Agha ME, Djokic M, Swerdlow SH, Bailey NG. Correction: Mu heavy chain disease with MYD88 L265P mutation: An unusual manifestation of lymphoplasmacytic lymphoma. Diagn Pathol 2022; 17:84. [PMID: 36266677 PMCID: PMC9583474 DOI: 10.1186/s13000-022-01265-w] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Sarah E Wheeler
- Department of Pathology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - David L Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mindy C Kohlhagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey A Vos
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - Svetlana A Yatsenko
- Department of Pathology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Mounzer E Agha
- Hillman Cancer Center, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Miroslav Djokic
- Department of Pathology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Steven H Swerdlow
- Department of Pathology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Nathanael G Bailey
- Department of Pathology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA.
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7
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Owosho AA, Ladeji AM, Adesina OM, Adebiyi KE, Olajide MA, Okunade T, Palmer J, Kehinde T, Vos JA, Cole G, Summersgill KF. SATB2 and MDM2 Immunoexpression and Diagnostic Role in Primary Osteosarcomas of the Jaw. Dent J (Basel) 2021; 10:dj10010004. [PMID: 35049602 PMCID: PMC8775091 DOI: 10.3390/dj10010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023] Open
Abstract
Primary osteosarcomas of the jaw (OSJ) are rare, accounting for 6% of all osteosarcomas. This study aims to determine the value of SATB2 and MDM2 immunohistochemistry (IHC) in differentiating OSJ from other jawbone mimickers, such as benign fibro-osseous lesions (BFOLs) of the jaw or Ewing sarcoma of the jaw. Certain subsets of osteosarcoma harbor a supernumerary ring and/or giant marker chromosomes with amplification of the 12q13-15 region, including the murine double-minute type 2 (MDM2) and cyclin-dependent kinase 4 (CDK4) genes. Special AT-rich sequence-binding protein 2 (SATB2) is an immunophenotypic marker for osteoblastic differentiation. Cases of OSJ, BFOLs (ossifying fibroma and fibrous dysplasia) of the jaw, and Ewing sarcoma of the jaw were retrieved from the Departments of Oral Pathology and Oral Medicine, Faculty of Dentistry, Obafemi Awolowo University and Lagos State University College of Medicine, Nigeria. All OSJ retrieved showed histologic features of high-grade osteosarcoma. IHC for SATB2 (clone EP281) and MDM2 (clone IF2), as well as fluorescence in situ hybridization (FISH) for MDM2 amplification, were performed on all cases. SATB2 was expressed in a strong intensity and diffuse staining pattern in all cases (11 OSJ, including a small-cell variant, 7 ossifying fibromas, and 5 fibrous dysplasias) except in Ewing sarcoma, where it was negative in neoplastic cells. MDM2 was expressed in a weak to moderate intensity and scattered focal to limited diffuse staining pattern in 27% (3/11) of cases of OSJ and negative in all BFOLs and the Ewing sarcoma. MDM2 amplification was negative by FISH in interpretable cases. In conclusion, the three cases of high-grade OSJs that expressed MDM2 may have undergone transformation from a low-grade osteosarcoma (LGOS). SATB2 is not a dependable diagnostic marker to differentiate OSJ from BFOLs of the jaw; however, it could serve as a valuable diagnostic marker in differentiating the small-cell variant of OSJ from Ewing sarcoma of the jaw, while MDM2 may be a useful diagnostic marker in differentiating OSJ from BFOLs of the jaw, especially in the case of an LGOS or high-grade transformed osteosarcoma.
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Affiliation(s)
- Adepitan A. Owosho
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO 63501, USA;
- Correspondence: ; Tel.: +1-660-626-2843
| | - Adeola M. Ladeji
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University, Lagos 101233, Nigeria; (A.M.L.); (K.E.A.); (M.A.O.)
| | - Olufunlola M. Adesina
- Department of Oral Medicine and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.M.A.); (T.O.)
| | - Kehinde E. Adebiyi
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University, Lagos 101233, Nigeria; (A.M.L.); (K.E.A.); (M.A.O.)
| | - Mofoluwaso A. Olajide
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University, Lagos 101233, Nigeria; (A.M.L.); (K.E.A.); (M.A.O.)
| | - Toluwaniyin Okunade
- Department of Oral Medicine and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.M.A.); (T.O.)
| | - Jacob Palmer
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO 63501, USA;
| | - Temitope Kehinde
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.K.); (J.A.V.)
| | - Jeffrey A. Vos
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.K.); (J.A.V.)
| | - Grayson Cole
- Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (G.C.); (K.F.S.)
| | - Kurt F. Summersgill
- Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (G.C.); (K.F.S.)
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Ahn JS, Al-Habib A, Vos JA, Sohani AR, Barboza-Quintana O, Flores JP, Wen S, Rosado FG. Plasmablastic Lymphomas: Characterization of Tumor Microenvironment Using CD163 and PD-1 Immunohistochemistry. Ann Clin Lab Sci 2020; 50:213-218. [PMID: 32366559 PMCID: PMC7439522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to characterize the tumor microenvironment of plasmablastic lymphoma (PBL) in regard to the quantities of CD163(+) tumor associated macrophages (TAM) and PD1(+) tumor infiltrating lymphocytes (TIL). This article also reviews the existing knowledge of the role of PD-1/PD-L1 pathway in the tumor microenvironment of hematopoietic neoplasms, discusses potential mechanisms to explain our findings, and outlines areas for future studies. We performed CD163 and PD1 immunohistochemical studies in 11 cases classified as plasmablastic lymphoma, and recorded the percentages of positive TAMs and TILs. Based on previous studies, cut off values of ≥30% and >5% were used to classify the cases into high TAMs and TILs, respectively. We determined that the majority of cases (8 of 11, or 73%) had high percentage of TAMs, while only a minority had high percentage of TILs (3 of 11, or 27%). Our data shows a trend towards a negative correlation between TAMs and TILs (p=0.08), and a predominance of the pattern TAMhigh/TILlow (7 of 11, or 63%) compared to other patterns. The microenvironment of plasma-blastic lymphoma tends to show high percentage of TAMs (≥30%) combined with low percentage of TILs (≤5%). Additional studies are needed to determine the clinical significance of TILs and the influence of EBV and HIV infections on numbers of TILs in PBL. As high microenvironment TAMs have been associated with high microenvironment PD-L1 in other hematopoietic malignancies, our data supports the need for future studies on the expression of PD-L1 in PBL.
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Affiliation(s)
- Janice S Ahn
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - Ali Al-Habib
- Department of Pathology and Laboratory Medicine, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Jeffrey A Vos
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Juan P Flores
- Department of Pathology, University Hospital Dr. Jose Eleuterio Gonzalez, Monterrey, Mexico
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | - Flavia G Rosado
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
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Mehta RI, Rai AT, Vos JA, Solis OE, Mehta RI. Intrathrombus polymer coating deposition: a pilot study of 91 patients undergoing endovascular therapy for acute large vessel stroke. Part I: Histologic frequency. J Neurointerv Surg 2019; 11:1191-1196. [PMID: 31103995 PMCID: PMC6902067 DOI: 10.1136/neurintsurg-2018-014684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/07/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Polymer coating embolism due to vascular medical device use is an increasingly recognized iatrogenic complication. This phenomenon has been linked with various adverse effects including neuroinflammation, acute ischemic stroke, cerebral hemorrhage, and death. Notably, procedure- and device-specific risks of this complication are poorly investigated. In this study, we evaluate the detectable frequency of intra-arterial polymer coating delamination among patients who underwent endovascular thrombectomy for treatment of acute ischemic stroke due to large vessel occlusion. METHODS Ninety-two cerebral thrombectomy specimens were retrospectively analyzed for the presence of polymer coating particulates. Histologic findings were correlated with demographic and procedural details and patient outcomes. RESULTS Evidence of polymer coating deposition was found in 30 of 92 extracted thrombi (33%). No correlation between intrathrombus polymer deposition and use of a specific thrombectomy device such as a stent retriever, aspiration catheter, or guide catheter was found. However, heterogeneous patterns of device use suggest a number of culprit devices. A trend toward longer procedure times and multiple thrombectomy passes was noted in positive cases. Intrathrombus polymer deposition was not associated with adverse clinical outcomes as measured by the 90-day modified Rankin Scale (mRS); however, small sample size and follow-up intervals limit interpretation. Ninety-day outcomes based on mRS may not fully capture the clinical effects of acute and/or delayed intracerebral polymer complications. CONCLUSION In light of documented adverse neurologic effects, the frequency of intrathrombus polymer particulates indicates the need for consensus testing methods and large-scale long-term prospective clinical device trials, with inclusion of relevant endpoints to better assess biomaterial and device risks to patients.
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Affiliation(s)
- Rashi I Mehta
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Ansaar T Rai
- Department of Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffrey A Vos
- Department of Pathology, West Virginia University, Morgantown, West Virginia, USA
| | - Orestes E Solis
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York, USA
| | - Rupal I Mehta
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York, USA.,Department of Neuroscience, University of Rochester, Rochester, NY, USA
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Zdilla MJ, Aldawood AM, Plata A, Vos JA, Lambert HW. A Workflow for Successful Collaboration between Anatomists and Pathologists: An Example of Pulmonary Adenocarcinoma Metastasis to a Virchow Node. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.767.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew J Zdilla
- Pathology, Anatomy, and Laboratory MedicineWest Virginia University School of MedicineMorgantownWV
- Graduate Health SciencesWest Liberty UniversityWest LibertyWV
- Natural Sciences & MathematicsWest LibertyUniversityWest LibertyWV
| | - Ali M Aldawood
- Pathology, Anatomy, and Laboratory MedicineWest Virginia University School of MedicineMorgantownWV
| | - Andrew Plata
- Pathology, Anatomy, and Laboratory MedicineWest Virginia University School of MedicineMorgantownWV
| | - Jeffrey A Vos
- Pathology, Anatomy, and Laboratory MedicineWest Virginia University School of MedicineMorgantownWV
| | - H. Wayne Lambert
- Pathology, Anatomy, and Laboratory MedicineWest Virginia University School of MedicineMorgantownWV
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11
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Zdilla MJ, Aldawood AM, Plata A, Vos JA, Lambert HW. Troisier sign and Virchow node: the anatomy and pathology of pulmonary adenocarcinoma metastasis to a supraclavicular lymph node. Autops Case Rep 2019; 9:e2018053. [PMID: 30863728 PMCID: PMC6394356 DOI: 10.4322/acr.2018.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/02/2018] [Indexed: 02/05/2023] Open
Abstract
Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node, known as the Virchow node (VN), leading to an appreciable mass that can be recognized clinically - a Troisier sign. The VN is of profound clinical importance; however, there have been few studies of its regional anatomical relationships. Our report presents a case of a Troisier sign/VN discovered during cadaveric dissection in an individual whose cause of death was, reportedly, chronic obstructive pulmonary disease. The VN was found to arise from an antecedent pulmonary adenocarcinoma. Our report includes a regional study of the anatomy as well as relevant gross pathology and histopathology. Our anatomical findings suggest that the VN may contribute to vascular thoracic outlet syndrome as well as the brachial plexopathy of neurogenic thoracic outlet syndrome. Further, the VN has the potential to cause compression of the phrenic nerve, contributing to unilateral phrenic neuropathy and subsequent dyspnea. Recognition of the Troisier sign/VN is of great clinical importance. Similarly, an appreciation of the anatomy surrounding the VN, and the potential for the enlarged node to encroach on neurovascular structures, is also important in the study of a patient. The presence of a Troisier sign/VN should be assessed when thoracic outlet syndrome and phrenic neuropathy are suspected. Conversely, when a VN is identified, the possibility of concomitant or subsequent thoracic outlet syndrome and phrenic neuropathy should be considered.
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Affiliation(s)
- Matthew J Zdilla
- West Liberty University, Department of Natural Sciences & Mathematics and Graduate Health Sciences. West Liberty, West Virginia, USA.,West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA.,West Liberty University, Department of Graduate Health Sciences. West Liberty, West Virginia, USA
| | - Ali M Aldawood
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
| | - Andrew Plata
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
| | - Jeffrey A Vos
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
| | - H Wayne Lambert
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
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12
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Stiebing BN, Rosado FG, Vos JA. Human Papillomavirus-Related Malignancies in the Setting of Posttransplantation Immunosuppression. Arch Pathol Lab Med 2018; 142:711-714. [PMID: 29848025 DOI: 10.5858/arpa.2017-0586-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - The use of immunosuppression to avoid allograft rejection within the host creates the opportunity for unchecked development of malignancy in the posttransplantation setting. These malignancies frequently show association with human papillomavirus. Within this specific patient population, understanding the oncogenic role of this virus is vital for prompt recognition and treatment of malignancy and precursor lesions as well as the institution of appropriate preventive measures. OBJECTIVE - To review the role of human papillomavirus in the development of malignancies and their precursor lesions in the posttransplantation setting. DATA SOURCES - The study comprised a review of the literature. CONCLUSIONS - The development of human papillomavirus-related malignancies in transplantation patients is dependent on several factors, such as virus subtype, length of immunosuppression, and type of immunosuppressive therapy. Malignancies within these patients differ from those in the general population in terms of pathogenesis, frequency, and recurrence rate, and therefore require further understanding to allow for optimal surveillance and clinical management.
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Affiliation(s)
| | | | - Jeffrey A Vos
- From the West Virginia University School of Medicine, Morgantown (Ms Stiebing); the Department of Pathology, University of Texas Southwestern BioCenter, Dallas (Dr Rosado); and the Department of Pathology, West Virginia University School of Medicine, Morgantown (Dr Vos)
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13
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Kappelhof M, Marquering HA, Berkhemer OA, Borst J, van der Lugt A, van Zwam WH, Vos JA, Lycklama À Nijeholt G, Majoie CBLM, Emmer BJ. Accuracy of CT Angiography for Differentiating Pseudo-Occlusion from True Occlusion or High-Grade Stenosis of the Extracranial ICA in Acute Ischemic Stroke: A Retrospective MR CLEAN Substudy. AJNR Am J Neuroradiol 2018; 39:892-898. [PMID: 29622556 DOI: 10.3174/ajnr.a5601] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/15/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The absence of opacification on CTA in the extracranial ICA in acute ischemic stroke may be caused by atherosclerotic occlusion, dissection, or pseudo-occlusion. The latter is explained by sluggish or stagnant flow in a patent artery caused by a distal intracranial occlusion. This study aimed to explore the accuracy of CTA for differentiating pseudo-occlusion from true occlusion of the extracranial ICA. MATERIALS AND METHODS All patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) with an apparent ICA occlusion on CTA and available DSA images were included. Two independent observers classified CTA images as atherosclerotic cause (occlusion/high-grade stenosis), dissection, or suspected pseudo-occlusion. Pseudo-occlusion was suspected if CTA showed a gradual contrast decline located above the level of the carotid bulb, especially in the presence of an occluded intracranial ICA bifurcation (T-occlusion). DSA images, classified into the same 3 categories, were used as the criterion standard. RESULTS In 108 of 476 patients (23%), CTA showed an apparent extracranial carotid occlusion. DSA was available in 46 of these, showing an atherosclerotic cause in 13 (28%), dissection in 16 (35%), and pseudo-occlusion in 17 (37%). The sensitivity for detecting pseudo-occlusion on CTA was 82% (95% CI, 57-96) for both observers; specificity was 76% (95% CI, 56-90) and 86% (95% CI, 68-96) for observers 1 and 2, respectively. The κ value for interobserver agreement was .77, indicating substantial agreement. T-occlusions were more frequent in pseudo- than true occlusions (82% versus 21%, P < .001). CONCLUSIONS On CTA, extracranial ICA pseudo-occlusions can be differentiated from true carotid occlusions.
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Affiliation(s)
- M Kappelhof
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.)
| | - H A Marquering
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.).,Biomedical Engineering and Physics (H.A.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - O A Berkhemer
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.).,Neurology (O.A.B.), Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - J Borst
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.)
| | | | - W H van Zwam
- Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - J A Vos
- Department of Radiology (J.A.V.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - G Lycklama À Nijeholt
- Department of Radiology (G.L.à.N.), Haaglanden Medical Centre, The Hague, the Netherlands
| | - C B L M Majoie
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.)
| | - B J Emmer
- From the Departments of Radiology (M.K., H.A.M., O.A.B., J.B., C.B.L.M.M, B.J.E.)
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14
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Ahn JS, Okal R, Vos JA, Smolkin M, Kanate AS, Rosado FG. Plasmablastic lymphoma versus plasmablastic myeloma: an ongoing diagnostic dilemma. J Clin Pathol 2017; 70:775-780. [DOI: 10.1136/jclinpath-2016-204294] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/03/2022]
Abstract
AimsTo determine the utility of clinical, morphological and phenotypical features in the differential diagnosis of plasmablastic lymphoma and myeloma with plasmablastic features.MethodsAll plasmablastic neoplasms identified from a 15-year retrospective search were reviewed and classified into ‘lymphoma’, ‘myeloma’ or ‘indeterminate’. The classification was then compared with the previously established clinical diagnosis. Lessons learned from this review were used to design a diagnostic algorithm for pathologists to use in the absence of known clinical history.ResultsThe classification was possible in 10 of 11 cases, 8 lymphomas and 2 myelomas (n=2). No distinctive morphological or phenotypical features were identified. The most useful histopathological parameter was a positive Epstein-Barr virus in situ hybridisation. Presence of associated lymphadenopathy and/or oral mass in the absence of complete myeloma-defining signs was used to favour a diagnosis of lymphoma in 4 of 8 cases.ConclusionsThe distinction between plasmablastic lymphoma from plasmablastic myeloma warrants detailed knowledge of clinical, radiological and laboratorial findings. New studies identifying distinctive phenotypical or genetic features are needed to improve the histopathological differentiation of plasmablastic neoplasms.
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15
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Crigger C, Barnard J, Zaslau S, Vos JA. Spermatic cord dedifferentiated liposarcoma presenting as a recurrent inguinal hernia. Can J Urol 2016; 23:8581-8584. [PMID: 27995856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Paratesticular sarcomas are a rare entity and provide a unique clinical challenge due to their slow growing, often painless natural course. Adding to this challenge is the complex anatomy of the scrotum that allows these masses to mimic other conditions, including inguinal hernia, cysts, or fluid collections. We report such a case and our approach to an 83-year-old male with dedifferentiated liposarcoma of the spermatic cord with a history of inguinal hernia. In doing so, we highlight the need for thorough evaluation of scrotal masses and the management of these rare, though well-described, tumors.
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Affiliation(s)
- Chad Crigger
- Division of Urology, West Virginia University, Morgantown, West Virginia, USA
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16
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Jansen IGH, Berkhemer OA, Yoo AJ, Vos JA, Lycklama À Nijeholt GJ, Sprengers MES, van Zwam WH, Schonewille WJ, Boiten J, van Walderveen MAA, van Oostenbrugge RJ, van der Lugt A, Marquering HA, Majoie CBLM. Comparison of CTA- and DSA-Based Collateral Flow Assessment in Patients with Anterior Circulation Stroke. AJNR Am J Neuroradiol 2016; 37:2037-2042. [PMID: 27418474 DOI: 10.3174/ajnr.a4878] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Collateral flow is associated with clinical outcome after acute ischemic stroke and may serve as a parameter for patient selection for intra-arterial therapy. In clinical trials, DSA and CTA are 2 imaging modalities commonly used to assess collateral flow. We aimed to determine the agreement between collateral flow assessment on CTA and DSA and their respective associations with clinical outcome. MATERIALS AND METHODS Patients randomized in MR CLEAN with middle cerebral artery occlusion and both baseline CTA images and complete DSA runs were included. Collateral flow on CTA and DSA was graded 0 (absent) to 3 (good). Quadratic weighted κ statistics determined agreement between both methods. The association of both modalities with mRS at 90 days was assessed. Also, association between the dichotomized collateral score and mRS 0-2 (functional independence) was ascertained. RESULTS Of 45 patients with evaluable imaging data, collateral flow was graded on CTA as 0, 1, 2, 3 for 3, 10, 20, and 12 patients, respectively, and on DSA for 12, 17, 10, and 6 patients, respectively. The κ-value was 0.24 (95% CI, 0.16-0.32). The overall proportion of agreement was 24% (95% CI, 0.12-0.38). The adjusted odds ratio for favorable outcome on mRS was 2.27 and 1.29 for CTA and DSA, respectively. The relationship between the dichotomized collateral score and mRS 0-2 was significant for CTA (P = .01), but not for DSA (P = .77). CONCLUSIONS Commonly applied collateral flow assessment on CTA and DSA showed large differences, indicating that these techniques are not interchangeable. CTA was significantly associated with mRS at 90 days, whereas DSA was not.
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Affiliation(s)
- I G H Jansen
- From the Departments of Radiology (I.G.H.J., O.A.B., M.E.S.S., C.B.L.M.M.)
| | - O A Berkhemer
- From the Departments of Radiology (I.G.H.J., O.A.B., M.E.S.S., C.B.L.M.M.).,Departments of Neurology (O.A.B.)
| | - A J Yoo
- Texas Stroke Institute (A.J.Y.), Plano, Texas
| | - J A Vos
- Departments of Radiology (J.A.V.)
| | | | - M E S Sprengers
- From the Departments of Radiology (I.G.H.J., O.A.B., M.E.S.S., C.B.L.M.M.)
| | | | - W J Schonewille
- Neurology (W.J.S.), St. Antonius Hospital, Nieuwegein, the Netherlands
| | - J Boiten
- Neurology (J.B.), Haaglanden Medical Center, The Haag, the Netherlands
| | - M A A van Walderveen
- Department of Radiology (M.A.A.v.W.), Leiden University Medical Center, Leiden, the Netherlands
| | - R J van Oostenbrugge
- Neurology (R.J.v.O.), Cardiovascular Research Institute, Maastricht, the Netherlands
| | - A van der Lugt
- Radiology (A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - H A Marquering
- Biomedical Engineering and Physics (H.A.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - C B L M Majoie
- From the Departments of Radiology (I.G.H.J., O.A.B., M.E.S.S., C.B.L.M.M.)
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17
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de Vries JPPM, Vos JA. Commentary on 'Selective AAA sac Embolization During EVAR to Prevent Type II Endoleaks'. Eur J Vasc Endovasc Surg 2016; 51:640. [PMID: 26952344 DOI: 10.1016/j.ejvs.2016.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/24/2016] [Indexed: 11/19/2022]
Affiliation(s)
- J P P M de Vries
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - J A Vos
- Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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18
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Grantham JT, Howell DM, Bacaj PJ, Coad JE, Vos JA. Myeloid Sarcoma of the Bladder in the Setting of Refractory Anemia with Excess Blasts-2 (RAEB-2). W V Med J 2015; 111:34-36. [PMID: 26665895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Myeloid sarcoma is an extramedullary tumor consisting of immature hematopoietic cells of granulocytic or monocytic differentiation. While rare, it can be seen in a variety of clinical settings and is most commonly associated with acute myeloid leukemia (AML), myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN). We present a rare case of myeloid sarcoma occurring in the bladder of a 56 year old male. Myeloid sarcoma may be difficult to recognize due to its rarity and clinical and morphologic similarity to many other conditions; however, swift diagnosis is necessary as it is considered equivalent to AML. Prognostic indicators for myeloid sarcoma have not been well established, but survival may be improved by undergoing chemotherapy designed to treat AML.
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19
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Kinkade Z, Esan OA, Rosado FG, Craig M, Vos JA. Ileal mucosa-associated lymphoid tissue lymphoma presenting with small bowel obstruction: a case report. Diagn Pathol 2015; 10:105. [PMID: 26178711 PMCID: PMC4504228 DOI: 10.1186/s13000-015-0353-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/09/2015] [Indexed: 01/04/2023] Open
Abstract
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT Lymphoma) of the gastrointestinal tract commonly involves the stomach in the setting of concurrent Helicobacter pylori (H. pylori) infection. Primary ileal MALT lymphoma is rare, and has not been associated with a specific infectious disease. We report a case of a 58-year-old man who presented to the emergency department with constipation and abdominal distension, and signs of an obstructing mass on computed tomography scan. A small bowel resection was performed which revealed an 8 cm saccular dilatation with thickened bowel wall and subjacent thickened tan-yellow tissue extending into the mesentery. Histologically, there was a diffuse lymphoid infiltrate consisting of small atypical cells with monocytoid features. These cells were CD20-positive B-lymphocytes that co-expressed BCL-2 and were negative for CD5, CD10, CD43, and cyclin D1 on immunohistochemical studies. Kappa-restricted plasma cells were also identified by in situ hybridization. The overall proliferation index was low with Ki-67 immunoreactivity in approximately 10 % of cells. No areas suspicious for large cell or high grade transformation were identified. The pathologic findings were diagnostic of an extranodal marginal zone lymphoma involving the ileum, with early involvement of mesenteric lymph nodes. Small hypermetabolic right mesenteric and bilateral hilar lymph nodes were identified by imaging. The bone marrow biopsy showed no evidence of involvement by lymphoma. The patient was clinically considered advanced stage and opted for therapy with rituximab infusions. After six months of therapy, follow-up radiologic studies demonstrated significant decrease in size of the mesenteric lymph nodes.
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Affiliation(s)
- Zoe Kinkade
- Department of Pathology, West Virginia University, PO Box 9203, Morgantown, WV, 26506, USA.
| | - Olukemi A Esan
- Department of Pathology, West Virginia University, PO Box 9203, Morgantown, WV, 26506, USA.
| | - Flavia G Rosado
- Department of Pathology, West Virginia University, PO Box 9203, Morgantown, WV, 26506, USA.
| | - Michael Craig
- Department of Medicine, Section of Hematology/Oncology, West Virginia University, PO Box 9162, Morgantown, WV, 26506, USA.
| | - Jeffrey A Vos
- Department of Pathology, West Virginia University, PO Box 9203, Morgantown, WV, 26506, USA.
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20
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Schrijver AM, De Borst GJ, Van Herwaarden JA, Vonken EJ, Moll FL, Vos JA, De Vries JPPM. Catheter-directed thrombolysis for acute upper extremity ischemia. J Cardiovasc Surg (Torino) 2015; 56:433-439. [PMID: 25729917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Acute nontraumatic upper extremity ischemia has significant chronic disability when not treated adequately and timely. As surgical treatment can be challenging, this study evaluates catheter-directed thrombolysis as first-line treatment for acute upper extremity ischemia. METHODS Between January 2006 and December 2010, 28 patients (22 women; mean age, 63±16 years) underwent catheter-directed thrombolysis for acute upper extremity ischemia, Rutherford class I or IIa. Proximal extent of the occlusion was in the subclavian (32%), axillary (7%), brachial (25%) and forearm arteries (36%). Median occlusion length was 18 cm (range, 12-43). Causes were embolus (14%), thrombus (39%), thoracic outlet syndrome (14%), paraneoplastic (4%), or unknown (29%). RESULTS Technical success was 96%, radiologic success (>95% clot lysis) 61%, and clinical success 68%. Median duration of thrombolysis was 24 hours (range, 18-96). Of the 11 radiologically unsuccessful patients (39%), five were treated conservatively and six underwent surgical intervention. In-hospital amputation-rate was 7%. Four complications occurred: embolization to the lower extremity, a transient ischemic attack, a subcapsular splenic hematoma and a pseudoaneurysm. Cumulative amputation-free survival at six months was 93%, standard error (SE) 4.87 and at one year 88%, SE 6.50. CONCLUSION These results show that catheter-directed thrombolysis is effective in over 60% of patients as first-line treatment of extensive acute upper extremity ischemia and can prevent surgical intervention in these patients.
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Affiliation(s)
- A M Schrijver
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands -
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21
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Rubenstein JN, Beatty C, Kinkade Z, Bryan C, Hogg JP, Gibson LF, Vos JA. Extranodal Marginal Zone Lymphoma of the Lung: Evolution from an Underlying Reactive Lymphoproliferative Disorder. ACTA ACUST UNITED AC 2015; 5. [PMID: 26457231 DOI: 10.4172/2161-0681.1000208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Extranodal Marginal Zone Lymphoma (ENMZL) of Mucosa-Associated Lymphoid Tissue (MALT) is a problematic and sometimes controversial diagnosis. While commonly seen in the stomach in the setting of chronic Helicobacter pylori infection, other extranodal sites, such as the lung, may also present with disease. ENMZL is clinically and morphologically heterogeneous; however, regardless of presentation, the etiology lies in the accumulation of lymphoid tissue in non-traditional sites. This phenomenon is typically secondary to an underlying inflammatory stimulus such as chronic infection or autoimmune states. The current case report details the clinical history of a patient with Sjögren syndrome over a four year period who eventually developed ENMZL. The patient initially presented with an atypical, but polyclonal, lymphoproliferative process diagnosed as lymphocytic interstitial pneumonia. Over time, the patient showed evolution to a monoclonal process with associated radiologic progression of disease. This evolution manifested as a dense lymphoid infiltrate with prominent plasmacytic differentiation and the development of a lung mass radiologically. This case contributes to the growing body of knowledge that suggests ENMZL lies along a biological spectrum of lymphoproliferative disorders whereby a benign, reactive process may eventually undergo malignant transformation. This evolution likely represents the acquisition of genetic abnormalities that allow autonomous proliferation in the absence of the initial immune stimulus. In practice, determining when this event occurs and, thus, distinguishing between reactive and neoplastic disorders within this spectrum may be difficult as no single clinicopathologic feature may be present to establish the diagnosis. This case further illustrates the importance of correlating the clinical, radiologic and pathologic data to evaluate patients with atypical pulmonary lymphoproliferative disorders and to allow the optimal management of their disease.
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Affiliation(s)
| | - Colleen Beatty
- Department of Pathology, West Virginia University School of Medicine, USA
| | - Zoe Kinkade
- Department of Pathology, West Virginia University School of Medicine, USA
| | - Cara Bryan
- Department of Radiology, West Virginia University School of Medicine, USA
| | - Jeffery Paul Hogg
- Department of Radiology, West Virginia University School of Medicine, USA
| | - Laura F Gibson
- Professor of Microbiology, Immunology and Cell Biology, Mary Babb Randolph Cancer Center at West Virginia University School of Medicine
| | - Jeffrey A Vos
- Department of Pathology, West Virginia University School of Medicine, USA
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22
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Van Strijen MJL, Vos JA. Experience with new techniques for the treatment of type II endoleaks post-EVAR. J Cardiovasc Surg (Torino) 2014; 55:581-592. [PMID: 25033921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Endovascular aneurysm management (EVAR) is hampered by persistent arterial blood flow in the aneurysm sac after treatment, known as endoleak (EL). Type II EL consist of blood flow from one or more aortic branch vessels; they only require treatment when the aneurysm sac fails to shrink. Post-EVAR follow up is mostly done with contrast enhanced computed tomography. If a type II EL requiring treatment is found, a variety of options exist, depending on the source of EL and the anatomy. Inferior mesenteric artery EL is best treated by endovascular embolization through the superior mesenteric artery and Riolans' arc. In hypogastric to lumbar artery EL success of endovascular treatment is limited. In these cases a successful embolization of the EL can often be performed by a direct percutaneous approach to the EL inside the aneurysmal sac. CT guidance provides a good way to exactly puncture the EL percutaneously in most cases, but limited workspace and lack of fluoroscopy availability for the ensuing catheter manipulation hampers this technique. A novel way to puncture the EL and subsequently treat it is performed on flat panel detector angiography units. By a rotation around the patients these units provide the possibility to create a cone-beam CT (CBCT) in the angio suite. Using the 3-dimensional dataset thus acquired, a needle path can be planned and the EL nidus can be punctured with great confidence and without danger of inadvertently perforating vital structures. After the EL has been punctured, microcatheters can be inserted to embolize the origins of branch vessels and/or the aneurysm sac can be filled with thrombogenic agents or glue. CBCT guided procedures incur lower radiation dose and have higher accuracy compared to conventional CT guided procedures. Details of CBCT guided procedures; the materials and technique used are detailed in this manuscript.
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Affiliation(s)
- M J L Van Strijen
- Department of Interventional Radiology St. Antonius Hospital, Nieuwegein, The Netherlands -
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23
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Vorselaars VMM, Velthuis S, Mager JJ, Snijder RJ, Bos WJ, Vos JA, van Strijen MJL, Post MC. Direct haemodynamic effects of pulmonary arteriovenous malformation embolisation. Neth Heart J 2014; 22:328-33. [PMID: 24604121 PMCID: PMC4099429 DOI: 10.1007/s12471-014-0539-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Transcatheter embolisation is widely used to close pulmonary arteriovenous malformations (PAVMs) in patients with hereditary haemorrhagic telangiectasia (HHT). Data on the direct cardiovascular haemodynamic changes induced by this treatment are scarce. OBJECTIVES We investigated the direct haemodynamic effects of transcatheter embolisation of PAVMs, using non-invasive finger pressure measurements. METHODS During the procedure, blood pressure, heart rate (HR), stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and delta pressure/delta time (dP/dt) were continuously monitored using a Finometer®. Potential changes in these haemodynamic parameters were calculated from the pressure registrations using Modelflow® methodology. Absolute and relative changes were calculated and compared using the paired sample t-test. RESULTS The present study includes 29 HHT patients (mean age 39 ± 15 years, 11 men) who underwent transcatheter embolotherapy of PAVMs. The total number of embolisations was 72 (mean per patient 2.5). Directly after PAVM closure, SV and CO decreased significantly by -11.9 % (p = 0.01) and -9.5 % (p = 0.01) respectively, without a significant change in HR (1.8 %). Mean arterial blood pressure increased by 4.1 % (p = 0.02), while the TPR and dP/dt did not increase significantly (5.8 % and 0.2 %, respectively). CONCLUSIONS Significant haemodynamic changes occur directly after transcatheter embolisation of PAVMs, amongst which a decrease in stroke volume and cardiac output are most important.
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Affiliation(s)
- V M M Vorselaars
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands,
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Hamadani M, Vos JA, Craig MD. Reply to S. Fuji et al. J Clin Oncol 2014; 32:1860-1. [PMID: 24799471 DOI: 10.1200/jco.2014.55.4048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jajosky AN, Coad JE, Vos JA, Martin KH, Senft JR, Wenger SL, Gibson LF. RepSox slows decay of CD34+ acute myeloid leukemia cells and decreases T cell immunoglobulin mucin-3 expression. Stem Cells Transl Med 2014; 3:836-48. [PMID: 24855276 DOI: 10.5966/sctm.2013-0193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Despite initial response to therapy, most acute myeloid leukemia (AML) patients relapse. To eliminate relapse-causing leukemic stem/progenitor cells (LPCs), patient-specific immune therapies may be required. In vitro cellular engineering may require increasing the "stemness" or immunogenicity of tumor cells and activating or restoring cancer-impaired immune-effector and antigen-presenting cells. Leukapheresis samples provide the cells needed to engineer therapies: LPCs to be targeted, normal hematopoietic stem cells to be spared, and cancer-impaired immune cells to be repaired and activated. This study sought to advance development of LPC-targeted therapies by exploring nongenetic ways to slow the decay and to increase the immunogenicity of primary CD34(+) AML cells. CD34(+) AML cells generally displayed more colony-forming and aldehyde dehydrogenase activity than CD34(-) AML cells. Along with exposure to bone marrow stromal cells and low (1%-5%) oxygen, culture with RepSox (a reprogramming tool and inhibitor of transforming growth factor-β receptor 1) consistently slowed decline of CD34(+) AML and myelodysplastic syndrome (MDS) cells. RepSox-treated AML cells displayed higher CD34, CXCL12, and MYC mRNA levels than dimethyl sulfoxide-treated controls. RepSox also accelerated loss of T cell immunoglobulin mucin-3 (Tim-3), an immune checkpoint receptor that impairs antitumor immunity, from the surface of AML and MDS cells. Our results suggest RepSox may reduce Tim-3 expression by inhibiting transforming growth factor-β signaling and slow decay of CD34(+) AML cells by increasing CXCL12 and MYC, two factors that inhibit AML cell differentiation. By prolonging survival of CD34(+) AML cells and reducing Tim-3, RepSox may promote in vitro immune cell activation and advance development of LPC-targeted therapies.
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MESH Headings
- Aldehyde Dehydrogenase/metabolism
- Antigens, CD34/genetics
- Antigens, CD34/metabolism
- Biomarkers, Tumor/metabolism
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cellular Reprogramming/drug effects
- Chemokine CXCL12/genetics
- Chemokine CXCL12/metabolism
- Coculture Techniques
- Dose-Response Relationship, Drug
- Feeder Cells
- Gene Expression Regulation, Leukemic/drug effects
- Hepatitis A Virus Cellular Receptor 2
- Humans
- Leukapheresis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Neoplastic Stem Cells/drug effects
- Neoplastic Stem Cells/immunology
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- Oxygen/metabolism
- Protein Serine-Threonine Kinases/antagonists & inhibitors
- Protein Serine-Threonine Kinases/metabolism
- Proto-Oncogene Proteins c-myc/genetics
- Proto-Oncogene Proteins c-myc/metabolism
- Pyrazoles/pharmacology
- Pyridines/pharmacology
- Receptor, Transforming Growth Factor-beta Type I
- Receptors, Transforming Growth Factor beta/antagonists & inhibitors
- Receptors, Transforming Growth Factor beta/metabolism
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- T-Lymphocytes/pathology
- Time Factors
- Tumor Cells, Cultured
- Tumor Escape
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Affiliation(s)
- Audrey N Jajosky
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program of the Mary Babb Randolph Cancer Center, Cancer Cell Biology Program, and Departments of Pathology, Neurobiology and Anatomy, and Microbiology, Immunology and Cell Biology, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - James E Coad
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program of the Mary Babb Randolph Cancer Center, Cancer Cell Biology Program, and Departments of Pathology, Neurobiology and Anatomy, and Microbiology, Immunology and Cell Biology, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Jeffrey A Vos
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program of the Mary Babb Randolph Cancer Center, Cancer Cell Biology Program, and Departments of Pathology, Neurobiology and Anatomy, and Microbiology, Immunology and Cell Biology, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Karen H Martin
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program of the Mary Babb Randolph Cancer Center, Cancer Cell Biology Program, and Departments of Pathology, Neurobiology and Anatomy, and Microbiology, Immunology and Cell Biology, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Jamie R Senft
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program of the Mary Babb Randolph Cancer Center, Cancer Cell Biology Program, and Departments of Pathology, Neurobiology and Anatomy, and Microbiology, Immunology and Cell Biology, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sharon L Wenger
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program of the Mary Babb Randolph Cancer Center, Cancer Cell Biology Program, and Departments of Pathology, Neurobiology and Anatomy, and Microbiology, Immunology and Cell Biology, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Laura F Gibson
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program of the Mary Babb Randolph Cancer Center, Cancer Cell Biology Program, and Departments of Pathology, Neurobiology and Anatomy, and Microbiology, Immunology and Cell Biology, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Sayedian F, Senft JR, Spruill MD, Wenger SL, Vos JA. c-MYC Amplification in Acute Myelogenous Leukemia Evolving from Double Minutes (dmins) to Homogeneously Staining Region (hsr). J Assoc Genet Technol 2014; 40:64-67. [PMID: 26029796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A bone marrow biopsy of a 68-year-old woman revealed 59% blasts and immature monocytes, consistent with acute myeloid leukemia (AML) with monocytic features. Occasional hypolobated megakaryocytes and decreased iron stores were also present. A peripheral blood sample showed 7% blasts in addition to monocytosis, macrocytic anemia and thrombocytopenia. Molecular testing was negative for FLT3-ITD, NPM1 and CEBPA. Fluorescence in situ hybridization (FISH) probes were negative for t(8;21), t(15;17), inversion 16 and 11q23 rearrangements. The karyotype was 46,XX,del(20)(q11.2q13.1),~50dmin[3]/47,idem,+4[13]/47,idem,+22[2]/46,XX[2]. FISH confirmed that the double minutes were c-MYC positive with cryptic deletion of the c-MYC FISH signal on one of the chromosome 8s. Two months post-diagnosis, 57% of our patient's cells were still positive for c-MYC amplification; however, by four months only 8% of cells were positive for c-MYC amplification. After seven months, the patient's karyotype had the 20q deletion, X chromosome loss and a ring chromosome that consisted of a homogeneously staining region (hsr) containing c-MYC amplification. This case demonstrates that gene amplification in the form of double minutes can transform into a more stable hsr.
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Affiliation(s)
- Farzaneh Sayedian
- Department of Pathology, 1 Medical Center Drive, Morgantown, West Virginia University, Morgantown, WV
| | - Jamie R Senft
- Department of Pathology, 1 Medical Center Drive, Morgantown, West Virginia University, Morgantown, WV
| | - Michelle D Spruill
- Department of Pathology, 1 Medical Center Drive, Morgantown, West Virginia University, Morgantown, WV
| | - Sharon L Wenger
- Department of Pathology, 1 Medical Center Drive, Morgantown, West Virginia University, Morgantown, WV
| | - Jeffrey A Vos
- Department of Pathology, 1 Medical Center Drive, Morgantown, West Virginia University, Morgantown, WV
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Hamadani M, Gibson LF, Remick SC, Wen S, Petros W, Tse W, Brundage KM, Vos JA, Cumpston A, Bunner P, Craig MD. Sibling donor and recipient immune modulation with atorvastatin for the prophylaxis of acute graft-versus-host disease. J Clin Oncol 2013; 31:4416-23. [PMID: 24166529 PMCID: PMC3842909 DOI: 10.1200/jco.2013.50.8747] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Graft-versus-host disease (GVHD) is major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Atorvastatin is a potent immunomodulatory agent that holds promise as a novel and safe agent for acute GVHD prophylaxis. PATIENTS AND METHODS We conducted a phase II trial to evaluate the safety and efficacy of atorvastatin administration for GVHD prophylaxis in both adult donors and recipients of matched sibling allogeneic HCT. Atorvastatin (40 mg per day orally) was administered to sibling donors, starting 14 to 28 days before the anticipated first day of stem-cell collection. In HCT recipients (n = 30), GVHD prophylaxis consisted of tacrolimus, short-course methotrexate, and atorvastatin (40 mg per day orally). RESULTS Atorvastatin administration in healthy donors and recipients was not associated with any grade 3 to 4 adverse events. Cumulative incidence rates of grade 2 to 4 acute GVHD at days +100 and +180 were 3.3% (95% CI, 0.2% to 14.8%) and 11.1% (95% CI, 2.7% to 26.4%), respectively. One-year cumulative incidence of chronic GVHD was 52.3% (95% CI, 27.6% to 72.1%). Viral and fungal infections were infrequent. One-year cumulative incidences of nonrelapse mortality and relapse were 9.8% (95% CI, 1.4% to 28%) and 25.4% (95% CI, 10.9% to 42.9%), respectively. One-year overall survival and progression-free survival were 74% (95% CI, 58% to 96%) and 65% (95% CI, 48% to 87%), respectively. Compared with baseline, atorvastatin administration in sibling donors was associated with a trend toward increased mean plasma interleukin-10 concentrations (5.6 v 7.1 pg/mL; P = .06). CONCLUSION A novel two-pronged strategy of atorvastatin administration in both donors and recipients of matched sibling allogeneic HCT seems to be a feasible, safe, and potentially effective strategy to prevent acute GVHD.
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Affiliation(s)
| | | | | | - Sijin Wen
- All authors: West Virginia University, Morgantown, WV
| | | | - William Tse
- All authors: West Virginia University, Morgantown, WV
| | | | | | | | - Pamela Bunner
- All authors: West Virginia University, Morgantown, WV
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Rashidi A, Goudar RK, Sayedian F, Vos JA, Goldin TA, Aguilera NS, Fisher SI. All-trans retinoic acid and early mortality in acute promyelocytic leukemia. Leuk Res 2013; 37:1391-2. [PMID: 23906626 DOI: 10.1016/j.leukres.2013.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
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29
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Khimani F, Livengood R, Esan O, Vos JA, Abhyankar V, Gutmann L, Tse W. Pancytopenia related to dental adhesive in a young patient. Am J Stem Cells 2013; 2:132-136. [PMID: 23862101 PMCID: PMC3708507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/27/2013] [Indexed: 06/02/2023]
Abstract
Copper deficiency resulting in hypocupremia is a rare cause of pancytopenia associated with a neurological syndrome. Hypocupremia may also occur as a consequence of excessive oral zinc consumption as described by Brewer et al and several other groups. Dental fixatives have been described as a potential source of hyperzincemia in patients. Despite the recently modified dental fixatives with safer zinc content, zinc poisoning results in hypocupremia secondary to inappropriate use of them can still happen and more likely be misdiagnosed. We describe a case of a patient with pancytopenia who was diagnosed with severe aplastic anemia and hypocellular myelodysplastic syndrome and was referred to us for consideration of bone marrow transplantation.
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Affiliation(s)
- Farhard Khimani
- Hematology/Oncology Mary Babb Randolph Cancer Center, West Virginia UniversityMorgantown, WV, USA
| | - Ryan Livengood
- Department of Pathology, West Virginia UniversityMorgantown, WV, USA
| | - Olukemi Esan
- Department of Pathology, West Virginia UniversityMorgantown, WV, USA
| | - Jeffrey A Vos
- Department of Pathology, West Virginia UniversityMorgantown, WV, USA
| | | | - Ludwig Gutmann
- Department of Neurology, West Virginia UniversityMorgantown, WV, USA
| | - William Tse
- Hematology/Oncology Mary Babb Randolph Cancer Center, West Virginia UniversityMorgantown, WV, USA
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Van Der Heyden J, Van Werkum J, Hackeng CM, Kelder JC, Breet NJ, Deneer VHM, Ackerstaff RGA, Tromp SC, De Vries JPPM, Vos JA, Suttorp MJ, Elsenberg EHA, Van Neerven D, Schonewille WJ, Wolters F, Ten Berg JM. High versus standard clopidogrel loading in patients undergoing carotid artery stenting prior to cardiac surgery to assess the number of microemboli detected with transcranial Doppler: results of the randomized IMPACT trial. J Cardiovasc Surg (Torino) 2013; 54:337-347. [PMID: 23138609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this study was to compare the effects of 300 mg or 600 mg clopidogrel loading dose, prior to carotid artery stenting (CAS) on the number of transcranial Doppler (TCD)-detected microembolic signals (MES) and to investigate the relationship between the magnitude of platelet reactivity and MES. METHODS In this prospective randomized, double-blind study, 35 consecutive asymptomatic patients (17.1% females), scheduled for CAS and cardiac surgery were included. The primary endpoint was the number of TCD-detected MES. The secondary endpoints were the absolute magnitude of on-treatment platelet reactivity and the adverse cerebral events. Negative binomial regression to find predictors for sum of single emboli, the student's t-test to assess the association between platelet function tests and randomized dose of 300 mg or 600 mg clopidogrel, and the R2 calculation for the assessment of the association between platelet function tests and embolic load, were used. RESULTS No statistically significant difference in the number of TCD-detected MES, in the sum of all the single emboli or showers and platelet aggregation measurements between the two groups was observed (aggregometry: 21.7±18.3 versus 23±18%, P=0.8499 and 45.8±17.5 versus 46.5±14.5%, P=0.9003) (verifyNow P2Y12 assay: 231±93 PRU versus 222±86 PRU, P=0.7704). In one patient a transient ischemic attack occurred. CONCLUSION A loading dose of 300 mg of clopidogrel in combination with aspirin is as effective as 600 mg of clopidogrel in achieving adequate platelet inhibition and preventing periprocedural events in asymptomatic patients undergoing CAS prior to cardiac surgery.
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Affiliation(s)
- J Van Der Heyden
- Department of Interventional Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
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Chaudhary LN, Bailey NG, Vos JA, Stotler CJ. Unique association of myeloid neoplasm with eosinophilia and abnormalities of PDGFRA with TTP. W V Med J 2013; 109:6-9. [PMID: 23600098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Myeloid neoplasm with eosinophilia and abnormalities of Alpha type platelet derived growth factor receptor (PDGFRA) is a type of hypereosinophilic syndrome characterized by multiorgan damage due to eosinophilia. Its association with thrombotic thrombocytopenic purpura (TTP) has rarely been reported. We describe here a case report of a female in whom TTP presented as one of the earlier manifestations of myeloproliferative HES with rearrangement of PDGFRA. Our patient was found to have a normal ADAMTS-13 level which is not commonly seen with TTP. This case illustrates the importance of recognizing the atypical presentations of HES which may be difficult to recognize.
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Affiliation(s)
- Lubna N Chaudhary
- Dept. of Internal Medicine, West Virginia University, Morgantown, WV 26506, USA.
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Avci M, Vos JA, Kolvenbach RR, Verhoeven EL, Perdikides T, Resch TA, Espinosa G, Böckler D, De Vries JPPM. The use of endoanchors in repair EVAR cases to improve proximal endograft fixation. J Cardiovasc Surg (Torino) 2012; 53:419-426. [PMID: 22854521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this paper was to evaluate short-term outcome of the use of endoanchors to secure the primary migrated endograft and additional extender cuffs to the aortic wall in patients with previous failed endovascular aortic aneurysm repair. METHODS Consecutive patients who needed proximal repair of a primary failed endograft due to migration (with or without type IA endoleaks) were treated with endoanchors, with or without additional extender cuffs. Data of this group were prospectively gathered in vascular referral centers that were early adopters of the endoanchor technique. Preprocedural and periprocedural data were prospectively gathered and retrospectively analyzed. Follow-up after endoanchor placement consisted of regular hospital visits, with computed tomography or duplex scanning at 1, 6, and 12 months. RESULTS From July 2010 to May 2011, 11 patients (8 men), mean age 77 years (range, 59-88 years), were treated with endoanchors for a failed primary endograft (2 Excluder endografts, 1 AneuRx endograft, and 8 Talent endografts) due to distal migration of the main body, with or without type IA endoleak. Revision consisted of using endoanchors to secure the body of the primary endograft to the aortic wall to avoid persistent migration. Most patients had additional proximal extender cuffs with suprarenal fixation, which were secured with endoanchors to the aortic wall and in some patients also to the primary endograft. A median of 6 endoanchors were implanted. All endoanchors were positioned correctly but one. One endoanchor dislodged but was successfully retrieved using an endovascular snare. During a mean follow-up of 10 months (range, 3-18 months) no endoanchor-related complications or renewed migration of the endografts occurred. Two patients underwent repeat intervention due to persistent type IA endoleak during follow-up. CONCLUSION The use of endoanchors to secure migrated endografts to the aortic wall is safe and feasible and might help to overcome persistent migration of primary failed endografts. In combination with the use of sole extender cuffs the majority of proximal EVAR failures can be solved.
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Affiliation(s)
- M Avci
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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de Vries JPPM, Vos JA. Comments regarding 'Carotid endarterectomy within seven days after the neurological index event is safe and effective in stroke prevention'. Eur J Vasc Endovasc Surg 2011; 42:740-1. [PMID: 21944568 DOI: 10.1016/j.ejvs.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/06/2011] [Indexed: 11/16/2022]
Affiliation(s)
- J P P M de Vries
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
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Akers SM, O'Leary HA, Minnear FL, Craig MD, Vos JA, Coad JE, Gibson LF. VE-cadherin and PECAM-1 enhance ALL migration across brain microvascular endothelial cell monolayers. Exp Hematol 2010; 38:733-43. [PMID: 20470859 DOI: 10.1016/j.exphem.2010.05.001] [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] [Received: 03/08/2010] [Revised: 04/30/2010] [Accepted: 05/03/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Infiltration of the central nervous system (CNS) by leukemia is a problematic disease manifestation of acute lymphoblastic leukemia (ALL). The mechanisms by which leukocytes interact with human brain-derived microvasculature endothelial cells (HBMEC) and enter the CNS are largely derived from models of inflammation. However, our data indicate that ALL cells do not elicit an inflammatory phenotype by HBMEC. Our current investigation focuses on the contribution of the unique coexpression of vascular endothelial (VE)-cadherin and platelet endothelial cell adhesion molecule-1 (PECAM-1) by ALL in mediating leukemic cell interactions with HBMEC as an in vitro model of the blood-brain barrier. MATERIALS AND METHODS Primary ALL and ALL cell lines were evaluated for VE-cadherin and PECAM-1 expression. Lentiviral-mediated transduction of VE-cadherin and PECAM-1 into REH cells and antibody neutralization of VE-cadherin and PECAM-1 in SUP-B15 cells was used to delineate the role of these two proteins in mediating ALL adhesion to, and migration through, HBMEC monolayers. RESULTS Although cell line models indicate that VE-cadherin and PECAM-1 expression is found on the surface Philadelphia chromosome-positive ALL, evaluation of primary ALL demonstrates that VE-cadherin and PECAM-1 are expressed independent of Philadelphia status. Expression of VE-cadherin and PECAM-1 by ALL enhanced the adhesion of ALL to HBMEC, while expression of PECAM-1 enhanced ALL adhesion to, and migration through, HBMEC. CONCLUSIONS Expression of VE-cadherin and PECAM-1 by ALL cells positions them to interact with HBMEC. By increasing our understanding of molecular mechanisms through which ALL cells gain entry into the CNS, new strategies may be designed to prevent leukemia cell entry into the CNS.
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Affiliation(s)
- Stephen M Akers
- Cancer Cell Biology Program, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, WV 26506, USA
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Fadare O, Carns B, Vos JA, Wang SA. Clinicopathologic features associated with cytohistologic noncorrelation in the diagnosis of cervical dysplasia: a study of concurrently obtained samples. Int J Surg Pathol 2009; 17:31-7. [PMID: 18480391 DOI: 10.1177/1066896908315818] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
On the basis of the unique subset of our database comprising patients who received a Papanicolaou test and a cervical biopsy during the same clinic visit, clinicopathologic factors potentially associated with cytohistologic diagnostic noncorrelation in these concurrently collected samples is investigated. In the first analysis, a selected group of variables potentially associated with noncorrelation relative to the diagnosis of high-grade dysplasia were examined, whereas the second analysis was centered on the effect of varying levels of Papanicolaou test inflammation (below the Bethesda 2001 threshold, ie, partially obscuring inflammation) on noncorrelation regarding the overall diagnosis of dysplasia. For the latter, the overall density of neutrophilic infiltrate on each Papanicolaou test slide was graded in a blinded fashion on a 4-tiered scale (no significant amount, mild, moderate, and severe), followed by a comparison of correlating and noncorrelating cases at each tier. There was no overrepresentation of noncorrelating cases in severe inflammation group. Indeed, correlating and noncorrelating cases did not significantly differ at any level of inflammation. In the first analysis, correlating (n = 17) and noncorrelating (n = 17) cases did not significantly differ in patient age, number of biopsies obtained, endocervical curettage status, glandular involvement by high-grade dysplasia, or frequency of background grade 1 cervical intraepithelial neoplasia. Noncorrelating cases were more likely than correlating cases to be grade 2 cervical intraepithelial neoplasia rather than grade 3 or worse (82% vs 41%, respectively, P = .02), which is probably attributable to the absence of a basaloid proliferation in the most superficial layers of grade 2 lesions. Furthermore, noncorrelating cases showed a comparatively smaller percentage of submitted biopsies involved by high-grade dysplasia (52% vs 75%, respectively, P = .03), consistent with smaller extent of disease. These findings further illustrate that lesional factors are important potential contributors to the false-negative rate of the Papanicolaou test.
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Affiliation(s)
- Oluwole Fadare
- Department of Pathology, Wilford Hall Medical Center, Lackland AFB, TX 78236, USA.
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Compter A, van der Worp HB, Schonewille WJ, Vos JA, Algra A, Lo TH, Mali WPTM, Moll FL, Kappelle LJ. VAST: Vertebral Artery Stenting Trial. Protocol for a randomised safety and feasibility trial. Trials 2008; 9:65. [PMID: 19025615 PMCID: PMC2611963 DOI: 10.1186/1745-6215-9-65] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 11/24/2008] [Indexed: 11/10/2022] Open
Abstract
Background Twenty to 30 percent of all transient ischaemic attacks and ischaemic strokes involve tissue supplied by the vertebrobasilar circulation. Atherosclerotic stenosis ≥ 50% in the vertebral artery accounts for vertebrobasilar stroke in at least one third of the patients. The risk of recurrent vascular events in patients with vertebral stenosis is uncertain and revascularisation of vertebral stenosis is rarely performed. Observational studies have suggested that the risk of subsequent stroke or death in patients with vertebrobasilar ischaemic events is comparable with that in patients with carotid territory events. Treatment of vertebral stenosis by percutaneous transluminal angioplasty has been introduced as an attractive treatment option. The safety and benefit of stenting of symptomatic vertebral stenosis as compared with best medical therapy alone remains to be elucidated in a randomised clinical trial. Study objectives The primary aim of the Vertebral Artery Stenting Trial (VAST) is to assess whether stenting for symptomatic vertebral artery stenosis ≥ 50% is feasible and safe. A secondary aim is to assess the rate of new vascular events in the territory of the vertebrobasilar arteries in patients with symptomatic vertebral stenosis ≥ 50% on best medical therapy with or without stenting. Design This is a randomised, open clinical trial, comparing best medical treatment with or without vertebral artery stenting in patients with recently symptomatic vertebral artery stenosis ≥ 50%. The trial will include a total of 180 patients with transient ischaemic attack or non-disabling ischaemic stroke attributed to vertebral artery stenosis ≥ 50%. The primary outcome is any stroke, vascular death, or non-fatal myocardial infarction within 30 days after start of treatment. Secondary outcome measures include any stroke or vascular death during follow-up and the degree of (re)stenosis after one year. Discussion Improvements both in imaging of the vertebral artery and in endovascular techniques have created new opportunities for the treatment of symptomatic vertebral artery stenosis. This trial will assess the feasibility and safety of stenting for symptomatic vertebral artery stenosis and will provide sufficient data to inform a conclusive randomised trial testing the benefit of this treatment strategy. The VAST is supported by the Netherlands Heart Foundation (2007B045; ISRCTN29597900).
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Affiliation(s)
- A Compter
- Department of Neurology, Rudolf Magnus Institute for Neuroscience, University Medical Centre Utrecht, HP G 03,228, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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de Borst GJ, Vos JA, Reichmann B, Hellings WE, de Vries JPPM, Suttorp MJ, Moll FL, Ackerstaff RGA. The Fate of the External Carotid Artery after Carotid Artery Stenting. A Follow-up Study with Duplex Ultrasonography. Eur J Vasc Endovasc Surg 2007; 33:657-63. [PMID: 17337347 DOI: 10.1016/j.ejvs.2007.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 10/18/2006] [Accepted: 01/16/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the long-term effect of carotid angioplasty and stenting (CAS) of the internal carotid artery (ICA) on the ipsilateral external carotid artery (ECA). SUBJECTS AND METHODS We prospectively registered the pre- and post-interventional duplex scans obtained from 312 patients (mean age 70 years) who underwent CAS. Duplex scans were scheduled the day before CAS, 3 and 12 months post-procedurally and yearly thereafter, to study progression of obstructive disease in the ipsilateral ECA compared to the contralateral ECA. The duplex ultrasound criteria used to identify ECA stenosis >or=50% were Peak Systolic Velocities of >or=125 cm/s. RESULTS Preprocedural evaluation of the ipsilateral ECA demonstrated >or=50% stenosis in 32.7% of cases vs 30% contralateral. Both ipsilateral and contralateral 3 (1%) ECA occlusions were noted. After stenting 5 (1.8%) occlusions were seen vs 1% contralateral. No additional ipsilateral occlusions and 2 additional contralateral occlusions were noted at extended follow-up. The prevalence of >or=50% stenosis of the ipsilateral ECA (Kaplan-Meier estimates) progressed from 49.1% at 3, to 56.4%, 64.7%, 78.2%, 72.3%, and 74% at 12, 24, 36, 48, and 60 months respectively. Contralateral prevalences were 31.3%, 37.7%, 41.7%, 43.1%, 46.0%, and 47.2% respectively (p<0.001). Progression of stenosis was more pronounced in 234 patients (75%) with overstenting of the carotid bifurcation (p=0.004). CONCLUSION Our results show that significant progression of >or=50% stenosis in the ipsilateral ECA occurs after CAS. There was greater progression of disease in the ipsilateral compared with the contralateral ECA. Progression of disease in the ECA did not lead to the occurrence of occlusion during follow up.
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Affiliation(s)
- G J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
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Kropman RHJ, Bemelman M, Vos JA, van den Berg JC, van de Pavoordt HDWM, van de Mortel RHW, Moll FL, de Vries JPPM. Long-term Results of Percutaneous Transluminal Angioplasty for Symptomatic Iliac In-stent Stenosis. Eur J Vasc Endovasc Surg 2006; 32:634-8. [PMID: 16875851 DOI: 10.1016/j.ejvs.2006.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 04/26/2006] [Accepted: 06/07/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study describes the long-term results of endoluminal therapy for iliac in-stent obstructions. DESIGN This is a retrospective study. MATERIALS AND METHODS From 1992 to 2005, 68 patients (22 women), with a mean age of 61+/- 13 years and 16 bi-iliac in-stent obstructions, underwent 84 endovascular interventions for focal iliac in-stent stenoses (n = 61) or occlusions (n = 23). Primarily, only uncovered stents were placed. All patients were symptomatic: 70% had disabling intermittent claudication, 23% had resting pain, and 7% had trophic changes. All had in-stent diameter reduction exceeding 50% that was confirmed by duplex scanning and angiography. Procedures were performed under local anesthesia via the femoral route. RESULTS All interventions were initially technically successful, with a minor complication of pneumonia in one patient (2%). Initial clinical success was achieved in 86% of patients. PTA alone was used to treat 72 (86%) in-stent obstructions, the other 12 (14%) had PTA and renewed stent placement. The 30-day mortality rate was 0%. Mean follow-up was 35 months (range, 3 months to 10 years) and included duplex scanning. Primary clinical patency was 88% at 1 year, 62% at 3 years, and 38% at 5 years follow-up. During follow-up, 28 (33%) of 84 extremities required secondary reinterventions because of symptomatic renewed in-stent stenosis, and 11 were treated successfully with repeated endovascular interventions. Secondary patency at 1 year was 94%, 78% at 3 years, and 63% at 5 years. Surgical intervention was eventually needed in 17 (20%) of the 84 extremities. CONCLUSIONS Endoluminal therapy for iliac focal in-stent obstructive disease seems to be a safe technique with acceptable long-term outcome and therefore a true alternative to primary surgical reconstruction.
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Affiliation(s)
- R H J Kropman
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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39
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Abstract
We report transection and embolization to the heart of a subclavian venous catheter in an immobilized and mechanical ventilated patient. The catheter tip was retrieved using a percutaneous method via the left femoral vein. Mechanical compression of the subclavian venous catheter at the costoclavicular area is termed pinch-off syndrome. It can be recognized by intermittent difficulties with drug injection, and chest wall swelling at the insertion site. The diagnosis can be confirmed by chest radiography with or without contrast administration. A more lateral approach of the subclavian vein is advocated to prevent compression.
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Affiliation(s)
- J C de Graaff
- Department of Anesthesiology and Intensive Care, St Antonius Hospital PO Box 2500, 3430 EM Nieuwegein, The Netherlands.
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Vos JA, Abbondanzo SL, Barekman CL, Andriko JW, Miettinen M, Aguilera NS. Histiocytic sarcoma: a study of five cases including the histiocyte marker CD163. Mod Pathol 2005; 18:693-704. [PMID: 15696128 DOI: 10.1038/modpathol.3800346] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.2] [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: 12/16/2022]
Abstract
Histiocytic sarcoma (HS) is a rare but controversial hematopoietic neoplasm. In the past, malignancies have been misclassified as histiocytic tumors due to overlapping histologic features and inadequate phenotypic data. CD163, a recently characterized hemoglobin scavenger receptor, appears to be a 'specific' marker of histiocytic lineage and a promising diagnostic tool for evaluating histiocytic neoplasms. Five cases of HS were studied to further elucidate the clinicopathologic features of these rare tumors and to demonstrate the diagnostic utility of CD163. Criteria for diagnosis included histologic and immunohistochemical evidence of histiocytic differentiation, CD45 positivity, and exclusion of lymphoid, epithelial, melanocytic and dendritic cell phenotype. Sites of disease included the colon (two cases), palate, inguinal lymph node, and testis. The clinical course was aggressive in 4/5 patients (survival=2-15 months). One patient with localized disease of the palate, survived 17 years after diagnosis. All patients with poor survival had tumors > or =3.5 cm. Histologically, all cases showed diffuse architecture with large, discohesive polygonal cells. Spindling of cells was focally noted. Hemophagocytosis was identified in 3/5 cases. A prominent inflammatory background was present in 4/5 tumors. All cases were immunoreactive for CD45, CD163, CD68, and lysozyme. S-100 was focally positive in 4/5 cases. Antibodies for melanocytic, epithelial, lymphoid, and dendritic cell markers were negative. Molecular studies showed monoclonal IgH gene rearrangements in three cases. Our findings suggest that HS is an uncommon neoplasm frequently extranodal in presentation and aggressive in behavior, with rare exceptions. Stage of disease and possibly tumor size are significant prognostic indicators. Molecular studies remain controversial in the diagnosis. The morphologic and phenotypic features are relatively uniform; however, the diagnosis requires exclusion of more common neoplasms by extensive immunophenotypic studies. CD163 appears to be a specific histiocytic marker and is important in establishing the diagnosis of HS.
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MESH Headings
- Adult
- Aged
- Antigens, CD/analysis
- Antigens, Differentiation, Myelomonocytic/analysis
- Female
- Gene Rearrangement
- Histiocytes/chemistry
- Histiocytes/pathology
- Histiocytes/ultrastructure
- Histiocytic Disorders, Malignant/genetics
- Histiocytic Disorders, Malignant/metabolism
- Histiocytic Disorders, Malignant/pathology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunohistochemistry
- Leukocyte Common Antigens/analysis
- Male
- Microscopy, Electron
- Middle Aged
- Receptors, Antigen, T-Cell/genetics
- Receptors, Cell Surface/analysis
- Sarcoma/genetics
- Sarcoma/metabolism
- Sarcoma/pathology
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Affiliation(s)
- Jeffrey A Vos
- Department of Hematopathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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41
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Biemans JMA, Vos JA. Bleeding stromal tumor in Meckel's diverticulum. JBR-BTR 2005; 88:112-3. [PMID: 16038218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- J M A Biemans
- Department of Radiology, Stichting Sint Antoniusziekenhuis, Nieuwegein, The Netherlands
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Hepburn MJ, Vos JA, Fillman EP, Lawitz EJ. The accuracy of the report of hepatic steatosis on ultrasonography in patients infected with hepatitis C in a clinical setting: a retrospective observational study. BMC Gastroenterol 2005; 5:14. [PMID: 15829009 PMCID: PMC1087838 DOI: 10.1186/1471-230x-5-14] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 04/13/2005] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Steatosis is occasionally reported during screening ultrasonography in patients with hepatitis C virus (HCV). We conducted a retrospective observational study to assess the factors associated with steatosis on ultrasonography and the relationship between steatosis on ultrasound versus biopsy in patients infected with HCV in a clinical setting. Our hypothesis was ultrasonography would perform poorly for the detection of steatosis outside of the context of a controlled study, primarily due to false-positive results caused by hepatic fibrosis and inflammation. METHODS A retrospective review of ultrasound reports was conducted on patients infected with HCV in a tertiary care gastroenterology clinic. Reports were reviewed for the specific documentation of the presence of steatosis. Baseline clinical and histologic parameters were recorded, and compared for patients with vs. without steatosis. Multiple logistic regression analysis was performed on these baseline variables. Liver biopsies were reviewed by two pathologists, and graded for steatosis. Steatosis on biopsy was compared to steatosis on ultrasound report, and the performance characteristics of ultrasonography were calculated, using biopsy as the gold standard. RESULTS Ultrasound reports were available on 164 patients. Patients with steatosis on ultrasound had a higher incidence of the following parameters compared to patients without steatosis: diabetes (12/49 [24%] vs. 7/115 [6%], p < 0.001), fibrosis stage > 2 (15/48 [31%] vs. 16/110 [15%], p = 0.02), histologic grade > 2 (19/48 [40%] vs. 17/103 [17%], p = 0.002), and ALT (129.5 +/- 89.0 IU/L vs. 94.3 +/- 87.0 IU/L, p = 0.01). Histologic grade was the only factor independently associated with steatosis with multivariate analysis. When compared to the histologic diagnosis of steatosis (n = 122), ultrasonography had a substantial number of false-positive and false-negative results. In patients with a normal ultrasound, 8/82 (10%) had > 30% steatosis on biopsy. Among patients with steatosis reported on ultrasound, only 12/40 (30%) had > 30% steatosis on biopsy review. CONCLUSION Steatosis on ultrasound is associated with markers of inflammation and fibrosis in HCV-infected patients, but does not consistently correlate with steatosis on biopsy outside of the context of a controlled study. Clinicians should be skeptical of the definitive diagnosis of steatosis on hepatic ultrasonography.
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Affiliation(s)
- Matthew J Hepburn
- Departments of Medicine Brooke Army Medical Center, Fort Sam Houston Texas, USA
| | - Jeffrey A Vos
- Departments of Medicine Brooke Army Medical Center, Fort Sam Houston Texas, USA
| | - Eric P Fillman
- Department of Pathology, Brooke Army Medical Center, Fort Sam Houston Texas, USA
| | - Eric J Lawitz
- Departments of Medicine Brooke Army Medical Center, Fort Sam Houston Texas, USA
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van der Laan L, Vos JA, de Boer E, van den Berg JC, Moll FL. [The central-venous compression syndrome: rare, but adequately treatable with endovascular stenting]. Ned Tijdschr Geneeskd 2004; 148:433-7. [PMID: 15038205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Two patients, women aged 30 and 29, had severe chronic pain in the left leg, and a woman aged 36 had pain in the left flank. On the grounds of the clinical symptoms, phlebography and venous-duplex ultrasonography, a central-venous compression syndrome was diagnosed: compression of the left common iliac vein between the crossing right common iliac artery and the body of the fifth lumbar vertebra (May-Thurner syndrome). The patient with left flank pain also had haematuria. Angiography, computed tomography and phlebography revealed that these symptoms were due to compression of the left renal vein between the abdominal aorta and the superior mesenteric artery (nutcracker phenomenon). The treatment of all 3 patients consisted of venous endovascular stenting. At follow-up after 12, 30 and 15 months, respectively, the complaints had subsided considerably.
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de Vries JPPM, van Den Heuvel DAF, Vos JA, van Den Berg JC, Moll FI. Freedom from secondary interventions to treat stenotic disease after percutaneous transluminal angioplasty of infrarenal aorta: long-term results. J Vasc Surg 2004; 39:427-31. [PMID: 14743148 DOI: 10.1016/j.jvs.2003.08.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [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: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to determine the long-term results (1-15 years) of percutaneous transluminal angioplasty (PTA) of localized atherosclerotic lesions of the infrarenal aorta. METHODS This was a retrospective study. From January 1987 to January 2002, 69 patients underwent PTA of an isolated stenosis of the lower abdominal aorta under local anesthesia in the department of interventional radiology. All atherosclerotic lesions were hemodynamically significant, defined as a subjective report of walking distance less than one block, resting pain, or trophic changes in combination with diameter reduction of 50% or greater at duplex ultrasound scanning and angiography. RESULTS The female-male ratio of study patients was 3.6:1; mean age was 58 years. Endovascular treatment was initially technically and clinically successful in all but one patient (98%), who had a near total occlusion. No major complications were noted. Mean follow-up was 57 months (range, 6 months-15 years). At life table analysis, 5-year primary patency was 75%, and secondary patency was 97%. Twelve patients (17%) required repeat interventions because of hemodynamically significant recurrent stenosis in combination with severe clinical symptoms. Most recurrent stenoses (67%) were successfully treated with repeat endovascular procedures. CONCLUSIONS Early and long-term results of PTA (with additional stent placement) of isolated stenosis of the infrarenal aorta are good. This minimally invasive procedure is a true alternative to traditional surgical methods.
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Affiliation(s)
- J P P M de Vries
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
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Abstract
PURPOSE In this article we will review some of the issues surrounding the relationship between TCD-detected emboli and brain function and architecture, both during conventional surgical carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS). MATERIAL AND METHODS In both procedures, the cerebral embolic load was semi quantitatively assessed and associated with clinical outcome during the procedure and after a symptom free interval within 7 days. RESULTS In CEA, particulate emboli that occurred during the wound closure stage were associated with intraoperative stroke and stroke related death, odds ratios [OR] 2.3 95% CI 1.2-4.4, p = 0.007. In CAS, showers of microemboli that appeared at postdilatation of the stent (OR 3.2, 95% CI 1.5-6.9, p = 0.002), particulate macroembolism (relative risk [RR] 10.2, 95% CI 5.9-17.3, p < 0.001), and massive air embolism (RR 10.2, 95%CI 5.8-17.7, p < 0.001) were associated with new transient and persistent cerebral deficits. CONCLUSION In both CEA and CAS, recording of cerebral emboli by TCD ultrasonography provides insight in the pathogenesis of procedure related adverse cerebral outcome. In several centres TCD monitoring during CEA is now accepted as a clinically relevant tool that helps the surgeon to make the operation safer. In CAS more research is needed, particularly with respect to the impact of cerebral protection devices.
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Affiliation(s)
- R G A Ackerstaff
- Department of Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein (Utrecht), The Netherlands.
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Vos JA, Simurdak JH, Davis BJ, Myers JB, Brissette MD. Vortex disaggregation for flow cytometry allows direct histologic correlation: a novel approach for small biopsies and inaspirable bone marrows. Cytometry B Clin Cytom 2003; 52:20-31. [PMID: 12599178 DOI: 10.1002/cyto.b.10002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many approaches to obtaining single cells from tissue for flow cytometric immunophenotyping are used; however, these methods result in tissue that is too disrupted for subsequent histologic examination. We introduce a new technique for cell dissociation of hematopoietic malignancies that preserves tissue for histology. This is especially important with small specimens for which this type of correlation is critical. METHODS Fresh tissue from lymph node, gastrointestinal (GI) tract, skin, and other soft tissue biopsies, in addition to cores of inaspirable bone marrows, were briefly vortexed until the RPMI cell culture medium became cloudy. Larger specimens such as lymph nodes were sectioned before disaggregating, whereas smaller ones were vortexed in toto. Resultant flow cytometric analyses were compared with the histology and, in some cases, the immunohistochemistry (IHC) to determine whether the data were concordant. Cell suspensions of 104 specimens-composed of 48 lymph nodes, 19 bone marrow cores (BMCs), 11 GI biopsies, 11 skin/soft tissue biopsies, and 15 miscellaneous specimens-were prepared via vortex disaggregation. RESULTS Flow cytometric analysis of 96 specimens (92.3%) showed adequacy of material and diagnostic correlation with the histology and IHC. Of the eight cases (7.7%) that were discordant, seven were attributable to significant specimen fibrosis or necrosis. With respect to tissue type, this method produced diagnostic cell suspensions for most lymph nodes (95.8%), GI biopsies (90.9%), and BMCs (89.5%); however, it was less useful for skin/soft tissue samples (81.8%). CONCLUSIONS Disaggregation of tissue for flow cytometric analysis by vortexing appears to provide adequate and representative cellular material. This technique is ideal for inaspirable bone marrows and small biopsies where tissue preservation for histology is paramount.
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Affiliation(s)
- Jeffrey A Vos
- Department of Pathology, Madigan Army Medical Center, Tacoma, Washington, USA.
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Vos JA. [Diagnostic image (63). Paraganglioma]. Ned Tijdschr Geneeskd 2001; 145:2173. [PMID: 11727616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
A 33-year-old woman was examined for a non-tender mass in the neck. Imaging findings were consistent with paraganglioma. The diagnosis was confirmed at surgery.
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Affiliation(s)
- J A Vos
- St. Antonius Ziekenhuis, afd. Radiologie, Koekoekslaan 1, 3435 CM Nieuwegein
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van Heesewijk HP, van der Graff Y, de Valois JC, Vos JA, Feldberg MA. Digital chest imaging using a selenium detector. The impact of hard copy size on observer performance: a computed tomography-controlled study. Invest Radiol 1997; 32:363-7. [PMID: 9179712 DOI: 10.1097/00004424-199706000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES The authors compare radiologist detection performance under clinical conditions for assessment of the effect of size reduction on the diagnostic performance of digital chest images obtained with a selenium detector. METHODS Sixty-five patients were examined with the digital system. The images were acquired without an antiscatter grid. Sixty-five posteroanterior life-size images (35 x 43 cm) and sixty-five posteroanterior minified images (56% of life size) were analyzed by three observers for detection of pulmonary, mediastinal, and pleural pathology, using computed tomography as the reference standard. The diagnostic value of life-size and minified images for the detection of these chest abnormalities was analyzed with receiver operating characteristic (ROC) methods. RESULTS For the detection of the various abnormalities by all radiologists, the areas under the ROC curves with life-size images versus minified images, respectively, were as follows: pulmonary opacities, 0.78 versus 0.78; interstitial disease, 0.74 versus 0.75; mediastinal disease, 0.70 versus 0.72; and pleural abnormalities 0.72 versus 0.67. CONCLUSIONS There was no statistically significant difference between the radiologists' performance in detecting pulmonary, mediastinal, and pleural pathology with life-size versus that with minified (56% of life size) digital selenium chest radiography.
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Affiliation(s)
- H P van Heesewijk
- Department of Diagnostic Radiology, St. Antonius Hospital, Utrecht, The Netherlands
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Litz CE, Vos JA, Copenhaver CM. Aberrant methylation of the major breakpoint cluster region in chronic myeloid leukemia. Blood 1996; 88:2241-9. [PMID: 8822945] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Isolated hypomethylated sites exist in the major breakpoint cluster region (M-bcr) where most Philadelphia chromosome (Ph) breakpoints are located. Twenty of 50 (40%) chronic myeloid leukemia (CML) patients were found to have aberrant hypermethylation of these sites on the rearranged M-bcr when compared with control marrows. The aberrancy correlated strongly with M-bcr breakpoint location; 19 of 20 cases had breakpoints located 5' of the M-bcr Sca I site, and 28 of 30 cases with normal M-bcr methylation had breakpoints located 3' of the M-bcr Sca I site. Sequence analysis of the Ph M-bcr breakpoints failed to find an M-bcr nucleotide position that delineated the transition between abnormally and normally methylated cases, indicating that the translocation of a critical M-bcr sequence was not responsible for the methylation abnormality. In 3 of 8 CML patients, cells without the t(9;22) were found to have abnormally methylated, unrearranged M-bcrs. The data indicate that abnormally methylated rearranged M-bcrs are present in CML cases with Ph breakpoints 5' of the M-bcr Sca I site and that the M-bcr in Ph- cells of patients with CML may also be abnormally methylated.
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Affiliation(s)
- C E Litz
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis
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van Heesewijk HP, van der Graaf Y, de Valois JC, Vos JA, Feldberg MA. Chest imaging with a selenium detector versus conventional film radiography: a CT-controlled study. Radiology 1996; 200:687-90. [PMID: 8756915 DOI: 10.1148/radiology.200.3.8756915] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [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: 02/02/2023]
Abstract
PURPOSE To compare radiologist detection performance under clinical conditions for assessment of conventional radiographs and digital chest images obtained with a selenium detector. MATERIALS AND METHODS One hundred four patients were examined with the digital and conventional systems under near identical technical conditions. The digital images were acquired without an antiscatter grid. Two hundred eight images were analyzed by three radiologists for detection of pulmonary, mediastinal, and pleural abnormalities; computed tomography was used as the reference standard. The diagnostic value of both techniques for the detection of these chest abnormalities was analyzed with receiver operating characteristic (ROC) methods. RESULTS For detection of the various abnormalities by all radiologists, the areas under the ROC curves with conventional imaging versus digital imaging, respectively, were as follows: pulmonary opacities, 0.81 versus 0.79; interstitial disease, 0.69 versus 0.73; mediastinal disease, 0.79 versus 0.74; and pleural abnormalities, 0.73 versus 0.68. CONCLUSION There was no statistically significant difference between the radiologists' performance in detecting pulmonary, mediastinal, and pleural abnormalities with conventional radiography versus that with digital selenium chest radiography.
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Affiliation(s)
- H P van Heesewijk
- Department of Diagnostic Radiology, St. Antonius Hospital, Nieuwegein (Utrecht), The Netherlands
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