1
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Nielson KJ, Rowsey R, Dasari S, Sukov WR, Kipp BR, Raghunathan A, Whaley RD, Ebare K, Stanton ML, Reynolds JP, Sharma V, Thompson RH, Boorjian SA, Leibovich BC, Hernandez LH, Jimenez RE, Cheville JC, Gupta S. Single nucleotide polymorphism (SNP) chromosomal microarray as a diagnostic tool for mucinous tubular and spindle cell carcinoma: A validation study. Hum Pathol 2024; 146:57-65. [PMID: 38615998 DOI: 10.1016/j.humpath.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
Mucinous tubular and spindle cell carcinoma (MTSCC) shows significant overlap with papillary renal cell carcinoma (PRCC), and harbor recurrent copy-number alterations (CNA). We evaluated 16 RCC with features suggestive of MTSCC using chromosomal microarrays. The cohort was comprised of 8 females and males, each, with an age range of 33-79 years (median, 59), and a tumor size range of 3.4-15.5 cm (median, 5.0). Half the tumors were high-grade (8/16, 50%) with features such as necrosis, marked cytologic atypia, and sarcomatoid differentiation, and 5/16 (31%) were high stage (≥pT3a). Three (of 16, 19%) cases had a predominant (>95%) spindle cell component, whereas 5/16 (31%) were composed of a predominant (>95%) epithelial component. Most cases (12/16, 75%) exhibited a myxoid background and/or extravasated mucin, at least focally. Twelve (of 16, 75%) cases demonstrated CNA diagnostic of MTSCC (losses of chromosomes 1, 4, 6, 8, 9, 13, 14, 15, and 22). In addition, 2 high-grade tumors showed loss of CDKN2A/B, and gain of 1q, respectively, both of which are associated with aggressive behavior. Three (of 16, 19%) cases, demonstrated nonspecific CNA, and did not meet diagnostic criteria for established RCC subtypes. One (of 16, 6%) low-grade epithelial predominant tumor (biopsy) demonstrated characteristic gains of 7, 17, and loss of Y, diagnostic of PRCC. MTSCC can be a morphologically heterogenous tumor. Our study validates the detection of characteristic chromosomal CNA for diagnostic use that may be useful in challenging cases with unusual spindle cell or epithelial predominant features, as well as in high-grade tumors.
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MESH Headings
- Humans
- Female
- Middle Aged
- Male
- Aged
- Adult
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Kidney Neoplasms/diagnosis
- Polymorphism, Single Nucleotide
- Adenocarcinoma, Mucinous/genetics
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/diagnosis
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/analysis
- DNA Copy Number Variations
- Carcinoma/genetics
- Carcinoma/pathology
- Carcinoma/diagnosis
- Oligonucleotide Array Sequence Analysis
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/diagnosis
- Predictive Value of Tests
- Neoplasm Grading
- Reproducibility of Results
- Diagnosis, Differential
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Affiliation(s)
- Kaitlyn J Nielson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Ross Rowsey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA.
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Kingsley Ebare
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, 85054, USA.
| | - Melissa L Stanton
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, 85054, USA.
| | - Jordan P Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, 32224, USA.
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN, 55905, USA.
| | | | | | | | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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2
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Tekin B, Hofich CD, Pitel BA, Schoolmeester JK, Whaley RD, Raghunathan A, Ebare K, Stanton ML, Reynolds JP, Sharma V, Thompson RH, Boorjian SA, Leibovich BC, Herrera Hernandez LP, Jimenez RE, Cheville JC, Ketterling RP, Geiersbach KB, Greipp PT, Sukov WR, Kipp BR, Halling KC, Gupta S. Next generation sequencing-based identification of fusion-driven renal neoplasia: A single institution experience. Hum Pathol 2023:S0046-8177(23)00253-8. [PMID: 38145826 DOI: 10.1016/j.humpath.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Christopher D Hofich
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Beth A Pitel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Kingsley Ebare
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA.
| | - Melissa L Stanton
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA.
| | - Jordan P Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA.
| | - Vidit Sharma
- The Department of Urology, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Rhett P Ketterling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | - Patricia T Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Kevin C Halling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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3
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El Khoury LY, Pan X, Hlady RA, Wagner RT, Shaikh S, Wang L, Humphreys MR, Castle EP, Stanton ML, Ho TH, Robertson KD. Extensive intratumor regional epigenetic heterogeneity in clear cell renal cell carcinoma targets kidney enhancers and is associated with poor outcome. Clin Epigenetics 2023; 15:71. [PMID: 37120552 PMCID: PMC10149001 DOI: 10.1186/s13148-023-01471-3] [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: 12/09/2022] [Accepted: 03/21/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Clear cell renal cell cancer (ccRCC), the 8th leading cause of cancer-related death in the US, is challenging to treat due to high level intratumoral heterogeneity (ITH) and the paucity of druggable driver mutations. CcRCC is unusual for its high frequency of epigenetic regulator mutations, such as the SETD2 histone H3 lysine 36 trimethylase (H3K36me3), and low frequency of traditional cancer driver mutations. In this work, we examined epigenetic level ITH and defined its relationships with pathologic features, aspects of tumor biology, and SETD2 mutations. RESULTS A multi-region sampling approach coupled with EPIC DNA methylation arrays was conducted on a cohort of normal kidney and ccRCC. ITH was assessed using DNA methylation (5mC) and CNV-based entropy and Euclidian distances. We found elevated 5mC heterogeneity and entropy in ccRCC relative to normal kidney. Variable CpGs are highly enriched in enhancer regions. Using intra-class correlation coefficient analysis, we identified CpGs that segregate tumor regions according to clinical phenotypes related to tumor aggressiveness. SETD2 wild-type tumors overall possess greater 5mC and copy number ITH than SETD2 mutant tumor regions, suggesting SETD2 loss contributes to a distinct epigenome. Finally, coupling our regional data with TCGA, we identified a 5mC signature that links regions within a primary tumor with metastatic potential. CONCLUSION Taken together, our results reveal marked levels of epigenetic ITH in ccRCC that are linked to clinically relevant tumor phenotypes and could translate into novel epigenetic biomarkers.
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Affiliation(s)
- Louis Y El Khoury
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Xiaoyu Pan
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Ryan A Hlady
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Ryan T Wagner
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Shafiq Shaikh
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Liguo Wang
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - Erik P Castle
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Thai H Ho
- Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
| | - Keith D Robertson
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA.
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4
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Sykora D, Chaliki HP, Cummings KW, Sell-Dottin K, Stanton ML, Scott LR. Incidentally Discovered Right Atrial Mass: A Rare and Unexpected Etiology. Tex Heart Inst J 2023; 50:492268. [PMID: 37060553 PMCID: PMC10178659 DOI: 10.14503/thij-21-7735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Primary cardiac sarcoma is a rare type of intracardiac mass. This report describes a patient with atrial flutter who had a new right atrial mass incidentally discovered on transesophageal echocardiography. A thrombus was suspected based on radiographic appearance, but there was minimal change with anticoagulation. The mass was resected and found to be an undifferentiated pleomorphic cardiac sarcoma, an uncommon sub-type within the already rare category of primary cardiac neoplasms. This report highlights the importance of considering primary malignancy and thoroughly correlating radiographic and clinical evidence during the diagnostic workup of patients with intracardiac masses.
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Affiliation(s)
- Daniel Sykora
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Hari P Chaliki
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Kristen Sell-Dottin
- Department of Cardiovascular Surgery, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Luis R Scott
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
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5
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Janiszewski RA, Pham M, Stanton ML, Nguyen BD. Imaging and pathologic correlation of composite pheochromocytoma-ganglioneuroma. Jpn J Clin Oncol 2023; 53:452-453. [PMID: 36846927 DOI: 10.1093/jjco/hyad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023] Open
Affiliation(s)
| | - Mitchel Pham
- Department of Radiology, Mayo Clinic Arizona, Arizona, USA
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ba D Nguyen
- Department of Radiology, Mayo Clinic Arizona, Arizona, USA
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6
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Hoegger MJ, Strnad BS, Ballard DH, Siegel CL, Shetty AS, Weimholt RC, Yano M, Stanton ML, Mellnick VM, Kawashima A, Zulfiqar M. Urinary Bladder Masses, Rare Subtypes, and Masslike Lesions: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e220034. [PMID: 36490210 DOI: 10.1148/rg.220034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Urinary bladder masses are commonly encountered in clinical practice, with 95% arising from the epithelial layer and rarer tumors arising from the lamina propria, muscularis propria, serosa, and adventitia. The extent of neoplastic invasion into these bladder layers is assessed with multimodality imaging, and the MRI-based Vesical Imaging Reporting and Data System is increasingly used to aid tumor staging. Given the multiple layers and cell lineages, a diverse array of pathologic entities can arise from the urinary bladder, and distinguishing among benign, malignant, and nonneoplastic entities is not reliably feasible in most cases. Pathologic assessment remains the standard of care for classification of bladder masses. Although urothelial carcinoma accounts for most urinary bladder malignancies in the United States, several histopathologic entities exist, including squamous cell carcinoma, adenocarcinoma, melanoma, and neuroendocrine tumors. Furthermore, there are variant histopathologic subtypes of urothelial carcinoma (eg, the plasmacytoid variant), which are often aggressive. Atypical benign bladder masses are diverse and can have inflammatory or iatrogenic causes and mimic malignancy. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Mark J Hoegger
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Benjamin S Strnad
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Cary L Siegel
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Anup S Shetty
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - R Cody Weimholt
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Motoyo Yano
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Melissa L Stanton
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Akira Kawashima
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
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7
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Gupta S, Stanton ML, Reynolds JP, Whaley RD, Herrera-Hernandez L, Jimenez RE, Cheville JC. Lessons from histopathologic examination of nephrectomy specimens in patients with tuberous sclerosis complex: cysts, angiomyolipomas, and renal cell carcinoma. Hum Pathol 2022; 129:123-139. [PMID: 36115585 DOI: 10.1016/j.humpath.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/08/2022] [Indexed: 02/07/2023]
Abstract
Renal manifestations in patients with tuberous sclerosis complex (TSC) include cysts, angiomyolipoma, and renal cell carcinoma. Unlike many hereditary predisposition syndromes, the spectrum of renal tumors in TSC patients (including both angiomyolipoma and renal cell carcinoma) is broad, with significant morphologic heterogeneity. An improved understanding of histopathologic findings in TSC patients and associated clinicopathologic correlates has significant implications not just in establishing a diagnosis of TSC, but also in the recognition of sporadic tumors occurring secondary to somatic alterations of TSC1/TSC2/MTOR pathway genes and accurate prognostication. In this review, we have discussed issues relevant to clinical management based on histopathologic findings in nephrectomy specimens from patients with TSC. This includes discussions related to screening for TSC, diagnosis of PKD1/TSC2 contiguous gene deletion syndrome, the morphologic spectrum of angiomyolipoma and renal epithelium-derived neoplasia, including the risk of disease progression.
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Affiliation(s)
- Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, 85054, USA.
| | - Jordan P Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, 32224, USA.
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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8
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McCarthy MR, Nichols PE, Sharma V, Stanton ML, Reynolds JP, Pitel BA, Halling KC, Lohse CM, Herrera-Hernandez L, Thompson RH, Leibovich BC, Jimenez RE, Boorjian SA, Cheville JC, Gupta S. Molecular and Immunophenotypic Correlates of Metastatic Epithelioid Angiomyolipoma Include Alterations of TP53, RB1, and ATRX. Arch Pathol Lab Med 2022:488042. [DOI: 10.5858/arpa.2022-0127-oa] [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] [Accepted: 05/26/2022] [Indexed: 11/06/2022]
Abstract
Context.—
Epithelioid angiomyolipomas (eAMLs) are rare tumors of the kidney that occur in patients with tuberous sclerosis complex or in a sporadic setting; a subset of these tumors exhibit metastatic behavior.
Objective.—
To analyze molecular profiling data to identify pathogenic alterations in rare cases of metastatic eAML, and to identify immunohistochemistry (IHC)-based surrogate markers.
Design.—
Molecular profiling data from the American Association for Cancer Research GENIE registry was accessed for 23 patients with angiomyolipomas, and 9 of 16 patients with eAMLs in our institutional registry were evaluated with next-generation sequencing. IHC was performed to screen for alterations of P53, RB, and ATRX for all 16 institutional cases.
Results.—
Combined alterations of 5 tumor-suppressor genes (TP53, ATRX, RB1, APC, and NF1) were identified using next-generation sequencing in 7 of 8 (88%) patients with metastatic disease compared to a single patient with nonmetastatic disease (RB1 variant of uncertain significance; 1 of 24, 4%). No cases with abnormal IHC results were identified in 11 patients with nonmetastatic disease compared to 3 of 5 patients with metastatic disease.
Conclusions.—
Our results show that the majority of metastatic eAMLs have mutations of 5 tumor-suppressor genes (TP53, ATRX, RB1, APC, and NF1), while these are rare in patients with nonmetastatic disease. Furthermore, IHC for P53, RB, and ATRX may serve as a screen for a subset of these alterations in resource-limited settings. These findings, if validated in larger data sets, have the potential to predict metastatic behavior in eAML.
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Affiliation(s)
- Michael R. McCarthy
- From the Department of Laboratory Medicine and Pathology (McCarthy, Pitel, Halling, Herrera-Hernandez, Jimenez, Cheville, Gupta), Mayo Clinic, Rochester, Minnesota
| | - Paige E. Nichols
- Department of Urology (Nichols, Sharma, Thompson, Leibovich, Boorjian), Mayo Clinic, Rochester, Minnesota
| | - Vidit Sharma
- Department of Urology (Nichols, Sharma, Thompson, Leibovich, Boorjian), Mayo Clinic, Rochester, Minnesota
| | - Melissa L. Stanton
- Mayo Clinic, Rochester, Minnesota; the Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona (Stanton)
| | - Jordan P. Reynolds
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Reynolds)
| | - Beth A. Pitel
- From the Department of Laboratory Medicine and Pathology (McCarthy, Pitel, Halling, Herrera-Hernandez, Jimenez, Cheville, Gupta), Mayo Clinic, Rochester, Minnesota
| | - Kevin C. Halling
- From the Department of Laboratory Medicine and Pathology (McCarthy, Pitel, Halling, Herrera-Hernandez, Jimenez, Cheville, Gupta), Mayo Clinic, Rochester, Minnesota
| | - Christine M. Lohse
- Department of Quantitative Health Sciences (Lohse), Mayo Clinic, Rochester, Minnesota
| | - Loren Herrera-Hernandez
- From the Department of Laboratory Medicine and Pathology (McCarthy, Pitel, Halling, Herrera-Hernandez, Jimenez, Cheville, Gupta), Mayo Clinic, Rochester, Minnesota
| | - R. Houston Thompson
- Department of Urology (Nichols, Sharma, Thompson, Leibovich, Boorjian), Mayo Clinic, Rochester, Minnesota
| | - Bradley C. Leibovich
- Department of Urology (Nichols, Sharma, Thompson, Leibovich, Boorjian), Mayo Clinic, Rochester, Minnesota
| | - Rafael E. Jimenez
- From the Department of Laboratory Medicine and Pathology (McCarthy, Pitel, Halling, Herrera-Hernandez, Jimenez, Cheville, Gupta), Mayo Clinic, Rochester, Minnesota
| | - Stephen A. Boorjian
- Department of Urology (Nichols, Sharma, Thompson, Leibovich, Boorjian), Mayo Clinic, Rochester, Minnesota
| | - John C. Cheville
- From the Department of Laboratory Medicine and Pathology (McCarthy, Pitel, Halling, Herrera-Hernandez, Jimenez, Cheville, Gupta), Mayo Clinic, Rochester, Minnesota
| | - Sounak Gupta
- From the Department of Laboratory Medicine and Pathology (McCarthy, Pitel, Halling, Herrera-Hernandez, Jimenez, Cheville, Gupta), Mayo Clinic, Rochester, Minnesota
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9
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Pham M, Janiszewski RA, Stanton ML, Nguyen BD. Renal transplants with perinephric myxoid pseudotumor of fat mimicking malignancy. Jpn J Clin Oncol 2022; 52:654-655. [PMID: 35383369 DOI: 10.1093/jjco/hyac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mitchel Pham
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Scottsdale, Arizona, USA
| | - Ba D Nguyen
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Faraj KS, Judge N, Chang YHH, Blodgett G, Stanton ML, Tyson MD. Variation in Lymph Node Yield After Radical Cystectomy. Am J Clin Pathol 2021; 156:391-398. [PMID: 33608695 DOI: 10.1093/ajcp/aqaa247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To test the hypothesis that lymph node yield will vary by pathology assistant (PA) in patients undergoing radical cystectomy (RC) with pelvic lymph node dissection (PLND). METHODS This is a single-institution retrospective review that included patients who underwent an RC with PLND for bladder cancer from January 1, 2007, to January 1, 2018. Predicted mean lymph node counts were generated using multivariable regression analysis. RESULTS In a total of 430 patients who underwent RC with PLND, the median lymph node count (interquartile range) was 15.0 (11.0-21.0). The frequency of the limits of lymphadenectomy was as follows: external iliac, internal iliac, and obturator (true pelvis) (33.3%); true pelvis plus common iliac to the level of the aortic bifurcation (47.9%); and inferior mesenteric artery (18.8%). On descriptive analysis, there were differences in lymph node yield when evaluating the following variables: level of dissection, clinical stage, neoadjuvant chemotherapy, surgical approach, surgeon, pathologist, and PA (P < .05). On multivariable analysis, adjusted lymph node counts varied between surgeons, pathologists, clinical stage, and level of dissection but not by PA (P = .18). CONCLUSIONS Lymph node yield after RC varies on several known levels, including surgeon, extent of lymphadenectomy, clinical stage, and pathologist. This study found no significant variation in lymph node yield according to PA.
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Affiliation(s)
| | | | | | - Gail Blodgett
- Patient Collaboration, Mayo Clinic, Scottsdale, AZ, USA
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Kriegshauser JS, Dahiya N, Smith ML, Zhang N, Heilman RL, Stanton ML, Young SW, Patel MD. Added Benefit and Risk of an Additional Biopsy or Targeting With Contrast-Enhanced Ultrasound for Patients With Renal Transplants. J Ultrasound Med 2021; 40:1603-1611. [PMID: 33103276 DOI: 10.1002/jum.15544] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine whether renal transplant diagnoses substantially change when 2 biopsy sites are chosen and whether contrast-enhanced ultrasound (CEUS) has value for targeting the second site. METHODS We prospectively enrolled 40 patients undergoing ultrasound-guided renal transplant biopsy within 2 years of transplant: 20, surveillance; and 20, for cause. A CEUS examination was performed to identify cortical regions with subjectively altered flow. One biopsy was performed at the operator-preferred (primary) site regardless of CEUS findings. Another biopsy was done at a second location, either targeted to an area in which CEUS perfusion findings differed from the primary site (targeted) or at a random location (secondary) if no other area differed. Specimens were randomly labeled A or B; pathologists were blinded to the CEUS result and biopsy location. Location-specific CEUS assessments were recorded. Pathologic results were compared, including acute and chronic Banff scores and any new findings from the targeted or secondary biopsy. RESULTS Forty patients were enrolled between January 2016 and December 2018. No location-specific pathologic differences correlated with differences in CEUS assessments. The second biopsy provided additional information that changed management in 4 of 40 patients (10.0% [95% confidence interval, 2.8%-23.7%]). Major bleeding complications occurred in 3 of 40 (7.5%) patients. CONCLUSIONS Contrast-enhanced ultrasound targeting was not useful. Major bleeding complications were higher than expected, possibly due to the additional biopsy away from the operator-preferred location. Obtaining a second renal transplant biopsy from a substantially different area than the initial operator-preferred location provided additional clinically useful information in 10% of patients.
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Affiliation(s)
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Maxwell L Smith
- Division of Anatomic Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Nan Zhang
- Division Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Raymond L Heilman
- Division of Nephrology, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Division Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Melissa L Stanton
- Division Anatomic Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Scott W Young
- Department of Radiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Maitray D Patel
- Department of Radiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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12
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El Khoury LY, Fu S, Hlady RA, Wagner RT, Wang L, Eckel-Passow JE, Castle EP, Stanton ML, Thompson RH, Parker AS, Ho TH, Robertson KD. Identification of DNA methylation signatures associated with poor outcome in lower-risk Stage, Size, Grade and Necrosis (SSIGN) score clear cell renal cell cancer. Clin Epigenetics 2021; 13:12. [PMID: 33461589 PMCID: PMC7814746 DOI: 10.1186/s13148-020-00998-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite using prognostic algorithms and standard surveillance guidelines, 17% of patients initially diagnosed with low risk clear cell renal cell carcinoma (ccRCC) ultimately relapse and die of recurrent disease, indicating additional molecular parameters are needed for improved prognosis. RESULTS To address the gap in ccRCC prognostication in the lower risk population, we performed a genome-wide analysis for methylation signatures capable of distinguishing recurrent and non-recurrent ccRCCs within the subgroup classified as 'low risk' by the Mayo Clinic Stage, Size, Grade, and Necrosis score (SSIGN 0-3). This approach revealed that recurrent patients have globally hypermethylated tumors and differ in methylation significantly at 5929 CpGs. Differentially methylated CpGs (DMCpGs) were enriched in regulatory regions and genes modulating cell growth and invasion. A subset of DMCpGs stratified low SSIGN groups into high and low risk of recurrence in independent data sets, indicating that DNA methylation enhances the prognostic power of the SSIGN score. CONCLUSIONS This study reports a global DNA hypermethylation in tumors of recurrent ccRCC patients. Furthermore, DMCpGs were capable of discriminating between aggressive and less aggressive tumors, in addition to SSIGN score. Therefore, DNA methylation presents itself as a potentially strong biomarker to further improve prognostic power in patients with low risk SSIGN score (0-3).
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Affiliation(s)
- Louis Y El Khoury
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA.,Center for Individualized Medicine, Epigenomics Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shuang Fu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA.,Center for Individualized Medicine, Epigenomics Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Hematology Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ryan A Hlady
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA.,Center for Individualized Medicine, Epigenomics Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ryan T Wagner
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA.,Center for Individualized Medicine, Epigenomics Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Liguo Wang
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Jeanette E Eckel-Passow
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Erik P Castle
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Alexander S Parker
- Office of Research Affairs, University of Florida, Jacksonville, FL, USA
| | - Thai H Ho
- Division of Hematology and Medical Oncology, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Keith D Robertson
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA. .,Center for Individualized Medicine, Epigenomics Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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13
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Nevo A, Muchtar E, Stern KL, Moore JP, Cheney SM, Humphreys MR, Grogan M, Stanton ML. The Clinical Implication of Incidental Prostatic Amyloidosis. Urology 2020; 145:253-257. [PMID: 32961226 DOI: 10.1016/j.urology.2020.08.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the clinicopathologic features of patients with incidental prostatic amyloidosis. PATIENTS AND METHODS We queried the genitourinary pathology database at Mayo Clinic Arizona for prostate specimens which showed amyloid deposits. Congo red stain was used for the diagnosis of amyloidosis and amyloid subtype was performed analysis using Liquid chromatography tandem mass spectrometry. We reviewed the patient's medical charts for past or subsequent diagnosis of systemic amyloidosis and clinical course. RESULTS Prostatic amyloidosis was identified in 7 patients between 2008-2018. Median age was 79 years (range 69-84) and median follow-up was 5 years (range 0-11). Benign prostate tissue was found in 4 patients, and prostate cancer was diagnosed in 3 patients. Amyloid subtyping was available in 6 patients and was consistent with Amyloid transthyretin Amyloidosis. Liquid chromatography tandem mass spectrometry did not detect an amino acid sequence abnormality in the transthyretin protein in any of the patients. Five of 6 patients were diagnosed with cardiac amyloidosis, which preceded and followed the diagnosis of prostatic amyloidosis in 1 and 4 patients, respectively. Of these 4 patients, 2 were diagnosed immediately and as a consequence of the diagnosis of prostatic amyloidosis, and the remaining 2 3 and 4 years later. CONCLUSION Incidental prostatic amyloidosis should prompt systemic and cardiac evaluation for amyloidosis. In patients with suspected cardiac amyloidosis, prior prostate specimens should be reviewed for the presence of amyloidosis.
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Affiliation(s)
- Amihay Nevo
- Department of Urology, Mayo Clinic, Phoenix, AZ.
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Martha Grogan
- Department of Cardiovascular diseases, Mayo Clinic, MN
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14
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Parra LA, Stanton ML, Nguyen BD. Urothelial cancer of the uretero-vesical junction on 18F-Fluciclovine PET/CT. Rev Esp Med Nucl Imagen Mol 2020; 39:180-181. [PMID: 31928921 DOI: 10.1016/j.remn.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/26/2019] [Accepted: 08/27/2019] [Indexed: 11/25/2022]
Affiliation(s)
- L A Parra
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona, EE. UU
| | - M L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, EE. UU
| | - B D Nguyen
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona, EE. UU..
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15
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Abstract
Despite systemic therapy and cystectomy, bladder cancer is characterized by a high recurrence rate. Serum glycomics represents a promising source of prognostic markers for monitoring patients. Our approach, which we refer to as "glycan node analysis", constitutes the first example of molecularly "bottom-up" glycomics. It is based on a global glycan methylation analysis procedure that is applied to whole blood plasma/serum. The approach detects and quantifies partially methylated alditol acetates arising from unique glycan features such as α2-6 sialylation, β1-4 branching, and core fucosylation that have been pooled together from across all intact glycans within a sample into a single GC-MS chromatographic peak. We applied this method to 122 plasma samples from former and current bladder cancer patients (n = 72 former cancer patients with currently no evidence of disease (NED); n = 38 non-muscle invasive bladder cancer (NMIBC) patients; and n = 12 muscle invasive bladder cancer (MIBC) patients) along with plasma from 30 certifiably healthy living kidney donors. Markers for α2-6 sialylation, β1-4 branching, β1-6 branching, and outer-arm fucosylation were able to separate current and former (NED) cases from certifiably healthy controls (ROC curve c-statistics ~ 0.80); but NED, NMIBC, and MIBC were not distinguished from one another. Based on the unexpectedly high levels of these glycan nodes in the NED patients, we hypothesized that recurrence of this disease could be predicted by some of the elevated glycan features. Indeed, α2-6 sialylation and β1-6 branching were able to predict recurrence from the NED state using a Cox proportional hazards regression model adjusted for age, gender, and time from cancer. The levels of these two glycan features were correlated to C-reactive protein concentration, an inflammation marker and known prognostic indicator for bladder cancer, further strengthening the link between inflammation and abnormal plasma protein glycosylation.
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Affiliation(s)
- Shadi Ferdosi
- School of Molecular Sciences, Arizona State University, Tempe, AZ, United States of America
- Virginia G. Piper Center for Personalized Diagnostics, The Biodesign Institute at Arizona State University, Tempe, AZ, United States of America
| | - Thai H. Ho
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, United States of America
| | - Erik P. Castle
- Department of Urology, Mayo Clinic, Phoenix, AZ, United States of America
| | - Melissa L. Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, United States of America
| | - Chad R. Borges
- School of Molecular Sciences, Arizona State University, Tempe, AZ, United States of America
- Virginia G. Piper Center for Personalized Diagnostics, The Biodesign Institute at Arizona State University, Tempe, AZ, United States of America
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16
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Fay AP, de Velasco G, Ho TH, Van Allen EM, Murray B, Albiges L, Signoretti S, Hakimi AA, Stanton ML, Bellmunt J, McDermott DF, Atkins MB, Garraway LA, Kwiatkowski DJ, Choueiri TK. Whole-Exome Sequencing in Two Extreme Phenotypes of Response to VEGF-Targeted Therapies in Patients With Metastatic Clear Cell Renal Cell Carcinoma. J Natl Compr Canc Netw 2017; 14:820-4. [PMID: 27407122 DOI: 10.6004/jnccn.2016.0086] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/21/2016] [Indexed: 12/24/2022]
Abstract
Advances in next-generation sequencing have provided a unique opportunity to understand the biology of disease and mechanisms of sensitivity or resistance to specific agents. Renal cell carcinoma (RCC) is a heterogeneous disease and highly variable clinical responses have been observed with vascular endothelial growth factor (VEGF)-targeted therapy (VEGF-TT). We hypothesized that whole-exome sequencing analysis might identify genotypes associated with extreme response or resistance to VEGF-TT in metastatic (mRCC). Patients with mRCC who had received first-line sunitinib or pazopanib and were in 2 extreme phenotypes of response were identified. Extreme responders (ERs) were defined as those with partial response or complete response for 3 or more years (n=13) and primary refractory patients (PRPs) were defined as those with progressive disease within the first 3 months of therapy (n=14). International Metastatic RCC Database Consortium prognostic scores were not significantly different between the groups (P=.67). Considering the genes known to be mutated in RCC at significant frequency, PBRM1 mutations were identified in 7 ERs (54%) versus 1 PRP (7%) (P=.01). In addition, mutations in TP53 (n=4) were found only in PRPs (P=.09). Our data suggest that mutations in some genes in RCC may impact response to VEGF-TT.
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Affiliation(s)
- Andre P Fay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Guillermo de Velasco
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Thai H Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eliezer M Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Broad Institute of MIT and Harvard, Cambridge, Boston, Massachusetts
| | - Bradley Murray
- Broad Institute of MIT and Harvard, Cambridge, Boston, Massachusetts
| | - Laurence Albiges
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - A Ari Hakimi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa L Stanton
- Department of Laboratory Medicine/Pathology, Mayo Clinic, Scottsdale, Arizona
| | - Joaquim Bellmunt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David F McDermott
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael B Atkins
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts,Department of Medical Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Levi A Garraway
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Broad Institute of MIT and Harvard, Cambridge, Boston, Massachusetts
| | | | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Bryce AH, Borad MJ, Egan JB, Condjella RM, Liang WS, Fonseca R, McCullough AE, Hunt KS, Ritacca NR, Barrett MT, Patel MD, Young SW, Silva AC, Ho TH, Halfdanarson TR, Stanton ML, Cheville J, Swanson S, Schneider DE, McWilliams RR, Baker A, Aldrich J, Kurdoglu A, Izatt T, Christoforides A, Cherni I, Nasser S, Reiman R, Cuyugan L, McDonald J, Adkins J, Mastrian SD, Von Hoff DD, Craig DW, Stewart AK, Carpten JD. Comprehensive Genomic Analysis of Metastatic Mucinous Urethral Adenocarcinoma Guides Precision Oncology Treatment: Targetable EGFR Amplification Leading to Successful Treatment With Erlotinib. Clin Genitourin Cancer 2016; 15:e727-e734. [PMID: 28057415 PMCID: PMC7513310 DOI: 10.1016/j.clgc.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alan H Bryce
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN.
| | - Mitesh J Borad
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Jan B Egan
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Rafael Fonseca
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Ann E McCullough
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | | | | | - Michael T Barrett
- Mayo Clinic Cancer Center, Phoenix, AZ; Translational Genomics Research Institute, Phoenix, AZ
| | | | - Scott W Young
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Alvin C Silva
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Thai H Ho
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Thorvardur R Halfdanarson
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | - John Cheville
- Department of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, MN
| | | | | | - Robert R McWilliams
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Cancer Center, Rochester, MN
| | - Angela Baker
- Translational Genomics Research Institute, Phoenix, AZ
| | | | | | - Tyler Izatt
- Translational Genomics Research Institute, Phoenix, AZ
| | | | - Irene Cherni
- Translational Genomics Research Institute, Phoenix, AZ
| | - Sara Nasser
- Translational Genomics Research Institute, Phoenix, AZ
| | | | - Lori Cuyugan
- Translational Genomics Research Institute, Phoenix, AZ
| | | | | | | | | | - David W Craig
- Translational Genomics Research Institute, Phoenix, AZ
| | - A Keith Stewart
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
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18
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Ho TH, Nunez-Nateras R, Hou YX, Bryce AH, Northfelt DW, Dueck AC, Wong B, Stanton ML, Joseph RW, Castle EP. A Study of Combination Bicalutamide and Raloxifene for Patients With Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2016; 15:196-202.e1. [PMID: 27771244 DOI: 10.1016/j.clgc.2016.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/08/2016] [Revised: 08/15/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prostate tissue expresses 2 estrogen receptor (ER) isoforms, ER-α and ER-β, and estrogen-based therapies have shown activity in preclinical studies. Raloxifene, a selective ER modulator, has inhibited the growth of prostate cancer xenograft models and was tested in a phase II trial of castration-resistant prostate cancer (CRPC), with some patients achieving stable disease. However, no studies have examined the safety of the combination of bicalutamide plus raloxifene for CRPC. Therefore, we investigated the safety of treatment with bicalutamide plus raloxifene in patients with CRPC in an initial study. MATERIALS AND METHODS We conducted a study to evaluate the toxicity (primary endpoint) of the combination of bicalutamide (50 mg) and raloxifene (60 mg) in 28-day cycles (maximum, 6 cycles) in men with progressive CRPC. The secondary endpoint, quality of life (QOL), was assessed by patients using a 6-item linear analog self-assessment or hormonal domain scale of the Expanded Prostate Cancer Index Composite. RESULTS We enrolled 18 patients with CRPC in the study to evaluate the safety of, and patient assessment of QOL (mental, physical, social, emotional, and spiritual) with, bicalutamide plus raloxifene therapy. No grade 3 or 4 adverse events occurred. None of the 18 patients required dose reductions. The patient assessment of QOL showed no statistically significant changes after 2 treatment cycles. The median progression-free survival with bicalutamide plus raloxifene was 1.9 months (95% confidence interval, 1.8-2.8 months). CONCLUSION The results of the present study have shown that bicalutamide/raloxifene treatment is well tolerated. However, limited clinical activity occurred in men with CRPC who had previously undergone secondary hormonal therapy or chemotherapy.
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Affiliation(s)
- Thai H Ho
- Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Yue-Xian Hou
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ
| | - Alan H Bryce
- Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - Donald W Northfelt
- Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - Amylou C Dueck
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, AZ
| | - Bryan Wong
- Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, AZ
| | - Richard W Joseph
- Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville, FL
| | - Erik P Castle
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ.
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19
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Zhu P, Stanton ML, Castle EP, Joseph RW, Adams DL, Li S, Amstutz P, Tang CM, Ho TH. Detection of tumor-associated cells in cryopreserved peripheral blood mononuclear cell samples for retrospective analysis. J Transl Med 2016; 14:198. [PMID: 27369977 PMCID: PMC4930561 DOI: 10.1186/s12967-016-0953-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 12/11/2015] [Accepted: 06/21/2016] [Indexed: 11/11/2022] Open
Abstract
Background Cryopreserved peripheral blood mononuclear cells (PBMCs) are commonly collected in biobanks. However, little data exist regarding the preservation of tumor-associated cells in cryopreserved collections. The objective of this study was to determine the feasibility of using the CellSieve™ microfiltration assay for the isolation of circulating tumor cells (CTCs) and circulating cancer-associated macrophage-like cells (CAMLs) from cryopreserved PBMC samples. Methods Blood samples spiked with breast (MCF-7), prostate (PC-3), and renal (786-O) cancer cell lines were used to establish analytical accuracy, efficiency, and reproducibility after cryopreservation. The spiked samples were processed through Ficoll separation, and cryopreservation was followed by thawing and microfiltration. Results MCF-7 cells were successfully retrieved with recovery efficiencies of 90.5 % without cryopreservation and 87.8 and 89.0 %, respectively, on day 7 and day 66 following cryopreservation. The corresponding recovery efficiencies of PC-3 cells were 83.3 % without cryopreservation and 85.3 and 84.7 %, respectively, after cryopreservation. Recovery efficiencies of 786-O cells were 92.7 % without cryopreservation, and 82.7 and 81.3 %, respectively, after cryopreservation. The recovered cells retained the morphologic characteristics and immunohistochemical markers that had been observed before freezing. The protocols were further validated by quantitation of CAMLs in blood samples from two patients with renal cell carcinoma (RCC). The recovery rates of CTCs and CAMLs from cryopreserved samples were not statistically significant different (P > 0.05) from matched fresh samples. Conclusions To our knowledge, this is the first report that CAMLs could be cryopreserved and analyzed after thawing with microfiltration technology. The application of microfiltration technology to cryopreserved samples will enable much greater retrospective study of cancer patients in relation to long-term outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0953-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peixuan Zhu
- Creatv MicroTech, Inc., 11609 Lake Potomac Drive, Potomac, MD, 20854, USA
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Erik P Castle
- Department of Urology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Richard W Joseph
- Division of Hematology and Medical Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Daniel L Adams
- Creatv MicroTech, Inc., 11609 Lake Potomac Drive, Potomac, MD, 20854, USA
| | - Shuhong Li
- Creatv MicroTech, Inc., 11609 Lake Potomac Drive, Potomac, MD, 20854, USA
| | - Platte Amstutz
- Creatv MicroTech, Inc., 11609 Lake Potomac Drive, Potomac, MD, 20854, USA
| | - Cha-Mei Tang
- Creatv MicroTech, Inc., 11609 Lake Potomac Drive, Potomac, MD, 20854, USA
| | - Thai H Ho
- Division of Hematology and Medical Oncology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
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20
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Ho TH, Choueiri TK, Wang K, Karam JA, Chalmers Z, Frampton G, Elvin JA, Johnson A, Liu X, Lin Y, Joseph RW, Stanton ML, Miller VA, Stephens PJ, Ross JS, Ali SM, Pal SK. Correlation Between Molecular Subclassifications of Clear Cell Renal Cell Carcinoma and Targeted Therapy Response. Eur Urol Focus 2016; 2:204-209. [DOI: 10.1016/j.euf.2015.11.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/02/2015] [Accepted: 11/16/2015] [Indexed: 11/27/2022]
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Ho TH, Choueiri TK, Wang K, Karam JA, Chalmers ZR, Frampton GM, Elvin JA, Johnson A, Liu X, Lin Y, Joseph RW, Stanton ML, Miller VA, Stephens PJ, Ross JS, Ali SM, Pal SK. Correlation between findings from comprehensive genomic profiling and targeted therapy response in metastatic renal cell carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
570 Background: Vascular endothelial growth factor- (VEGF-) and mammalian target of rapamycin- (mTOR-) directed therapies represent a standard of care in metastatic renal cell carcinoma (mRCC). However, these agents are not employed based on an assessment of predictive biomarkers such as genomic alterations (GA). We sought to determine if an association exists between GA detected by comprehensive genomic profiling (CGP) and the response to VEGFR and mTOR pathway targeted therapies in a cohort of mRCC treated in a clinical practice setting. Methods: The results of CGP performed in the course of clinical care on 31 consecutive mRCC obtained from patients who had received VEGFR- and/or mTOR-inhibitors were reviewed. Duration of treatment (DOT), extent and duration of clinical response was obtained from review of medical records. All classes of genomic alterations - base substitutions, short insertions, deletions, gene fusions, rearrangements and copy number - were assessed via CGP. Descriptive statistics were used to determine the frequency of GAs in groups segregated by the DOT with VEGF-directed agents. Results: The most common GAs detected in this series were in VHL (70%), PBRM1 (48%), SETD2 (32%), TSC1 (29%), MLL (19%), TERT (16%), ARID1B (16%) and KDM5C (16%). Across 61 administrations of VEGF-directed therapy in 27 patients, exceptional responses (DOT > 21 months) were more frequent amongst patients with GAs in KDM5C, PBRM1, and VHL. Conversely, these patients also featured a lower frequency of GA associated with response to mTOR-directed therapy, such as TSC1. Conclusions: Multiple GAs are more prevalent in exceptional responders to VEGF-directed therapy. Prospective validation of these findings may lead to use of CGP to optimize therapeutic selection.
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Affiliation(s)
| | | | - Kai Wang
- Foundation Medicine, Inc., Cambridge, MA
| | - Jose A. Karam
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Ho TH, Swensen J, Ghazalpour A, Hes O, Stanton ML, Joshi M, Sanati S, Purnanada P, Arguello D, Reddy SK, Gatalica Z. Comprehensive profiling of renal medullary and collecting duct carcinomas. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.572] [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
572 Background: Renal medullary carcinoma (RMC) is an aggressive malignancy affecting predominantly young African Americans with sickle cell trait (SCT) or disease (SCD), while a pathologically similar collecting duct carcinoma (CDC) affects patients without sickle cell trait. Clinical responses to chemotherapy and IL-2 in RMC/CDC are poor and novel therapies are needed. Methods: 9 patients with RMC (ages 13-58 y. o., all male) and 15 patients (ages 26-74 y. o., M:F = 13:2) with collecting duct carcinoma (CDC) were studied. Expression of PD-L1 was evaluated with 2 monoclonal antibodies (SP142 and SP263) and tumor infiltrating lymphocytes (TIL) were evaluated for PD1 expression (MRQ-22 antibody) using immunohistochemistry (IHC). Additional studies included ALK protein expression (D5F3 antibody), gene translocation (break apart FISH), next generation sequencing (NGS), and microsatellite instability (MSI). Results: Cancer cell PD-L1 expression above the threshold ( ≥ 2+, ≥ 5%) was seen in 7/9 RMC and 5/13 CDC cases. Concordance between 2 PD-L1 antibodies was 94.4%. PD-1+ TIL were absent in 6/18 cases and variably present in 12/18 cases (from 1 to > 15 TIL/40x power field). No MSI was detected in any of the cases tested (0/6). No case expressed ALK protein, but one case of CDC showed ALK gene re-arrangement. Mutations were identified in SMARCB1, FH, TP53 (3x), ATM, BRCA2, CHEK2 (2x), NF2 (3x), SETD2, and CDKN2A. No mutations in VHL or KDR were detected. One patient with RMC (and SCT) achieved complete clinical remission after treatment with bevacizumab plus paclitaxel. Conclusions: RMC and CDC strongly express PD-L1 in the majority of cases (12/22), suggesting that these patients may benefit from targeting the PD-L1/PD1 interaction. The absence of MSI in these cancers indicates a different mechanism of PD-L1 upregulation from colorectal carcinomas. Consistent with our previous study that showed frequent activation of (pseudo)hypoxia-induced pathways in RMCs (Human Pathology 2011;42:1979), we describe a case of RMC successfully treated with anti-VEGF therapy.
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Affiliation(s)
| | | | | | - Ondrej Hes
- University Hospital Plzen, Plzen, Czech Republic
| | | | - Monika Joshi
- Penn State Milton S. Hershey Medical Center, Harrisburg, PA
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Joseph RW, Millis SZ, Carballido EM, Bryant D, Gatalica Z, Reddy S, Bryce AH, Vogelzang NJ, Stanton ML, Castle EP, Ho TH. PD-1 and PD-L1 Expression in Renal Cell Carcinoma with Sarcomatoid Differentiation. Cancer Immunol Res 2015; 3:1303-7. [PMID: 26307625 DOI: 10.1158/2326-6066.cir-15-0150] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/12/2015] [Indexed: 12/21/2022]
Abstract
Monoclonal antibodies that target the programmed death-1 (PD-1)-programmed death ligand-1 (PD-L1) axis have antitumor activity against multiple cancers. The presence of sarcomatoid differentiation in renal cell carcinoma (RCC) is associated with resistance to targeted therapy and poor responses to IL2 immunotherapy. Given the aggressive nature of RCC with sarcomatoid differentiation and the exclusion of sarcomatoid histology from metastatic RCC clinical trials, less is understood regarding selection of therapies. Here, we characterized the PD-1/PD-L1 axis in RCC with sarcomatoid differentiation. We directly compared two PD-L1 antibodies and found concordance of PD-L1 positivity in 89% of tested RCCs with sarcomatoid differentiation. Coexpression of PD-L1 on neoplastic cells and the presence of PD-1-positive tumor-infiltrating lymphocytes were identified in 50% (13 of 26) of RCCs with sarcomatoid differentiation. In contrast, only 1 of 29 clear cell RCCs (3%) had concurrent expression of PD-L1 and PD-1 (P = 0.002). Our study suggests that RCC with sarcomatoid differentiation may express PD-1/PD-L1 at a higher percentage than RCC without sarcomatoid differentiation, and patients with these tumors may be good candidates for treatment with anti-PD-1/PD-L1 therapies.
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Affiliation(s)
- Richard W Joseph
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | | | | | | | - Alan H Bryce
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona
| | | | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
| | - Erik P Castle
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Thai H Ho
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona.
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Ho TH, Millis SZ, Bryant D, Gatalica Z, Reddy SK, Stanton ML, Castle EP, Joseph RW, Vogelzang NJ. Molecular analysis of sarcomatoid renal cell carcinoma (sRCC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.4556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fay AP, Van Allen EM, Murray B, Albiges L, Signoretti S, Ho TH, Hakimi AA, Mickey SS, Stanton ML, Bellmunt J, McDermott DF, Atkins MB, Garraway LA, Kwiatkowski DJ, Choueiri TK. Whole-exome sequencing (WES) predicting two extreme phenotypes of response to VEGF-targeted therapies (VEGF-TT) in patients with metastatic clear cell renal cell carcinoma (mRCC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
422 Background: There is significant variability in the response to VEGF-TT in mRCC with no validated predictive biomarkers. We hypothesized that whole exome analysis might identify markers of response and resistance to VEGF-TT in mRCC. Methods: mRCC patients who received first-line sunitinib or pazopanib and were in two extreme phenotypes of response were identified. Extreme responders (ER) were defined as PR or CR for ≥3 years (n=10) and primary refractory patients (PRP) were defined as PD within the first 3 months of therapy (n=10). WES was performed in pre-treatment specimens and established Broad Institute analytical pipelines were utilized to identify point mutations and copy number alterations across the exome. ER (n=4) and PRP (n=4) who were part of TCGA project for clear-cell RCC were included in this analysis. Nonsense, missense and indel mutations in established or novel RCC genes were investigated. Results: IMDC prognostic scores were not significantly different between the two groups. VHL mutations were observed at similar frequency in ER and PRP, overall 57%. Mutations in PBRM1 were identified in 7 ER (50%) vs. 1 PRP (7%) (p=0.03). In addition, mutations in TP53 were only found in PRP (p=0.09). No other gene had mutations that were associated with either response or primary refractory disease (Table). Conclusions: In this pilot study, PBRM1 mutations were associated with extreme response to VEGF-TT. However, this was exploratory, and multivariable analysis was not performed. Analysis of additional patient samples is ongoing to confirm or refute this association. If true it suggests that epigenetic effects of PBRM1 mutation may contribute to response to VEGF-TT in mRCC. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - A. Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
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Zhu P, Ho T, Castle EP, Joseph RW, Stanton ML, Li S, Adams D, Makarova OV, Amstutz PT, Tang CM. Abstract 3081: Isolation and identification of circulating tumor cells in renal cell carcinoma. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-3081] [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: Renal cell carcinoma (RCC) is the most common type of kidney cancer responsible for ∼80% of kidney cancer cases. Circulating tumor cells (CTCs) are emerging as an important prognostic and predictive biomarker in several types of metastatic cancers. However, methods for CTC detection that target only EpCAM and/or cytokeratin (CK) to enrich CTCs, may fail to recognize the CTCs in clear cell RCC (ccRCC) because ccRCC lacks expression of EpCAM. The objective of this study was to develop a new technology capable of detecting CTCs including those with a mesenchymal phenotype in metastatic RCC.
Methods: Blood samples from patients affected by metastatic RCC were provided by Mayo Clinic Arizona and analyzed by Creatv MicroTech. CellSieveTM microfilters, which have 7 µm diameter pores in a uniform array, with 160,000 pores in a 9 mm diameter area, were used for separation of CTCs in the blood specimen. 7.5 mL of whole blood was diluted in the prefixation buffer and filtered through the microfilter. Clinical immunohistochemical markers for RCC such as CD10 and vimentin were used to identify candidate CTCs. The cells collected on the filter were fixed, permeabilized, and stained with DAPI and fluorescent antibodies specific to CD10, vimentin, and CD45. The assay protocol was developed using three RCC cell lines, 786-O, Caki-1, and Caki-2, and validated using blood samples from patients with metastatic RCC.
Results: The capture efficiencies for 786-O, Caki-1, and Caki-2 cell lines were determined to be 98%, 98% and 97%, respectively. On-filter antibody staining revealed heterogeneous expressions of vimentin and CD10 in RCC cells. Patient samples were collected in duplicate CellSaveTM tubes and processed one day later. A CD10+/vimentin+/CD45- cell population was detected in blood samples with enumeration ranging from 4 to 86 cells/7.5 mL of blood. We found that the RCC CTC profile was distinct from other types of cancers. The typical CTCs display abnormal morphology, including large nuclei (typically 15-30 µm in size), irregular cell size and shape, and high nucleus-to-cytoplasm ratio. Although CD10 and vimentin antibodies have cross-reactivity with white blood cells (WBC), the CTCs could be distinguished from WBC based on morphology, cell size and CD45- staining.
Conclusions: We demonstrated that the CellSieveTM microfiltration assay is a very simple and efficient method to isolate a CD10+/vimentin+/CD45- cell population from patients affected by metastatic ccRCC. Future studies include fluorescence in situ hybridization to confirm loss of 3p, a molecular event that occurs in >90% of ccRCC. We are also analyzing blood samples from patients treated with tyrosine kinase inhibitors to determine if cell enumeration is predictive of response to treatment. This technology might greatly facilitate detection of EpCAM negative ccRCC CTCs. The clinical significance of these unusual, large, rod-shaped, naked nuclei require further molecular characterization.
Citation Format: Peixuan Zhu, Thai Ho, Erik P. Castle, Richard W. Joseph, Melissa L. Stanton, Shuhong Li, Daniel Adams, Olga V. Makarova, Platte T. Amstutz, Cha-Mei Tang. Isolation and identification of circulating tumor cells in renal cell carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3081. doi:10.1158/1538-7445.AM2014-3081
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Affiliation(s)
| | - Thai Ho
- 2Mayo Clinic Arizona, Scottsdale, AZ
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Choueiri TK, Fay AP, Gray KP, Callea M, Ho TH, Albiges L, Bellmunt J, Song J, Carvo I, Lampron M, Stanton ML, Hodi FS, McDermott DF, Atkins MB, Freeman GJ, Hirsch MS, Signoretti S. PD-L1 expression in nonclear-cell renal cell carcinoma. Ann Oncol 2014; 25:2178-2184. [PMID: 25193987 DOI: 10.1093/annonc/mdu445] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Programmed death ligand-1 (PD-L1) expression in nonclear-cell RCC (non-ccRCC) and its association with clinical outcomes are unknown. METHODS Formalin-fixed paraffin-embedded (FFPE) specimens were obtained from 101 patients with non-ccRCC. PD-L1 expression was evaluated by immunohistochemistry in both tumor cell membrane and tumor-infiltrating mononuclear cells (TIMC). PD-L1 tumor positivity was defined as ≥5% tumor cell membrane staining. For PD-L1 expression in TIMC, a combined score based on the extent of infiltrate and percentage of positive cells was used. Baseline clinico-pathological characteristics and outcome data [time to recurrence (TTR) and overall survival (OS)] were correlated with PD-L1 staining. RESULTS Among 101 patients, 11 (10.9%) were considered PD-L1+ in tumor cells: 2/36 (5.6%) of chromophobe RCC, 5/50 (10%) of papillary RCC, 3/10 (30%) of Xp11.2 translocation RCC and 1/5 (20%) of collecting duct carcinoma. PD-L1 positivity (PD-L1+) in tumor cells was significantly associated with higher stage (P = 0.01) and grade (P = 0.03), as well as shorter OS (P < 0.001). On the other hand, PD-L1 positivity by TIMC was observed in 57 (56.4%) patients: 13/36 (36.1%) of chromophobe RCC, 30/50 (60%) of papillary RCC, 9/10 (90%) of Xp11.2 translocation RCC and 5/5 (100%) of collecting duct carcinoma. A trend toward shorter OS was observed in patients with PD-L1+ in TIMC (P = 0.08). PD-L1+ in both tumor cell membrane and TIMC cells were associated with shorter TTR (P = 0.02 and P = 0.03, respectively). CONCLUSION In non-ccRCC, patients with PD-L1+ tumors appear to have worse clinical outcomes, although only PD-L1 positivity in tumor cells is associated with higher tumor stage and grade.
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Affiliation(s)
- T K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Medical Oncology, Brigham and Women's Hospital, Boston; Harvard Medical School, Boston.
| | - A P Fay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - K P Gray
- Biostatistics and Computational Biology, Harvard School of Public Health, Boston
| | - M Callea
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - T H Ho
- Department of Medical Oncology, Mayo Clinic, Scottsdale
| | - L Albiges
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Bellmunt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Medical Oncology, Brigham and Women's Hospital, Boston; Harvard Medical School, Boston
| | - J Song
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - I Carvo
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - M Lampron
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - M L Stanton
- Department of Medical Oncology, Mayo Clinic, Scottsdale
| | - F S Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston; Center for Immuno-oncology, Dana-Farber Cancer Institute, Boston
| | - D F McDermott
- Harvard Medical School, Boston; Department of Medical Oncology, Beth-Israel Deaconess Medical Center, Boston
| | - M B Atkins
- Department of Medical Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, USA
| | - G J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston
| | - M S Hirsch
- Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
| | - S Signoretti
- Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
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Fay AP, Callea M, Gray KP, Ho TH, Song J, Carvo I, Lampron ME, Albiges L, Stanton ML, McDermott DF, Atkins MB, Freeman GJ, Hirsch MS, Signoretti S, Choueiri TK. PD-L1 expression in non-clear cell renal cell carcinoma and benign kidney tumors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Jiaxi Song
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | | | - Michael B. Atkins
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
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Ho TH, Lee JH, Nateras RN, Castle EP, Stanton ML, Joseph RW, Bryce AH, Carballido EM, Parker AS, Zhang Z, Ordog T. Genome-wide profiling of histone 3 lysine 36 trimethylation in clear cell renal cell carcinoma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.464] [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
464 Background: Although the von Hippel-Lindau (VHL) tumor suppressor gene is mutated in 60% of ccRCC, deletion of VHL in mice is insufficient for tumorigenesis. Sequencing of ccRCC tumors identified mutations in SETD2, a histone H3 lysine 36 (H3K36) trimethyltransferase. We hypothesize that loss of SETD2 methyltransferase activity alters the genome wide pattern of H3K36 trimethylation (H3K36me3) in ccRCC, and contributes to the cancer phenotype. Methods: To generate a genome-wide profile of H3K36me3 in frozen nephrectomy samples and RCC cell lines, we optimized a chromatin immunoprecipitation (ChIP) protocol for the isolation of DNA associated with H3K36me3. H3K36me3 is associated with open chromatin and an H3K36me3-specific antibody was used for immunoprecipitation of endogenous H3K36me3-bound DNA. ChIP PCR primers were optimized for active genes, such as actin, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and a “gene desert” on chromosome 12 (negative control). ChIP libraries were then generated from 3 paired uninvolved kidney and RCC and 2 RCC cell lines. In order to identify H3K36Me3 upregulated regions in uninvolved kidney and RCC, reads from the ChIP sequencing were mapped to the human genome using Burrows-Wheeler Aligner and SICER algorithms. Results: Using ChIP PCR, we found that active genomic regions were enriched 15-30 fold over the negative controls indicating that the quality and yield of immunoprecipitated DNA/chromatin complexes from frozen tissue was sufficient for ChIP sequencing. A preliminary ChIP sequencing analysis of RCC cell lines and frozen ccRCC tissue indicates that H3K36me3 enriched DNA sequences were mapped to exons (31.3%) compared to introns (13.5%, p<0.001), consistent with the role of H3K36me3 in transcription. Conclusions: Genomic regions enriched for H3K36Me3 binding were identified from patient-derived tissue and RCC cell lines. Current efforts are focused on comparing the H3K36me3 profiles between matched tumor and uninvolved kidney ChIP libraries to generate a genome wide map of dysregulated H3K36me3 modifications.
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Fay AP, Callea M, Gray KP, Ho TH, Song J, Carvo I, Lampron ME, Stanton ML, McDermott DF, Atkins MB, Freeman GJ, Hirsch MS, Signoretti S, Choueiri TK. PD-L1 expression in non-clear cell renal cell carcinoma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
424 Background: Programmed death-1 (PD-1) receptor negatively regulates T cell-mediated responses.PD-1 ligand (PD-L1) is aberrantly expressed in clear cell renal cell carcinoma (ccRCC) and is associated with worse prognosis. Levels of PD-L1 expressions in non-ccRCC and its association with clinicopathological features and survival are unknown. Methods: Formalin-fixed paraffin-embedded (FFPE) specimens were obtained from 97 patients with chromophobe (CHR), papillary (PAP), translocation Xp11.2 (TrL) RCC and oncoytoma (ONC) and were included in the analysis. PD-L1 expression was evaluated by immunohistochemistry using a mouse monoclonal anti-PD-L1 antibody (405.9A11). The assay was validated using FFPE cell line controls known to be positive or negative for PD-L1 expression by flow cytometry. PD-L1 tumor positivity (PD-L1+) was defined as ≥5% tumor cell membrane staining. For PD-L1 expression in immune cells, a combined score based on the intensity of infiltrate and percentage of positive cells was used. Baseline characteristics including stage/grade, and survival data were collected. Comparisons between PD-L1 expression and clinicopathological features were evaluated using chisq or wilcoxon rank sum tests. Cox model tests for association of PD-L1 expression with OS in univariate and multivariable analysis. Results: Among 97 patients, 12 (12.4%) were considered PD-L1+ in tumor cells: 2/36 (5%) of CHR RCC, 5/50 (10%) of PAP RCC, 3/7 (43%) of TrL RCC, and 2/4 (50%) of ONC. PD-L1 positivity in tumor cells was significantly associated with higher stage (p=0.026) and grade (p=0.046), as well as lower OS on univariate (p=0.02) but not multivariate analysis (p=0.29). On the other hand, PD-L1 positivity by immune cells was observed in 50 (51.5%) patients: 13/36 (36%) of CHR RCC, 30/50 (60%) of PAP RCC, 6/7 (86%) of TrL RCC, and 1/4 (25%) of ONC. PD-L1 positivity in immune cells did not correlate with stage (p=0.7), grade (p=0.1) or OS (p=0.8). Conclusions: PD-L1 expression is variable in non-ccRCC and depends on histology and tumor vs. immune cells scoring. Only PD-L1 positivity in tumors cells was associated with aggressive features. Patients with non-ccRCC should not be automatically excluded from trials of agents that target the PD-1/PD-L1 pathway.
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Affiliation(s)
| | | | | | | | - Jiaxi Song
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | - Michael B. Atkins
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
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Hakim FA, Singh S, Pandit A, Alegria JR, Camoriano J, Stanton ML, Mookadam F. Interferon-α and pericardial injury: a case report and literature review. Heart Asia 2014; 6:48-53. [PMID: 27326167 DOI: 10.1136/heartasia-2013-010488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/19/2014] [Accepted: 03/14/2014] [Indexed: 11/03/2022]
Abstract
Interferon- α (IFN-α) alone or in combination with other chemotherapeutic agents has been used in the management of many malignant and non-malignant conditions. Pericarditis with or without pericardial effusion has been reported with IFN-α therapy, and available literature is limited to case reports. Pericardial constriction after interferon use has not been described in the published literature to date. We performed a systematic review of literature to address the demographic features, clinical presentation, diagnosis, treatment and outcome of interferon-related pericardial injury.
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Affiliation(s)
- Fayaz A Hakim
- Department of Cardiovascular Diseases, Scottsdale, Arizona , USA
| | | | - Anil Pandit
- Department of Cardiovascular Diseases, Scottsdale, Arizona , USA
| | - Jorge R Alegria
- Department of Cardiovascular Diseases, Scottsdale, Arizona , USA
| | | | - Melissa L Stanton
- Laboratory Medicine and pathology , Mayo Clinic , Scottsdale, Arizona , USA
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Scottsdale, Arizona , USA
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Stanton ML, Xiao L, Czerniak BA, Guo CC. Urothelial tumors of the urinary bladder in young patients: a clinicopathologic study of 59 cases. Arch Pathol Lab Med 2013; 137:1337-41. [PMID: 24079760 DOI: 10.5858/arpa.2012-0322-oa] [Citation(s) in RCA: 32] [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: 11/06/2022]
Abstract
CONTEXT Urothelial tumors are rare in young patients. Because of their rarity, the natural history of the disease in young patients remains poorly understood. OBJECTIVE To understand the pathologic and clinical features of urothelial tumors of the urinary bladder in young patients. DESIGN We identified 59 young patients with urothelial tumors of the urinary bladder treated at our institution and analyzed the tumors' pathologic features and the patients' clinical outcomes. RESULTS All patients were 30 years or younger, with a mean age of 23.5 years (range, 4-30). Thirty-eight patients (64%) were male, and 21 (36%) were female. Most tumors were noninvasive, papillary urothelial tumors (49 of 59; 83%), including papillary urothelial neoplasms of low malignant potential (7 of 49; 14%), low-grade papillary urothelial carcinomas (38 of 49; 78%), and high-grade papillary urothelial carcinomas (4 of 49; 8%). Only a few (n=10) of the urothelial tumors were invasive, invading the lamina propria (n=5; 50%), muscularis propria (n=4; 40%), or perivesical soft tissue (n=1; 10%). Clinical follow-up information was available for 41 patients (69%), with a mean follow-up time of 77 months. Of 31 patients with noninvasive papillary urothelial tumors, only 1 patient (3%) later developed an invasive urothelial carcinoma and died of the disease, and 30 of these patients (97%) were alive at the end of follow-up, although 10 (32%) had local tumor recurrences. In the 10 patients with invasive urothelial carcinomas, 3 patients (30%) died of the disease and 5 others (50%) were alive with metastases (the other 2 [20%] were alive with no recurrence). CONCLUSION Urothelial tumors in young patients are mostly noninvasive, papillary carcinomas and have an excellent prognosis; however, a small subset of patients may present with high-grade invasive urothelial carcinomas that result in poor clinical outcomes.
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Affiliation(s)
- Melissa L Stanton
- From the Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston
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Nunez-Nateras R, Castle EP, Protheroe CA, Stanton ML, Ocal TI, Ferrigni EN, Ochkur SI, Jacobsen EA, Hou YX, Andrews PE, Colby TV, Lee NA, Lee JJ. Predicting response to bacillus Calmette-Guérin (BCG) in patients with carcinoma in situ of the bladder. Urol Oncol 2013; 32:45.e23-30. [PMID: 24055426 DOI: 10.1016/j.urolonc.2013.06.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/13/2013] [Accepted: 06/17/2013] [Indexed: 01/21/2023]
Abstract
PURPOSE Currently, there is no reliable tool to predict response to intravesical bacillus Calmette-Guérin (BCG). Based on the fact that BCG is a Th1-polarizing immunotherapy, we attempt to correlate the pretreatment immunologic tumor microenvironment (Th1 or Th2) with response to therapy. MATERIALS AND METHODS Bladder cancer patients with initial diagnosis of carcinoma in situ (Tis) were stratified based on their response to BCG treatment. A total of 38 patients met inclusion criteria (20 patients who responded and 18 patients who did not respond). Immunohistochemical (IHC) methods known to assess the type of immunologic microenvironment (Th1 vs. Th2) were performed on tumor tissue obtained at initial biopsy/resection: the level of tumor eosinophil infiltration and degranulation (Th2 response); the number of tumor-infiltrating GATA-3(+) (Th2-polarized) lymphocytes; and the number of tumor-infiltrating T-bet(+) (Th1-polarized) lymphocytes. Results obtained from these metrics were correlated with response to treatment with BCG immunotherapy. RESULTS The IHC metrics of the tumor immune microenvironment prior to BCG treatment were each statistically significant predictors of responders (R) vs. nonresponders (NR). Eosinophil infiltration and degranulation was higher for R vs. NR: 1.02 ± 0.17 vs. 0.5 ± 0.12 (P = 0.01) and 1.1 ± 0.15 vs. 0.56 ± 0.15 (P = 0.04), respectively. Ratio of GATA-3(+) (Th2-polarized) lymphocytes to T-bet(+) (Th1-polarized) lymphocytes was higher for R vs. NR: 4.85 ± 0.94 vs. 0.98 ± 0.19 (P<0.001). The 3 markers were combined to create a Th2 signature biomarker, which was a statistically significant (P<0.0001) predictor of R vs. NR. All IHC markers demonstrated that a preexisting Th1 immunologic environment within the tumor was predictive of BCG failure. CONCLUSION The Th1 vs. Th2 polarization of bladder tumor immune microenvironment prior to treatment with BCG represents a prognostic metric of response to therapy. If a patient has a preexisting Th1 immunologic response within the tumor, there is no value in using a therapy intended to create a Th1 immunologic response. An algorithm integrating 3 IHC methods provided a sensitive and specific technique that may become a useful tool for pathologists and urologists to predict response to BCG in patients with carcinoma in situ of the bladder.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/therapeutic use
- Administration, Intravesical
- Aged
- BCG Vaccine/administration & dosage
- BCG Vaccine/immunology
- BCG Vaccine/therapeutic use
- Biomarkers, Tumor/immunology
- Biomarkers, Tumor/metabolism
- Carcinoma in Situ/immunology
- Carcinoma in Situ/metabolism
- Carcinoma in Situ/therapy
- Cell Degranulation/immunology
- Eosinophils/drug effects
- Eosinophils/immunology
- Eosinophils/physiology
- Female
- GATA3 Transcription Factor/immunology
- GATA3 Transcription Factor/metabolism
- Humans
- Immunity, Active/drug effects
- Immunity, Active/immunology
- Immunohistochemistry
- Immunotherapy/methods
- Lymphocytes/drug effects
- Lymphocytes/immunology
- Lymphocytes/metabolism
- Lymphocytes, Tumor-Infiltrating/drug effects
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Male
- Prognosis
- T-Box Domain Proteins/immunology
- T-Box Domain Proteins/metabolism
- Tumor Microenvironment/drug effects
- Tumor Microenvironment/immunology
- Urinary Bladder Neoplasms/immunology
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/therapy
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Affiliation(s)
| | - Erik P Castle
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ
| | - Cheryl A Protheroe
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Melissa L Stanton
- Department of Laboratory Medicine/Pathology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Tolgay I Ocal
- Department of Laboratory Medicine/Pathology, Mayo Clinic Arizona, Scottsdale, AZ
| | | | - Sergei I Ochkur
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Elizabeth A Jacobsen
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Yue-Xian Hou
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Thomas V Colby
- Department of Laboratory Medicine/Pathology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Nancy A Lee
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale, AZ
| | - James J Lee
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ
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Nunez-Nateras R, Stanton ML, Ferrigni EN, Protheroe CA, Lee NA, Lee JJ, Castle EP. Bladder cancer: Predicting response to BCG. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.287] [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
287 Background: Our preliminary immunohistochemical studies of bladder cancer patients have shown that the inflammatory/immune responses associated with bladder cancer appear to be Th2-polarized as judged by the preponderance of tumor infiltrating GATA-3+ (Th2) vs. T-bet+ (Th1) T cells, as well as by evidence of tumor-associated eosinophil infiltration and activation. The standard-of-care treatment for Tis bladder cancer is intravesical administration of BCG, a Th1-polarizing immunomodulator. The aim of the present study was to assess the Th2/Th1 ratio correlation with response to BCG therapy in patients with Tis bladder cancer. Methods: Two groups of patients were studied. Group A included 20 patients that responded to BCG, and Group B included 20 patients that did not respond to therapy. Response to BCG was determined as presence/absence of disease at 6 months post-BCG therapy. The initial diagnostic biopsies of these patients were subjected to immunohistochemical analysis using commercially available antibodies specific for Th2 (GATA-3+) and Th1 (T-bet+) lymphocytes, and our unique monoclonal antibody specific for eosinophil peroxidase (EPX-mAb). Ten random high powered (400X) fields at the maximum focus of mononuclear infiltration were examined and the number of GATA 3+ and T-bet+ tumor infiltrating T cells were counted to define the G/T ratio for each patient sample. Eosinophils and their degranulation activity were counted in the same fields. Results: Patients with response to BCG therapy had a G/T ratio of ≥ 3 and patients with non-response to BCG therapy had a G/T ratio of ≤ 1.5. Correlation of these scores with subsequent patient outcomes following BCG immune therapy demonstrated that patient responsiveness (i.e., tumor elimination at 6 months) trended with the higher G/T ratio patients. In addition, initial biopsies of BCG responsive patients display a higher number of eosinophils and degranulation relative to BCG non-responsive patients. Conclusions: Evaluations of initial biopsies revealed a strong correlation between Th1 and Th2 immune response with BCG therapy outcomes. The development of specific and novel tools to identify/measure Th2 immune responses in Tis bladder cancer provides a unique opportunity to predict outcomes at the time of diagnosis.
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Wisenbaugh ES, Stanton ML, Grimsby GM, Tyson MD, Castle EP. Metastatic malignant melanoma to the bladder: a case series. Curr Urol 2012; 6:53-6. [PMID: 24917713 DOI: 10.1159/000338872] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 02/21/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Metastatic melanoma to the bladder is rarely reported, and the role of surgery is still largely unknown. We review 4 such cases and highlight their management and outcomes. We also review the relevant literature. METHODS The Mayo Clinic tumor database was searched and 4 such cases were found. RESULTS All 4 patients were treated locally with transurethral resection. The only patient who had a solitary metastasis did relatively well, having no evidence of disease 10 months after his presentation, while the other 3 died within 6 months. The literature highlights various approaches to management, but there is no definitive evidence that radical cystectomy offers any benefit over transurethral resection. CONCLUSION Resection may improve survival in the setting of a solitary metastasis, but there is no evidence that radical cystectomy offers any benefit over local resection. With diffuse disease, however, resection is likely only beneficial for treatment of hematuria.
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Guo CC, Shen SS, Si Q, Dancer J, Stanton ML, Tamboli P, Ro JY, Czerniak BA. Necrosis assessment in renal carcinoma—reply. Hum Pathol 2012. [DOI: 10.1016/j.humpath.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Si Q, Dancer J, Stanton ML, Tamboli P, Ro JY, Czerniak BA, Shen SS, Guo CC. Small cell carcinoma of the kidney: a clinicopathologic study of 14 cases. Hum Pathol 2011; 42:1792-8. [PMID: 21733553 DOI: 10.1016/j.humpath.2011.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 03/08/2011] [Accepted: 03/16/2011] [Indexed: 12/18/2022]
Abstract
Small cell carcinoma of the kidney is distinctively rare. We searched pathology files in 2 institutions and found 14 cases of renal small cell carcinoma. The patients' mean age at diagnosis was 59 years (range, 22-75 years); 8 were women, and 6 were men. Patients usually presented with hematuria (n = 6) and abdominal pain (n = 5). The mean tumor size was 7.1 cm (range, 3.5-14.0 cm). The small cell carcinoma was pure in 9 cases and mixed with high-grade urothelial carcinoma in 5 cases. None was associated with any type of renal cell carcinoma. Tumor necrosis was present in all cases, and lymphovascular invasion was identified in 6 cases. The tumor invaded the perinephric adipose tissue in 13 cases and was confined to the kidney in only 1 case. Lymph node metastases were identified in all patients who underwent lymph node dissection (5/5). On immunostains, the small cell carcinoma cells were positive for pancytokeratin (11/12), chromogranin (6/9), and synaptophysin (8/9). Follow-up data were available for 13 patients, and 11 died of small cell carcinoma at a mean of 15 months (range, 4-31 months) after diagnosis. Of the 2 surviving patients, 1 was alive at 5 months after diagnosis, and the other, whose disease was confined to the kidney, was alive with no evidence of disease at 137 months. In summary, renal small cell carcinoma is a highly aggressive disease that often presents at an advanced stage with widespread metastases. Patients usually have a poor clinical outcome despite multimodal therapy. The frequent coexistence of small cell carcinoma with urothelial carcinoma suggests that renal small cell carcinomas may evolve from a preexisting urothelial carcinoma.
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Affiliation(s)
- Qiusheng Si
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Shen Q, Stanton ML, Feng W, Rodriguez ME, Ramondetta L, Chen L, Brown RE, Duan X. Morphoproteomic analysis reveals an overexpressed and constitutively activated phospholipase D1-mTORC2 pathway in endometrial carcinoma. Int J Clin Exp Pathol 2010; 4:13-21. [PMID: 21228924 PMCID: PMC3016100] [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] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 11/09/2010] [Indexed: 05/30/2023]
Abstract
The mammalian target of rapamycin (MTOR) assembles into two distinct complexes: mTOR complex 1 (mTORC1) is predominantly cytoplasmic and highly responsive to rapamycin, whereas mTOR complex 2 (mTORC2) is both cytoplasmic and nuclear, and relatively resistant to rapamycin. mTORC1 and mTORC2 phosphorylatively regulate their respective downstream effectors p70S6K/4EBP1, and Akt. The resulting activated mTOR pathways stimulate protein synthesis, cellular proliferation, and cell survival. Moreover, phospholipase D (PLD) and its product, phosphatidic acid (PA) have been implicated as one of the upstream activators of mTOR signaling. In this study, we investigated the activation status as well as the subcellular distribution of mTOR, and its upstream regulators and downstream effectors in endometrial carcinomas (ECa) and non-neoplastic endometrial control tissue. Our data show that the mTORC2 activity is selectively elevated in endometrial cancers as evidenced by a predominant nuclear localization of the activated form of mTOR (p-mTOR at Ser2448) in malignant epithelium, accompanied by overexpression of nuclear p-Akt (Ser473), as well as overexpression of vascular endothelial growth factor (VEGF)-A isoform, the latter a resultant of target gene activation by mTORC2 signaling via hypoxia-inducible factor (HIF)-2alpha. In addition, expression of PLD1, one of the two major isoforms of PLD in human, is increased in tumor epithelium. In summary, we demonstrate that the PLD1/PA-mTORC2 signal pathway is overactivated in endometrial carcinomas. This suggests that the rapamycin-insensitive mTORC2 pathway plays a major role in endometrial tumorigenesis and that therapies designed to target the phospholipase D pathway and components of the mTORC2 pathway should be efficacious against ECa.
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Affiliation(s)
- Qi Shen
- Department of Pathology and Laboratory Medicine, The University of Texas Medical School at Houston, TX 77030, USA
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Dhingra S, Rodriguez ME, Shen Q, Duan X, Stanton ML, Chen L, Zhang R, Brown RE. Constitutive activation with overexpression of the mTORC2-phospholipase D1 pathway in uterine leiomyosarcoma and STUMP: morphoproteomic analysis with therapeutic implications. Int J Clin Exp Pathol 2010; 4:134-146. [PMID: 21326806 PMCID: PMC3037199] [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] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 01/26/2010] [Indexed: 05/30/2023]
Abstract
The mammalian target of rapamycin (mTOR) is centrally involved in growth, survival and metabolism. In cancer, mTOR is frequently hyperactivated and is a clinically validated target for therapy and drug development. Biologically, mTOR acts as the catalytic subunit of two functionally distinct complexes, called mTOR complex 1 (mTORC1) which is predominantly cytoplasmic in subcellular localization and mTOR complex 2 (mTORC2) which is both cytoplasmic and nuclear. mTORC1 is sensitive to the selective inhibitor rapamycin. By contrast, mTORC2 is relatively resistant to rapamycin. Moreover, its putative downstream effector, Akt phosphorylated on serine 473 represents a signal transduction pathway for tumor survival. Phospholipase D (PLD) and its product, phosphatidic acid (PA) have been implicated as an activator of mTOR signaling, including the direct phosphorylative activation of p70S6K atthreonine 389. The latter promotes cell cycle progression. In this study, we investigated the activation status and subcellular localization of mTOR and the relative expression of PLD1, as well as their downstream effectors in a spectrum of uterine smooth muscle tumors using normal myometria as controls. The results show significant activation with overexpression of phosphorylated mTORC2 complex in uterine leiomyosarcoma (ULMS) and smooth muscle tumors of uncertain malignant potential (STUMP) as evidenced by nuclear localization of p-mTOR (Ser 2448) in ULMS>STUMP>uterine leiomyoma and normal myometria (p<0.05) and with overexpression of PLD1(p<0.05). Cor-relatively, there are overexpressions of nuclear p-Akt (Ser 473) and nuclear p-p70S6K (Thr 389) in ULMS and STUMP (p<0.05). The activation with overexpression of components of the mTORC2-PLD1 pathway in ULMS and to a lesser degree in STUMP provides insight into their tumorigenic mechanisms. Thus the development of therapies designed to target mTORC2 and PLD1 activity may be beneficial in treating ULMS.
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Affiliation(s)
- Sadhna Dhingra
- Department of Pathology and Laboratory Medicine, UT Health- Medical School at Houston, 6431 Fannin St, Houston, TX 77030, USA
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Abstract
Plants possess a remarkable capacity to alter their phenotype in response to the highly heterogeneous light conditions they commonly encounter in natural environments. In the present study with the weedy annual plant Sinapis arvensis, we (a) tested for the adaptive value of phenotypic plasticity in morphological and life history traits in response to low light and (b) explored possible fitness costs of plasticity. Replicates of 31 half-sib families were grown individually in the greenhouse under full light and under low light (40% of ambient) imposed by neutral shade cloth. Low light resulted in a large increase in hypocotyl length and specific leaf area (SLA), a reduction in juvenile biomass and a delayed onset of flowering. Phenotypic selection analysis within each light environment revealed that selection favoured large SLA under low light, but not under high light, suggesting that the observed increase in SLA was adaptive. In contrast, plasticity in the other traits measured was maladaptive (i.e. in the opposite direction to that favoured by selection in the low light environment). We detected significant additive genetic variance in plasticity in most phenotypic traits and in fitness (number of seeds). Using genotypic selection gradient analysis, we found that families with high plasticity in SLA had a lower fitness than families with low plasticity, when the effect of SLA on fitness was statistically kept constant. This indicates that plasticity in SLA incurred a direct fitness cost. However, a cost of plasticity was only expressed under low light, but not under high light. Thus, models on the evolution of phenotypic plasticity will need to incorporate plasticity costs that vary in magnitude depending on environmental conditions.
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Affiliation(s)
- T Steinger
- Department of Environmental Sciences, Geobotanical Institute, Swiss Federal Institute of Technology (ETHZ), Zürichbergstrasse, Zürich, Switzerland.
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Stanton ML, Roy BA, Thiede DA. Evolution in stressful environments. I. Phenotypic variability, phenotypic selection, and response to selection in five distinct environmental stresses. Evolution 2000; 54:93-111. [PMID: 10937187 DOI: 10.1111/j.0014-3820.2000.tb00011.x] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Considerable debate has accompanied efforts to integrate the selective impacts of environmental stresses into models of life-history evolution. This study was designed to determine if different environmental stresses have consistent phenotypic effects on life-history characters and whether selection under different stresses leads to consistent evolutionary responses. We created lineages of a wild mustard (Sinapis arvensis) that were selected for three generations under five stress regimes (high boron, high salt, low light, low water, or low nutrients) or under near-optimal conditions (control). Full-sibling families from the six selection histories were divided among the same six experimental treatments. In that test generation, lifetime plant fecundity and six phenotypic traits were measured for each plant. Throughout this greenhouse study, plants were grown individually and stresses were applied from the early seedling stage through senescence. Although all stresses consistently reduced lifetime fecundity and most size- and growth-related traits, different stresses had contrasting effects on flowering time. On average, stress delayed flowering compared to favorable conditions, although plants experiencing low nutrient stress flowered earliest and those experiencing low light flowered latest. Contrary to expectations of Grime's triangle model of life-history evolution, this ruderal species does not respond phenotypically to poor environments by flowering earlier. Most stresses enhanced the evolutionary potential of the study population. Compared with near-optimal conditions, stresses tended to increase the opportunity for selection as well as phenotypic variance, although both of these quantities were reduced in some stresses. Rather than favoring traits characteristic of stress tolerance, such as slow growth and delayed reproduction, phenotypic selection favored stress-avoidance traits: earlier flowering in all five stress regimes and faster seedling height growth in three stresses. Phenotypic correlations reinforced direct selection on these traits under stress, leading to predicted phenotypic change under stress, but no significant selection in the control environment. As a result of these factors, selection under stress resulted in an evolutionary shift toward earlier flowering. Environmental stresses may drive populations of ruderal plant species like S. arvensis toward a stress-avoidance strategy, rather than toward stress tolerance. Further studies will be needed to determine when selection in stressful environments leads to these alternative life-history strategies.
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Affiliation(s)
- M L Stanton
- Center for Population Biology, University of California, Davis 95616, USA.
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Abstract
In recent years, increasing numbers of experts have recommended that psychological support be available for cleft children and their parents. Few cleft palate centers however offer comprehensive psychological services. This paper presents some conceptual factors which may contribute to the paucity of psychological treatments available to cleft children and their families. Shortcomings in current concepts of emotional dysfunction in cleft children are discussed, and the effects of conceptual confusion on options for psychotherapy are outlined. Suggested directions in psychotherapy research for cleft children are discussed.
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Affiliation(s)
- M E Bennett
- University of Pittsburgh, School of Dental Medicine, Pittsburgh, PA 15261
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Abstract
Pollen of Raphanus raphanistrum produced under low nutrient conditions sired fewer seeds than pollen produced under better conditions when the two types were applied on a stigma together. No difference was seen in single-donor crosses. Male mating success can be strongly influenced by the environmental conditions of pollen-bearing plants, a factor overlooked in studies of plant reproductive biology and in standard quantitative genetic crossing designs, where effects of male parent are equated with heritable genetic variation.
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Abstract
Because availability of resources often limits seed or fruit set, increased visits by pollinators may not always lead to increases in maternal reproduction. This observation has led evolutionary biologists to hypothesize that a plant's ability to attract pollinators may have its primary impact on male fitness achieved through the fertlization of ovules. This interpretation of angiosperm reproductive ecology is supported by field experiments. Pollinating insects strongly discriminated between two Mendelian petal-color morphs in Raphanus raphanistrum, a widespread, self-incompatible crucifer. In experimental populations composed of petal-color homozygotes. color discrimination by naturally occurring pollinators had no statistically significant effect on relative maternal function (fruit and seed production) in the two morphs. In contrast, yellow-flowered individuals were far more successful as fathers (pollen donors) than were the less visited whites. These results suggest that the evolution of floral signals such as petal color may be driven primarily by selection on male function.
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Stanton ML. A new definition--implications for curriculum planning. The Baccalaureate Program. J N Y State Nurses Assoc 1973; 4:16-9. [PMID: 4520778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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