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Aksoy YA, Xu B, Viswanathan K, Ahadi MS, Al Ghuzlan A, Alzumaili B, Bani MA, Barletta JA, Chau N, Chou A, Clarkson A, Clifton-Bligh RJ, De Leo A, Dogan S, Ganly I, Ghossein R, Gild ML, Glover AR, Hadoux J, Lamartina L, Lubin DJ, Magliocca K, Najdawi F, Nigam A, Papachristos A, Repaci A, Robinson BG, Sheen A, Shi Q, Sidhu SB, Sioson L, Solaroli E, Sywak MS, Tallini G, Tsang V, Turchini J, Untch BR, Gill AJ, Fuchs TL. Novel prognostic nomogram for predicting recurrence-free survival in medullary thyroid carcinoma. Histopathology 2024; 84:947-959. [PMID: 38253940 DOI: 10.1111/his.15141] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
AIMS Recently, there have been attempts to improve prognostication and therefore better guide treatment for patients with medullary thyroid carcinoma (MTC). In 2022, the International MTC Grading System (IMTCGS) was developed and validated using a multi-institutional cohort of 327 patients. The aim of the current study was to build upon the findings of the IMTCGS to develop and validate a prognostic nomogram to predict recurrence-free survival (RFS) in MTC. METHODS AND RESULTS Data from 300 patients with MTC from five centres across the USA, Europe, and Australia were used to develop a prognostic nomogram that included the following variables: age, sex, AJCC stage, tumour size, mitotic count, necrosis, Ki67 index, lymphovascular invasion, microscopic extrathyroidal extension, and margin status. A process of 10-fold cross-validation was used to optimize the model's performance. To assess discrimination and calibration, the area-under-the-curve (AUC) of a receiver operating characteristic (ROC) curve, concordance-index (C-index), and dissimilarity index (D-index) were calculated. Finally, the model was externally validated using a separate cohort of 87 MTC patients. The model demonstrated very strong performance, with an AUC of 0.94, a C-index of 0.876, and a D-index of 19.06. When applied to the external validation cohort, the model had an AUC of 0.9. CONCLUSIONS Using well-established clinicopathological prognostic variables, we developed and externally validated a robust multivariate prediction model for RFS in patients with resected MTC. The model demonstrates excellent predictive capability and may help guide decisions on patient management. The nomogram is freely available online at https://nomograms.shinyapps.io/MTC_ML_DFS/.
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Affiliation(s)
- Yagiz A Aksoy
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Bin Xu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kartik Viswanathan
- Department of Pathology, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Mahsa S Ahadi
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Abir Al Ghuzlan
- Medical Pathology and Biology Department, Gustave Roussy Campus Cancer, Villejuif, France
| | - Bayan Alzumaili
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Mohamed-Amine Bani
- Medical Pathology and Biology Department, Gustave Roussy Campus Cancer, Villejuif, France
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole Chau
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Angela Chou
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adele Clarkson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Roderick J Clifton-Bligh
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Antonio De Leo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Snjezana Dogan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matti L Gild
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Anthony R Glover
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Julien Hadoux
- Endocrine Oncology, Gustave Roussy Campus Cancer, Villejuif, France
| | - Livia Lamartina
- Endocrine Oncology, Gustave Roussy Campus Cancer, Villejuif, France
| | - Daniel J Lubin
- Department of Pathology, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Kelly Magliocca
- Department of Pathology, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Fedaa Najdawi
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aradhya Nigam
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alex Papachristos
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Andrea Repaci
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Bruce G Robinson
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Amy Sheen
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Qiuying Shi
- Department of Pathology, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Stan B Sidhu
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Loretta Sioson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Erica Solaroli
- Endocrinology Unit, Azienda USL di Bologna, Bologna, Italy
| | - Mark S Sywak
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Giovanni Tallini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Venessa Tsang
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - John Turchini
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Douglass Hanly Moir Pathology, Macquarie Park, New South Wales, Australia
| | - Brian R Untch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Talia L Fuchs
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Douglass Hanly Moir Pathology, Macquarie Park, New South Wales, Australia
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Rana HQ, Koeller DR, Walker M, Unal B, Levine AS, Chittenden A, Isidro RA, Hayes CP, Manam MD, Buehler RM, Manning DK, Barletta JA, Hornick JL, Garber JE, Ghazani AA. Advancing Precision Oncology in Hereditary Paraganglioma-Pheochromocytoma Syndromes: Integrated Interpretation and Data Sharing of the Germline and Tumor Genomes. Cancers (Basel) 2024; 16:947. [PMID: 38473309 PMCID: PMC10931192 DOI: 10.3390/cancers16050947] [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: 12/19/2023] [Revised: 01/22/2024] [Accepted: 02/03/2024] [Indexed: 03/14/2024] Open
Abstract
Standard methods of variant assessment in hereditary cancer susceptibility genes are limited by the lack of availability of key supporting evidence. In cancer, information derived from tumors can serve as a useful source in delineating the tumor behavior and the role of germline variants in tumor progression. We have previously demonstrated the value of integrating tumor and germline findings to comprehensively assess germline variants in hereditary cancer syndromes. Building on this work, herein, we present the development and application of the INT2GRATE|HPPGL platform. INT2GRATE (INTegrated INTerpretation of GeRmline And Tumor gEnomes) is a multi-institution oncology consortium that aims to advance the integrated application of constitutional and tumor data and share the integrated variant information in publicly accessible repositories. The INT2GRATE|HPPGL platform enables automated parsing and integrated assessment of germline, tumor, and genetic findings in hereditary paraganglioma-pheochromocytoma syndromes (HPPGLs). Using INT2GRATE|HPPGL, we analyzed 8600 variants in succinate dehydrogenase (SDHx) genes and their associated clinical evidence. The integrated evidence includes germline variants in SDHx genes; clinical genetics evidence: personal and family history of HPPGL-related tumors; tumor-derived evidence: somatic inactivation of SDHx alleles, KIT and PDGFRA status in gastrointestinal stromal tumors (GISTs), multifocal or extra-adrenal tumors, and metastasis status; and immunohistochemistry staining status for SDHA and SDHB genes. After processing, 8600 variants were submitted programmatically from the INT2GRATE|HPPGL platform to ClinVar via a custom-made INT2GRATE|HPPGL variant submission schema and an application programming interface (API). This novel integrated variant assessment and data sharing in hereditary cancers aims to improve the clinical assessment of genomic variants and advance precision oncology.
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Affiliation(s)
- Huma Q. Rana
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA 02215, USA (A.C.)
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Diane R. Koeller
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA 02215, USA (A.C.)
| | - McKenzie Walker
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA (B.U.)
| | - Busra Unal
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA (B.U.)
| | - Alison Schwartz Levine
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA 02215, USA (A.C.)
| | - Anu Chittenden
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA 02215, USA (A.C.)
| | - Raymond A. Isidro
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Connor P. Hayes
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA (B.U.)
| | - Monica D. Manam
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Ryan M. Buehler
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA 02215, USA (A.C.)
| | - Danielle K. Manning
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Justine A. Barletta
- Harvard Medical School, Boston, MA 02115, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Jason L. Hornick
- Harvard Medical School, Boston, MA 02115, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Judy E. Garber
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA 02215, USA (A.C.)
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Arezou A. Ghazani
- Harvard Medical School, Boston, MA 02115, USA
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA (B.U.)
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
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3
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Xu B, Viswanathan K, Ahadi MS, Ahmadi S, Alzumaili B, Bani MA, Baudin E, Behrman DB, Capelletti M, Chau NG, Chiarucci F, Chou A, Clifton-Bligh R, Coluccelli S, de Biase D, De Leo A, Dogan S, Fagin JA, Fuchs TL, Glover AR, Hadoux J, Lacroix L, Lamartina L, Lubin DJ, Luxford C, Magliocca K, Maloberti T, Mohanty AS, Najdawi F, Nigam A, Papachristos AJ, Repaci A, Robinson B, Scoazec JY, Shi Q, Sidhu S, Solaroli E, Sywak M, Tuttle RM, Untch B, Barletta JA, Al Ghuzlan A, Gill AJ, Ghossein R, Tallini G, Ganly I. Association of the Genomic Profile of Medullary Thyroid Carcinoma with Tumor Characteristics and Clinical Outcomes in an International Multicenter Study. Thyroid 2024; 34:167-176. [PMID: 37842841 PMCID: PMC10884546 DOI: 10.1089/thy.2023.0279] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Purpose: The prognostic importance of RET and RAS mutations and their relationship to clinicopathologic parameters and outcomes in medullary thyroid carcinoma (MTC) need to be clarified. Experimental Design: A multicenter retrospective cohort study was performed utilizing data from 290 patients with MTC. The molecular profile was determined and associations were examined with clinicopathologic data and outcomes. Results: RET germ line mutations were detected in 40 patients (16.3%). Somatic RET and RAS mutations occurred in 135 (46.9%) and 57 (19.8%) patients, respectively. RETM918T was the most common somatic RET mutation (n = 75). RET somatic mutations were associated with male sex, larger tumor size, advanced American Joint Committee Cancer (AJCC) stage, vascular invasion, and high International Medullary Thyroid Carcinoma Grading System (IMTCGS) grade. When compared with other RET somatic mutations, RETM918T was associated with younger age, AJCC (eighth edition) IV, vascular invasion, extrathyroidal extension, and positive margins. RET somatic or germ line mutations were significantly associated with reduced distant metastasis-free survival on univariate analysis, but there were no significant independent associations on multivariable analysis, after adjusting for tumor grade and stage. There were no significant differences in outcomes between RET somatic and RET germ line mutations, or between RETM918T and other RET mutations. Other recurrent molecular alterations included TP53 (4.2%), ARID2 (2.9%), SETD2 (2.9%), KMT2A (2.9%), and KMT2C (2.9%). Among them, TP53 mutations were associated with decreased overall survival (OS) and disease-specific survival (DSS), independently of tumor grade and AJCC stage. Conclusions: RET somatic mutations were associated with high-grade, aggressive primary tumor characteristics, and decreased distant metastatic-free survival but this relationship was not significant after accounting for tumor grade and disease stage. RETM918T was associated with aggressive primary tumors but was not independently associated with clinical outcomes. TP53 mutation may represent an adverse molecular event associated with decreased OS and DSS in MTC, but its prognostic value needs to be confirmed in future studies.
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Affiliation(s)
- Bin Xu
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - Kartik Viswanathan
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Mahsa S Ahadi
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sara Ahmadi
- Division of Endocrinology and Metabolism, Department of Medicine; Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Bayan Alzumaili
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - Mohamed-Amine Bani
- Medical Pathology and Biology Department; Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Eric Baudin
- Département d'imagerie, Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - David Blake Behrman
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Marzia Capelletti
- Department of Pathology; Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole G Chau
- Department of Pathology; Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Federico Chiarucci
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Angela Chou
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Roderick Clifton-Bligh
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sara Coluccelli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology; Bologna, Italy
| | - Antonio De Leo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Snjezana Dogan
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - James A Fagin
- Division of Specialized Medicine; New York, New York, USA
| | - Talia L Fuchs
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anthony Robert Glover
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Julien Hadoux
- Département d'imagerie, Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Ludovic Lacroix
- Medical Pathology and Biology Department; Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Livia Lamartina
- Département d'imagerie, Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Daniel J Lubin
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Catherine Luxford
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Kelly Magliocca
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Thais Maloberti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Abhinita S Mohanty
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - Fedaa Najdawi
- Department of Pathology; Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Aradhya Nigam
- Department of Surgery; Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander James Papachristos
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Andrea Repaci
- Division of Endocrinology and Diabetes Prevention and Care; IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Bruce Robinson
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jean-Yves Scoazec
- Medical Pathology and Biology Department; Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Qiuying Shi
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Stan Sidhu
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Erica Solaroli
- Endocrinology Unit, Azienda USL di Bologna, Bologna, Italy
| | - Mark Sywak
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | | | - Brian Untch
- Department of Surgery; Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Justine A Barletta
- Department of Pathology; Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Abir Al Ghuzlan
- Medical Pathology and Biology Department; Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Anthony J Gill
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ronald Ghossein
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - Giovanni Tallini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Ian Ganly
- Department of Surgery; Memorial Sloan Kettering Cancer Center, New York, New York, USA
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4
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Walker SM, Schneider A, Olulade O, Zabel T, Wakefield C, Auer B, Barletta JA, Marqusee E, Shah H. Illustrative Review of Nuclear Medicine Thyroid Studies. Radiographics 2024; 44:e230095. [PMID: 38271256 DOI: 10.1148/rg.230095] [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] [Indexed: 01/27/2024]
Affiliation(s)
- Stephanie M Walker
- From the Departments of Radiology (S.M.W., A.S., O.O., T.Z., B.A., H.S.), Pathology (C.W., J.A.B.), and Endocrinology (E.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195; and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (H.S.)
| | - Andrew Schneider
- From the Departments of Radiology (S.M.W., A.S., O.O., T.Z., B.A., H.S.), Pathology (C.W., J.A.B.), and Endocrinology (E.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195; and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (H.S.)
| | - Olumide Olulade
- From the Departments of Radiology (S.M.W., A.S., O.O., T.Z., B.A., H.S.), Pathology (C.W., J.A.B.), and Endocrinology (E.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195; and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (H.S.)
| | - Taylor Zabel
- From the Departments of Radiology (S.M.W., A.S., O.O., T.Z., B.A., H.S.), Pathology (C.W., J.A.B.), and Endocrinology (E.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195; and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (H.S.)
| | - Craig Wakefield
- From the Departments of Radiology (S.M.W., A.S., O.O., T.Z., B.A., H.S.), Pathology (C.W., J.A.B.), and Endocrinology (E.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195; and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (H.S.)
| | - Benjamin Auer
- From the Departments of Radiology (S.M.W., A.S., O.O., T.Z., B.A., H.S.), Pathology (C.W., J.A.B.), and Endocrinology (E.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195; and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (H.S.)
| | - Justine A Barletta
- From the Departments of Radiology (S.M.W., A.S., O.O., T.Z., B.A., H.S.), Pathology (C.W., J.A.B.), and Endocrinology (E.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195; and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (H.S.)
| | - Ellen Marqusee
- From the Departments of Radiology (S.M.W., A.S., O.O., T.Z., B.A., H.S.), Pathology (C.W., J.A.B.), and Endocrinology (E.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195; and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (H.S.)
| | - Hina Shah
- From the Departments of Radiology (S.M.W., A.S., O.O., T.Z., B.A., H.S.), Pathology (C.W., J.A.B.), and Endocrinology (E.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195; and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (H.S.)
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5
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Wakefield CB, Sadow PM, Hornick JL, Fletcher CDM, Barletta JA, Anderson WJ. PEComa of the Adrenal Gland: A Clinicopathologic Series of 7 Cases. Am J Surg Pathol 2023; 47:1316-1324. [PMID: 37545320 DOI: 10.1097/pas.0000000000002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PEComas are a family of mesenchymal neoplasms composed of histologically distinctive perivascular epithelioid cells which demonstrate myomelanocytic differentiation. PEComas of the adrenal gland are very rare and can represent a considerable diagnostic challenge given their morphologic overlap with more common adrenal cortical neoplasms. We present the clinicopathologic features of 7 primary adrenal PEComas. The cohort comprised 5 male and 2 female patients with a median age of 63 years (range: 31 to 71 y). One patient had Birt-Hogg-Dubé syndrome and another had Lynch syndrome; however, none had a history of tuberous sclerosis complex. Histologically, tumors showed nested and/or sheet-like growth and epithelioid cytomorphology with pale-to-eosinophilic granular cytoplasm. Two tumors had an admixed spindle cell component. There was a median of 4 mitoses per 10 HPFs (range: 0 to 8). Necrosis was present in 4 tumors and lymphovascular invasion in 1. Four tumors were classified as malignant. By immunohistochemistry, tumors were positive for HMB-45 (3/7), MITF (3/3), Melan-A (3/7), smooth muscle actin (5/7), desmin (5/7), and caldesmon (1/1). Two tumors were positive for TFE3 (2/4). Inhibin and SF1 were negative in all tumors assessed (0/6). Of 3 patients with available clinical follow-up information, 1 patient developed locally recurrent and metastatic disease (at 18 mo) and was alive with persistent disease at the last follow-up. Two patients had no recurrent or metastatic disease at the last follow-up (60 and 25 mo). Although PEComas of the adrenal gland are rare, pathologists need to be alert to this entity in the differential diagnosis of primary adrenocortical neoplasms. In suspected cases, the judicious use of melanocytic and smooth muscle markers, in addition to TFE3 and markers of adrenocortical differentiation (such as SF1 and inhibin) can assist in diagnosis. As in PEComas arising at other visceral sites, an association with tuberous sclerosis complex seems to be uncommon.
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Affiliation(s)
- Craig B Wakefield
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School
| | | | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School
| | - William J Anderson
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School
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6
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Bikas A, Ahmadi S, Pappa T, Marqusee E, Wong K, Nehs MA, Cho NL, Haase J, Doherty GM, Sehgal K, Barletta JA, Alexander EK, Landa I. Additional Oncogenic Alterations in RAS-Driven Differentiated Thyroid Cancers Associate with Worse Clinicopathologic Outcomes. Clin Cancer Res 2023; 29:2678-2685. [PMID: 37260297 PMCID: PMC10524472 DOI: 10.1158/1078-0432.ccr-23-0278] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 05/12/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE RAS mutations occur across the spectrum of thyroid neoplasms, and more tools are needed for better prognostication. The objective of this study was to evaluate how additional genetic events affecting key genes modify prognosis in patients with RAS-mutant thyroid cancers, and specifically differentiated thyroid cancers (DTC). EXPERIMENTAL DESIGN We performed a clinical-genomic analysis of consecutive patients with DTC, poorly differentiated (PDTC), or anaplastic thyroid cancer (ATC) between January 2014 and December 2021, in whom a custom-targeted next-generation sequencing assay was performed. Patients harboring RAS mutations were included, and we compared their clinical features and outcomes based upon the presence of additional oncogenic alterations. RESULTS Seventy-eight patients were identified, with 22% (17/78) harboring a driver RAS mutation plus an additional oncogenic alteration. All six (100%) ATCs had an additional mutation. Compared with DTCs harboring a solitary RAS mutation, patients with DTC with RAS and additional mutation(s) were more likely to be classified as American Thyroid Association high-risk of recurrence (77% vs. 12%; P < 0.001) and to have larger primary tumors (4.7 vs. 2.5 cm; P = 0.002) and advanced stage (III or IV) at presentation (67% vs. 3%; P < 0.001). Importantly, over an average 65-month follow-up, DTC-specific-mortality was more than 10-fold higher (20% vs. 1.8%; P = 0.011) when additional mutations were identified. CONCLUSIONS Identification of key additional mutations in patients with RAS-mutant thyroid cancers confers a more aggressive phenotype, increases mortality risk in DTC, and can explain the diversity of RAS-mutated thyroid neoplasia. These data support genomic profiling of DTCs to inform prognosis and clinical decision-making.
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Affiliation(s)
- Athanasios Bikas
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Sara Ahmadi
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Theodora Pappa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts
| | - Ellen Marqusee
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Kristine Wong
- Harvard Medical School, Boston Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston Massachusetts
| | - Matthew A. Nehs
- Harvard Medical School, Boston Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston Massachusetts
| | - Nancy L. Cho
- Harvard Medical School, Boston Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston Massachusetts
| | - Jacob Haase
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Gerard M. Doherty
- Harvard Medical School, Boston Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston Massachusetts
| | - Kartik Sehgal
- Harvard Medical School, Boston Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts
| | - Justine A. Barletta
- Harvard Medical School, Boston Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston Massachusetts
| | - Erik K. Alexander
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Iñigo Landa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
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7
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Slack JC, Hollowell M, Barletta JA. Thyroid Nodules and Follicular Cell-Derived Thyroid Carcinomas in Children. Endocr Pathol 2023:10.1007/s12022-023-09764-2. [PMID: 37160531 DOI: 10.1007/s12022-023-09764-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 05/11/2023]
Abstract
Although pediatric thyroid tumors have many similarities to those occurring in adults, significant differences are also recognized. For example, although thyroid nodules in children are much less common than in adults, a higher percentage is malignant. Moreover, while pediatric papillary thyroid carcinoma (PTC) is associated with more advanced disease, death due to disease in children and adolescents is very rare, even when distant metastases are present. Some subtypes of thyroid carcinoma, like diffuse sclerosing variant, are especially common in children and adolescents. Moreover, certain histologic findings, such as a tall cell morphology or increased mitotic activity, may not carry the same prognostic significance in children as in adults. Recent studies exploring the molecular underpinnings of pediatric thyroid carcinoma indicate that while driver alterations of thyroid tumorigenesis in children and adults are essentially the same, they occur at very different frequencies, with translocation-associated tumors (most commonly harboring RET and NTRK fusions) comprising a sizable and distinct group of pediatric PTC. DICER1 mutations, an infrequent mutation in adult thyroid tumors, are relatively frequent in pediatric encapsulated follicular-patterned thyroid tumors (with or without invasion or nuclear features of PTC). Additionally, tumor predisposition syndromes (most notably DICER1 syndrome and PTEN hamartoma tumor syndromes such as Cowden syndrome) should be considered in children with thyroid tumors, especially follicular-patterned thyroid tumors and poorly differentiated thyroid carcinoma. This review will explore the current state of knowledge of thyroid nodules and carcinomas in children and adolescents.
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Affiliation(s)
- Jonathan C Slack
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Monica Hollowell
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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8
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Bikas A, Wong K, Pappa T, Ahmadi S, Wakefield CB, Marqusee E, Xiang P, Altshuler B, Haase J, Barletta JA, Landa I, Alexander EK. Papillary Thyroid Carcinomas with Tall Cell Features: An Intermediate Entity between Classic and Tall Cell Subtypes. Thyroid 2023. [PMID: 36960703 DOI: 10.1089/thy.2022.0534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND While the diagnosis of papillary thyroid carcinomas with tall cell features (PTCtcf) is often made for carcinomas with histologic features intermediate between classic and tall cell subtypes of PTC (tcPTC), its comparative signature to that of either tcPTC or classic PTC is less clear. The objective of this study was to perform an integrative clinicopathologic and genomic analysis elucidating the spectrum of tcPTC, PTCtcf and classic PTC. METHODS We analyzed all consecutive patients with tcPTC and PTCtcf evaluated at a tertiary academic referral center between 2005-2020, as well as a comparative cohort of classic PTC, in a retrospective observational cohort analysis. Clinicopathological data were compared among the three groups, including progression-free survival (PFS), recurrent/persistent disease, and a negative composite outcome of death, progression, or need for advanced therapy. To specifically understand differences between tcPTC and PTCtcf, targeted next-generation sequencing (NGS) was performed in a subset of these cohorts. RESULTS A total of 292 patients were analyzed (81 tcPTC, 65 PTCtcf, 146 classic PTC). Thirteen percent tcPTC vs. 8% PTCtcf vs. 1% classic PTC had advanced AJCC stage (p=0.002). Similarly, macroscopic extrathyroidal extension was observed in 38% of tcPTC, 14% of PTCtcf and 12% of classic PTC (p<0.001). The 5-year PFS was 76.5%, 81.5% and 88.3% for tcPTC, PTCtcf and classic PTC, respectively, while the rates of the negative composite outcome 40.2% for tcPTC, 20.7% for PTCtcf and 11.2% for classic PTC (p<0.001). In a multivariable Cox regression analysis, the negative composite outcome was independently associated with tcPTC [HR 4.3 95% CI (1.1-16.1), p=0.03]. tcPTC demonstrated substantially more hotspot TERT promoter mutations than PTCtcf (44% vs. 6%, p=0.012). CONCLUSIONS Our study demonstrates a continuum of disease-specific risk of PTC, pointing at PTCtcf as an intermediate entity between tcPTC and classic PTC. These data provide a more refined understanding of risk at time of presentation, while better elucidating the diversity of genomic drivers.
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Affiliation(s)
- Athanasios Bikas
- Brigham and Women's Hospital, 1861, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Boston, Massachusetts, United States;
| | - Kristine Wong
- Brigham and Women's Hospital, 1861, Department of Pathology, Boston, Massachusetts, United States;
| | - Theodora Pappa
- Brigham and Women's Hospital, 1861, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Boston, Massachusetts, United States;
| | - Sara Ahmadi
- Brigham and Women's Hospital, 1861, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Boston, Massachusetts, United States;
| | - Craig B Wakefield
- Brigham and Women's Hospital, 1861, Department of Pathology, Boston, Massachusetts, United States;
| | - Ellen Marqusee
- Brigham and Women's Hospital, 1861, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Boston, Massachusetts, United States;
| | - Pingping Xiang
- Brigham and Women's Hospital, 1861, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Boston, Massachusetts, United States;
| | - Benjamin Altshuler
- Brigham and Women's Hospital, 1861, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Boston, Massachusetts, United States;
| | - Jacob Haase
- Brigham and Women's Hospital, 1861, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Boston, Massachusetts, United States;
| | - Justine A Barletta
- Brigham and Women's Hospital, 1861, Department of Pathology, Boston, Massachusetts, United States;
| | - Iñigo Landa
- Brigham and Women's Hospital Department of Medicine, 370908, Division of Endocrinology, Diabetes and Hypertension, 77 Avenue Louis Pasteur, 4BF building, Office 642A, Boston, Massachusetts, United States, 02115;
| | - Erik K Alexander
- Brigham and Women's Hospital, 1861, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Boston, Massachusetts, United States;
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9
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Wong KS, Barletta JA. Challenges in Encapsulated Follicular-Patterned Tumors: How Much Is Enough? Evaluation of Nuclear Atypia, Architecture, and Invasion. Surg Pathol Clin 2023; 16:27-44. [PMID: 36739165 DOI: 10.1016/j.path.2022.09.005] [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] [Indexed: 12/14/2022]
Abstract
Thyroid pathology is notoriously fraught with high interobserver variability, and follicular-patterned tumors are among some of the most challenging to assess accurately and reproducibly. Given that encapsulated or well-circumscribed follicular-patterned tumors often have similar molecular profiles, that is, frequent RAS or RAS-like alterations, the diagnosis usually relies on histopathologic examination alone. Unfortunately, many of the features that are used for diagnosis and prognosis of these tumors have long been controversial and frequently debated topics, both due to their subjectivity and their evolving (or not yet resolved) definitions. In more recent years, the introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features has added further complexity to this discussion. In particular, the criteria and significance of nuclear features of papillary thyroid carcinoma, architectural patterns, and invasive growth still pose significant diagnostic challenges and confusion. This review explores some of the challenges in evaluating encapsulated follicular-patterned tumors, focusing on those histologic elements.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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10
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Wrenn SM, Moore AL, Shah HJ, Barletta JA, Vaidya A, Kilbridge KL, Doherty GM, Jacene HA, Nehs MA. Higher SUV max on FDG-PET is associated with shorter survival in adrenocortical carcinoma. Am J Surg 2023; 225:309-314. [PMID: 36137821 DOI: 10.1016/j.amjsurg.2022.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/14/2022] [Revised: 07/29/2022] [Accepted: 08/27/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is an aggressive, rare malignancy. 2-deoxy-2-[18F]-fluoro-d-glucose positron emission tomography (FDG-PET) assesses tumor metabolism and glucose utilization. We hypothesized that higher maximum standard uptake value (SUVmax) is associated with decreased survival. METHODS We performed a retrospective analysis of patients with ACC. Included patients (n = 26) had an FDG-PET scan available with a documentable SUVmax. Patients were dichotomized into "High" (≥8.4, n = 12) and "Low" (<8.4, n = 14) SUVmax. Univariate analysis and survival analysis were performed to compare groups. RESULTS Demographics between groups were equivalent. The high SUVmax cohort demonstrated lower survival (median 479 days or 15.7 months) compared to the low group (median 1490 days or 48.6 months, p = .01). Log-Rank curve confirmed differences in survival (p = .007). CONCLUSIONS Higher SUVmax was associated with significantly worse survival in ACC and may reflect a more aggressive phenotype. FDG-PET may provide clinically useful information to determine prognosis and treatment. Further studies should prospectively evaluate using FDG-PET/CT in ACC.
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Affiliation(s)
- Sean M Wrenn
- .Brigham and Women's Hospital, Boston, MA, USA; .Rush University Medical Center, Chicago, IL, USA
| | | | - Hina J Shah
- .Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Kerry L Kilbridge
- .Brigham and Women's Hospital, Boston, MA, USA; .Dana-Farber Cancer Institute Lank Center for Genitourinary Oncology, USA.
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11
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Barletta JA, Gilday SD, Afkhami M, Bell D, Bocklage T, Boisselier P, Chau NG, Cipriani NA, Costes-Martineau V, Ghossein RA, Hertzler HJ, Kramer AM, Limaye S, Lopez CA, Ng TL, Weissferdt A, Xu B, Zhang S, French CA. NUTM1 -rearranged Carcinoma of the Thyroid : A Distinct Subset of NUT Carcinoma Characterized by Frequent NSD3 - NUTM1 Fusions. Am J Surg Pathol 2022; 46:1706-1715. [PMID: 36040068 PMCID: PMC9669222 DOI: 10.1097/pas.0000000000001967] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 01/07/2023]
Abstract
NUT carcinoma (NC) is a rare subtype of squamous cell carcinoma defined by NUTM1 rearrangements encoding NUT fusion oncoproteins (the most frequent fusion partner being BRD4 ) that carries a very poor prognosis, with most patients dying in under 1 year. Only rare primary thyroid NCs have been reported. Here, we evaluated a series of 14 cases. The median patient age at diagnosis was 38 years (range: 17 to 72 y). Eight of 13 cases with slides available for review (62%) showed a morphology typical of NC, whereas 5 (38%) had a non-NC-like morphology, some of which had areas of cribriform or fused follicular architecture resembling a follicular cell-derived thyroid carcinoma. For cases with immunohistochemistry results, 85% (11/13) were positive for NUT on biopsy or resection, though staining was significantly decreased on resection specimens due to fixation; 55% (6/11) were positive for PAX8, and 54% (7/13) for TTF-1. Tumors with a non-NC-like morphology were all positive for PAX8 and TTF-1. The fusion partner was known in 12 cases: 9 (75%) cases had a NSD3-NUTM1 fusion, and 3 (25%) had a BRD4-NUTM1 fusion. For our cohort, the 2-year overall survival (OS) was 69%, and the 5-year OS was 58%. Patients with NC-like tumors had a significantly worse OS compared with that of patients with tumors with a non-NC-like morphology ( P =0.0462). Our study shows that NC of the thyroid can mimic other thyroid primaries, has a high rate of NSD3 - NUTM1 fusions, and an overall more protracted clinical course compared with nonthyroid primary NC.
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Affiliation(s)
- Justine A. Barletta
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Steven D. Gilday
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Afkhami
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Diana Bell
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Theresa Bocklage
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Pierre Boisselier
- Department of Radiation Oncology, ICM, Montpellier Cancer Institute, Montpellier, France
| | - Nicole G. Chau
- Department of Medical Oncology, BC Cancer, Vancouver BC, Canada
| | | | | | - Ronald A. Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans J. Hertzler
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Sewanti Limaye
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Carlos A. Lopez
- Division of Medical Oncology & Hematology, Northwell Health Cancer Institute, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY 11042, USA
| | - Tony L. Ng
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Annikka Weissferdt
- Department of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Bin Xu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Songlin Zhang
- Department of Pathology and Laboratory Medicine, McGovern Medical School, Houston, TX
| | - Christopher A. French
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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12
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Williams JF, Zhao M, Najdawi F, Ahmadi S, Hornick JL, Wong KS, Barletta JA. Grading of Medullary Thyroid Carcinoma: an Interobserver Reproducibility Study. Endocr Pathol 2022; 33:371-377. [PMID: 35553368 DOI: 10.1007/s12022-022-09718-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 02/01/2023]
Abstract
Grade, based on proliferative activity and tumor necrosis, has recently been shown to be prognostic in medullary thyroid carcinoma (MTC) in multivariate analysis. The aim of this study was to evaluate the interobserver reproducibility of assessed grade in MTC. Three groups (each group included one resident/fellow and one attending pathologist) independently evaluated a cohort of 44 sporadic MTC. For each case, all available tumor slides were reviewed, and mitotic count and the presence of tumor necrosis were recorded. Ki-67 was performed, and the Ki-67 proliferative index was determined in the area of highest proliferative activity. Tumors were graded according to the recently published International Medullary Thyroid Carcinoma Grading System (IMTCGS). Kappa statistics were calculated for each individual criterion (mitotic count, Ki-67 proliferative index, and necrosis) and for assigned IMTCGS grade. For our cohort of 44 MTCs, the kappa statistic for mitotic count, Ki-67 proliferative index, and necrosis was 0.68, 0.86, and 0.89, respectively. The kappa statistic for assigned IMTCGS grade was 0.87. Our findings indicate that there was a strong level of agreement for assessment of grade in our cohort of MTC, indicating that grade as assessed by the IMTCGS is not only prognostic but also reproducible.
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Affiliation(s)
- Jessica F Williams
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Melissa Zhao
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Fedaa Najdawi
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara Ahmadi
- Division of Endocrinology, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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13
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Schwartz A, Manning DK, Koeller DR, Chittenden A, Isidro RA, Hayes CP, Abraamyan F, Manam MD, Dwan M, Barletta JA, Sholl LM, Yurgelun MB, Rana HQ, Garber JE, Ghazani AA. An integrated somatic and germline approach to aid interpretation of germline variants of uncertain significance in cancer susceptibility genes. Front Oncol 2022; 12:942741. [PMID: 36091175 PMCID: PMC9453486 DOI: 10.3389/fonc.2022.942741] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Genomic profiles of tumors are often unique and represent characteristic mutational signatures defined by DNA damage or DNA repair response processes. The tumor-derived somatic information has been widely used in therapeutic applications, but it is grossly underutilized in the assessment of germline genetic variants. Here, we present a comprehensive approach for evaluating the pathogenicity of germline variants in cancer using an integrated interpretation of somatic and germline genomic data. We have previously demonstrated the utility of this integrated approach in the reassessment of pathogenic germline variants in selected cancer patients with unexpected or non-syndromic phenotypes. The application of this approach is presented in the assessment of rare variants of uncertain significance (VUS) in Lynch-related colon cancer, hereditary paraganglioma-pheochromocytoma syndrome, and Li-Fraumeni syndrome. Using this integrated method, germline VUS in PMS2, MSH6, SDHC, SHDA, and TP53 were assessed in 16 cancer patients after genetic evaluation. Comprehensive clinical criteria, somatic signature profiles, and tumor immunohistochemistry were used to re-classify VUS by upgrading or downgrading the variants to likely or unlikely actionable categories, respectively. Going forward, collation of such germline variants and creation of cross-institutional knowledgebase datasets that include integrated somatic and germline data will be crucial for the assessment of these variants in a larger cancer cohort.
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Affiliation(s)
- Alison Schwartz
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Danielle K. Manning
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Diane R. Koeller
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Anu Chittenden
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Raymond A. Isidro
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Connor P. Hayes
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Feruza Abraamyan
- Harvard Medical School, Boston, MA, United States
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Monica Devi Manam
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Meaghan Dwan
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Justine A. Barletta
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Lynette M. Sholl
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Matthew B. Yurgelun
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Huma Q. Rana
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Judy E. Garber
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Arezou A. Ghazani
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- *Correspondence: Arezou A. Ghazani,
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14
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Wong KS, Barletta JA. The new endocrine WHO classification: What does this mean for thyroid cytology? Cancer Cytopathol 2022; 130:658-662. [PMID: 35969231 DOI: 10.1002/cncy.22634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/11/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022]
Abstract
The new World Health Organization classification of endocrine tumors will include many updates on thyroid pathology. This summary highlights the changes that are most relevant for cytopathologists.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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15
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Schiantarelli J, Pappa T, Conway J, Crowdis J, Reardon B, Dietlein F, Huang J, Stanizzi D, Carey E, Bosma-Moody A, Imamovic A, Han S, Camp S, Kofman E, Shannon E, Barletta JA, He MX, Liu D, Park J, Lorch JH, Van Allen EM. Mutational Footprint of Platinum Chemotherapy in a Secondary Thyroid Cancer. JCO Precis Oncol 2022; 6:e2200183. [PMID: 36075011 PMCID: PMC9489159 DOI: 10.1200/po.22.00183] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/27/2022] [Accepted: 07/19/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Julia Schiantarelli
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Theodora Pappa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA
| | - Jake Conway
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Jett Crowdis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Brendan Reardon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Felix Dietlein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | | | - Darren Stanizzi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Evan Carey
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Alice Bosma-Moody
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Alma Imamovic
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Seunghun Han
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
- Department of Biological and Biomedical Sciences, Harvard Medical School, Boston, MA
| | - Sabrina Camp
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Eric Kofman
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA
| | - Erin Shannon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Justine A. Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Meng Xiao He
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
- Harvard Graduate Program in Biophysics, Boston, MA
| | - David Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Jihye Park
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Jochen H. Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Eliezer M. Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
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16
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Collins K, Hwang M, Antic T, Paintal A, Argani P, Matoso A, Gopinath A, Baskovich B, Mehra R, Williamson SR, Idrees MT, Barletta JA, Anderson WJ, Hirsch MS, Hornick JL, Acosta AM. Merlin Immunohistochemistry Is Useful in Diagnosis of Tumors within the Spectrum of Biphasic Hyalinizing Psammomatous Renal Cell Carcinoma. Histopathology 2022; 81:577-586. [DOI: 10.1111/his.14731] [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: 05/27/2022] [Revised: 07/09/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Katrina Collins
- The Department of Pathology of Indiana University School of Medicine Indianapolis IN USA
| | - Michael Hwang
- The Department of Pathology of Indiana University School of Medicine Indianapolis IN USA
| | - Tatjana Antic
- The Department of Pathology of The University of Chicago Chicago IL USA
| | - Ajit Paintal
- The Department of Pathology of NorthShore University HealthSystem Evanston IL USA
| | - Pedram Argani
- The Department of Pathology ofJohns Hopkins University School of Medicine Baltimore USA
| | - Andres Matoso
- The Department of Pathology ofJohns Hopkins University School of Medicine Baltimore USA
| | - Arun Gopinath
- The Department of Pathology of University of Florida College of Medicine Jacksonville Jacksonville FL USA
| | - Brett Baskovich
- The Department of Pathology of University of Florida College of Medicine Jacksonville Jacksonville FL USA
| | - Rohit Mehra
- The Department of Pathology of Michigan Medicine and University of Michigan Ann Arbor MI USA
| | | | - Muhammad T. Idrees
- The Department of Pathology of Indiana University School of Medicine Indianapolis IN USA
| | - Justine A. Barletta
- The Department of Pathology of Brigham and Women’s Hospital/Harvard Medical School Boston MA USA
| | - William J. Anderson
- The Department of Pathology of Brigham and Women’s Hospital/Harvard Medical School Boston MA USA
| | - Michelle S. Hirsch
- The Department of Pathology of Brigham and Women’s Hospital/Harvard Medical School Boston MA USA
| | - Jason L. Hornick
- The Department of Pathology of Brigham and Women’s Hospital/Harvard Medical School Boston MA USA
| | - Andres M. Acosta
- The Department of Pathology of Brigham and Women’s Hospital/Harvard Medical School Boston MA USA
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17
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Abstract
In the past 30 years, there has been a substantial rise in the detection of thyroid nodules. Largely asymptomatic, thyroid nodules are most often incidental findings that typically pose minimal risk. Data supporting these findings show a rapid rise in the incidental detection of thyroid nodules and cancer, but minimal effect on mortality rates, despite treatment. These data imply that historical approaches to thyroid nodule and cancer care might at times include unnecessary or excessive care. To address this issue, the past decade has witnessed an increasingly conservative approach to nodule management, seeking to individualise care and provide the most focused intervention that leads to favourable outcomes. Benign nodules can be safely monitored with minimal, or long-interval follow-up imaging. Molecular testing should be considered for cytologically indeterminate nodules because of its ability to improve preoperative cancer risk determination and reduce unnecessary surgery. The treatment of biopsy-proven malignant nodules has become increasingly nuanced, since recommendations for near-total thyroidectomy are no longer routine. Hemithyroidectomy is now commonly considered when operative intervention is favoured. Some patients with small volume, isolated cancerous nodules are safely managed non-operatively with active monitoring. In summary, modern management strategies for thyroid nodular disease seek to incorporate the growing amount of available diagnostic and prognostic data, inclusive of demographic, radiological, pathological and molecular findings. Once obtained, an individualised management plan can be effectively formulated.
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Affiliation(s)
- Erik K Alexander
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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18
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Wyvekens N, Tsai HK, Sholl LM, Tucci J, Giannico GA, Gordetsky JB, Hirsch MS, Barletta JA, Acosta AM. Histopathologic and Genetic Features of Mismatch Repair-Deficient High-Grade Prostate Cancer. Histopathology 2022; 80:1050-1060. [PMID: 35395112 DOI: 10.1111/his.14645] [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: 02/04/2022] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
AIMS Mismatch repair (MMR) deficiency is commonly caused by functional inactivation of MLH1, PMS2, MSH2 or MSH6. The morphologic and molecular correlates of MMR deficiency have been extensively characterized in certain tumor types such as colorectal and endometrial adenocarcinoma. In contrast, the histologic and molecular features of MMR-deficient prostate cancer remain incompletely described. In this study, we evaluated 19 MMR-deficient prostate cancers, including 11 cases without prior systemic treatment. METHODS AND RESULTS All treatment-naïve cases (11/11, 100%) were Grade Group 4-5 and had predominant cribriform and/or solid growth patterns. Solid components (any amount) and tumor infiltrating lymphocytes were seen in 7/11 (64%) of these cases each. In 68 MMR-proficient Grade Group 5 prostate cancers, predominant cribriform or solid growth patterns, solid components (any amount) and tumor infiltrating lymphocytes were seen at significantly lower frequencies (31/68, 46%; 9/68, 13% and 6/62, 9%, respectively; p<0.001 for all comparisons). Molecular evaluation of 19 cases demonstrated that MMR-deficiency was secondary to functional loss of MSH2/MSH6 and MLH1/PMS2 in 15 cases (79%) and 4 cases (21%), respectively. Definite or likely germline mutations were present in 4 cases (4/19, 21%). TMPRSS2::ERG rearrangements were identified in 2 cases (2/19, 11%). Recurrent cancer-relevant somatic mutations included (but were not limited to) ATM, TP53, FOXA1, RB1, BRCA2 and PTEN. CONCLUSIONS MMR deficiency was most commonly secondary to inactivation of MSH2/MSH6 in this study. Importantly, MMR-deficient high-grade prostatic adenocarcinomas had morphologic features that might be useful to identify selected cases for MMR IHC.
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Affiliation(s)
- Nicolas Wyvekens
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Harrison K Tsai
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jonathan Tucci
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Giovanna A Giannico
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer B Gordetsky
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andres M Acosta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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19
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Sauer M, Barletta JA. Proceedings of the North American Society of Head and Neck Pathology, Los Angeles, CA, March 20, 2022: DICER1-Related Thyroid Tumors. Head Neck Pathol 2022; 16:190-199. [PMID: 35307774 PMCID: PMC9018915 DOI: 10.1007/s12105-022-01417-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/18/2022] [Indexed: 10/18/2022]
Abstract
DICER1 syndrome is an autosomal dominant tumor predisposition syndrome caused by germline DICER1 mutations. In the thyroid, DICER1 syndrome is associated with early-onset multinodular goiter and thyroid carcinomas. Subsequent studies have shown that somatic DICER1 mutations, though rare, can occur in follicular-patterned thyroid tumors, such as follicular adenomas and follicular thyroid carcinomas, with a higher rate seen in pediatric follicular thyroid carcinomas and in follicular thyroid carcinomas with a macrofollicular architecture. Somatic DICER1 mutations have also been reported in pediatric papillary thyroid carcinomas lacking other alterations typically associated with thyroid tumorigenesis. Although thyroid carcinomas with underlying DICER1 mutations are usually indolent, recent studies have shown that pediatric poorly differentiated thyroid carcinoma and thyroblastoma, both aggressive tumors, also harbor DICER1 mutations. This review will discuss mechanisms of DICER1 tumorigenesis and describe thyroid tumors associated with germline and somatic DICER1 mutations.
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Affiliation(s)
- Madeline Sauer
- University of Missouri School of Medicine, Columbia, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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20
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Baloch ZW, Asa SL, Barletta JA, Ghossein RA, Juhlin CC, Jung CK, LiVolsi VA, Papotti MG, Sobrinho-Simões M, Tallini G, Mete O. Overview of the 2022 WHO Classification of Thyroid Neoplasms. Endocr Pathol 2022; 33:27-63. [PMID: 35288841 DOI: 10.1007/s12022-022-09707-3] [Citation(s) in RCA: 313] [Impact Index Per Article: 156.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
This review summarizes the changes in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors that relate to the thyroid gland. The new classification has divided thyroid tumors into several new categories that allow for a clearer understanding of the cell of origin, pathologic features (cytopathology and histopathology), molecular classification, and biological behavior. Follicular cell-derived tumors constitute the majority of thyroid neoplasms. In this new classification, they are divided into benign, low-risk, and malignant neoplasms. Benign tumors include not only follicular adenoma but also variants of adenoma that are of diagnostic and clinical significance, including the ones with papillary architecture, which are often hyperfunctional and oncocytic adenomas. For the first time, there is a detailed account of the multifocal hyperplastic/neoplastic lesions that commonly occur in the clinical setting of multinodular goiter; the term thyroid follicular nodular disease (FND) achieved consensus as the best to describe this enigmatic entity. Low-risk follicular cell-derived neoplasms include non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), thyroid tumors of uncertain malignant potential, and hyalinizing trabecular tumor. Malignant follicular cell-derived neoplasms are stratified based on molecular profiles and aggressiveness. Papillary thyroid carcinomas (PTCs), with many morphological subtypes, represent the BRAF-like malignancies, whereas invasive encapsulated follicular variant PTC and follicular thyroid carcinoma represent the RAS-like malignancies. This new classification requires detailed subtyping of papillary microcarcinomas similar to their counterparts that exceed 1.0 cm and recommends not designating them as a subtype of PTC. The criteria of the tall cell subtype of PTC have been revisited. Cribriform-morular thyroid carcinoma is no longer classified as a subtype of PTC. The term "Hürthle cell" is discouraged, since it is a misnomer. Oncocytic carcinoma is discussed as a distinct entity with the clear recognition that it refers to oncocytic follicular cell-derived neoplasms (composed of > 75% oncocytic cells) that lack characteristic nuclear features of PTC (those would be oncocytic PTCs) and high-grade features (necrosis and ≥ 5 mitoses per 2 mm2). High-grade follicular cell-derived malignancies now include both the traditional poorly differentiated carcinoma as well as high-grade differentiated thyroid carcinomas, since both are characterized by increased mitotic activity and tumor necrosis without anaplastic histology and clinically behave in a similar manner. Anaplastic thyroid carcinoma remains the most undifferentiated form; squamous cell carcinoma of the thyroid is now considered as a subtype of anaplastic carcinoma. Medullary thyroid carcinomas derived from thyroid C cells retain their distinct section, and there is a separate section for mixed tumors composed of both C cells and any follicular cell-derived malignancy. A grading system for medullary thyroid carcinomas is also introduced based on mitotic count, tumor necrosis, and Ki67 labeling index. A number of unusual neoplasms that occur in the thyroid have been placed into new sections based on their cytogenesis. Mucoepidermoid carcinoma and secretory carcinoma of the salivary gland type are now included in one section classified as "salivary gland-type carcinomas of the thyroid." Thymomas, thymic carcinomas and spindle epithelial tumor with thymus-like elements are classified as "thymic tumors within the thyroid." There remain several tumors whose cell lineage is unclear, and they are listed as such; these include sclerosing mucoepidermoid carcinoma with eosinophilia and cribriform-morular thyroid carcinoma. Another important addition is thyroblastoma, an unusual embryonal tumor associated with DICER1 mutations. As in all the WHO books in the 5th edition, mesenchymal and stromal tumors, hematolymphoid neoplasms, germ cell tumors, and metastatic malignancies are discussed separately. The current classification also emphasizes the value of biomarkers that may aid diagnosis and provide prognostic information.
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Virginia A LiVolsi
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Manuel Sobrinho-Simões
- Department of Pathology, Institute of Molecular Pathology and Immunology, IPATIMUP, University of Porto, Porto, Portugal
| | - Giovanni Tallini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Ozgur Mete
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
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21
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Xu B, Fuchs TL, Ahmadi S, Alghamdi M, Alzumaili B, Bani MA, Baudin E, Chou A, De Leo A, Fagin JA, Ganly I, Glover A, Hartl D, Kanaan C, Khneisser P, Najdawi F, Nigam A, Papachristos A, Repaci A, Spanheimer PM, Solaroli E, Untch BR, Barletta JA, Tallini G, Al Ghuzlan A, Gill AJ, Ghossein RA. International Medullary Thyroid Carcinoma Grading System: A Validated Grading System for Medullary Thyroid Carcinoma. J Clin Oncol 2022; 40:96-104. [PMID: 34731032 PMCID: PMC8683221 DOI: 10.1200/jco.21.01329] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Medullary thyroid carcinoma (MTC) is an aggressive neuroendocrine tumor (NET) arising from the calcitonin-producing C cells. Unlike other NETs, there is no widely accepted pathologic grading scheme. In 2020, two groups separately developed slightly different schemes (the Memorial Sloan Kettering Cancer Center and Sydney grade) on the basis of proliferative activity (mitotic index and/or Ki67 proliferative index) and tumor necrosis. Building on this work, we sought to unify and validate an internationally accepted grading scheme for MTC. PATIENTS AND METHODS Tumor tissue from 327 patients with MTC from five centers across the United States, Europe, and Australia were reviewed for mitotic activity, Ki67 proliferative index, and necrosis using uniform criteria and blinded to other clinicopathologic features. After reviewing different cutoffs, a two-tiered consensus grading system was developed. High-grade MTCs were defined as tumors with at least one of the following features: mitotic index ≥ 5 per 2 mm2, Ki67 proliferative index ≥ 5%, or tumor necrosis. RESULTS Eighty-one (24.8%) MTCs were high-grade using this scheme. In multivariate analysis, these patients demonstrated decreased overall (hazard ratio [HR] = 11.490; 95% CI, 3.118 to 32.333; P < .001), disease-specific (HR = 8.491; 95% CI, 1.461 to 49.327; P = .017), distant metastasis-free (HR = 2.489; 95% CI, 1.178 to 5.261; P = .017), and locoregional recurrence-free (HR = 2.114; 95% CI, 1.065 to 4.193; P = .032) survivals. This prognostic power was maintained in subgroup analyses of cohorts from each of the five centers. CONCLUSION This simple two-tiered international grading system is a powerful predictor of adverse outcomes in MTC. As it is based solely on morphologic assessment in conjunction with Ki67 immunohistochemistry, it brings the grading of MTCs in line with other NETs and can be readily applied in routine practice. We therefore recommend grading of MTCs on the basis of mitotic count, Ki67 proliferative index, and tumor necrosis.
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Affiliation(s)
- Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Talia L. Fuchs
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia,University of Sydney, Sydney, NSW, Australia
| | - Sara Ahmadi
- Department of Medicine, Division of Endocrinology and Metabolism, Brigham and Women's Hospital, Boston, Harvard Medical School, MA
| | - Mohammed Alghamdi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bayan Alzumaili
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mohamed-Amine Bani
- Medical Pathology and Biology Department, Gustave Roussy Campus Cancer, Villejuif, France
| | - Eric Baudin
- Department of Endocrine Oncology and Nuclear Medicine, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Angela Chou
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia,University of Sydney, Sydney, NSW, Australia
| | - Antonio De Leo
- Pathology Unit-Azienda USL di Bologna, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - James A. Fagin
- Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anthony Glover
- University of Sydney, Sydney, NSW, Australia,Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Dana Hartl
- Department of Surgery, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Christina Kanaan
- Medical Pathology and Biology Department, Gustave Roussy Campus Cancer, Villejuif, France
| | - Pierre Khneisser
- Medical Pathology and Biology Department, Gustave Roussy Campus Cancer, Villejuif, France
| | - Fedaa Najdawi
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Aradhya Nigam
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alex Papachristos
- University of Sydney, Sydney, NSW, Australia,Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Andrea Repaci
- Endocrinology Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, Bologna, Italy
| | | | - Erica Solaroli
- Endocrinology Unit-Azienda USL di Bologna, Bologna, Italy
| | - Brian R. Untch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Giovanni Tallini
- Pathology Unit-Azienda USL di Bologna, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Abir Al Ghuzlan
- Medical Pathology and Biology Department, Gustave Roussy Campus Cancer, Villejuif, France
| | - Anthony J. Gill
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia,University of Sydney, Sydney, NSW, Australia
| | - Ronald A. Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY,Ronald A. Ghossein, MD, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; e-mail:
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22
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Affiliation(s)
- Arthur S Tischler
- Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Sylvia LAsa
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, United States
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ozgur Mete
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada.
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23
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Cherella CE, Richman DM, Liu E, Frates MC, Modi BP, Zendejas B, Smith JR, Barletta JA, Hollowell ML, Wassner AJ. Predictors of Bilateral Disease in Pediatric Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2021; 106:e4242-e4250. [PMID: 33780538 PMCID: PMC8475192 DOI: 10.1210/clinem/dgab210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Indexed: 12/11/2022]
Abstract
CONTEXT Total thyroidectomy is recommended for children with papillary thyroid carcinoma, partly because of a high prevalence of bilateral disease. Identifying characteristics that predict bilateral disease might identify candidates for more limited surgery. OBJECTIVE Investigate associations of preoperative or histopathological characteristics with bilateral disease in children with differentiated thyroid cancer. METHODS Retrospective cohort study (1998-2020) at 2 academic hospitals. Patients <19 years who underwent total thyroidectomy for differentiated thyroid cancer were included. Clinical, sonographic, and histopathological characteristics were evaluated. The presence of bilateral disease on histopathology was assessed by univariable analysis and multivariable logistic regression. RESULTS One hundred and fifteen subjects were analyzed (90% with papillary carcinoma). Median (range) age at diagnosis was 15.0 (8.1-18.9) years. Bilateral disease was present in 47/115 subjects (41%). Bilateral disease was associated with solid parenchyma, calcifications, irregular margins, and abnormal lymph nodes detected by ultrasound, Bethesda class V/VI cytology, papillary histology, tumor multifocality in the primary lobe, extrathyroidal extension, lymphovascular invasion, and nodal metastases. In multivariable analysis, only multifocality in the primary lobe was independently associated with bilateral disease (OR 7.61, 95% CI 2.44-23.8, P < .001). Among clinically node-negative subjects with papillary carcinoma who did not have tumor multifocality in the primary lobe, bilateral disease was present in 5/32 (16%). CONCLUSIONS In children with differentiated thyroid cancer, tumor multifocality in the primary lobe is associated with bilateral disease and should prompt consideration of completion thyroidectomy after initial lobectomy. Clinically node-negative children with tumors that are unifocal in the primary lobe have a low likelihood of contralateral disease.
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Affiliation(s)
- Christine E Cherella
- Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA
- Correspondence: Christine E. Cherella, MD, Thyroid Center, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | | | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
| | - Mary C Frates
- Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
- Department of Radiology, Boston, MA, USA
| | - Biren P Modi
- Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Benjamin Zendejas
- Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Jessica R Smith
- Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA
| | | | - Monica L Hollowell
- Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
- Department of Pathology, Boston Children’s Hospital, Boston, MA, USA
| | - Ari J Wassner
- Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA
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Zhao B, Aggarwal A, Marshall JA, Barletta JA, Kijewski MF, Lorch JH, Nehs MA. Glycolytic inhibition with 3-bromopyruvate suppresses tumor growth and improves survival in a murine model of anaplastic thyroid cancer. Surgery 2021; 171:227-234. [PMID: 34334212 DOI: 10.1016/j.surg.2021.05.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 02/08/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anaplastic thyroid cancer is a rare but devastating malignancy. Anaplastic thyroid cancer cells exhibit the Warburg effect by preferentially undergoing glycolysis even in aerobic conditions, leading to high glucose use. Here we assess if targeted inhibition of glycolysis can diminish anaplastic thyroid cancer growth and improve outcomes. METHODS Human anaplastic thyroid cancer cell line 8505C was grown in medium containing high (25 mmol/L) or low (3 mmol/L) glucose concentration and hexokinase II inhibitor 3-bromopyruvate (200 μM). Cellular proliferation, migration, and invasion were measured. An orthotopic xenograft model of anaplastic thyroid cancer was generated in nude mice using 8505C cells. Animals were provided standard chow or a ketogenic diet and treated with 3-bromopyruvate (1.8 mg/kg). Overall survival time was monitored. Necropsies were performed to harvest tumors for analysis. RESULTS Growth of 8505C in low-glucose medium with 3-bromopyruvate decreased cell proliferation by 89%, migration by 44%, and invasion by 73% (P < .001 for all) compared with high glucose. Animals concomitantly receiving a ketogenic diet and 3-bromopyruvate exhibited smaller tumor volumes (P = .03), slower tumor growth rates (P = .01), and improved overall survival (P = .006) compared with standard-diet control subjects. Monotherapy with a ketogenic diet or 3-bromopyruvate alone did not reduce tumor size or increase survival over the standard-diet control group. CONCLUSION Glycolytic inhibition with 3-bromopyruvate inhibits tumor growth and extends survival in a murine model of anaplastic thyroid cancer when combined with the ketogenic diet. Thus, targeted glycolytic inhibition of anaplastic thyroid cancer exhibits context-specific utility and may only be effective during ketosis induced by dietary restriction of glycolytic inputs.
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Affiliation(s)
- Bixiao Zhao
- Department of Surgery, Brigham and Women's Hospital, Boston MA. https://twitter.com/@BixiaoZhao
| | - Abha Aggarwal
- Department of Surgery, Brigham and Women's Hospital, Boston MA
| | | | | | - Marie F Kijewski
- Department of Radiology, Brigham and Women's Hospital, Boston MA
| | - Jochen H Lorch
- Head and Neck Center, Dana Farber Cancer Institute, Boston, MA. https://twitter.com/@DrLorch
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Boston MA.
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25
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Baniak N, Barletta JA, Hirsch MS. Key Renal Neoplasms With a Female Predominance. Adv Anat Pathol 2021; 28:228-250. [PMID: 34009777 DOI: 10.1097/pap.0000000000000301] [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: 11/26/2022]
Abstract
Renal neoplasms largely favor male patients; however, there is a growing list of tumors that are more frequently diagnosed in females. These tumors include metanephric adenoma, mixed epithelial and stromal tumor, juxtaglomerular cell tumor, mucinous tubular and spindle cell carcinoma, Xp11.2 (TFE3) translocation-associated renal cell carcinoma, and tuberous sclerosis complex (somatic or germline) associated renal neoplasms. The latter category is a heterogenous group with entities still being delineated. Eosinophilic solid and cystic renal cell carcinoma is the best-described entity, whereas, eosinophilic vacuolated tumor is a proposed entity, and the remaining tumors are currently grouped together under the umbrella of tuberous sclerosis complex/mammalian target of rapamycin-related renal neoplasms. The entities described in this review are often diagnostic considerations when evaluating renal mass tissue on biopsy or resection. For example, Xp11.2 translocation renal cell carcinoma is in the differential when a tumor has clear cell cytology and papillary architecture and occurs in a young or middle-aged patient. In contrast, tuberous sclerosis complex-related neoplasms often enter the differential for tumors with eosinophilic cytology. This review provides an overview of the clinical, gross, microscopic, immunohistochemical, genetic, and molecular alterations in key renal neoplasms occurring more commonly in females; differential diagnoses are also discussed regardless of sex predilection.
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Affiliation(s)
- Nicholas Baniak
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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26
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Najdawi F, Ahmadi S, Capelletti M, Dong F, Chau NG, Barletta JA. Evaluation of grade in a genotyped cohort of sporadic medullary thyroid carcinomas. Histopathology 2021; 79:427-436. [PMID: 33763905 DOI: 10.1111/his.14370] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022]
Abstract
AIMS Tumour grade and RET mutation status, especially the presence of high-risk exon 15 and 16 RET mutations, have been reported to be prognostic in patients with sporadic medullary thyroid carcinoma (MTC). The aims of our study were to evaluate the performance of two recently proposed grading systems and to assess the association between grade and genotype in a cohort of sporadic MTCs. METHODS AND RESULTS We identified 44 sporadic MTCs. All available tumour slides were examined, and cases were assigned a grade on the basis of either mitotic count and tumour necrosis, or mitotic count, tumour necrosis, and Ki-67 proliferative index, as described in two recent studies. Additional clinicopathological features and outcome information were obtained from the pathology reports and electronic medical records. The presence of RET and RAS mutations was determined either with direct sequencing or with massively parallel sequencing. Both grading systems were prognostic for progression-free survival and disease-specific survival on univariate analysis. There was no correlation between grade and mutation status. Specifically, neither RET nor high-risk RET mutations were enriched in high-grade tumours, as assessed by either grading scheme. CONCLUSION Our findings suggest that grade is not correlated with RET/RAS mutation status, indicating that grade and genotype may give independent prognostic information.
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Affiliation(s)
- Fedaa Najdawi
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Ahmadi
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marzia Capelletti
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Fei Dong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole G Chau
- Head and Neck Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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27
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Pappa T, Ahmadi S, Marqusee E, Johnson HL, Nehs MA, Cho NL, Barletta JA, Lorch JH, Doherty GM, Lindeman NI, Alexander EK, Landa I. Oncogenic Mutations in PI3K/AKT/mTOR Pathway Effectors Associate with Worse Prognosis in BRAFV600E -Driven Papillary Thyroid Cancer Patients. Clin Cancer Res 2021; 27:4256-4264. [PMID: 34088725 DOI: 10.1158/1078-0432.ccr-21-0874] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The extent to which routine genomic sequencing can identify relevant secondary genomic alterations among BRAFV600E -mutant papillary thyroid carcinoma (PTC) is unknown. Such markers would prove highly valuable for prognostic purposes. EXPERIMENTAL DESIGN We reviewed clinicopathologic data of 225 patients with BRAFV600E -mutant PTC and integrated them with genomic data derived from targeted next-generation sequencing (NGS) on tumor specimens. We defined patient subgroups based on bona fide secondary oncogenic events (separate from BRAFV600E ) and compared their clinical features and outcomes with those without additional oncogenic alterations. RESULTS Additional oncogenic alterations were identified in 16% of tumors. Patients in the "BRAF+additional mutations" group were more likely to be at high American Thyroid Association (ATA) risk of recurrence (48.6% vs. 17.6%; P = 0.0009), had larger baseline tumor (2.7 vs. 1.9 cm; P = 0.0005) and more advanced stage at presentation (14.3% vs. 1.1% stage 4; P < 0.0001). Importantly, over a 65-month follow-up, disease-specific mortality (DSM) was increased when additional mutations were identified (13.8% vs. 1.4% in the BRAF-only group; P = 0.005). Separately, we identified a subcluster of patients harboring oncogenic mutations in key effectors of the PI3K/AKT/mTOR pathway, which were independently associated with DSM (OR = 47.9; 95% confidence interval, 3.5-1,246.5; P = 0.0043). CONCLUSIONS Identification of additional PIK3/AKT/mTOR alterations in patients with BRAFV600E -mutant PTC provides important and actionable prognostic risk stratification. These data support genomic profiling of PTC tumors to inform prognosis and clinical strategy.
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Affiliation(s)
- Theodora Pappa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sara Ahmadi
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Ellen Marqusee
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Hannah L Johnson
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. .,Harvard Medical School, Boston, Massachusetts
| | - Iñigo Landa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. .,Harvard Medical School, Boston, Massachusetts
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28
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Wong KS, Dong F, Telatar M, Lorch JH, Alexander EK, Marqusee E, Cho NL, Nehs MA, Doherty GM, Afkhami M, Barletta JA. Papillary Thyroid Carcinoma with High-Grade Features Versus Poorly Differentiated Thyroid Carcinoma: An Analysis of Clinicopathologic and Molecular Features and Outcome. Thyroid 2021; 31:933-940. [PMID: 33143568 DOI: 10.1089/thy.2020.0668] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Similar to poorly differentiated thyroid carcinoma (PDTC), papillary thyroid carcinoma with high-grade features (PTC HGF) demonstrates increased mitotic activity and/or necrosis; however, PTC HGF is excluded from the World Health Organization (WHO) definition of PDTC based on maintained nuclear features of PTC. Methods: Consecutive tumors that met criteria for PTC HGF, defined as tumors with maintained nuclear features of PTC and mitoses numbering 5 or more per 10 contiguous high-power fields and/or tumor necrosis, and PDTC (defined as per the WHO criteria) were identified. Clinicopathologic characteristics, follow-up data, and targeted next-generation sequencing results were compared between groups. Results: There were 15 PTC HGF and 47 PDTC. PTC HGF was associated with a higher rate of pT4 disease (53% vs. 13%, p = 0.0027) and lymph node metastases (73% vs. 38%, p = 0.049). The disease-specific survival was worse for patients with PTC HGF compared with those with PDTC using Kaplan-Meier estimation (p < 0.001) and was worse in subgroup analysis evaluating patients with widely invasive PDTC (i.e., those with a similar rate of pT4 disease) and PTC HGF (p = 0.040). PTC HGF had a higher BRAFV600E mutation rate (42% vs. 3%; p = 0.003), a trend toward more gene fusions (25% vs. 3%; p = 0.052), and a higher rate of relative gain of 1q (67% vs. 15%; p = 0.002) than PDTC. Conclusions: Our results demonstrate that PTC HGF are important to recognize based on their aggressive behavior. The molecular differences between PTC HGF and PDTC suggest that PTC HGF should be considered a distinct group from PDTC.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Fei Dong
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Milhan Telatar
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Erik K Alexander
- Division of Endocrinology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen Marqusee
- Division of Endocrinology, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy L Cho
- Division of Endocrinology, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew A Nehs
- Department of Surgery; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard M Doherty
- Department of Surgery; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Afkhami
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Justine A Barletta
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
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29
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Janovitz T, Williamson DFK, Wong KS, Dong F, Barletta JA. Genomic profile of columnar cell variant of papillary thyroid carcinoma. Histopathology 2021; 79:491-498. [PMID: 33783022 DOI: 10.1111/his.14374] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Columnar cell variant (CCV) is a rare papillary thyroid carcinoma subtype. The majority of CCV occur in older patients and are large, invasive tumours that pursue an aggressive clinical course. Rare well-circumscribed CCV occur in younger female patients and are comparatively indolent. METHODS AND RESULTS We retrospectively identified CCV with material available to perform targeted next-generation sequencing and correlated molecular results with clinicopathological features and outcome. Our cohort was comprised of nine CCV. Nearly all were aggressive tumours; however, one was predominantly well-circumscribed and arose in a thyroglossal duct cyst of a 26-year-old woman who had no evidence of disease at last follow-up. Seven (78%) cases demonstrated activating oncogenic driver alterations in BRAF, including BRAF V600E, an activating N486_P490del deletion, and BRAF-AGK fusions. Activating RAS mutations were seen in two (22%) cases. Additionally, three (33%) cases had TERT promoter mutations, four (44%) had loss of the tumour suppressor CDKN2A and one (11%) case had a loss of function TP53 mutation. Most cases (89%) also demonstrated copy number alterations, including recurrent gain of chromosome 1q (five cases) and losses of chromosome 9p (three cases) and 22q (four cases). The one case without secondary pathogenic mutations or copy number alterations was the tumour in the 26-year-old woman. CONCLUSIONS We found that CCV is primarily a BRAF-driven tumour, with most also harbouring secondary oncogenic mutations and multiple chromosomal gains and losses. Moreover, our findings suggest that molecular analysis could potentially be used to help risk stratify CCV.
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Affiliation(s)
- Tyler Janovitz
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Drew F K Williamson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fei Dong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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30
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Frates MC, Parziale MP, Alexander EK, Barletta JA, Benson CB. Role of Sonographic Characteristics of Thyroid Bed Lesions Identified Following Thyroidectomy in the Diagnosis or Exclusion of Recurrent Cancer. Radiology 2021; 299:374-380. [PMID: 33650902 DOI: 10.1148/radiol.2021201596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background US of the thyroid bed in patients with thyroid cancer often depicts small lesions, but it is unclear whether US characteristics of lesions can help predict cancer recurrence. Purpose To determine whether size or US features of lesions in the thyroid bed after thyroidectomy in conjunction with clinical features can help predict thyroid cancer recurrence. Materials and Methods With use of a US reporting database, all patients imaged between July 2006 and June 2016 with an indication of post-thyroidectomy follow-up were retrospectively identified. Recorded data included patient demographic characteristics; date of thyroidectomy; thyroid cancer type; presence, size, and US characteristics of thyroid bed lesions; and results of fine-needle aspiration (FNA). Images were reviewed for lesions that underwent FNA. The Fisher exact test was used for analysis. Results A total of 1885 patients (mean age ± standard deviation, 48 years ± 15; 1493 female patients) underwent 5732 US examinations. Most patients (1541 of 1885 [82%]) had papillary cancer. Overall, 3163 thyroid bed lesions were reported in 5732 US examinations (40.4%). More than half of these lesions (1860 of 3163 [58.8%]) had a maximum measurement of 6 mm or greater. FNA was performed in 144 of the 3163 lesions (4.6%), of which 61 (42.4%) were malignant, 33 (22.9%) were benign, and 50 (34.7%) were nondiagnostic. Five nondiagnostic lesions eventually proved malignant. Only the presence of punctate echogenicities in the lesion (28 of 61 malignant lesions [45.9%]; three of 33 benign lesions [9%]; 12 of 50 nondiagnostic lesions [24%]; P < .001) or the history of positive lymph nodes at thyroidectomy (44 of 61 malignant lesions [72.1%]; 10 of 33 benign lesions [30%]; 19 of 50 nondiagnostic lesions [38%]; P < .001) were associated with malignancy. Of 3019 thyroid bed lesions that did not undergo FNA, three were malignant and 2248 showed no growth at follow-up US ranging from 6 months to 10 years and are presumed benign. Of the 1303 lesions smaller than 6 mm, only two (0.2%) were malignant. Conclusion Small lesions are commonly found in the thyroid bed after thyroidectomy, and most are likely to be benign. Lesions smaller than 6 mm with no punctate echogenicities had a minimal risk for malignancy. © RSNA, 2021 See also the editorial by Grant and Malhi in this issue.
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Affiliation(s)
- Mary C Frates
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
| | - Melanie P Parziale
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
| | - Erik K Alexander
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
| | - Justine A Barletta
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
| | - Carol B Benson
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
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31
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Abstract
Our understanding of the genomics and epigenomics of medullary thyroid carcinoma (MTC) has advanced since the initial recognition of RET as a driver of MTC tumorigenesis in familial MTC. We now have insight into the frequency and prognostic significance of specific RET mutations in sporadic MTC. For example, the most common RET mutation in sporadic MTC is the RET Met918Thr mutation, the same mutation that underlies MEN2B and a poor prognosticator. This mutation is relatively infrequent in medullary thyroid microcarcinomas but is over-represented in advanced-stage disease. RAS mutations are detected in 70% of sporadic, RET wild-type MTC. Although next-generation and whole-exome sequencing studies have shown that tumors that are wild-type for RET and RAS mutations essentially lack other recurrent mutations, additional pathways and epigenetic alterations have been implicated in MTC tumorigenesis. Increased insight into the clinical course of patients with familial MTC with specific RET mutations has guided treatment recommendations for these patients. Finally, an understanding of the genomics has informed treatment for patients with advanced MTC. In this review, we will examine the genomics and epigenomics of sporadic and familial MTC, along with the prognostic significance of molecular alterations, management of patients with germline RET mutations, and treatment strategies for MTC patients.
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Affiliation(s)
- Justine A Barletta
- Departments of Pathology, Brigham and Women's Hospital, Boston, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Vânia Nosé
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter M Sadow
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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32
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Acosta AM, Sholl LM, Fanelli GN, Gordetsky JB, Baniak N, Barletta JA, Lindeman NI, Hirsch MS. Intestinal metaplasia of the urinary tract harbors potentially oncogenic genetic variants. Mod Pathol 2021; 34:457-468. [PMID: 32860003 DOI: 10.1038/s41379-020-00655-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
In the urinary tract, there is an uncertain relationship between intestinal metaplasia (IM), primary adenocarcinoma, and urothelial carcinoma. Although IM is usually found adjacent to concurrent urothelial carcinoma or adenocarcinoma, small retrospective series have shown that most bladder biopsies with only IM do not subsequently develop cancer. However, IM with dysplasia does seem to be associated with a higher risk of concurrent malignancy or progressing to cancer. Since the molecular landscape of these lesions has remained largely unexplored, there are significant uncertainties about the oncogenic potential of IM in the bladder and urethra. This study investigated the presence of potentially oncogenic genetic variants in cases of IM with and without dysplasia. Twenty-three (23) cases of IM (3 urethra, 20 bladder) were sequenced using a solid tumor next-generation sequencing panel. Of these, five contained IM with high-grade dysplasia (including a case with paired IM-adenocarcinoma and another with paired IM-urothelial carcinoma) and 18 lacked dysplasia. Oncogenic genetic variants were found in all cases of IM with high-grade dysplasia and in five non-dysplastic IM cases, including mutations and copy number variants commonly seen in primary adenocarcinoma of the bladder and urothelial carcinoma. This study demonstrates that IM can harbor potentially oncogenic genetic variants, suggesting that it might represent a cancer precursor or a marker of increased cancer risk in a subset of cases.
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Affiliation(s)
- Andres M Acosta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA.
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Molecular Pathology Division, Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, Boston, MA, USA
| | - Giuseppe N Fanelli
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua, PD, Italy
| | - Jennifer B Gordetsky
- Departments of Pathology and Urology, Vanderbilt University Medical Center and Vanderbilt University, Nashville, TN, USA
| | - Nicholas Baniak
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Molecular Pathology Division, Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA
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33
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Ghazani AA, Breen KM, Dwan M, Barletta JA, Vatnick DR, Stokes SM, Block C, Doherty GM, Cohn AY, Marqusee E, Garber JE, Rana HQ. Unexpected Pathogenic RET p.V804M Variant Leads to the Clinical Diagnosis and Management of Medullary Thyroid Carcinoma. Am J Case Rep 2020; 21:e927415. [PMID: 33361738 PMCID: PMC7774021 DOI: 10.12659/ajcr.927415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/16/2022]
Abstract
Patient: Female, 62-year-old Final Diagnosis: Medullary thyroid microcarcinoma Symptoms: No pain or swelling in her neck • no dysphagia or odynophagia • no changes in voice Medication: — Clinical Procedure: Genetic analysis Specialty: Genetics
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Affiliation(s)
- Arezou A Ghazani
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Katelyn M Breen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Meaghan Dwan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Justine A Barletta
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Donna R Vatnick
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Samantha M Stokes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caroline Block
- Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Gerard M Doherty
- Harvard Medical School, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Aviva Y Cohn
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Woman's Hospital, Boston, MA, USA
| | - Ellen Marqusee
- Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Woman's Hospital, Boston, MA, USA
| | - Judy E Garber
- Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Huma Q Rana
- Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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34
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Wong KS, Angell TE, Barletta JA, Krane JF. Hürthle cell lesions of the thyroid: Progress made and challenges remaining. Cancer Cytopathol 2020; 129:347-362. [PMID: 33108684 DOI: 10.1002/cncy.22375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022]
Abstract
Hürthle cell-predominant thyroid fine needle aspirations (FNA) are encountered frequently in routine practice, yet they are often challenging to diagnose accurately and are associated with significant interobserver variability. This is largely due to the ubiquity of Hürthle cells in thyroid pathology, ranging from nonneoplastic conditions to aggressive malignancies. Although limitations in cytomorphologic diagnoses likely will remain for the foreseeable future, our knowledge of the molecular pathogenesis of Hürthle cell neoplasia and application of molecular testing to cytologic material have increased dramatically within the past decade. This review provides context behind the challenges in diagnosis of Hürthle cell lesions and summarizes the more recent advances in diagnostic tools.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trevor E Angell
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey F Krane
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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35
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Ghossein R, Barletta JA, Bullock M, Johnson SJ, Kakudo K, Lam AK, Moonim MT, Poller DN, Tallini G, Tuttle RM, Xu B, Gill AJ. Data set for reporting carcinoma of the thyroid: recommendations from the International Collaboration on Cancer Reporting. Hum Pathol 2020; 110:62-72. [PMID: 32920035 DOI: 10.1016/j.humpath.2020.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 12/29/2022]
Abstract
Thyroid cancer therapy is increasingly tailored to patients' risk of recurrence and death, placing renewed importance on pathologic parameters. The International Collaboration on Cancer Reporting (ICCR), an organization promoting evidence-based, internationally agreed-upon standardized pathology data sets, is the ideal conduit for the development of a pathology reporting protocol aimed at improving the care of patients with thyroid carcinomas. An international expert panel reviewed each element of thyroid pathology reporting. Recommendations were made based on the most recent literature and expert opinion.The data set uses the most recent World Health Organization (WHO) classification for the purpose of a more clinically and prognostically relevant nomenclature. One example is the restriction of the term minimally invasive follicular carcinoma to tumors with capsular invasion only. It reinforces the already established criteria for blood vessel invasion adopted by the most recent WHO classification and Armed Forces Institute of Pathology fascicle. It emphasizes the importance of the extent of blood vessel invasion and extrathyroid extension to better stratify patients for appropriate therapy. It is the first data set that requires pathologists to use the more recently recognized prognostically powerful parameters of mitotic activity and tumor necrosis. It highlights the importance of assessing nodal disease volume in predicting the risk of recurrence.The ICCR thyroid data set provides the tools to generate a report that will guide patient treatment in a more rational manner aiming to prevent the undertreatment of threatening malignancies and spare patients with indolent tumors the morbidity of unnecessary therapy. We recommend its routine use internationally for reporting thyroid carcinoma histology.
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Affiliation(s)
- Ronald Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Martin Bullock
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 4R2 Canada
| | - Sarah J Johnson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, UK
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Centre, Izumi City General Hospital, Izumi, 594-0073, Japan
| | - Alfred K Lam
- Department of Pathology, School of Medicine, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Mufaddal T Moonim
- Department of Histopathology, Guy's & St. Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - David N Poller
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - Giovanni Tallini
- Department of Pathology, University of Bologna Medical Center, 40138, Bologna, Italy
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Anthony J Gill
- University of Sydney, Sydney, New South Wales, 2006, Australia; Cancer Diagnosis and Pathology Group Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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36
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Wong KS, Lorch JH, Alexander EK, Marqusee E, Cho NL, Nehs MA, Doherty GM, Barletta JA. Histopathologic Features and Clinical Outcome of Anaplastic Thyroid Carcinoma with a Minor Anaplastic Component. Endocr Pathol 2020; 31:283-290. [PMID: 32445173 DOI: 10.1007/s12022-020-09627-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although prior studies have reported that patients with anaplastic thyroid carcinoma (ATC) with a focal anaplastic component may have a prolonged survival compared to other ATC patients, the outcome data are limited. We evaluated a cohort of ATC resected between 2003 and 2018. Tumor slides were reviewed to confirm the diagnosis and to identify cases with a minor ATC component (defined as comprising < 10% of the tumor). We evaluated the clinical outcome of these patients compared to that of all other cohort patients (characterized as having conventional ATC). Our cohort was composed of 24 cases of ATC that underwent resection, including 8 (33%) with a minor ATC component. Tumors with a minor ATC component were predominantly associated with papillary thyroid carcinoma. For patients with tumors with a minor ATC component, the 1-year and 2-year survival rates and median survival for patients who died of disease were 88%, 43%, and 17 months (range 6-73 months), respectively. In comparison, for patients with conventional ATC, the 1-year and 2-year survival rates and median survival for patients who died of disease were 56%, 44%, and 7 months (range 2-26 months), respectively. There was no difference in 1- and 2-year survival or overall survival by Kaplan-Meier analysis for patients with tumors with a minor ATC component and those with conventional ATC. In conclusion, the difference in overall survival between ATC groups in our cohort was not significant; however, this could be due to the small cohort size or due to characteristics of our group with a minor ATC component; that is, no tumors in this group were limited to the thyroid (stage IVA), resectability with negative margins was infrequent, and 38% of this group had distant metastases at diagnosis (stage IVC).
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Erik K Alexander
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ellen Marqusee
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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37
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Bellmunt J, Kim J, Reardon B, Perera-Bel J, Orsola A, Rodriguez-Vida A, Wankowicz SA, Bowden M, Barletta JA, Morote J, de Torres I, Juanpere N, Lloreta-Trull J, Hernandez S, Mouw KW, Taplin ME, Cejas P, Long HW, Van Allen EM, Getz G, Kwiatkowski DJ. Genomic Predictors of Good Outcome, Recurrence, or Progression in High-Grade T1 Non-Muscle-Invasive Bladder Cancer. Cancer Res 2020; 80:4476-4486. [PMID: 32868381 DOI: 10.1158/0008-5472.can-20-0977] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/27/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
High-grade T1 (HGT1) bladder cancer is the highest risk subtype of non-muscle-invasive bladder cancer with unpredictable outcome and poorly understood risk factors. Here, we examined the association of somatic mutation profiles with nonrecurrent disease (GO, good outcome), recurrence (R), or progression (PD) in a cohort of HGT1 patients. Exome sequencing was performed on 62 HGT1 and 15 matched normal tissue samples. Both tumor only (TO) and paired analyses were performed, focusing on 95 genes known to be mutated in bladder cancer. Somatic mutations, copy-number alterations, mutation load, and mutation signatures were studied. Thirty-three GO, 10 R, 18 PD, and 1 unknown outcome patients were analyzed. Tumor mutational burden (TMB) was similar to muscle-invasive disease and was highest in GO, intermediate in PD, and lowest in R patients (P = 0.017). DNA damage response gene mutations were associated with higher TMB (P < 0.0001) and GO (P = 0.003). ERCC2 and BRCA2 mutations were associated with GO. TP53, ATM, ARID1A, AHR, and SMARCB1 mutations were more frequent in PD. Focal copy-number gain in CCNE1 and CDKN2A deletion was enriched in PD or R (P = 0.047; P = 0.06). APOBEC (46%) and COSMIC5 (34%) signatures were most frequent. APOBEC-A and ERCC2 mutant tumors (COSMIC5) were associated with GO (P = 0.047; P = 0.0002). pT1b microstaging was associated with a genomic cluster (P = 0.05) with focal amplifications of E2F3/SOX4, PVRL4, CCNE1, and TP53 mutations. Findings were validated using external public datasets. These findings require confirmation but suggest that management of HGT1 bladder cancer may be improved via molecular characterization to predict outcome. SIGNIFICANCE: Detailed genetic analyses of HGT1 bladder tumors identify features that correlate with outcome, e.g., high mutational burden, ERCC2 mutations, and high APOBEC-A/ERCC2 mutation signatures were associated with good outcome.
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Affiliation(s)
- Joaquim Bellmunt
- Beth Israel Deaconess Medical Center, Boston, Massachusetts. .,Harvard Medical School University, Boston, Massachusetts.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,IMIM-Hospital del Mar Medical Research Institute; Hospital del Mar, Barcelona, Spain
| | - Jaegil Kim
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Brendan Reardon
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Júlia Perera-Bel
- IMIM-Hospital del Mar Medical Research Institute; Hospital del Mar, Barcelona, Spain
| | - Anna Orsola
- IMIM-Hospital del Mar Medical Research Institute; Hospital del Mar, Barcelona, Spain
| | - Alejo Rodriguez-Vida
- IMIM-Hospital del Mar Medical Research Institute; Hospital del Mar, Barcelona, Spain
| | - Stephanie A Wankowicz
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michaela Bowden
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Juan Morote
- Department of Urology, University Hospital Valle de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Inés de Torres
- Department of Pathology, University Hospital Valle de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Juanpere
- Department of Pathology, University Hospital del Mar, Pompeu Fabra University, Barcelona, Spain
| | - Josep Lloreta-Trull
- Department of Pathology, University Hospital del Mar, Pompeu Fabra University, Barcelona, Spain
| | - Silvia Hernandez
- Department of Pathology, University Hospital del Mar, Pompeu Fabra University, Barcelona, Spain
| | - Kent W Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Mary-Ellen Taplin
- Harvard Medical School University, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Paloma Cejas
- Center for Functional Cancer Epigenetics, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Henry W Long
- Center for Functional Cancer Epigenetics, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Eliezer M Van Allen
- Harvard Medical School University, Boston, Massachusetts.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gad Getz
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Cancer Center and Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - David J Kwiatkowski
- Harvard Medical School University, Boston, Massachusetts. .,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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38
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Chen TY, Lorch JH, Wong KS, Barletta JA. Histological features of BRAF V600E-mutant anaplastic thyroid carcinoma. Histopathology 2020; 77:314-320. [PMID: 32428249 DOI: 10.1111/his.14144] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022]
Abstract
AIMS Treatment with a BRAF inhibitor, alone or in combination with a MEK inhibitor, may be considered for BRAF-mutant anaplastic thyroid carcinoma (ATC). The purpose of this study was to characterise the histology of BRAF V600E-mutant ATC. METHODS AND RESULTS We identified 28 ATC that were consecutively resected between 2003 and 2019. All tumour slides for each case were evaluated for the presence of a precursor tumour and for ATC morphology (sarcomatoid, pleomorphic giant cell, epithelioid or squamous). BRAF V600E mutation status was determined by BRAF V600E IHC or molecular analysis (OncoPanel NGS). Eighteen (64%) ATC had an associated well-differentiated precursor, including 10 (36%) with associated papillary thyroid carcinoma (PTC) and eight (29%) with associated follicular thyroid carcinoma (FTC) or Hürthle cell carcinoma (HCC). Most ATC (19 cases, 68%) demonstrated a mixed anaplastic morphology. Squamous morphology was present in four cases. Ten (36%) ATC had a BRAF V600E mutation. All ATC that had a PTC precursor had a BRAF V600E mutation (and all ATC with a BRAF V600E mutation had a PTC precursor), whereas no ATC with an FTC or HCC precursor had a BRAF V600E mutation. All four cases of ATC with a squamous morphology had a PTC precursor and a BRAF V600E mutation. CONCLUSION In our cohort, the presence of a PTC precursor predicted the presence of the BRAF V600E mutation, whereas ATC with an FTC or HCC precursor lacked a BRAF V600E mutation. A squamous morphology was associated with the presence of a PTC precursor and a BRAF V600E mutation.
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Affiliation(s)
- Tiffany Y Chen
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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39
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Abstract
Anaplastic thyroid carcinoma (ATC) is a rare but significant malignancy due to its high mortality rate. Rendering an accurate diagnosis is crucial given the prognostic implications and treatment ramifications. Based on the prognostic significance of the extent of invasion of the primary tumor, T staging for ATC changed in the most recent edition of the American Joint Committee on Cancer (AJCC) staging manual. In the past 5 years there has been a rapid increase in our understanding of the molecular basis of ATC which has provided the basis for targeted therapy for some ATC patients. In this review, ATC prognostic factors, histologic and immunotypic features, staging updates, and molecular alterations, with an emphasis on those that may impact treatment, will be discussed.
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Affiliation(s)
- Jing Yang
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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40
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Kuo LE, Angell TE, Pandian TK, Moore AL, Alexander EK, Barletta JA, Gawande AA, Lorch JH, Marqusee E, Moore FD, Nehs MA, Doherty GM, Cho NL. Completion Thyroidectomy is Less Common Following Updated 2015 American Thyroid Association Guidelines. Ann Surg Oncol 2020; 28:484-491. [PMID: 32583197 DOI: 10.1245/s10434-020-08709-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The 2015 American Thyroid Association (ATA) guidelines recommended that low-risk, differentiated thyroid cancers (DTC) between 1 and 4 cm may be treated with thyroid lobectomy alone. We sought to determine the effect of these guideline changes on the rate of completion thyroidectomy (CT) for low-risk DTC and factors influencing surgical decision-making. METHODS All patients from 2014 to 2018 who received an initial thyroid lobectomy at our institution with final pathology demonstrating DTC were included. Patients were divided into "pre" and "post" guideline cohorts (2014-2015 and 2016-2018, respectively). The rate of CT was compared between the two cohorts. Patient demographics and tumor characteristics were examined for association with CT. RESULTS A total of 163 patients met study criteria: 63 patients in the 2014-2015 ("pre") and 100 in the 2016-2018 ("post") group. In the "pre" period, 41 (65.1%) patients received CT compared with 43 (43.0%) in the "post" period (p < 0.01)-a 34% decrease in the rate of completion surgery (p < 0.01). Of low-risk patients with DTC between 1 and 4 cm in size, 17 of 35 (48.6%) received CT in the "pre" period compared with 15 of 60 (25.0%) in the post period-a 48.6% decrease in the rate of completion surgery (p = 0.02). Greater tumor size, capsular invasion, and multifocality were associated with CT in low-risk "post" guideline patients (p < 0.05 for all). CONCLUSIONS The rate of CT decreased significantly by 48.6% for low-risk patients with DTC between 1 and 4 cm, demonstrating recognition of the 2015 ATA guidelines. However, 25% of these patients underwent CT, suggesting additional factors influencing the decision for further treatment.
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Affiliation(s)
- Lindsay E Kuo
- Department of Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Trevor E Angell
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - T K Pandian
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Erik K Alexander
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Atul A Gawande
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Jochen H Lorch
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ellen Marqusee
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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41
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Lorch JH, Barletta JA, Nehs M, Uppaluri R, Alexander EK, Haddad RI, Hanna GJ, Margalit DN, Tishler RB, Schoenfeld JD, Goguen LA, Jabiev A, Sorensen MJ, Ahmadi S, Marqusee E, Kim MI, Stanizzi D, Harris E, Kacew A, Barbie DA. A phase II study of nivolumab (N) plus ipilimumab (I) in radioidine refractory differentiated thyroid cancer (RAIR DTC) with exploratory cohorts in anaplastic (ATC) and medullary thyroid cancer (MTC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6513] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6513 Background: Treatment options for aggressive TC are limited. Pre-clinical data suggests efficacy of CTLA-4 plus PD-1 blockade in aggressive RAIR TC. Methods: This investigator initiated phase II study tested N (3mg/kg every 2 weeks) plus I (1mg/kg every 6 weeks) until disease progression or completion of 24 mo of treatment in RAIR differentiated TC including poorly differentiated TC (PDTC) with exploratory cohorts in anaplastic (ATC) and medullary TC (MTC). Radiographic response rate by RECIST v1.1 (CR+PR) was primary endpoint. At least 6 pts with disease response among n=32 DTC provided 84% power to distinguish between a 10% and a 25% RR (one-sided 9% binomial test). Results: Accrual is complete with n=32 patients with DTC, 10 with ATC and 7 with MTC enrolled between October 2017 and May 2019. Thirty-two DTC included: n=17 papillary, n=7 Hurthle, n=4 follicular TC, n=4 PDTC. Among n=49, median (range) age was 65 (30-88), 51% (25/49) were female. To date, in DTC, 3/32 achieved a PR (n=2 Hurthle and n=1 PDTC), 9.4% RR (.95CI:2%-25%). One near complete response has been observed. Among pts w ATC, 3/ 10 profound PR by RECIST occurred (30% RR, .95CI: 7%-65%). Among them, two remain without clear evidence of disease at 26 and 13 mo after treatment start. No PR's were observed in MTC. Most frequent grade 3-4 TRAEs were as expected and included increased lipase (n=8), increased serum amylase (n=4). There was an unexpected number of treatment related adrenal insufficiency (AI) (n=4) which was associated with long PFS (range 10.1—16.4+mo). Conclusions: N+I appears to have considerable activity in ATC. In unselected RAIR DTC, activity was low but responses were seen in PDTC and Hurthle cell TC. Exceptional responses with prolonged remissions were observed. Clinical trial information: NCT03246958 .
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Affiliation(s)
| | | | | | - Ravindra Uppaluri
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA
| | | | - Robert I. Haddad
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA
| | | | - Danielle Nina Margalit
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Roy B. Tishler
- Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | | | | | | - Alec Kacew
- Dana-Farber Cancer Instutute, Boston, MA
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Wong KS, Chen TY, Higgins SE, Howitt BE, Lorch JH, Alexander EK, Marqusee E, Cho NL, Nehs MA, Doherty GM, Barletta JA. A potential diagnostic pitfall for hobnail variant of papillary thyroid carcinoma. Histopathology 2020; 76:707-713. [DOI: 10.1111/his.14042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/04/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Kristine S Wong
- Department of Pathology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Tiffany Y Chen
- Department of Pathology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Sara E Higgins
- Department of Pathology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Brooke E Howitt
- Department of Pathology Stanford University Medical Center Palo Alto CA USA
| | - Jochen H Lorch
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston MA USA
| | - Erik K Alexander
- Division of Endocrinology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Ellen Marqusee
- Division of Endocrinology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Nancy L Cho
- Department of Surgery Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Matthew A Nehs
- Department of Surgery Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Gerard M Doherty
- Department of Surgery Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Justine A Barletta
- Department of Pathology Brigham and Women's Hospital Harvard Medical School Boston MA USA
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Costigan DC, Shaar M, Frates MC, Alexander EK, Barletta JA, Cibas ES. Defining thyroid spherules: A benign cytomorphologic feature that mimics microfollicles. Cancer Cytopathol 2019; 128:171-176. [PMID: 31856389 DOI: 10.1002/cncy.22219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Distinctive rounded structures termed spherules have been observed in thyroid fine-needle aspiration (FNA) samples. Although they are often small and interpreted as microfollicles, spherules are notable for the even spacing of the follicular cells along the perimeter of the structure. Because they have an orderly architectural arrangement, it has been hypothesized that spherules are benign and do not carry the same risk of malignancy that traditional microfollicles do. The aim of this study was to identify the clinical significance and histopathologic correlate of spherules. METHODS Thyroid FNAs (n = 637) with an interpretation of atypia of undetermined significance (AUS) were reviewed for the presence of spherules, which were defined as small follicles with a rounded, smooth, sharply defined outer contour, evenly spaced nuclei, and a 3-dimensional appearance. Cases were included if spherules accounted for >50% of follicular cell arrangements. Clinical, histopathologic, molecular, and sonographic follow-up data were obtained. RESULTS Twenty-five spherule cases were identified, and they represented 3.9% of all AUS cases reviewed. All 24 cases with follow-up had a benign outcome. Eleven were tested with the Afirma gene expression classifier; 8 were benign according to the gene expression classifier, and 3 were suspicious but histologically benign after surgical resection. Four additional cases were histologically benign after surgery. Five patients had repeat benign cytology. Four patients had repeat stable ultrasound findings. CONCLUSIONS Thyroid nodules diagnosed as AUS, if composed predominantly of spherules, are associated with a benign outcome. Recognizing this distinctive cytomorphologic finding may help to reduce the number of FNAs interpreted as AUS and save patients from unnecessary additional testing and surgery.
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Affiliation(s)
- Danielle C Costigan
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mohanad Shaar
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mary C Frates
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Abstract
This article examines more uncommon thyroid entities, including anaplastic thyroid carcinoma, poorly differentiated thyroid carcinoma, rare papillary thyroid carcinoma variants, medullary thyroid carcinoma, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and multiple adenomatous nodules in the setting of Cowden syndrome. These entities were chosen based on their clinical significance and because they can be diagnostically challenging due to their morphologic diversity and overlap with other thyroid tumors. This article addresses the diagnostic features of each entity, focusing on how to avoid potential pitfalls and mimics while also highlighting the clinical implications of each diagnosis.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Nanba K, Omata K, Gomez-Sanchez CE, Stratakis CA, Demidowich AP, Suzuki M, Thompson LDR, Cohen DL, Luther JM, Gellert L, Vaidya A, Barletta JA, Else T, Giordano TJ, Tomlins SA, Rainey WE. Genetic Characteristics of Aldosterone-Producing Adenomas in Blacks. Hypertension 2019; 73:885-892. [PMID: 30739536 DOI: 10.1161/hypertensionaha.118.12070] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Somatic mutations have been identified in aldosterone-producing adenomas (APAs) in genes that include KCNJ5, ATP1A1, ATP2B3, and CACNA1D. Based on independent studies, there appears to be racial differences in the prevalence of somatic KCNJ5 mutations, particularly between East Asians and Europeans. Despite the high cardiovascular disease mortality of blacks, there have been no studies focusing on somatic mutations in APAs in this population. In the present study, we investigated genetic characteristics of APAs in blacks using a CYP11B2 (aldosterone synthase) immunohistochemistry-guided next-generation sequencing approach. The adrenal glands with adrenocortical adenomas from 79 black patients with primary aldosteronism were studied. Seventy-three tumors from 69 adrenal glands were confirmed to be APAs by CYP11B2 immunohistochemistry. Sixty-five of 73 APAs (89%) had somatic mutations in aldosterone-driver genes. Somatic CACNA1D mutations were the most prevalent genetic alteration (42%), followed by KCNJ5 (34%), ATP1A1 (8%), and ATP2B3 mutations (4%). CACNA1D mutations were more often observed in APAs from males than those from females (55% versus 29%, P=0.033), whereas KCNJ5 mutations were more prevalent in APAs from females compared with those from males (57% versus 13%, P<0.001). No somatic mutations in aldosterone-driver genes were identified in tumors without CYP11B2 expression. In conclusion, 89% of APAs in blacks harbor aldosterone-driving mutations, and unlike Europeans and East Asians, the most frequently mutated aldosterone-driver gene was CACNA1D. Determination of racial differences in the prevalence of aldosterone-driver gene mutations may facilitate the development of personalized medicines for patients with primary aldosteronism.
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Affiliation(s)
- Kazutaka Nanba
- From the Department of Molecular and Integrative Physiology (K.N., W.E.R.), University of Michigan, Ann Arbor
| | - Kei Omata
- Department of Pathology (K.O., T.J.G., S.A.T.), University of Michigan, Ann Arbor
| | - Celso E Gomez-Sanchez
- Endocrine and Research Service, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS (C.E.G.-S.).,Division of Endocrinology, University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Constantine A Stratakis
- Section of Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (C.A.S., A.P.D., M.S.)
| | - Andrew P Demidowich
- Section of Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (C.A.S., A.P.D., M.S.)
| | - Mari Suzuki
- Section of Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (C.A.S., A.P.D., M.S.)
| | - Lester D R Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group (L.D.R.T.)
| | - Debbie L Cohen
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.L.C.)
| | - James M Luther
- Division of Clinical Pharmacology (J.M.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Lan Gellert
- Department of Pathology, Microbiology and Immunology (L.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Justine A Barletta
- Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Tobias Else
- Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine (T.E., T.J.G., W.E.R.), University of Michigan, Ann Arbor
| | - Thomas J Giordano
- Department of Pathology (K.O., T.J.G., S.A.T.), University of Michigan, Ann Arbor.,Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine (T.E., T.J.G., W.E.R.), University of Michigan, Ann Arbor.,Rogel Cancer Center (T.J.G., S.A.T.), University of Michigan, Ann Arbor
| | - Scott A Tomlins
- Department of Pathology (K.O., T.J.G., S.A.T.), University of Michigan, Ann Arbor.,Rogel Cancer Center (T.J.G., S.A.T.), University of Michigan, Ann Arbor.,Department of Urology (S.A.T.), University of Michigan, Ann Arbor.,Michigan Center for Translational Pathology (S.A.T.), University of Michigan, Ann Arbor
| | - William E Rainey
- From the Department of Molecular and Integrative Physiology (K.N., W.E.R.), University of Michigan, Ann Arbor.,Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine (T.E., T.J.G., W.E.R.), University of Michigan, Ann Arbor
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Angell TE, Maurer R, Wang Z, Kim MI, Alexander CA, Barletta JA, Benson CB, Cibas ES, Cho NL, Doherty GM, Doubilet PM, Frates MC, Gawande AA, Krane JF, Marqusee E, Moore FD, Nehs MA, Larsen PR, Alexander EK. A Cohort Analysis of Clinical and Ultrasound Variables Predicting Cancer Risk in 20,001 Consecutive Thyroid Nodules. J Clin Endocrinol Metab 2019; 104:5665-5672. [PMID: 31310316 DOI: 10.1210/jc.2019-00664] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Assessing thyroid nodules for malignancy is complex. The impact of patient and nodule factors on cancer evaluation is uncertain. OBJECTIVES To determine precise estimates of cancer risk associated with clinical and sonographic variables obtained during thyroid nodule assessment. DESIGN Analysis of consecutive adult patients evaluated with ultrasound-guided fine-needle aspiration for a thyroid nodule ≥1 cm between 1995 and 2017. Demographics, nodule sonographic appearance, and pathologic findings were collected. MAIN OUTCOME MEASURES Estimated risk for thyroid nodule malignancy for patient and sonographic variables using mixed-effect logistic regression. RESULTS In 9967 patients [84% women, median age 53 years (range 18 to 95)], thyroid cancer was confirmed in 1974 of 20,001 thyroid nodules (9.9%). Significant ORs for malignancy were demonstrated for patient age <52 years [OR: 1.82, 95% CI (1.63 to 2.05), P < 0.0001], male sex [OR: 1.68 (1.45 to 1.93), P < 0.0001], nodule size [OR: 1.30 (1.14 to 1.49) for 20 to 19 mm, OR: 1.59 (1.34 to 1.88) for 30 to 39 mm, and OR: 1.71 (1.43 to 2.04) for ≥40 mm compared with 10 to 19 mm, P < 0.0001 for all], cystic content [OR: 0.43 (0.37 to 0.50) for 25% to 75% cystic and OR: 0.21 (0.15 to 0.28) for >75% compared with predominantly solid, P < 0.0001 for both], and the presence of additional nodules ≥1 cm [OR: 0.69 (0.60 to 0.79) for two nodules, OR: 0.41 (0.34 to 0.49) for three nodules, and OR: 0.19 (0.16 to 0.22) for greater than or equal to four nodules compared with one nodule, P < 0.0001 for all]. A free online calculator was constructed to provide malignancy-risk estimates based on these variables. CONCLUSIONS Patient and nodule characteristics enable more precise thyroid nodule risk assessment. These variables are obtained during routine initial thyroid nodule evaluation and provide new insights into individualized thyroid nodule care.
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Affiliation(s)
- Trevor E Angell
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rie Maurer
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zhihong Wang
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Thyroid Surgery, First Hospital of China Medical University, Shenyang, China
| | - Matthew I Kim
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caroline A Alexander
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mary C Frates
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Atul A Gawande
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeff F Krane
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ellen Marqusee
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - P Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Justine A Barletta
- Chief, Endocrine Pathology Service, Department of Pathology, Brigham and Women's Hospital, Associate Professor of Pathology, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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48
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Aggarwal A, Yuan Z, Barletta JA, Lorch JH, Nehs MA. Ketogenic diet combined with antioxidant N-acetylcysteine inhibits tumor growth in a mouse model of anaplastic thyroid cancer. Surgery 2019; 167:87-93. [PMID: 31521320 DOI: 10.1016/j.surg.2019.06.042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/19/2019] [Accepted: 06/02/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anaplastic thyroid cancer is an aggressive and fatal malignancy. Many advanced cancers are characterized by glucose dependency, leading to oxidative stress and cellular proliferation. Therefore, we sought to determine if a low glucose environment (in vitro) or a ketogenic diet (in vivo) could inhibit anaplastic thyroid cancer tumor growth when combined with the antioxidant N-acetylcysteine. METHODS In vivo, nude mice were injected with the anaplastic thyroid cancer cell line 8505C (n = 6/group). Group 1 was fed a standard diet; Group 2 was fed a ketogenic diet; Group 3 was given standard diet with N-acetylcysteine (40 mM in the drinking water); and Group 4 was fed ketogenic diet with N-acetylcysteine. Tumor volumes, ketones, and glucose were measured. H&E stains and immunohistochemistry for Ki-67 and Caspase 3 were performed on the tumors. In vitro, 8505C cells were cultured in high glucose (25 mM), low glucose (3 mM), high glucose plus N-acetylcysteine (200 uM), or low glucose plus N-acetylcysteine for 96 hours. We performed CyQUANT proliferation (Thermo Fisher Scientific, Waltham, MA), Seahorse glycolytic stress (Agilent, Santa Clara, CA), and reactive oxidative stress assays. RESULTS Ketogenic diet plus N-acetylcysteine decreased in vivo tumor volume compared to standard diet (22.5 ± 12.4 mm3 vs 147 ± 54.4 mm3, P < .05) and standard diet plus N-acetylcysteine (P < .05). Blood ketone levels were significantly higher for the mice in the ketogenic diet group compared to standard diet (1.74 mmol/L vs 0.38 mmol/L at week 5, P < .001). However, blood glucose levels were not significantly different between ketogenic diet and standard diet groups. Cells cultured in low glucose plus N-acetylcysteine had significantly reduced proliferation compared to high glucose (98.1 ± 5.0 relative fluorescence units vs 157.8 ± 2.1 relative fluorescence units, P < .001). Addition of N-acetylcysteine to low glucose lowered glycolysis function compared to high glucose (39.0 ± 2.2 mpH/min/cell vs 89.1 ± 13.2 mpH/min/cell, P < .001) and high glucose plus N-acetylcysteine (37.4 ± 2.5 mpH/min/cell vs 70.3 ± 3.3 mpH/min/cell, P < .001). Low glucose plus N-acetylcysteine decreased reactive oxidative stress compared to high glucose (119 ± 34.7 relative fluorescence units vs 277 ± 16.0 relative fluorescence units, P = .014). CONCLUSION The combination of a ketogenic diet or glucose restriction with the antioxidant- N-acetylcysteine significantly reduced tumor growth in vivo and in vitro. Further studies are warranted to explore these metabolic therapies in anaplastic thyroid cancer.
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Affiliation(s)
- Abha Aggarwal
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Zuliang Yuan
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Jochen H Lorch
- Head and Neck Center, Dana Farber Cancer Institute, Boston, MA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Boston, MA.
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Wong KS, Lorch JH, Alexander EK, Marqusee E, Cho NL, Nehs MA, Doherty GM, Barletta JA. Prognostic Significance of Extent of Invasion in Poorly Differentiated Thyroid Carcinoma. Thyroid 2019; 29:1255-1261. [PMID: 31397224 DOI: 10.1089/thy.2019.0263] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: The 2017 World Health Organization (WHO) Classification of Tumors of Endocrine Organs defines poorly differentiated thyroid carcinoma (PDTC) as a tumor with conventional criteria of malignancy (capsular penetration or vascular invasion) with solid, insular, or trabecular growth, a lack of nuclear features of papillary thyroid carcinoma, and increased mitotic activity, tumor necrosis, or convoluted nuclei. The extent of invasion has been shown to be prognostic in follicular thyroid carcinoma and Hürthle cell carcinoma. Our aim was to evaluate how extent of invasion impacts clinical outcome for PDTC. Methods: We retrospectively identified 47 consecutively diagnosed cases of PDTC that were resected between 2005 and 2018. All cases were reviewed to confirm that the tumors met the 2017 Endocrine WHO criteria of PDTC. In addition, tumors were categorized as follows: encapsulated with capsular penetration only, encapsulated with focal vascular invasion (fewer than four foci), encapsulated with extensive vascular invasion (four or more foci), or widely invasive. Histopathologic characteristics and clinical outcome data were recorded. Results: A total of 47 cases of PDTC, including 15 oncocytic tumors, were identified from 28 (60%) women and 19 (40%) men (mean age of 57 years at diagnosis). The mean tumor size was 4.3 cm. Mitoses numbered 8 per 10 high-power fields (HPF) on average (range: 1-34), and necrosis was present in 21 (45%) cases. Eight (17%) cases were encapsulated with capsular penetration only, 5 (11%) were encapsulated with focal vascular invasion, 18 (38%) were encapsulated with extensive vascular invasion, and 16 (34%) were widely invasive. Of the 42 (89%) patients with follow-up data, 7 (17%) died of disease (with a mean survival time of 6.4 years), 11 (26%) have distant metastatic disease, and 24 (57%) have no evidence of disease (mean follow-up 5.6 years). Eight (19%) patients presented with M1 disease at diagnosis. The 5-year disease-free survival (DFS) for patients with M0 disease at diagnosis was 100% for patients with tumors with capsular invasion only or focal vascular invasion (n = 7), 73% for patients with encapsulated tumors with extensive vascular invasion (n = 11), and 17% for patients with widely invasive PDTCs (n = 6). DFS estimates by Kaplan-Meier analysis were significantly different between these groups (p = 0.0016). Conclusions: Extent of invasion appears to be an important parameter that affects clinical outcome for patients with PDTC. In our cohort, patients with encapsulated PDTC with capsular invasion only or focal vascular invasion had an excellent outcome.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ellen Marqusee
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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50
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Borrelli N, Panebianco F, Condello V, Barletta JA, Kaya C, Yip L, Nikiforova MN, Nikiforov YE. Characterization of Activating Mutations of the MEK1 Gene in Papillary Thyroid Carcinomas. Thyroid 2019; 29:1279-1285. [PMID: 31407636 PMCID: PMC6913803 DOI: 10.1089/thy.2019.0065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Genetic alterations activating the mitogen-activated protein kinase (MAPK) signaling pathway, most commonly BRAF and RAS mutations, are common in papillary thyroid carcinoma (PTC). Somatic mutations of the MEK gene, also known as mitogen-activated protein kinase kinase 1 (MAP2K1), coding for a signaling protein downstream of BRAF, have been found in several cancer types. The goal of this study was to investigate if functional MEK1 mutations occur in thyroid cancer (TC). Methods: We analyzed MEK1 mutation status in a series of 101 PTCs lacking other known driver mutations using Sanger sequencing and targeted next-generation sequencing. In addition, 64 follicular and Hürthle cell carcinomas and 32 follicular adenomas were studied. The occurrence of MEK1 mutations was evaluated using another series of thyroid tumors studied by targeted next-generation sequencing. Western blot and RNA-seq analyses were performed on selected tumors. Results: We detected MEK1 mutations in 2/101 (2%) PTCs that otherwise had no known genetic alterations, in 0/64 follicular and Hürthle cell carcinomas, and in 0/32 follicular adenomas. Two positive tumors carried the same in-frame deletion p.L98_I103del; K104I (c.292_309del18; c.311A>T) located in exon 3 of the gene. One additional MEK1 mutation was identified following routine molecular tumor profiling. The tumor had an in-frame deletion p.I99_K104del (c.294_311del18) also located in exon 3. Western blot analysis of one of the tumors showed activation of the MAPK pathway. Using RNA-seq analysis to evaluate changes in gene expression, these tumors were RAS-like and showed a high thyroid differentiation score. Phenotypically, the MEK1-positive PTCs were all encapsulated and had a predominantly or exclusively follicular architecture, being diagnosed as a classic papillary type with a significant follicular pattern ( × 2) or follicular variant PTC ( × 1). Follow-up was available for 2 patients, with no evidence of disease found 2 and 10 years postsurgery. Conclusions: In this study, we report the occurrence of functional MEK1 mutations in PTC. All mutations are in-frame deletions in exon 3 of MEK1, representing another mechanism of activation of the MAPK pathway in papillary carcinomas with a predominantly follicular growth pattern.
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Affiliation(s)
- Nicla Borrelli
- Department of Pathology and Laboratory Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Federica Panebianco
- Department of Pathology and Laboratory Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Vincenzo Condello
- Department of Pathology and Laboratory Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Justine A. Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cihan Kaya
- Department of Pathology and Laboratory Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Marina N. Nikiforova
- Department of Pathology and Laboratory Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yuri E. Nikiforov
- Department of Pathology and Laboratory Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Address correspondence to: Yuri E. Nikiforov, MD, PhD, Department of Pathology and Laboratory Medicine, School of Medicine, University of Pittsburgh, Clinical Lab Building, Room 8031, 3477 Euler Way, Pittsburgh, PA 15213
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