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Hou W, Song S, Duan X, Hou W, Shi Z, Ma L, Niu J, Jin M. Morphological Characteristics of Various Cells in Esophageal Squamous Dysplasia: Extremely Wide Morphological Spectrum. Int J Surg Pathol 2024; 32:692-707. [PMID: 37489001 DOI: 10.1177/10668969231188906] [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: 07/26/2023]
Abstract
The WHO classification of esophageal tumors divides esophageal squamous intraepithelial dysplasia into high and low grades, but does not specify its morphological spectrum. Here, the morphological characteristics of various cells were investigated in esophageal squamous (high-grade) dysplasia, and a morphological spectrum and terminology for this lesion were proposed to avoid misdiagnosis. The clinicopathological data of 540 patients with esophageal squamous dysplasia were analyzed retrospectively. According to the unique cytomorphological characteristics of the lesions and the predominant cell type, the esophageal squamous dysplasia was divided into the following morphological groups: classic type (34.6%, 187/540), basaloid subtype (10.7%, 58/540), spindle-cell subtype (4.6%, 25/540), differentiated subtype (48.9%, 264/540), and verrucous subtype (1.1%, 6/540). Gender, age, and lesions location did not differ among the subtypes (P > 0.05), while Paris classification and lesions diameter significantly differed among the subtypes (P < 0.01). Classic-type cells showed severe atypia. In the basaloid subtype, the cells were small, and resembled basal cells; most of these lesions were of the 0-IIb type with small lesion diameter. In the spindle-cell subtype, the cells and nuclei were spindle-shaped or long and spindle-shaped and arranged in parallel. Differentiated-subtype showed well-to-moderately differentiated cells, and epithelial basal cells were mature. Verrucous-subtype showed well-differentiated cells, and were characterized by verrucous or papillary structures. Esophageal squamous dysplasia has extremely wide morphological spectrum. Awareness of the spectrum of morphological presentations of this lesion, specifically the basaloid subtype, spindle-cell subtype, differentiated subtype, and verrucous subtype, is important for accurate diagnosis.
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Affiliation(s)
- Weihua Hou
- Department of Pathology, Pingdingshan Medical District (formerly 152 Central Hospital), 989 Hospital of PLA Joint Logistic Support Force, Pingdingshan, Henan, China
| | - Shujie Song
- Department of Gastroenterology, Pingdingshan Medical District (formerly 152 Central Hospital), 989 Hospital of PLA Joint Logistic Support Force, Pingdingshan, Henan, China
| | - Xinke Duan
- Department of Gastroenterology, Pingdingshan Medical District (formerly 152 Central Hospital), 989 Hospital of PLA Joint Logistic Support Force, Pingdingshan, Henan, China
| | - Weidong Hou
- Department of Endocrinology, Pingdingshan Municipal First People's Hospital, Pingdingshan, Henan, China
| | - Zhongyue Shi
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lijuan Ma
- Department of Gastroenterology, Pingdingshan Medical District (formerly 152 Central Hospital), 989 Hospital of PLA Joint Logistic Support Force, Pingdingshan, Henan, China
| | - Jingwei Niu
- Department of Gastroenterology, Pingdingshan Medical District (formerly 152 Central Hospital), 989 Hospital of PLA Joint Logistic Support Force, Pingdingshan, Henan, China
| | - Mulan Jin
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Brzeziński M, Stukan M. Anal Cancer and Anal Intraepithelial Neoplasia Risk among Patients Treated for HPV-Related Gynecological Diseases-A Systematic Review. J Clin Med 2023; 12:4216. [PMID: 37445251 DOI: 10.3390/jcm12134216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The most important causative agent of neoplasms in the anogenital area is the human papillomavirus (HPV). Due to the anatomical proximity of the genital and anus area and the ease with which HPV infection is transmitted, it seems that patients after the treatment of HPV-related gynecological diseases may have an increased risk of developing a second HPV-related neoplasm anal cancer. The aim of this study was to determine the risk of anal intraepithelial neoplasia (AIN) and anal cancer (AC) among patients after the treatment of HPV-related gynecological diseases. METHODS We conducted a comprehensive review of the available literature from multiple databases. The study was performed following Cochrane Reviewers' Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. Moreover, we assessed the quality of each study using QUADAS-2. RESULTS Twenty-five studies were included in the final analysis. Patients after the treatment of HPV-related gynecological diseases have a significantly higher risk of AC (mean standardized incidence ratio (SIR) = 5.387, mean incidence risk (IR) = 0.096%, mean IR per 100,000 person-years = 10.37) and AIN (mean IR = 23.683%) compared to the population risk. CONCLUSIONS patients with HPV-related gynecological diseases should constitute a group for which an appropriate primary and secondary screening for AC should be introduced.
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Affiliation(s)
- Michał Brzeziński
- Department of Gynecological Oncology, Pomeranian Hospitals, 81-519 Gdynia, Poland
- Division of Oncological Propedeutics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Maciej Stukan
- Department of Gynecological Oncology, Pomeranian Hospitals, 81-519 Gdynia, Poland
- Division of Oncological Propedeutics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Kniazeva M, Zabegina L, Shalaev A, Smirnova O, Lavrinovich O, Berlev I, Malek A. NOVAprep-miR-Cervix: New Method for Evaluation of Cervical Dysplasia Severity Based on Analysis of Six miRNAs. Int J Mol Sci 2023; 24:ijms24119114. [PMID: 37298066 DOI: 10.3390/ijms24119114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Cervical cancer is one of the most common gynecological malignancies and it is preventable through the yearly diagnosis and management of pre-cancerous cervical disease. The profile of miRNA expression in cervical epithelium cells is altered with cervical dysplasia development and further progression. The NOVAprep-miR-CERVIX is a new approach for the assessment of cervical dysplasia through the analysis of six marker miRNAs. This study aims to evaluate theperformance and diagnostic potency of the new method. Cytological smears from 226 women (NILM, n.114; HSIL, n.112) were included in the study. A VPH test was performed with RealBest DNAHPV HR screen Kit, six marker miRNAs (miR-21, -29b, -145, -451a, -1246, -1290) were assayed using NOVAprep-miR-CERVIX kit. Obtained data were analyzed using the Delta Ct method and random forest machine learning algorithm. The results of the quantitative analysis of six microRNAs were expressed as a miR-CERVIX parameter, which ranged from 0 to 1, where "0" corresponded to the healthy cervical epithelium, while "1" corresponded to high-grade squamous intraepithelial dysplasia. The average value of miR-CERVIX differed in groups of NILM and HSIL samples (0.34 vs. 0.72; p < 0.000005). An estimation of miR-CERVIX allowed for the differentiation between healthy and pre-cancerous samples with sensitivity of 0.79 and specificity of 0.79, as well as to confirm HSIL with specificity of 0.98. Interestingly, the HSIL group included HPV(+) and HPV(-) samples, which were statistically significantly different in terms of miR-CERVIX value. Analysis of CC-associated miRNAs in material of cervical smear might serve as an additional method for the evaluation of cervical dysplasia severity.
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Affiliation(s)
- Margarita Kniazeva
- Subcellular Technology Lab., N.N. Petrov National Medical Research Center of Oncology, 197758 St. Petersburg, Russia
| | - Lidia Zabegina
- Subcellular Technology Lab., N.N. Petrov National Medical Research Center of Oncology, 197758 St. Petersburg, Russia
| | - Andrey Shalaev
- Subcellular Technology Lab., N.N. Petrov National Medical Research Center of Oncology, 197758 St. Petersburg, Russia
| | - Olga Smirnova
- Department of Gynecological Oncology, N.N. Petrov National Medical Research Center of Oncology, 197758 St. Petersburg, Russia
| | - Olga Lavrinovich
- Department of Gynecological Oncology, N.N. Petrov National Medical Research Center of Oncology, 197758 St. Petersburg, Russia
| | - Igor Berlev
- Department of Gynecological Oncology, N.N. Petrov National Medical Research Center of Oncology, 197758 St. Petersburg, Russia
| | - Anastasia Malek
- Subcellular Technology Lab., N.N. Petrov National Medical Research Center of Oncology, 197758 St. Petersburg, Russia
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Sanderson PA, Esnal-Zufiaurre A, Arends MJ, Herrington CS, Collins F, Williams ARW, Saunders PTK. Improving the Diagnosis of Endometrial Hyperplasia Using Computerized Analysis and Immunohistochemical Biomarkers. Front Reprod Health 2022; 4:896170. [PMID: 36303676 PMCID: PMC9580641 DOI: 10.3389/frph.2022.896170] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Endometrial hyperplasia (EH) is a precursor lesion to endometrial carcinoma (EC). Risks for EC include genetic, hormonal and metabolic factors most notably those associated with obesity: rates are rising and there is concern that cases in pre-menopausal women may remain undetected. Making an accurate distinction between benign and pre-malignant disease is both a challenge for the pathologist and important to the gynecologist who wants to deliver the most appropriate care to meet the needs of the patient. Premalignant change may be recognized by histological changes of endometrial hyperplasia (which may occur with or without atypia) and endometrial intraepithelial neoplasia (EIN). In this study we created a tissue resource of EH samples diagnosed between 2004 and 2009 (n = 125) and used this to address key questions: 1. Are the EIN/WHO2014 diagnostic criteria able to consistently identify premalignant endometrium? 2. Can computer aided image analysis inform identification of EIN? 3. Can we improve diagnosis by incorporating analysis of protein expression using immunohistochemistry. Our findings confirmed the inclusion of EIN in diagnostic criteria resulted in a better agreement between expert pathologists compared with the previous WHO94 criteria used for the original diagnosis of our sample set. A computer model based on assessment of stromal:epithelial ratio appeared most accurate in classification of areas of tissue without EIN. From an extensive panel of putative endometrial protein tissue biomarkers a score based on assessment of HAND2, PTEN, and PAX2 was able to identify four clusters one of which appeared to be more likely to be benign. In summary, our study has highlighted new opportunities to improve diagnosis of pre-malignant disease in endometrium and provide a platform for further research on this important topic.
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Affiliation(s)
- Peter A. Sanderson
- Centre for Inflammation Research, Edinburgh Bioquarter, The University of Edinburgh, Edinburgh, United Kingdom
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, The University of Edinburgh, Edinburgh, United Kingdom
| | - Arantza Esnal-Zufiaurre
- Centre for Inflammation Research, Edinburgh Bioquarter, The University of Edinburgh, Edinburgh, United Kingdom
| | - Mark J. Arends
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, The University of Edinburgh, Edinburgh, United Kingdom
| | - C. Simon Herrington
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, The University of Edinburgh, Edinburgh, United Kingdom
| | - Frances Collins
- Centre for Inflammation Research, Edinburgh Bioquarter, The University of Edinburgh, Edinburgh, United Kingdom
| | - Alistair R. W. Williams
- Department of Pathology, Edinburgh BioQuarter, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Philippa T. K. Saunders
- Centre for Inflammation Research, Edinburgh Bioquarter, The University of Edinburgh, Edinburgh, United Kingdom
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Zhang Q, Lian ZY, Cai JQ, Bai Y, Wang Z. Safety and effectiveness of mucosal traction using a snare combined with endoclips to assist the resection of esophageal intraepithelial neoplasia: a propensity score matching analysis. Dis Esophagus 2022; 35:6231766. [PMID: 33870425 DOI: 10.1093/dote/doab018] [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: 07/22/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
Currently, the reports on esophageal endoscopic submucosal dissection (ESD) assisted by traction with a snare are rare. Because a snare is a commonly used endoscopic accessory and is easily available, its application in mucosal traction is worth exploring. The present study aims to evaluate the safety and effectiveness of snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia. Cases of esophageal intraepithelial neoplasia resected using ESD in the Digestive Endoscopy Center of Guangzhou Nanfang Hospital, China from June 2013 to March 2019 were retrospectively analyzed. The procedure of snare-endoclip traction-assisted ESD was compared with nontraction-assisted ESD by using a propensity score matching analysis. Operation time, en bloc and R0 resection, intra- and postoperative complications, and surgery-related costs were mainly evaluated. Overall, 99 cases of esophageal intraepithelial neoplasia under tissue biopsy were included in the present study. Further, 22 exact matched pairs were obtained. There were no differences in en bloc and R0 resection rates, intra- and postoperative complications, and costs of disposable surgical accessories between the traction group and the nontraction group. However, median operation time showed a significant difference: traction group, 50.0 min (range, 20-100 min); nontraction group, 70.0 min (range, 35-133 min), P=0.012. In conclusion, snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia was safe and shortened operation time in the study, thereby improving the efficiency of ESD. Despite the additional use of a snare and endoclips for traction, the total costs of endoscopic accessories seemed not to be increased.
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Affiliation(s)
- Qiang Zhang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhou-Yang Lian
- Department of Radiology, Guangdong Provincial People' Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Jian-Qun Cai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yang Bai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhen Wang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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Kamaradová K. Non-conventional types of dysplastic changes in gastrointestinal tract mucosa - review of morphological features of individual subtypes. Cesk Patol 2022; 58:38-51. [PMID: 35387456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Evaluation of the dysplastic changes evolving in mucosa of various segments of gastrointestinal tract is a part of routine practice. Morphologically different or non-conventional types of dysplastic changes are described in the mucosa of gastrointestinal tract besides the most common conventional type of dysplasia. Non-conventional dysplasias can arise de-novo or they can be found in association with chronic gastrointestinal conditions, such as Barretts esophagus, chronic atrophic gastritis, and inflammatory bowel disease. Non-conventional types of dysplasia include serrated, crypt base of foveolar dysplasia and lesions as pyloric or oxyntic gland adenoma. Non-conventional types of dysplasia arising in inflammatory bowel disease represent specific category with broad morphological spectrum of changes. The aim of this work is to present a comprehensive review of morphological characteristics of individual subtypes of non-conventional dysplastic changes with focus on differences and specificity in particular parts of gastrointestinal tract and provide a functional handout for daily diagnostic practice.
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Janicka-Kośnik M, Sarecka-Hujar B, Jakiel G, Słabuszewska-Jóźwiak A. Cervicovaginal Microbiome after Cervical Intraepithelial Neoplasia Treatment. A Protocol for Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021; 18:9050. [PMID: 34501639 DOI: 10.3390/ijerph18179050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022]
Abstract
(1) Background: The microbiome consists of microorganisms from various kingdoms with numerous physical and chemical properties Lactobacillus species constitute the highest percentage of healthy cervical and vaginal microbiota. Dysbiosis may cause adverse outcomes, e.g., bacterial vaginosis, pelvic inflammatory disease and pregnancy complications. The cervicovaginal microbiome might contribute to the development of a persistent HPV infection—the main risk factor of cervical cancer—and influence progression to malignancy The aim is to perform a systematic review of current literature and a meta-analysis regarding microbiome changes after cervical intraepithelial neoplasia treatment. (2) Methods: We will search PubMed, Scopus, Google Scholar and Embase Database and trace citations in the reference sections. Randomized and non-randomized controlled studies, case–control and cohort studies published between January 2000 and May 2021 will be included in the study protocol. The following keywords will be used: ‘microbiome’, ‘vaginal microbiome’, ‘cervical microbiome’, ‘cervical neoplasia treatment’, ’conization’, ‘electroconization’, and ‘electrosurgical treatment’. Statistical analyses will be performed using RevMan 5.4. (3) Results: The results will be published as a peer-reviewed article. (4) Conclusions: The study will show which forms of intraepithelial neoplasia treatment change the cervicovaginal microbiome. Finding the best form of treatment by studying the cervicovaginal microbiome after various forms of treatment is essential. Patients would benefit not only from the treatment of the initial disease but also the management of dysbiosis, which might underlie other pathologies.
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Ramberg I, Møller‐Hansen M, Toft PB, Funding M, Heegaard S. Human papillomavirus infection plays a role in conjunctival squamous cell carcinoma: a systematic review and meta-analysis of observational studies. Acta Ophthalmol 2021; 99:478-488. [PMID: 33191633 DOI: 10.1111/aos.14666] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/11/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to study the prevalence of human papillomavirus (HPV) in conjunctival intraepithelial neoplasia and carcinoma. Furthermore, we aimed to explore whether geographical differences or different detection modalities are associated with the conflicting information regarding HPV and the development of the disease. METHODS We searched the MEDLINE, EMBASE and Scopus databases for studies reporting on HPV and conjunctival intraepithelial neoplasia or carcinoma. The pooled prevalence proportions, odds ratio (OR) and corresponding 95% confidence intervals were calculated assuming a random-effects model. Subgroup analyses and meta-regression explored possible sources of heterogeneity. RESULTS A total of 39 studies were included in the systematic review. The pooled prevalence of HPV in conjunctival intraepithelial neoplasia and carcinoma was 26%, with HPV16, 18, and 33 being the most frequently reported genotypes. Human papillomavirus (HPV) infection was associated with an increased risk of conjunctival intraepithelial neoplasia and carcinoma (OR 8.4, 95% confidence interval (CI) 3.7-19.1); lower in studies from African countries (OR 1.7, 95% CI 0.9-3.5) than other countries (OR 16.1, 95% CI 5.8-44.3), p = 0.013. CONCLUSION Human papillomavirus infection increases the odds of conjunctival intraepithelial neoplasia and carcinoma by 8.4 compared to healthy conjunctival mucosa or other ocular surface diseases. There seem to be geographical differences regarding HPV in conjunctival intraepithelial neoplasia and carcinoma. HPV16 was the most prevalent genotype, followed by HPV18 and HPV33, meaning that most of the HPV-related conjunctival intraepithelial neoplasia and carcinoma may be prevented by the HPV vaccines that are currently available.
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Affiliation(s)
- Ingvild Ramberg
- Department of Pathology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Copenhagen Denmark
| | - Michael Møller‐Hansen
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Copenhagen Denmark
| | - Peter Bjerre Toft
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Mikkel Funding
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
| | - Steffen Heegaard
- Department of Pathology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Hara Y, Goda K, Hirooka S, Mitsuishi T, Ikegami M, Sumiyama K. Association between Endoscopic Milk-White Mucosa, Epithelial Intracellular Lipid Droplets, and Histological Grade of Superficial Non-Ampullary Duodenal Epithelial Tumors. Diagnostics (Basel) 2021; 11:diagnostics11050769. [PMID: 33923005 PMCID: PMC8146723 DOI: 10.3390/diagnostics11050769] [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: 02/28/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023] Open
Abstract
We previously reported that superficial non-ampullary duodenal tumors (SNADETs) commonly had a whitish mucosal surface, named milk-white mucosa (MWM). The aim of this study was to evaluate the association of MWM with epithelial intracellular lipid droplets (immunohistochemically stained by adipose differentiation-related protein (ADRP)) and histological tumor grades. We reviewed endoscopic images and the histopathology of SNADETs resected en bloc endoscopically. We analyzed the correlation between the positive rates of endoscopic MWM in preoperative endoscopy and resected specimens, and ADRP-positive rates in the resected specimens. Associations between the MWM-positive rates and tumor grades, high-grade intraepithelial neoplasia (HGIN)/intramucosal carcinoma (IC), and low-grade intraepithelial neoplasia (LGIN) were analyzed. All the 92 SNADETs analyzed were <20 mm and histologically classified into 39 HGIN/IC and 53 LGIN. Spearman's rank correlation coefficient showed a significant correlation between MWM-positive and ADRP-positive rates (p < 0.001). MWM-positive rates were significantly lower in the HGIN/IC than in the LGIN in preoperative endoscopy (p < 0.001) and resected specimens (p = 0.02). Our results suggest that endoscopic MWM is closely associated with epithelial intracellular lipid droplets and that the MWM-positive rate may be a predictor of histological grade in small SNADETs.
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Affiliation(s)
- Yuko Hara
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
- Correspondence:
| | - Kenichi Goda
- Gastrointestinal Endoscopy Center, Dokkyo Medical University, Tochigi 321-0293, Japan;
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.H.); (M.I.)
| | - Takehiro Mitsuishi
- Department of Pathology, Kawasaki Saiwai Hospital, Kanagawa 212-0014, Japan;
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.H.); (M.I.)
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
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Lazo de la Vega L, Bick N, Hu K, Rahrig SE, Silva CD, Matayoshi S, Picciarelli P, Wang X, Sugar A, Soong HK, Mian SI, Robinson DR, Chinnaiyan AM, Demirci H, Daniels AB, Worden F, Eberhart CG, Tomlins SA, Rao RC, Harms PW. Invasive squamous cell carcinomas and precursor lesions on UV-exposed epithelia demonstrate concordant genomic complexity in driver genes. Mod Pathol 2020; 33:2280-94. [PMID: 32461624 DOI: 10.1038/s41379-020-0571-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022]
Abstract
Although squamous cell carcinomas (SCC) are the most frequent human solid tumor at many anatomic sites, the driving molecular alterations underlying their progression from precursor lesions are poorly understood, especially in the context of photodamage. Therefore, we used high-depth, targeted next-generation sequencing (NGS) of RNA and DNA from routine tissue samples to characterize the progression of both well- (cutaneous) and poorly (ocular) studied SCCs. We assessed 56 formalin-fixed paraffin-embedded (FFPE) cutaneous lesions (n = 8 actinic keratosis, n = 30 carcinoma in situ [CIS], n = 18 invasive) and 43 FFPE ocular surface lesions (n = 2 conjunctival/corneal intraepithelial neoplasia, n = 20 CIS, n = 21 invasive), from institutions in the US and Brazil. An additional seven cases of advanced cutaneous SCC were profiled by hybrid capture-based NGS of >1500 genes. The cutaneous and ocular squamous neoplasms displayed a predominance of UV-signature mutations. Precursor lesions had highly similar somatic genomic landscapes to SCCs, including chromosomal gains of 3q involving SOX2, and highly recurrent mutations and/or loss of heterozygosity events affecting tumor suppressors TP53 and CDKN2A. Additionally, we identify a novel molecular subclass of CIS with RB1 mutations. Among TP53 wild-type tumors, human papillomavirus transcript was detected in one matched pair of cutaneous CIS and SCC. Amplicon-based whole-transcriptome sequencing of select 20 cutaneous lesions demonstrated significant upregulation of pro-invasion genes in cutaneous SCCs relative to precursors, including MMP1, MMP3, MMP9, LAMC2, LGALS1, and TNFRSF12A. Together, ocular and cutaneous squamous neoplasms demonstrate similar alterations, supporting a common model for neoplasia in UV-exposed epithelia. Treatment modalities useful for cutaneous SCC may also be effective in ocular SCC given the genetic similarity between these tumor types. Importantly, in both systems, precursor lesions possess the full complement of major genetic changes seen in SCC, supporting non-genetic drivers of invasiveness.
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Wang Z, Gao X, Zeng R, Wu Q, Sun H, Wu W, Zhang X, Sun G, Yan B, Wu L, Ren R, Guo M, Peng L, Yang Y. Changes of the Gastric Mucosal Microbiome Associated With Histological Stages of Gastric Carcinogenesis. Front Microbiol 2020; 11:997. [PMID: 32547510 PMCID: PMC7272699 DOI: 10.3389/fmicb.2020.00997] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 04/23/2020] [Indexed: 12/22/2022] Open
Abstract
The changes of gastric microbiome across stages of neoplastic progression remain poorly understood, especially for intraepithelial neoplasia (IN) which has been recognized as a phenotypic bridge between atrophic/intestinal metaplastic lesions and invasive cancer. The gastric microbiota was investigated in 30 healthy controls (HC), 21 non-atrophic chronic gastritis (CG), 27 gastric intestinal metaplasia (IM), 25 IN, and 29 gastric cancer (GC) patients by 16S rRNA gene profiling. The bacterial diversity, and abundances of phyla Armatimonadetes, Chloroflexi, Elusimicrobia, Nitrospirae, Planctomycetes, Verrucomicrobia, and WS3 reduced progressively from CG, through IM, IN to GC. Actinobacteria, Bacteriodes, Firmicutes, Fusobacteria, SR1, and TM7 were enriched in the IN and GC. At the community level, the proportions of Gram-positive and anaerobic bacteria increased in the IN and GC compared to other histological types, whereas the aerobic and facultatively anaerobic bacteria taxa were significantly reduced in GC. Remarkable changes in the gastric microbiota functions were detected after the formation of IN. The reduced nitrite-oxidizing phylum Nitrospirae together with a decreased nitrate/nitrite reductase functions indicated nitrate accumulation during neoplastic progression. We constructed a random forest model, which had a very high accuracy (AUC > 0.95) in predicating the histological types with as low as five gastric bacterial taxa. In summary, the changing patterns of the gastric microbiota composition and function are highly indicative of stages of neoplastic progression.
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Affiliation(s)
- Zikai Wang
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xuefeng Gao
- Department of Hematology-Oncology, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Health Science Center, Shenzhen, China
| | - Ranran Zeng
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Qiong Wu
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Huaibo Sun
- Institute of Soil Science, Chinese Academy of Sciences, Nanjing, China
| | - Wenming Wu
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaomei Zhang
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Gang Sun
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Bin Yan
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Lili Wu
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Rongrong Ren
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingzhou Guo
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Lihua Peng
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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12
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Canete-Portillo S, Sanchez DF, Cubilla AL. Pathology of Invasive and Intraepithelial Penile Neoplasia. Eur Urol Focus 2019; 5:713-7. [PMID: 31288989 DOI: 10.1016/j.euf.2019.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/10/2019] [Accepted: 06/21/2019] [Indexed: 11/23/2022]
Abstract
Since 1995 it has been known that tumors harboring human papillomavirus (HPV) preferentially show basaloid or condylomatous histological features, while HPV-negative tumors have a different morphology. New classification models separate subtypes of penile squamous cell carcinomas in two groups, non-HPV- and HPV-related. It is purported that HPV-related tumors have better prognosis. Other features such as inflammatory cell-rich medullary, clear-cell, and lymphoepithelioma-like patterns are also strong predictors of the presence of HPV. These tumors are morphologically distinctive and with some experience, pathologists may recognize them after routine hematoxylin and eosin staining. Occasionally, p16 immunostaining may aid in differential diagnosis. The gold standard for HPV detection is polymerase chain reaction, but this technique is expensive and not available in most pathology laboratories. In situ hybridization is useful and p16 immunostaining can detect HPV in approximately 85% of cases. There is correlation between morphology and outcome. PATIENT SUMMARY: This mini review provides an overview of the latest classification for penile invasive carcinoma and penile intraepithelial neoplasia.
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Leeman A, Del Pino M, Marimon L, Torné A, Ordi J, Ter Harmsel B, Meijer CJLM, Jenkins D, Van Kemenade FJ, Quint WGV. Reliable identification of women with CIN3+ using hrHPV genotyping and methylation markers in a cytology-screened referral population. Int J Cancer 2018; 144:160-168. [PMID: 30098013 PMCID: PMC6587551 DOI: 10.1002/ijc.31787] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/28/2018] [Revised: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 12/21/2022]
Abstract
Cervical screening aims to identify women with high‐grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 2‐3 (HSIL/CIN2‐3) or invasive cervical cancer (ICC). Identification of women with severe premalignant lesions or ICC (CIN3+) could ensure their rapid treatment and prevent overtreatment. We investigated high‐risk human papillomavirus (hrHPV) detection with genotyping and methylation of FAM19A4/miR124‐2 for detection of CIN3+ in 538 women attending colposcopy for abnormal cytology. All women had an additional cytology with hrHPV testing (GP5+/6+‐PCR‐EIA+), genotyping (HPV16/18, HPV16/18/31/45), and methylation analysis (FAM19A4/miR124‐2) and at least one biopsy. CIN3+ detection was studied overall and in women <30 (n = 171) and ≥30 years (n = 367). Positivity for both rather than just one methylation markers increased in CIN3, and all ICC was positive for both. Overall sensitivity and specificity for CIN3+ were, respectively, 90.3% (95%CI 81.3–95.2) and 31.8% (95%CI 27.7–36.1) for hrHPV, 77.8% (95%CI 66.9–85.8) and 69.3% (95%CI 65.0–73.3) for methylation biomarkers and 93.1% (95%CI 84.8–97.0) and 49.4% (95%CI 44.8–53.9) for combined HPV16/18 and/or methylation positivity. For CIN3, hrHPV was found in 90.9% (95%CI 81.6–95.8), methylation positivity in 75.8% (95%CI 64.2–84.5) and HPV16/18 and/or methylation positivity in 92.4% (95%CI 83.5–96.7). In women aged ≥30, the sensitivity of combined HPV16/18 and methylation was increased (98.2%, 95%CI 90.6–99.7) with a specificity of 46.3% (95%CI 40.8–51.9). Combination of HPV16/18 and methylation analysis was very sensitive and offered improved specificity for CIN3+, opening the possibility of rapid treatment for these women and follow‐up for women with potentially regressive, less advanced, HSIL/CIN2 lesions. What's new? Reliable triage of women with cervical intraepithelial neoplasia (CIN) is of high priority as not all lesions progress to invasive carcinoma. Here the authors show that combining the methylation status of tumor suppressor genes FAM19A4 and miR124‐2 with genotyping for high‐risk human papillomavirus results in a highly sensitive and moderately specific triage strategy that identifies women with CIN lesions likely to need rapid treatment. The authors recommend clinical evaluation of the strategy in prospective studies.
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Affiliation(s)
| | - Marta Del Pino
- Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic -Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Lorena Marimon
- Department of Pathology, ISGlobal, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Aureli Torné
- Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic -Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Jaume Ordi
- Department of Pathology, ISGlobal, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Bram Ter Harmsel
- Roosevelt Kliniek, Department of Pathology, Leiden, The Netherlands
| | - Chris J L M Meijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - David Jenkins
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Folkert J Van Kemenade
- Erasmus MC University Medical Center, Department of Pathology, Rotterdam, The Netherlands
| | - Wim G V Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
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14
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Papoutsis D, Kandanearachchi P, Antonakou A, Tzavara C, Sahu B. A method to improve the accuracy between the presumed depth of excision and the actual depth of excision in women receiving LLETZ cervical treatment; a single-center, two-operator experience. Hippokratia 2018; 22:113-121. [PMID: 31642448 PMCID: PMC6801120] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND We aimed to determine whether continuous auditing of the presumed depth of excision and comparing with the actual depth of excision in women having large loop excision of the transformation zone (LLETZ) improves the ability to acquire the desired depth of excision. METHODS This was a prospective study of women submitted to a single LLETZ treatment between 2017-2018. Two senior colposcopists recorded what they presumed was the depth of excision at the time of treatment and the subsequent histopathology report provided the actual excised depth. Multiple linear regression identified independently associated parameters with the difference between presumed and actual excision depth. Non-linear regression determined the learning plateau defined as the theoretical minimal score of difference one could achieve with infinite practice. RESULTS There were significant differences in practices with the first colposcopist using an 18-mm loop and the second colposcopist a 15-mm loop in the majority of cases. The median absolute and percentage difference between the presumed and actual excised depth was 2 mm and 16.6 % and 3.5 mm and 35.4 % for the two colposcopists, respectively. A learning plateau was identified only for the first colposcopist. We found that auditing consecutive excisions decreased significantly the difference between the presumed and actual depth of excision with a learning plateau at 2.2 mm of absolute difference and 22.6 % of percentage difference and with a learning rate of 13 cervical excisions. CONCLUSION There might be a benefit in auditing our treatment practice as there seems to be a learning plateau through this method. HIPPOKRATIA 2018, 22(3): 113-121.
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Affiliation(s)
- D Papoutsis
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Telford, United Kingdom
| | - P Kandanearachchi
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Telford, United Kingdom
| | - A Antonakou
- Department of Midwifery, Midwifery School, 'Alexander' Technological Educational Institute of Thessaloniki, Greece
| | - C Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - B Sahu
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Telford, United Kingdom
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15
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Li LH, Jiang WZ, Kang DY, Liu X, Li HS, Guan GX, Zhuo SM, Chen ZF, Chen JX. Second-harmonic imaging microscopy for identifying colorectal intraepithelial neoplasia. J Microsc 2018; 271:31-35. [PMID: 29505679 DOI: 10.1111/jmi.12690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/05/2018] [Accepted: 02/06/2018] [Indexed: 11/28/2022]
Abstract
In this study, second-harmonic imaging microscopy was used to monitor precancerous colorectal lesions at different stages. It was found that the morphology of glands and lamina propria in mucosa changes with the progression of colorectal diseases from normal to low-grade intraepithelial neoplasia to high-grade intraepithelial neoplasia and this microscopy has the ability of direct visualization of these warning symptoms. Furthermore, two morphologic variables were quantified to determine the changes of glands and collagen in lamina propria during the development of colorectal intraepithelial neoplasia. These results suggest that second-harmonic imaging microscopy has the potential in label-freely and effectively distinguishing between normal and precancerous colorectal tissues, and will be helpful for early diagnosis and treatment of colorectal diseases.
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Affiliation(s)
- L H Li
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou, Fujian, China
| | - W Z Jiang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - D Y Kang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - X Liu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - H S Li
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou, Fujian, China
| | - G X Guan
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - S M Zhuo
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou, Fujian, China
| | - Z F Chen
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - J X Chen
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou, Fujian, China
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Lorincz AT, Nathan M, Reuter C, Warman R, Thaha MA, Sheaff M, Vasiljevic N, Ahmad A, Cuzick J, Sasieni P. Methylation of HPV and a tumor suppressor gene reveals anal cancer and precursor lesions. Oncotarget 2017; 8:50510-50520. [PMID: 28881579 PMCID: PMC5584159 DOI: 10.18632/oncotarget.17984] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/06/2017] [Indexed: 12/24/2022] Open
Abstract
We studied DNA methylation patterns of human papillomavirus (HPV) and tumor suppressor gene EPB41L3 in 148 anal and perianal biopsies to determine whether high levels of methylation would be associated with anal intraepithelial neoplasia (AIN). The most prevalent HPV type was HPV16, detected in 54% of the 30 benign biopsies, 33% of the 43 low-grade AIN (lgAIN), 82% of the 59 high grade AIN (hgAIN) and 4 of the 5 anal cancers. A methylation score was developed (0.561*HPV16me+0.439*EPB41L3) which had increasing values with severity of disease: the mean was 8.1% in benign, 13.2% in lgAIN, 22.3% in hgAIN and 49.3% in cancers (p < 0.0001). The methylation score as a triage classifier at a cut-off of 8.8 gave a sensitivity of 90.6% (95% CI: 82.8, 96.9), specificity of 50.7% (95% CI: 39.7, 61.6) and area under the curve of 0.82 (95% CI: 0.75-0.89) for separating hgAIN and cancer from benign and lgAIN biopsies. We conclude that methylation of HPV16 and EPB41L3 show highly significant association with increasing severity of AIN and cancer and may be useful as biomarkers in anal disease.
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Affiliation(s)
- Attila T. Lorincz
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Mayura Nathan
- Homerton Anal Neoplasia Service, Homerton University Hospital NHS Foundation Trust, London E9 6SR, UK
| | - Caroline Reuter
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Rhian Warman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Mohamed A. Thaha
- National Bowel Research Centre, Blizard Institute, Queen Mary University of London, London E1 2AT, UK
- Barts Anal Neoplasia Centre, Department of Colorectal Surgery, Surgery and Cancer CAG, The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London E1 1BB, UK
| | - Michael Sheaff
- Cellular Pathology, Barts Health NHS Trust, London E1 2ES, UK
| | - Natasa Vasiljevic
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Amar Ahmad
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
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Abstract
PURPOSE To compare the effectiveness and safety of loop electrosurgical excision procedures (LEEP) with four different excisions in treating cervical intraepithelial neoplasia (CIN) of different areas. METHODS Four hundred and sixty-six cases of CIN were treated with different types of LEEP. Following visual inspection with acetic acid and Lugol's iodine, LEEP were performed to excise the transformation zone to a 20-25 mm depth with a 2-3 mm margin. Four categories of procedures are described below: (i) LEEP-A for lesion ≥2/3 of cervical area: conization of ≥2/3 of cervical tissue. (ii) LEEP-B for ≥1/3 but <2/3: conization of 1/3 to <2/3. (iii) LEEP-C for <1/3: conization of <1/3. (iv) LEEP-D: endocervical canal resection. RESULTS The cases included 108 of CIN I, 232 of CIN II, and 106 of CIN III (not including carcinoma in situ) patients. No positive margin was found in any specimens. The cure rates for LEEP-A, B, C, and D were 99.1%, 98.5%, 100.0%, and 93.2%, respectively (p > .05). The pregnancy rate at two years after LEEP was significantly higher in groups C and D compared to group A (p < .05). CONCLUSIONS Four categories of LEEP are highly effective in the treatment of CIN when appropriately applied. However, large loop excision may lead to adverse obstetric outcomes in pregnancy.
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Affiliation(s)
- Geping Yin
- a Department of Obstetrics & Gynecology , Jinan Military General Hospital , Jinan , China
| | - Juan Li
- a Department of Obstetrics & Gynecology , Jinan Military General Hospital , Jinan , China
| | - Aifang Wu
- a Department of Obstetrics & Gynecology , Jinan Military General Hospital , Jinan , China
| | - Jing Liang
- a Department of Obstetrics & Gynecology , Jinan Military General Hospital , Jinan , China
| | - Zheng Yuan
- a Department of Obstetrics & Gynecology , Jinan Military General Hospital , Jinan , China
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Voltaggio L, Cimino-Mathews A, Bishop JA, Argani P, Cuda JD, Epstein JI, Hruban RH, Netto GJ, Stoler MH, Taube JM, Vang R, Westra WH, Montgomery EA. Current concepts in the diagnosis and pathobiology of intraepithelial neoplasia: A review by organ system. CA Cancer J Clin 2016; 66:408-36. [PMID: 27270763 DOI: 10.3322/caac.21350] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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] [Indexed: 12/20/2022] Open
Abstract
Answer questions and earn CME/CNE In this report, a team of surgical pathologists has provided a review of intraepithelial neoplasia in a host of (but not all) anatomic sites of interest to colleagues in various medical specialties, namely, uterine cervix, ovary, breast, lung, head and neck, skin, prostate, bladder, pancreas, and esophagus. There is more experience with more readily accessible sites (such as the uterine cervix and skin) than with other anatomic sites, and the lack of uniform terminology, together with divergent biology in various sites, makes it difficult to paint a unifying, relevant portrait. The authors' aim was to provide a framework from which to move forward as we care for patients with such precancerous lesions. CA Cancer J Clin 2016;66:408-436. © 2016 American Cancer Society.
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Affiliation(s)
- Lysandra Voltaggio
- Assistant Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ashley Cimino-Mathews
- Assistant Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Justin A Bishop
- Associate Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Pedram Argani
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jonathan D Cuda
- Assistant Professor of Dermatology, Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jonathan I Epstein
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
- Professor of Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD
| | - Ralph H Hruban
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - George J Netto
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Mark H Stoler
- Professor of Pathology, Department of Pathology, University of Virginia Health System, Charlottesville, VA
| | - Janis M Taube
- Associate Professor of Dermatology and Pathology, Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Russell Vang
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - William H Westra
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Elizabeth A Montgomery
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
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Kurmyshkina OV, Belova LL, Kovchur PI, Volkova TO. [Remodeling of angiogenesis and lymphangiogenesis in cervical cancer development]. Biomed Khim 2015; 61:579-97. [PMID: 26539865 DOI: 10.18097/pbmc20156105579] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ability to stimulate angiogenesis/lymphangiogenesis is recognized as an inherent feature of cancer cells providing necessary conditions for their growth and dissemination. "Angiogenic switch" is one of the earliest consequences of malignant transformation that encompasses a great number of genes and triggers a complex set of signaling cascades in endothelial cells. The processes of tumor microvasculature development are closely connected to the steps of carcinogenesis (from benign lesions to invasive forms) and occur through multiple deviations from the norm. Analysis of expression of proangiogenic factors at successive steps of cervical cancer development (intraepithelial neoplasia, cancer in situ, microinvasive, and invasive cancer) enables to reconstruct the regulatory mechanisms of (lymph-)angiogenesis and to discriminate the most important components. This review presents detailed analysis of literature data on expression of the key regulators of angiogenesis in cervical intraepithelial neoplasia and cervical cancer. Their possible involvement in molecular mechanisms of neoplastic transformation of epithelial cells, as well as invasion and tumor metastasis is discussed. Correlation between expression of proangiogenic molecular factors and various clinicopathological parameters is considered, the potential of their use in molecular diagnostics and targeted therapy of cervical cancer is reviewed. Particular attention is paid to relatively poorly studied regulators of lymphangiogenesis and "non-VEGF dependent", or alternative, angiogenic pathways that constitute the prospect of future research in the field.
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Affiliation(s)
- O V Kurmyshkina
- Institute of High-Tech Biomedicine, Petrozavodsk State University, Petrozavodsk, Russia
| | - L L Belova
- Institute of High-Tech Biomedicine, Petrozavodsk State University, Petrozavodsk, Russia
| | - P I Kovchur
- Institute of High-Tech Biomedicine, Petrozavodsk State University, Petrozavodsk, Russia
| | - T O Volkova
- Institute of High-Tech Biomedicine, Petrozavodsk State University, Petrozavodsk, Russia
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Abstract
Although anal cancer remains a relatively uncommon tumour its frequency is rising, especially in high-risk groups. It is now well recognized that anal squamous cell carcinoma, the largely predominant tumour type, shares many similarities with cancer of the uterine cervix, with a major role for oncogenic human papilloma viruses in both tumours. Anal squamous precancerous lesions have now to be classified with the same criteria and terminology as their cervical counterparts, by using the Lower Anogenital Squamous Terminology (LAST) proposal. Only p16 protein is a useful marker in this setting at the present time. As most cases of anal cancer are treated by non-surgical procedures, pathology has a limited role in the staging of the disease, except for early lesions treated by local excision, and when the sentinel lymph node procedure is undertaken that is still under evaluation. A variety of other tumour types can occur more rarely, with difficult diagnostic issues, solved in most cases by immunohistochemistry.
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Affiliation(s)
- Jean-François Fléjou
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Saint-Antoine, Paris, France
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21
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Vanoli A, Lucioni M, Biletta E, Chiaravalli AM, Alvisi C, Luinetti O. A Wolf in Sheep's Clothing: A Sporadic Juvenile Polyp of the Colon Harboring an Intramucosal Adenocarcinoma. Int J Surg Pathol 2015. [PMID: 26215217 DOI: 10.1177/1066896915596809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We describe a solitary peduncolated polypoid lesion with a bilobated head in the transverse colon mucosa of a 51-year-old Caucasian man. Histologically, the lesion was consistent with juvenile polyp (JP), but showing a few dysplastic glands and a focus of intramucosal adenocarcinoma. This finding suggests that, at least in adults, even the sporadic JPs might carry an inherent potential for malignancy, which has so far only been pointed out for syndromic lesions. Additionally, we observed p53 overexpression in both the dysplastic lesions and in the invasive cells but not in the remaining epithelium. We can argue that p53 immunohistochemistry may be helpful in differentiating hyperplastic regenerative atypia of the epithelium, frequently found in JPs, from true dysplasia, a much more rare change in the sporadic JPs.
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Affiliation(s)
- Alessandro Vanoli
- University of Pavia, Pavia, Italy Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
| | - Marco Lucioni
- University of Pavia, Pavia, Italy Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
| | - Elena Biletta
- University of Pavia, Pavia, Italy Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
| | | | - Costanza Alvisi
- Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
| | - Ombretta Luinetti
- University of Pavia, Pavia, Italy Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy
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Freire P, Figueiredo P, Cardoso R, Manuel Donato M, Ferreira M, Mendes S, Silva MR, Cipriano MA, Ferreira AM, Vasconcelos H, Portela F, Sofia C. Predictive value of rectal aberrant crypt foci for intraepithelial neoplasia in ulcerative colitis - a cross-sectional study. Scand J Gastroenterol 2014; 49:1219-29. [PMID: 25157637 DOI: 10.3109/00365521.2014.951390] [Citation(s) in RCA: 5] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer (CRC). Aberrant crypt foci (ACF) are important biomarkers of sporadic CRC risk. Their correlation with the risk of intraepithelial neoplasia (IN) in UC remains unclear. AIMS To assess whether ACF are a risk factor for IN in long-standing UC and to investigate any correlation between the clinico-epidemiological characteristics and prevalence/number of ACF in these patients. METHODS Seventy-six patients with long-standing UC were prospectively screened by colonoscopy with chromoendoscopy-guided endomicroscopy. ACF were sought in the lower rectum. RESULTS Eight INs were detected in seven (9.2%) patients. The ACF prevalence and mean number were 60.5% and 2.4 ± 2.8, respectively. The number of ACF was independently associated with the risk of having IN (odds ratio = 1.338; 95% confidence interval 1.030-1.738). ACF number revealed a good calibration (area under the receiver operating characteristic curve = 0.829) and discriminative ability (p = 0.205, Hosmer-Lemeshow test) for the prediction of synchronous IN. Patients with ≥3 ACF have a significantly higher prevalence of IN than patients with <3 ACF (22.6% vs. 0%, p = 0.001). Using this cut-off value, the performance of ACF in predicting the presence of IN was as follows: sensitivity = 100%, specificity = 65.2%, positive predictive value = 22.6%, and negative predictive value = 100%. Age >40 years, family history of CRC, and increased body mass index (BMI) were associated with a significantly higher number of ACF. CONCLUSION Long-standing UC patients with ≥3 ACF have a significantly higher likelihood of having IN. Age >40 years, family history of CRC, and increased BMI have significant positive associations with the number of ACF.
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Affiliation(s)
- Paulo Freire
- Department of Gastroenterology , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
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Goda K, Dobashi A, Yoshimura N, Chiba M, Fukuda A, Nakao Y, Ohya TR, Sasaki Y, Kato M, Aihara H, Sumiyama K, Toyoizumi H, Kato T, Tajiri H, Ikegami M. Clinicopathological features of narrow-band imaging endoscopy and immunohistochemistry in ultraminute esophageal squamous neoplasms. Dis Esophagus 2014; 27:267-75. [PMID: 23796261 DOI: 10.1111/dote.12090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 12/11/2022]
Abstract
To reveal clinicopathological features of narrow-band imaging (NBI) endoscopy and immunohistochemistry in ultraminute esophageal squamous neoplasms. If a lesion diameter was smaller or same compared with a width of closed biopsy forceps, a lesion was defined to be an ultraminute lesion. Twenty-five consecutive patients with 33 ultraminute esophageal lesions that were removed by endoscopic mucosal resection were included in the present study. We conducted two questionnaire surveys of six endoscopists by their retrospective review of endoscopic still images. The six endoscopists evaluated the endoscopic findings of the ultraminute lesions on still images taken by conventional white-light imaging endoscopy and non-magnified NBI endoscopy in the first questionnaire, and taken by magnified NBI endoscopy in the second questionnaire. An experienced pathologist who was unaware of any endoscopic findings made histological diagnosis and evaluated immunoexpression of p53 and Ki67. The 33 ultraminute lesions were all determined to be either 11 high-grade intraepithelial neoplasias (HGIENs) or 22 low-grade intraepithelial neoplasias (LGIENs). The tumor diameters were histologically confirmed to be <3 mm. All of the ultraminute tumors were visualized as unstained areas and brownish areas by real-time endoscopy with Lugol dye staining and non-magnified NBI endoscopy, respectively. All of the ultraminute IENs were visualized as brownish areas by real-time non-magnified NBI endoscopy. Three of the 25 patients with the ultraminute IENs (12%) had multiple brownish areas (more than several areas) in the esophagus on real-time non-magnified NBI endoscopy. All of the ultraminute IENs were visualized as unstained areas by real-time Lugol chromoendoscopy. Twenty of the 25 patients (80%) had multiple unstained areas (more than several areas) in the esophagus on real-time Lugol chromoendoscopy. The first questionnaire survey revealed that a significantly higher detection rate of the ultraminute IENs on non-magnified NBI endoscopy images compared with conventional white-light imaging endoscopy ones (100% vs. 72%, respectively: P < 0.0001). The second questionnaire survey revealed that presence rates of any magnified NBI endoscopy findings were not significantly different between HGIENs and LGIENs. Proliferation, dilation, and various shapes of intrapapillary capillary loops indicated remarkably high presence rates of more than 90% in both HGIENs and LGIENs. Six of 22 LGIENs (27%) and 3 of 11 HGIENs (27%) show a positive expression for p53. None of peri-IEN epithelia was positive for p53. A mean of Ki67 labeling index of LGIENs was 33% and that of HGIENs 36%. Ki67 labeling index was significantly greater in the LGIENs and HGIENs compared with that in the peri-IEN epithelia. There were no significant differences in p53 expression and Ki67 labeling index between the HGIENs and LGIENs. Non-magnified/magnified NBI endoscopy could facilitate visualization and characterization of ultraminute esophageal squamous IENs. The ultraminute HGIENs and LGIENs might have comparable features of magnified NBI endoscopy and immunohistochemistry.
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Affiliation(s)
- K Goda
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
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Tong WWY, Hillman RJ, Kelleher AD, Grulich AE, Carr A. Anal intraepithelial neoplasia and squamous cell carcinoma in HIV-infected adults. HIV Med 2013; 15:65-76. [PMID: 24007498 DOI: 10.1111/hiv.12080] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 12/25/2022]
Abstract
Anal cancer is one of the most common non-AIDS-defining malignancies in the era of combination antiretroviral therapy. Its precursor lesion, anal intraepithelial neoplasia (AIN), is highly prevalent in HIV-infected populations. More than 90% of anal squamous cell cancers are attributable to human papillomavirus (HPV). While the biology of HPV-related intraepithelial neoplasia is consistent across lower anogenital sites, the natural history of AIN is not well established and cannot be assumed to be identical to that of cervical intraepithelial neoplasia. Screening strategies to prevent anal cancer should be developed based on robust natural history data in HIV-infected and uninfected populations. Likewise, treatments need to be tested in randomized clinical trials, and reserved for those at significant risk of progression to cancer. This review covers the epidemiology, pathogenesis and immunology of HPV infection, AIN and anal cancer, and summarizes the current diagnosis, screening and treatment strategies in HIV-infected adults.
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Affiliation(s)
- W W Y Tong
- Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia
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Mokrowiecka A, Zonnur S, Veits L, Musial J, Kordek R, Lochowski M, Kozak J, Malecka-Panas E, Vieth M, Hartmann A. Liver-intestine-cadherin is a sensitive marker of intestinal differentiation during Barrett's carcinogenesis. Dig Dis Sci 2013; 58:699-705. [PMID: 23053896 DOI: 10.1007/s10620-012-2425-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 09/19/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Histopathologic differentiation between the stages of Barrett's carcinogenesis is often challenging. Liver-intestine (LI)-cadherin, an intestine-specific marker, is involved in intestinal metaplasia development in gastric and colon cancers and could be of value in diagnosis and differentiation. AIMS To examine the expression of LI-cadherin in the sequence of Barrett's carcinogenesis and to evaluate its association with clinicopathological data. METHODS LI-cadherin expression was immunohistologically investigated, by use of anti-CDH17 antibody, in gastric mucosa (GM) biopsies taken from the cardia (n = 9), in Barrett's esophagus (BE) without intraepithelial neoplasia (without IEN) (n = 9) and BE with low-grade IEN (n = 11), and in esophageal adenocarcinoma (ADC) (n = 13). RESULTS The immunoreactivity score was highest in adenocarcinoma (mean IRS = 4.0), and dropped gradually from BE with IEN and BE without IEN (mean IRS = 2.0) to cardia mucosa (IRS = 0). Similarly, the intensity of staining and the percentage of positive cells increased during the sequential stages of BE carcinogenesis. Comparative analysis showed that LI-cadherin expression was significantly different between cardiac epithelium and ADC. Also, percentage of positive cells in GM was significantly different from that in BE with IEN. LI-cadherin IRS was lower for tumors with poor differentiation than for moderately differentiated tumors, but the difference was not statistically significant. CONCLUSIONS LI-cadherin is a sensitive marker of intestinal metaplasia and can be helpful for early histologic diagnosis of Barrett's esophagus; it is, however, not significantly different between BE with and without IEN, and cannot be used to distinguish between these.
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Canfell K, Chesson H, Kulasingam SL, Berkhof J, Diaz M, Kim JJ. Modeling preventative strategies against human papillomavirus-related disease in developed countries. Vaccine 2012; 30 Suppl 5:F157-67. [PMID: 23199959 PMCID: PMC3783354 DOI: 10.1016/j.vaccine.2012.06.091] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [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: 02/02/2012] [Revised: 06/11/2012] [Accepted: 06/13/2012] [Indexed: 02/08/2023]
Abstract
Over the last 5 years, prophylactic vaccination against human papillomavirus (HPV) in pre-adolescent females has been introduced in most developed countries, supported by modeled evaluations that have almost universally found vaccination of pre-adolescent females to be cost-effective. Studies to date suggest that vaccination of pre-adolescent males may also be cost-effective at a cost per vaccinated individual of ~US$400-500 if vaccination coverage in females cannot be increased above ~50%; but if it is possible, increasing coverage in females appears to be a better return on investment. Comparative evaluation of the quadrivalent (HPV16,18,6,11) and bivalent (HPV16,18) vaccines centers around the potential trade-off between protection against anogenital warts and vaccine-specific levels of cross-protection against infections not targeted by the vaccines. Future evaluations will also need to consider the cost-effectiveness of a next generation nonavalent vaccine designed to protect against ~90% of cervical cancers. The timing of the effect of vaccination on cervical screening programs will be country-specific and will depend on vaccination catch-up age range and coverage and the age at which screening starts. Initial evaluations suggest that if screening remains unchanged, it will be less cost-effective in vaccinated compared to unvaccinated women but, in the context of current vaccines, will remain an important prevention method. Comprehensive evaluation of new approaches to screening will need to consider the population-level effects of vaccination over time. New screening strategies of particular interest include delaying the start age of screening, increasing the screening interval and switching to primary HPV screening. Future evaluations of screening will also need to focus on the effects of disparities in screening and vaccination uptake, the potential effects of vaccination on screening participation, and the effects of imperfect compliance with screening recommendations. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Affiliation(s)
- Karen Canfell
- Cancer Epidemiology Research Unit, Cancer Council NSW, Sydney, Australia.
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27
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Chung JY, Yi JM, Xie R, Brown V, Lee O, Ahuja N, Braunschweig T, Hewitt SM. A pressure cooking-based DNA extraction from archival formalin-fixed, paraffin-embedded tissue. Anal Biochem 2012; 425:128-34. [PMID: 22449494 PMCID: PMC3358925 DOI: 10.1016/j.ab.2012.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 02/02/2012] [Revised: 03/15/2012] [Accepted: 03/16/2012] [Indexed: 12/18/2022]
Abstract
As emerging novel DNA-based methodologies are adopted, nucleic acid-based assays depend critically on the quality and quantity of extracted DNA. Formalin-fixed, paraffin embedded (FFPE) tissue samples provide an invaluable resource for subsequent molecular studies of clinical phenotypes, but high-quality DNA extraction from archival FFPE tissue specimens remains complex and time-consuming. To address this challenge, we have developed a reliable rapid DNA extraction method for FFPE tissue specimens. It is based on deparaffinization at high temperature coupled with relieving crosslink in a pressure cooker. The DNA yield by this rapid method resulted in an average 1.8-fold increase in comparison with the commercial kit and OD 260/280 ratios between 1.87 and 1.95. The DNA obtained by the rapid method was suitable for methylation analyses in colon cancer patients. These data suggest that this new DNA extraction method coupled with methylation-specific polymerase chain reaction can be used for epigenetic studies with the advantages of rapidity and high quality and may contribute to the development of biomarkers in clinical studies.
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Affiliation(s)
- Joon-Yong Chung
- Tissue Array Research Program, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Joo Mi Yi
- Departments of Oncology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Ran Xie
- Tissue Array Research Program, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Victoria Brown
- Tissue Array Research Program, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Olivia Lee
- Tissue Array Research Program, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nita Ahuja
- Departments of Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | | | - Stephen M. Hewitt
- Tissue Array Research Program, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Marshall JR, Tangen CM, Sakr WA, Wood DP, Berry DL, Klein EA, Lippman SM, Parnes HL, Alberts DS, Jarrard DF, Lee WR, Gaziano JM, Crawford ED, Ely B, Ray M, Davis W, Minasian LM, Thompson IM. Phase III trial of selenium to prevent prostate cancer in men with high-grade prostatic intraepithelial neoplasia: SWOG S9917. Cancer Prev Res (Phila) 2011; 4:1761-9. [PMID: 21896650 PMCID: PMC3208719 DOI: 10.1158/1940-6207.capr-10-0343] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [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] [Indexed: 01/24/2023]
Abstract
The threat of prostate cancer and the significant and often negative impact of its treatment underscore the importance of prevention. High-grade prostatic intraepithelial neoplasia (HGPIN) has been identified as a potential premalignant lesion marking an increased risk of prostate cancer and substantial evidence suggests that men with HGPIN are in need of prostate cancer prevention. In vitro, in vivo, epidemiologic, and clinical trial evidence that selenium supplementation protects against prostate cancer motivated the study we report here: a double-blind, randomized, placebo-controlled trial of selenium 200 (μg/d) as selenomethionine in men with HGPIN. The primary endpoint was progression of HGPIN to prostate cancer over a 3-year period. This National Cancer Institute Intergroup trial was coordinated by the Southwest Oncology Group (SWOG). Of 619 enrolled patients, 423 randomized men with HGPIN (212 selenium and 211 placebo) were eligible (by central pathology review) and included in the primary analysis. Three-year cancer rates were 36.6% (placebo) versus 35.6% (selenium; P = 0.73, adjusted). The majority of patients who developed cancer on trial (70.8%, selenium and 75.5%, placebo) had a Gleason score of 6 or less than 6; there were no differences in Gleason scores between the two arms. Subset analyses included the finding of a nonsignificantly reduced prostate cancer risk (relative risk = 0.82; 95% CI: 0.40-1.69) in selenium versus placebo patients in the lowest quartile of baseline plasma selenium level (<106 ng/mL). Overall, and in all other subsets defined by baseline blood selenium levels, selenium supplementation had no effect on prostate cancer risk. The 36% prostate cancer rate in men with HGPIN indicates the association of this lesion with an elevated prostate cancer risk. Future study in this setting should focus on selenium-deficient populations and selenium pharmacogenetics.
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Affiliation(s)
- James R Marshall
- Department of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA.
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Abstract
Invasive tumors (cancers or malignant lesions) typically develop in the setting in which there is the presence of putative non-invasive lesions and the development of these non-invasive lesions frequently precedes the development of cancers. For some organs, such as the oral cavity, cervix and skin, the respective putative pre-invasive lesions can be observed over time and documented to progress to invasive lesions. However, for less readily observable lesions, such as those of the prostate, the progression of the pre-invasive lesions, e.g., prostatic intraepithelial neoplasia (PIN) and prostatic proliferative inflammatory atrophy (PIA) to prostatic cancer are more difficult to document. Thus, for most organ systems, specific pre-invasive neoplastic lesions have been proposed based upon the apparent observations of one or more of the following: 1) microinvasive disease developing from a pre-invasive neoplastic lesion, 2) the general association of the pre-invasive lesion with invasive lesions, 3) the subsequent development of invasive lesions following diagnosis of the pre-invasive lesion, 4) correlations of the molecular features of the putative pre-invasive lesion with the matching invasive lesions, and 5) reductions in the rate of cancer following removal of the pre-invasive lesion. When there are mixtures of pre-invasive lesions with actual cancers in the same case, some of the above specific associations are more difficult to make. Several terms have been used to describe pre-invasive lesions, many of which are now less useful as our knowledge of these lesions increases. It is now commonly accepted that these lesions are a features of the spectrum of neoplastic development and most are accepted as ``neoplastic lesions'' with associated molecular features, even though they may be reversible even if they have mutations in suppressor genes (e.g., p53) or are associated with viral etiologies (e.g., cervical intraepithelial neoplasia). The overall term, "pre-invasive neoplasia", seems to best describe these putative pre-invasive lesions. Thus, terms such as incipient neoplasia should be abandoned. The term "intra-epithelial neoplasia" with an associated grade, which has been developed for pre-invasive neoplastic lesions of the cervix, i.e. cervical intraepithelial neoplasia (CIN), seems to be a terminology that adds consistency across epithelial organs. Thus, adoption of these terms for the additional organ sites of pancreas (PanIN) and prostate (PIN) seems accepted. Less descriptive terms such as the degrees of dysplasia of the oral cavity and bronchopulmonary system and actinic keratosis and Bowen's disease of the skin might be better designated as oral intraepithelial neoplasia (OIN), pulmonary intraepithelial neoplasia (PulIN) and dermal intraepithelial neoplasia (DIN). The etiology of pre-invasive neoplasia is the etiology of the matching cancers. Some obvious initiating factors include exposure to the whole range of ionizing and non-ionizing radiation, tobacco abuse and a broad range of other carcinogens (e.g., benzene). A frequent initiation factor is the setting of long standing continuing damage, inflammation and repair (LOCDIR) which leads to early molecular features associated with neoplasia after about one year. An excellent example of this is ulcerative colitis (UC) in which dysregulation of microsatellite repair enzymes have been documented one year following diagnosis of UC. While the nomenclature, description, diagnosis and etiology of pre-invasive neoplasia has advanced, approaches to therapy of such lesions have not progressed adequately even though it has been identified that, for example, removal of polyps periodically from the colorectum, DCIS from the breast, and high grade CIN from the cervix, results in a reduction in the development of cancers of the colorectum, breast, and cervix, respectively. With the development of more molecularly targeted therapy with fewer side effects, preventive therapies may be more successfully targeted to pre-invasive neoplastic lesions.
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Affiliation(s)
- William E Grizzle
- Department of Pathology, Division of Anatomic Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Oncins R, Fuente C, Nájar M. [Descriptive study of cervical intraepithelial neoplasia grade III (CIN III) cases in the area of the hospital of Barbastro]. Aten Primaria 2001; 28:457-62. [PMID: 11718640 PMCID: PMC7675959 DOI: 10.1016/s0212-6567(01)70421-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Accepted: 06/18/2001] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE A description of early diagnosis of cervical cancer in the Barbastro Hospital area. DESIGN Descriptive and retrospective study on all the CIN III cases collected in the Tumor Hospital Registry from 1989 to 1998. To correlate the data to the population covered by the hospital. PARTICIPANTS AND METHODS 59 CIN III cases were detected and 16 invasive cancers. The total smears studied were 31409. The population covered was 50220 women, 15% of whom are between the age of 35 and 64. RESULTS The frequency of CIN III was 12 cases per 100000 women and year and of invasive cancers 3.2. From 59 CIN III 20 belong to the first five-year period and 39 to the second. The mean age was 37 12 (20-82). No significant statistical differences were found between five-year periods. The most frequent decade was 30-39 years (50% of cases). 10489 smears were studied from the first five-year period and 20911 from the second. 75% of invasive cases did not come from screening. CONCLUSIONS The tendency is that when the number of screened smears increases so does the number of CIN III. The frequency of the preneoplastic disease and invasive cancer is low. Therefore, close coordination between hospital departments of gynaecology and pathology together with primary health care is vital in order to extend the coverage, to reach risk groups and rationalise the screening of cervical cancer.
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Affiliation(s)
- R Oncins
- Servicios de Anatomía Patológica, Hospital de Barbasdtro, Spain.
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