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Cook E, Van de Vijver K, Parra-Herran C. Diagnosis of verruciform acanthotic vulvar intra-epithelial neoplasia (vaVIN) using CK17, SOX2 and GATA3 immunohistochemistry. Histopathology 2024; 84:1212-1223. [PMID: 38356340 DOI: 10.1111/his.15156] [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: 12/27/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
AIMS Verruciform acanthotic vulvar intra-epithelial neoplasia (vaVIN) is an HPV-independent, p53 wild-type lesion with distinct morphology and documented risk of recurrence and cancer progression. vaVIN is rare, and prospective distinction from non-neoplastic hyperplastic lesions can be difficult. CK17, SOX2 and GATA3 immunohistochemistry has emerging value in the diagnosis of HPV-independent lesions, particularly differentiated VIN. We aimed to test the combined value of these markers in the diagnosis of vaVIN versus its non-neoplastic differentials in the vulva. METHODS AND RESULTS CK17, SOX2 and GATA3 immunohistochemistry was evaluated on 16 vaVINs and 34 mimickers (verruciform xanthoma, lichen simplex chronicus, lichen sclerosus, psoriasis, pseudo-epitheliomatous hyperplasia). CK17 was scored as 3+ = full-thickness, 2+ = partial-thickness, 1+ = patchy, 0 = absent; SOX2 as 3+ = strong staining ≥ 10% cells, 2+ = moderate, 1 + =weak, 0 = staining in < 10% cells; and GATA3 as pattern 0 = loss in < 25% basal cells, 1 = loss in 25-75% basal cells, 2 = loss in > 75% basal cells. For analysis, results were recorded as positive (CK17 = 3+, SOX2 = 3+, GATA3 = patterns 1/2) or negative (CK17 = 2+/1+/0, SOX2 = 2+/1+/0, GATA3 = pattern 0). CK17, SOX2 and GATA3 positivity was documented in 81, 75 and 58% vaVINs, respectively, versus 32, 17 and 22% of non-neoplastic mimickers, respectively; ≥ 2 marker positivity conferred 83 sensitivity, 88 specificity and 86% accuracy in vaVIN diagnosis. Compared to vaVIN, SOX2 and GATA3 were differentially expressed in lichen sclerosus, lichen simplex chronicus and pseudo-epitheliomatous hyperplasia, whereas CK17 was differentially expressed in verruciform xanthoma and adjacent normal mucosa. CONCLUSIONS CK17, SOX2 and GATA3 can be useful in the diagnosis of vaVIN and its distinction from hyperplastic non-neoplastic vulvar lesions. Although CK17 has higher sensitivity, SOX2 and GATA3 are more specific, and the combination of all markers shows optimal diagnostic accuracy.
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Affiliation(s)
- Eleanor Cook
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
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Cordier F, Van Roy N, Matthys B, De Paepe P, Van de Vijver K, Van Dorpe J, Creytens D. Fibroepithelial Stromal Polyp of the Vulvovaginal Region as Part of the RB1 Family of Tumors: Friend or Foe? Int J Gynecol Pathol 2024; 43:215-220. [PMID: 37922949 DOI: 10.1097/pgp.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Fibroepithelial stromal polyps (FSPs) are benign mesenchymal lesions occurring in the vulvovaginal region. Following the identification of loss of Retinoblastoma 1 (RB1) on immunohistochemical staining in routine practice, we stained a series of FSPs and performed additional fluorescence in situ hybridization (FISH) and copy number variation (CNV) sequencing to detect losses/deletions in the Retinoblastoma transcriptional corepressor 1 (RB1) gene. Fifteen FSP cases were stained for RB1, and subsequently, 9 cases were examined by FISH to detect a loss of RB1 (13q). Next, CNV sequencing was performed to assess genomic alterations. The mean age of the patients was 50 years. Loss of RB1 expression on immunohistochemistry was seen in 13 cases, and heterogeneous RB1 staining in the remaining 2 cases. FISH showed deletion of RB1 in all of the cases. CNV sequencing failed in almost all cases due to a low tumor content. Based on our findings, we hypothesize that FSPs are part of a spectrum of genetically related lesions, namely the 13q/RB1 family of tumors (which includes pleomorphic fibromas and spindle cell/pleomorphic lipomas). Due to the clinical, morphologic, and molecular overlap, we suggest that FSPs are pleomorphic fibromas occurring in the specialized stroma of the genital region.
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Fieuws C, Van der Meulen J, Proesmans K, De Jaeghere EA, Loontiens S, Van Dorpe J, Tummers P, Denys H, Van de Vijver K, Claes KBM. Identification of potentially actionable genetic variants in epithelial ovarian cancer: a retrospective cohort study. NPJ Precis Oncol 2024; 8:71. [PMID: 38519644 PMCID: PMC10959961 DOI: 10.1038/s41698-024-00565-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
Ovarian cancer is the most lethal gynecologic malignancy, mainly due to late-stage diagnosis, frequent recurrences, and eventually therapy resistance. To identify potentially actionable genetic variants, sequencing data of 351 Belgian ovarian cancer patients were retrospectively captured from electronic health records. The cohort included 286 (81%) patients with high-grade serous ovarian cancer, 17 (5%) with low-grade serous ovarian cancer, and 48 (14%) with other histotypes. Firstly, an overview of the prevalence and spectrum of the BRCA1/2 variants highlighted germline variants in 4% (11/250) and somatic variants in 11% (37/348) of patients. Secondly, application of a multi-gene panel in 168 tumors revealed a total of 214 variants in 28 genes beyond BRCA1/2 with a median of 1 (IQR, 1-2) genetic variant per patient. The ten most often altered genes were (in descending order): TP53, BRCA1, PIK3CA, BRCA2, KRAS, ERBB2 (HER2), TERT promotor, RB1, PIK3R1 and PTEN. Of note, the genetic landscape vastly differed between the studied histotypes. Finally, using ESCAT the clinical evidence of utility for every genetic variant was scored. Only BRCA1/2 pathogenic variants were classified as tier-I. Nearly all patients (151/168; 90%) had an ESCAT tier-II variant, most frequently in TP53 (74%), PIK3CA (9%) and KRAS (7%). In conclusion, our findings imply that although only a small proportion of genetic variants currently have direct impact on ovarian cancer treatment decisions, other variants could help to identify novel (personalized) treatment options to address the poor prognosis of ovarian cancer, particularly in rare histotypes.
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Affiliation(s)
- Charlotte Fieuws
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Joni Van der Meulen
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | | | - Emiel A De Jaeghere
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Siebe Loontiens
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Jo Van Dorpe
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Philippe Tummers
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Hannelore Denys
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Kathleen B M Claes
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium.
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.
- Cancer Research Institute Ghent, Ghent, Belgium.
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Bartosch C, Nadal A, Braga AC, Salerno A, Rougemont AL, Van Rompuy AS, Fitzgerald B, Joyce C, Allias F, Maher GJ, Turowski G, Tille JC, Alsibai KD, Van de Vijver K, McMahon L, Sunde L, Pyzlak M, Downey P, Wessman S, Patrier S, Kaur B, Fisher R. Practical guidelines of the EOTTD for pathological and genetic diagnosis of hydatidiform moles. Virchows Arch 2024; 484:401-422. [PMID: 37857997 DOI: 10.1007/s00428-023-03658-8] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
Hydatidiform moles are rare and thus most pathologists and geneticists have little experience with their diagnosis. It is important to promptly and correctly identify hydatidiform moles given that they are premalignant disorders associated with a risk of persistent gestational trophoblastic disease and gestational trophoblastic neoplasia. Improvement in diagnosis can be achieved with uniformization of diagnostic criteria and establishment of algorithms. To this aim, the Pathology and Genetics Working Party of the European Organisation for Treatment of Trophoblastic Diseases has developed guidelines that describe the pathological criteria and ancillary techniques that can be used in the differential diagnosis of hydatidiform moles. These guidelines are based on the best available evidence in the literature, professional experience and consensus of the experts' group involved in its development.
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Affiliation(s)
- Carla Bartosch
- Department of Pathology, Cancer Biology & Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC) and Centro Hospitalar Universitário S. João, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.
| | - Alfons Nadal
- Department of Pathology, Clínic Barcelona, Department of Basic Clinical Practice, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana C Braga
- Department of Pathology, University Hospital Centre of São João (CHUSJ) / Faculty of Medicine - University of Porto (FMUP) / School of Health (ESS) - Polytechnic Institute of Porto (P. PORTO), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Angela Salerno
- Anatomia Patologica, Ospedale Maggiore AUSL Bologna, Bologna, Italy
| | | | | | | | - Caroline Joyce
- Department of Clinical Biochemistry, Cork University Hospital, Ireland/ Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
| | - Fabienne Allias
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Geoffrey J Maher
- Trophoblastic Tumour Screening & Treatment Centre, Imperial College NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Gitta Turowski
- Department of Pathology, Oslo University Hospital, INNPATH Tirolkliniken, Innsbruck, Austria
| | | | - Kinan Drak Alsibai
- Department of Pathology and Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center Andrée Rosemon, 97306, Cayenne, France
| | | | - Lesley McMahon
- Scottish Hydatidiform Mole Follow-Up Service, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Lone Sunde
- Department of Clinical Genetics, Aalborg University Hospital, Denmark/Department of Biomedicine, Aarhus University, Aalborg, Aarhus, Denmark
| | - Michal Pyzlak
- Department of Pathology, Institute of Mother and Child, Warsaw, Poland
| | - Paul Downey
- Department of Pathology, National Maternity Hospital, Dublin, D02YH21, Ireland
| | - Sandra Wessman
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Baljeet Kaur
- Department of Pathology, North West London Pathology, Imperial College NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Rosemary Fisher
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital. Fulham Palace Road, London, W6 8RF, UK
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Bartosch C, Nadal A, Braga AC, Salerno A, Rougemont AL, Van Rompuy AS, Fitzgerald B, Joyce C, Allias F, Maher GJ, Turowski G, Tille JC, Alsibai KD, Van de Vijver K, McMahon L, Sunde L, Pyzlak M, Downey P, Wessman S, Patrier S, Kaur B, Fisher R. Correction to: Practical guidelines of the EOTTD for pathological and genetic diagnosis of hydatidiform moles. Virchows Arch 2024; 484:539-548. [PMID: 38421406 DOI: 10.1007/s00428-023-03715-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Carla Bartosch
- Department of Pathology, Cancer Biology & Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@ CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC) and Centro HospitalarUniversitário S. João, Rua Dr. António Bernardino de Almeida, 4200‑072, Porto, Portugal.
| | - Alfons Nadal
- Department of Pathology, Clínic Barcelona, Department of Basic Clinical Practice, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana C Braga
- Department of Pathology, University Hospital Centre of São João (CHUSJ) / Faculty of Medicine - University of Porto (FMUP) / School of Health (ESS) - Polytechnic Institute of Porto (P. PORTO), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Angela Salerno
- Anatomia Patologica, Ospedale Maggiore AUSL Bologna, Bologna, Italy
| | | | | | | | - Caroline Joyce
- Department of Clinical Biochemistry, Cork University Hospital, Ireland/ Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
| | - Fabienne Allias
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Geoffrey J Maher
- Trophoblastic Tumour Screening & Treatment Centre, Imperial College NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Gitta Turowski
- Department of Pathology, Oslo University Hospital, INNPATH Tirolkliniken, Innsbruck, Austria
| | | | - Kinan Drak Alsibai
- Department of Pathology and Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center Andrée Rosemon, 97306, Cayenne, France
| | | | - Lesley McMahon
- Scottish Hydatidiform Mole Follow‑Up Service, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Lone Sunde
- Department of Clinical Genetics, Aalborg University Hospital, Denmark/Department of Biomedicine, Aarhus University, Aalborg, Aarhus, Denmark
| | - Michal Pyzlak
- Department of Pathology, Institute of Mother and Child, Warsaw, Poland
| | - Paul Downey
- Department of Pathology, National Maternity Hospital, Dublin, D02YH21, Ireland
| | - Sandra Wessman
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Baljeet Kaur
- Department of Pathology, North West London Pathology, Imperial College NHS Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Rosemary Fisher
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
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Vermorgen S, Gelton T, Bult P, Kusters-Vandevelde HVN, Hausnerová J, Van de Vijver K, Davidson B, Stefansson IM, Kooreman LFS, Qerimi A, Huvila J, Gilks B, Shahi M, Zomer S, Bartosch C, Pijnenborg JMA, Bulten J, Ciompi F, Simons M. Endometrial Pipelle Biopsy Computer-Aided Diagnosis: A Feasibility Study. Mod Pathol 2024; 37:100417. [PMID: 38154654 DOI: 10.1016/j.modpat.2023.100417] [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] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
Endometrial biopsies are important in the diagnostic workup of women who present with abnormal uterine bleeding or hereditary risk of endometrial cancer. In general, approximately 10% of all endometrial biopsies demonstrate endometrial (pre)malignancy that requires specific treatment. As the diagnostic evaluation of mostly benign cases results in a substantial workload for pathologists, artificial intelligence (AI)-assisted preselection of biopsies could optimize the workflow. This study aimed to assess the feasibility of AI-assisted diagnosis for endometrial biopsies (endometrial Pipelle biopsy computer-aided diagnosis), trained on daily-practice whole-slide images instead of highly selected images. Endometrial biopsies were classified into 6 clinically relevant categories defined as follows: nonrepresentative, normal, nonneoplastic, hyperplasia without atypia, hyperplasia with atypia, and malignant. The agreement among 15 pathologists, within these classifications, was evaluated in 91 endometrial biopsies. Next, an algorithm (trained on a total of 2819 endometrial biopsies) rated the same 91 cases, and we compared its performance using the pathologist's classification as the reference standard. The interrater reliability among pathologists was moderate with a mean Cohen's kappa of 0.51, whereas for a binary classification into benign vs (pre)malignant, the agreement was substantial with a mean Cohen's kappa of 0.66. The AI algorithm performed slightly worse for the 6 categories with a moderate Cohen's kappa of 0.43 but was comparable for the binary classification with a substantial Cohen's kappa of 0.65. AI-assisted diagnosis of endometrial biopsies was demonstrated to be feasible in discriminating between benign and (pre)malignant endometrial tissues, even when trained on unselected cases. Endometrial premalignancies remain challenging for both pathologists and AI algorithms. Future steps to improve reliability of the diagnosis are needed to achieve a more refined AI-assisted diagnostic solution for endometrial biopsies that covers both premalignant and malignant diagnoses.
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Affiliation(s)
- Sanne Vermorgen
- Department of Pathology, Radboudumc, Nijmegen, the Netherlands
| | - Thijs Gelton
- Department of Pathology, Radboudumc, Nijmegen, the Netherlands
| | - Peter Bult
- Department of Pathology, Radboudumc, Nijmegen, the Netherlands
| | | | - Jitka Hausnerová
- Department of Pathology, University Hospital Brno, Brno, Czech Republic
| | | | - Ben Davidson
- Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Ingunn Marie Stefansson
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway; Department of Pathology, Haukeland University Hospital Bergen, Bergen, Norway
| | - Loes F S Kooreman
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Adelina Qerimi
- Department of Pathology, ViraTherapeutics GmbH, Innsbruck, Austria
| | - Jutta Huvila
- Department of Pathology, University of Turku, Turku University Hospital, Turku, Finland
| | - Blake Gilks
- Department of Pathology, University of British Columbia, Vancouver, Canada
| | - Maryam Shahi
- Department of Pathology, Mayo Clinic, Rochester, Minnesota
| | - Saskia Zomer
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute Lisbon, Lisbon, Portugal
| | | | - Johan Bulten
- Department of Pathology, Radboudumc, Nijmegen, the Netherlands
| | | | - Michiel Simons
- Department of Pathology, Radboudumc, Nijmegen, the Netherlands.
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Cordier F, Ferdinande L, Hoorens A, Van de Vijver K, Van Dorpe J, Creytens D. Soft Tissue and Bone Tumor Diagnostics: Harnessing the Power of Molecular Techniques. Genes (Basel) 2023; 14:2229. [PMID: 38137051 PMCID: PMC10742688 DOI: 10.3390/genes14122229] [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] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Since the introduction of new molecular techniques, the diagnostic landscape of soft tissue and bone tumors has expanded greatly over the past few years. The use of new molecular techniques has led to the identification of new genetic alterations and, therefore, to a better understanding of tumorigenesis, tumor detection and classification. Furthermore, methylation profiling has emerged as a classification tool for soft tissue and bone tumors. Molecular pathology also plays an important role in the determination of patient prognosis and in the identification of targets that can be used for targeted therapy. As a result, molecular pathology has gained a more prominent role in the daily practice of the surgical pathologist. This review delves into various molecular techniques applied in the surgical pathology of soft tissue and bone tumors. It highlights their applications through the analysis of five specific cases.
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Affiliation(s)
- Fleur Cordier
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; (F.C.); (L.F.); (A.H.); (K.V.d.V.); (J.V.D.)
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Liesbeth Ferdinande
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; (F.C.); (L.F.); (A.H.); (K.V.d.V.); (J.V.D.)
| | - Anne Hoorens
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; (F.C.); (L.F.); (A.H.); (K.V.d.V.); (J.V.D.)
| | - Koen Van de Vijver
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; (F.C.); (L.F.); (A.H.); (K.V.d.V.); (J.V.D.)
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; (F.C.); (L.F.); (A.H.); (K.V.d.V.); (J.V.D.)
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; (F.C.); (L.F.); (A.H.); (K.V.d.V.); (J.V.D.)
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
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Göker M, Denys H, Hendrix A, De Wever O, Van de Vijver K, Braems G. Histologic tumor type as a determinant of survival in hormone receptor-positive, HER2-negative, pT1-3 invasive ductal and lobular breast cancer. Breast Cancer Res 2023; 25:146. [PMID: 37993928 PMCID: PMC10664297 DOI: 10.1186/s13058-023-01745-x] [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] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/12/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE The aim of the study was to compare the difference in survival between invasive ductal (IDC) and lobular carcinoma (ILC). METHODS Data of patients (n = 1843) with a hormone receptor-positive, HER2-negative, pT1-3 IDC or ILC cancer without distant metastasis, treated at the Ghent University Hospital over the time period 2001-2015, were analyzed. RESULTS ILC represented 13.9% of the tumors, had a higher percentage of pT3 and pN3 stages than IDC, lymphovascular space invasion (LVSI) was less present and Ki-67 was mostly low. 73.9% of ILCs were grade 2, whereas IDC had more grade 1 and grade 3 tumors. Kaplan-Meier curves and log-rank testing showed a significant worse DFS for ILC with pN ≥ 1 than for their IDC counterpart. In a multivariable Cox regression analysis the histologic tumor type, ductal or lobular, was a determinant of DFS over 120 months (IDC as reference; hazard ratio for ILC 1.77, 95% CI 1.08-2.90) just as the ER Allred score (hazard ratio 0.84, 95% CI 0.78-0.91), LVSI (hazard ratio 1.75, 95% CI 1.12-2.74) and pN3 (hazard ratio 2.29, 95% CI 1.03-5.09). Determinants of OS over ten years were age (hazard ratio 1.05, 95% CI 1.02-1.07), LVSI (hazard ratio 3.62, 95% CI 1.92-6.82) and the ER Allred score (hazard ratio 0.80, 95% CI 0.73-0.89). CONCLUSION The histologic tumor type, ductal or lobular, determines DFS in hormone receptor-positive, HER2-negative, pT1-3 breast cancer besides the ER Allred score, LVSI and pN3.
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Affiliation(s)
- Menekse Göker
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium.
| | - Hannelore Denys
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - An Hendrix
- Laboratory for Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Olivier De Wever
- Laboratory for Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Geert Braems
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
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van Wagensveld L, Walker C, Hahn K, Sanders J, Kruitwagen R, van der Aa M, Sonke G, Rottenberg S, de Vijver KV, Janowczyk A, Horlings H. The prognostic value of tumor-stroma ratio and a newly developed computer-aided quantitative analysis of routine H&E slides in high-grade serous ovarian cancer. Res Sq 2023:rs.3.rs-3511087. [PMID: 38014112 PMCID: PMC10680933 DOI: 10.21203/rs.3.rs-3511087/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Tumor-stroma ratio (TSR) is prognostic in multiple cancers, while its role in high-grade serous ovarian cancer (HGSOC) remains unclear. Despite the prognostic insight gained from genetic profiles and tumor-infiltrating lymphocytes (TILs), the prognostic use of histology slides remains limited, while it enables the identification of tumor characteristics via computational pathology reducing scoring time and costs. To address this, this study aimed to assess TSR's prognostic role in HGSOC and its association with TILs. We additionally developed an algorithm, Ovarian-TSR (OTSR), using deep learning for TSR scoring, comparing it to manual scoring. Methods : 340 patients with advanced-stage who underwent primary debulking surgery (PDS) or neo-adjuvant chemotherapy (NACT) with interval debulking (IDS). TSR was assessed in both the most invasive (MI) and whole tumor (WT) regions through manual scoring by pathologists and quantification using OTSR. Patients were categorized as stroma-rich (≥ 50% stroma) or stroma-poor (< 50%). TILs were evaluated via immunohistochemical staining. Result s: In PDS, stroma-rich tumors were significantly associated with a more frequent papillary growth pattern (60% vs 34%), while In NACT stroma-rich tumors had a lower Tumor Regression Grading (TRG 4&5, 21% vs 57%) and increased pleural metastasis (25% vs 16%). Stroma-rich patients had significantly shorter overall and progression-free survival compared to stroma-poor (31 versus 45 months; P < 0.0001, and 15 versus 17 months; P = 0.0008, respectively). Combining stromal percentage and TILs led to three distinct survival groups with good (stroma-poor, high TIL), medium (stroma-rich, high TIL, or; stroma-poor, Low TIL), and poor(stroma-rich, low TIL) survival. These survival groups remained significant in CD8 and CD103 in multivariable analysis (Hazard ratio (HR) = 1.42, 95% Confidence-interval (CI) = 1.02-1.99; HR = 1.49, 95% CI = 1.01-2.18, and HR = 1.48, 95% CI = 1.05-2.08; HR = 2.24, 95% CI = 1.55-3.23, respectively). OTSR was able to recapitulate these results and demonstrated high concordance with expert pathologists (correlation = 0.83). Conclusions : TSR is an independent prognostic factor for survival assessment in HGSOC. Stroma-rich tumors have a worse prognosis and, in the case of NACT, a higher likelihood of pleural metastasis. OTSR provides a cost and time-efficient way of determining TSR with high reproducibility and reduced inter-observer variability.
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10
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De Vlieghere E, Van de Vijver K, Blondeel E, Carpentier N, Ghobeira R, Pauwels J, Riemann S, Minsart M, Fieuws C, Mestach J, Baeyens A, De Geyter N, Debbaut C, Denys H, Descamps B, Claes K, Vral A, Van Dorpe J, Gevaert K, De Geest BG, Ceelen W, Van Vlierberghe S, De Wever O. A preclinical platform for assessing long-term drug efficacy exploiting mechanically tunable scaffolds colonized by a three-dimensional tumor microenvironment. Biomater Res 2023; 27:104. [PMID: 37853495 PMCID: PMC10583378 DOI: 10.1186/s40824-023-00441-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Long-term drug evaluation heavily relies upon rodent models. Drug discovery methods to reduce animal models in oncology may include three-dimensional (3D) cellular systems that take into account tumor microenvironment (TME) cell types and biomechanical properties. METHODS In this study we reconstructed a 3D tumor using an elastic polymer (acrylate-endcapped urethane-based poly(ethylene glycol) (AUPPEG)) with clinical relevant stiffness. Single cell suspensions from low-grade serous ovarian cancer (LGSOC) patient-derived early passage cultures of cancer cells and cancer-associated fibroblasts (CAF) embedded in a collagen gel were introduced to the AUPPEG scaffold. After self-organization in to a 3D tumor, this model was evaluated by a long-term (> 40 days) exposure to a drug combination of MEK and HSP90 inhibitors. The drug-response results from this long-term in vitro model are compared with drug responses in an orthotopic LGSOC xenograft mouse model. RESULTS The in vitro 3D scaffold LGSOC model mimics the growth ratio and spatial organization of the LGSOC. The AUPPEG scaffold approach allows to test new targeted treatments and monitor long-term drug responses. The results correlate with those of the orthotopic LGSOC xenograft mouse model. CONCLUSIONS The mechanically-tunable scaffolds colonized by a three-dimensional LGSOC allow long-term drug evaluation and can be considered as a valid alternative to reduce, replace and refine animal models in drug discovery.
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Affiliation(s)
- Elly De Vlieghere
- Department of Human Structure and Repair, Laboratory of Experimental Cancer Research, Ghent University, Ghent, Belgium
- Polymer Chemistry and Biomaterials Group, Centre of Macromolecular Chemistry, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University Hospital, Ghent, Belgium
| | - Eva Blondeel
- Department of Human Structure and Repair, Laboratory of Experimental Cancer Research, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Nathan Carpentier
- Polymer Chemistry and Biomaterials Group, Centre of Macromolecular Chemistry, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Rouba Ghobeira
- Department of Applied Physics, Research Unit Plasma Technology (RUPT), Ghent University, Ghent, Belgium
| | - Jarne Pauwels
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, VIB Center for Medical Biotechnology, Ghent University, Ghent, Belgium
| | - Sebastian Riemann
- Department of Human Structure and Repair, Laboratory of Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Manon Minsart
- Polymer Chemistry and Biomaterials Group, Centre of Macromolecular Chemistry, Ghent University, Ghent, Belgium
| | - Charlotte Fieuws
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - Johanna Mestach
- Department of Human Structure and Repair, Laboratory of Experimental Cancer Research, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Ans Baeyens
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Radiobiology Group, Ghent University, Ghent, Belgium
| | - Nathalie De Geyter
- Department of Applied Physics, Research Unit Plasma Technology (RUPT), Ghent University, Ghent, Belgium
| | - Charlotte Debbaut
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Electronics and Information Systems, IBiTech-Biommeda, Ghent University, Ghent, Belgium
| | - Hannelore Denys
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Benedicte Descamps
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Electronics and Information Systems, IbiTech-Medisip, Ghent University, Ghent, Belgium
| | - Kathleen Claes
- Department of Biomolecular Medicine, Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - Anne Vral
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Radiobiology Group, Ghent University, Ghent, Belgium
| | - Jo Van Dorpe
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University Hospital, Ghent, Belgium
| | - Kris Gevaert
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, VIB Center for Medical Biotechnology, Ghent University, Ghent, Belgium
| | - Bruno G De Geest
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Pharmaceutics, Ghent University, Ghent, Belgium
| | - Wim Ceelen
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Experimental Surgery Lab, Ghent University, Ghent, Belgium
| | - Sandra Van Vlierberghe
- Polymer Chemistry and Biomaterials Group, Centre of Macromolecular Chemistry, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Olivier De Wever
- Department of Human Structure and Repair, Laboratory of Experimental Cancer Research, Ghent University, Ghent, Belgium.
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium.
- Department of Pharmaceutics, Ghent University, Ghent, Belgium.
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11
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Debacker JM, Maris L, Cordier F, Creytens D, Deron P, Descamps B, D'Asseler Y, De Man K, Keereman V, Libbrecht S, Schelfhout V, Van de Vijver K, Vanhove C, Huvenne W. Direct co-registration of [ 18F]FDG uptake and histopathology in surgically excised malignancies of the head and neck: a feasibility study. Eur J Nucl Med Mol Imaging 2023; 50:2127-2139. [PMID: 36854863 DOI: 10.1007/s00259-023-06153-z] [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] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Recent technical advancements in PET imaging have improved sensitivity and spatial resolution. Consequently, clinical nuclear medicine will be confronted with PET images on a previously unfamiliar resolution. To better understand [18F]FDG distribution at submillimetric scale, a direct correlation of radionuclide-imaging and histopathology is required. METHODS A total of five patients diagnosed with a malignancy of the head and neck were injected with a clinical activity of [18F]FDG before undergoing surgical resection. The resected specimen was imaged using a preclinical high-resolution PET/CT, followed by slicing of the specimen. Multiple slices were rescanned using a micro-PET/CT device, and one of the slices was snap-frozen for frozen sections. Frozen sections were placed on an autoradiographic film, followed by haematoxylin and eosin staining to prepare them for histopathological assessment. The results from both autoradiography and histopathology were co-registered using an iterative co-registration algorithm, and regions of interest were identified to study radiotracer uptake. RESULTS The co-registration between the autoradiographs and their corresponding histopathology was successful in all specimens. The use of this novel methodology allowed direct comparison of autoradiography and histopathology and enabled the visualisation of uncharted heterogeneity in [18F]FDG uptake in both benign and malignant tissue. CONCLUSION We here describe a novel methodology enabling the direct co-registration of [18F]FDG autoradiography with the gold standard of histopathology in human malignant tissue. The future use of the current methodology could further increase our understanding of the distribution of radionuclides in surgically excised malignancies and hence, improve the integration of pathology and molecular imaging in a multiscale perspective. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05068687.
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Affiliation(s)
- Jens M Debacker
- Department of Head and Skin, Ghent University, Ghent, Belgium.
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium.
- Department of Nuclear Medicine, UZ Brussel, Brussels, Belgium.
- In vivo Cellular and Molecular Imaging Laboratory (ICMI), Vrije Universiteit Brussel, Brussels, Belgium.
- Cancer Research Institute Ghent, Ghent, Belgium.
| | - Luna Maris
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
- XEOS Medical, Ghent, Belgium
| | - Fleur Cordier
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - David Creytens
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Philippe Deron
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Benedicte Descamps
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
- INFINITY Lab, Ghent University, Ghent, Belgium
| | - Yves D'Asseler
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Medical Imaging, Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Kathia De Man
- Department of Medical Imaging, Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Vincent Keereman
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
- XEOS Medical, Ghent, Belgium
| | - Sasha Libbrecht
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Vanessa Schelfhout
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Medical Imaging, Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Christian Vanhove
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
- INFINITY Lab, Ghent University, Ghent, Belgium
| | - Wouter Huvenne
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
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12
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Göker M, Deblaere S, Denys H, Vergauwen G, Naert E, Veldeman L, Monten C, Van den Broecke R, Van Dorpe J, Braems G, Van de Vijver K. Tumor-Infiltrating Lymphocytes and PD-L1 Expression in Pleomorphic Lobular Breast Carcinoma. Cancers (Basel) 2023; 15:cancers15112894. [PMID: 37296857 DOI: 10.3390/cancers15112894] [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: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The prognostic and predictive role of stromal tumor-infiltrating lymphocytes (sTILs) is undetermined in pleomorphic invasive lobular cancer (pILC). The same applies for the expression of PD-1/PD-L1 in this rare breast cancer subtype. Here, we aimed to investigate the expression of sTILs and analyze the PD-L1 expression levels in pILC. METHODS Archival tissues from sixty-six patients with pILC were collected. The sTIL density was scored as a percentage of tumor area using the following cut-offs: 0%; <5%; 5-9%; and 10-50%. The PD-L1 expression was analyzed using IHC on formalin-fixed, paraffin-embedded tissue sections using SP142 and 22C3 antibodies. RESULTS A total of 82% of the sixty-six patients were hormone receptor positive and 8% of cases were triple negative (TN), while 10% showed human epidermal growth factor receptor 2 (HER2) amplification. sTILs (≥1%) were present in 64% of the study population. Using the SP142 antibody, 36% of tumors demonstrated a positive PD-L1 score of ≥1%, and using the 22C3 antibody, 28% had a positive PD-L1 score of ≥1. There was no correlation between sTILs or PD-L1 expression and tumor size, tumor grade, nodal status, expression of estrogen receptor (ER), or amplification of HER2. Our data did not show any difference in survival between the three molecular subtypes of pILC with respect to sTILs and PD-L1 expression. CONCLUSION This study shows that pILCs show some degree of sTILs and PD-L1 expression; however, this was not associated with a survival improvement. Additional large trials are needed to understand immune infiltration in lobular cancer, especially in the pleomorphic subtype.
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Affiliation(s)
- Menekse Göker
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
| | - Stephanie Deblaere
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Hannelore Denys
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Glenn Vergauwen
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
| | - Eline Naert
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Liv Veldeman
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium
| | - Chris Monten
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Jo Van Dorpe
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Geert Braems
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
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13
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Vergauwen G, Cools P, Denys H, Fiers T, Van de Vijver K, Veldeman L, Verstraelen H. GRACE-trial: a randomised active-controlled trial for vulvovaginal atrophy in patients with breast cancer on endocrine therapy - study protocol. BMJ Open 2023; 13:e068053. [PMID: 37041060 PMCID: PMC10106022 DOI: 10.1136/bmjopen-2022-068053] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/27/2023] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Breast cancer is the most common cancer type in women worldwide. Due to hormone receptor positivity in the majority of the breast cancer tumours is endocrine therapy a crucial part in the treatment landscape of breast cancer. Endocrine therapy consists of the use of selective oestrogen-receptor modulators or aromatase inhibitors. These medicines generate a hypoestrogenic environment by reducing circulating oestrogen or by altering the effect of oestrogen on tissue cells by receptor blockade. As a common side effect, vulvovaginal atrophy occurs in the majority of patients with breast cancer using endocrine therapy. Vulvovaginal atrophy has a significant impact on physical and psychological well-being due to negative influence on quality-of-life, self-esteem and sexuality. As a consequence, adherence to endocrine therapy for the standard duration of 5-10 years is challenging, resulting in higher rates of therapy interruption, leading to poorer prognosis with shorter distant disease-free survival. The standard treatment for vulvovaginal atrophy in postmenopausal women is based on the use of local hormonal treatment. However, when a patient has a history of breast cancer, delay of treatment and undertreatment are ubiquitous. METHODS AND ANALYSIS In this first ever prospective randomised trial patients with breast cancer on endocrine therapy with vulvovaginal atrophy will be treated with the available local treatment modalities with a 1:1:1:1 randomisation: oestrogen, dehydroepiandrosterone, moisturisers and a co-treatment of oestrogen and probiotics. Patient-reported outcomes measurements will be implemented to investigate the efficacy of the implemented treatments. Safety of the treatments will be evaluated by assessing systemic sex hormones concentrations. ETHICS AND DISSEMINATION This study was approved by the Ethical Committee of Ghent University Hospital and by the Federal Agency for Medicines and Health Products. Results will be published in peer-reviewed journals and released in international conferences. TRIAL REGISTRATION NUMBER 2021-001921-31.
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Affiliation(s)
- Glenn Vergauwen
- Cancer Research Institute Ghent, Ghent University, Gent, Belgium
- Department of Obstetrics - Gynaecology, University Hospital Ghent, Gent, Belgium
| | - Piet Cools
- Department of Diagnostic Sciences, Ghent University, Gent, Belgium
| | - Hannelore Denys
- Cancer Research Institute Ghent, Ghent University, Gent, Belgium
- Department of Medical Oncology, University Hospital Ghent, Gent, Belgium
| | - Tom Fiers
- Department of Medical Microbiology, University Hospital Ghent, Gent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent, Ghent University, Gent, Belgium
- Department of Pathology, University Hospital Ghent, Gent, Belgium
| | - Liv Veldeman
- Cancer Research Institute Ghent, Ghent University, Gent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Gent, Belgium
| | - Hans Verstraelen
- Department of Obstetrics - Gynaecology, University Hospital Ghent, Gent, Belgium
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Cordier F, Van der Meulen J, Loontiens S, Van Roy N, Lapeire L, Willaert W, Ferdinande L, Van de Vijver K, Van Dorpe J, Creytens D. High-grade endometrial stromal sarcoma-like' sarcoma in male: Does it exist? A case report and review of the literature. Pathol Res Pract 2023; 241:154228. [PMID: 36455366 DOI: 10.1016/j.prp.2022.154228] [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] [Received: 09/04/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
We report an exceptional case of an undifferentiated round and spindle cell sarcoma, occurring in the periprostatic region of a 54-year-old male, with a 'high-grade endometrial stromal sarcoma-like' (HG-ESS) morphology and harboring a ZC3H7B::BCOR gene fusion identified by RNA-based next-generation sequencing. In this report, we describe the striking overlap of morphologic, immunohistochemical and molecular features of this current case and previously reported similar cases with ZC3H7B::BCOR fusion-positive HG-ESS, and discuss the differential diagnosis and possible pathogenesis of this unusual entity.
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Affiliation(s)
- Fleur Cordier
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Joni Van der Meulen
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Siebe Loontiens
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Nadine Van Roy
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Lore Lapeire
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Wouter Willaert
- CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of GI Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Liesbeth Ferdinande
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Koen Van de Vijver
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium.
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15
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Ordulu Z, Mino-Kenudson M, Young RH, Van de Vijver K, Zannoni GF, Félix A, Burandt E, Wong A, Nardi V, Oliva E. Morphologic and Molecular Heterogeneity of Cervical Neuroendocrine Neoplasia: A Report of 14 Cases. Am J Surg Pathol 2022; 46:1670-1681. [PMID: 36069807 DOI: 10.1097/pas.0000000000001943] [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: 12/24/2022]
Abstract
Neuroendocrine neoplasms (NENs) of the cervix are rare aggressive tumors associated with poor prognosis and only limited treatment options. Although there is some literature on molecular underpinnings of cervical small cell neuroendocrine carcinomas (SCNECs), detailed morphologic and associated molecular characteristics of cervical NENs remains to be elucidated. Herein, 14 NENs (SCNEC: 6, large cell neuroendocrine carcinoma [LCNEC]: 6, neuroendocrine tumor [NET]: 2), including 5 admixed with human papillomavirus (HPV)-associated adenocarcinoma (carcinoma admixed with neuroendocrine carcinoma) were analyzed. All except 3 SCNECs were HPV16/18 positive. TP53 (3) and/or RB1 (4) alterations (3 concurrent) were only seen in SCNECs (4/6) and were enriched in the HPV16/18-negative tumors. The other most common molecular changes in neuroendocrine carcinomas (NECs) overlapping with those reported in the literature for cervical carcinomas involved PI3K/MAPK pathway (4) and MYC (4) and were seen in both SCNECs and LCNECs. In contrast, the 2 NETs lacked any significant alterations. Two LCNECs admixed with adenocarcinoma had enough material to sequence separately each component. In both pathogenic alterations were shared between the 2 components, including ERBB2 amplification in one and an MSH6 mutation with MYC amplification in the other. Overall, these findings suggest that cervical HPV-associated NETs are genomically silent and high-grade NECs (regardless of small or large cell morphology) share molecular pathways with common cervical carcinomas as it has been reported in the endometrium and are different from NECs at other sites. Molecular analysis of these highly malignant neoplasms might inform the clinical management for potential therapeutic targets.
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Affiliation(s)
- Zehra Ordulu
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Robert H Young
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Koen Van de Vijver
- Department of Pathology, Ghent University Hospital and Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Gynecologic Oncology, Center for Gynecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gian Franco Zannoni
- Department of Pathology, Catholic University of the Sacred Hearth, Roma, Italy
| | - Ana Félix
- Department of Pathology, Nova Medical School and University of Lisbon, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisbon, Portugal
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adele Wong
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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16
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Loret N, Vandamme N, De Coninck J, Taminau J, De Clercq K, Blancke G, Jonckheere S, Goossens S, Lemeire K, De Prijck S, Verstaen K, Seurinck R, Van Dorpe J, Weyers S, Denys H, Van de Vijver K, Lambrecht BN, Tummers P, Saeys Y, Berx G. Distinct transcriptional programs in ascitic and solid cancer cells induce different responses to chemotherapy in high-grade serous ovarian cancer. Mol Cancer Res 2022; 20:1532-1547. [PMID: 35749080 DOI: 10.1158/1541-7786.mcr-21-0565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 04/09/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
Abstract
High-grade serous ovarian cancer (HGSOC) is responsible for the largest number of ovarian cancer deaths. The frequent therapy resistant relapses necessitate a better understanding of mechanisms driving therapy resistance. Therefore, we mapped more than hundred thousand cells of HGSOC patients in different phases of the disease, using single-cell RNA sequencing. Within patients, we compared chemonaive with chemotreated samples. As such, we were able to create a single-cell atlas of different HGSOC lesions and their treatment. This revealed a high intra-patient concordance between spatially distinct metastases. In addition, we found remarkable baseline differences in transcriptomics of ascitic and solid cancer cells, resulting in a different response to chemotherapy. Moreover, we discovered different robust subtypes of cancer-associated fibroblasts (CAFs) in all patients. Besides inflammatory CAFs (iCAFs), vascular CAFs (vCAFs) and matrix CAFs (mCAFs), we identified a new CAF subtype that was characterized by high expression of STAR, TSPAN8 and ALDH1A1 and clearly enriched after chemotherapy. Together, tumor heterogeneity in both cancer and stromal cells contributes to therapy resistance in HGSOC and could form the basis of novel therapeutic strategies that differentiate between ascitic and solid disease. Implications: The newly characterized differences between ascitic and solid cancer cells before and after chemotherapy could inform novel treatment strategies for metastatic HGSOC.
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Affiliation(s)
- Nele Loret
- CRIG and Ghent University, Ghent, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Geert Berx
- CRIG and Ghent University, Ghent, Belgium
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17
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Vakaet V, Van Hulle H, Van de Vijver K, Hilderson I, Naert E, De Neve W, Vandorpe J, Hendrix A, Göker M, Depypere H, Vergauwen G, Van den Broecke R, De Visschere P, Braems G, Vandecasteele K, Denys H, Veldeman L. Safety of pre- or postoperative accelerated radiotherapy in 5 fractions: A randomized pilot trial. Breast 2022; 62:10-15. [PMID: 35091184 PMCID: PMC8800131 DOI: 10.1016/j.breast.2022.01.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Neo-adjuvant radiotherapy (NART) for breast cancer has shown promising survival results in retrospective trials. However, there are some obstacles such as a chemotherapy delay, an increased overall treatment time (OTT) and the risk of increasing surgical morbidity. Accelerated radiotherapy (RT) in 5 fractions allows to deliver NART in a very short time span and minimizes the delay of surgery and chemotherapy. This trial investigates this NART schedule for safety, feasibility and OTT. MATERIAL AND METHODS Twenty patients eligible for neo-adjuvant chemotherapy (NACT) and breast conserving surgery, were randomized between NART before NACT or NACT and postoperative RT. In both arms, RT treatment was given in 5 fractions to the whole breast with a simultaneously integrated boost (SIB) on the tumor(bed). Lymph node irradiation was given concomitantly in case of lymph node involvement. OTT was defined as the time from diagnosis to last surgery in the intervention group, while in the control group the time between diagnosis and last RT-fraction was used. In the intervention group NACT-delay was defined as time between diagnosis and start of chemotherapy. RESULTS 20 patients were included, and 19 patients completed treatment. OTT was significantly shorter in the intervention group (mean 218 days, range 196-253) compared to the control group (mean 237, range 211-268, p = 0.001). The difference in mean duration from diagnosis to the first treatment was a non-significant 4 days longer (31 vs 27 days, p = 0.28), but the start of NACT after diagnosis was delayed by 21 days (48 vs 27 days, p < 0.001). NART did not result in additional surgery complications. CONCLUSION This pilot trial is the first to report on accelerated NART in 5 fractions with SIB. NART before NACT resulted in a shorter OTT with good safety results.
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Affiliation(s)
- Vincent Vakaet
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Radiation Oncology, Ghent University Hospital, Belgium.
| | - Hans Van Hulle
- Dept. of Human Structure and Repair, Ghent University, Belgium.
| | - Koen Van de Vijver
- Dept. of Pathology, Ghent University Hospital, Belgium; Dept. of Diagnostic Sciences, Ghent University, Belgium.
| | | | - Eline Naert
- Dept. of Medical Oncology, Ghent University Hospital, Belgium; Dept. of Internal Medicine and Pediatrics, Ghent University, Belgium.
| | | | - Jo Vandorpe
- Dept. of Pathology, Ghent University Hospital, Belgium; Dept. of Diagnostic Sciences, Ghent University, Belgium.
| | - An Hendrix
- Dept. of Human Structure and Repair, Ghent University, Belgium.
| | - Menekse Göker
- Dept. of Gynaecology, Ghent University Hospital, Belgium.
| | - Herman Depypere
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Gynaecology, Ghent University Hospital, Belgium.
| | | | - Rudy Van den Broecke
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Gynaecology, Ghent University Hospital, Belgium.
| | - Pieter De Visschere
- Dept. of Diagnostic Sciences, Ghent University, Belgium; Dept. of Radiology and Nuclear Medicine, Ghent University Hospital, Belgium.
| | - Geert Braems
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Gynaecology, Ghent University Hospital, Belgium.
| | - Katrien Vandecasteele
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Radiation Oncology, Ghent University Hospital, Belgium.
| | - Hannelore Denys
- Dept. of Medical Oncology, Ghent University Hospital, Belgium; Dept. of Internal Medicine and Pediatrics, Ghent University, Belgium.
| | - Liv Veldeman
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Radiation Oncology, Ghent University Hospital, Belgium.
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18
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Christgen M, Kandt LD, Antonopoulos W, Bartels S, Van Bockstal MR, Bredt M, Brito MJ, Christgen H, Colpaert C, Cserni B, Cserni G, Daemmrich ME, Danebrock R, Dedeurwaerdere F, van Deurzen CH, Erber R, Fathke C, Feist H, Fiche M, Gonzalez CA, Ter Hoeve ND, Kooreman L, Krech T, Kristiansen G, Kulka J, Laenger F, Lafos M, Lehmann U, Martin-Martinez MD, Mueller S, Pelz E, Raap M, Ravarino A, Reineke-Plaass T, Schaumann N, Schelfhout AM, De Schepper M, Schlue J, Van de Vijver K, Waelput W, Wellmann A, Graeser M, Gluz O, Kuemmel S, Nitz U, Harbeck N, Desmedt C, Floris G, Derksen PW, van Diest PJ, Vincent-Salomon A, Kreipe H. Inter-observer agreement for the histological diagnosis of invasive lobular breast carcinoma. J Pathol Clin Res 2022; 8:191-205. [PMID: 34889530 PMCID: PMC8822373 DOI: 10.1002/cjp2.253] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022]
Abstract
Invasive lobular breast carcinoma (ILC) is the second most common breast carcinoma (BC) subtype and is mainly driven by loss of E‐cadherin expression. Correct classification of BC as ILC is important for patient treatment. This study assessed the degree of agreement among pathologists for the diagnosis of ILC. Two sets of hormone receptor (HR)‐positive/HER2‐negative BCs were independently reviewed by participating pathologists. In set A (61 cases), participants were provided with hematoxylin/eosin (HE)‐stained sections. In set B (62 cases), participants were provided with HE‐stained sections and E‐cadherin immunohistochemistry (IHC). Tumor characteristics were balanced. Participants classified specimens as non‐lobular BC versus mixed BC versus ILC. Pairwise inter‐observer agreement and agreement with a pre‐defined reference diagnosis were determined with Cohen's kappa statistics. Subtype calls were correlated with molecular features, including CDH1/E‐cadherin mutation status. Thirty‐five pathologists completed both sets, providing 4,305 subtype calls. Pairwise inter‐observer agreement was moderate in set A (median κ = 0.58, interquartile range [IQR]: 0.48–0.66) and substantial in set B (median κ = 0.75, IQR: 0.56–0.86, p < 0.001). Agreement with the reference diagnosis was substantial in set A (median κ = 0.67, IQR: 0.57–0.75) and almost perfect in set B (median κ = 0.86, IQR: 0.73–0.93, p < 0.001). The median frequency of CDH1/E‐cadherin mutations in specimens classified as ILC was 65% in set A (IQR: 56–72%) and 73% in set B (IQR: 65–75%, p < 0.001). Cases with variable subtype calls included E‐cadherin‐positive ILCs harboring CDH1 missense mutations, and E‐cadherin‐negative ILCs with tubular elements and focal P‐cadherin expression. ILCs with trabecular growth pattern were often misclassified as non‐lobular BC in set A but not in set B. In conclusion, subtyping of BC as ILC achieves almost perfect agreement with a pre‐defined reference standard, if assessment is supported by E‐cadherin IHC. CDH1 missense mutations associated with preserved E‐cadherin protein expression, E‐ to P‐cadherin switching in ILC with tubular elements, and trabecular ILC were identified as potential sources of discordant classification.
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Affiliation(s)
| | | | | | - Stephan Bartels
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | | | - Martin Bredt
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Maria Jose Brito
- Pathology and Breast Unit, Champalimaud Foundation, Lisbon, Portugal
| | | | - Cecile Colpaert
- Department of Pathology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | - Gábor Cserni
- Department of Pathology, University of Szeged, Szeged, Hungary
| | | | | | | | | | - Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), and Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christine Fathke
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Henning Feist
- Institute of Pathology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - Maryse Fiche
- Institute of Pathology Aurigen, Aurigen SA, Lausanne, Switzerland
| | - Claudia Aura Gonzalez
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Natalie D Ter Hoeve
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Loes Kooreman
- Institute of Pathology and GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Till Krech
- Institute of Pathology, University Clinics Hamburg-Eppendorf, Hamburg, Germany.,Germany and Pathocom Network for Pathology, Osnabrück, Germany
| | | | - Janina Kulka
- 2nd Department of Pathology, Semmelweis University Budapest, Budapest, Hungary
| | - Florian Laenger
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Marcel Lafos
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Ulrich Lehmann
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | | | - Sophie Mueller
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Enrico Pelz
- Institute of Pathology Viersen, Viersen, Germany
| | - Mieke Raap
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | | | | | - Nora Schaumann
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | | | - Maxim De Schepper
- Department of Pathology, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium.,Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Jerome Schlue
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Koen Van de Vijver
- Cancer Research Institute Ghent, Ghent University Hospital, Ghent, Belgium
| | - Wim Waelput
- Department of Pathology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany.,Gynecologic University Clinic Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany
| | - Sherko Kuemmel
- West German Study Group, Moenchengladbach, Germany.,Breast Unit, Kliniken Essen-Mitte, Essen, Germany, and Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany
| | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium.,Department of Imaging and Radiology, Laboratory for Cell and Tissue Translational Research, KU-Leuven/UZ Leuven, Leuven, Belgium
| | - Patrick Wb Derksen
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne Vincent-Salomon
- Pathology-Genetics-Immunology Department, Institut Curie, PSL Research University, Paris, France
| | - Hans Kreipe
- Institute of Pathology, Hannover Medical School, Hannover, Germany
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19
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Van der Eecken K, Van der Linden M, Raman L, Creytens D, Dedeurwaerdere F, De Winne K, Ferdinande L, Lammens M, Menten B, Rottiers I, Van Gaever B, Van den Broecke C, Van de Vijver K, Van Roy N, Verbeke S, Van Dorpe J. Shallow whole-genome sequencing: a useful, easy to apply molecular technique for CNA detection on FFPE tumor tissue-a glioma-driven study. Virchows Arch 2022; 480:677-686. [PMID: 35034191 DOI: 10.1007/s00428-022-03268-w] [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] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/10/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
Copy number alterations (CNAs) have increasingly become part of the diagnostic algorithm of glial tumors. Alterations such as homozygous deletion of CDKN2A/B, 7 +/ 10 - chromosome copy number changes or EGFR amplification are predictive of a poor prognosis. The codeletion of chromosome arms 1p and 19q, typically associated with oligodendroglioma, implies a more favorable prognosis. Detection of this codeletion by the current diagnostic standard, being fluorescence in situ hybridization (FISH), is sometimes however subject to technical and interpretation problems. In this study, we evaluated CNA detection by shallow whole-genome sequencing (sWGS) as an inexpensive, complementary molecular technique. A cohort of 36 glioma tissue samples, enriched with "difficult" and "ambiguous" cases, was analyzed by sWGS. sWGS results were compared with FISH assays of chromosomes 1p and 19q. In addition, CNAs relevant to glioblastoma diagnosis were explored. In 4/36 samples, EGFR (7p11.2) amplifications and homozygous loss of CDKN2A/B were identified by sWGS. Six out of 8 IDH-wild-type glioblastomas demonstrated a prognostic chromosome 7/chromosome 10 signature. In 11/36 samples, local interstitial and terminal 1p/19q alterations were detected by sWGS, implying that FISH's targeted nature might promote false arm-level extrapolations. In this cohort, differences in overall survival between patients with and without codeletion were better pronounced by the sequencing-based distinction (likelihood ratio of 7.48) in comparison to FISH groupings (likelihood ratio of 0.97 at diagnosis and 1.79 ± 0.62 at reobservation), suggesting sWGS is more accurate than FISH. We recognized adverse effects of tissue block age on FISH signals. In addition, we show how sWGS reveals relevant aberrations beyond the 1p/19q state, such as EGFR amplification, combined gain of chromosome 7 and loss of chromosome 10, and homozygous loss of CDKN2A/B. The findings presented by this study might stimulate implementation of sWGS as a complementary, easy to apply technique for copy number detection.
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Affiliation(s)
- Kim Van der Eecken
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute (CRIG), Ghent, Belgium
| | - Malaïka Van der Linden
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute (CRIG), Ghent, Belgium
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Lennart Raman
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - David Creytens
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute (CRIG), Ghent, Belgium
| | | | - Koen De Winne
- Department of Pathology, Antwerp University Hospital, Antwerp, Belgium
| | - Liesbeth Ferdinande
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute (CRIG), Ghent, Belgium
| | - Martin Lammens
- Department of Pathology, Antwerp University Hospital, Antwerp, Belgium
| | - Björn Menten
- Cancer Research Institute (CRIG), Ghent, Belgium
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Rottiers
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute (CRIG), Ghent, Belgium
| | - Bram Van Gaever
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
| | | | - Koen Van de Vijver
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute (CRIG), Ghent, Belgium
| | - Nadine Van Roy
- Cancer Research Institute (CRIG), Ghent, Belgium
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verbeke
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute (CRIG), Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University, Ghent University Hospital, Ghent, Belgium.
- Cancer Research Institute (CRIG), Ghent, Belgium.
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20
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Debacker JM, Schelfhout V, Brochez L, Creytens D, D’Asseler Y, Deron P, Keereman V, Van de Vijver K, Vanhove C, Huvenne W. High-Resolution 18F-FDG PET/CT for Assessing Three-Dimensional Intraoperative Margins Status in Malignancies of the Head and Neck, a Proof-of-Concept. J Clin Med 2021; 10:jcm10163737. [PMID: 34442033 PMCID: PMC8397229 DOI: 10.3390/jcm10163737] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 01/27/2023] Open
Abstract
The surgical treatment of head and neck malignancies relies on the complete removal of tumoral tissue, while inadequate margins necessitate the use of adjuvant therapy. However, most positive margins are identified postoperatively as deep margins, and intraoperative identification of the deep positive margins could help achieve adequate surgical margins and decrease adjuvant therapies. To improve deep-margin identification, we investigated whether the use of high-resolution preclinical PET and CT could increase certainty about the surgical margins in three dimensions. Patients with a malignancy of the head and neck planned for surgical resection were administered a clinical activity of 4MBq/kg 18F-FDG approximately one hour prior to surgical initiation. Subsequently, the resected specimen was scanned with a micro-PET-CT imaging device, followed by histopathological assessment. Eight patients were included in the study and intraoperative PET/CT-imaging of 11 tumoral specimens and lymph nodes of three patients was performed. As a result of the increased resolution, differentiation between inflamed and dysplastic tissue versus malignant tissue was complicated in malignancies with increased peritumoral inflammation. The current technique allowed the three-dimensional delineation of 18F-FDG using submillimetric PET/CT imaging. While further optimization and patient stratification is required, clinical implementation could enable deep margin assessment in head and neck resection specimens.
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Affiliation(s)
- Jens M. Debacker
- Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (L.B.); (P.D.); (W.H.)
- Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Nuclear Medicine, University Hospital Brussels, 1090 Brussels, Belgium
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (V.S.); (D.C.); (Y.D.); (K.V.d.V.); (C.V.)
- Correspondence: ; Tel.: +32-9-332-39-90
| | - Vanessa Schelfhout
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (V.S.); (D.C.); (Y.D.); (K.V.d.V.); (C.V.)
- Department of Medical Imaging, Nuclear Medicine, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Lieve Brochez
- Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (L.B.); (P.D.); (W.H.)
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (V.S.); (D.C.); (Y.D.); (K.V.d.V.); (C.V.)
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium
| | - David Creytens
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (V.S.); (D.C.); (Y.D.); (K.V.d.V.); (C.V.)
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Yves D’Asseler
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (V.S.); (D.C.); (Y.D.); (K.V.d.V.); (C.V.)
- Department of Medical Imaging, Nuclear Medicine, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Philippe Deron
- Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (L.B.); (P.D.); (W.H.)
- Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (V.S.); (D.C.); (Y.D.); (K.V.d.V.); (C.V.)
| | - Vincent Keereman
- Department of Electronics and Information Systems, Ghent University, 9000 Ghent, Belgium;
- XEOS Medical NV, 9000 Ghent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (V.S.); (D.C.); (Y.D.); (K.V.d.V.); (C.V.)
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Christian Vanhove
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (V.S.); (D.C.); (Y.D.); (K.V.d.V.); (C.V.)
- Department of Electronics and Information Systems, Ghent University, 9000 Ghent, Belgium;
- INFINITY Lab, Ghent University, 9000 Ghent, Belgium
| | - Wouter Huvenne
- Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (L.B.); (P.D.); (W.H.)
- Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (V.S.); (D.C.); (Y.D.); (K.V.d.V.); (C.V.)
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21
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Abstract
Introduction: Ovarian clear cell carcinoma (OCCC) is a less common subtype accounting for approximately 5% of all epithelial ovarian cancers (EOCs). Clinical experience and research findings confirm the remarkable differences in clinical behavior, molecular alterations and pathogenesis of OCCC. The diagnosis of OCCC is typically set at a younger age, and earlier stage and in a background of endometriosis.Results: Molecularly, OCCCs rarely harbor BRCA1/BRCA2 mutations and have fewer copy number variants (CNVs). The most common molecular changes occur in the SWI/SNF chromatin remodeling complex genes, the PI3K/AKT signaling pathway and the receptor tyrosine kinase (RTK)/Ras signaling pathway.Five-year disease-specific survival of patients with OCCC is worse compared to high grade serous carcinomas (HGSOC). The current treatment options for OCCC are based on studies that included patients with predominantly HGSOC and only a minor proportion of cancers with clear cell histology. In order to improve outcomes for patients with OCCC, research should be specific for this subtype.Discussion: As the available information about the specific characteristics of OCCC is increasing, especially at a molecular level, it should be possible to continuously improve the specific diagnostics and treatment. Since OCCC is so rare, it is essential to collect new evidence at an international level. To avoid extrapolation from EOC trials with possible erroneous conclusions, patients should always be encouraged to participate in specific histological trials and basket trials, while paying extra attention to OCCC-like subtypes.
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Affiliation(s)
- Aglaja De Pauw
- Department of Internal Medicine and Pediatrics, Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Eline Naert
- Department of Internal Medicine and Pediatrics, Medical Oncology, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Koen Van de Vijver
- Department of Diagnostic Sciences, Pathology, Ghent University Hospital, Ghent, Belgium
| | - Tummers Philippe
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Human Structure and Repair, Gynecology, Gent University Hospital, Ghent, Belgium
| | - Katrien Vandecasteele
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Human Structure and Repair, Radiation Therapy, Ghent University Hospital, Ghent, Belgium
| | - Hannelore Denys
- Department of Internal Medicine and Pediatrics, Medical Oncology, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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22
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Libbrecht S, Van Cleemput J, Vandekerckhove L, Colman S, Padalko E, Verhasselt B, Van de Vijver K, Dendooven A, Dehaene I, Van Dorpe J. A rare but devastating cause of twin loss in a near-term pregnancy highlighting the features of severe SARS-CoV-2 placentitis. Histopathology 2021; 79:674-676. [PMID: 33982813 PMCID: PMC8239879 DOI: 10.1111/his.14402] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Sasha Libbrecht
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Jolien Van Cleemput
- Department of Internal Medicine and Paediatrics, HIV Cure Research Centre, Ghent University, Ghent, Belgium
| | - Linos Vandekerckhove
- Department of Internal Medicine and Paediatrics, HIV Cure Research Centre, Ghent University, Ghent, Belgium.,Department of General Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Sofie Colman
- Department of Medical Microbiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Elizaveta Padalko
- Department of Medical Microbiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Bruno Verhasselt
- Department of Medical Microbiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Koen Van de Vijver
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Amélie Dendooven
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Isabelle Dehaene
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent University, Ghent, Belgium
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23
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Deolet E, Van Dorpe J, Van de Vijver K. Mesonephric-Like Adenocarcinoma of the Endometrium: Diagnostic Advances to Spot This Wolf in Sheep's Clothing. A Review of the Literature. J Clin Med 2021; 10:jcm10040698. [PMID: 33670088 PMCID: PMC7916853 DOI: 10.3390/jcm10040698] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 01/02/2023] Open
Abstract
Mesonephric-like adenocarcinoma is a recently described rare neoplasm occurring in the uterine corpus and ovary. This under-recognized subtype of carcinoma can be very challenging to diagnose. In mesonephric adenocarcinoma a variety of growth patterns can be present within the same tumor, as a result of which they can be misinterpreted and diagnosed as low-grade endometrioid adenocarcinoma, clear cell carcinoma, or even serous carcinoma and carcinosarcoma. We report a case of mesonephric-like adenocarcinoma misdiagnosed as a low-grade endometrioid endometrial adenocarcinoma that had an early local recurrence and metastasized to the liver and the lungs. Histopathological, immunohistochemical and molecular analysis were performed and compared to published literature, providing a comprehensive overview of the current knowledge. Databases (Pubmed, Web of Science, Google Scholar) were searched with a combination of the following search terms: mesonephric-like, mesonephric, adenocarcinoma, carcinoma, uterine body, uterine corpus, endometrium. Mesonephric-like adenocarcinoma is a difficult-to-diagnose entity. Advanced diagnostics, including improved morphologic, immunohistochemical and molecular knowledge can help develop new therapeutic strategies against this specific subtype of endometrial cancer with an aggressive clinical behavior.
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Affiliation(s)
- Ellen Deolet
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium; (E.D.); (J.V.D.)
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium; (E.D.); (J.V.D.)
- Cancer Research Institute Ghent (CRIG), Ghent University, 9000 Ghent, Belgium
| | - Koen Van de Vijver
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium; (E.D.); (J.V.D.)
- Cancer Research Institute Ghent (CRIG), Ghent University, 9000 Ghent, Belgium
- Correspondence:
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24
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Vande Berg A, Segers K, Van de Vijver K, Van Rompuy AS, Colpaert C. Serous Tubal Intraepithelial Carcinoma-Like and Pagetoid Tubal Metastasis of an Ovarian Large Cell Neuroendocrine Carcinoma: Peculiar Metastatic Growth Patterns of a Rare Tumor. Int J Surg Pathol 2020; 29:281-283. [PMID: 33164612 DOI: 10.1177/1066896920972489] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A large cell neuroendocrine carcinoma of the ovary is presented because of tubal metastases with peculiar growth patterns: pagetoid and serous tubal intraepithelial carcinoma-like. The possibility that a tubal intraepithelial carcinoma could represent a metastasis should be considered by pathologists.
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Affiliation(s)
| | | | | | | | - Cecile Colpaert
- 60182UZ Leuven, Leuven, Belgium.,70515AZ Turnhout, Turnhout, Belgium
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25
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Van Hulle H, Vakaet V, Post G, Van Greveling A, Monten C, Hendrix A, Van de Vijver K, Van Dorpe J, De Visschere P, Braems G, Vandecasteele K, Denys H, De Neve W, Veldeman L. Feasibility study on pre or postoperative accelerated radiotherapy (POP-ART) in breast cancer patients. Pilot Feasibility Stud 2020; 6:154. [PMID: 33062295 PMCID: PMC7547514 DOI: 10.1186/s40814-020-00693-z] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/23/2020] [Indexed: 12/25/2022] Open
Abstract
Background In early-stage breast cancer, the cornerstone of treatment is surgery. After breast-conserving surgery, adjuvant radiotherapy has shown to improve locoregional control and overall survival rates. The use of breast radiotherapy in the preoperative (preop) setting is far less common. Nevertheless, it might improve disease-free survival as compared to postoperative radiotherapy. There is also a possibility of downsizing the tumour which might lead to a lower need for mastectomy. There are some obstacles that complicate its introduction into daily practice. It may complicate surgery or lead to an increase in wound complications or delayed wound healing. Another fear of preop radiotherapy is delaying surgery for too long. At Ghent University Hospital, we have experience with a 5-fraction radiotherapy schedule allowing radiotherapy delivery in a very short time span. Methods Twenty female breast cancer patients with non-metastatic disease receiving preop chemotherapy will be randomized between preop or postoperative radiotherapy. The feasibility of preop radiotherapy will be evaluated based on overall treatment time. All patients will be treated in 5 fractions of 5.7 Gy to the whole breast with a simultaneous integrated boost to the tumour/tumour bed of 5 × 6.2 Gy. In case of lymph node irradiation, the lymph node regions will receive a dose of 27 Gy in 5 fractions of 5.4 Gy. The total duration of therapy will be 10 to 12 days. In the preop group, overall treatment time is defined as the time between diagnosis and the day of last surgery, in the postop group between diagnosis and last irradiation fraction. Toxicity related to surgery, radio-, and chemotherapy will be evaluated on dedicated case-report forms at predefined time points. Tumour response will be evaluated on the pathology report and on MRI at baseline and in the interval between chemotherapy and surgery. Discussion The primary objective of the trial is to investigate the feasibility of preop radiotherapy. Secondary objectives are to search for biomarkers of response and toxicity and identify the involved cell death mechanisms and the effect of preop breast radiotherapy on the in-situ immune micro-environment.
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Affiliation(s)
- Hans Van Hulle
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Vincent Vakaet
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Giselle Post
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Annick Van Greveling
- Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Chris Monten
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - An Hendrix
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Koen Van de Vijver
- Department of Pathology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Pieter De Visschere
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Geert Braems
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Gynaecology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Katrien Vandecasteele
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Hannelore Denys
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.,Department of Medical Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Wilfried De Neve
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
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26
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De Jaeghere EA, Laloo F, Lippens L, Van Bockstal M, De Man K, Naert E, Van Dorpe J, Van de Vijver K, Tummers P, Makar A, De Visschere PJL, De Wever O, Amant F, Denys HG, Vandecasteele K. Splenic 18F-FDG uptake on baseline PET/CT is associated with oncological outcomes and tumor immune state in uterine cervical cancer. Gynecol Oncol 2020; 159:335-343. [PMID: 32859399 DOI: 10.1016/j.ygyno.2020.08.001] [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: 04/25/2020] [Accepted: 08/02/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The spleen represents an important contributor to tumor immune escape, but the relevance of increased splenic metabolic activity remains to be fully elucidated. METHODS We retrospectively measured the spleen-to-liver standard uptake value (SLR) on 18F-FDG PET/CT examinations of 92 consecutive patients with FIGO stage IB1 to IVA cervical cancer and integrated the results with survival, response to treatment, tumor immune infiltrate, and baseline characteristics. RESULTS SLRmax > 0.92 (p = .026) and SLRmean > 0.94 (p = .005) were significantly associated with decreased DFS in univariable analysis. Multivariable models were built using best subset selection; ΔSLRmax and either SLRmax or SLRmean were consistently selected, strongly reinforcing the association between SLR variables and DFS in relation to potential confounders (all models p ≤ .002). Independent associations were found for SLRmax using multivariable Cox regression models for DFS (all p ≤ .003). Further, uni- and multivariable analyses demonstrated the negative impact of higher SLR values on pathological complete response. A statistically significant higher proportion of patients with high SLRmax had a dense infiltrate of CD20+ (p = .036) and CD68+ (p = .015) immune cells, as well as PD-L1+ tumor cells (p = .019) as compared to those with low SLRmax. Finally, high SLRmax status was neither associated with systemic inflammatory markers (except for an increased white blood cell count; p = .038), nor with clinically overt infection. CONCLUSION This hypothesis-generating study provides the first evidence that increased splenic metabolic activity is a negative prognostic and predictive biomarker in locally advanced cervical cancer. In addition, it might help to discriminate immunologically 'hot' from 'cold' cervical tumors.
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Affiliation(s)
- Emiel A De Jaeghere
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Laboratory of Experimental Cancer Research (LECR), Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium.
| | - Frederiek Laloo
- Radiology and Nuclear Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Lien Lippens
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Laboratory of Experimental Cancer Research (LECR), Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | | | - Kathia De Man
- Radiology and Nuclear Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Eline Naert
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | - Jo Van Dorpe
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Pathology, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Pathology, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Philippe Tummers
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Gynecology, Department of Human Structure and Repair, Ghent University Hospital, Belgium
| | - Amin Makar
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Gynecology, Department of Human Structure and Repair, Ghent University Hospital, Belgium
| | - Pieter J L De Visschere
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Radiology and Nuclear Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Olivier De Wever
- Laboratory of Experimental Cancer Research (LECR), Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | - Frédéric Amant
- Centers Gynecologic Oncology Amsterdam, Netherlands Cancer Institute and Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Hannelore G Denys
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | - Katrien Vandecasteele
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Radiation Oncology, Department of Human Structure and Repair, Ghent University Hospital, Belgium
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27
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Van Dam P, Verhoeven Y, De Waele J, Jacobs J, Van Dam PJ, Kockx M, Van de Vijver K, Lammens M, Wouters A, Smits E, Lardon F, Trinh XB. Uncovering the immune-modulating role of anti-RANKL therapy for cervical cancer: Preliminary results. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e18028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18028 Background: Conventional treatments for cervical cancer (CC) have reached a plateau and only limited progress for targeted therapy has been made over the last decades, resulting in a meager five-year survival rate of only 17% for the advanced stages. To improve long-term benefits for the patient, a promising hot field of research in oncology that opens new perspectives is immunotherapy. Even though CC has shown to be immunogenic, only a minority of patients respond to this type of treatment. In recent years, the RANKL/RANK signaling pathway has been implicated as a key immune modulating factor in the tumor microenvironment, allowing the cancer cells to evade the immune response by disrupting the immune-intrinsic crosstalk. Both RANKL and RANK are highly co-expressed in CC, which correlates with inferior clinicopathological parameters and an increased risk of death. Targeting this pathway may therefore be of great value in the treatment of CC and the quest to release the brakes on the immune system, thereby reinvigorating the tumors’ susceptibility to immunotherapy. Hence, we aim to elucidate the effects of anti-RANKL therapy on the tumor-immune microenvironment in CC. Methods: Two cervical biopsies were taken before and after anti-RANKL therapy in CC patients. One fresh biopsy was immediately processed to a single cell suspension for flow cytometry (FCM) using enzymatic digestion, while the other was formalin-fixed and paraffin-embedded for immunohistochemistry (IHC) and RNA sequencing. For FCM and IHC, the samples were stained with different markers for RANK/L signaling, the immune infiltrate and immune checkpoints. FCM was performed on a BD FACSAria IIä cytometer and analyzed with FlowJo. IHC staining was performed on a Ventana Benchmark Ultra and Ventana Discovery Ultra and scored by a pathologist or by HistoScientist using Visiopharm, while RNA sequencing was performed with the Truseq RNA exome panel on the NextSeq 500 system. Results: Our preliminary results show a relative increase of the CD8+ population, while a trend is observed in increased lymphocyte activation after anti-RANKL therapy. Updated results will be presented in more detail at the conference, including RNA sequencing data. Conclusions: Preliminary findings indicate that anti-RANKL therapy modifies the tumor-immune microenvironment in CC. Higher patient accrual will allow to dissect targets for combination therapy with anti-RANKL to further optimize this treatment strategy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Xuan Bich Trinh
- TCRG-A/Oncology Centre, St. Augustinus Hospital, Antwerp, Belgium
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28
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De Thaye E, Van de Vijver K, Van der Meulen J, Taminau J, Wagemans G, Denys H, Van Dorpe J, Berx G, Ceelen W, Van Bocxlaer J, De Wever O. Establishment and characterization of a cell line and patient-derived xenograft (PDX) from peritoneal metastasis of low-grade serous ovarian carcinoma. Sci Rep 2020; 10:6688. [PMID: 32317693 PMCID: PMC7174384 DOI: 10.1038/s41598-020-63738-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/13/2020] [Indexed: 12/24/2022] Open
Abstract
Peritoneal spread indicates poor prognosis in patients with serous ovarian carcinoma (SOC) and is generally treated by surgical cytoreduction and chemotherapy. Novel treatment options are urgently needed to improve patient outcome. Clinically relevant cell lines and patient-derived xenograft (PDX) models are of critical importance to therapeutic regimen evaluation. Here, a PDX model was established, by orthotopic engraftment after subperitoneal tumor slurry injection of low-grade SOC, resulting in an early-stage transplantable peritoneal metastasis (PM)-PDX model. Histology confirmed the micropapillary and cribriform growth pattern with intraluminal tumor budding and positivity for PAX8 and WT1. PM-PDX dissociated cells show an epithelial morphotype with a 42 h doubling time and 40% colony forming efficiency, they are low sensitive to platinum derivatives and highly sensitive to paclitaxel (IC50: 6.3 ± 2.2 nM, mean ± SEM). The patient primary tumor, PM, PM-PDX and derived cell line all show a KRAS c.35 G > T (p.(Gly12Val)) mutation and show sensitivity to the MEK inhibitor trametinib in vitro (IC50: 7.2 ± 0.5 nM, mean ± SEM) and in the PM mouse model. These preclinical models closely reflecting patient tumors are useful to further elucidate LGSOC disease progression, therapy response and resistance mechanisms.
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Affiliation(s)
- Elien De Thaye
- Laboratory of Medical Biochemistry and Clinical Analysis, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Joni Van der Meulen
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Molecular Diagnostics Ghent University Hospital, Ghent, Belgium
| | - Joachim Taminau
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Molecular and Cellular Oncology lab, Ghent University, Ghent, Belgium
| | - Glenn Wagemans
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Laboratory of Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Hannelore Denys
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Jo Van Dorpe
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Geert Berx
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Molecular and Cellular Oncology lab, Ghent University, Ghent, Belgium
| | - Wim Ceelen
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
| | - Jan Van Bocxlaer
- Laboratory of Medical Biochemistry and Clinical Analysis, Ghent University, Ghent, Belgium
| | - Olivier De Wever
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium.
- Laboratory of Experimental Cancer Research, Ghent University, Ghent, Belgium.
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29
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Lippens L, Van Bockstal M, De Jaeghere EA, Tummers P, Makar A, De Geyter S, Van de Vijver K, Hendrix A, Vandecasteele K, Denys H. Immunologic impact of chemoradiation in cervical cancer and how immune cell infiltration could lead toward personalized treatment. Int J Cancer 2020; 147:554-564. [PMID: 32017078 DOI: 10.1002/ijc.32893] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/21/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 02/06/2023]
Abstract
We investigated the potential of tumor-infiltrating immune cells (ICs) as predictive or prognostic biomarkers for cervical cancer patients. In total, 38 patients treated with (chemo)radiotherapy and subsequent surgery were included in the current study. This unique treatment schedule makes it possible to analyze IC markers in pretreatment and posttreatment tissue specimens and their changes during treatment. IC markers for T cells (CD3, CD4, CD8 and FoxP3), macrophages (CD68 and CD163) and B cells (CD20), as well as IL33 and PD-L1, were retrospectively analyzed via immunohistochemistry. Patients were grouped in the low score or high score group based on the amount of positive cells on immunohistochemistry. Correlations to pathological complete response (pCR), cause-specific survival (CSS) and metastasis development during follow-up were evaluated. In analysis of pretreatment biopsies, significantly more pCR was seen for patients with CD8 = CD3, CD8 ≥ CD4, positive IL33 tumor cell (TC) scores, IL33 IC < TC and PD-L1 TC ≥5%. Besides patients with high CD8 scores, also patients with CD8 ≥ CD4, CD163 ≥ CD68 or PD-L1 IC ≥5% had better CSS. In the analysis of posttreatment specimens, less pCR was observed for patients with high CD8 or CD163 scores. Patients with decreasing CD8 or CD163 scores between pretreatment and posttreatment samples showed more pCR, whereas those with increasing CD8 or decreasing IL33 IC scores showed a worse CSS. Meanwhile, patients with an increasing CD3 score or stable/increasing PD-L1 IC score showed more metastasis during follow-up. In this way, the intratumoral IC landscape is a promising tool for prediction of outcome and response to (chemo)radiotherapy.
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Affiliation(s)
- Lien Lippens
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Mieke Van Bockstal
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Pathology, Department of Diagnostic Sciences, Ghent University Hospital, Ghent, Belgium
| | - Emiel A De Jaeghere
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Philippe Tummers
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium.,Gynecology, Department of Human Structure and Repair, Gent University Hospital, Ghent, Belgium
| | - Amin Makar
- Gynecology, Department of Human Structure and Repair, Gent University Hospital, Ghent, Belgium
| | - Sofie De Geyter
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Koen Van de Vijver
- Pathology, Department of Diagnostic Sciences, Ghent University Hospital, Ghent, Belgium
| | - An Hendrix
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Katrien Vandecasteele
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium.,Radiation Therapy, Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Hannelore Denys
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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30
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Sobral-Leite M, Van de Vijver K, Michaut M, van der Linden R, Hooijer GK, Horlings HM, Severson TM, Mulligan AM, Weerasooriya N, Sanders J, Glas AM, Wehkamp D, Mittempergher L, Kersten K, Cimino-Mathews A, Peters D, Hooijberg E, Broeks A, van de Vijver MJ, Bernards R, Andrulis IL, Kok M, de Visser KE, Schmidt MK. Assessment of PD-L1 expression across breast cancer molecular subtypes, in relation to mutation rate, BRCA1-like status, tumor-infiltrating immune cells and survival. Oncoimmunology 2018; 7:e1509820. [PMID: 30524905 PMCID: PMC6279322 DOI: 10.1080/2162402x.2018.1509820] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 01/28/2023] Open
Abstract
To better understand the expression pattern of programmed death-ligand 1 (PD-L1) expression in different breast cancer types, we characterized PD-L1 expression in tumor and tumor-infiltrating immune cells, in relation to mutation rate, BRCA1-like status and survival. We analyzed 410 primary treatment-naive breast tumors comprising 162 estrogen receptor-positive (ER+) and HER2-, 101 HER2+ and 147 triple-negative (TN) cancers. Pathologists quantified tumor-infiltrating lymphocytes (TILs) and PD-L1 expression in tumor cells and TILs using whole slides and tissue microarray. Mutation rate was assessed by DNA sequencing, BRCA1-like status using multiplex ligation-dependent probe amplification, and immune landscape by multiplex image analyses of CD4, CD68, CD8, FOXP3, cytokeratin, and PD-L1. Half of PD-L1 scores evaluated by tissue microarray were false negatives compared to whole slide evaluations. We observed at least 1% of PD-L1-positive (PD-L1+) cells in 53.1% of ER+HER2-, 73.3% of HER2+, and 84.4% of TN tumors. PD-L1 expression was higher in ductal compared to lobular carcinomas, also within ER+HER2- tumors (p = 0.04). High PD-L1+ TILs score (> 50%) was independently associated with better outcome in TN tumors (HR = 0.27; 95%CI = 0.10-0.69). Within TN tumors, PD-L1 and TIL scores showed a modest but significant positive association with the number of silent mutations, but no association with BRCA1-like status. Multiplex image analyses indicated that PD-L1 is expressed on multiple immune cells (CD68+ macrophages, CD4+, FOXP3+, and CD8+ T cells) in the breast tumor microenvironment, independent of the PD-L1 status of the tumor cells. We found no evidence that levels of PD-L1+ TILs in TN breast cancer are driven by high mutation rate or BRCA1-like status.
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Affiliation(s)
- Marcelo Sobral-Leite
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Coordenação de Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
| | - Koen Van de Vijver
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Magali Michaut
- Division of Molecular Carcinogenesis, Oncode Institute, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Gerrit K.J. Hooijer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Hugo M. Horlings
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tesa M. Severson
- Division of Molecular Carcinogenesis, Oncode Institute, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anna Marie Mulligan
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Joyce Sanders
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | - Kelly Kersten
- Division of Tumor Biology and Immunology, Oncode Institute, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Dennis Peters
- Core Facility Molecular Pathology and Biobanking, Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik Hooijberg
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annegien Broeks
- Core Facility Molecular Pathology and Biobanking, Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Rene Bernards
- Division of Molecular Carcinogenesis, Oncode Institute, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Irene L. Andrulis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Marleen Kok
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marjanka K. Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Sobral-Leite M, Salomon I, Opdam M, Beelen K, Vlierberghe RLV, Blok EJ, Horlings HM, Sanders J, Vijver KVD, Kuppen PJ, Linn S, Schmidt MK, Kok M. Abstract 5612: Cancer-immune interactions in luminal breast cancers: PI3KCA mutations, PI3K/AKT/mTOR activation and tumor-infiltrating lymphocytes. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Therapy resistance to adjuvant tamoxifen in estrogen receptor positive (ER+) breast cancer (BC) is related to activation of downstream proteins in the PI3K/AKT/mTOR pathway. However, clinical efficacy of mTOR inhibitors has so far been modest. Growing evidence shows that genomic make-up of cancer cells plays a crucial role in an anti-cancer immune response and this is reflected in the presence of tumor infiltrating immune cells. This begs the need for understanding the relationship between tumor-related immune activity, PIK3CA hot-spot mutations (PIK3CAm) and PI3K/AKT/mTOR pathway activation in ER+BC.
Material and methods: The IKA trial recruited stage I to III postmenopausal BC patients (1982 till 1994), who were randomized to tamoxifen or no adjuvant therapy. Sequenom mass spectrometry-based genotyping was used for PIK3CAm assessment. Immune markers and phosphorylation status of proteins in the PI3K/AKT/mTOR pathway [p-AKT (Thr308 and 473), p-mTOR, p-ERK1/2, p-p-70S6K and p-4EBP1] were assessed by immunohistochemistry and scored by two pathologists. Expression of CD4, CD8 and FOXP3 was evaluated using automatic scoring by image-analysis software (SlidePath® or AxioVision®) and compared with manual scoring by two pathologists. Associations were assessed using multivariable logistic regression models, including as co-variables: age, tumor grade, lymph node status, tumor size, and progesterone receptor and HER2 status.
Results: We included 563 ER+BC cases. PIK3CAm were found in 159 (32%) of the 486 tumors genotyped. On average, PI3K/AKT/mTOR downstream proteins and immune markers were scored in 409 tumors (range: 366 to 438). Stromal CD8 expression, but not CD4 or FOXP3, was significantly higher in PIK3CA mutated tumors (OR=1.11; 95%CI: 1.02-1.22). Stromal FOXP3 expression, but not CD4 or CD8, was significantly increased in tumors with activated proteins from the PI3K/AKT/mTOR pathway (except p-mTOR). The largest association was with p-4EBP1 (OR=1.34; 95%CI: 1.21-1.48) and smallest with p-70S6K (OR=1.15; 95%CI: 1.08-1.22).
Conclusion: In our dataset of ER+BC, PIK3CAm are associated with higher level of CD8+ T cells. Tumors with activation of the PI3K/Akt/mTOR pathway tend to have more FOXP3+ T cells. Together, our results suggest that PIK3CA mutation/activation harbor an immune-related tumor microenvironment.
Citation Format: Marcelo Sobral-Leite, Izhar Salomon, Mark Opdam, Karin Beelen, Ronald L. van Vlierberghe, Erik J. Blok, Hugo M. Horlings, Joyce Sanders, Koen Van de Vijver, Peter J. Kuppen, Sabine Linn, Marjanka K. Schmidt, Marleen Kok. Cancer-immune interactions in luminal breast cancers: PI3KCA mutations, PI3K/AKT/mTOR activation and tumor-infiltrating lymphocytes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5612. doi:10.1158/1538-7445.AM2017-5612
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Affiliation(s)
| | - Izhar Salomon
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Mark Opdam
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Karin Beelen
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Erik J. Blok
- 2Leiden University Medical Center, Leiden, Netherlands
| | | | - Joyce Sanders
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Sabine Linn
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Marleen Kok
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
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Sobral-Leite M, Vijver KVD, Michaut M, Horlings HM, Severson TM, Schouten PC, Linden RVD, Kersten K, Mulligan AM, Weerasooriya N, Sanders J, Cimino-Mathews A, Peters D, Hooijer GK, Hooijberg E, Broeks A, Bernards R, Linn S, Andrulis IL, Vijver MJVD, Wessels LF, Kok M, Visser KED, Schmidt MK. Abstract 575: PD-L1 positive tumor-infiltrating lymphocytes and mutational load in breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: PD-1 blockade has emerged as an effective treatment for a subset of cancer patients. Studies have shown that PD-L1 expression is associated with likelihood of response to PD-1 blockade. In order to select the right breast cancer patient for immunotherapy, characterization of the immune landscape of breast tumors is required. Therefore, we assessed PD-L1 expression and tumor-infiltrating lymphocytes (TILs) in different breast tumor subtypes and the link with prognosis. We also sequenced a panel of genes to assess the mutational load in triple negative tumors (TNBC) and investigate the association with PD-L1 positive TILs.
Material and methods: We analyzed 438 tumor samples from breast cancer patients of all ages treated between 1986 and 2007 with surgery, with or without adjuvant therapy. PD-L1 was stained using whole slide specimens (E1L3N® antibody) after methodological validation. Pathologists quantified TILs based on International TILs Working Group recommendations and scored PD-L1 based on the percentage of positive (tumor and/or immune) cells; as negative if 0%, positive if ≥1%, and high if >50%. Mutational load was assessed based on DNA kinome sequencing. Associations were measured by Cox/logistic regression model, including pathological variables. Multiplex imaging of 20 immune-infiltrated areas from four ER negative tumors were performed using the Vectra® system based on immunofluorescence staining panel of: CD4, CD68, CD8, FOXP3 and PD-L1.
Results: PD-L1 expression and TILs were higher in ductal (compared with lobular), high grade and estrogen receptor (ER)-negative tumors (p<0.001). TILs (density ≥5%) were significantly associated with worse distant metastasis-free survival (DMFS) only in ER-positive tumors (n=204): HR=2.72; 95%CI: 1.07-6.94. PD-L1 positivity (≥1%) followed the same trend: HR=1.66; 95%CI: 0.87-3.15. However, in ER-negative tumors (n=171), high PD-L1 expression (>50%) was significantly associated with better DMFS: HR=0.51; 95%CI: 0.27-0.98. TNBC with high PD-L1 expression of TILs (>50%) showed an association with increased mutation load (p=0.019) and a trend for better DMFS (HR=0.41; 95%CI: 0.16-1.04) compared with tumors lacking TILs. Further characterization of PD-L1 positivity in the immune-infiltrated cells was conducted by a multiplex imaging analysis. Preliminary results indicated that PD-L1 is expressed in CD68+, CD4+, FOXP3+ and CD8+ immune-cells.
Conclusion: Our findings suggest that PD-L1 positive TILs are associated with worse prognosis in ER-positive breast cancer and with better outcome in ER-negative group. In TNBC, high mutational load correlates with high PD-L1 positive TILs.
Citation Format: Marcelo Sobral-Leite, Koen Van de Vijver, Magali Michaut, Hugo M. Horlings, Tesa M. Severson, Philip C. Schouten, Rianne van der Linden, Kelly Kersten, Anna Marie Mulligan, Nayana Weerasooriya, Joyce Sanders, Ashley Cimino-Mathews, Dennis Peters, Gerrit K. Hooijer, Erik Hooijberg, Annegien Broeks, Rene Bernards, Sabine Linn, Irene L. Andrulis, Marc J. van de Vijver, Lodewyk F. Wessels, Marleen Kok, Karin E. de Visser, Marjanka K. Schmidt. PD-L1 positive tumor-infiltrating lymphocytes and mutational load in breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 575. doi:10.1158/1538-7445.AM2017-575
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Affiliation(s)
| | | | - Magali Michaut
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | | | - Kelly Kersten
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Joyce Sanders
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Dennis Peters
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Erik Hooijberg
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Rene Bernards
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sabine Linn
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | - Marleen Kok
- 1The Netherlands Cancer Institute, Amsterdam, Netherlands
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Cuppens T, Annibali D, Coosemans A, Trovik J, ter Haar N, Colas E, Garcia-Jimenez A, Van de Vijver K, Kruitwagen RP, Brinkhuis M, Zikan M, Dundr P, Huvila J, Carpén O, Haybaeck J, Moinfar F, Salvesen HB, Stukan M, Mestdagh C, Zweemer RP, Massuger LF, Mallmann MR, Wardelmann E, Mints M, Verbist G, Thomas D, Gommé E, Hermans E, Moerman P, Bosse T, Amant F. Potential Targets' Analysis Reveals Dual PI3K/mTOR Pathway Inhibition as a Promising Therapeutic Strategy for Uterine Leiomyosarcomas—an ENITEC Group Initiative. Clin Cancer Res 2017; 23:1274-1285. [DOI: 10.1158/1078-0432.ccr-16-2149] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 11/16/2022]
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de Boer LL, Hendriks BHW, van Duijnhoven F, Peeters-Baas MJTFDV, Van de Vijver K, Loo CE, Jóźwiak K, Sterenborg HJCM, Ruers TJM. Using DRS during breast conserving surgery: identifying robust optical parameters and influence of inter-patient variation. Biomed Opt Express 2016; 7:5188-5200. [PMID: 28018735 PMCID: PMC5175562 DOI: 10.1364/boe.7.005188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/11/2016] [Accepted: 11/13/2016] [Indexed: 05/12/2023]
Abstract
Successful breast conserving surgery consists of complete removal of the tumor while sparing healthy surrounding tissue. Despite currently available imaging and margin assessment tools, recognizing tumor tissue at a resection margin during surgery is challenging. Diffuse reflectance spectroscopy (DRS), which uses light for tissue characterization, can potentially guide surgeons to prevent tumor positive margins. However, inter-patient variation and changes in tissue physiology occurring during the resection might hamper this light-based technology. Here we investigate how inter-patient variation and tissue status (in vivo vs ex vivo) affect the performance of the DRS optical parameters. In vivo and ex vivo measurements of 45 breast cancer patients were obtained and quantified with an analytical model to acquire the optical parameters. The optical parameter representing the ratio between fat and water provided the best discrimination between normal and tumor tissue, with an area under the receiver operating characteristic curve of 0.94. There was no substantial influence of other patient factors such as menopausal status on optical measurements. Contrary to expectations, normalization of the optical parameters did not improve the discriminative power. Furthermore, measurements taken in vivo were not significantly different from the measurements taken ex vivo. These findings indicate that DRS is a robust technology for the detection of tumor tissue during breast conserving surgery.
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Affiliation(s)
- Lisanne L. de Boer
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
| | - Benno H. W. Hendriks
- Philips Research, Eindhoven, The Netherlands
- Biomechanical Engineering Department, Delft University of Technology, Delft, The Netherlands
| | | | | | - Koen Van de Vijver
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
| | - Claudette E. Loo
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
| | - Katarzyna Jóźwiak
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
| | - Henricus J. C. M. Sterenborg
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
- Academic Medical Center, Department of Biomedical Engineering and Physics, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
| | - Theo J. M. Ruers
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
- MIRA Institute, University Twente, The Netherlands
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Cox JA, Lukande RL, Kalungi S, Van Marck E, Van de Vijver K, Kambugu A, Nelson AM, Colebunders R, Manabe YC. Is Urinary Lipoarabinomannan the Result of Renal Tuberculosis? Assessment of the Renal Histology in an Autopsy Cohort of Ugandan HIV-Infected Adults. PLoS One 2015; 10:e0123323. [PMID: 25897661 PMCID: PMC4405591 DOI: 10.1371/journal.pone.0123323] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 12/06/2014] [Accepted: 02/19/2015] [Indexed: 02/02/2023] Open
Abstract
Objective The detection of urinary lipoarabinomannan (LAM), a mycobacterial cell wall component, is used to diagnose tuberculosis (TB). How LAM enters the urine is not known. To investigate if urinary LAM-positivity is the result of renal TB infection we correlated the outcomes of urinary LAM-antigen testing to renal histology in an autopsy cohort of hospitalized, Ugandan, HIV-infected adults. Methods We performed a complete autopsy, including renal sampling, in HIV-infected adults that died during hospitalization after written informed consent was obtained from the next of kin. Urine was collected postmortem through post-mortem catheterisation or by bladder puncture and tested for LAM with both a lateral flow assay (LFA) and an ELISA assay. Two pathologists assessed the kidney histology. We correlated the LAM-assay results and the histology findings. Results Of the 13/36 (36%) patients with a positive urinary LAM ELISA and/or LFA, 8/13 (62%) had renal TB. The remaining 5 LAM-positive patients had disseminated TB without renal involvement. Of the 23 LAM-negative patients, 3 had disseminated TB without renal involvement. The remaining LAM-negative patients had no TB infection and died mostly of fungal and bacterial infections. LAM LFA had a sensitivity of 81% and specificity of 100% to diagnose TB at any location, and the LAM ELISA a sensitivity of 63% and a specificity of 100%. 54% (7/13) LAM LFA-positive patients were not on anti-TB treatment at the time of death. Conclusion Renal TB infection explained LAM-positivity in the majority of patients. Patients with disseminated TB without renal involvement can also be diagnosed with LAM. This suggests that other mechanisms that lead to urinary LAM-positivity exist in a minority of patients.
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Affiliation(s)
- Janneke A Cox
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert L Lukande
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sam Kalungi
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda; Department of Pathology, Mulago Hospital Complex, Kampala, Uganda
| | - Eric Van Marck
- Department of Pathology, University Hospital Antwerp, University of Antwerp, Belgium
| | - Koen Van de Vijver
- Department of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ann M Nelson
- Joint Pathology Center, Silver Spring, United States of America
| | - Robert Colebunders
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Epidemiology and Social Medicine, University of Antwerp, Belgium
| | - Yukari C Manabe
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Cox JA, Lukande RL, Kalungi S, Van Marck E, Van de Vijver K, Kambugu A, Nelson AM, Manabe YC, Colebunders R. Needle autopsy to establish the cause of death in HIV-infected hospitalized adults in Uganda: a comparison to complete autopsy. J Acquir Immune Defic Syndr 2015; 67:169-76. [PMID: 25072614 DOI: 10.1097/qai.0000000000000290] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Minimal invasive but accurate methods to establish the cause of death in HIV-infected patients are needed. We studied the agreement in cause of death between blind and ultrasound-guided needle autopsy and complete autopsy in HIV-infected patients in Uganda. METHODS We subsequently performed a blind and ultrasound-guided needle autopsy followed by a complete autopsy in HIV-infected adults who died during hospitalization. Two teams of pathologists reviewed the tissue from either the needle autopsies or the complete autopsy and formulated the major diagnoses, that is, diseases directly contributing to death. The primary outcome was concordance in major diagnosis between needle and complete autopsies. RESULTS We performed 96 blind needle and complete autopsies and 95 ultrasound-guided needle autopsies. Concordance in major diagnosis between blind needle and complete autopsy was 50%. For the main major diagnosis, tuberculosis (TB) concordance was higher (71%; P < 0.01). Blind needle autopsy identified at least 1 major diagnosis in 60% of patients; and in 46%, there was complete concordance for all major diagnoses. The main reason for discordance was sampling error of the lesion. Concordance with the addition of ultrasound guidance was 52% for all major diagnoses and 79% for TB. Major diagnoses were mainly identified in tissue cores from the liver (76%) and the spleen (82%). DISCUSSION Blind needle autopsy identified half of the major diagnosis. The addition of ultrasound guidance did not significantly improve the performance of needle autopsy. Needle autopsy is a valuable method to confirm causes of death in HIV-infected patients, especially for highly prevalent diseases like TB.
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Affiliation(s)
- Janneke A Cox
- *Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; †Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; ‡Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda; §Department of Pathology, Mulago Hospital Complex, Kampala, Uganda; ‖Department of Pathology, University Hospital Antwerp, University of Antwerp, Belgium; ¶Department of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; #Joint Pathology Center, Silver Spring, MD; **Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; and ††Faculty of Medicine, University of Antwerp, Belgium
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Cox JA, Lukande RL, Kalungi S, Van de Vijver K, Van Marck E, Nelson AM, Munema A, Manabe YC, Colebunders R. Practice of percutaneous needle autopsy; a descriptive study reporting experiences from Uganda. BMC Clin Pathol 2014; 14:44. [PMID: 25506261 PMCID: PMC4265453 DOI: 10.1186/1472-6890-14-44] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 11/24/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Percutaneous needle autopsy can overcome a number of barriers that limit the use of complete autopsies. We performed blind-and ultrasound guided needle autopsies in HIV-infected adults in Uganda. In this study we describe in detail the methods we used, the ability of both procedures to obtain sufficient tissue for further examination and the learning curve of the operators over time. METHODS If written informed consent was granted from the next of kin, we first performed a blind needle autopsy, puncturing brain, heart, lungs, liver, spleen and kidneys using predefined surface marking points. We then performed an ultrasound guided needle autopsy puncturing heart, liver, spleen and kidneys. The number of attempts, expected success and duration of the procedure were noted. A pathologist read the slides and indicated if the target tissue was present and of sufficient quality for pathological review. We report the predicted and true success rates, compare the yield of blind to ultrasound guided needle biopsies and evaluate the failure rate over time. RESULTS Two operators performed 96 blind needle autopsies and 95 ultrasound guided needle autopsies. For blind needle biopsies true success rates varied from 56-99% and predicted success rates from 89-99%. For ultrasound guided needle biopsies true success rates varied from 72-100% and predicted success rates from 84-98%. Ultrasound guidance led to a significantly higher success rate in heart and left kidney. A learning curve was observed over time with decreasing failure rates with increasing experience and a shorter duration of the needle autopsy. CONCLUSION Needle autopsy can successfully obtain tissue for further pathological review in the vast majority of cases, with a decrease in failure rate with increasing experience of the operator. The benefit of ultrasound guidance will depend on the population, the disease and organ of interest and the local circumstances. Our results justify further evaluation of needle autopsies as a method to establish a cause of death.
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Affiliation(s)
- Janneke A Cox
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium ; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert L Lukande
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sam Kalungi
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda ; Department of Pathology, Mulago Hospital Complex, Kampala, Uganda
| | - Koen Van de Vijver
- Department of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Eric Van Marck
- Department of Pathology, University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Asafu Munema
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yukari C Manabe
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda ; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert Colebunders
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium ; Faculty of Medicine, University of Antwerp, Antwerp, Belgium
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Kruse AJ, Slangen B, Dunselman GA, Pirens T, Bakers FC, Baak JP, de Vijver KV. Neoplastic transformation of endocervicosis into an extraovarian mucinous cystadenocarcinoma. Hum Pathol 2011; 42:743-8. [DOI: 10.1016/j.humpath.2010.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 08/09/2010] [Accepted: 08/20/2010] [Indexed: 10/18/2022]
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Cools B, Plaskie K, Van de Vijver K, Suys B. Unsuccessful resuscitation of a preterm infant due to a pneumothorax and a masked tension pneumopericardium. Resuscitation 2008; 78:236-9. [PMID: 18485563 DOI: 10.1016/j.resuscitation.2008.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 01/14/2008] [Accepted: 02/23/2008] [Indexed: 01/11/2023]
Abstract
Pneumopericardium is the least common form of air leak in infants. A tension pneumopericardium is even more infrequent but associated with a very high mortality rate. We describe the case of an unsuccessful resuscitation in a preterm infant due to a pneumothorax and tension pneumopericardium. Despite relatively mild pressure ventilation the patient developed massive pulmonary interstitial emphysema. The extra-alveolar air spread from the interstitium towards the mediastinal space (Macklin effect) and caused a pneumothorax and pneumopericardium, which evolved towards a tension pneumopericardium after a traumatic mechanical procedure. The infant deteriorated acutely. Despite prompt pleural drainage there were no signs of recovery at any time. Postmortal examination revealed a tension pneumopericardium and massive interstitial pulmonary emphysema, which was not obvious on radiographical investigation. In cases of acute deterioration of a ventilated neonate, one should always rule out pneumothorax. If the patient does not recover after pleural drainage and cardiac resuscitation a (tension) pneumopericardium should be considered.
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Affiliation(s)
- Bjorn Cools
- Department of Neonatal Intensive Care, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium.
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Claessens A, Van de Vijver K, Van Bockstaele DR, Wauters J, Berneman ZN, Van Marck E, Merregaert J. Expression and localization of CHODLDeltaE/CHODLfDeltaE, the soluble isoform of chondrolectin. Cell Biol Int 2007; 31:1323-30. [PMID: 17606388 DOI: 10.1016/j.cellbi.2007.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 05/06/2007] [Accepted: 05/12/2007] [Indexed: 10/23/2022]
Abstract
The C-type lectin family is a group of animal proteins which can be distinguished from other lectins by the presence of a Ca2+-dependent carbohydrate recognition domain (CRD) in their protein sequence. They are classified into 17 groups according to their domain architecture and have a wide variety of functions. The human chondrolectin gene encodes transmembrane (CHODL, CHODLf) and soluble proteins (CHODLDeltaE, CHODLfDeltaE) belonging to the family of C-type lectins because of the presence of one CRD domain in their N-terminal region. The CHODL splice variants (CHODLf, CHODLDeltaE and CHODLfDeltaE) are differentially expressed in T lymphocytes. The transmembrane-containing isoform CHODLf is localized in the ER-Golgi apparatus. CHODLDeltaE and CHODLfDeltaE are devoid of the transmembrane domain and terminate in QDEL, an ER retention signal. In this paper we have investigated the expression of the CHODLDeltaE/CHODLfDeltaE protein. This variant localizes in the late endoplasmic reticulum. We detected the protein in spleen and tonsils in a small population of lymphocytes. Moreover, the isoform seems to be differentially expressed in thymocytes and lymphocytes suggesting an important biological function during T cell development.
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Affiliation(s)
- An Claessens
- Laboratory of Molecular Biotechnology, Department of Biomedical Sciences, Faculty of Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, and Antwerp University Hospital, Edegem, Belgium
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