Cohesive Pattern Research Articles

Anaplastic thyroid cancer spheroids as preclinical models to test therapeutics

Anaplastic thyroid cancer (ATC) is the most aggressive thyroid cancer. Despite advances in tissue culture techniques, a robust model for ATC spheroid culture is yet to be developed. In this study, we created an efficient and cost-effective 3D tumor spheroids culture system from human ATC cells and existing cell lines that better mimic patient tumors and that can enhance our understanding of in vivo treatment response. We found that patient-derived ATC cells and cell lines can readily form spheroids in culture with a unique morphology, size, and cytoskeletal organization. We observed both cohesive (dense and solid structures) and discohesive (irregularly shaped structures) spheroids within the same culture condition across different cell lines. BRAFWT ATC spheroids grew in a cohesive pattern, while BRAFV600E-mutant ATC spheroids had a discohesive organization. In the patient-derived BRAFV600E-mutant ATC spheroids, we observed both growth patterns, but mostly the discohesive type. Histologically, ATC spheroids had a similar morphology to the patient’s tumor through H&E staining and proliferation marker staining. Moreover, RNA sequencing analysis revealed that the gene expression profile of tumor cells derived from the spheroids closely matched parental patient tumor-derived cells in comparison to monolayer cultures. In addition, treatment response to combined BRAF and MEK inhibition in BRAFV600E-mutant ATC spheroids exhibited a similar sensitivity to the patient clinical response. Our study provides a robust and novel ex vivo spheroid model system that can be used in both established ATC cell lines and patient-derived tumor samples to better understand the biology of ATC and to test therapeutics.

The purpose of the theological patterns in Jesus’ healing stories in the Gospel of Matthew

Matthean scholars have predominantly viewed Jesus’ healing ministry through the lens of ‘fulfillment of prophecy’, which connects his healings to David the shepherd and the fulfilment of the covenant, the restoration of the covenant people, and the establishment of the new covenant. This interpretation has largely emerged from an analysis of Jesus’ healing ministry as a singular event. However, it is necessary to revisit previous studies that have posited that the stories of Jesus’ healings were arranged in a larger context and theological perspective, rather than as a disjointed list of individual events. In particular, the healing events in Matthew 8–9 appear to have been arranged with the intention of teaching discipleship, indicating that the healing stories in the Gospel of Matthew, while scattered, are part of a cohesive pattern of theological themes. These themes include the forgiveness of sins, compassion and mercy, healing through faith, and confession of Jesus as the Messiah. The author of Matthew employs this pattern to systematically present a theological perspective that acknowledges Jesus as divine and confesses him as the Messiah.Contribution: This study aimed to analyse the pattern of these theological themes as they appear in Jesus’ healing narrative. The repetition of these themes serves to establish Jesus’ divinity and reinforce the confession of him as the Messiah. Furthermore, the pattern of theological themes in the healing narrative suggests that it was constructed during a period of transition for the Matthean community, as they moved from Judaism to Christianity. The pattern highlights the community’s confession of Jesus as God and their efforts to solidify their faith.

Factors Influencing the Conversion of Ngiturkana People in Turkana County to Islam

This study investigated factors that contributed to Christian conversion to Islam among Ngiturkana people. Islam has been on record as the religion that is spreading at a faster rate in the world and attracting a lot of people from other religious backgrounds and cultures. This study aimed to determine the factors that influence the conversion of Ngiturkana people. The question this research intended to answer was what reason Ngiturkana Christians give for their conversion to Islam? The findings of this research reveal that there exists no single cohesive pattern that describes converts of Islam from Christianity. The study also reveals that there is denominational pluralism where some are from Catholic Church and others were Protestants. This appears to create a huge dissonance among young people due to different practices such as the place of Mary and the additional Books of the Bible. This research gives credence to Wayne Gruden’s conclusion that religious conversion involves adopting a new sort of belief. It is critical to notice that the converts recounted adopted a new set of beliefs and abandoned the religious beliefs they previously clung to. All the converts in this study neglected their fidelity Christianity and its related practices and chose to adopt Islam. The findings of this research also conclude that the experiences of converts are not specific to Christianity. The experiences are not the exclusive sphere of Christian conversion. Christians should have awareness and come up with alternative explanations of conversion. Also, Christians converting to Islam reported felt needs as leading to their conversion. This is also not a preserve of Christianity since it goes both ways. The converts in this study reveal an individualistic mindset even though they came from a collectivist society. Collectivist and individualistic personalities or cultures play a role in religious motives. In view of these findings there is a need for the church to develop the knowledge and skills of pastors. From the interviews, it is evident that pastors could not convince those who attended debates between Christians and Muslims. Pastors and church leaders therefore need training through introducing theological studies to teach them on church doctrines. Churches should conduct workshops and seminars to sensitize members on the significance of spreading the gospel to the Muslims and defend their faith. There is need for return and revival of biblical theology through Bible studies in the church and the Sunday schools for discipleship.

Multidimensional framework for analyzing the distribution patterns of traditional villages in the karst landscape regions of China

The habitat environment of karst regions is facing challenges, such as rocky desertification and soil erosion. Traditional villages are among the most important components for the long-term survival and development of the habitat in karst areas, so the distribution patterns of traditional villages need to be understood for the conservation of karst habitats. In this study, a multidimensional framework was constructed to explore the distribution patterns of traditional villages in karst areas of China from planimetric, topographic, humanistic, socioeconomic, and hydrogeologic dimensions. We used geographical spatial analysis indicators and related analysis methods to analyze the main distribution patterns of traditional villages in karst landscape areas. Results showed that in the planimetric dimension, the distribution of traditional villages exhibited a cohesive pattern of “one core and many points.” In the topographic dimension, the number of traditional villages showed an inverted-U-shape change with rising altitude, and the villages were concentrated in the area with an altitude of 600–800 m a.s.l and a slope <5°. In the humanistic dimension, the distribution was dominated by Han (37.32%), Miao (21.3%), and Dong (10.61%) ethnic minorities, which were mostly found in the low-population-density area with 100–200 people/km2. In the socioeconomic dimension, the traditional villages had low traffic density and GDP per capita and were far from cities. In the hydrogeological dimension, the traditional villages were mainly located in areas with a groundwater runoff modulus >30 L/s-km2. This study expands our understanding of the characteristics of traditional settlements in karst areas and provides effective guidance for the future planning and heritage management of settlements in karst areas.

TO ASSESS ROLE OF WORST PATTERN OF INVASION,DEPTH OF INVASION AND EXTRANODAL SPREAD IN PREDICTING RECURRENCE IN 1000 CASES OF SQUAMOUS CELL CARCINOMA IN ORAL CAVITY-SINGLE TERTIARY CANCER CENTER STUDY

The incidence of oral squamous cell carcinoma (OSCC) remains high .Oral and oro-pharyngeal carcinomas are the sixth most common cancers in the world. Aim- The present study was conducted in a tertiary care cancer hospital in India to evaluate recurrence in squamous cell carcinoma of oral cavity. The present study was carried out in department of pathology at regional cancer tertiary centre from .Material And Methods- February 2011 to June 2021 .The cases were selected on basis of inclusion and exclusion criteria. The average age of the patients sufferingResults- from oral squamous cell carcinoma ( 48.8 years) with male predominance (M:F =9.7:1). Recurrence rate was 23.6%. Most common site of presentation was buccal mucosa. The most common grade in recurrent as well non recurrent cases was moderately differentiated . 388 patients out of 1000 had pathologically node positive disease. The recurrence rate among node positive was 27.5 % (107 out of 388). Non-cohesive pattern was more common in recurrent cases (55.92%) . Risk of recurrence was 82.62% with depth of invasion &gt; 5 mm . Extranodal extension was seen in 34 cases (14.40%) . Perineural invasion , lymphovascular invasion and bone invasion was seen in 44.5% , 26.7% and 22.45% respectively . Out of total 236 recurrent cases, 3 year survival rate was 64.8%, 5 year survival rate was 34.7% and disease free survival rate was 81%. Conclusion- Squamous cell carcinoma of oral cavity has poor overall prognosis with high tendency to recur. Risk factors for recurrence are -lymphatic permeation, depth of invasion – 5 mm or more, poorly differentiated tumor, non- cohesive pattern of invasion .

Constructing a cohesive pattern for collective navigation based on a swarm of robotics.

Swarm robotics carries out complex tasks beyond the power of simple individual robots. Limited capabilities of sensing and communication by simple mobile robots have been essential inspirations for aggregation tasks. Aggregation is crucial behavior when performing complex tasks in swarm robotics systems. Many difficulties are facing the aggregation algorithm. These difficulties are as such: this algorithm has to work under the restrictions of no information about positions, no central control, and only local information interaction among robots. This paper proposed a new aggregation algorithm. This algorithm combined with the wave algorithm to achieve collective navigation and the recruitment strategy. In this work, the aggregation algorithm consists of two main phases: the searching phase, and the surrounding phase. The execution time of the proposed algorithm was analyzed. The experimental results showed that the aggregation time in the proposed algorithm was significantly reduced by 41% compared to other algorithms in the literature. Moreover, we analyzed our results using a one-way analysis of variance. Also, our results showed that the increasing swarm size significantly improved the performance of the group.

Patient perspectives on interventional pain management: thematic analysis of a qualitative interview study

BackgroundChronic pain is a widespread problem that is usually approached by focusing on its psychological aspects or on trying to reduce the pain from the pain generator. Patients report that they feel responsible for their pain and that they are disempowered and stigmatized because of it. Here, we explored interventional pain management from the patient’s perspective to understand the process better.MethodsA purposive sample of 19 subjects was interviewed by an independent interviewer. The interviews were transcribed into text and thematic analysis was performed.ResultsThe subjects’ perceptions covered three key themes: themselves as objects; the caregivers, including the process of tests and retests, the encounters and interactions with professionals, and the availability of the caregivers; and finally the outcomes, including the results of the tests and treatments and how these inspired them to think of other people with pain. Linking these themes, the subjects reported something best described as “gained empowerment” during interventional pain management; they were feeling heard and seen, they gained knowledge that helped them understand their problem better, they could ask questions and receive answers, and they felt safe and listened to.ConclusionsMany of the themes evolved in relation to the subjects’ contact with the healthcare services they received, but when the themes were merged and structured into the model, a cohesive pattern of empowerment appeared. If empowerment is a major factor in the positive effects of interventional pain management, it is important to facilitate and not hinder empowerment.Trial registrationClinicaltrials.gov 2013-04-24 (Protocol ID SE-Dnr-2012-446-31 M-3, ClinicalTrials ID NCT01838603).

Morphologic Patterns and the Correlation With MYD88 L265P, CD79B Mutations in Primary Adrenal Diffuse Large B-Cell Lymphoma.

Primary adrenal diffuse large B-cell lymphoma (PA-DLBCL) is a rare subtype of extranodal DLBCL. Because of the rarity of this disease, its morphologic and genetic features are not comprehensively studied. Here, we systematically reviewed the clinicopathologic features of 42 cases of PA-DLBCL from our institution and investigated the frequency of MYD88 L265P and CD79B (exon 5) mutation in 29 eligible cases using Sanger sequencing. Clinically, PA-DLBCL was predominant in elderly male patients with advanced clinical stage and poor outcomes. Morphologically, the tumors often showed a sinusoidal and/or cohesive pattern with condensed chromatin and inconspicuous nucleolus which mimicked neuroendocrine carcinoma. Moreover, increased Reed-Sternberg-like cells were observed frequently. These confounding morphologic manifestations may lead to misdiagnosis. Genetically, PA-DLBCL harbored a high prevalence of MYD88 L265P (24%) and CD79B mutations (52%) which may be involved in lymphomagenesis. The CD79B mutation was significantly associated with a worse prognosis. A novel Histo-Molecular Classification system (4 categories) was proposed based on correlation with genetic changes. Generally, the neuroendocrine carcinoma-like type was associated with CD79B mutation, whereas the RS-like cell type indicated MYD88 L265P. The biphasic type was correlated with coexisting mutations of MYD88 and CD79B, whereas the common type implied no mutation. Furthermore, the common type showed significantly better survival. In conclusion, the proposed new category system could indicate the genetic changes as well as facilitate risk stratification to guide treatment and predict prognosis. Although this study augmented our understanding of PA-DLBCL, further analysis is required to validate our results and extend them to extranodal DLBCL at other sites.

Research on the Spatial Features of the E-RetailingEconomic Linkages at County Level: A Case Study for Zhejiang Province, China

Quantitatively evaluating the spatial characteristics of regional e-retailing economy linkages is of great significance for clarifying the spatial organization of regional e-retailing economies, and promoting regional coordinated development. However, due to the lack of study data, it is difficult toconduct quantitative research on these regional e-retailing economic linkages. Taking advantage of emerging new data sources, the depth and breadth of related research cannow be improved. This paper considers 64 county-level economic areas in Zhejiang Province as network nodes.A revised gravity model was used to measure the intensity of the e-retailing economic linkage in 2016,based upon the e-retailing data provided by the Department of Commerce of Zhejiang Province, China. On this basis, the geographic information system (GIS) tool, a model-potential method and a social network, were used to analyze the spatial features of the e-retail economic linkages at the countylevel in Zhejiang Province. The results showed that the spatial polarization of the economic linkage pattern emerged as prominent, with the overall difference and east-west gradient difference between counties proving significant. In addition, the major linking partners of most regions were relatively singular, and a problem of vulnerability in e-retail economic development was shown.Secondly, the southwest region of Zhejiang Province was an important obstacle in the integration process of regional e-retail economy, through analyzing the connection scope of e-retailing economics. Thirdly, the central Zhejiang subgroupwas a key plate connecting east and west, which plays an importantlinking role in the development of regional equalizationwhen we analyzethe cohesive subgroup pattern. Inspired by this, we hypothesized that a microscopic analysis results of Zhejiang Province could provide some enlightenment for the balanced and integrated development of China’s regional e-retailing economy.

Integrating in vitro experiments with in silico approaches for Glioblastoma invasion: the role of cell-to-cell adhesion heterogeneity

Glioblastoma cells adopt migration strategies to invade into the brain parenchyma ranging from individual to collective mechanisms, whose role and dynamics are not yet fully understood. In this work, we explore Glioblastoma heterogeneity and recapitulate its invasive patterns both in vitro, by utilizing primary cells along with the U87MG cell line, and in silico, by adopting discrete, individual cell-based mathematics. Glioblastoma cells are cultured three-dimensionally in an ECM-like substrate. The primary Glioblastoma spheroids adopt a novel cohesive pattern, mimicking perivascular invasion in the brain, while the U87MG adopt a typical, starburst invasive pattern under the same experimental setup. Mathematically, we focus on the role of the intrinsic heterogeneity with respect to cell-to-cell adhesion. Our proposed mathematical approach mimics the invasive morphologies observed in vitro and predicts the dynamics of tumour expansion. The role of the proliferation and migration is also explored showing that their effect on tumour morphology is different per cell type. The proposed model suggests that allowing cell-to-cell adhesive heterogeneity within the tumour population is sufficient for variable invasive morphologies to emerge which remain originally undetectable by conventional imaging, indicating that exploration in pathological samples is needed to improve our understanding and reveal potential patient-specific therapeutic targets.

Barriers to the recognition of medullary thyroid carcinoma on FNA: Implications relevant to the new American Thyroid Association guidelines.

The 2016 American Thyroid Association guidelines recommend multiple endocrine neoplasia testing and evaluation for pheochromocytoma before thyroidectomy after a thyroid fine-needle aspiration biopsy (FNA) is positive for medullary thyroid carcinoma (MTC). In the current study, the authors examined the reasons why FNA was unable to definitively diagnose MTC preoperatively, with attention to morphologic patterns that can be misleading. Cases of MTC diagnosed on thyroid surgical resection for which there was a prior FNA and slides available for review were included (28 cases). Clinicopathologic data were collected. Slides were reviewed for numerous features blinded to the original FNA interpretation. Morphologic features were compared between concordant cases (20 cases) ("positive for MTC" or "suspicious for MTC") and discordant cases (4 cases) (any other interpretation). Three cases of microscopic MTC (measuring <1 cm) were excluded from statistical analysis, as was 1 case of sampling error (benign thyroid tissue). Nine men and 19 women were diagnosed with MTC. Four patients ultimately were diagnosed with multiple endocrine neoplasia, and 1 had bilateral pheochromocytomas. At the time of surgical excision, the mean tumor size was 2.3 cm (range, 0.1-7.5 cm). Review of morphologic features demonstrated that the discrepant cases were significantly more likely to have limiting factors (air-drying artifact/excess blood), a cohesive pattern, or to lack plasmacytoid morphology. None of the discordant cases had pseudoinclusions or amyloid (finding was not statistically significant). The majority (86%) of thyroid FNAs from patients with MTC are concordant (positive/suspicious for MTC). Patterns of failure include sampling error and limited typical morphologic features, particularly a lack of plasmacytoid morphology and cellular dyshesion. A high level of suspicion for MTC is critical to ensure patients receive appropriate preoperative testing. Cancer Cytopathol 2018;126:397-405. © 2018 American Cancer Society.

Statistical Learning of Melodic Patterns Influences the Brain's Response to Wrong Notes.

The theory of statistical learning has been influential in providing a framework for how humans learn to segment patterns of regularities from continuous sensory inputs, such as speech and music. This form of learning is based on statistical cues and is thought to underlie the ability to learn to segment patterns of regularities from continuous sensory inputs, such as the transition probabilities in speech and music. However, the connection between statistical learning and brain measurements is not well understood. Here we focus on ERPs in the context of tone sequences that contain statistically cohesive melodic patterns. We hypothesized that implicit learning of statistical regularities would influence what was held in auditory working memory. We predicted that a wrong note occurring within a cohesive pattern (within-pattern deviant) would lead to a significantly larger brain signal than a wrong note occurring between cohesive patterns (between-pattern deviant), even though both deviant types were equally likely to occur with respect to the global tone sequence. We discuss this prediction within a simple Markov model framework that learns the transition probability regularities within the tone sequence. Results show that signal strength was stronger when cohesive patterns were violated and demonstrate that the transitional probability of the sequence influences the memory basis for melodic patterns. Our results thus characterize how informational units are stored in auditory memory trace for deviance detection and provide new evidence about how the brain organizes sequential sound input that is useful for perception.

An Integrated Care Charter - Correcting the Organisational Focus Paradox by Empowering the Citizen

An introduction: (comprising background and problem statement) Integrated care is in principle a ‘no contest’ goal – no-one can argue against it. Vertical integration seeks to link secondary care, primary care, and community care, while Horizontal integration seeks to link separate streams of clinical and related activity for persons with multiple conditions, drawing formal, family and societal care into a cohesive patient-focused pattern of care delivery and support. However, the real test of achievement is whether the patient feels care is integrated. Description of policy context and objective: Many organisations are focussing on addressing the organisational challenges, including the World Health Organisation’s WHO global strategy on people-centred and integrated health services, the WHO Regional Office for Europe with its programme Towards people-centred health systems: an innovative approach for better health systems International, the Foundation for Integrated Care’s activities, and the EU Project Integrate and its Conceptual Framework for Integrated care. These all focus on organisations, systems, and governance, which are clearly key determinants of care integration. But while these documents emphasise the importance of putting the patient at the centre (and also family and informal carers), they do not do this practically. There is something missing, and that is the provision of a person-centric definition of integrated care, and the person’s means of recognising and measuring it. Targeted population: Citizens for whom integrated care is appropriate; organisations seeking to deliver integrated care. Highlights: (innovation, Impact and outcomes) The Canadian Health Outcomes for Better Information and Care (C-HOBIC) project has to some degree started on this route by seeking to devise standardised measures of health and functioning of a person in a holistic sense, but this is still largely based on physiological assessment. Several studies have looked at system-based measures of integration, but the citizen is not directly involved. The Policy Innovation Research Institute (2014) devised a recipient-based survey tool. However, what is missing is a proactive tool. Citizen’s Charters and Customer Charters set standards by which the citizen could assess in lay terms whether a service met specified standards, in terms and measures meaningful to the lay citizen. Not least in the English NHS the Patient’s Charter has become an established concept. Such measures inform the citizen as to what they can reasonably expect, empower the citizen (or their advocates) to assess the quality of the service they are receiving, and provide a performance monitor for the organisation. In all the discussion and debate about organisational structures and processes, and changes to them to facilitate integrated care, it is paradoxical that there has been no focus on empowering citizens to identify, measure, or argue for integrated care, not least in their own personal situation. Comments on transferability: The concept is widely transferable, framed in local terms. Conclusions: (comprising key findings, discussion and lessons learned) The presentation will show how this might be achieved by producing the mirror image of organisational tools including those listed above, giving the patient expectations and a means of assessment.

Facial nerve ganglioneuroblastoma in a feline leukemia virus-positive cat

ABSTRACT: Neuroblastic tumors can originate from the central neuraxis, olfactory epithelium, adrenal medullary region or autonomous system. Ganglioneuroblastoma are a type of neuroblastic tumor, with very few case descriptions in animals. Diagnosis of facial nerve ganglioneuroblastoma was made in a feline leukemia virus-positive 11-month-old cat. The cat had hyporexia, left head tilt, depressed mental state, horizontal nystagmus, inability to retract the pinched left lip, anisocoria, ptosis, and absence of the menace reflex. Gross necropsy showed a mass at the left facial nerve root region. Histological examination of this mass showed neoplastic proliferation of neuroblasts arranged in a cohesive pattern and mature ganglion cells. Ganglion cells were positive for neurofilament, neuron-specific enolase, S100, and glial fibrillary acidic protein by immunohistochemistry, while neuroblasts were positive for vimentin, S100, neuron-specific enolase and feline leukemia virus.

Antenatal glucocorticoids and neonatal inflammation-associated proteins

BackgroundTo date, studies of the relationship between antenatal glucocorticoids (AGC) and neonatal inflammation in preterm newborns have been largely limited to umbilical cord blood specimens. AimTo explore the association between exposure to antenatal glucocorticoids and concentrations of inflammation-related proteins in whole blood collected from very preterm newborns at multiple times during the first postnatal month. MethodsWe measured the protein concentrations on postnatal day 1 (N=1118), day 7 (N=1138), day 14 (N=1030), day 21 (N=936) and day 28 (N=877) from infants born before the 28th week of gestation and explored the relationship between antenatal steroid receipt and protein concentrations in the highest and lowest quartiles. The creation of multinomial logistic regression models (adjusted for potential confounders) allowed us calculate odds ratios and 95% confidence intervals. ResultsTwenty of 420 assessments [21 (proteins)×2 (exposure levels: partial and full)×2 (quartile levels: top and bottom)×5 (days)] were statistically significant without any cohesive pattern. ConclusionAmong infants born before 28 weeks of gestational age, neither full, nor partial courses of antenatal glucocorticoids have a sustained anti-inflammatory effect.

Plasmablastic Lymphoma Mimicking Acute Pancreatitis.

Background. Plasmablastic lymphoma (PBL) is a rare B-cell neoplasm. It predominantly occurs in the oral cavity of human immunodeficiency virus (HIV)-positive patients and exhibits a highly aggressive clinical behavior. Case Presentation. We describe an unusual case of a 37-year-old HIV-positive male who presented with acute pancreatitis secondary to multiple peripancreatic masses compressing the pancreas. Histopathological examination of the lesions showed diffuse and cohesive pattern of large B-cells resembling immunoblasts or plasmablasts. The neoplastic cells were positive for BOB1 and MUM1, partially positive for CD79a, and negative for CD20, CD56, CD138, CD3, CD5, AE1/AE3, and HHV8. Epstein-Barr virus-encoded RNA in situ hybridization was positive. These features were consistent with PBL. The patient was initiated on cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy, demonstrating a striking response. Conclusion. To our research, this is the first report of PBL with the initial presentation of acute pancreatitis. The findings in this case suggest that PBL should be included in the differential diagnosis of pancreatic and peripancreatic tumors.

Refined Clustering of Software Components by Using K-Mean and Neural Network

Data Mining is extraction of relevant information about data set. A data-warehouse is a location where information is stored. There are various services of data mining, clustering is one of them. Clustering is an effort to group similar data onto single cluster. In this paper we propose and implement k-mean and neural network for clustering same components in single cluster. Clustering reduces the search space by grouping similar test cases together according to the requirements and, hence minimizing the search time, for the retrieval of the test cases, resulting in reduced time complexity. In this research paper we proposed approach for re-usability of test cases by unsupervised approach and supervised approach. In unsupervised learning we proposed k-mean and in supervised learning neural network. We have designed the algorithm for requirement and test case document clustering according to its tf-idf vector space and the output is set of highly cohesive pattern groups.

比較的高い細胞接着性をもつ diffuse large B-cell lymphoma の 1 例

比較的高い細胞接着性をもつ diffuse large B-cell lymphoma の 1 例

HER2 testing in malignant effusions of metastatic gastric carcinoma: is it feasible?

HER2 testing on effusions of metastatic gastric carcinoma may provide a valuable alternative to testing on primary biopsies. This study assessed the feasibility of this method by immunohistochemistry (IHC) and silver in situ hybridization (SISH). Cell blocks from 46 effusions from metastatic gastric carcinoma were examined. IHC was scored using the modified criteria of Hofmann et al. An average of ≥6 signals per nucleus was considered amplification on SISH. Results were compared with histological specimens to assess HER2 status concordance. Cell blocks showed a poorly cohesive pattern in 30 (65%), aggregates in 7 (15%), and mixed pattern in 9 (20%). Seven (15%) showed an IHC 2+/3+ reaction with a membranous pattern, appearing more granular than in histology. Three (7%) showed HER2 amplification on SISH. In 18 cases (39%), HER2 status was compared with histological specimens, showing 100% concordance. Difficulties were encountered in distinguishing malignant cells from reactive mesothelial cells in 12 (26%). This study supports the feasibility of HER2 assessment on effusions. The incidence of HER2 positivity (7% with SISH+ and IHC 2+/3+) was lower than reported in histological samples. Further refinement and validation will enhance the use of this method in clinical practice and overcome difficulties encountered.

New Therapeutic Approaches for Invasive Lobular Carcinoma

Invasive lobular carcinoma (ILC) is the second most common histological subtype among newly diagnosed breast cancers. The clinical features of ILC are related to the underlying biology of this disease, which is distinguished by loss of the cell adhesion protein e-cadherin. The resulting poorly cohesive growth pattern is responsible for the comparatively poor detection of ILC both on imaging and palpation. Recent genomic and proteomic discoveries have identified other molecular features of ILC which may lead to its future treatment with more targeted therapy. The presentation, treatment, and outcome of ILC is reviewed and future research directions are considered.