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Rosenberg JM, Peters JM, Hughes T, Lareau CA, Ludwig LS, Massoth LR, Austin-Tse C, Rehm HL, Bryson B, Chen YB, Regev A, Shalek AK, Fortune SM, Sykes DB. JAK inhibition in a patient with a STAT1 gain-of-function variant reveals STAT1 dysregulation as a common feature of aplastic anemia. Med (N Y) 2022; 3:42-57.e5. [PMID: 35590143 PMCID: PMC9123284 DOI: 10.1016/j.medj.2021.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Idiopathic aplastic anemia is a potentially lethal disease, characterized by T cell-mediated autoimmune attack of bone marrow hematopoietic stem cells. Standard of care therapies (stem cell transplantation or immunosuppression) are effective but associated with a risk of serious toxicities. METHODS An 18-year-old man presented with aplastic anemia in the context of a germline gain-of-function variant in STAT1. Treatment with the JAK1 inhibitor itacitinib resulted in a rapid resolution of aplastic anemia and a sustained recovery of hematopoiesis. Peripheral blood and bone marrow samples were compared before and after JAK1 inhibitor therapy. FINDINGS Following therapy, samples showed a decrease in the plasma concentration of interferon-γ, a decrease in PD1-positive exhausted CD8+ T cell population, and a decrease in an interferon responsive myeloid population. Single-cell analysis of chromatin accessibility showed decreased accessibility of STAT1 across CD4+ and CD8+ T cells, as well as CD14+ monocytes. To query whether other cases of aplastic anemia share a similar STAT1-mediated pathophysiology, we examined a cohort of 9 patients with idiopathic aplastic anemia. Bone marrow from six of nine patients also displayed abnormal STAT1 hyper-activation. CONCLUSIONS These findings raise the possibility that STAT1 hyperactivition defines a subset of idiopathic aplastic anemia patients for whom JAK inhibition may be an efficacious therapy. FUNDING Funding was provided by the Massachusetts General Hospital Department of Medicine Pathways Program and NIH T32 AI007387. A trial registration is at https://clinicaltrials.gov/ct2/show/NCT03906318.
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Affiliation(s)
- Jacob M. Rosenberg
- Department of Medicine, Massachusetts General Hospital; Boston, MA, 02114,Ragon Institute of MGH, MIT, and Harvard; Cambridge, MA,Harvard Medical School; Boston, MA,Harvard T.H. Chan School of Public Health; Boston, MA,Corresponding Author and Lead Contact: Jacob M. Rosenberg, 55 Fruit Street, Boston, MA, 02114, USA, , 860-930-5744
| | - Joshua M. Peters
- Ragon Institute of MGH, MIT, and Harvard; Cambridge, MA,Broad Institute of MIT and Harvard; Cambridge, MA
| | - Travis Hughes
- Ragon Institute of MGH, MIT, and Harvard; Cambridge, MA,Harvard Medical School; Boston, MA,Institute for Medical Engineering and Science, Department of Chemistry, and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology; Cambridge, MA
| | - Caleb A. Lareau
- Harvard Medical School; Boston, MA,Broad Institute of MIT and Harvard; Cambridge, MA
| | - Leif S. Ludwig
- Harvard Medical School; Boston, MA,Broad Institute of MIT and Harvard; Cambridge, MA
| | - Lucas R. Massoth
- Harvard Medical School; Boston, MA,Department of Pathology, Massachusetts General Hospital; Boston, MA
| | - Christina Austin-Tse
- Department of Medicine, Massachusetts General Hospital; Boston, MA, 02114,Center for Genomic Medicine, Massachusetts General Hospital; Boston, MA,Laboratory for Molecular Medicine, Partners Personalized Medicine; Cambridge, MA,Department of Pathology, Massachusetts General Hospital; Boston, MA
| | - Heidi L. Rehm
- Department of Medicine, Massachusetts General Hospital; Boston, MA, 02114,Harvard Medical School; Boston, MA,Broad Institute of MIT and Harvard; Cambridge, MA,Center for Genomic Medicine, Massachusetts General Hospital; Boston, MA,Department of Pathology, Massachusetts General Hospital; Boston, MA
| | - Bryan Bryson
- Ragon Institute of MGH, MIT, and Harvard; Cambridge, MA,Institute for Medical Engineering and Science, Department of Chemistry, and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology; Cambridge, MA
| | - Yi-Bin Chen
- Department of Medicine, Massachusetts General Hospital; Boston, MA, 02114,Massachusetts General Hospital Cancer Center; Boston, MA
| | - Aviv Regev
- Broad Institute of MIT and Harvard; Cambridge, MA,Genentech, South San Francisco, CA, USA
| | - Alex K. Shalek
- Ragon Institute of MGH, MIT, and Harvard; Cambridge, MA,Harvard Medical School; Boston, MA,Institute for Medical Engineering and Science, Department of Chemistry, and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology; Cambridge, MA,Broad Institute of MIT and Harvard; Cambridge, MA
| | - Sarah M. Fortune
- Ragon Institute of MGH, MIT, and Harvard; Cambridge, MA,Harvard Medical School; Boston, MA,Harvard T.H. Chan School of Public Health; Boston, MA
| | - David B. Sykes
- Department of Medicine, Massachusetts General Hospital; Boston, MA, 02114,Center for Regenerative Medicine, Department of Medicine, Massachusetts General Hospital; Boston, MA,Harvard Stem Cell Institute; Cambridge, MA,Massachusetts General Hospital Cancer Center; Boston, MA
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Kemps PG, Picarsic J, Durham BH, Hélias-Rodzewicz Z, Hiemcke-Jiwa L, van den Bos C, van de Wetering MD, van Noesel CJM, van Laar JAM, Verdijk RM, Flucke UE, Hogendoorn PCW, Woei-A-Jin FJSH, Sciot R, Beilken A, Feuerhake F, Ebinger M, Möhle R, Fend F, Bornemann A, Wiegering V, Ernestus K, Méry T, Gryniewicz-Kwiatkowska O, Dembowska-Baginska B, Evseev DA, Potapenko V, Baykov VV, Gaspari S, Rossi S, Gessi M, Tamburrini G, Héritier S, Donadieu J, Bonneau-Lagacherie J, Lamaison C, Farnault L, Fraitag S, Jullié ML, Haroche J, Collin M, Allotey J, Madni M, Turner K, Picton S, Barbaro PM, Poulin A, Tam IS, El Demellawy D, Empringham B, Whitlock JA, Raghunathan A, Swanson AA, Suchi M, Brandt JM, Yaseen NR, Weinstein JL, Eldem I, Sisk BA, Sridhar V, Atkinson M, Massoth LR, Hornick JL, Alexandrescu S, Yeo KK, Petrova-Drus K, Peeke SZ, Muñoz-Arcos LS, Leino DG, Grier DD, Lorsbach R, Roy S, Kumar AR, Garg S, Tiwari N, Schafernak KT, Henry MM, van Halteren AGS, Abla O, Diamond EL, Emile JF. ALK-positive histiocytosis: a new clinicopathologic spectrum highlighting neurologic involvement and responses to ALK inhibition. Blood 2022; 139:256-280. [PMID: 34727172 PMCID: PMC8759533 DOI: 10.1182/blood.2021013338] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022] Open
Abstract
ALK-positive histiocytosis is a rare subtype of histiocytic neoplasm first described in 2008 in 3 infants with multisystemic disease involving the liver and hematopoietic system. This entity has subsequently been documented in case reports and series to occupy a wider clinicopathologic spectrum with recurrent KIF5B-ALK fusions. The full clinicopathologic and molecular spectra of ALK-positive histiocytosis remain, however, poorly characterized. Here, we describe the largest study of ALK-positive histiocytosis to date, with detailed clinicopathologic data of 39 cases, including 37 cases with confirmed ALK rearrangements. The clinical spectrum comprised distinct clinical phenotypic groups: infants with multisystemic disease with liver and hematopoietic involvement, as originally described (Group 1A: 6/39), other patients with multisystemic disease (Group 1B: 10/39), and patients with single-system disease (Group 2: 23/39). Nineteen patients of the entire cohort (49%) had neurologic involvement (7 and 12 from Groups 1B and 2, respectively). Histology included classic xanthogranuloma features in almost one-third of cases, whereas the majority displayed a more densely cellular, monomorphic appearance without lipidized histiocytes but sometimes more spindled or epithelioid morphology. Neoplastic histiocytes were positive for macrophage markers and often conferred strong expression of phosphorylated extracellular signal-regulated kinase, confirming MAPK pathway activation. KIF5B-ALK fusions were detected in 27 patients, whereas CLTC-ALK, TPM3-ALK, TFG-ALK, EML4-ALK, and DCTN1-ALK fusions were identified in single cases. Robust and durable responses were observed in 11/11 patients treated with ALK inhibition, 10 with neurologic involvement. This study presents the existing clinicopathologic and molecular landscape of ALK-positive histiocytosis and provides guidance for the clinical management of this emerging histiocytic entity.
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Affiliation(s)
- Paul G Kemps
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jennifer Picarsic
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Benjamin H Durham
- Human Oncology and Pathogenesis Program, Department of Medicine, and
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Zofia Hélias-Rodzewicz
- Department of Pathology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
- EA4340-Biomarqueurs et Essais Cliniques en Cancérologie et Onco-Hématologie, Versailles Saint-Quentin-en-Yvelines University, Boulogne, France
| | | | - Cor van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Emma Children's Hospital, and
| | - Marianne D van de Wetering
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Emma Children's Hospital, and
| | - Carel J M van Noesel
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jan A M van Laar
- Department of Internal Medicine and Immunology, and
- Section of Clinical Immunology, Department of Immunology, and
| | - Robert M Verdijk
- Department of Pathology, Erasmus Medical Center University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Uta E Flucke
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - F J Sherida H Woei-A-Jin
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | | | - Martin Ebinger
- Department I - General Pediatrics, Children's Hospital, Hematology and Oncology
| | | | - Falko Fend
- Department of Pathology and Neuropathology and Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany
| | - Antje Bornemann
- Department of Pathology and Neuropathology and Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany
| | - Verena Wiegering
- Department of Oncology, Hematology and Stem Cell Transplantation, University Children's Hospital Würzburg, Würzburg, Germany
| | - Karen Ernestus
- Department of Pathology, University of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Tina Méry
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Klinikum Chemnitz, Chemnitz, Germany
| | | | | | - Dmitry A Evseev
- Dmitriy Rogachev National Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Vsevolod Potapenko
- Department of Hematology and Oncology, Municipal Educational Hospital N°31, Saint Petersburg, Russia
- Department of Bone Marrow Transplantation and
| | - Vadim V Baykov
- Department of Pathology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Stefania Gaspari
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Laboratories Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Gianpiero Tamburrini
- Department of Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sébastien Héritier
- Department of Pediatric Hematology and Oncology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Donadieu
- EA4340-Biomarqueurs et Essais Cliniques en Cancérologie et Onco-Hématologie, Versailles Saint-Quentin-en-Yvelines University, Boulogne, France
- Department of Pediatric Hematology and Oncology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Claire Lamaison
- Department of Pathology, Rennes University Hospital, Rennes, France
| | - Laure Farnault
- Department of Hematology, La Conception, University Hospital of Marseille, Marseille, France
| | - Sylvie Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie-Laure Jullié
- Department of Pathology, University Hospital of Bordeaux, Bordeaux, France
| | - Julien Haroche
- Department of Internal Medicine, University Hospital La Pitié-Salpêtrière Paris, French National Reference Center for Histiocytoses, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthew Collin
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | | | - Majid Madni
- Department of Pediatric Hematology and Oncology, Nottingham University Hospitals, Nottingham, United Kingdom
| | | | - Susan Picton
- Department of Pediatric Oncology, Leeds Children's Hospital, Leeds, United Kingdom
| | - Pasquale M Barbaro
- Department of Hematology, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Alysa Poulin
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ingrid S Tam
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dina El Demellawy
- Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Brianna Empringham
- Department of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James A Whitlock
- Department of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Amy A Swanson
- Division of Anatomic Pathology, Mayo Clinic Rochester, Rochester, MN
| | - Mariko Suchi
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Jon M Brandt
- Department of Pediatric Oncology, Hospital Sisters Health System St Vincent Children's Hospital, Green Bay, WI
| | - Nabeel R Yaseen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joanna L Weinstein
- Department of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Irem Eldem
- Department of Pediatric Hematology and Oncology, St Louis Children's Hospital, Washington University in St Louis, St Louis, MO
| | - Bryan A Sisk
- Department of Pediatric Hematology and Oncology, St Louis Children's Hospital, Washington University in St Louis, St Louis, MO
| | - Vaishnavi Sridhar
- Department of Pediatric Hematology and Oncology, Carilion Children's Pediatric Hematology and Oncology, Roanoke, VA
| | - Mandy Atkinson
- Department of Pediatric Hematology and Oncology, Carilion Children's Pediatric Hematology and Oncology, Roanoke, VA
| | - Lucas R Massoth
- Department of Pathology, Massachusetts General Hospital, and
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sanda Alexandrescu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Pathology, Boston Children's Hospital, Boston, MA
| | - Kee Kiat Yeo
- Department of Pediatric Oncology, Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | | | - Stephen Z Peeke
- Department of Hematology and Medical Oncology, Maimonides Medical Center, Brooklyn, NY
| | - Laura S Muñoz-Arcos
- Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel G Leino
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David D Grier
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Robert Lorsbach
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Somak Roy
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Ashish R Kumar
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | - Michael M Henry
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ
| | - Astrid G S van Halteren
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Oussama Abla
- Department of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jean-François Emile
- Department of Pathology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
- EA4340-Biomarqueurs et Essais Cliniques en Cancérologie et Onco-Hématologie, Versailles Saint-Quentin-en-Yvelines University, Boulogne, France
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Affiliation(s)
- Hanno Hock
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
| | - Hillary R Kelly
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
| | - Eric A Meyerowitz
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
| | - Matthew J Frigault
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
| | - Lucas R Massoth
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
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Venkataraman V, Massoth LR, Sullivan RJ, Friedmann AM. Secondary histiocytic sarcoma with BRAF V600E mutation responsive to MAPK-targeted therapy presenting with recurrence with mTOR mutation responsive to mTOR-targeted therapy. Pediatr Blood Cancer 2021; 68:e29166. [PMID: 34061432 DOI: 10.1002/pbc.29166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Vinayak Venkataraman
- Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucas R Massoth
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ryan J Sullivan
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alison M Friedmann
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
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Massoth LR, Hung YP, Ferry JA, Hasserjian RP, Nardi V, Nielsen GP, Sadigh S, Venkataraman V, Selig M, Friedmann AM, Samore W, Killian JK, Milante R, Giessinger J, Foley-Peres K, Marcus C, Severson E, Duncan D, Sivakumar S, Ross JS, Desphande V, Ramkissoon SH, Vergilio JA, Louissaint A, Zukerberg LR, Williams EA. Histiocytic and Dendritic Cell Sarcomas of Hematopoietic Origin Share Targetable Genomic Alterations Distinct from Follicular Dendritic Cell Sarcoma. Oncologist 2021; 26:e1263-e1272. [PMID: 33904632 PMCID: PMC8265357 DOI: 10.1002/onco.13801] [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: 12/31/2020] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Background Histiocytic and dendritic cell neoplasms are a diverse group of tumors arising from monocytic or dendritic cell lineage. Whereas the genomic features for Langerhans cell histiocytosis and Erdheim‐Chester disease have been well described, other less common and often aggressive tumors in this broad category remain poorly characterized, and comparison studies across the World Health Organization diagnostic categories are lacking. Methods Tumor samples from a total of 102 patient cases within four major subtypes of malignant histiocytic and dendritic cell neoplasms, including 44 follicular dendritic cell sarcomas (FDCSs), 41 histiocytic sarcomas (HSs), 7 interdigitating dendritic cell sarcomas (IDCSs), and 10 Langerhans cell sarcomas (LCSs), underwent hybridization capture with analysis of up to 406 cancer‐related genes. Results Among the entire cohort of 102 patients, CDKN2A mutations were most frequent across subtypes and made up 32% of cases, followed by TP53 mutations (22%). Mitogen‐activated protein kinase (MAPK) pathway mutations were present and enriched among the malignant histiocytosis (M) group (HS, IDCS, and LCS) but absent in FDCS (72% vs. 0%; p < .0001). In contrast, NF‐κB pathway mutations were frequent in FDCSs but rare in M group histiocytoses (61% vs. 12%; p < .0001). Tumor mutational burden was significantly higher in M group histiocytoses as compared with FDCSs (median 4.0/Mb vs. 2.4/Mb; p = .012). We also describe a pediatric patient with recurrent secondary histiocytic sarcoma treated with targeted therapy and interrogated by molecular analysis to identify mechanisms of therapeutic resistance. Conclusion A total of 42 patient tumors (41%) harbored pathogenic mutations that were potentially targetable by approved and/or investigative therapies. Our findings highlight the potential value of molecular testing to enable precise tumor classification, identify candidate oncogenic drivers, and define personalized therapeutic options for patients with these aggressive tumors. Implications for Practice This study presents comprehensive genomic profiling results on 102 patient cases within four major subtypes of malignant histiocytic and dendritic cell neoplasms, including 44 follicular dendritic cell sarcomas (FDCSs), 41 histiocytic sarcomas (HSs), 7 interdigitating dendritic cell sarcomas (IDCSs), and 10 Langerhans cell sarcomas (LCSs). MAPK pathway mutations were present and enriched among the malignant histiocytosis (M) group (HS, IDCS, and LCS) but absent in FDCSs. In contrast, NF‐κB pathway mutations were frequent in FDCSs but rare in M group histiocytosis. A total of 42 patient tumors (41%) harbored pathogenic mutations that were potentially targetable by approved and/or investigative therapies. Histiocytic and dendritic cell neoplasms are a diverse group of tumors arising from the monocytic or dendritic cell lineage. This article presents the molecular characteristics of the four major subtypes of malignant histiocytic and dendritic cell neoplasms, focusing on genomic alterations that could represent therapeutic targets.
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Affiliation(s)
- Lucas R Massoth
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sam Sadigh
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Vinayak Venkataraman
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Selig
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alison M Friedmann
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Wesley Samore
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Riza Milante
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Joseph Giessinger
- A.T. Still University School of Osteopathic Medicine, Mesa, Arizona, USA
| | - Kathleen Foley-Peres
- Department of Biology, Bristol Community College, Fall River, Massachusetts, USA
| | - Chelsea Marcus
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | - Eric Severson
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | - Daniel Duncan
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | | | - Jeffrey S Ross
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA.,Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Vikram Desphande
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shakti H Ramkissoon
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA.,Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence R Zukerberg
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Erik A Williams
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA.,Department of Pathology, Department of Dermatology, UCSF Dermatopathology Service, University of California San Francisco, San Francisco, California, USA
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Bouffard MA, Chwalisz BK, Romero JM, Arrillaga-Romany IC, Massoth LR. Case 6-2021: A 65-Year-Old Man with Eye Pain and Decreased Vision. N Engl J Med 2021; 384:745-753. [PMID: 33626257 DOI: 10.1056/nejmcpc2027089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marc A Bouffard
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
| | - Bart K Chwalisz
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
| | - Javier M Romero
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
| | - Isabel C Arrillaga-Romany
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
| | - Lucas R Massoth
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
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Sadigh S, Massoth LR, Christensen BB, Stefely JA, Keefe J, Sohani AR. Peripheral blood morphologic findings in patients with COVID-19. Int J Lab Hematol 2020; 42:e248-e251. [PMID: 32730694 DOI: 10.1111/ijlh.13300] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/15/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sam Sadigh
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucas R Massoth
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bianca B Christensen
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan A Stefely
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joan Keefe
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aliyah R Sohani
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
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Venkataraman V, Massoth LR, Sullivan RJ, Friedmann AM. Secondary histiocytic sarcoma with BRAF V600E mutation after T-cell acute lymphoblastic leukemia in a very young child with dramatic response to dabrafenib and trametinib. Pediatr Blood Cancer 2020; 67:e28200. [PMID: 32037654 DOI: 10.1002/pbc.28200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/02/2020] [Accepted: 01/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Vinayak Venkataraman
- Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Lucas R Massoth
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ryan J Sullivan
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alison M Friedmann
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
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Massoth LR, Selig MK, Little BP, Chebib I, Kradin RL. Multiple calcifying fibrous pseudotumors of the pleura: ultrastructural analysis provides insight on mechanism of dissemination. Ultrastruct Pathol 2020; 43:154-161. [PMID: 31746679 DOI: 10.1080/01913123.2019.1687631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/25/2022]
Abstract
Calcifying fibrous pseudotumor (CFP) is a rare, benign soft tissue tumor that may uncommonly arise in the pleura. These tumors can show multifocal dissemination across the pleural surface, but the mechanism underlying this dissemination is unclear. Review of previously reported cases of pleural CFP demonstrates a strong predilection for basal and diaphragmatic pleural surfaces, and a significantly higher rate of multifocality compared with other locations. We present a 59-year-old male with multiple CFP of the pleura. Reactive-appearing adhesions spanning the pleural surfaces were present, and by electron microscopy, were involved by tumor. We suggest this is the likely mode of dissemination across the pleural surfaces.
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Affiliation(s)
- Lucas R Massoth
- Departments of Pathology (L.R.M., M.K.S., I.C., R.L.K.) and Radiology (B.P.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin K Selig
- Departments of Pathology (L.R.M., M.K.S., I.C., R.L.K.) and Radiology (B.P.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brent P Little
- Departments of Pathology (L.R.M., M.K.S., I.C., R.L.K.) and Radiology (B.P.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ivan Chebib
- Departments of Pathology (L.R.M., M.K.S., I.C., R.L.K.) and Radiology (B.P.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard L Kradin
- Departments of Pathology (L.R.M., M.K.S., I.C., R.L.K.) and Radiology (B.P.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Massoth LR, Hung YP, Dias-Santagata D, Onozato M, Shah N, Severson E, Duncan D, Gillespie BJ, Williams NF, Ross JS, Vergilio JA, Harkins SK, Glomski K, Nardi V, Zukerberg LR, Hasserjian RP, Louissaint A, Williams EA. Pan-Cancer Landscape Analysis Reveals Recurrent KMT2A- MAML2 Gene Fusion in Aggressive Histologic Subtypes of Thymoma. JCO Precis Oncol 2020; 4:1900288. [PMID: 32923872 DOI: 10.1200/po.19.00288] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Thymomas are epithelial neoplasms that represent the most common thymic tumors in adults. These tumors have been shown to harbor a relatively low mutational burden. As a result, there is a lack of genetic alterations that may be used prognostically or targeted therapeutically for this disease. Here, we describe a recurrent gene rearrangement in type B2 + B3 thymomas. PATIENTS AND METHODS A single index case of thymoma was evaluated by an RNA-based solid fusion assay. Separately, tissues from 255,008 unique advanced cancers, including 242 thymomas, were sequenced by hybrid capture-based next-generation DNA sequencing/comprehensive genomic profiling of 186 to 406 genes, including lysine methyltransferase 2A (KMT2A) rearrangements, and a portion were evaluated for RNA of 265 genes. We characterized molecular and clinicopathologic features of the pertinent fusion-positive patient cases. RESULTS We identified 11 patients with thymomas harboring a gene fusion of KMT2A and mastermind-like transcriptional coactivator 2 (MAML2). Fusion breakpoints were identified between exon 8, 9, 10, or 11 of KMT2A and exon 2 of MAML2. Fifty-five percent were men, with a median age of 48 years at surgery (range, 29-69 years). Concurrent genomic alterations were infrequent. The 11 thymomas were of B2 or B3 type histology, with 1 case showing foci of thymic carcinoma. The frequency of KMT2A-MAML2 fusion was 4% of all thymomas (10 of 242) and 6% of thymomas of B2 or B3 histology (10 of 169). CONCLUSION KMT2A-MAML2 represents the first recurrent fusion described in type B thymoma. The fusion seems to be specific to type B2 and B3 thymomas, the most aggressive histologic subtypes. The identification of this fusion offers insights into the biology of thymoma and may have clinical relevance for patients with disease refractory to conventional therapeutic modalities.
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Affiliation(s)
- Lucas R Massoth
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Dora Dias-Santagata
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Maristela Onozato
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | | | | | | | - Nathan F Williams
- Department of Mathematical Sciences, University of Texas at Dallas, Dallas, TX
| | - Jeffrey S Ross
- Foundation Medicine, Cambridge, MA.,Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY
| | | | - Shannon K Harkins
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Krzysztof Glomski
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Lawrence R Zukerberg
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Massoth LR, Hung YP, Nardi V, Nielsen GP, Hasserjian RP, Louissaint A, Fisch AS, Deshpande V, Zukerberg LR, Lennerz JK, Selig M, Glomski K, Patel PJ, Williams KJ, Sokol ES, Alexander BM, Vergilio JA, Ross JS, Pavlick DC, Chebib I, Williams EA. Pan-sarcoma genomic analysis of KMT2A rearrangements reveals distinct subtypes defined by YAP1-KMT2A-YAP1 and VIM-KMT2A fusions. Mod Pathol 2020; 33:2307-2317. [PMID: 32461620 PMCID: PMC7581494 DOI: 10.1038/s41379-020-0582-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
Sarcomas are driven by diverse pathogenic mechanisms, including gene rearrangements in a subset of cases. Rare soft tissue sarcomas containing KMT2A fusions have recently been reported, characterized by a predilection for young adults, sclerosing epithelioid fibrosarcoma-like morphology, and an often aggressive course. Nonetheless, clinicopathologic and molecular descriptions of KMT2A-rearranged sarcomas remain limited. In this study, we identified by targeted next-generation RNA sequencing an index patient with KMT2A fusion-positive soft tissue sarcoma. In addition, we systematically searched for KMT2A structural variants in a comprehensive genomic profiling database of 14,680 sarcomas interrogated by targeted next-generation DNA and/or RNA sequencing. We characterized the clinicopathologic and molecular features of KMT2A fusion-positive sarcomas, including KMT2A breakpoints, rearrangement partners, and concurrent genetic alterations. Collectively, we identified a cohort of 34 sarcomas with KMT2A fusions (0.2%), and YAP1 was the predominant partner (n = 16 [47%]). Notably, a complex rearrangement with YAP1 consistent with YAP1-KMT2A-YAP1 fusion was detected in most cases, with preservation of KMT2A CxxC-binding domain in the YAP1-KMT2A-YAP1 fusion and concurrent deletions of corresponding exons in KMT2A. The tumors often affected younger adults (age 20-66 [median 40] years) and histologically showed variably monomorphic epithelioid-to-spindle shaped cells embedded in a dense collagenous stroma. Ultrastructural evidence of fibroblastic differentiation was noted in one tumor examined. Our cohort also included two sarcomas with VIM-KMT2A fusions, each harboring concurrent mutations in CTNNB1, SMARCB1, and ARID1A and characterized histologically by sheets of spindle-to-round blue cells. The remaining 16 KMT2A-rearranged sarcomas in our cohort exhibited diverse histologic subtypes, each with unique novel fusion partners. In summary, KMT2A-fusion-positive sarcomas most commonly exhibit sclerosing epithelioid fibrosarcoma-like morphology and complex YAP1-KMT2A-YAP1 fusions. Cases also include rare spindle-to-round cell sarcomas with VIM-KMT2A fusions and tumors of diverse histologic subtypes with unique KMT2A fusions to non-YAP1 non-VIM partners.
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Affiliation(s)
- Lucas R. Massoth
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Yin P. Hung
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Valentina Nardi
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - G. Petur Nielsen
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Robert P. Hasserjian
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Abner Louissaint
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Adam S. Fisch
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Vikram Deshpande
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Lawrence R. Zukerberg
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Jochen K. Lennerz
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Martin Selig
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Krzysztof Glomski
- grid.277313.30000 0001 0626 2712Department of Pathology and Laboratory Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102 USA
| | - Parth J. Patel
- grid.264727.20000 0001 2248 3398Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140 USA
| | - Kevin Jon Williams
- grid.264727.20000 0001 2248 3398Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140 USA ,grid.264727.20000 0001 2248 3398Department of Physiology and Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140 USA
| | - Ethan S. Sokol
- grid.418158.10000 0004 0534 4718Foundation Medicine, Inc., 150 Second Street, Cambridge, MA 02141 USA
| | - Brian M. Alexander
- grid.418158.10000 0004 0534 4718Foundation Medicine, Inc., 150 Second Street, Cambridge, MA 02141 USA
| | - Jo-Anne Vergilio
- grid.418158.10000 0004 0534 4718Foundation Medicine, Inc., 150 Second Street, Cambridge, MA 02141 USA
| | - Jeffrey S. Ross
- grid.418158.10000 0004 0534 4718Foundation Medicine, Inc., 150 Second Street, Cambridge, MA 02141 USA ,grid.411023.50000 0000 9159 4457Department of Pathology, State University of New York Upstate Medical University, 766 Irving Avenue, Syracuse, NY 13210 USA
| | - Dean C. Pavlick
- grid.418158.10000 0004 0534 4718Foundation Medicine, Inc., 150 Second Street, Cambridge, MA 02141 USA
| | - Ivan Chebib
- grid.38142.3c000000041936754XDepartment of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Erik A. Williams
- grid.418158.10000 0004 0534 4718Foundation Medicine, Inc., 150 Second Street, Cambridge, MA 02141 USA
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Ison MG, Lebeis TA, Barros N, Lewis GD, Massoth LR. Case 20-2019: A 52-Year-Old Woman with Fever and Rash after Heart Transplantation. N Engl J Med 2019; 380:2564-2573. [PMID: 31242366 DOI: 10.1056/nejmcpc1904040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael G Ison
- From the Department of Medicine, Northwestern Memorial Hospital, and the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Taylor A Lebeis
- From the Department of Medicine, Northwestern Memorial Hospital, and the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Nicolas Barros
- From the Department of Medicine, Northwestern Memorial Hospital, and the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Gregory D Lewis
- From the Department of Medicine, Northwestern Memorial Hospital, and the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Lucas R Massoth
- From the Department of Medicine, Northwestern Memorial Hospital, and the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (T.A.L., N.B., G.D.L.) and Pathology (L.R.M.), Harvard Medical School - both in Boston
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Affiliation(s)
- Andrew Z Fenves
- From the Departments of Medicine (A.Z.F.), Radiology (A.M.), Psychiatry (M.N.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (A.Z.F.), Radiology (A.M.), Psychiatry (M.N.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Amirkasra Mojtahed
- From the Departments of Medicine (A.Z.F.), Radiology (A.M.), Psychiatry (M.N.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (A.Z.F.), Radiology (A.M.), Psychiatry (M.N.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Mladen Nisavic
- From the Departments of Medicine (A.Z.F.), Radiology (A.M.), Psychiatry (M.N.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (A.Z.F.), Radiology (A.M.), Psychiatry (M.N.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Lucas R Massoth
- From the Departments of Medicine (A.Z.F.), Radiology (A.M.), Psychiatry (M.N.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (A.Z.F.), Radiology (A.M.), Psychiatry (M.N.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
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Affiliation(s)
- Jacob D Soumerai
- From the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Shahein H Tajmir
- From the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Martin S Hirsch
- From the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Lucas R Massoth
- From the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
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