1
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Borst AJ, Eng W, Griffin M, Ricci KW, Engel E, Adams DM, Dayneka J, Cohen-Cutler SJ, Andreoli SM, Wu MD, Wheeler AP, Heym KM, Crary SE, Nakano TA, Schulte RR, Setty BA, McLean TW, Pahl KS, Intzes S, Pateva I, Teitelbaum M, Zong Z, Li Y, Jeng MR. Treatment practices and response in kaposiform hemangioendothelioma: A multicenter cohort study. Pediatr Blood Cancer 2024; 71:e30779. [PMID: 38073018 DOI: 10.1002/pbc.30779] [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: 08/11/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) are rare vascular tumors in children historically associated with significant morbidity and mortality. This study was conducted to determine first-line therapy in the absence of available prospective clinical trials. METHODS Patients from 17 institutions diagnosed with KHE/TA between 2005 and 2020 with more than 6 months of follow-up were included. Response rates to sirolimus and vincristine were compared at 3 and 6 months. Durability of response and response to other treatment modalities were also evaluated. RESULTS Of 159 unique KHE/TA subjects, Kasabach-Merritt phenomenon (KMP) was present in 64 (40.3%), and only two patients were deceased (1.3%). Over 60% (n = 96) demonstrated treatment response at 3 months, and more than 70% (n = 114) by 6 months (no significant difference across groups). The vincristine group had higher radiologic response at 3 months compared to sirolimus (72.7% vs. 20%, p = .03), but there were no differences between these groups at 6 months. There were no differences in rates of recurrent or progressive disease between vincristine and sirolimus. CONCLUSIONS In this large, multicenter cohort of 159 patients with KHE/TA, rates of KMP were consistent with historical literature, but the mortality rate (1.3%) was much lower. Overall treatment response rates were high (>70%), and there was no significant difference in treatment response or durability of disease comparing sirolimus to vincristine. Our results support individualized treatment decision plans depending on clinical scenario and patient/physician preferences. Response criteria and response rates reported here will be useful for guiding future treatment protocols for vascular tumors.
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Affiliation(s)
- Alexandra J Borst
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Whitney Eng
- Harvard Medical School/Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Morgan Griffin
- Harvard Medical School/Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Kiersten W Ricci
- The University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Elissa Engel
- The University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Denise M Adams
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jillian Dayneka
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Tulane School of Medicine/Children's Hospital New Orleans, New Orleans, Louisiana, USA
| | - Sally J Cohen-Cutler
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Keck School of Medicine of University of Southern California/Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Steven M Andreoli
- University of Florida College of Medicine-Jacksonville/Nemours Children's Specialty Care, Jacksonville, Florida, USA
| | - Melinda D Wu
- Oregon Health & Science University, Doernbecher Children's Hospital, Portland, Oregon, USA
| | - Allison P Wheeler
- Vanderbilt University School of Medicine/Monroe Carell Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Shelley E Crary
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Taizo A Nakano
- University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rachael R Schulte
- Indiana University School of Medicine/Riley Children's Hospital, Indianapolis, Indiana, USA
| | - Bhuvana A Setty
- Ohio State University College of Medicine/Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Thomas W McLean
- Wake Forest University School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Kristy S Pahl
- Duke University School of Medicine, Duke Children's Hospital, Durham, North Carolina, USA
| | - Stefanos Intzes
- Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington, USA
| | - Irina Pateva
- Case Western Reserve University/Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | | | - Zili Zong
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yimei Li
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael R Jeng
- Stanford University School of Medicine/Lucile Packard Children's Hospital, Palo Alto, California, USA
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2
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Barry KK, Liang MG, Balkin DM, Srivastava S, Church AJ, Eng W. Next generation sequencing aids diagnosis and management in a case of encephalocraniocutaneous lipomatosis. Pediatr Dermatol 2024; 41:76-79. [PMID: 37486073 DOI: 10.1111/pde.15353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/30/2023] [Indexed: 07/25/2023]
Abstract
Encephalocraniocutaneous lipomatosis (ECCL) is a rare neurocutaneous disorder caused by somatic FGFR1 and KRAS variants. It shares significant phenotypic overlap with several closely related disorders caused by mutations in the RAS-MAPK pathway (mosaic RASopathies). We report a diagnostically challenging case of ECCL in which next-generation sequencing of affected tissue identified a pathologic FGFR1 p.K656E variant, thereby establishing a molecular diagnosis. Patients with FGFR1-associated ECCL carry a risk of developing malignant brain tumors; thus, genetic testing of patients with suspected ECCL has important management implications.
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Affiliation(s)
- Kelly K Barry
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel M Balkin
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Siddharth Srivastava
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Whitney Eng
- Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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3
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Slack JC, Putra J, Callahan MJ, Church AJ, Teot LA, Eng W, Perez-Atayde AR. Splenic Lymphatic Malformation With Papillary Endothelial Proliferation: A Rare Histologic Variant or a Unique Entity? Am J Surg Pathol 2023; Publish Ahead of Print:00000478-990000000-00184. [PMID: 37334821 DOI: 10.1097/pas.0000000000002070] [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: 06/21/2023]
Abstract
Lymphatic malformations (LMs) are congenital anomalies of the lymphatic system due to abnormalities that occur during the development of the lymphovascular system. Also known as lymphangiomas, they are usually multifocal, affect multiple organ systems, and are seen in a variety of developmental or overgrowth syndromes. Splenic lymphangiomas are uncommon and usually occur in the context of multiorgan lymphangiomatosis. Within the spleen, 7 prior cases have been reported of LMs with unusual papillary endothelial proliferations (PEPs), which can mimic more aggressive splenic lymphovascular tumors. It is not currently known if splenic LM-PEP represents a unique entity, or is simply an unusual, site-specific, morphologic variant of LM. To address this question, we conducted a retrospective, single-institutional review of this rare entity and systematically evaluated its clinical, histologic, radiologic, electron microscopical, and molecular features. In all 3 splenic LM-PEPs, the clinical course was benign, imaging demonstrated subcapsular lesions with characteristic "spoke-and-wheel" appearance, histology showed distinctive PEPs within lymphatic microcysts, immunohistochemistry confirmed a lymphatic endothelial phenotype and electron microscopy demonstrated lesional endothelial cells, rich in mitochondria and intermediate filaments with prominent cytoplasmic lumina and vacuoles and lacking Weibel-Palade granules. Occasional lymphothelial cells were situated within the cytoplasm of another lesional cell, appearing to be engulfed. Next-generation sequencing identified a PIK3CA mutation in 1 patient, while in 2 others no molecular alterations were identified. We conclude with a summary of all prior published cases and discuss key diagnostic elements that distinguish this benign entity from its more aggressive mimickers.
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Affiliation(s)
| | | | | | | | | | - Whitney Eng
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
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4
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Barry KK, Schienda J, Morrow JJ, Al-Ibraheemi A, Balkin DM, Church AJ, Eng W, Janeway KA, Kamihara J, Liang MG. Genomic analysis reveals germline and somatic PDGFRB variants with clinical implications in familial infantile myofibromatosis. Pediatr Blood Cancer 2023; 70:e30262. [PMID: 36861440 DOI: 10.1002/pbc.30262] [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] [Received: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Kelly K Barry
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jaclyn Schienda
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - James J Morrow
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alyaa Al-Ibraheemi
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Daniel M Balkin
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alanna J Church
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Whitney Eng
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Katherine A Janeway
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Junne Kamihara
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marilyn G Liang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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5
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Alomari MH, Shahin MM, Fishman SJ, Kerr CL, Smith ER, Eng W, Ruiz-Gutierrez M, Adams DM, Orbach DB, Chaudry G, Shaikh R, Chewning R, Alomari AI. Cerebrospinal fluid leak in epidural venous malformations and blue rubber bleb nevus syndrome. J Neurosurg Spine 2022; 37:439-445. [PMID: 35364593 DOI: 10.3171/2022.1.spine2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Clinical manifestations of blue rubber bleb nevus syndrome (BRBNS) and multifocal venous malformation (MVM) vary depending on the location of the lesions. The aim of this study was to assess the risk of developing CSF leaks in patients with epidural venous malformations (VMs). METHODS The authors retrospectively investigated the relationship between the development of a CSF leak and the presence of epidural VMs. RESULTS Nine patients (5 females) had epidural VMs and presentation that was confirmatory or suggestive of a CSF leak: 4 had BRBNS, 4 had MVMs, and 1 had a solitary VM. Of 66 patients with BRBNS, clinical and imaging features of CSF leak were noted in 3 (4.5%) with epidural VMs at the age of 11-44 years. A fourth patient had suggestive symptoms without imaging confirmation. An epidural blood patch was ineffective in 2 patients, both with more than one source of leakage, requiring surgical repair or decompression. Symptomatic downward displacement of the cerebellar tonsils was noted in 3 patients with MVM and 1 with a solitary VM; 3 required surgical decompression. CONCLUSIONS These findings suggest an increased risk of CSF leak in patients with epidural VM, including BRBNS, MVMs, and solitary VMs. Awareness of the association between epidural VM and CSF leakage may facilitate earlier diagnosis and therapeutic intervention.
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Affiliation(s)
| | | | | | - Cindy L Kerr
- 1Division of Vascular and Interventional Radiology
| | | | - Whitney Eng
- 4Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Melisa Ruiz-Gutierrez
- 4Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Denise M Adams
- 4Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Raja Shaikh
- 1Division of Vascular and Interventional Radiology
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6
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Shimano KA, Eng W, Adams DM. How we approach the use of sirolimus and new agents: Medical therapy to treat vascular anomalies. Pediatr Blood Cancer 2022; 69 Suppl 3:e29603. [PMID: 35253343 DOI: 10.1002/pbc.29603] [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: 09/19/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 12/11/2022]
Abstract
Vascular anomalies (VAs) are a heterogeneous group of primarily congenital tumors and malformations. The International Society for the Study of Vascular Anomalies (ISSVA) has developed a standard classification of these disorders, creating a uniform approach to their diagnosis. Recent discoveries evaluating the genetic causes of VAs have revealed that they are due to mutations in cancer pathways, including the PI3K/AKT/mTOR and RAS/MAPK/MEK pathways. These discoveries have led to improved phenotype-genotype correlation and have expanded medical therapy for this group of unique disorders.
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Affiliation(s)
- Kristin A Shimano
- Division of Allergy, Immunology, and Bone Marrow Transplant, UCSF Benioff Children's Hospital, University of California, San Francisco, California, USA
| | - Whitney Eng
- Division of Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Denise M Adams
- Division of Oncology, Comprehensive Vascular Anomalies Program/Frontier Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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7
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Perez-Atayde AR, Debelenko L, Al-Ibraheemi A, Eng W, Ruiz-Gutierrez M, O'Hare M, Croteau SE, Trenor CC, Boyer D, Balkin DM, Barclay SF, Hsi Dickie B, Liang MG, Chaudry G, Alomari AI, Mulliken JB, Adams DM, Kurek KC, Fishman SJ, Kozakewich HPW. Kaposiform Lymphangiomatosis: Pathologic Aspects in 43 Patients. Am J Surg Pathol 2022; 46:963-976. [PMID: 35385405 DOI: 10.1097/pas.0000000000001898] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kaposiform lymphangiomatosis is an uncommon generalized lymphatic anomaly with distinctive clinical, radiologic, histopathologic, and molecular findings. Herein, we document the pathology in 43 patients evaluated by the Boston Children's Hospital Vascular Anomalies Center from 1999 to 2020. The most frequent presentations were respiratory difficulty, hemostatic abnormalities, and a soft tissue mass. Imaging commonly revealed involvement of some combination of mediastinal, pulmonary, pleural, and pericardial compartments and most often included spleen and skeleton. Histopathology was characterized by dilated, redundant, and abnormally configured lymphatic channels typically accompanied by dispersed clusters of variably canalized, and often hemosiderotic, spindled lymphatic endothelial cells that were immunopositive for D2-40, PROX1, and CD31. An activating lesional NRAS variant was documented in 9 of 10 patients. The clinical course was typically aggressive, marked by hemorrhage, thrombocytopenia, diminished fibrinogen levels, and a mortality rate of 21%.
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Affiliation(s)
| | - Larisa Debelenko
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | | | | | - Melisa Ruiz-Gutierrez
- Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute
| | | | - Stacy E Croteau
- Dana-Farber/Boston Children's Hospital Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA
| | - Cameron C Trenor
- Dana-Farber/Boston Children's Hospital Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA
| | | | | | - Sarah F Barclay
- Departments of Pathology & Laboratory Medicine
- Medical Genetics, Alberta Children's Hospital Research Institute and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Gulraiz Chaudry
- Division of Interventional Radiology, Boston Children's Hospital and Harvard Medical School
| | - Ahmad I Alomari
- Division of Interventional Radiology, Boston Children's Hospital and Harvard Medical School
| | | | - Denise M Adams
- Division of Oncology, Department of Pediatrics, Comprehensive Vascular Anomalies Program, Children's Hospital of Philadelphia, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Kyle C Kurek
- Departments of Pathology & Laboratory Medicine
- Medical Genetics, Alberta Children's Hospital Research Institute and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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8
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Al-Samkari H, Eng W. A precision medicine approach to hereditary hemorrhagic telangiectasia and complex vascular anomalies. J Thromb Haemost 2022; 20:1077-1088. [PMID: 35343049 PMCID: PMC10044495 DOI: 10.1111/jth.15715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
Vascular anomalies represent a diverse group of disorders classified broadly as malformations or tumors and include the second most common hereditary bleeding disorder worldwide, hereditary hemorrhagic telangiectasia (HHT). Patients with HHT and other vascular anomalies suffer morbid consequences of these diseases, including bleeding, thrombosis, anemia, localized intravascular coagulation, tissue overgrowth, infections, and other complications. The International Society for the Study of Vascular Anomalies (ISSVA) has developed a standard classification of these disorders, creating a uniform approach to their diagnosis, and the treatments for vascular anomalies are rapidly evolving. Recent discoveries have elucidated the molecular basis of a number of common and uncommon vascular anomalies. HHT occurs due to mutations in the transforming growth factor beta (TGF-β) pathway, resulting in vascular endothelial growth factor excess. Complex vascular anomalies including Klippel-Trénaunay syndrome (KTS) and arteriovenous malformation (AVM) may occur due to mutations in the PI3K/AKT/mTOR and RAS/MAPK/MEK pathways. The discovery of the pathophysiologic mechanisms driving these diseases has led to improved phenotype-genotype correlation and the opportunity to target molecular pathways with medical therapies. Therefore, targeted agents have quickly become a standard of care in the treatment of vascular disorders (particularly HHT). Herein, we provide a case-based approach to the use of antiangiogenic therapies including bevacizumab and pazopanib for the treatment of bleeding in HHT and the use of mammalian target of rapamycin (sirolimus), PIK3CA (alpelisib), and MEK (trametinib) inhibitors in the treatment of complex vascular anomalies.
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Affiliation(s)
- Hanny Al-Samkari
- Division of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Whitney Eng
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
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9
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Sudduth CL, Konczyk DJ, Smits PJ, Eng W, Al-Ibraheemi A, Upton J, Greene AK. Bockenheimer Disease is Associated With a TEK Variant. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006119. [PMID: 34649969 PMCID: PMC8751421 DOI: 10.1101/mcs.a006119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023] Open
Abstract
Bockenheimer disease is a venous malformation involving all tissues of an extremity. Patients have significant morbidity and treatment is palliative. The purpose of this study was to identify the cause of Bockenheimer disease to develop pharmacotherapy for the condition. Paraffin-embedded tissue from 9 individuals with Bockenheimer disease obtained during a clinically-indicated operation underwent DNA extraction. Droplet digital PCR (ddPCR) was used to screen for variants most commonly associated with sporadic venous malformations [TEK (NM_000459.5:c.2740C>T; p.Leu914Phe), PIK3CA (NM_006218.4:c.1624G>A; p.Glu542Lys and NM_006218.4:c.3140A>G; p.His1047Arg)]. ddPCR detected a TEK L914F variant in all 9 patients (variant allele fraction 2%-13%). PIK3CA E542K and H1047R variants were not identified in the specimens. Sanger sequencing and restriction enzyme digestion confirmed variants identified by ddPCR. A pathogenic variant in the endothelial cell tyrosine kinase receptor TEK is associated with Bockenheimer disease. Pharmacotherapy targeting the TEK signaling pathway might benefit patients with the condition.
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Affiliation(s)
| | | | | | - Whitney Eng
- Boston Children's Hospital, Harvard Medical School
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10
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Eng W, Sudduth CL, Konczyk DJ, Smits PJ, Taghinia AH, Fishman SJ, Alomari A, Adams DM, Greene AK. Parkes Weber syndrome with lymphedema caused by a somatic KRAS variant. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006118. [PMID: 34607843 PMCID: PMC8751413 DOI: 10.1101/mcs.a006118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/26/2021] [Accepted: 09/07/2021] [Indexed: 02/05/2023] Open
Abstract
Parkes Weber syndrome is a vascular malformation overgrowth condition typically involving the legs. Its main features are diffuse arteriovenous fistulas and enlargement of the limb. The condition has been associated with pathogenic germline variants in RASA1 and EPHB4. We report two individuals with Parkes Weber syndrome of the leg and primary lymphedema containing a somatic KRAS variant (NM_004985.5:c.35G > A; p.Gly12Asp). KRAS variants, which cause somatic intracranial and extracranial arteriovenous malformations, also result in Parkes Weber syndrome with lymphatic malformations.
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Affiliation(s)
- Whitney Eng
- Division of Hematology and Oncology, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Christopher L Sudduth
- Department of Plastic and Oral Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Dennis J Konczyk
- Department of Plastic and Oral Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Patrick J Smits
- Department of Plastic and Oral Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Amir H Taghinia
- Department of Plastic and Oral Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Steven J Fishman
- Department of Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Ahmad Alomari
- Department of Radiology, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Denise M Adams
- Division of Hematology and Oncology, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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11
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Abstract
Overgrowth syndromes represent a diverse group of disorders with overlapping features. Interdisciplinary management by a team of experts in vascular anomalies is crucial for establishing the correct diagnosis and optimizing outcomes for these patients. Unique management considerations include increased risk for thrombosis and in some cases, cancer. In recent years, research has demonstrated that these disorders are primarily caused by somatic mutations in growth pathways, particularly the PI3K-mTOR pathway. This improved understanding had led to promising new therapies for this group of patients.
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Affiliation(s)
- Whitney Eng
- Cancer and Blood Disorders Center, Division of Hematology/Oncology, Dana Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Adrienne M Hammill
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, United States.
| | - Denise M Adams
- Cancer Center, Division of Oncology, Director Comprehensive Vascular Anomalies Program, Children's Hospital of Philadelphia, Department of Pediatrics and University of Pennsylvania Medical Center, Philadelphia, PA, United States
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12
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Saikaly L, Saikaly S, Norman R, Eng W, Melamed M, Samiratedu M. 794 Genetic expression profiling in the diagnosis of amelanotic melanoma: An emerging technology and a caution to potential increased reliance. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.870] [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: 10/27/2022]
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13
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Norman R, Nascimento V, Li D, Eng W. 179 Allergy patterns in a florida-based private practice dermatology office. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.255] [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: 10/27/2022]
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14
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Eng W, Norman R. 883 Detection of scabies by anti-house dust mite antibody immunoblot test. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.895] [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: 10/17/2022]
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Gridley SJ, Crouch JM, Evans Y, Eng W, Antoon E, Lyapustina M, Schimmel-Bristow A, Woodward J, Dundon K, Schaff R, McCarty C, Ahrens K, Breland DJ. Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth. J Adolesc Health 2016; 59:254-261. [PMID: 27235374 DOI: 10.1016/j.jadohealth.2016.03.017] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [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: 12/20/2015] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Few transgender youth eligible for gender-affirming treatments actually receive them. Multidisciplinary gender clinics improve access and care coordination but are rare. Although experts support use of pubertal blockers and cross-sex hormones for youth who meet criteria, these are uncommonly offered. This study's aim was to understand barriers that transgender youth and their caregivers face in accessing gender-affirming health care. METHODS Transgender youth (age 14-22 years) and caregivers of transgender youth were recruited from Seattle-based clinics, and readerships from a blog and support group listserv. Through individual interviews, focus groups, or an online survey, participants described their experiences accessing gender-affirming health care. We then used theoretical thematic analysis to analyze data. RESULTS Sixty-five participants (15 youth, 50 caregivers) described barriers spanning six themes: (1) few accessible pediatric providers are trained in gender-affirming health care; (2) lack of consistently applied protocols; (3) inconsistent use of chosen name/pronoun; (4) uncoordinated care and gatekeeping; (5) limited/delayed access to pubertal blockers and cross-sex hormones; and (6) insurance exclusions. CONCLUSIONS This is the first study aimed at understanding perceived barriers to care among transgender youth and their caregivers. Themed barriers to care led to the following recommendations: (1) mandatory training on gender-affirming health care and cultural humility for providers/staff; (2) development of protocols for the care of young transgender patients, as well as roadmaps for families; (3) asking and recording of chosen name/pronoun; (4) increased number of multidisciplinary gender clinics; (5) providing cross-sex hormones at an age that permits peer-congruent development; and (6) designating a navigator for transgender patients in clinics.
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Affiliation(s)
- Samantha J Gridley
- Vanderbilt University School of Medicine, Nashville, Tennessee; Seattle Children's Research Institute, Seattle, Washington
| | - Julia M Crouch
- Seattle Children's Research Institute, Seattle, Washington
| | - Yolanda Evans
- Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Whitney Eng
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Emily Antoon
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Melissa Lyapustina
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington
| | - Allison Schimmel-Bristow
- Seattle Children's Research Institute, Seattle, Washington; Loyola University Maryland, Baltimore, Maryland
| | - Jake Woodward
- Seattle Children's Research Institute, Seattle, Washington; Carleton College, Northfield, Minnesota
| | - Kelly Dundon
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - RaNette Schaff
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Carolyn McCarty
- Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Kym Ahrens
- Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
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Eng W, Saikaly S, Jimenez-Capdeville M, Rodriguez-Leyva I, Norman R. 665 Expression of α-Synuclein in melanocytic cells. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.706] [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: 12/01/2022]
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Robison K, Clark L, Eng W, Wu L, Raker C, Clark M, Tejada-Berges T, Dizon DS. Cervical cancer prevention: Asian-American women's knowledge and participation in screening practices. Womens Health Issues 2014; 24:e231-6. [PMID: 24533982 DOI: 10.1016/j.whi.2013.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 11/20/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to compare cervical cancer knowledge and prevention strategy participation among Chinese-American women compared with Southeast-Asian-American women. METHODS We performed a cross-sectional survey of Chinese and Southeast Asian women in Rhode Island. Anonymous surveys were administered following informed consent. The survey included demographics and questions related to health care practices, cervical cancer, and the human papilloma virus (HPV). Categorical variables were compared by Fisher's exact test. Mean scores of correct answers on the knowledge questions were compared by Student's t-test and analysis of variance. RESULTS Ninety-six Chinese women and 132 Southeast Asian women were included in the analysis. Sixty-seven percent of Chinese women had at least a college education compared with 37% of Southeast Asian women (p < .0001). Nineteen percent of Chinese women reported annual household incomes of greater than $100,000 compared with 3% of Southeast Asian women (p = .0003). Twenty percent of Southeast Asian women did not have health insurance compared with 10% of Chinese women (p = .06). Among both groups, 25% of participants either never had a pap test or did not know if they ever had a pap test. There was a greater lack of knowledge about the relationship between HPV and cervical cancer among Chinese (mean 2.9 out of 8 questions) compared with Southeast Asian (mean 3.6 out of 8 questions; p = .02). CONCLUSIONS Regardless of ethnic subgroup, education, or income, all participants had a poor knowledge of cervical cancer and HPV. This study supports the need for improvement in cervical cancer prevention education among all Asian women.
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Affiliation(s)
- Katina Robison
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Lindsay Clark
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Whitney Eng
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lily Wu
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christina Raker
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Melissa Clark
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Trevor Tejada-Berges
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Don S Dizon
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
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Nunn A, Eng W, Cornwall A, Beckwith C, Dickman S, Flanigan T, Kwakwa H. African American patient experiences with a rapid HIV testing program in an urban public clinic. J Natl Med Assoc 2012; 104:5-13. [PMID: 22708242 DOI: 10.1016/s0027-9684(15)30125-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Of 1174 new human immunodeficiency virus (HIV) cases diagnosed in Philadelphia, Pennsylvania, in 2008, a total of 771 (66%) were among African Americans. Philadelphia recently introduced a citywide rapid HIV testing program in public clinics. METHODS We conducted a qualitative study among 60 African Americans undergoing rapid HIV testing in one of Philadelphia's public clinics located in a zip code with high HIV incidence. Employing grounded theory, we used semistructured interviews to assess patients' motivations, perceptions, and clinical experiences with rapid HIV testing. Interviews were transcribed and coded; 20% were double coded to enhance reliability. RESULTS Primary motivations for undergoing rapid HIV testing included: testing during routine clinical care, presenting for care with symptomatic sexually transmitted infections or opportunistic infections, knowing someone living with HIV/ AIDS, and perceiving oneself at risk for HIV. Most patients reported positive experiences with rapid testing and preferred it to conventional testing because it eliminated the need for return visits and decreased anxiety; however, many expressed concerns about accuracy of rapid HIV testing. Barriers to HIV testing among this population included low self-perceived risk, HIV stigma, and reported homophobia in respondents' communities. CONCLUSION This rapid testing program was acceptable, convenient, and preferred over conventional HIV testing. Providing educational information about rapid and confirmatory HIV testing may further enhance acceptability of rapid HIV testing in this population. Nationwide expansion of rapid HIV testing in public health centers is an important and acceptable means of achieving President Obama's National AIDS Strategy goals of reducing racial disparities in HIV infection and improving linkage to HIV/AIDS treatment and care services.
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Affiliation(s)
- Amy Nunn
- Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, Rhode Island 02906, USA.
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Eng W, Dorsey M, Sleasman J, Petrovic A, Westbrock W. A Novel Mutation CHS1 (LYST) Mutation: Osteomyelitis in a Child with Chediak-Higashi Syndrome. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.289] [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: 11/26/2022]
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Hamill TG, Sato N, Jitsuoka M, Tokita S, Krause S, Ryan C, Gantert L, Sleph H, Zeng Z, Miller P, Patel S, Riffel K, Sanabria S, Eng W, Chen T, Renger J, Doran S, Garson S, Iannone R, Hargreaves R, Burns H. Histamine H3 inverse agonist PET tracers labelled with carbon-11 or fluorine-18. Neuroimage 2008. [DOI: 10.1016/j.neuroimage.2008.04.196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Eng W, Heimberg RG, Hart TA, Schneier FR, Liebowitz MR. Attachment in individuals with social anxiety disorder: the relationship among adult attachment styles, social anxiety, and depression. Emotion 2001; 1:365-80. [PMID: 12901398 DOI: 10.1037/1528-3542.1.4.365] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite their apparent implications for social functioning, adult attachment styles have never been specifically explored among persons with social anxiety disorder. In the current study, a cluster analysis of the Revised Adult Attachment Scale (N. L. Collins, 1996) revealed that 118 patients with social anxiety were best represented by anxious and secure attachment style clusters. Members of the anxious attachment cluster exhibited more severe social anxiety and avoidance, greater depression, greater impairment, and lower life satisfaction than members of the secure attachment cluster. This pattern was replicated in a separate sample of 56 patients and compared with the pattern found in 36 control participants. Social anxiety mediated the association between attachment insecurity and depression. Findings are discussed in the context of their relevance to the etiology, maintenance, and cognitive-behavioral treatment of social anxiety disorder.
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Affiliation(s)
- W Eng
- Adult Anxiety Clinic, Temple University, Philadelphia, Pennsylvania 19122-6085, USA
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Eng W, Coles ME, Heimberg RG, Safren SA. Quality of life following cognitive behavioral treatment for social anxiety disorder: preliminary findings. Depress Anxiety 2001; 13:192-3. [PMID: 11413567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Affiliation(s)
- W Eng
- Adult Anxiety Clinic of Temple University, Philadelphia, Pennsylvania 19122-6085, USA
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Abstract
BACKGROUND The present study used cluster analysis procedures to identify empirically subgroups of patients with social phobia in a large clinical sample. METHOD The Liebowitz Social Anxiety Scale (LSAS) was administered to 382 patients from several studies of the treatment of social phobia. LSAS fear ratings were summed into four subscale scores (social interaction, public speaking, observation by others, eating and drinking in public) based on a previous factor analytical study of the LSAS. In order to produce a stable and robust solution, these factor scores were submitted to a two-stage clustering procedure consisting of an agglomerative-hierarchical clustering method followed by an iterative non-hierarchical clustering method. RESULTS Three patient subgroups were identified based on their pattern of feared social situations on the LSAS. These groups were labelled: (1) pervasive social anxiety; (2) moderate social interaction anxiety; and (3) dominant public speaking anxiety. Clusters differed significantly on age and age of social phobia onset, as well as on measures of social anxiety, general anxiety and depressive symptomatology. Clusters also differed in the percentage of assigned patients who met criteria for the generalized subtype of social phobia and avoidant personality disorder. CONCLUSIONS The results provide empirical support for the existence of three subgroups in a clinical sample of individuals with social phobia and contribute to the growing evidence for the heterogeneity of social phobia. Further study of the conceptual, clinical and aetiological significance of these subgroups is needed.
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Affiliation(s)
- W Eng
- Adult Anxiety Clinic, Temple University, Philadelphia, PA, USA
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Abeyama K, Eng W, Jester JV, Vink AA, Edelbaum D, Cockerell CJ, Bergstresser PR, Takashima A. A role for NF-kappaB-dependent gene transactivation in sunburn. J Clin Invest 2000; 105:1751-9. [PMID: 10862790 PMCID: PMC378515 DOI: 10.1172/jci9745] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Exposure of skin to ultraviolet (UV) radiation is known to induce NF-kappaB activation, but the functional role for this pathway in UV-induced cutaneous inflammation remains uncertain. In this study, we examined whether experimentally induced sunburn reactions in mice could be prevented by blocking UV-induced, NF-kappaB-dependent gene transactivation with oligodeoxynucleotides (ODNs) containing the NF-kappaB cis element (NF-kappaB decoy ODNs). UV-induced secretion of IL-1, IL-6, TNF-alpha, and VEGF by skin-derived cell lines was inhibited by the decoy ODNs, but not by the scrambled control ODNs. Systemic or local injection of NF-kappaB decoy ODNs also inhibited cutaneous swelling responses to UV irradiation. Moreover, local UV-induced inflammatory changes (swelling, leukocyte infiltration, epidermal hyperplasia, and accumulation of proinflammatory cytokines) were all inhibited specifically by topically applied decoy ODNs. Importantly, these ODNs had no effect on alternative types of cutaneous inflammation caused by irritant or allergic chemicals. These results indicate that sunburn reactions culminate from inflammatory events that are triggered by UV-activated transcription of NF-kappaB target genes, rather than from nonspecific changes associated with tissue damage.
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Affiliation(s)
- K Abeyama
- Department of Dermatology, and. Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Eng W, Tschen JA. Comparison of S-100 versus hematoxylin and eosin staining for evaluating dermal invasion and peripheral margins by desmoplastic malignant melanoma. Am J Dermatopathol 2000; 22:26-9. [PMID: 10698212 DOI: 10.1097/00000372-200002000-00005] [Citation(s) in RCA: 17] [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] [Indexed: 11/26/2022]
Abstract
Desmoplastic malignant melanoma (DMM) is a rare and locally aggressive variant of malignant melanoma, which is difficult to diagnose clinically and microscopically. A retrospective study of 21 DMM were collected during 7 years, representing 1.7% of melanomas. By comparing S-100 and hematoxylin and eosin (H & E) staining in DMM, we sought to determine whether S-100 staining offered a more accurate means of assessing dermal and neural invasion, tumor thickness, and peripheral margins. Eleven cases were excluded because the tumor extended past the deep margin. Six cases that were stained with S-100 showed a greater tumor thickness than by H & E (difference of 0. 13 to 2.79 mm). In two cases, the tumor thickness was greater by using H & E than S-100, and there was no difference in the remaining two cases. Of the eight cases in which the peripheral margins were positive by S-100, neoplastic cells were only apparent at those margins in four cases when examined with H & E. The remaining two cases showed negative margins by both stains. Clinical follow-up was obtained from nine cases, and none had recurrence of melanoma. Particularly for hypocellular and amelanotic tumors, S-100 staining proved to be a valuable adjunct in determining the extent of the tumor at the peripheral margins.
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Affiliation(s)
- W Eng
- Department of Pathology, University of Texas-Houston Medical School, USA
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Abstract
BACKGROUND The presence of mature adipose cells among the dermal melanocytes of nevi (nevi with fat) has previously been reported. However, its clinical features are not well characterized. OBJECTIVE Our goal was to develop a better clinical understanding and insight into the histogenesis of nevi with fat by characterizing the patients' age, sex, height, weight, and location of lesion. METHODS This was a prospective study of 100 nevi with fat from 89 patients over an 18-month period. RESULTS Nevi with fat occur 4 times more commonly in women than men. They were diagnosed most often in patients between the ages of 40 to 49 years. The most frequent location is the head and neck. Most nevi with fat are intradermal. CONCLUSION The appearance of fat within nevi is probably a multifactorial process. Age, weight, and sun exposure may be factors associated with the occurrence of nevi with fat.
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Affiliation(s)
- W Eng
- Department of Pathology, University of Texas-Houston Medical School, USA
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Pekrun A, Lakomek M, Eng W, Schröter W. [Pyrimidine 5'-nucleotidase deficiency as the congenital cause of nonspherocytic hemolytic anemia]. Dtsch Med Wochenschr 1993; 118:1276-80. [PMID: 8375297 DOI: 10.1055/s-2008-1059451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
An 11-year-old girl had marked haemolytic anaemia since the first year of life. Physical examination revealed scleral and cutaneous icterus and slight splenomegaly. Haemoglobin concentration was reduced to 9.5 g/dl, while platelet count and bilirubin concentration were increased (350,000/microliter and 2.2 mg/dl, respectively). The erythrocytes showed marked basophilic stippling, its extent typical of pyrimidine-5'-nucleotidase deficiency. The enzyme activity in the erythrocytes was 15% of normal. Deficiency of this enzyme, inherited as an autosomal recessive, is probably one of the most common erythrocyte enzyme deficiencies causing haemolytic anaemia. It brings about the intracellular accumulation of pyrimidine nucleotides which via secondary metabolic changes causes an accelerated destruction of erythrocytes. There is no known causative treatment: splenectomy is ineffective against the anaemia.
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Affiliation(s)
- A Pekrun
- Universitäts-Kinderklinik, Göttingen
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Eng W, Palumbo AV, Sriharan S, Strandberg GW. Methanol suppression of trichloroethylene degradation by Methylosinus trichosporium (OB3b) and methane-oxidizing mixed cultures. Appl Biochem Biotechnol 1991; 28-29:887-99. [PMID: 1929390 DOI: 10.1007/bf02922658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The effect of methanol on trichloroethylene (TCE) degradation by mixed and pure methylotrophic cultures was examined in batch culture experiments. Methanol was found to relieve growth inhibition of Methylosinus trichosporium (OB3b) at high (14 mg/L) TCE concentrations. Degradation of TCE was determined by both radiolabeling and gas chromatography techniques. When cultures were grown on methanol over 10 to 14 d with 0.3 mg/L TCE, OB3b degraded 16.89 +/- 0.82% (mean +/- SD) of the TCE, and a mixed culture (DT type II) degraded 4.55 +/- 0.11%. Mixed culture (JS type I) degraded 4.34 +/- 0.06% of the TCE. When grown on methane with 0.3 mg/L TCE, 32.93 +/- 2.01% of the TCE was degraded by OB3b, whereas the JS culture degraded 24.3 +/- 1.38% of the TCE, and the DT culture degraded 34.3 +/- 2.97% of the TCE. The addition of methanol to cultures grown on methane reduced TCE degradation to 16.21 +/- 1.17% for OB3b and to 5.08 +/- 0.56% for JS. Although methanol reduces the toxicity of TCE to the cultures, biodegradation of TCE cannot be sustained in methanol-grown cultures. Since high TCE concentrations appear to inhibit methane uptake and growth, we suggest the primary toxicity of TCE is directed towards the methane monooxygenase.
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Affiliation(s)
- W Eng
- Department of Microbiology, University of Tennessee, Knoxville 37996
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Palli SR, Osir EO, Eng W, Boehm MF, Edwards M, Kulcsar P, Ujvary I, Hiruma K, Prestwich GD, Riddiford LM. Juvenile hormone receptors in insect larval epidermis: identification by photoaffinity labeling. Proc Natl Acad Sci U S A 1990; 87:796-800. [PMID: 11607060 PMCID: PMC53353 DOI: 10.1073/pnas.87.2.796] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Tritiated photoaffinity analogs of the natural lepidopteran juvenile hormones, JH I and II [epoxy[3H]bishomofarnesyl diazoacetate ([3H]EBDA) and epoxy[3H]homofarnesyl diazoacetate ([3H]EHDA)], and of the JH analog methoprene [[3H]methoprene diazoketone ([3H]MDK)] were synthesized and used to identify specific JH binding proteins in the larval epidermis of the tobacco hornworm (Manduca sexta). EBDA and EHDA specifically photolabeled a 29-kDa nuclear protein (pI 5.8). This protein and a second 29-kDa protein (pI 6.0) were labeled by MDK, but excess unlabeled methoprene or MDK only prevented binding to the latter. These 29-kDa proteins are also present in larval fat body but not in epidermis from either wandering stage or allatectomized larvae, which lack high-affinity JH binding sites. A 29-kDa nuclear protein with the same developmental specificity as this JH binder bound the DNA of two larval endocuticle genes. A 38-kDa cytosolic protein was also specifically photolabeled by these photoaffinity analogs. The 29-kDa nuclear protein is likely the high-affinity receptor for JH that mediates its genomic action, whereas the 38-kDa cytosolic protein may serve as an intracellular carrier for these highly lipophilic hormones and hormone analogs.
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Affiliation(s)
- S R Palli
- Department of Zoology, University of Washington, Seattle, WA 98185, USA
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Eng W, Esterly JR. Histochemical localization of enzymes in cartilage in neonatal and adult rats. Arch Pathol 1972; 94:291-7. [PMID: 4341457] [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: 01/10/2023]
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