Publications by authors named "Ayoub Nahal"

37 Publications

Establishing an Anatomic Pathology Laboratory at Cleveland Clinic Abu Dhabi.

Arch Pathol Lab Med 2018 09;142(9):1036-1046

From the Department of Anatomic Pathology, Pathology & Laboratory Medicine Institute (Drs Liaqat, Turner, Nahal, AbdelWareth, and Mirza, and Messrs Anderson and Palmer), the Department of Information Technology (Messrs Taher, Koshy, and Kolar), and the Department of Operations (Mr Burton), Cleveland Clinic Abu Dhabi, United Arab Emirates; the National Reference Laboratory, Abu Dhabi, United Arab Emirates (Mr de Jesus); and the Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Dr AbdulKarim).

Context: - The Department of Anatomic Pathology is a division of the Pathology & Laboratory Medicine Institute at Cleveland Clinic Abu Dhabi. The hospital offers the same model of care as its US-based counterpart the Cleveland Clinic, established in 1921 in Cleveland, Ohio. Pathology services at Cleveland Clinic are internationally acclaimed: the endeavor for Cleveland Clinic Abu Dhabi was to create a parallel facility, with the same standards in a greenfield start-up environment.

Objective: - To narrate how we addressed challenges customary in any laboratory start-up and issues distinctive to our setting with the aim to provide a model for others involved in a similar undertaking.

Data Sources: - All information in this article is based on published literature obtained by search on internet-based search engines, Clinical and Laboratory Standards Institute, and the authors' firsthand experience.

Conclusions: - Key considerations in establishing an anatomic pathology laboratory are careful planning and design, adherence to local and international regulatory standards, selection of equipment and supplies, appropriate staffing, development of a laboratory information system, and sound test validation. In addition to meeting our clinical needs, alliance with the US Cleveland Clinic had an integral role in establishing our laboratory and regional reputation.
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http://dx.doi.org/10.5858/arpa.2018-0101-RADOI Listing
September 2018

Setting Up an ePathology Service at Cleveland Clinic Abu Dhabi: Joint Collaboration With Cleveland Clinic, United States.

Arch Pathol Lab Med 2018 10 24;142(10):1216-1222. Epub 2018 Apr 24.

From the Pathology and Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (Dr Nahal and Ms Batac); the Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio (Ms Slaw and Dr Bauer); and the Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York (Dr Bauer).

Context.—: The production of whole slide images is the most advanced form of digital pathology, in which a high-resolution digital scanner is used to rapidly scan glass microscope slides and produce a computer-generated whole slide image that can be saved, stored in a network-attached storage device, and accessed through slide management software within the hospital domain and remotely by authorized users. Digital transformation of glass slides has revolutionized the practice of anatomic pathology by facilitating and expediting consultative services, improving clinical workflow, and becoming an indispensable tool in education and research.

Objective.—: To highlight the institutional need of Cleveland Clinic Abu Dhabi (Abu Dhabi, United Arab Emirates) and the cultural background for obtaining the United Arab Emirates' first comprehensive digital pathology program; to describe a multiphase road map for achieving full implementation of this platform; and to describe the system's clinical applications and its future potential growth.

Data Sources.—: At Cleveland Clinic Abu Dhabi, we prioritized our efforts to initiate digital consultations (eConsultations) and digital immunohistochemistry services (eIHC) with Cleveland Clinic Laboratories (Cleveland, Ohio). After this, we established an internal archiving system together with a subspecialty-based, organ-specific digital library of pathologic diseases.

Conclusions.—: We describe the strategic adoption and implementation of digital pathology into the clinical workflow of the pathology and laboratory medicine institute of Cleveland Clinic Abu Dhabi, and we highlight its impact on clinical operations, educational activities, and patient care.
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http://dx.doi.org/10.5858/arpa.2017-0216-RADOI Listing
October 2018

Rare Aggressive Calvarial Osteoblastoma with Dural Invasion.

Cureus 2017 Sep 30;9(9):e1733. Epub 2017 Sep 30.

Montreal Neurological Institute, McGill University Health Centre.

We report a rare case of an aggressive osteoblastoma (OB) involving the calvaria and infiltrating the dura, a finding that was not previously reported in the literature. A 50-year-old man presented with a progressive mass in the left frontoparietal skull with headaches and a six-month history of sudden mass growth. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large skull lesion with areas of hemorrhage, calcification, restricted diffusion, and enhancement.  A left temporoparietal craniotomy with a complete resection of the tumor with grossly clean margins was performed. Follow-up at 60 months showed a stable clinical picture and no sign of local recurrence of the lesion on MRI.
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http://dx.doi.org/10.7759/cureus.1733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708758PMC
September 2017

Substrain-specific differences in bone parameters, alpha-2-macroglobulin circulating levels, and osteonecrosis incidence in a rat model.

J Orthop Res 2017 06 12;35(6):1183-1194. Epub 2017 May 12.

Vascular, Biology Research Lab, Research Institute, McGill University Health Centre, C9 Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada.

Osteonecrosis of the femoral head (ONFH) is a potentially devastating complication that occurs in up to 40% of young adults receiving chronic glucocorticoid (GC) therapy. Through a validated GC therapy rat model, we have previously shown that Wistar Kyoto (WK) rats exhibit a genetic susceptibility to GC-induced ONFH compared to Sasco Fischer (F344) rats. We have undertaken this study in order to investigate differences between these two strains for their bone parameters, alpha-2-macroglobulin (A2M) circulating levels and incidence of GC-induced osteonecrosis of the femoral head. WK and F344 rats were treated either with 1.5 mg/kg/day of prednisone or placebo for 6 months. Blood was taken every month. The femoral heads were harvested for histological examination to detect ONFH and analyzed with micro-computed tomography. After 3 months of GC-therapy, plasma A2M was elevated in treated rats only. GC-treated WK rats exhibited histological evidence of early ONFH through higher rates of cellular apoptosis and empty osteocyte lacunae in the subchondral bone compared to placebos and to F344 rats. Furthermore, micro-CT analysis exhibited femoral head collapse only in GC-treated WK rats. Interestingly, GC-treated F344 rats exhibited significant micro-CT changes, but such changes were less concentrated in the articular region and were accompanied histologically with increased marrow fat. These µCT and histological findings suggest that elevated A2M serum level is not predictive and suitable as an indicative biomarker for early GC-induced ONFH in rodents. Elevated A2M levels observed during GC treatment suggests that it plays role in the host reparative response to GC-associated effects. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1183-1194, 2017.
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http://dx.doi.org/10.1002/jor.23199DOI Listing
June 2017

Brown tumor of the pelvis.

Cleve Clin J Med 2015 Dec;82(12):799-800

Assistant Professor, Division of Rheumatology, Department of Medicine, McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada. E-mail:

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http://dx.doi.org/10.3949/ccjm.82a.14146DOI Listing
December 2015

Urine cytology: does the number of atypical urothelial cells matter? A qualitative and quantitative study of 112 cases.

J Am Soc Cytopathol 2015 Jul - Aug;4(4):232-238. Epub 2015 Jan 13.

Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada.

Introduction: This study presents a detailed and systematic morphological and quantitative analysis of urine cytology specimens in order to determine which qualitative and quantitative features are mostly associated with high-grade urothelial carcinoma (HGUCA).

Material And Methods: This study included 112 urine cytology cases with a surgical follow-up within 1 year that were originally reported as "atypical," "suspicious for HGUCA," or "positive for HGUCA." The morphological characteristics as well as the number of abnormal cells were correlated with a diagnosis of HGUCA on follow-up biopsy.

Results: Multivariate analysis showed that the presence of hyperchromatic atypical cells with nuclear-cytoplasmic ratio ≥ 0.7 was an independent predictor of HGUCA. Similarly, irregular nuclear membranes, single cells, and pleomorphism correlated with surgical outcome whereas eccentric nuclear location, prominent nucleoli, nuclear-cytoplasmic ratio between 0.5 and 0.7 did not. Cases with ≤10 atypical cells had significantly lower rates of subsequent HGUCA than did those with >10 atypical cells (58% versus 77%). Cases with ≤5 atypical cells (n = 26) showed similar prediction rates (58%) for HGUCA than did those with 6 to 10 atypical cells (n = 12).

Conclusions: The number of atypical urothelial cells is an important criterion that should be taken into account when assigning cases to the "positive" or the "suspicious" categories. A preliminary cutoff of 10 cells appears to be easily applicable and valid from the clinical standpoint.
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http://dx.doi.org/10.1016/j.jasc.2015.01.003DOI Listing
January 2015

Penile metastasis from rectal cancer by PET/CT.

Clin Nucl Med 2015 Apr;40(4):e245-50

From the Departments of *Radiology, †Nuclear Medicine, MUHC, McGill University, Montreal, Quebec, Canada; ‡Medical Imaging, King Abdulaziz Medical City, Kingdom of Saudi Arabia; and §Pathology, MUHC, McGill University, Montreal, Quebec, Canada.

It is extremely rare for rectal tumors to metastasize to the penis, and when it occurs, it is associated with poor prognosis. The appearance of penile metastasis from rectal primary tumor on PET imaging has not been widely reported. We report a case of a 70-year-old man with previous history of treated stage III adenocarcinoma of the rectum 26 months ago. The restaging 18F-FDG PET/CT scan demonstrated a hypermetabolic mass at the base of his penile shaft. This lesion was confirmed on core biopsy to be a metastatic adenocarcinoma of colorectal origin consistent with the known primary rectal tumor.
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http://dx.doi.org/10.1097/RLU.0000000000000635DOI Listing
April 2015

Imaging characteristics of spindle cell lipoma and its variants.

Skeletal Radiol 2014 May 20;43(5):591-7. Epub 2014 Feb 20.

Department of Radiology, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada,

A spindle cell lipoma (SCL) is a relatively common tumor that can be challenging to the radiologist, pathologist, or surgeon to diagnose, particularly when internal fat content is scant or absent. Although these lesions may be found at various locations, the typical presentation for this lesion is a well-circumscribed and non-aggressive subcutaneous mass in the posterior neck presenting in a middle-aged to elderly man. In this article, the typical and atypical imaging characteristics of a spindle cell lipoma (SCL) will be reviewed. Knowledge of the common imaging and pathologic features of SCLs can help suggest the diagnosis and guide patient management.
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http://dx.doi.org/10.1007/s00256-014-1834-5DOI Listing
May 2014

Metabolic activity measured on PET/CT correlates with clinical outcomes in patients with limb and girdle sarcomas.

J Surg Oncol 2014 Apr 6;109(5):410-4. Epub 2013 Dec 6.

Department of Radiation Oncology, McGill University Health Centre/Montreal General Hospital, Montreal, Quebec, Canada.

Objective: To explore the relationship between metabolic activity and outcome in patients with extremity sarcomas.

Methods: Between June 2004 and December 2011, 120 patients with newly diagnosed limb and girdle sarcomas underwent FDG-PET/CT for disease staging prior to curative intent treatment. The maximum standardized uptake value (SUV(max)) was measured for each primary tumor and correlated with outcome. Progression-free survival and overall survival (OS) were analyzed using the Kaplan-Meier method.

Results: Soft-tissue sarcomas were more frequent (68%) than bone (27%) or cartilage (5%) tumors. Median follow-up was 33.2 months. 51% of patients progressed during the follow-up interval and 38% died. SUV(max) was dichotomized with a cut-point of 10.3. Patients with SUV(max) < 10.3 had better DFS and OS compared with patients with SUV(max) ≥ 10.3 (P < 0.001 and P < 0.001, respectively [log-rank test]). Multivariate analysis confirmed that even after adjusting for age, sex, site, tumor type (bone vs. soft-tissue), grade, and stage; an SUV(max) ≥ 10.3 correlated with a twofold risk of progression and 2.4 times greater risk of death (hazard ratio [HR] 2.0, 95% CI, 1.1-3.7, and HR, 2.4, 95% CI, 1.1-4.9).

Conclusion: SUV(max) is an independent adverse prognostic factor for both progression and OS in patients with extremity sarcomas.
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http://dx.doi.org/10.1002/jso.23523DOI Listing
April 2014

Necrosis on FDG PET/CT correlates with prognosis and mortality in sarcomas.

AJR Am J Roentgenol 2013 Jul;201(1):170-7

Department of Nuclear Medicine, Royal Victoria Hospital, 687 Pine Ave, Montreal, QC H3A 1A1, Canada.

Objective: The purpose of this study was to determine if there is an association between necrosis as identified on staging (18)F-FDG PET/CT and overall survival (OS) and progression-free survival (PFS) in patients with sarcoma.

Materials And Methods: Sixty-six patients with newly diagnosed limb and girdle sarcoma underwent PET/CT at our institution between June 2004 and July 2009 for sarcoma staging before treatment with curative intent. The tumor maximum standardized up-take values (SUVmax), the presence of necrosis, and the volume of necrosis were measured for each primary tumor and correlated with follow-up data. PFS and OS were analyzed using the Kaplan-Meier method. Proportional hazards models were used to estimate hazard ratios.

Results: Median patient age was 49 years, and 51.6% of the patients were men. Sarcomas were categorized as soft tissue (69.2%), bone (23.5%), or other (7.3%). Mean follow-up time was 33.3 months. During the follow-up interval, 53% of patients experienced disease progression, and 40.9% died. There was a statistically significant relationship between the presence of necrosis and OS (by log-rank test, p = 0.001), as well as PFS (by log-rank test, p = 0.0001). Twenty-four-month OS was 96%, 65%, and 38% in patients with tumors with absence necrosis, those with presence of necrosis, and with necrosis volume greater than 50%, respectively. Forty-eight-month OS was 81% in patients with absence of necrosis and 41% in patients with presence of necrosis. Twelve-month PFS was 96%, 60%, and 42% in patients with tumors with absence of necrosis, those with presence of necrosis, and those with necrosis volume greater than 50%, respectively. Twenty-four-month PFS was 83%, 38%, and 22%, respectively, in these groups.

Conclusion: The presence of necrosis and the volume of necrosis, as identified on the staging FDG PET/CT and after adjusting for SUVmax, are strong independent adverse prognostic factors for disease recurrence and death in patients with limb and girdle sarcomas.
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http://dx.doi.org/10.2214/AJR.12.9795DOI Listing
July 2013

Oral cellular neurothekeoma.

Case Rep Otolaryngol 2013 4;2013:935435. Epub 2013 Apr 4.

Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada H3A 1A1.

Cellular neurothekeoma is known as a cutaneous tumor with uncertain histogenesis. Very little involvement of mucosal membrane has been reported in the literature so far. This is a case report of an intraoral lesion in a 15-years-old girl. Histopathologic evaluation showed a tumor-consists of spindle to epitheloid cells forming micronodules in a concentric whorled shape pattern. Tumor cells were positive for CD63, vimentin, and NKI-C3. Total excision was performed and no recurrence happened after 16-month followup.
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http://dx.doi.org/10.1155/2013/935435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638503PMC
May 2013

Primitive neuroectodermal tumor (PNET) as somatic-type malignancy arising from an extragonadal germ-cell tumor: clinical, pathological and molecular features of a case.

Tumori 2013 Jan-Feb;99(1):e24-7

Department of Oncology, McGill University, Montreal, Quebec, Canada.

We report a rare case of a 34-year-old man with a right axillary mass. Ten years previously, he had been diagnosed with a right scapular nonseminomatous germ-cell tumor consisting of teratoma, completely resected without any further treatment. Presently he was found to have a metastatic malignant small round cell tumor consistent with a secondary somatic malignancy arising in the background of nonseminomatous germ-cell tumor, teratoma, yolk sac tumor, and primitive neuroectodermal tumor with distinct chromosome 22 translocation. Although the patient initially responded well to chemotherapy with etoposide, cisplatin, ifosfamide and mesna, he relapsed shortly after.
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http://dx.doi.org/10.1700/1248.13807DOI Listing
May 2013

Soft tissue tumors of the anorectum: rare, complex and misunderstood.

J Gastrointest Oncol 2013 Mar;4(1):82-94

Division of Experimental Surgery, McGill University, 845 Sherbrooke Street West Montreal, Quebec, Canada H3A 2T5; ; Department of Surgery, King Abdulaziz University, P.O. Box 80205, Zip Code 21589, Jeddah, Saudi Arabia;

Anorectal soft tissue tumors are uncommon and often present both diagnostic and therapeutic challenges. Although many of these tumors are identified with imaging performed for unrelated reasons, most present with nonspecific symptoms that can lead to a delay in diagnosis. Historically, radical surgery (abdominoperineal resection) has been the mainstay of treatment for both benign and malignant anorectal soft tissue tumors. However, a lack of proven benefit in benign disease along with changes in technology has called this practice into question. In addition, the role of radiation and/or chemotherapy remains controversial. In this manuscript, we review the history and current status of anorectal soft tissue tumor management, with a particular focus on challenges in optimizing survival.
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http://dx.doi.org/10.3978/j.issn.2078-6891.2012.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562632PMC
March 2013

Urinary bladder leiomyosarcoma: staging with 18F-FDG PET/CT.

Clin Nucl Med 2013 May;38(5):e218-22

Department of Nuclear Medicine, Brandon Regional Health Centre, Brandon, Manitoba, Canada.

A 28-year-old woman with a history of prior bilateral retinoblastoma presented with general fatigue, anemia, and a urinary bladder mass seen on abdominal ultrasound and CT. She was referred for a staging 18F-FDG PET/CT, which showed an intensely FDG-avid bladder mass that was biopsied to reveal a leiomyosarcoma, with no evidence of metastases, which guided her management. 18F-FDG PET/CT is routinely used in the evaluation of leiomyosarcomas; however, its use in the staging of a leiomyosarcoma of the urinary bladder has not been previously described in the literature. This case highlights the usefulness of PET/CT in the staging of this rare tumor.
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http://dx.doi.org/10.1097/RLU.0b013e3182523e33DOI Listing
May 2013

Transoral endoscopic resection of esophageal liposarcoma.

Ann Thorac Surg 2012 Nov;94(5):e121-2

Department of Surgery, McGill University Montreal, Quebec, Canada.

A 63-year-old man presented with a 1-month history of dysphagia. Endoscopy showed the patient had a mass in the cervical esophagus. Multiple biopsy specimens were taken, which were inconclusive for a diagnosis. A positron-emission tomography scan showed a hypermetabolic lesion. A transoral endoscopic approach was used to resect the tumor. Final histologic examination revealed a completely resected low-grade liposarcoma.
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http://dx.doi.org/10.1016/j.athoracsur.2012.04.130DOI Listing
November 2012

Primary perivascular epithelioid cell neoplasm (PEComa) of bone: report of two cases and review of the literature.

Skeletal Radiol 2012 Nov 3;41(11):1469-74. Epub 2012 Jul 3.

Department of Orthopaedic Surgery, McGill University Health Center, 1650 Cedar Avenue, Montreal, Quebec, Canada.

Primary perivascular epithelioid cell neoplasms (PEComas) of bone are rare mesenchymal tumors. Histologically, they are composed predominantly of perivascular epithelioid cells and have the capacity to metastasize. PEComas have been reported within intra-abdominal and intra-pelvic organs. To the best of our knowledge, only seven primary PEComas of bone have been described in the English literature. We present two cases of PEComa of bone, one arising from the distal fibula and one from the acetabulum. Both were treated by surgical excision and one also received adjuvant chemotherapy.
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http://dx.doi.org/10.1007/s00256-012-1479-1DOI Listing
November 2012

Giant Cell Tumor Pulmonary Metastases Mimic Primary Malignant Pulmonary Nodules on (18)F-FDG PET/CT.

Nucl Med Mol Imaging 2012 Jun 21;46(2):134-7. Epub 2012 Apr 21.

Department of Nuclear Medicine, Royal Victoria Hospital, McGill University Health Centre, 687 Pine Ave West, M2, Montreal, QC H3A 1A1 Canada.

A 59-year-old man with a 30-year history of multiple recurrences of a giant cell tumor (GCT) of the left knee was referred for an (18)F-FDG PET/CT to evaluate a solitary pulmonary nodule. The nodule was mildly FDG-avid, raising suspicion of malignancy. It was excised and histologically proven to be a GCT pulmonary metastasis. A follow-up PET/CT done 2 years later revealed a new, larger lung mass that was more intensely FDG-avid, but of the same histology. This rare report highlights a pitfall in the evaluation of solitary pulmonary lesions by (18)F-FDG PET/CT in patients with GCT of the bone.
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http://dx.doi.org/10.1007/s13139-012-0134-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042995PMC
June 2012

Correlating metabolic activity on 18F-FDG PET/CT with histopathologic characteristics of osseous and soft-tissue sarcomas: a retrospective review of 136 patients.

AJR Am J Roentgenol 2012 Jun;198(6):1409-16

Department of Nuclear Medicine, Royal Victoria Hospital, Montreal, QC, Canada.

Objective: The objective of our study was to determine whether there is a statistically significant correlation between metabolic activity of osseous and soft-tissue sarcomas as measured by the maximum standardized uptake value (SUV(max)) on (18)F-FDG PET/CT and histopathologic characteristics such as mitotic counts, the presence of necrosis, and the presence of a myxoid component.

Materials And Methods: We retrospectively evaluated 238 consecutive patients with known soft-tissue or osseous sarcoma who underwent (18)F-FDG PET/CT for initial staging or assessment for recurrence of disease. The SUV(max) of each primary or of the most intense metastatic lesion was measured and was compared with the histologic data provided in the final pathology reports.

Results: Histopathologic data were available for 136 sarcomas. The median SUV(max) values of sarcomas with mitotic counts of less than 2.00 (per 10 high-power fields [HPF]), 2.00-6.99, 7.00-16.24, and 16.25 or greater were 5.0, 6.6, 10.3, and 13.0, respectively (p = 0.0003). The median SUV(max) for the sarcomas with necrosis (90 patients) was 8.6 and for those without necrosis (43 patients), 6.0 (p = 0.026). The median SUV(max) for the sarcomas without a myxoid component (118 patients) was 7.7 and with a myxoid component (16 patients) was 6.2 (p = 0.28).

Conclusion: There was a statistically significant correlation between the mitotic count and the SUV(max) as well as between the presence of tumor necrosis and the SUV(max). Although a correlation between the presence of a myxoid component and SUV(max) was shown, it was not found to be statistically significant. These findings improve on the current information in the literature regarding the use of PET/CT for guidance in sarcoma biopsy. Correlating the SUV(max) with histologic markers that also feature prominently in major sarcoma grading systems may help improve the accuracy of grading and of prognostication by allowing the SUV(max) to potentially serve as a surrogate marker in these grading systems, particularly in cases in which there is interobserver disagreement in the pathologic diagnosis or in cases in which the sarcoma cannot be properly classified on the basis of histopathologic evaluation alone.
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http://dx.doi.org/10.2214/AJR.11.7560DOI Listing
June 2012

The appearance of osseous PEComa on F-18 FDG PET/CT.

Clin Nucl Med 2012 Feb;37(2):190-2

Department of Nuclear Medicine, Royal Victoria Hospital, Montreal, Quebec, Canada.

A 29-year-old male presented with a 6-month history of left hip pain. Radiography and CT demonstrated a 6-cm lytic lesion of the left acetabulum. F-18 FDG PET for staging of the biopsy-proven malignant PEComa demonstrated intense hypermetabolism corresponding to the lytic left acetabulum. The patient underwent left hemipelvectomy with reconstructive surgery. On a follow-up F-18 FDG PET scan 3 months after initial surgery, a left lung pleural-based 9-mm nodule with hypermetabolism (SUVmax 4.1) was discovered and pathologically proven to be metastases from the primary osseous PEComa.
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http://dx.doi.org/10.1097/RLU.0b013e31823e9aecDOI Listing
February 2012

A rat model of early stage osteonecrosis induced by glucocorticoids.

J Orthop Surg Res 2011 Dec 21;6:62. Epub 2011 Dec 21.

Department of Human Genetics, McGill University Health Center (MUHC), 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada.

Background: Glucocorticoid (GC)-induced osteonecrosis (ON) is an important complication of medical therapy. The exact pathomechanisms of ON has not been clearly elucidated. There is a need for a reproducible animal model that better approximates the clinical scenario.

Methods: To determine the genetic susceptibility of rats to develop GC-induced femoral head ON, we evaluated 5 different inbred strains of rats (Spontaneous Hypertensive Rat, Wistar Kyoto, Wistar Furth, SASCO Fisher and Lewis). Prednisone pellets (dosage of 1.82-2.56 mg/kg/day) were implanted subcutaneously for 90. After 90 days, the femurs were resected and examined histologically and radiographically. Pathological and histological examination was performed. Hematoxylin and eosin (H & E) staining was used to delineate the femoral head osteonecrosis lesions as well as abnormalities of articular cartilage and growth plate.

Results: The greatest differences in H & E staining were seen in the Wistar Kyoto and Wistar Furth groups. In these groups 4 out of 5 and 3 out of 5, respectively, steroid-induced rats revealed growth plate disruption with acellular areas. The TUNEL apoptosis staining assay for apoptosis revealed that 4 out of 5 of Wistar Kyoto rats, 5 out of 5 of Wistar Furth, 2 out of 4 of surviving Lewis and 2 out of 2 of the surviving spontaneous hypertensive rats had apoptotic osteocytes in trabeculae, whereas none of the Fisher rats showed apoptotic osteocytes.

Conclusions: We postulate that Wistar Kyoto, Wistar Furth and spontaneous hypertensive rats may be strains of rats more susceptible to develop ON of the femoral head while Fisher rats were the most resistant.
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http://dx.doi.org/10.1186/1749-799X-6-62DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284440PMC
December 2011

Round cell liposarcoma presenting as an FDG-positive primary with an FDG-negative retroperitoneal metastasis: a pitfall for F-18 FDG PET/CT imaging.

Clin Nucl Med 2011 Dec;36(12):e213-6

Department of Nuclear Medicine, Royal Victoria Hospital, Montreal, Quebec, Canada.

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http://dx.doi.org/10.1097/RLU.0b013e3182335e32DOI Listing
December 2011

Melorheostosis of the sacrum causing acute-onset neurological symptoms.

Skeletal Radiol 2011 Oct 12;40(10):1369-73. Epub 2011 Jun 12.

McGill University, McIntyre Medical Building, 3655 Promenade Sir William Osler, Montreal, QC H3G 1Y6, Canada.

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http://dx.doi.org/10.1007/s00256-011-1216-1DOI Listing
October 2011

Malignant epithelioid hemangioendothelioma of the lower extremity: staging with F-18 FDG PET/CT.

Clin Nucl Med 2011 Jul;36(7):590-2

Department of Nuclear Medicine, Brandon Regional Health Centre, Brandon, Manitoba, Canada.

A 36-year-old woman presented with a 5-month history of a growing left thigh mass, causing difficulty walking. Biopsy revealed a malignant epithelioid hemangioendothelioma (EHE), and the patient was referred for a staging F-18 FDG PET/CT that showed intense FDG uptake in the thigh mass, but no FDG-avid local lymph nodes or distant metastases. A few reports have noted the usefulness of F-18 FDG PET/CT imaging in the staging of EHEs in the lung, liver, and bone marrow. This rare study highlights the usefulness of F-18 FDG PET/CT in the staging of malignant EHE of the soft tissues of the extremities.
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http://dx.doi.org/10.1097/RLU.0b013e318217733bDOI Listing
July 2011

Neonatal Gardner fibroma: a sentinel presentation of severe familial adenomatous polyposis.

Pediatrics 2010 Dec 8;126(6):e1599-602. Epub 2010 Nov 8.

Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada.

Familial adenomatous polyposis (FAP) is a rare cause of colorectal cancer and rarely presents in early childhood. Various extracolonic manifestations, however, may be present before the development of overt polyposis. One of the rarest manifestations is the Gardner fibroma (GAF), which has particular histologic features. Here we report the case of a child who presented in the neonatal period with a paraspinal mass. Although the initial diagnosis was unclear, biopsy of a second lesion at 32 months of age, and a review of the first lesion, resulted in the diagnosis of GAF. After rectal bleeding at 47 months, colonoscopy revealed 75 to 100 colonic polyps. Adenomas were identified in multiple biopsies throughout the colon and from several polyps located in the duodenum. Polyps were visualized in the jejunum by wireless-capsule endoscopy. A total proctocolectomy was performed, and no malignant transformation was observed in the colon on pathologic inspection. A truncating mutation in APC (c.4479_4480delGG p.Glu1494LysfsX19) was identified in the child. Her parents and sister do not carry this mutation in lymphocyte DNA. To our knowledge, this is the first report of neonatal GAF as the presenting feature of a molecularly confirmed case of sporadic FAP and the earliest colonic and small bowel involvement reported of FAP. It illustrates the need to exclude FAP in a child who harbors fibromas suggestive of GAF, even in the absence of supportive evidence of FAP in the patient or relatives.
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http://dx.doi.org/10.1542/peds.2010-1045DOI Listing
December 2010

Radiological and pathological response following pre-operative radiotherapy for soft-tissue sarcoma.

Radiother Oncol 2010 Dec 30;97(3):404-7. Epub 2010 Oct 30.

Division of Radiation Oncology, McGill University Heath Center, Canada.

Purpose: To report radiological and pathological response to neo-adjuvant radiotherapy for extremity and trunk soft-tissue sarcomas.

Materials/methods: Fifty patients were identified retrospectively. All patients had MRI imaging pre and post neo-adjuvant external beam radiotherapy. Tumor volumes were measured in 3D on T1 Gadolinium enhanced sequences. Pathological treatment response was quantified in terms of percentage of treatment-related necrosis for each case.

Results: Histopathologic responses to treatment varied from 0% to 100%. The median pathological treatment response was 67.5% for low-grade sarcomas and 50% for high-grade sarcomas. The median decrease in tumor volume was 13.8% for non-myxoid low-grade sarcomas, 82.1% for myxoid liposarcomas and <1% for high-grade sarcomas. A partial response on MRI (volume reduction ≥50%) was highly predictive of a good pathological response (p<0.001). Patients with stable disease on imaging or volumetric progression had wide ranging pathological responses.

Conclusions: Soft-tissue sarcomas show significant pathological treatment responses in the form of hyaline fibrosis, necrosis and granulation tissue. Despite this, there is minimal early volumetric response to radiation, especially for high-grade tumors. Although radiological partial response was predictive of pathological response, the significance of radiological progression was unclear. Myxoid liposarcoma tumor type was predictive of both pathological and radiological tumor response.
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http://dx.doi.org/10.1016/j.radonc.2010.10.007DOI Listing
December 2010

Solitary fibrous tumor: an update on the spectrum of extrapleural manifestations.

Skeletal Radiol 2012 Jan 16;41(1):5-13. Epub 2010 Oct 16.

Department of Radiology, McGill University Health Centre, Montreal General Hospital, 1650 Avenue Cedar, C5-118, Montréal, Québec, H3G 1A4, Canada.

Solitary fibrous tumor (SFT) is a rare tumor initially believed to be a benign localized pleural tumor of mesothelial origin. Over the past few years, the literature on this tumor has grown tremendously. The tumor is now reported in diverse bodily locations, and recognized to have a wider range of clinical and radiological features. The most common extrapleural sites of the tumor are the orbits and the extremities. Tumors are often well-circumscribed masses, and vary in size from 1 cm to over 30 cm. The admixture of histological components in the tumor, namely, fibrous tissue, cellular components, and highly vascularized areas consisting of numerous closely packed small to medium-sized blood vessels, influence the imaging appearances of the tumor. On magnetic resonance imaging (MRI), the diagnosis of solitary fibrous tumor is suggested by a well-circumscribed mass that has smooth margins, and focal or diffuse hypointense signal on T2-weighted imaging due to fibrous content in the tumor. SFTs demonstrate strong focal or diffuse contrast enhancement due to the highly vascularized areas in the tumor.
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http://dx.doi.org/10.1007/s00256-010-1032-zDOI Listing
January 2012

Angiomatoid fibrous histiocytoma: magnetic resonance imaging appearance in 2 cases.

J Comput Assist Tomogr 2010 Sep-Oct;34(5):791-4

Radiology Department, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

Objective: Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor usually affecting the extremities of children and young adults and has a favorable prognosis. The purpose of this study was to report the magnetic resonance imaging appearance in 2 cases of AFH.

Conclusions: Although the overall features of AFH can be confused with other subtypes of malignant fibrous histiocytoma, the young age at presentation, the location of the mass, the presence of intralesional blood-filled cystic spaces with fluid-fluid levels, associated features of hemosiderin deposition, and an enhancing fibrous pseudocapsule are all potential hints favoring this entity.
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http://dx.doi.org/10.1097/RCT.0b013e3181e39755DOI Listing
October 2010

New insights into the pathogenesis of glucocorticoid-induced avascular necrosis: microarray analysis of gene expression in a rat model.

Arthritis Res Ther 2010 25;12(3):R124. Epub 2010 Jun 25.

Department of Human Genetics, McGill University Health Center (MUHC), 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada.

Introduction: Avascular necrosis of the femoral head (ANFH) occurs variably after exposure to corticosteroids. Microvascular thrombosis is a common pathological finding. Since systemic thrombophilia is only weakly linked with ANFH, we propose that microvascular vessel pathology may be more related to local endothelial dysfunction and femoral head apoptosis. Corticosteroid effects on the endothelium and resultant apoptosis have been reported. We hypothesize that corticosteroids contribute to a differential gene expression in the femoral head in rats with early ANFH.

Methods: Besides bone marrow necrosis, which is a common sign in ANFH and reported in the early stages, we include the presence of apoptosis in this study as a criterion for diagnosing early disease. Forty Wistar Kyoto (WKY) rats were randomized to either a corticosteroid-treated group or an age-matched control group for six months. After sacrifice, the femoral heads were examined for ANFH. Total mRNA was extracted from femoral heads. Affymetrix exon array (Santa Clara, CA, USA) was performed on 15 selected RNA samples. Validation methods included RT-PCR and immunohistochemistry (IHC).

Results: Although rat exon array demonstrated a significant upregulation of 51 genes (corticosteroid(+)/ANFH(+) VS control), alpha-2-macroglobulin (A2M) gene was particularly over-expressed. Results were validated by RT-PCR and IHC. Importantly, A2M is known to share vascular, osteogenic and cartilage functions relevant for ANFH.

Conclusions: The findings suggest that corticosteroid-induced ANFH in rats might be mediated by A2M. Investigation of A2M as a potential marker, and a treatment target, for early ANFH should be carried out.
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http://dx.doi.org/10.1186/ar3062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911918PMC
November 2010

Pulmonary inflammatory myofibroblastic tumor invading the gastroesophageal junction.

Ann Thorac Surg 2010 May;89(5):1659-61

Division of Thoracic Surgery, McGill University, Montreal, Quebec, Canada.

Pulmonary inflammatory myofibroblastic tumors are rare neoplasms of intermediate malignant potential. Most patients are asymptomatic and present with incidental findings on imaging. Dysphagia due to direct invasion into the esophagus is an extremely rare presentation of this uncommon tumor. The diagnosis is difficult to make preoperatively. Complete surgical resection offers the best chance of cure. We describe a 27-year-old man who presented with progressive dysphagia and the diagnosis was only revealed after en bloc resection of the esophagus, cardia, and left lower lobe.
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http://dx.doi.org/10.1016/j.athoracsur.2009.09.082DOI Listing
May 2010

Lipoleiomyosarcoma of the rectosigmoid colon: a unique site for a rare variant of liposarcoma.

Am J Clin Oncol 2009 Aug;32(4):353-5

Department of Pathology, McGill University Health Center, Montreal, Quebec.

Objectives: Soft tissue tumors with dual adipocytic and smooth muscle differentiation are generally rare with most being benign. Sarcomas with dual fatty and smooth muscle differentiation are even rarer. The purpose of this paper is to discuss a rare presentation of a lipoleiomyosarcoma and review, the method of pathologic diagnosis and the literature.

Methods: Detailed clinical and histopathologic review of a clinical case and review of the literature using PUBMED for publications on lipoleiomyosarcoma.

Results: Based on the literature, lipoleiomyosarcomas favor body cavities and visceral sites although an occurrence in the intestine has been reported. Pathologic diagnosis requires immunohistochemical staining with MDM2 and CDK4.

Conclusions: This is the first reported case of an intestinal lipoleiomyosarcoma. Its diagnosis requires immunohistochemistry and awareness of its possible existence.
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http://dx.doi.org/10.1097/COC.0b013e31818c0926DOI Listing
August 2009