Alireza Torabi

Depleted interstitial cells of Cajal and fibrosis in the pylorus: Novel features of gastroparesis

Depletion and ultrastructural changes of interstitial cells of Cajal (ICC) in the gastric body and antrum have been observed in gastroparesis. This research was performed to investigate the ICC population in the muscularis propria and fibrosis of the muscular layer of the pylorus in gastroparesis.

Activity of Angiogenesis Inhibitors in Metastatic Epithelioid Hemangioendothelioma: A Case Report

This report describes a patient with metastatic epithelioid hemangioendothelioma treated with bevacizumab and nanoparticle albumin-bound paclitaxel. The treatment was well tolerated and led to the stabilization of an aggressive variant of the disease. This case report is the first one that describes the activity of the combination of chemotherapy and bevacizumab in epithelioid hemangioendothelioma. Literature describing the activity of bevacizumab and other agents (thalidomide, lenalidomide, and interferon) believed to possess anti-angiogenic activities is also reviewed.

PD-1 and PD-L1 expression in bone and soft tissue sarcomas

PD-1 and its ligands have been shown to play a significant role in evasion of malignant tumour cells from the immune system. Last year, the Unites States Food and Drug Administration (FDA) approved anti-PD-1 inhibitors for treatment of non-small cell lung carcinoma and recently expanded the use of immunotherapy for metastatic urothelial cell carcinoma and Hodgkin lymphoma. However, studies on expression of PD-1 and its ligand in malignant bone and soft tissue sarcoma are sparse. In this study, we evaluated PD-1 and PD-L1 expression on variants of liposarcomas and rhabdomyosarcomas, osteosarcomas and chondrosarcomas. Tissue microarrays (TMAs) for liposarcomas (well differentiated, myxoid/round cell, and pleomorphic), rhabdomyosarcomas (alveolar, embryonal, pleomorphic, and spindle cell), conventional osteosarcomas and chondrosarcomas were stained for PD-1 and PD-L1 antibodies. Adipose tissue, skeletal muscle, bone, osteochondroma and lipoma were used as control and benign counterparts. Western blot was performed to evaluate expression of PD-1 and PD-L1 in four sarcoma cell lines. Osteosarcomas, chondrosarcomas, and all variants of liposarcomas and rhabdomyosarcomas over-expressed PD-1 relative to normal tissue. Expression of PD-1 in rhabdomyosarcomas was associated with higher tumour stage. Only one case of pleomorphic liposarcoma, one case of pleomorphic rhabdomyosarcoma and two cases of alveolar rhabdomyosarcomas were positive for PD-L1. Normal adipose tissue, skeletal muscle, and bone were negative for both PD-1 and PD-L1 and lipomas and osteochondroma weakly expressed PD-1 but not PD-L1. Western blot confirmed the presence of PD-1 protein in all four sarcoma cell lines. Overall, our results showed cytoplasmic expression of PD-1 in the bone and soft tissue sarcomas, while PD-L1 was negative. Whether these data are an indication for effectiveness of immunotherapy in the management of malignant bone and soft tissue sarcomas remains to be elucidated.

The cellularity yield of three different 22-gauge endoscopic ultrasound fine needle aspiration needles: CELLULARITY YIELD OF THREE DIFFERENT 22-GAUGE ENDOSCOPIC ULTRASOUND FNA NEEDLES

Endoscopic ultrasound (EUS) fine needle aspiration (FNA) is an integral part in the diagnosis of pancreatic, intestinal and extra‐intestinal masses or lesions. There is no clear data on the superiority of the core biopsy needle over standard 22‐gauge needles. The aim of this study is to prospectively compare the cellularity yield of three commonly used 22‐gauge FNA needles available in the US market. Methods: This is a prospective, randomized study comparing the cellularity yield of three commercially available EUS needles (two standard FNA needles and core biopsy needle). Two blinded pathologists evaluated the cytology specimens based on an already agreed upon cytology score. We included adult patients (18–80 years old) who presented to our endoscopy unit for FNA of pancreatic or extrapancreatic masses.

Use of non-selective β-blockers is associated with decreased tumor proliferative indices in early stage breast cancer

Previous studies suggest beta-adrenergic receptor (β-AR) antagonists (β-blockers) decrease breast cancer progression, tumor metastasis, and patient mortality; however the mechanism for this is unknown. Immunohistochemical analysis of normal and malignant breast tissue revealed overexpression of β1-AR and β3-AR in breast cancer. A retrospective cross-sectional study of 404 breast cancer patients was performed to determine the effect of β-blocker usage on tumor proliferation. Our analysis revealed that non-selective β-blockers, but not selective β-blockers, reduced tumor proliferation by 66% (p < 0.0001) in early stage breast cancer compared to non-users. We tested the efficacy of propranolol on an early stage breast cancer patient, and quantified the tumor proliferative index before and after treatment, revealing a propranolol-mediated 23% reduction (p = 0.02) in Ki67 positive tumor cells over a three-week period. The anti-proliferative effects of β-blockers were measured in a panel of breast cancer lines, demonstrating that mammary epithelial cells were resistant to propranolol, and that most breast cancer cell lines displayed dose dependent viability decreases following treatment. Selective β-blockers alone or in combination were not as effective as propranolol at reducing breast cancer cell proliferation. Molecular analysis revealed that propranolol treatment of the SK-BR-3 breast cancer line, which showed high sensitivity to beta blockade, led to a reduction in Ki67 protein expression, decreased phosphorylation of the mitogenic signaling regulators p44/42 MAPK, p38 MAPK, JNK, and CREB, increased phosphorylation of the cell survival/apoptosis regulators AKT, p53, and GSK3β. In conclusion, use of non-selective β-blockers in patients with early stage breast cancer may lead to decreased tumor proliferation.

Trans-arterial Onyx Embolization of a Functional Thoracic Paraganglioma

Paragangliomas are rare tumors of the endocrine system. They are highly vascular and in some cases hormonally active, making their management challenging. Although there is strong evidence of the safety and effectiveness of preoperative embolization in the management of spinal tumors, only five cases have been reported in the setting of thoracic paragangliomas. We present the case of a 19-year-old man with a large, primary, functional, malignant paraganglioma of the thoracic spine causing a vertebral fracture and spinal cord compression. To our knowledge this is the first report of preoperative trans-arterial balloon augmented Onyx embolization of a thoracic paraganglioma.

Imaging of fat-containing lesions of the breast

Fat‐containing breast lesions constitute a heterogeneous group of predominantly benign tumors and non‐neoplastic conditions. The role of imaging is to distinguish leave‐me‐alone lesions from rarely occurring malignant fat‐containing tumors that require histologic analysis. Correlating mammographic findings with appearance at ultrasonography often helps in identifying lesions that do not require further work‐up. MRI can be valuable to confirm the presence of fat and characterize lesions indeterminate on conventional imaging. The purpose of this multimodality imaging review is to exemplify the radiologic appearances of common and uncommon fat‐containing breast lesions to facilitate accurate diagnosis, avoid unnecessary interventions, and ensure appropriate management.

Imaging of fat-containing lesions of the breast: A pictorial essay

Fat‐containing breast lesions constitute a heterogeneous group of predominantly benign tumors and non‐neoplastic conditions. The role of imaging is to distinguish leave‐me‐alone lesions from rarely occurring malignant fat‐containing tumors that require histologic analysis. Correlating mammographic findings with appearance at ultrasonography often helps in identifying lesions that do not require further work‐up. MRI can be valuable to confirm the presence of fat and characterize lesions indeterminate on conventional imaging. The purpose of this multimodality imaging review is to exemplify the radiologic appearances of common and uncommon fat‐containing breast lesions to facilitate accurate diagnosis, avoid unnecessary interventions, and ensure appropriate management.

Acute myeloid leukemia with KMT2A-SEPT5 translocation: A case report and review of the literature:

Chromosomal rearrangement involving the KMT2A gene is one of the most common genetic alteration in acute myeloid leukemia. A total of 135 different KMT2A rearrangements have been identified, where 94 translocation partner genes are now characterized at the molecular level. Of these 94 translocation partner genes, 35 translocation partner genes occur recurrently, but only 9 specific gene fusions account for more than 90% of cases. Translocation of KMT2A with SEPT5 gene at 22q11.2 is rare, with few reported cases in the literature. In this report, we are presenting a case of KMT2A-SEPT5 fusion in de novo acute myeloid leukemia with t(11;22)(q23;q11.2) with a review of the literature.

Testicular Choriocarcinoma Metastasizing to the Small Bowel Causing Intussusception: Case Report

Testicular cancers are divided into germ cell tumors (GCT) and non-germ cell tumors. Testicular germ cell tumors (TGCT) are the most frequent malignancy among young men although they are uncommon among general population [1]. There are recent evidences that the incidence of TCGT TGCTs is are increasing among Hispanic men with an expected increase over the next decade [2]. Germ cell tumors are either seminomas or non-seminomas (NSGCT) [3]. Testicular choriocarcinoma is a highly aggressive vascular germ cell tumor with trophoblastic differentiation [4]. It is usually detected as a component of the mixed malignant germ cell tumors. However, in a pure form, it is exceedingly rare and compromise only 0.2–0.6% of all testis tumors [5]. Testicular choriocarcinoma is characterized by its early hematogenous and lymphatic spread, with frequent metastasis to the central nervous system, lungs, bone, liver, and lymph nodes. It usually presents with symptoms related to metastases rather than a palpable mass in the testis [6]. Gastrointestinal tube involvement as a metastatic site for testicular choriocarcinoma is present in less than 5% of cases and its involvement worsens prognosis [7, 8]. The main symptoms of GIT metastasis are related to the presence of hemorrhage, or bowel obstruction or perforation. However, presenting as intussusception is exceedingly rare [9]. We are presenting a case of pure testicular choriocarcinoma with small intestinal metastasis intussusception.