Publications by authors named "Richard T Cheney"

59 Publications

Trends in Bone Marrow Sampling and Core Biopsy Specimen Adequacy in the United States and Canada: A Multicenter Study.

Am J Clin Pathol 2018 Oct;150(5):393-405

Pathology and Anatomical Sciences, University at Buffalo-The State University of New York.

Objectives: To assess bone marrow (BM) sampling in academic medical centers.

Methods: Data from 6,374 BM samples obtained in 32 centers in 2001 and 2011, including core length (CL), were analyzed.

Results: BM included a biopsy (BMB; 93%) specimen, aspirate (BMA; 92%) specimen, or both (83%). The median (SD) CL was 12 (8.5) mm, and evaluable marrow was 9 (7.6) mm. Tissue contraction due to processing was 15%. BMB specimens were longer in adults younger than 60 years, men, and bilateral, staging, and baseline samples. Only 4% of BMB and 2% of BMB/BMA samples were deemed inadequate for diagnosis. BM for plasma cell dyscrasias, nonphysician operators, and ancillary studies usage increased, while bilateral sampling decreased over the decade. BM-related quality assurance programs are infrequent.

Conclusions: CL is shorter than recommended and varies with patient age and sex, clinical circumstances, and center experience. While pathologists render diagnoses on most cases irrespective of CL, BMB yield improvement is desirable.
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http://dx.doi.org/10.1093/ajcp/aqy066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166687PMC
October 2018

Phase III Randomized, Placebo-Controlled, Double-Blind Trial of Celecoxib in Addition to Standard Chemotherapy for Advanced Non-Small-Cell Lung Cancer With Cyclooxygenase-2 Overexpression: CALGB 30801 (Alliance).

J Clin Oncol 2017 Jul 10;35(19):2184-2192. Epub 2017 May 10.

Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Xiaofei Wang and Lydia Hodgson, Alliance Statistical and Data Center, Duke University; Thomas E. Stinchcombe, Duke University School of Medicine, Durham, NC; Richard T. Cheney, Roswell Park Cancer Institute, Buffalo; Ajeet Gajra, State University of New York Upstate Medical University, Syracuse, NY; Maria Q. Baggstrom, Washington University School of Medicine, St Louis, MO; Sachdev P. Thomas, Illinois Cancer Care, Peoria; Paula N. Friedman and Everett E. Vokes, University of Chicago; Olwen M. Hahn, Alliance Protocol Office, University of Chicago, Chicago, IL; Erin Bertino, The Ohio State University Medical Center, Columbus, OH; Karen L. Reckamp, City of Hope Comprehensive Cancer Center, Duarte, CA; Julian Molina, Mayo Clinic, Rochester; Jon Ritter, University of Minnesota, Minneapolis, MN; Joan H. Schiller, University of Texas Southwestern Medical Center, Dallas, TX; Kisha Mitchell-Richards, Yale University, New Haven, CT; and Ginger Milne, Vanderbilt University, Nashville, TN.

Purpose Tumor overexpression of cyclooxygenase-2 (COX-2) has been associated with worse outcome in non-small-cell lung cancer (NSCLC). In Cancer and Leukemia Group B (CALGB) 30203, we found that the selective COX-2 inhibitor celecoxib in addition to chemotherapy in advanced NSCLC improved progression-free and overall survival in patients with moderate to high COX-2 expression by immunohistochemistry (IHC). CALGB 30801 (Alliance) was designed to prospectively confirm that finding. Patients and Methods Patients with NSCLC (stage IIIB with pleural effusion or stage IV according to American Joint Committee on Cancer [sixth edition] criteria) were preregistered, and biopsy specimens were analyzed for COX-2 by IHC. Patients with COX-2 expression ≥ 2, performance status of 0 to 2, and normal organ function were eligible. Chemotherapy was determined by histology: carboplatin plus pemetrexed for nonsquamous NSCLC and carboplatin plus gemcitabine for squamous histology. Patients were randomly assigned to celecoxib (400 mg twice per day; arm A) or placebo (arm B). The primary objective was to demonstrate improvement in progression-free survival in patients with COX-2 index ≥ 4 with hazard ratio of 0.645 with approximately 85% power at two-sided significance level of .05. Results The study was halted for futility after 312 of the planned 322 patients with COX-2 index ≥ 2 were randomly assigned. There were no significant differences between the groups (hazard ratio, 1.046 for COX-2 ≥ 4). Subset analyses evaluating histology, chemotherapy regimen, and incremental COX-2 expression did not demonstrate any advantage for COX-2 inhibition. Elevation of baseline urinary metabolite of prostaglandin E2, indicating activation of the COX-2 pathway, was a negative prognostic factor. Values above the third quartile may have been a predictive factor. Conclusion COX-2 expression by IHC failed to select patients who could benefit from selective COX-2 inhibition. Urinary metabolite of prostaglandin E2 may be able to identify patients who could benefit from COX-2 inhibition.
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http://dx.doi.org/10.1200/JCO.2016.71.3743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493050PMC
July 2017

NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016.

J Natl Compr Canc Netw 2016 07;14(7):825-36

From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Huntsman Cancer Institute at the University of Utah; UC San Diego Moores Cancer Center; Fox Chase Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; Duke Cancer Institute; Moffitt Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Fred & Pamela Buffett Cancer Center; Massachusetts General Hospital Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Michigan Comprehensive Cancer Center; Stanford Cancer Institute; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; City of Hope Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Mayo Clinic Cancer Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network.

These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Malignant Pleural Mesothelioma (MPM). These NCCN Guidelines Insights discuss systemic therapy regimens and surgical controversies for MPM. The NCCN panel recommends cisplatin/pemetrexed (category 1) for patients with MPM. The NCCN panel also now recommends bevacizumab/cisplatin/pemetrexed as a first-line therapy option for patients with unresectable MPM who are candidates for bevacizumab. The complete version of the NCCN Guidelines for MPM, available at NCCN.org, addresses all aspects of management for MPM including diagnosis, evaluation, staging, treatment, surveillance, and therapy for recurrence and metastasis; NCCN Guidelines are intended to assist with clinical decision-making.
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http://dx.doi.org/10.6004/jnccn.2016.0087DOI Listing
July 2016

Basal Cell Skin Cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology.

J Natl Compr Canc Netw 2016 05;14(5):574-97

Basal cell carcinoma (BCC) of the skin is the most common cancer, with a higher incidence than all other malignancies combined. Although it is rare to metastasize, patients with multiple or frequently recurring BCC can suffer substantial comorbidity and be difficult to manage. Assessment of risk is a key element of management needed to inform treatment selection. The overall management of BCC primarily consists of surgical approaches, with radiation therapy as an alternate or adjuvant option. Many superficial therapies for BCC have been explored and continue to be developed, including topicals, cryosurgery, and photodynamic therapy. Two hedgehog pathway inhibitors were recently approved by the FDA for systemic treatment of advanced and metastatic BCC, and others are in development. The NCCN Guidelines for Basal Cell Skin Cancer, published in full herein, include recommendations for selecting among the various surgical approaches based on patient-, lesion-, and disease-specific factors, as well as guidance on when to use radiation therapy, superficial therapies, and hedgehog pathway inhibitors.
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http://dx.doi.org/10.6004/jnccn.2016.0065DOI Listing
May 2016

NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 4.2016.

J Natl Compr Canc Netw 2016 03;14(3):255-64

National Comprehensive Cancer Network

These NCCN Guidelines Insights focus on recent updates in the 2016 NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC; Versions 1-4). These NCCN Guidelines Insights will discuss new immunotherapeutic agents, such as nivolumab and pembrolizumab, for patients with metastatic NSCLC. For the 2016 update, the NCCN panel recommends immune checkpoint inhibitors as preferred agents (in the absence of contraindications) for second-line and beyond (subsequent) therapy in patients with metastatic NSCLC (both squamous and nonsquamous histologies). Nivolumab and pembrolizumab are preferred based on improved overall survival rates, higher response rates, longer duration of response, and fewer adverse events when compared with docetaxel therapy.
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http://dx.doi.org/10.6004/jnccn.2016.0031DOI Listing
March 2016

Homogenous Good Outcome in a Heterogeneous Group of Tumors: An Institutional Series of Outcomes of Superficial Soft Tissue Sarcomas.

Sarcoma 2015 8;2015:325049. Epub 2015 Nov 8.

Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.

Introduction. Superficial soft tissue sarcomas (S-STS) are generally amenable to wide excision. We hypothesized that local recurrence (LR) should be low, even without radiation therapy (RT), and sought to examine the contribution of depth to LR and OS. Methods. Patients with S-STS were retrospectively reviewed. Demographics, tumor features, treatment received, and outcomes were analyzed. Results. 103 patients were identified. Median age was 55 years; 53% of patients were female. Tumor site was 39% in trunk, 38% in the lower extremity, 14% in the upper extremity, and 9% in other locations. The most common histology was 36% leiomyosarcoma. Median tumor size was 2.8 cm (range 0.2-14 cm). Sixty-six percent of tumors were of intermediate/high grade. RT was administered preoperatively in 6% of patients and postoperatively in 15% of patients. An R0 resection was accomplished in 92%. At a median follow-up of 34.2 months (range 2.3-176), 9 patients had a LR (8.7%). Tumor size and grade were not associated with LR. OS was not associated with any tumor or patient variables on univariate analysis. Conclusions. LR was low for S-STS, even with large or high grade tumors and selective use of RT. Surgical resection alone may be adequate therapy for most patients. Superficial location seems to supersede other factors imparting a good prognosis for this group of tumors.
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http://dx.doi.org/10.1155/2015/325049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655067PMC
December 2015

Non-Small Cell Lung Cancer, Version 6.2015.

J Natl Compr Canc Netw 2015 May;13(5):515-24

The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; Huntsman Cancer Institute at the University of Utah; UC San Diego Moores Cancer Center; Fox Chase Cancer Center; University of Colorado Cancer Center; Roswell Park Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; Duke Cancer Institute; Moffitt Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; City of Hope Comprehensive Cancer Center; Vanderbilt-Ingram Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Memorial Sloan Kettering Cancer Center; Fred & Pamela Buffett Cancer Center; Massachusetts General Hospital Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Michigan Comprehensive Cancer Center; Stanford Cancer Institute; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Mayo Clinic Cancer Center; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; and National Comprehensive Cancer Network.

These NCCN Guidelines Insights focus on recent updates to the 2015 NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC). Appropriate targeted therapy is very effective in patients with advanced NSCLC who have specific genetic alterations. Therefore, it is important to test tumor tissue from patients with advanced NSCLC to determine whether they have genetic alterations that make them candidates for specific targeted therapies. These NCCN Guidelines Insights describe the different testing methods currently available for determining whether patients have genetic alterations in the 2 most commonly actionable genetic alterations, notably anaplastic lymphoma kinase (ALK) gene rearrangements and sensitizing epidermal growth factor receptor (EGFR) mutations.
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http://dx.doi.org/10.6004/jnccn.2015.0071DOI Listing
May 2015

Non-small cell lung cancer, version 1.2015.

J Natl Compr Canc Netw 2014 Dec;12(12):1738-61

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Non-Small Cell Lung Cancer (NSCLC) focuses on the principles of radiation therapy (RT), which include the following: (1) general principles for early-stage, locally advanced, and advanced/metastatic NSCLC; (2) target volumes, prescription doses, and normal tissue dose constraints for early-stage, locally advanced, and advanced/palliative RT; and (3) RT simulation, planning, and delivery. Treatment recommendations should be made by a multidisciplinary team, including board-certified radiation oncologists who perform lung cancer RT as a prominent part of their practice.
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http://dx.doi.org/10.6004/jnccn.2014.0176DOI Listing
December 2014

Lymphangioma circumscriptum of the vulva in a patient with Noonan syndrome.

Cutis 2014 Jun;93(6):297-300

Division of Dermatology, Ohio State University Medical Center, 2012 Kenny Rd, Columbus, OH 43221, USA.

Lymphangioma circumscriptum (LC) results from the development of abnormal lymphatic vasculature and is characterized by the presence of grouped vesicles filled with clear or colored fluid. Vulvar localization is uncommon. Abnormalities of the lymphatic system, such as lymphedema and cystic hygroma, are well-known features of genetic disorders such as Noonan syndrome (NS) and Turner syndrome. We report the case of a patient with NS who presented with LC of the vulva. We also discuss the expanding spectrum of clinical anomalies associated with the presentation of NS.
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June 2014

Dermatofibrosarcoma protuberans, version 1.2014.

J Natl Compr Canc Netw 2014 Jun;12(6):863-8

From University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; City of Hope Comprehensive Cancer Center; University of Washington/Seattle Cancer Care Alliance; Huntsman Cancer Institute at the University of Utah; Roswell Park Cancer Institute; UC San Diego Moores Cancer Center; Moffitt Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Memorial Sloan-Kettering Cancer Center; University of Colorado Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Fox Chase Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; University of Alabama at Birmingham Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; and National Comprehensive Cancer Network.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor characterized by a relatively high risk of local recurrence and low risk of metastasis. The NCCN Guidelines for DFSP provide multidisciplinary recommendations on the management of patients with this rare disease. These NCCN Guidelines Insights highlight the addition of the Principles of Pathology section, which provides recommendations on the pathologic assessment of DFSP. Because DFSP can mimic other lesions, immunohistochemical studies are often required to establish diagnosis. Cytogenetic testing for the characteristic translocation t(17;22)(q22;q13) can also be valuable in the differential diagnosis of DFSP with other histologically similar tumors.
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http://dx.doi.org/10.6004/jnccn.2014.0081DOI Listing
June 2014

Merkel cell carcinoma, version 1.2014.

J Natl Compr Canc Netw 2014 Mar;12(3):410-24

Merkel cell carcinoma is a rare, aggressive cutaneous tumor that combines the local recurrence rates of infiltrative nonmelanoma skin cancer with the regional and distant metastatic rates of thick melanoma. The NCCN Guidelines for Merkel Cell Carcinoma provide recommendations on the diagnosis and management of this aggressive disease based on clinical evidence and expert consensus. This version includes revisions regarding the use of PET/CT imaging and the addition of a new section on the principles of pathology to provide guidance on the analysis, interpretation, and reporting of pathology results.
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http://dx.doi.org/10.6004/jnccn.2014.0041DOI Listing
March 2014

Non-small cell lung cancer, version 2.2013.

J Natl Compr Canc Netw 2013 Jun;11(6):645-53; quiz 653

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, USA.

These NCCN Guidelines Insights focus on the diagnostic evaluation of suspected lung cancer. This topic was the subject of a major update in the 2013 NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Non-Small Cell Lung Cancer. The NCCN Guidelines Insights focus on the major updates in the NCCN Guidelines and discuss the new updates in greater detail.
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http://dx.doi.org/10.6004/jnccn.2013.0084DOI Listing
June 2013

Giant keratoacanthoma: case report and review of the English literature.

Am J Dermatopathol 2014 Mar;36(3):252-7

*Departments of Pathology, and †Dermatology, Roswell Park Cancer Institute, Buffalo, NY.

The giant keratoacanthoma (KA) is a rare variant of KA with a maximum size exceeding 2-3 cm. Like other forms of KA, it has a tendency to spontaneously regress but can cause significant anatomic damage. A 69-year-old male presented to our hospital with a giant KA of the nose that showed complete pathological regression by the time of surgery. Pathology showed dermal scar with keratin granulomas extending through the nasal wall to the respiratory mucosa. A total of 57 similar cases from the English literature were reviewed for comparison. Few provide similar details of histological regression. Literature cases occurred predominately in males (74.1%) with a mean age of 59 years. Head tumors were most common (70.7%) and most were treated by surgery (34.5%) or a combination of surgery and radiotherapy (24.1%). Other treatment modalities reported include methotrexate, 5-fluorouracil, and interferon.
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http://dx.doi.org/10.1097/DAD.0b013e318291c582DOI Listing
March 2014

Thymomas and thymic carcinomas: Clinical Practice Guidelines in Oncology.

J Natl Compr Canc Netw 2013 May;11(5):562-76

Masses in the anterior mediastinum can be neoplasms (eg, thymomas, thymic carcinomas, or lung metastases) or non-neoplastic conditions (eg, intrathoracic goiter). Thymomas are the most common primary tumor in the anterior mediastinum, although they are rare. Thymic carcinomas are very rare. Thymomas and thymic carcinomas originate in the thymus. Although thymomas can spread locally, they are much less invasive than thymic carcinomas. Patients with thymomas have 5-year survival rates of approximately 78%. However, 5-year survival rates for thymic carcinomas are only approximately 40%. These guidelines outline the evaluation, treatment, and management of these mediastinal tumors.
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http://dx.doi.org/10.6004/jnccn.2013.0072DOI Listing
May 2013

Non-small cell lung cancer.

J Natl Compr Canc Netw 2012 Oct;10(10):1236-71

The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Most patients with non-small cell lung cancer (NSCLC) are diagnosed with advanced cancer. These guidelines only include information about stage IV NSCLC. Patients with widespread metastatic disease (stage IV) are candidates for systemic therapy, clinical trials, and/or palliative treatment. The goal is to identify patients with metastatic disease before initiating aggressive treatment, thus sparing these patients from unnecessary futile treatment. If metastatic disease is discovered during surgery, then extensive surgery is often aborted. Decisions about treatment should be based on multidisciplinary discussion.
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http://dx.doi.org/10.6004/jnccn.2012.0130DOI Listing
October 2012

Inflammatory myofibroblastic tumor of the mesentery: a clinical dilemma.

Int J Clin Oncol 2012 Aug 9;17(4):380-4. Epub 2011 Aug 9.

Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.

Although rare, extra-pulmonary inflammatory myofibroblastic tumors (IMTs) are becoming increasingly recognized. While surgical resection is currently an effective and accepted treatment for IMTs, the optimal management of unresectable or residual IMTs remains a clinical dilemma. We present the case of an incompletely resected IMT treated successfully with anti-inflammatory therapy alone, and describe the rationale for this approach.
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http://dx.doi.org/10.1007/s10147-011-0297-0DOI Listing
August 2012

ERBB2 juxtamembrane domain (trastuzumab binding site) gene mutation is a rare event in invasive breast cancers overexpressing the ERBB2 gene.

Mod Pathol 2011 Aug 15;24(8):1055-9. Epub 2011 Apr 15.

Department of Pathology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.

The recent development of targeted therapies using monoclonal antibodies has added new dimensions to breast cancer treatment. Trastuzumab has been added to the regimens that contain chemotherapeutic agents, which has improved the clinical outcomes of patients in both the adjuvant and metastatic settings. However, trastuzumab resistance, both de novo and acquired, continues to be problematic. There have been scattered studies reporting ERBB2 gene mutation, but nothing is currently known about the ERBB2 binding site mutations. In the current study, we examined the ERBB2 juxtamembrane domain trastuzumab binding site for mutations in invasive breast cancers overexpressing ERBB2. Pure tumor cells of 54 breast cancer patients were procured using laser capture microdissection. Two polymerase chain reaction primer pairs were designed to amplify the trastuzumab binding site sequence. The polymerase chain reaction product was sequenced. Standard clinicopathological data were recorded. For the 54 patients, there was one (2%) case that showed missense point mutation in exon 17 (H559A). There were nine patients treated with trastuzumab in the metastatic setting, none of which had gene mutation. Therefore, we conclude that ERBB2 juxtamembrane domain (trastuzumab binding site) gene mutation is a rare event in breast cancer. Although it is unclear whether this substitution would result in trastuzumab target therapy resistance, this would not account for the relatively high frequency of this resistance encountered clinically.
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http://dx.doi.org/10.1038/modpathol.2011.64DOI Listing
August 2011

The biologic spectrum of thymic epithelial neoplasms: current status and future prospects.

Authors:
Richard T Cheney

J Natl Compr Canc Netw 2010 Nov;8(11):1322-8

Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.

Thymoma is the most common anterior mediastinal tumor in adults and is frequently associated with autoimmune disorders such as myasthenia gravis. Thymomas are a diverse group of epithelial neoplasms with a behavioral spectrum that spans the complete clinical gamut from entirely benign to highly aggressive, lethal thymic carcinomas. The biologic behavior seems to depend primarily on the clinical stage at presentation and histologic subtype. This article discusses thymic organogenesis, Masaoka staging, WHO histologic classification of thymoma and thymic carcinoma, and selected molecular characteristics that highlight this diversity. This discussion will further underscore both the similarities and differences between categories of thymic epithelial neoplasms and offer support for the notion that tumor heterogeneity and/or tumor progression may explain the observed clinical variation in behavior. Recommendations are offered for future investigational approaches to further the understanding of the complexity of these tumors.
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http://dx.doi.org/10.6004/jnccn.2010.0097DOI Listing
November 2010

Tumour eosinophilia combined with an immunohistochemistry panel is useful in the differentiation of type B3 thymoma from thymic carcinoma.

Int J Exp Pathol 2011 Apr 2;92(2):87-96. Epub 2010 Nov 2.

Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA.

It is sometimes difficult to differentiate between type B3 thymoma from thymic carcinoma histologically. Given the rarity of these tumours, studies have been limited. A series of 66 thymic neoplasms were reviewed and classified according to the World Health Organization (WHO) scheme. We performed a tissue microarray analysis of surgically resected thymic tumour specimens including 12 thymic carcinomas, 17 type B3 thymomas and 37 thymomas of other types. Percentage and staining intensity of immunohistochemical markers were recorded. Tumour eosinophilia was recorded positive if at least one eosinophilic cell identified. Positive staining of the following markers significantly differentiated type B3 thymoma from thymic carcinoma: cytokeratin 5/6 (15 vs. 3), Mesothelin (0 vs. 5), cytoplasmic androgen receptor (10 vs. 0), CD57 (9 vs. 0), CD5 (0 vs. 7), TdT (lymphocytic) (14 vs. 1), CD1a (lymphocytic) (14 vs. 2), CD117 (1 vs. 9), MOC31 (2 vs. 6), p21 (2 vs. 8), cytoplasmic Survivin (0 vs. 4), and tumour eosinophilia (1 vs. 11). Combining two or three markers was able to differentiate these two tumours with area under the curve percentage of at least 92%. Tumour eosinophilia combined with a panel of immunohistochemistry could differentiate type B3 thymoma from thymic carcinoma.
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http://dx.doi.org/10.1111/j.1365-2613.2010.00745.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081511PMC
April 2011

IMP3 distinguishes uterine serous carcinoma from endometrial endometrioid adenocarcinoma.

Am J Clin Pathol 2010 Jun;133(6):899-908

Department of Pathology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.

Differentiating uterine serous carcinoma (USC) from endometrioid adenocarcinoma (EAC) could be problematic, especially in high-grade EACs and tumors exhibiting architectural variations. To address this issue, we evaluated 103 endometrial carcinoma cases using 4 immunomarkers, beta-catenin, IMP3, PTEN, and p53. Cases included 31 USCs, 57 EACs, and 15 mixed EAC-USCs. Of 31 USCs and 57 EACs, 8 and 9, respectively, were considered diagnostically difficult and challenging. beta-catenin was more frequently expressed in EAC (P = .001); p53, PTEN, and IMP3 were more frequently found in USC (P < .001 for each). IMP3 was the best independent predictive marker for USCs. The best marker combination for predicting USCs was PTEN+/IMP3+ (exact odds ratio, 163.87; 95% confidence interval, 19.62 to infinity; P < .001). IMP3 was consistently negative in all 9 challenging EAC cases and consistently positive in all 8 challenging USC cases. None of the markers or their combinations demonstrated any value in making the diagnosis of serous component in mixed EAC-USC tumors. IMP3 immunoexpression and the IMP3+/PTEN+ pattern are the best independent and combination markers, respectively, to predict USCs. We strongly recommend using them in difficult and challenging cases.
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http://dx.doi.org/10.1309/AJCPQDQXJ4FNRFQBDOI Listing
June 2010

Submission of the entire lymph node dissection for histologic examination in gynecologic-oncologic specimens. Clinical and pathologic relevance.

Gynecol Oncol 2009 Dec 7;115(3):354-6. Epub 2009 Oct 7.

Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA.

Background And Aims: Lymph node (LN) status in gynecologic malignancies plays an important role in patient staging, management, and prognosis. Therefore, an adequacy of LN harvest is crucial. The aim of this study is to determine whether the submission of the entire LN dissection for histologic examination will affect patients' outcome or clinical stage. We also evaluated the time required and cost-effectiveness for the laboratory.

Materials And Methods: A prospective study of 134 surgical cases from various gynecologic malignancies was conducted. The LN dissection specimen was performed using a conventional manual node dissection method with all the remaining fat being submitted in additional cassettes. One pathologist evaluated (1) the number and status of palpable LNs identified by the conventional method as well as the number of tissue cassettes and (2) the number, size, and status of the non-palpable LNs as well as the number of tissue cassettes.

Results: The palpable LNs ranged from 0 to 36 with average 14.8 LNs per case (Poisson 95% CI: 14.1-15.4). The additional non-palpable LNs ranged from 0 to 16 with an average of 3.1 (Poisson 95% CI: 2.8-3.4). In only one case, a 3-mm non-palpable LN with metastasis was identified; however, it did not affect tumor staging or patient management.

Conclusion: The impact on patient outcome is minimal and it does not prove to be cost and time effective when submitting the entire LN dissection specimen in gynecologic malignancies. However, this method could be justified in selective cases in which the manual node dissection does not reveal an adequate number of LNs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047373PMC
http://dx.doi.org/10.1016/j.ygyno.2009.09.008DOI Listing
December 2009

Nevus spilus with synchronous melanomas: case report and literature review.

J Cutan Med Surg 2009 Mar-Apr;13(2):96-101

Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.

Background: Nevus spilus is a rare, acquired, and often large cutaneous lesion consisting of a light brown background macule containing varying numbers of small darker macular or papular areas.

Objective: Nevus spilus may contain dysplastic melanocytic elements, and there are also reports of melanoma arising from nevus spilus. However, the absolute risk for malignant transformation is not well defined.

Conclusion: We discuss a case of synchronous melanomas arising from a nevus spilus and potential management recommendations based on a review of the pertinent literature.
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http://dx.doi.org/10.2310/7750.2008.07090DOI Listing
July 2009

Lymphatic vessel density is not associated with lymph node metastasis in non-small cell lung carcinoma.

Arch Pathol Lab Med 2008 Dec;132(12):1882-8

Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA.

Context: Angiogenesis is essential for tumors to grow and metastasize. Lymphatic metastasis is also an important means of tumor spread. In non-small cell lung carcinoma, the relationship of lymphangiogenesis with lymph node metastasis and, ultimately, patient prognosis is unknown.

Objective: To evaluate whether lymphangiogenesis is related to lymph node metastasis and/or overall survival.

Design: Seventy-eight cases of non-small cell lung carcinoma diagnosed from 1987 to 2004 were retrospectively analyzed for intratumoral, peritumoral, and uninvolved adjacent lung tissue lymphatic vessel density (LVD) by D2-40 immunostaining. Lymphatics in 6 cases of squamous dysplasia/carcinoma in situ were similarly evaluated. Appropriate statistical methods were used.

Results: Intratumoral and peritumoral LVD was significantly higher than in the uninvolved adjacent lung but showed no significant association with lymph node stage at the time of tumor resection. Survival in patients with above average D2-40 values was not significantly different when compared with those who had below average values (median survival, 895 vs 1131 days; P = .97). Furthermore, patients with affected lymph nodes had significantly shorter survival (median survival, 467 vs 1425 days; P = .002). Overall, regardless of lymph node status, there was a significantly higher intratumoral (P < .001) and peritumoral (P < .001) LVD when compared with the adjacent uninvolved lung LVD. There was a trend toward increasing LVD with higher grade of squamous dysplasia.

Conclusions: The results suggest that although lymphangiogenesis occurs in association with non-small cell lung carcinoma, it may not be an important factor in lymph node metastasis. In fact, there is a suggestion that the number of lymphatics that a person inherently has appears to be more important than lymphangiogenesis when it comes to the development of lymph node metastasis.
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http://dx.doi.org/10.1043/1543-2165-132.12.1882DOI Listing
December 2008