1
|
Kizhakkoottu S, Ramani P. [Oral squamous cell carcinoma in the background of oral submucous fibrosis - a systematic review]. Arkh Patol 2024; 86:57-64. [PMID: 38319274 DOI: 10.17116/patol20248601157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Oral squamous cell carcinoma (OSCC) in the background of oral submucous fibrosis (OSMF) is one of the most common presentations of oral cancer among Asian population. OSCC arising in the background of OSMF (OSCC with OSMF) has been a topic of interest among researchers recently and a few studies have considered this to be a distinct clinicopathological entity. This systematic review analyses the demographic and clinicopathological variations of OSCC with OSMF from conventional OSCC to evaluate the distinctiveness of OSCC with OSMF. A comprehensive search from PubMed, Google scholar and manual search were carried out and 4 articles were retrieved and analysed systematically. Out of the total 377 OSCC with OSMF cases and 542 conventional OSCC, males were found to be predominantly affected (82.7% and 73.6%). 47% of the OSCC with OSMF cases were well differentiated squamous cell carcinomas as against 33.4% in conventional OSCC. Lymph node metastases were seen predominantly in conventional OSCC (49.1%) than OSCC with OSMF cases (40.7%). OSCC with OSMF were more prevalent in males and showed better tumour differentiation and lesser lymph node metastasis. Even though the present results inculpate OSCC with OSMF as a distinct clinicopathological entity, there is a dire need for thorough investigation.
Collapse
Affiliation(s)
- S Kizhakkoottu
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - P Ramani
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| |
Collapse
|
2
|
Yasothkumar D, Ramalingam K, Ramani P. EPIGENETIC ALTERATIONS DRIVING ONCOGENESIS IN HEAD AND NECK SQUAMOUS CELL CARCINOMA. Exp Oncol 2023; 45:393-396. [PMID: 38186015 DOI: 10.15407/exp-oncology.2023.03.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Indexed: 01/09/2024]
Abstract
To the Editor, Head and neck squamous cell carcinoma (HN- SCC) accounts for about 600,000 new cases globally every year and stands the sixth most common cancer, arising from the squamous epithelium. It is localized in the head and neck area involving oral cavity, pharynx, and larynx. Despite the rigorous therapy, the 5-year overall survival remains poor in HNSCC and has not changed appreciably in the last 30 years. The majority of patients develop resistance to chemotherapeutic agents, and cancer progression occurs. Cetuximab, which targets the epidermal growth factor receptor, and pembrolizumab, an anti-programmed-death ligand 1 antibody, are among few FDA-approved medications. Current therapies are poor and cause severe long-term toxicity, which has a long-term impact on the quality of life [1].......
Collapse
Affiliation(s)
- D Yasothkumar
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - K Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - P Ramani
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| |
Collapse
|
3
|
Gandhi P, Ramani P, Barr F. Idiopathic CSF leak leading to spontaneous intracranial hypotension in pediatric patient. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00395-6] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
4
|
Ramani P, Modi A, Krellwitz L, Joshi S. A case of atypical inflammatory myopathy in a 4-year-$$$old girl after hematopoietic bone marrow transplantation. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00533-5] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
5
|
Paul SP, Raja DI, Sandhu BK, Rao SR, Spray CH, Wiskin AE, Selvarajan L, Volonaki E, Ramani P, Tashtoush LB, Basude D. Evidence supporting safe diagnosis of coeliac disease in children with antitissue transglutaminase titre ≥5 times upper limit of normal. Arch Dis Child 2022; 107:747-751. [PMID: 35172964 PMCID: PMC8882636 DOI: 10.1136/archdischild-2021-322000] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines on coeliac disease (CD) recommend that children who have IgA-based antitissue transglutaminase (TGA-IgA) titre ≥10× upper limit of normal (ULN) and positive antiendomysial antibody, can be reliably diagnosed with CD via the no-biopsy pathway. The aim of this study was to examine the relationship between TGA-IgA ≥5×ULN and histologically confirmed diagnosis of CD. METHODS Data including TGA-IgA levels at upper gastrointestinal endoscopy and histological findings from children diagnosed with CD following endoscopy from 2006 to 2021 were analysed. CD was confirmed by Marsh-Oberhuber histological grading 2 to 3 c. Statistical analysis was performed using χ² analysis (p<0.05= significant). RESULTS 722 of 758 children had histological confirmation of CD. 457 children had TGA-IgA ≥5×ULN and 455 (99.5%) of these had histological confirmation for CD; the two that did not had eventual diagnosis of CD based on clinicopathological features. 114 of 457 had between TGA-IgA ≥5×ULN and <10×ULN, all had confirmed CD. The likelihood of a positive biopsy with TGA-IgA ≥5×ULN (455/457) compared with TGA-IgA <5×ULN (267/301) has strong statistical significance (p<0.00001). The optimal TGA-IgA cut-off from receiver operating characteristic curve analysis was determined to be below 5×ULN for the two assays used. CONCLUSION 99.5% of children with TGA-IgA ≥5×ULN had histological confirmation of CD, suggesting that CD diagnosis can be made securely in children with TGA-IgA ≥5×ULN. If other studies confirm this finding, there is a case to be made to modify the ESPGHAN guidelines to a lower threshold of TGA-IgA for serological diagnosis of CD.
Collapse
Affiliation(s)
- Siba Prosad Paul
- Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
- Paediatrics, Yeovil District Hospital, Yeovil, UK
| | - Daniyal Isam Raja
- Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
- Medical School, University of Exeter, Exeter, Devon, UK
| | | | - Srinivasa R Rao
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Christine H Spray
- Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
| | | | | | - Eleni Volonaki
- Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
| | - Pramila Ramani
- Paediatric Histopathology, Bristol Royal Hospital for Children, Bristol, UK
| | | | - Dharamveer Basude
- Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
| |
Collapse
|
6
|
Pandiar D, Ramani P, Krishnan RP, Y D. Histopathological analysis of soft tissue changes in gingival biopsied specimen from patients with underlying corona virus disease associated mucormycosis (CAM). Med Oral Patol Oral Cir Bucal 2022; 27:e216-e222. [PMID: 35368005 PMCID: PMC9054173 DOI: 10.4317/medoral.25050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 03/28/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Corona Virus Disease-2019 (COVID-19) is perhaps the disastrous medical emergencies that has ever hit globally with multiple strains. Amongst various sequelae, mucormycosis may be considered as the most debilitating one. Post COVID-19 mucormycosis is formally regarded as corona virus disease associated mucormycosis (CAM). The aim of the current paper is to present twelve cases of CAM with unique clinical presentation with a detailed histopathological correlation of the gingival biopsied material. MATERIAL AND METHODS Twelve cases of CAM were included in the study who presented initially with non-purulent swelling of the gingiva. The clinic-demographic data pertaining to age, gender, location, laterality and presence of co-morbidities was collected along with histopathological examination of biopsied specimen. RESULTS The patients ranged from 31-65 years (mean age 47.33 years). There was a male predominance. Clearly, maxillary right gingiva was mostly affected and all cases presented with non purulent, non tender swelling of the gingiva. The incisional biopsy from the gingiva consistently showed pseudoepitheliomatous hyperplasia of the surface epithelium along with vacuolar degeneration, extensive stromal edema, massive mixed inflammatory reaction, congested blood vessels, hemorrhage and abundant multinucleated giant cells. Potassium hydroxide (10% KOH) mount served no additional diagnostic advantage. After two initial biopsies any suspected case of CAM with these features was treated with appropriate antifungal therapy and conservative excision. CONCLUSIONS Gingival swelling with aforementioned histopathological features resembling post COVID-19 histological alterations could be alarming early signs of CAM and are candidate of prompt antifungal therapy rather than repeat biopsy for confirmation.
Collapse
Affiliation(s)
- D Pandiar
- Department of Oral Pathology and Microbiology Saveetha Dental College and Hospitals Chennai, Tamil Nadu, Republic of India
| | | | | | | |
Collapse
|
7
|
Jayaraj G, Sherlin HJ, Ramani P, Premkumar P, Natesan A. Stromal myofibroblasts in oral squamous cell carcinoma and potentially malignant disorders. Indian J Cancer 2016; 52:87-92. [PMID: 26837985 DOI: 10.4103/0019-509x.175580] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Concurrent with the progression of a non- diseased epithelium to the pre-cancerous epithelium to carcinoma, the stroma also undergoes modifications. Myofibroblasts are important stromal cells that play a crucial role in carcinogenesis. The current study investigated the presence of myofibroblasts in healthy oral mucosa, potentially malignant disorders (PMDs) and squamous cell carcinoma (SCC). MATERIALS AND METHODS The study material consisted of a total of 106 samples categorized into three groups, namely, Group I - Oral SCC (OSCC) (n = 42), Group II - PMDs (n = 32) and Group III - Oral healthy mucosa (n = 32) subjected to immunohistochemical analysis using alpha Smooth Muscle Actin. RESULTS Among the 42 cases of OSCC, the staining index was negative in 23 cases (54.7%), low in 9 cases(21.4%) and moderate in 10 cases (23.8%). The stroma of cases of verrucous carcinoma, cases of Hyperkeratosis with epithelial dysplasia, 77.5% of the cases of oral Submucous Fibrosis (OSMF) and healthy oral mucosa were devoid of myofibroblasts resulting in a grade of "0" in all cases.Two of the cases of OSMF (12.5%) showed low staining index for myofibroblast. There was a significant difference in the myofibroblasts expression between the Groups (Kruskal-Wallis test P<0.001). CONCLUSION The findings of the current study justify "myofibroblast" as one among the key stromal element in tumor progression. Future studies involving a larger sample size along with follow up of patients with PMDs are essential to identify the exact stage in which they emerge in the stroma of these lesions.
Collapse
Affiliation(s)
- G Jayaraj
- Department of Oral and Maxillofacial Pathology, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India
| | | | | | | | | |
Collapse
|
8
|
Ramani P, Nash R, Sowa-Avugrah E, Rogers C. High levels of polo-like kinase 1 and phosphorylated translationally controlled tumor protein indicate poor prognosis in neuroblastomas. J Neurooncol 2015; 125:103-11. [PMID: 26318737 DOI: 10.1007/s11060-015-1900-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 08/24/2015] [Indexed: 01/15/2023]
Abstract
Despite multimodality treatment, the long-term survival of high-risk patients with neuroblastomas is below 50%. New anti-mitotic drugs against targets, such as polo-like kinase 1 (PLK1), are being evaluated in early phase clinical trials. PLK1 phosphorylates the translationally controlled tumor protein (TCTP). We investigated the expression of PLK1 and the phosphorylated substrate, pTCTP, by immunostaining eighty-eight neuroblastomas. Digitally scanned slides were scored using image analysis software. The median PLK1 and pTCTP proliferation indices (PIs) were 4.6 and 1% respectively. There was moderate positive correlation between PLK1 and pTCTP (ρ = 0.65). The PIs for both markers were significantly higher in neuroblastomas from patients with adverse clinical (advanced-stage, high-risk group, primary abdominal compared to extra-abdominal sites), biological (MYCN amplification, 1p deletion, 17q gain) and pathological (undifferentiated or poorly differentiated status, high mitosis-karyorrhexis index, [MKI], unfavorable histology) factors. Using Cox regression models, higher-than-median PLK1 and pTCTP PIs were associated with a shorter overall survival (OS) and event-free survival (EFS) in the univariate analyses. In the multivariate analyses, a high PLK1 PI count was associated with significantly shorter OS and EFS, independent of MYCN amplification and MKI; in addition, the significantly shorter EFS was independent of the risk-group. After adjustment for MKI and MYCN amplification, and for risk-group, high pTCTP PI was also associated with significantly shorter OS. Our study shows that PLK1 provides valuable prognostic information in patients with neuroblastomas.
Collapse
Affiliation(s)
- Pramila Ramani
- School of Cellular and Molecular Medicine, University of Bristol, School of Medical Sciences, University Walk, Bristol, BS8 1TD, UK.
- Department of Histopathology, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
| | - Rachel Nash
- Clinical Trials and Evaluation Unit, University of Bristol, School of Clinical Sciences, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Emile Sowa-Avugrah
- Department of Histopathology, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Chris Rogers
- Clinical Trials and Evaluation Unit, University of Bristol, School of Clinical Sciences, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| |
Collapse
|
9
|
Ramani P, Taylor S, Miller E, Sowa-Avugrah E, May MT. High phosphohistone H3 expression correlates with adverse clinical, biological, and pathological factors in neuroblastomas. J Histochem Cytochem 2015; 63:397-407. [PMID: 25711230 DOI: 10.1369/0022155415576966] [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: 07/01/2014] [Accepted: 02/14/2015] [Indexed: 11/22/2022] Open
Abstract
Phosphohistone H3 (pHH3), a biomarker of the late G2- and M-phase of the cell cycle, provides a powerful indication of the proliferative state of many cancers. We investigated the prognostic significance of pHH3 by immunostaining 80 neuroblastomas and counting the average number of strongly stained nuclei and mitotic figures. The median and 75th percentile pHH3 proliferation indices (PIs) were 0.54% and 1.06% (range, 0.01% to 2.23%) respectively. pHH3 expression was significantly higher in neuroblastomas from patients with adverse clinical characteristics, all unfavorable pathological factors including high mitosis karyorrhexis index (MKI), and adverse biological factors including MYCN oncogene amplification. High pHH3-PIs, at 1% threshold, were significantly associated with a shorter overall survival (OS) and event-free survival (EFS) in the univariable Cox regression analyses. In the multivariable models, high pHH3 counts were significantly associated with worse OS after adjustment for age but were not independent of either high MKI or MYCN amplification. In children less than 18 months of age, high MKIs and high PHH3-PIs were associated with significantly worse OS and EFS. In conclusion, high pHH3 expression correlates strongly with high MKI and MYCN amplification and indicates poor prognosis in neuroblastomas.
Collapse
Affiliation(s)
- Pramila Ramani
- Department of Histopathology, Bristol Royal Infirmary, Bristol, United Kingdom (PR, ST, EM, ESA),Department of Cellular and Molecular Medicine, School of Medical Sciences, University of Bristol, Bristol, United Kingdom(PR)
| | - Scott Taylor
- Department of Histopathology, Bristol Royal Infirmary, Bristol, United Kingdom (PR, ST, EM, ESA)
| | - Elizabeth Miller
- Department of Histopathology, Bristol Royal Infirmary, Bristol, United Kingdom (PR, ST, EM, ESA)
| | - Emile Sowa-Avugrah
- Department of Histopathology, Bristol Royal Infirmary, Bristol, United Kingdom (PR, ST, EM, ESA)
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (MTM)
| |
Collapse
|
10
|
Ramani P, Nash R, Rogers CA. Aurora kinase A is superior to Ki67 as a prognostic indicator of survival in neuroblastoma. Histopathology 2014; 66:370-9. [PMID: 25297850 DOI: 10.1111/his.12520] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/31/2014] [Indexed: 01/09/2023]
Abstract
AIMS To compare the expression and prognostic value of the cell cycle markers Aurora kinase A (AURKA) and Ki67 in neuroblastoma, because AURKA expression levels have greater prognostic significance than those of Ki67 in some cancers. METHODS AND RESULTS Eighty-eight neuroblastomas were immunostained with anti-AURKA and Ki67 antibodies. Digitally scanned slides were scored using imaging analysis software. Median AURKA and Ki67 proliferation indices (PIs) were 1.5% and 26%, respectively. Higher than median AURKA and Ki67 levels were detected in the neuroblastomas from patients belonging to the high-risk group, those with MYCN amplification, and those with unfavourable pathology, including a high mitosis-karyorrhexis index (MKI). High AURKA and Ki67 levels were significantly associated with shorter overall survival (OS) and event-free survival (EFS) in univariate analyses. In multivariate analyses, high AURKA level was associated with significantly shorter OS and EFS, independently of risk group, and of MYCN amplification and MKI. High Ki67 level was not associated with shorter OS or EFS after adjustment for risk group or MYCN amplification and MKI. CONCLUSIONS High AURKA and Ki67 levels were associated with adverse prognostic factors and shorter survival, but AURKA provides more valuable prognostic information than Ki67 in neuroblastoma.
Collapse
Affiliation(s)
- Pramila Ramani
- School of Cellular and Molecular Medicine, School of Medical Sciences, University of Bristol, Bristol, UK; Department of Histopathology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | |
Collapse
|
11
|
Ramani P, Headford A, Sowa-Avugrah E, Hunt LP. Angiogenin expression in human kidneys and Wilms' tumours: relationship with hypoxia and angiogenic factors. Int J Exp Pathol 2013; 94:115-25. [PMID: 23419171 DOI: 10.1111/iep.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 11/28/2012] [Indexed: 12/21/2022] Open
Abstract
Angiogenin (ANG) is a potent angiogenic factor that is up-regulated by hypoxia. ANG expression is well documented in normal tissues and in common tumours, but its expression has not been reported in the normal human kidney or in Wilms' tumours (WT). We examined ANG expression in WTs, human fetal kidney (FK) and childhood kidney (NK) samples and studied its relationship with microvascular density (MVD) and with three other hypoxia-induced angiogenic factors: lactate dehydrogenase A (LDHA), vascular endothelial growth factor (VEGFA) and BHLHE40 (basic helix-loop-helix transcription factor E40). Total ANG protein levels were significantly lower in WTs when compared with those in 15 matched-paired NKs. ANG immunoreactivity was observed in the glomeruli, proximal tubules and vessels in the FKs and NKs, indicating that ANG plays a physiological role in the human kidney. ANG cellular localization and distribution in 27 WTs reflected the pattern observed in the FKs. ANG colocalized with LDHA in the perinecrotic areas of untreated WTs suggesting up-regulation by hypoxia. There was a significant correlation between CD31-MVD and ANG-MVD. ANG, CD31, VEGFA and BHLHE40 mRNA levels were significantly lower in 15 WTs compared with matched-paired NKs. Univariable and multivariable statistical analyses showed significant correlations between ANG and CD31, ANG and BHLHE40 mRNAs and a weaker relationship between ANG and VEGFA mRNAs. ANG expression in WTs recapitulates that seen during nephrogenesis, and correlation with CD31-MVDs and mRNAs is consistent with a contribution to angiogenesis in WTs. Our study contributes to the understanding of angiogenesis during development and in WTs.
Collapse
Affiliation(s)
- Pramila Ramani
- Department of Histopathology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK; Department of Cellular and Molecular Medicine, School of Medical Sciences, University of Bristol, University Walk, Bristol, UK
| | | | | | | |
Collapse
|
12
|
Ramani P, Headford A, May MT. GLUT1 protein expression correlates with unfavourable histologic category and high risk in patients with neuroblastic tumours. Virchows Arch 2013; 462:203-9. [PMID: 23307190 DOI: 10.1007/s00428-012-1370-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/28/2012] [Accepted: 12/31/2012] [Indexed: 12/11/2022]
Abstract
GLUT1 is a hypoxia-induced gene that has many biologically important functions, and the overexpression of the GLUT1 protein correlates with poor prognosis in several adult cancers. The clinical significance of the GLUT1 protein in peripheral neuroblastic tumours (NTs) has not been comprehensively documented. In the present retrospective study, immunohistochemical analyses revealed the presence of GLUT1 in 44/96 (46 %) NTs. Membranous GLUT1 was present in neuroblasts of 44/87 neuroblastomas (NBs) and nodular ganglioneuroblastomas (nGNBs) but was absent in ganglion cells. The presence of GLUT1 was significantly increased in NBs and nGNBs compared with maturing ganglioneuromas and intermixed ganglioneuroblastomas (P < 0.001). The proportion of NBs and nGNBs expressing GLUT1 was significantly increased in the high-risk and low/intermediate-risk groups compared with the very-low-risk group (P = 0.022) and the unfavourable compared with the favourable pathology prognostic group (P = 0.027). In the Cox regression analyses, GLUT1 expression indicated a worse overall survival (OS; hazard rate ratio (HR) 2.29, P = 0.053) and event-free survival (EFS; HR 1.68, P = 0.181) which was not attenuated by adjustment for the mitosis-karyorrhexis index and MYCN amplification (OS: adjusted HR 2.44, P = 0.053 and EFS: adjusted HR 1.63, P = 0.244). This indicated that GLUT1 protein expression was independent of mitosis-karyorrhexis index and MYCN amplification as a prognostic factor. Our data may have clinical significance because GLUT1 was also present in a higher proportion of high-risk NTs.
Collapse
Affiliation(s)
- Pramila Ramani
- Department of Histopathology, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
| | | | | |
Collapse
|
13
|
Bates DO, Catalano PJ, Symonds KE, Varey AHR, Ramani P, O'Dwyer PJ, Giantonio BJ, Meropol NJ, Benson AB, Harper SJ. Association between VEGF splice isoforms and progression-free survival in metastatic colorectal cancer patients treated with bevacizumab. Clin Cancer Res 2012; 18:6384-91. [PMID: 23104894 DOI: 10.1158/1078-0432.ccr-12-2223] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [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
PURPOSE Bevacizumab improves survival for patients with metastatic colorectal cancer with chemotherapy, but no proven predictive markers exist. The VEGF-A splice form, VEGF(165)b, anti-angiogenic in animal models, binds bevacizumab. We tested the hypothesis that prolonged progression-free survival (PFS) would occur only in patients with low relative VEGF(165)b levels treated with bevacizumab. EXPERIMENTAL DESIGN Blinded tumor samples from the phase III trial of FOLFOX4 ± bevacizumab were assessed for VEGF(165)b and VEGF(total) by immunohistochemistry and scored relative to normal tissue. A predictive index (PI) was derived from the ratio of VEGF(165)b:VEGF(total) for 44 samples from patients treated with FOLFOX + bevacizumab (arm A) and 53 samples from patients treated with FOLFOX4 (arm B), and PFS, and overall survival (OS) analyzed on the basis of PI relative to median ratio. RESULTS Unadjusted analysis of PFS showed significantly better outcome for individuals with VEGF(165)b:VEGF(total) ratio scores below median treated with FOLFOX4 + bevacizumab compared with FOLFOX4 alone (median, 8.0 vs. 5.2 months; P < 0.02), but no effect of bevacizumab on PFS in patients with VEGF(165)b:VEGF(total) ratio >median (5.9 vs. 6.3 months). These findings held after adjustment for other clinical and demographic features. OS was increased in arm A (median, 13.6 months) compared with arm B (10.6 months) in the low VEGF(165)b group, but this did not reach statistical significance. There was no difference in the high VEGF(165)b:VEGF(total) group between FOLFOX + bevacizumab (10.8 months) and FOLFOX alone (11.3 months). CONCLUSION Low VEGF(165)b:VEGF(total) ratio may be a predictive marker for bevacizumab in metastatic colorectal cancer, and individuals with high relative levels may not benefit.
Collapse
Affiliation(s)
- David O Bates
- Microvascular Research Laboratories, Department of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
AIMS More than 50% of neuroblastomas (NBs) present with haematogenous and/or lymphatic metastasis; however, little is known about the clinicopathological significance in NBs of the key lymphangiogenesis growth factors vascular endothelial growth factor (VEGF)-C and VEGF-D and the receptor VEGFR-3. METHODS AND RESULTS Ninety-three NBs and nine ganglioneuromas (GNs) were immunostained for VEGF-C, VEGF-D and VEGFR-3. VEGF-C and VEGF-D were present in 76% and 82% of the NBs, respectively. There was no significant difference in VEGF-C expression between NBs and GNs. VEGF-D expression was significantly higher in NBs compared with GNs and in MYCN-amplified NBs. VEGFR-3 tumoral cell expression (VEGFR-3c), present in 48% of the NBs, was significantly higher in NBs from children ≥ 18 months at presentation and those belonging to a high-risk group. VEGFR-3 lymphovascular density was increased significantly in NBs compared with GNs and in NBs associated with adverse clinicopathological and biological factors. Lymphovascular invasion, assessed in VEGFR-3-stained vessels, was present in ∼50% of NBs. Cox regression analyses demonstrated that VEGFR-3c expression was associated with a significantly shorter event-free survival and that its effect was independent of the important pathological variable, mitosis-karyorrhexis index. CONCLUSIONS VEGF-D and VEGFR-3 up-regulation support tumour progression in NB and VEGFR-3c may provide a useful prognostic marker in NBs.
Collapse
Affiliation(s)
- Pramila Ramani
- School of Cellular and Molecular Medicine, University of Bristol, School of Medical Sciences, University Walk, Bristol, UK.
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
AIMS To study the expression of hypoxia-inducible factor 1α (HIF-1α) in clinical neuroblastoma (NB) samples and its association with the clinicopathological features, biological features and survival of NB patients. METHODS AND RESULTS Immunohistochemistry indicated that elevated HIF-1α expression was present in 30 of 90 (33%) NBs. This expression was correlated significantly and positively with higher clinical stage (P = 0.002), ≥18 months of age at presentation (P = 0.020), high-risk group (P = 0.005), unfavourable pathology (P = 0.002), MYCN amplification (P < 0.001), 1p deletion (P = 0.004) and 17q gain (P = 0.002). Enzyme-linked immunosorbent assays showed that total HIF-1α protein was significantly higher in NBs of patients with all examined adverse prognostic factors except for age. Univariate survival analysis revealed that higher-than-median HIF-1α total protein levels were associated significantly with a decrease in event-free survival (EFS) (P = 0.017), but not in overall survival (OS) (P = 0.12). HIF-1α immunoexpression by ≥10% of tumour cells was associated significantly with decreased OS and EFS (P = 0.002 and P = 0.004, respectively), but not in multivariate analysis after adjusting for the high-risk group (P = 0.16 and P = 0.19, respectively). CONCLUSIONS HIF-1α was increased significantly in patients with NB associated with unfavourable characteristics. HIF-1α is a prognostic indicator of poor OS and EFS and defines subgroups of NBs with aggressive clinical behaviour.
Collapse
Affiliation(s)
- Josiah V Dungwa
- Department of Histopathology, Bristol Royal Infirmary, Bristol, UK
| | | | | |
Collapse
|
16
|
Dungwa JV, Hunt LP, Ramani P. Carbonic anhydrase IX up-regulation is associated with adverse clinicopathologic and biologic factors in neuroblastomas. Hum Pathol 2012; 43:1651-60. [PMID: 22436629 DOI: 10.1016/j.humpath.2011.12.006] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 12/01/2011] [Accepted: 12/01/2011] [Indexed: 10/28/2022]
Abstract
The overexpression of carbonic anhydrase IX, a hypoxia-induced enzyme, is associated with an adverse prognosis in many cancers. However, carbonic anhydrase IX expression in neuroblastoma, the most common extracranial pediatric tumor, has not been reported. Membranous and/or strong cytoplasmic carbonic anhydrase IX expression, assessed by immunohistochemistry, was present in 21 (23%) of 91 neuroblastomas but was absent in ganglioneuromas (n = 9). The proportion of neuroblastomas showing membranous carbonic anhydrase IX expression was higher in neuroblastomas with 1p deletion and MYCN amplification. Nuclear carbonic anhydrase IX expression was seen in less than 10% of ganglion cells in all ganglioneuromas. Of 91 neuroblastomas, 16 (18%) showed nuclear carbonic anhydrase IX expression in 10% or more tumoral cells. The proportion of neuroblastomas showing nuclear carbonic anhydrase IX expression was significantly higher in patients with adverse clinical (increasing stage and high-risk group), pathologic (unfavorable group and high mitosis-karyorrhexis-index), and biologic (MYCN-amplification and 1p deletion) factors. Carbonic anhydrase IX total protein levels, quantified by enzyme-linked immunosorbent assay, were higher in neuroblastomas (n = 49; geometric mean, 0.47 pg/µg; range, 0.0-6.52 pg/µg) than in ganglioneuromas (n = 6; geometric mean, 0.20 pg/µg; range, 0.09-0.47 pg/µg) and were significantly higher in MYCN-amplified neuroblastomas. Nuclear carbonic anhydrase IX expression was associated with a poorer overall survival (P = .003) and event-free survival (P = .004), although the relationships were no longer significant when adjusted for high-risk disease. There was no significant association of membranous carbonic anhydrase IX expression or higher-than-median total protein levels with overall survival or event-free survival. Carbonic anhydrase IX is expressed at significantly higher levels in neuroblastomas from patients with adverse clinicopathologic and biologic factors indicating that it is a biomarker of aggressive disease in neuroblastomas.
Collapse
Affiliation(s)
- Josiah V Dungwa
- Department of Histopathology, Bristol Royal Infirmary, BS2 8HW Bristol, UK.
| | | | | |
Collapse
|
17
|
Ramani P, Norton A, Somerville MS, May MT. PROX1 lymphatic density correlates with adverse clinicopathological factors, lymph node metastases and survival in neuroblastomas. J Neurooncol 2012; 108:375-83. [DOI: 10.1007/s11060-012-0838-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 02/20/2012] [Indexed: 12/25/2022]
|
18
|
Dungwa JV, Uparkar U, May MT, Ramani P. Angiogenin up-regulation correlates with adverse clinicopathological and biological factors, increased microvascular density and poor patient outcome in neuroblastomas. Histopathology 2012; 60:911-23. [PMID: 22372545 DOI: 10.1111/j.1365-2559.2012.04176.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS As new biomarkers are urgently needed to identify children with high-risk neuroblastoma (NB), we studied the contribution of angiogenin (ANG) to angiogenesis and its association with clinicopathological and biological features and patient outcome in NB. METHODS AND RESULTS Ninety NBs and 12 ganglioneuromas (GNs) were immunostained for ANG and CD31. ANG expression in NB tumoral cells (ANG scores) and vessels [ANG microvascular density (MVD)] and total MVD (CD31 MVD) were determined. The ANG score was significantly greater in NBs than in GNs (P = 0.015) and in NBs from children with stage 4 tumours, high-risk disease, unfavourable pathology (P < 0.001 for each), MYCN amplification (P = 0.003), and 1p deletion (P = 0.002). ANG scores correlated with ANG MVD and CD31 MVD (P < 0.001 for each). Total ANG and CD31 protein levels, measured with a sensitive enzyme-linked immunosorbent assay, were highly correlated (P = 0.003). High ANG scores were associated with decreased overall and event-free survival (log-rank test, P = 0.025 and P = 0.018, respectively). High ANG MVD was associated with decreased overall and event-free survival (log-rank test, P = 0.009 and P = 0.026, respectively). High CD31 MVD was associated with decreased event-free survival (P = 0.045). CONCLUSIONS The strong correlation of ANG up-regulation with total MVD and adverse clinicopathological and biological factors indicates that ANG supports growth and progression in NB.
Collapse
Affiliation(s)
- Josiah V Dungwa
- Department of Histopathology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | | |
Collapse
|
19
|
Bates DO, Catalano PJ, Symonds KE, Varey AHR, Ramani P, O'Dwyer PJ, Giantonio BJ, Meropol NJ, Benson AB, Harper SJ. Predictive value of the antiangiogenic VEGF splice variant expression for bevacizumab efficacy in the phase III trial of bevacizumab and FOLFOX4 versus FOLFOX4 in previously treated patients with advanced colorectal cancer (ECOG E3200T2). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.545] [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
545 Background: Treatment of metastatic colorectal cancer (CRC) with bevacizumab (anti-VEGF) in combination with chemotherapy increases survival in a proportion of patients, but it is not possible a priori to predict which patients will receive benefit. The VEGF-A gene is alternatively spliced into two families by alternative splice site usage in exon 8. The pro-angiogenic (e.g. VEGF165) isoforms are generated by proximal splice site selection, and the anti-angiogenic (e.g. VEGF165b) by distal splice site selection. The relative levels of the isoforms vary in CRC. VEGF165b over-expression in mice inhibits bevacizumab treatment.We tested the hypothesis that survival would be better in patients with low VEGF165b levels on bevacizumab than placebo. Methods: To determine whether survival was better in patietns with low VEGF165b when treated with FOLFOX4+bevacizumab (Arm A) than FOLFOX4 + placebo (Arm B), 108 coded patient samples from the E3200 trial of FOLFOX4±bevacizumab (NCT NCT00897754 ) were successfully stained for VEGF-A165b and scored in well differentiated tissue relative to normal tissue blind to outcome. The VEGF165b expression relative to normal tissue was calculated. 108 cases were analysed for VEGF165b/Normal, 48 in arm A, 60 in Arm B. Results: Adjusted Cox Binary analysis of VEGF165b/Normal comparing staining ratio in bevacizumab versus placebo treated patients demonstrated significantly better survival for the less than median ratios (HR=0.28, p=0.0031, median progression free survival, 8.4 versus 5.1 months in placebo), whereas in the higher than median VEGF165b/Normal group there was no effect of bevacizumab (HR=0.96, median PFS, 11.9 compared with 11.0months). Results held after adjustment for other clinical and demographic features in proportional hazards regression modelling. Conclusions: In conclusion, these results indicate that low VEGF165b levels in well-differentiated tumours may predict response to bevacizumab.
Collapse
Affiliation(s)
- David O. Bates
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Paul J. Catalano
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Kirsty E. Symonds
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Alexander H. R. Varey
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Pramila Ramani
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Peter James O'Dwyer
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Bruce J. Giantonio
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Neal J. Meropol
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Al Bowen Benson
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Steven J. Harper
- University of Bristol, Bristol, United Kingdom; Dana-Farber Cancer Institute, Boston, MA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Case Western Reserve University, Cleveland, OH; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| |
Collapse
|
20
|
Ramani P, Dungwa JV, May MT. LYVE-1 upregulation and lymphatic invasion correlate with adverse prognostic factors and lymph node metastasis in neuroblastoma. Virchows Arch 2012; 460:183-91. [PMID: 22241180 DOI: 10.1007/s00428-011-1190-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 12/12/2011] [Accepted: 12/26/2011] [Indexed: 11/28/2022]
Abstract
Neuroblastoma (NB) accounts for 15% of all childhood cancer deaths. The majority of patients have widespread lymphatic and/or haematogenous metastases at diagnosis, but lymphangiogenesis has not been well documented. Sixty-seven NBs were immunostained for the lymphatic endothelial marker, LYVE-1, and the lymphatic density (LD) and lymphatic invasion (LI), were counted in LYVE-1-expressing lymphatics. LYVE-1-stained lymphatic vessels and LI were present in 26/67 (39%) and 14/67 (21%) of the NBs, respectively. Central LD (CLD) and LI were higher in NBs from stage 4 (p = 0.012, p = 0.004, respectively), high-risk group (p = 0.030, p = 0.002), NBs with high mitosis karyorrhexis index (MKI) (p = 0.011, p = 0.005), unfavourable histology group (p = 0.040, p = 0.017) and distant lymph node metastasis (LNM) (p < 0.001 for each). Marginal LD (MLD) was higher in patients with LNM (p < 0.001). CLD and MLD correlated with LI (p < 0.001 each). Total LYVE-1 protein levels, quantified by a sensitive enzyme-linked immunosorbent assay (n = 55), were also higher in NBs from patients with stage 4 disease (p = 0.046), high-risk group (p = 0.028), MYCN-amplified NBs (p = 0.034) and LNM (p = 0.038). Kaplan-Meier analysis showed that the presence of CLD was associated with both worse OS at 5 years (77% [95% CI: 62-87%] versus 60% [95% CI: 32-80%], p = 0.062) and EFS (74% [95% CI: 58-85%] versus 43% [95% CI: 15-69%], p = 0.070) and LI with OS (71% [95% CI: 57-81%] versus 56% [95% CI: 26-78%], p = 0.055). Significant upregulation of LYVE-1 and the presence of LI in patients with stage 4 and high-risk disease, MYCN-amplification and LNM suggests that LYVE-1 may have value as predictors of outcome.
Collapse
Affiliation(s)
- Pramila Ramani
- Department of Histopathology, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
| | | | | |
Collapse
|
21
|
Abstract
Background Overexpression of carbonic anhydrase (CA IX) is associated with poor survival in several adult-type cancers but its expression is undocumented in Wilms tumour (WT), the most common tumour of the paediatric kidney. Methods CA9 expression was measured using polymerase chain reaction (PCR) in 13 WTs and matched-paired non-neoplastic kidneys (NKs). CA IX and hypoxia-inducible factor-1 α-subunit (HIF-1α) protein were quantified in 15 matched-paired WTs and NKs using enzyme-linked immunosorbent assays. CA IX and HIF-1α were localised by immunostaining tissue sections of 70 WTs (untreated WTs, n = 22; chemotherapy-treated WTs, n = 40; relapsed/metastatic WTs, n = 8). CA IX-positive untreated WTs (n = 14) were immunostained for vascular endothelial growth factor (VEGF), glucose transporter-1 (GLUT1) and CD31. Double staining for CA IX and CD31 was performed in WTs (n = 14). Results CA9 full length (FL) was significantly up-regulated in WTs compared to NKs (p = 0.009) by real-time PCR. Conventional PCR showed expression of alternative splice variant in all NKs and WTs but FL in WTs only. WTs showed a 2-fold increase in CA IX protein over NKs (p = 0.01). HIF-1α levels were up-regulated in WTs compared to NKs, although the difference was not statistically significant (p = 0.09). CA IX and HIF-1α immunolocalisation were observed in 63% and 93% of WTs, respectively. The median fraction of cells staining positively for CA IX and HIF-1α was 5% and 22%, respectively. There was no significant association between the expression of either CA IX or HIF-1α and clinicopathological variables in WTs resected following chemotherapy. VEGF and GLUT1 immunoreactivity was seen in 94% and 100% with the median fraction of 10% and 60% respectively. Co-expression and co-localisation of all four hypoxia markers was seen in 7/14 and 6/14 cases respectively. CA IX was seen in well vascularised areas as well as in the peri-necrotic areas. Conclusions Carbonic anhydrase 9 (mRNA and protein), and HIF-1α protein are overexpressed in a significant portion of WTs. No significant association was detected between the expression of either CA IX or HIF-1α and clinicopathological variables in WTs resected following chemotherapy. Cellular localisation studies in untreated WTs suggest that CA IX and HIF-1α are regulated by hypoxia and non-hypoxia mechanisms.
Collapse
Affiliation(s)
- Josiah V Dungwa
- Department of Histopathology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | | | | |
Collapse
|
22
|
Jagannathan N, Neelakantan P, Thiruvengadam C, Ramani P, Premkumar P, Natesan A, Herald JS, Luder HU. Age estimation in an Indian population using pulp/tooth volume ratio of mandibular canines obtained from cone beam computed tomography. J Forensic Odontostomatol 2011; 29:1-6. [PMID: 21841263 PMCID: PMC5734837] [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] [Indexed: 05/31/2023]
Abstract
The present study assessed the suitability of pulp/tooth volume ratio of mandibular canines for age prediction in an Indian population. Volumetric reconstruction of scanned images of mandibular canines from 140 individuals (aged ten - 70 years), using computed tomography was used to measure pulp and tooth volumes. Age calculated using a formula reported earlier for a Belgian sample, resulted in errors > ten years in almost 86% of the study population. The regression equation obtained for the Indian population: Age = 57.18 + (- 413.41 x pulp/tooth volume ratio), was applied to an independent control group (n = 48), and this resulted in mean absolute errors of 8.54 years which was significantly (p < 0.05) lower than those derived with the Belgian formula. The pulp/tooth volume ratio is a useful indicator of age, although correlations may vary in different populations and hence, specific formulae should be applied for the estimates.
Collapse
Affiliation(s)
- N Jagannathan
- Department of Oral and Maxillofacial Pathology, Saveetha Dental College and Hospitals, Saveetha University, 167, PH Road, Velappanchavadi, Chennai, Tamil Nadu, India
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Peiris-Pagès M, Harper SJ, Bates DO, Ramani P. Balance of pro- versus anti-angiogenic splice isoforms of vascular endothelial growth factor as a regulator of neuroblastoma growth. J Pathol 2010; 222:138-47. [PMID: 20662003 DOI: 10.1002/path.2746] [Citation(s) in RCA: 18] [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] [Indexed: 12/25/2022]
Abstract
Neuroblastoma (NB) is the second most common extracranial tumour of childhood. Angiogenesis plays a crucial role in the growth and development of NB and vascular endothelial growth factor (VEGF), one of the most potent stimuli of angiogenesis, has been studied extensively in vitro. VEGF(165) has been shown to be the predominant angiogenic isoform expressed in NB cell lines and tumours. In this study, we investigated the anti-angiogenic isoform of VEGF-A, generated from distal splice site selection in the terminal exon of VEGF (VEGF(165)b) and shown to be down-regulated in epithelial malignancies. The expression of both the pro- (VEGF(xxx)) and the anti-angiogenic (VEGF(xxx)b) isoforms was compared in a range of NB and ganglioneuroma (GN) tumours. Whereas VEGF(xxx)b and VEGF(xxx) were both expressed in GN, specific up-regulation of the VEGF(xxx) isoforms was seen in NB at RNA and protein levels. Highly tumourigenic NB cell lines also showed up-regulation of the angiogenic isoforms relative to VEGF(xxx)b compared to less tumourigenic cell lines, and the isoforms were differentially secreted. These results indicate that VEGF(165) is up-regulated in NB and that there is a difference in the balance of isoform expression from anti-angiogenic VEGF(165)b to angiogenic VEGF(165). Treatment with recombinant human VEGF(165)b significantly reduced the growth rate of established xenografts of SK-N-BE(2)-C cells (4.24 +/- 1.01 fold increase in volume) compared with those treated with saline (9.76 +/- 3.58, p < 0.01). Microvascular density (MVD) was significantly decreased in rhVEGF(165)b-treated tumours (19.4 +/- 1.9 vessels/mm(3)) in contrast to the saline-treated tumours (45.5 +/- 8.6 vessels/mm(3)). VEGF(165)b had no significant effect on the proliferative or apoptotic activity, viability or cytotoxicity of SK-N-BE(2)-C cells after 48 h. In conclusion, VEGF(165)b is an effective inhibitor of NB growth. These findings provide the rationale for further investigation of VEGF(165)b in NB and other paediatric malignancies.
Collapse
Affiliation(s)
- Maria Peiris-Pagès
- Cellular and Molecular Medicine, University of Bristol, School of Medical Sciences, University Walk, Bristol BS8 1TD, UK
| | | | | | | |
Collapse
|
24
|
Abstract
We present the 1st case report of an additional enteric smooth muscle layer in a patient with Mowat-Wilson syndrome and Hirschsprung disease. After resection of the aganglionic colon at the age of 5 months, our patient initially suffered from intermittent constipation, and subsequently by the age of 5 years, he developed ongoing diarrhea requiring medical treatment for more than a decade. Although the exact mechanism of abnormal gut motility in this case is unknown, we postulate that the supernumerary muscle and its associated neural plexus may be responsible for the patient's unusual late complication in treated Hirschsprung disease.
Collapse
Affiliation(s)
- May Leong
- Department of Histopathology, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | | | | | | |
Collapse
|
25
|
Peiris M, Bates D, Ramani P. VEGF
xxx
b is relatively down‐regulated in malignant neuroblastoma but not in benign ganglioneuroma. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.954.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Dave Bates
- Physiology and PharmacologyUniversity of BristolBristolUnited Kingdom
| | | |
Collapse
|
26
|
Roderick M, Ramani P, Tulloh R, Ramanan AV. Age no barrier to diagnosis. Arch Dis Child Educ Pract Ed 2009; 94:42-5. [PMID: 19304899 DOI: 10.1136/adc.2008.145219] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Roderick
- Department of Paediatrics, Gloucester Hospitals NHS Trust, Gloucester, UK
| | | | | | | |
Collapse
|
27
|
Melegh Z, Patel Y, Ramani P. Solitary pulmonary infantile hemangioma in an infant with atrial septal defect. Pediatr Dev Pathol 2008; 11:465-8. [PMID: 17990917 DOI: 10.2350/07-03-0249.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 06/12/2007] [Indexed: 11/20/2022]
Abstract
Pulmonary infantile hemangiomas are extremely rare in infancy and childhood. We describe a case of a 22-month-old infant who presented with repeated chest infections. Imaging studies revealed a solitary parenchymal lung lesion in the left upper lobe, an atrial septal defect, and mild right ventricular dilatation. Various investigations failed to delineate the precise nature of the lung lesion and it was resected. Histological examination of the lung lesion showed an infantile hemangioma, which expressed glucose transporter-1 protein, GLUT-1, a marker of infantile hemangiomas. This case represents a unique coexistence of 2 lesions, both of which resulted in right-sided overload, contributed to mainly by the atrial septal defect causing increased volume and, to a lesser extent, by the pulmonary hemangioma resulting in increased pressure. This case also emphasizes the fact that infantile hemangioma, although rare, should be considered as a differential diagnosis of solitary lung lesions.
Collapse
Affiliation(s)
- Zsombor Melegh
- Department of Histopathology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, United Kingdom.
| | | | | |
Collapse
|
28
|
Short M, Dramis A, Ramani P, Parikh DH. Mediastinal and pulmonary infantile myofibromatosis: an unusual surgical presentation. J Pediatr Surg 2008; 43:e29-31. [PMID: 18970917 DOI: 10.1016/j.jpedsurg.2008.06.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 06/21/2008] [Accepted: 06/22/2008] [Indexed: 11/25/2022]
Abstract
A 4-week-old boy was extensively investigated for stridor and respiratory distress and was found to have a soft tissue mass superior to the left hilum and emphysema of the entire left lung. An exploratory thoracotomy was undertaken for diagnosis and possibly to improve respiratory distress. Intraoperatively, a firm plaquelike mass was identified encasing the entire hilum including left pulmonary artery and left main bronchus. It became apparent that a left pneumonectomy was needed to be performed to resect the tumor completely and achieve hemostasis. Histopathologic examination revealed infantile myofibromatosis with multiple foci within the entire lung parenchyma as well as in the hilar mass. The child is completely recurrence-free and symptom-free after 6 years of follow-up. The literature review was carried out to discuss management of this rare but benign and surgically challenging condition.
Collapse
Affiliation(s)
- Melissa Short
- Department of Pediatric Surgery, Birmingham Children's Hospital, Steelhouse Ln, Birmingham, United Kingdom
| | | | | | | |
Collapse
|
29
|
Leong MY, English M, McMullan D, Ramani P. Aberrant expression of beta-HCG in anaplastic large cell lymphoma. Pediatr Dev Pathol 2008; 11:230-4. [PMID: 17990918 DOI: 10.2350/07-03-0251.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 06/12/2007] [Indexed: 11/20/2022]
Abstract
We report a case of anaplastic large cell lymphoma (ALCL) showing aberrant expression of beta subunit of human chorionic gonadotrophin (beta-HCG). The patient was a 14-year-old boy who presented with a right inguinal mass and a raised serum beta-HCG level. Biopsy of the mass revealed a malignant neoplasm composed of large, pleomorphic cells with prominent nucleoli. These malignant cells showed positive staining with CD30, ALK, epithelial membrane antigen, and beta-HCG. Chromosomal analysis showed t(2;5)(p23;q35) translocation, and polymerase chain reaction demonstrated T-cell receptor gene rearrangement. The patient did not respond well to chemotherapy, and he died 8 months after the diagnosis. To the best of our knowledge, this is the 1st case of ALCL showing aberrant expression of beta-HCG and associated with a raised serum level of beta-HCG. We report this case to bring awareness of this presumably rare occurrence to avoid the risk of misdiagnosis.
Collapse
Affiliation(s)
- May Ying Leong
- Department of Histopathology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, United Kingdom
| | | | | | | |
Collapse
|
30
|
Patel Y, Ramani P, Grier D, McNally J. Bleeding jejunal phlebectasia in an adolescent: case report. J Pediatr Surg 2008; 43:405-6. [PMID: 18280301 DOI: 10.1016/j.jpedsurg.2007.09.081] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Revised: 09/26/2007] [Accepted: 09/29/2007] [Indexed: 10/22/2022]
Abstract
The first case of jejunal phlebectasia in a pediatric patient presenting with life-threatening gastrointestinal bleeding is described. The pathology of vascular anomalies is discussed.
Collapse
Affiliation(s)
- Yatin Patel
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, BS2 8BJ Bristol, United Kingdom.
| | | | | | | |
Collapse
|
31
|
Abstract
In this article, we report a case of collagenous gastritis in a child and review the paediatric cases reported to date. Collagenous gastritis is a rare entity, with only less than 30 cases reported so far, including 12 children, since the first description of this entity by Colletti and Trainer in 1989. This is a histological diagnosis characterised by a dramatically thickened subepithelial collagen band in the gastric mucosa associated with an inflammatory infiltrate. Children with this condition often present with epigastric pain and severe anaemia, with no evidence of extragastric involvement, in contrast to the adult patients, where chronic watery diarrhoea is the main presentation due to associated collagenous colitis. A macroscopic pattern of gastritis with nodularity of gastric mucosa, erythema and erosions are characteristic endoscopic findings in paediatric patients. Specific therapy has not been established and resolution of the abnormalities, either endoscopic or histological, has not been documented. In conclusion, collagenous gastritis is a rare entity of unknown aetiology, pathogenesis and prognosis. Gastroenterologists and pathologists need to be aware of this condition when evaluating a child with epigastric pain, anaemia and upper gastrointestinal bleeding, particularly when endoscopy reveals the nodularity of gastric mucosa. The identification, reporting and long-term follow-up of cases will shed more light on this puzzling condition.
Collapse
Affiliation(s)
- Madhur Ravikumara
- Department of Gastroenterology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | | | | |
Collapse
|
32
|
Abstract
A case of a left congenital diaphragmatic hernia (CDH), absent pericardium, and a hernial sac containing ectopic liver tissue is presented. This triplicate of defects is exceedingly rare with only 2 previous reports in the literature dating back to 1936. This case supports the evidence that CDH is the result of failure of the closure of the pleuroperitoneal canals by the growth of the posthepatic mesenchymal plate. Moreover, the role of the phrenic nerve as a mediator for both CDH and absent pericardium is discussed.
Collapse
Affiliation(s)
- Y Patel
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | | | | |
Collapse
|
33
|
Abstract
Juvenile xanthogranulomatosis (JXG) is a rare benign condition, which usually presents with characteristic skin lesions and can be diagnosed clinically. However, systemic JXG may involve a wide range of extracutaneous sites and may pose a diagnostic dilemma for the clinician, radiologist, and pathologist. In particular it may simulate malignancy. Here, we report a case of systemic JXG within the abdominal wall musculature and lungs, which imitated a sarcoma with pulmonary metastases on computerized tomography. To the best of our knowledge, this is the first such reported case. In particular, systemic disease presenting without skin lesions is unusual.
Collapse
Affiliation(s)
- Nicola J Matcham
- Department of Paediatric Radiology, Bristol Royal Hospital for Children, Marlborough Street, Bristol BS2 8HW, UK.
| | | | | | | | | |
Collapse
|
34
|
Abstract
To correlate sodium-potassium levels in saliva of pediatric patients having different intensities of toothache assessed by Visual Analogue Scale (VAS) in age group 3-14 yrs. A prospective study of 50 children having different intensities of pain was carried out in the Dept. of Pedodontics, Sareetha Dental College and Hospital. 50 children (aged 3-14 yrs) having different intensities of toothache including normal children (control) were included in the study. Saliva samples were collected and Na+, K+ levels in saliva were measured by using Na+, k+ colorimeter kit. Photographs were taken using Digital camera and VAS was prepared accordingly. Sodium levels decreased with increasing pain intensity and potassium levels increased, facial expressions correlated with Na+, K+ levels. Correlation between Na+, K+ levels and pain intensity exists. Also, VAS is a valid measure for pain.
Collapse
Affiliation(s)
- V Gupta
- Department of Oral and Maxillofacial Pathology, Saveetha Dental College, Chennai, India.
| | | | | |
Collapse
|
35
|
Chughtai SA, Genus T, Ramani P, Dyer S, Powell JE, McMullan D, Davison V, McConville CM. Multilocus loss of heterozygosity allelotypes identify a genetic pathway associated with progression from low to high stage disease in neuroblastoma. Eur J Cancer 2006; 42:1826-34. [PMID: 16872824 DOI: 10.1016/j.ejca.2006.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 02/27/2006] [Accepted: 03/15/2006] [Indexed: 01/02/2023]
Abstract
Neuroblastoma is a heterogeneous tumour with a variety of clinical phenotypes, ranging from a localised tumour with excellent outcome (stage 1) to a metastatic, usually fatal malignancy (stage 4). In order to investigate the genetic relationship between these tumour subtypes, a loss of heterozygosity (LOH) analysis was carried out. Composite LOH allelotypes incorporating data from 96 loci on 5 chromosomes (1p, 3p, 4p, 11q, 14q), were constructed for 62 neuroblastomas. Neuroblastomas with similar allelotypes were clustered into groups and allelotype patterns correlated with clinical features. Three distinct genetic subgroups of neuroblastoma were observed. The largest group (50% of tumours) was characterised by specific allelotype patterns indicative of a stepwise accumulation of genetic alterations (11q LOH-->1p, 4p, and/or 14q LOH-->3p LOH), associated with progression from low to high stage disease. These tumours are distinct from MYCN amplified neuroblastomas which have a more rapid and aggressive disease course, and also a proportion of low stage tumours, often ganglioneuromas or ganglioneuroblastomas, with restricted growth potential.
Collapse
Affiliation(s)
- Shaheen A Chughtai
- Division of Reproductive and Child Health, University of Birmingham, B15 2TT, UK
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Ramani P, Murugesan K, Chandrasekar T, Anuja N. Cholesterol granuloma of maxillary sinus. Int J Oral Maxillofac Surg 2006; 35:1063-5. [PMID: 16828539 DOI: 10.1016/j.ijom.2006.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 04/15/2006] [Accepted: 04/27/2006] [Indexed: 11/29/2022]
Abstract
The cholesterol granuloma is a particular form of granulation tissue developing as part of a variety of tissue reactions. It is usually associated with chronic middle ear disease and is common in the mastoid antrum of temporal bone. Cholesterol granuloma is rare in maxillary antrum. A case is reported of cholesterol granuloma in the maxillary sinus of a 42-year-old man, with the unique feature that the soft tissue lesion is enclosed by thick bone, entirely within the sinus.
Collapse
Affiliation(s)
- P Ramani
- Department of Oral and Maxillofacial Pathology, College of Dental Surgery, Saveetha Institute of Medical and Technical Sciences, Chennai, India.
| | | | | | | |
Collapse
|
37
|
Sharif K, Ramani P, Lochbühler H, Grundy R, de Ville de Goyet J. Recurrent mesenchymal hamartoma associated with 19q translocation. A call for more radical surgical resection. Eur J Pediatr Surg 2006; 16:64-7. [PMID: 16544232 DOI: 10.1055/s-2005-873072] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hepatic mesenchymal hamartoma is a rare benign tumour in children. It is often large and centrally located in the liver at diagnosis, making surgical resection difficult; thus non-radical resection has been proposed in the past as acceptable management. However, a literature survey and a case with recurrence associated with cytogenetic anomalies suggest that radical liver surgery (resection with a margin of normal liver parenchyma, as for malignant tumour) should be recommended for mesenchymal hamartoma.
Collapse
Affiliation(s)
- K Sharif
- Liver Unit, Birmingham Children's Hospital, Birmingham, UK
| | | | | | | | | |
Collapse
|
38
|
Abstract
Necrotising enterocolitis (NEC) is characterised by severe mucosal loss and therefore gastrointestinal (GI) cell proliferation is essential for survival, epithelial repair and recovery of function. Trefoil peptides play a key role in epithelial restitution and repair, and we previously reported a down-regulation of these peptides in NEC. Oral administration of epidermal growth factor has a protective effect in a rat model of colitis. These observations raised the question of a link between the pathogenesis of NEC and decreased mucosal cell proliferation. This study investigates the pattern of mucosal cell proliferation in the GI tract of fetuses, normal neonatal controls, infants with NEC and those recovering from NEC. Parents of neonates up to 44 weeks' gestation undergoing laparotomy and bowel resection were approached for consent. Bowel samples from resection specimens, and GI tract extractions from products of conception at termination of pregnancy, were fixed in formalin and then embedded in paraffin blocks. Patterns of small and large bowel mucosal proliferation were assessed by immunohistochemical staining for Ki67. Seventeen foetal and 58 postnatal bowel samples [34 with NEC (22 acute, 12 recovery) and 24 controls] were analysed. The pattern of proliferation seen in the fetus and normal neonate was identical to that in mature bowel. In NEC severe mucosal necrosis was observed, but in viable crypts remaining, there was crypt hyperplasia and a relative increase in the proportion of cells staining positive for Ki67. In those patients recovering from NEC the pattern of proliferation was returning towards the normal range. In those patients with post-NEC strictures the recovery of normal bowel morphology was delayed. In NEC there is massive loss of potential proliferative tissue. The remaining viable tissue shows an increase in proliferative activity in the small and large bowel. Failure of rapid regeneration of functional mucosa may therefore be related to an inability of increased proliferative activity to match the losses from the surface; alternatively there may be rapid production of immature, short-lived cells. This study shows that the proliferative response, although present, is insufficient to rapidly reverse the mucosal insult observed in NEC.
Collapse
Affiliation(s)
- Daniela Vieten
- Department of Paediatric Surgery, Directorate of Children's Services, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK.
| | | | | | | |
Collapse
|
39
|
Abstract
There are previous reports of dilated cardiomyopathy (DCM) in recessive dystrophic epidermolysis bullosa (RDEB), a debilitating blistering skin disorder. The pathogenesis of DCM in RDEB remains uncertain, although dietary deficiency of selenium and carnitine have been implicated. A 6 year old girl with RDEB who died of DCM is reported; attention is drawn to the possible role of two potentially cardiotoxic drugs, amitriptyline and cisapride.
Collapse
Affiliation(s)
- S M Taibjee
- Department of Dermatology, Birmingham Children's Hospital, UK.
| | | | | | | |
Collapse
|
40
|
Abstract
Necrotising enterocolitis (NEC) remains an overwhelming gastrointestinal (GI) emergency in premature infants, with an annual incidence of 350 cases and a mortality of 23% in the United Kingdom. The aetiology of NEC is multifactorial and its pathogenesis poorly understood. It is characterised by severe necrotic damage to the intestine. Mucus is an adherent, viscoelastic gel layer protecting the delicate underlying epithelium from lumenal aggressors such as digestive enzymes and bacterial toxins. The group of trefoil factor peptides (TFF1-3) are part of the protective mechanism operating in the intestinal mucosa and play a fundamental role in epithelial protection, repair, and restitution. These secreted peptides have been identified in a site-specific pattern in the GI mucosa, and their expression has been shown to be upregulated in early stages of mucosal repair. The role of trefoil peptides in neonatal mucosal protection has not been well investigated. Impaired mucosal regeneration due in part to failure of upregulation of TFF expression may contribute to the pathogenesis of NEC. The aim of this study was to investigate TFF1-3 mRNA expression and to identify the gene product in the GI tracts of normal neonatal controls and infants with NEC. Parents of all babies having a laparotomy in the neonatal period (defined as up to 44 weeks' gestation) and bowel resection were approached for written consent. Bowel samples were fixed in formalin and then embedded in paraffin in an RNAse-free manner. In situ hybridisation and immunohistochemistry were performed to examine the pattern of trefoil mRNA expression and to localise the peptides in the neonatal GI tract. Forty neonatal bowel specimens were examined. Twelve patients had NEC, eight were recovering from NEC, and 20 control specimens were obtained. TFF1 and TFF2 mRNA expression were not detected in the majority of NEC specimens, and there was a relative downregulation of TFF3 expression in 83% of NEC patients. TFF1 and TFF2 expression were noted in the recovery phase from NEC. Immunohistochemistry revealed a decrease in TFF3 gene product in sites adjacent to mucosal damage secondary to NEC. In acute NEC there was no apparent expression of TFF1 and 2 protein. In the group of patients recovering from NEC, TFF1 and 2 expression were seen in association with regenerative changes in the mucosa. Previous data has shown TFF1-3 to be upregulated in the acute phase response to mucosal injury in the gut. Trefoil peptides have been shown to promote epithelial cell migration and protect against apoptosis. Our results suggest that there is a lack of TFF expression in response to NEC in the premature gut. This may lead to impaired restitution of the mucosa and contribute to the cascade of bowel necrosis and generalised sepsis characteristic of NEC.
Collapse
Affiliation(s)
- Daniela Vieten
- Department of Paediatric Surgery, Directorate of Children's Services, Bristol Royal Hospital for Children, Paul O'Gorman Building Upper Maudlin Street, Bristol, BS2 8BJ, UK.
| | | | | | | | | |
Collapse
|
41
|
Freeman A, Geddes N, Munson P, Joseph J, Ramani P, Sandison A, Fisher C, Parkinson MC. Anaplastic lymphoma kinase (ALK 1) staining and molecular analysis in inflammatory myofibroblastic tumours of the bladder: a preliminary clinicopathological study of nine cases and review of the literature. Mod Pathol 2004; 17:765-71. [PMID: 15105807 DOI: 10.1038/modpathol.3800078] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inflammatory myofibroblastic tumours (IMFT) may arise at any anatomical site, including lung, soft tissues, retroperitoneum and bladder. Although morphologically similar, these lesions encompass a spectrum of entities with differing aetiology, ranging from reactive/regenerative proliferations to low-grade neoplasms with a risk of local recurrence, but no significant metastatic potential. Vesical IMFT usually presents as a polypoid mass with a pale firm cut surface and can be of considerable size, mimicking a malignant tumour clinically and radiologically. Its good outcome, however, warrants conservative surgical excision, emphasising the importance of identification and distinction from malignant tumours of the bladder that may require more radical surgery and/or adjuvant therapy. We conducted a preliminary retrospective, comparative immunocytochemical study of 20 bladder tumours, including nine IMFTs, five spindle cell (sarcomatoid) carcinomas, two rhabdomyosarcomas, two leiomyosarcomas and two neurofibromas. The results confirmed IMFT positivity for smooth muscle actin, desmin and cytokeratin in 78-89% cases, resulting in potential confusion with sarcomatoid carcinoma or leiomyosarcoma. In contrast, cytoplasmic anaplastic lymphoma kinase (ALK 1) staining was present in eight IMFT (89%), but was not seen in any other lesion examined. The ALK 1 staining was confirmed by fluorescence in situ hybridisation, with translocation of the ALK gene present in 15-60% tumour cells in four of six IMFT examined, but not in four cases of sarcomatoid carcinoma or three of leiomyosarcoma. In conclusion, ALK 1 staining may be of value in the distinction of vesical IMFT from morphologically similar entities, and often reflects ALK gene translocations in these lesions.
Collapse
Affiliation(s)
- Alex Freeman
- Department of Histopathology, University College Hospital, London.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
This report describes a case of fatal haemolytic uraemic syndrome (HUS) developing in a child with acute lymphoblastic leukaemia (ALL) during induction chemotherapy. The aetiology in this case is uncertain but it may have resulted from treatment with L-asparaginase or vincristine. The possibility of HUS during induction chemotherapy for ALL should be considered early on in the treatment regimen, if clinical signs and symptoms suggest this diagnosis, so that appropriate treatment can be instituted.
Collapse
Affiliation(s)
- D Chandra
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
| | | | | |
Collapse
|
43
|
Sharif K, English M, Ramani P, Alberti D, Otte JB, McKiernan P, Gosseye S, Jenney M, de Ville de Goyet J. Management of hepatic epithelioid haemangio-endothelioma in children: what option? Br J Cancer 2004; 90:1498-501. [PMID: 15083175 PMCID: PMC2409708 DOI: 10.1038/sj.bjc.6601720] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Hepatic epithelioid haemangio-endothelioma (HEHE) is an endothelium-derived tumour of low-to-medium grade malignancy. It is predominantly seen in adults and is unresponsive to chemotherapy. Liver transplantation is an accepted indication when the tumour is unresectable. Hepatic epithelioid haemangio-endothelioma is very rare in children and results after transplantation are not reported. The aim of this study is to review the experience of three European centres in the management of HEHE in children. A retrospective review of all paediatric patients with HEHE managed in three European centres is presented. Five children were identified. Four had unresectable tumours. The first had successful resection followed by chemotherapy and is alive, without disease 3 years after diagnosis. One child died of sepsis and one of tumour recurrence in the graft and lungs 2 and 5 months, respectively, after transplant. Two children who had progressive disease with ifosfamide-based chemotherapy have had a reduction in clinical symptoms and stabilisation of disease up to 18 and 24 months after the use of platinum-based chemotherapy. HEHE seems more aggressive in children than reported in adults and the curative role of transplantation must be questioned. Ifosfamide-based chemotherapy was not effective. Further studies are necessary to confirm if HEHE progression in children may be influenced by platinum-based chemotherapy.
Collapse
Affiliation(s)
- K Sharif
- Liver Unit and Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - M English
- Liver Unit and Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - P Ramani
- Department of Pathology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - D Alberti
- Liver Transplant Centre, Ospedali Riuniti, Largo Barozzi 1, 24100 Bergamo, Italy
| | - J-B Otte
- Department of Paediatric Surgery, St Luc University Clinics Brussels, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - P McKiernan
- Department of Pathology, St Luc University Clinics Brussels, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - S Gosseye
- Department of Pathology, St Luc University Clinics Brussels, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - M Jenney
- Department of Paediatric Haemato-Oncology, Llandough Hospital, Penlan Road, Llandough, Penarth, Vale of Glamorgan CF64 2XX, UK
| | - J de Ville de Goyet
- Liver Unit and Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
- Liver and Paediatric Surgery, Cliniques St Luc-UCL, Av Hippocrate 10, B1200 Brussels, Belgium. E-mail:
| |
Collapse
|
44
|
Abstract
BACKGROUND AND AIMS Necrotising enterocolitis (NEC) is a potentially devastating disorder of preterm infants but its aetiology remains unclear. The aim of these studies was to develop a neonatal piglet model for NEC and to then use the model to investigate the role of platelet activating factor (PAF) in its pathogenesis. METHODS Anaesthetised newborn piglets were divided into six groups: (i) controls, and groups subjected to (ii) hypoxia, (iii) lipopolysaccharide (LPS), (iv) hypoxia+LPS, (v) hypoxia+LPS and the PAF antagonist WEB 2170, and (vi) PAF. Arterial blood pressure (ABP), superior mesenteric artery blood flow (MBF), mesenteric vascular conductance (MVC), and arterial blood gases were recorded, and intestinal histology was evaluated. RESULTS Exposure to LPS, hypoxia+LPS, or PAF all caused haemorrhagic intestinal lesions associated with varying degrees of intestinal injury. PAF caused a significant initial decrease in both MVC and MBF whereas hypoxia+LPS caused a significant late reduction in ABP and MBF with a trend towards a decrease in MVC. The effects of hypoxia+LPS on both haemodynamic changes and intestinal injury were ameliorated by WEB 2170. CONCLUSIONS Administration of hypoxia and LPS or of PAF in the neonatal piglet induces haemodynamic changes and intestinal lesions that are consistent with NEC. These effects are ameliorated by prior administration of WEB 2170, indicating an important role for PAF in the pathogenesis of NEC.
Collapse
Affiliation(s)
- A K Ewer
- Neonatal Unit, Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG, UK.
| | | | | | | | | | | |
Collapse
|
45
|
Shing DC, McMullan DJ, Roberts P, Smith K, Chin SF, Nicholson J, Tillman RM, Ramani P, Cullinane C, Coleman N. FUS/ERG gene fusions in Ewing's tumors. Cancer Res 2003; 63:4568-76. [PMID: 12907633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Ewing's tumors are rare pediatric neoplasms that are characterized by specific chromosomal translocations and gene rearrangements. All of the fusion genes reported to date in Ewing's tumors juxtapose the EWS gene at 22q12 to an ETS-related gene, the most common of which are FLI1 at 11q24 and ERG at 21q22. We present here four cases of Ewing's tumor, which showed no evidence of a EWS gene rearrangement, but instead contained translocations involving 16p11 and 21q22. A rearrangement involving the same chromosome bands, t(16;21)(p11;q22), is found in rare cases of acute myeloid leukemia and fuses the FUS gene at 16p11 to the ERG gene at 21q22. In two of our Ewing's tumor cases, we were able to show at the sequence level that the translocation between chromosomes 16 and 21 similarly results in a FUS/ERG fusion. In one case, exons 1-5 and most of exon 6 of FUS were fused in-frame to exon 9 of ERG; in the other case, FUS exons 1-7 were fused in-frame to ERG exons 8-9. The functional fusion transcript is expected to be expressed from the der(21)t(16;21) derivative. In the two other t(16;21)-positive Ewing's cases, we performed bacterial artificial chromosome fluorescence in situ hybridization analysis on metaphases and interphase nuclei to demonstrate colocalization of bacterial artificial chromosomes containing FUS and ERG genes, also highly suggestive of fusion gene formation. These represent the first four cases where FUS, rather than EWS, is rearranged with an ETS-family transcription factor in Ewing's tumors. Our data provide additional evidence that the transactivation domains of the TET family of RNA-binding proteins (such as EWS and FUS) are interchangeable, and suggests a novel mechanism of oncogenesis in Ewing's tumors.
Collapse
Affiliation(s)
- Danielle C Shing
- Medical Research Council Cancer Cell Unit, Hutchison/MRC Research Centre, Hills Road, Cambridge CB2 2XZ, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
A case of an epigastric giant-cell fibroblastoma is reported in a 6-year-old girl who had undergone a bone-marrow transplant for severe combined immunodeficiency secondary to adenosine deaminase deficiency. A small subcutaneous nodule had been excised from the epigastrium at age 12 months.
Collapse
Affiliation(s)
- D Carroll
- Department of Paediatric Surgery, Bristol Royal Hospital for Sick Children, St. Michael's Hill, Bristol, BS8 2BJ, UK.
| | | | | |
Collapse
|
47
|
Dyer S, Prebble E, Davison V, Davies P, Ramani P, Ellison D, Grundy R. Genomic imbalances in pediatric intracranial ependymomas define clinically relevant groups. Am J Pathol 2002; 161:2133-41. [PMID: 12466129 PMCID: PMC1850918 DOI: 10.1016/s0002-9440(10)64491-4] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The outcome of pediatric ependymomas is difficult to predict based on clinical and histological parameters. To address this issue, we have performed a comparative genomic hybridization screen of 42 primary and 11 recurrent pediatric ependymomas and correlated the genetic findings with clinical outcome. Three distinct genetic patterns were identified in the primary tumors and confirmed by hierarchical cluster analysis. The first group of structural tumors, showed few, mainly partial imbalances (n = 19). A second numerical group showed 13 or more chromosome imbalances with a nonrandom pattern of whole chromosome gains and losses (n = 5). The remaining tumors (n = 18) showed a balanced genetic profile that was significantly associated with a younger age at diagnosis (P < 0.0001), suggesting that ependymomas arising in infants are biologically distinct from those occurring in older children. Multivariate analysis showed that the structural group had a significantly worse outcome compared to tumors with a numerical (P = 0.05) or balanced profile (P = 0.02). Moreover genetic group and extent of surgical resection contributed significantly to outcome whereas histopathology, age, and other clinical parameters did not. We conclude that patterns of genetic imbalances in pediatric intracranial ependymomas may help to predict clinical outcome.
Collapse
Affiliation(s)
- Sara Dyer
- Department of Pediatrics and Child Health, University of Birmingham, Birmingham B4 6NH, UK
| | | | | | | | | | | | | |
Collapse
|
48
|
Lee WS, Kelly DA, Tanner MS, Ramani P, de Ville de Goyet J, McKiernan PJ. Neonatal liver transplantation for fulminant hepatitis caused by herpes simplex virus type 2. J Pediatr Gastroenterol Nutr 2002; 35:220-3. [PMID: 12187302 DOI: 10.1097/00005176-200208000-00023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
MESH Headings
- Acyclovir/therapeutic use
- Diagnosis, Differential
- Female
- Hepatitis, Viral, Human/complications
- Hepatitis, Viral, Human/drug therapy
- Hepatitis, Viral, Human/virology
- Herpes Simplex/complications
- Herpes Simplex/drug therapy
- Herpesvirus 2, Human/isolation & purification
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Liver Failure/etiology
- Liver Failure/surgery
- Liver Failure/virology
- Liver Transplantation
- Pregnancy
Collapse
Affiliation(s)
- W S Lee
- Liver Units, Birmingham Children's Hospital, Birmingham, United Kingdom
| | | | | | | | | | | |
Collapse
|
49
|
Iyer VK, Chua C, Milford DV, Ramani P. Focal segmental glomerulosclerosis in childhood: histology, glomerular morphometry, electron microscopy and immunofluorescence findings in biopsies performed early in the course of the disease. INDIAN J PATHOL MICR 2002; 45:233-9. [PMID: 12785158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
The histological evolution of Focal Segmental Glomerulosclerosis (FSGS) is poorly documented due to variation in the time at which the biopsy is taken. We looked at patients presenting with steroid resistant nephrotic syndrome (SRNS) in which the first biopsy was performed within 3 months of presentation. FSGS lesion was demonstrable in 68.5% of cases in the first biopsy. Glomerular size was increased in 86% of patients indicating that is an early event in the course of the disease. The group was heterogenous with respect of mesangial cellularity, mesangial matrix, position of FSGS lesion in the glomeruli, glomerular size, lamina densa thickness and immunofluorescence findings. No association of morphological features was seen permitting subclassification of this group on morphological grounds. Thus, both the FSGS lesion and glomerular enlargement occur early in the evolution of idiopathic FSGS presenting with SRNS.
Collapse
|
50
|
Ganesan V, Milford DV, Taylor CM, Hulton SA, Parvaresh S, Ramani P. Cyclosporin-related nephrotoxicity in children with nephrotic syndrome. Pediatr Nephrol 2002; 17:225-6; author reply 227. [PMID: 11956868 DOI: 10.1007/s00467-001-0810-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|