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1.
Medicine (Baltimore) ; 103(31): e39045, 2024 Aug 02.
Article in English | MEDLINE | ID: mdl-39093728

ABSTRACT

RATIONALE: SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a recently reported rare malignancy that can rapidly metastasize to tissues and organs throughout the body. The tumor is characterized by a lower response to platinum-based chemotherapy. More regrettably, the mean survival time of patients with this disease after diagnosis is only 4 to 7 months. PATIENT CONCERNS: A 58-year-old man was admitted to a hospital for fatigue, sudden syncope, and a mass-like shadow of his left upper lobe demonstrated by a pulmonary computed tomographic. Based on his subsequent clinical and pathological features, he was highly suspected of SMARCA4-UT. DIAGNOSES: Combined with next-generation sequencing genetic testing and immunohistochemical examination results, the patient was diagnosed with SMARCA4-UT. INTERVENTIONS: The patient received a left upper lobectomy and lymph node dissection, four-course chemotherapy divided into 8 sessions with the use of paclitaxel simply, and a proper post-discharge self-care. OUTCOMES: The patient's operation and chemotherapy were all successful and he maintained a high quality of life after surgery that far exceeded his predicted survival. LESSONS: Early diagnosis, higher education level, attention to the disease and complications, reducing chemotherapy damage, adequate nutrient intake, relieving symptoms, controlling depression, and maintaining immunity and the ability to perform activities of daily living may all be the positive factors that can prolong the survival of patients with SMARCA4-UT.


Subject(s)
DNA Helicases , Lung Neoplasms , Quality of Life , Transcription Factors , Humans , Male , Middle Aged , DNA Helicases/genetics , DNA Helicases/deficiency , Transcription Factors/genetics , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Pneumonectomy
2.
Pathologica ; 116(3): 163-169, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38979590

ABSTRACT

The 5th WHO classification of thoracic tumours includes thoracic SMARCA4-deficient undifferentiated tumour (SMARCA4-UT) among the "other epithelial tumours of the lung" chapter. Herein, we present a case of undifferentiated thoracic neoplasm with retention of SMARCA4 expression, lack of NUT fusion protein and loss of SMARCB1/INI1 expression. After presenting the clinical and pathological features of the tumour, we carried out a review of the literature on the same topic. Albeit very rare, we believe this entity should be included in the heterogeneous group of undifferentiated neoplasms of the thorax.


Subject(s)
DNA Helicases , SMARCB1 Protein , Thoracic Neoplasms , Transcription Factors , Humans , SMARCB1 Protein/deficiency , SMARCB1 Protein/genetics , Transcription Factors/genetics , Transcription Factors/deficiency , Thoracic Neoplasms/pathology , Thoracic Neoplasms/genetics , DNA Helicases/deficiency , DNA Helicases/genetics , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Male , Female , Biomarkers, Tumor/analysis , Biomarkers, Tumor/genetics , Middle Aged , Lung Neoplasms/pathology , Lung Neoplasms/genetics , Lung Neoplasms/diagnosis
3.
Front Immunol ; 15: 1371379, 2024.
Article in English | MEDLINE | ID: mdl-38881888

ABSTRACT

SMARCA4-deficient undifferentiated tumor (SMARCA4-dUT) is a devastating subtype of thoracic tumor with SMARCA4 inactivation and is characterized by rapid progression, poor prognosis, and high risk of postoperative recurrence. However, effective treatments for SMARCA4-dUT are lacking. Herein, we describe a patient with SMARCA4-dUT who exhibited an impressive response to the anti-programmed cell death protein-1 (PD-1) antibody (tislelizumab) in combination with conventional chemotherapy (etoposide and cisplatin). To the best of our knowledge, this is the first case of SMARCA4-dUT treated with chemotherapy, comprising etoposide and cisplatin, combined with anti-PD-1 inhibitors. Immunotherapy combined with etoposide and cisplatin may be a promising strategy to treat SMARCA4-dUT.


Subject(s)
Antibodies, Monoclonal, Humanized , Antineoplastic Combined Chemotherapy Protocols , DNA Helicases , Transcription Factors , Humans , Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal, Humanized/administration & dosage , DNA Helicases/genetics , DNA Helicases/deficiency , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Transcription Factors/genetics , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Etoposide/therapeutic use , Etoposide/administration & dosage , Male , Cisplatin/therapeutic use , Cisplatin/administration & dosage , Treatment Outcome , Female
4.
Orphanet J Rare Dis ; 19(1): 237, 2024 Jun 14.
Article in English | MEDLINE | ID: mdl-38877473

ABSTRACT

BACKGROUND: SMARCA4, as one of the subunits of the SWI/SNF chromatin remodeling complex, drives SMARCA4-deficient tumors. Gastric SMARCA4-deficient tumors may include gastric SMARCA4-deficient carcinoma and gastric SMARCA4-deficient undifferentiated tumor (SMARCA4-UT). Gastric SMARCA4-UT is rare and challenging to diagnose in clinical practice. The present report aims to provide insight into the clinicopathological characteristics and genetic alterations of gastric SMARCA4-UTs. RESULTS: We retrospectively reported four rare cases of gastric SMARCA4-UTs. All four cases were male, aged between 61 and 82 years. These tumors presented as ulcerated and transmural masses with infiltration, staged as TNM IV in cases 1, 2 and 4, and TNM IIIA in case 3. Pathologically, four cases presented solid architecture with undifferentiated morphology. Cases 2 and 3 showed focal necrosis and focal rhabdoid morphology. Immunohistochemical staining showed negative expression of epithelial markers and deficient expression of SMARCA4. Furthermore, positivity for Syn (cases 1, 2 and 3) and SALL4 (cases 1 and 2) were observed. Mutant p53 expression occurred in four cases, resulting in strong and diffuse staining of p53 expression in cases 1, 2 and 4, and complete loss in case 3. The Ki67 proliferative index exceeded 80%. 25% (1/4, case 4) of cases had mismatch repair deficiency (dMMR). Two available cases (cases 1 and 3) were detected with SMRACA4 gene alterations. The response to neoadjuvant therapy was ineffective in case 1. CONCLUSIONS: Gastric SMARCA4-UT is a rare entity of gastric cancer with a poor prognosis, predominantly occurs in male patients. The tumors are typically diagnosed at advanced stages and shows a solid architecture with undifferentiated morphology. Negative expression of epithelial markers and complete loss of SMARCA4 immunoexpression are emerging as a useful diagnostic tool for rare gastric SMARCA4-UTs.


Subject(s)
DNA Helicases , Nuclear Proteins , Stomach Neoplasms , Transcription Factors , Humans , Transcription Factors/genetics , Transcription Factors/metabolism , Transcription Factors/deficiency , Male , Stomach Neoplasms/pathology , Stomach Neoplasms/genetics , Stomach Neoplasms/metabolism , DNA Helicases/genetics , DNA Helicases/deficiency , DNA Helicases/metabolism , Middle Aged , Nuclear Proteins/genetics , Nuclear Proteins/metabolism , Nuclear Proteins/deficiency , Aged, 80 and over , Retrospective Studies , Aged
5.
Cancer Rep (Hoboken) ; 7(6): e2127, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38923369

ABSTRACT

BACKGROUND: SMARCA4 is a component gene of the SWI/SNF (SWItch/Sucrose NonFermentable) chromatin remodeling complex; undifferentiated tumors associated with its functional deletion have been described in several organs. However, no established treatment for these tumors currently exists. CASE: In this study, we report a case of a SMARCA4-deficient undifferentiated urothelial carcinoma with high PD-L1 expression that was effectively treated with nivolumab after early relapse following treatment for non-invasive bladder cancer. The histological morphology of the rhabdoid-like undifferentiated tumor of unknown primary led us to suspect a SWI/SNF-deficient tumor, and subsequent immunostaining led to the diagnosis of a SMARCA4-deficient undifferentiated tumor. This effort also led to the identification of the developmental origin of this SMARCA4-deficient undifferentiated tumor as a non-invasive bladder cancer. We also carried out a detailed immune phenotypic assay on peripheral T cells. In brief, a phenotypic change of CD8+T cells from naive to terminally differentiated effector memory cells was observed. CONCLUSION: Regardless of the organ of cancer origin or cancer type, SWI/SNF-deficient tumors should be suspected in undifferentiated and dedifferentiated tumors, and immune checkpoint inhibitors may be considered as a promising treatment option for this type of tumor. The pathogenesis of SMARCA4-deficient anaplastic tumors awaits further elucidation for therapeutic development.


Subject(s)
B7-H1 Antigen , DNA Helicases , Nivolumab , Nuclear Proteins , Transcription Factors , Urinary Bladder Neoplasms , Humans , DNA Helicases/genetics , DNA Helicases/deficiency , Transcription Factors/genetics , Transcription Factors/deficiency , Transcription Factors/metabolism , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/genetics , Urinary Bladder Neoplasms/diagnosis , B7-H1 Antigen/metabolism , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Nuclear Proteins/metabolism , Nivolumab/therapeutic use , Male , Carcinoma, Transitional Cell/drug therapy , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/genetics , Carcinoma, Transitional Cell/diagnosis , Aged , Treatment Outcome
6.
J Mol Cell Cardiol ; 191: 76-87, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38718920

ABSTRACT

The reactivated adult epicardium produces epicardium-derived cells (EPDCs) via epithelial-mesenchymal transition (EMT) to benefit the recovery of the heart after myocardial infarction (MI). SMARCA4 is the core catalytic subunit of the chromatin re-modeling complex, which has the potential to target some reactivated epicardial genes in MI. However, the effects of epicardial SMARCA4 on MI remain uncertain. This study found that SMARCA4 was activated over time in epicardial cells following MI, and some of activated cells belonged to downstream differentiation types of EPDCs. This study used tamoxifen to induce lineage tracing and SMARCA4 deletion from epicardial cells in Wt1-CreER;Smarca4fl/fl;Rosa26-RFP adult mice. Epicardial SMARCA4 deletion reduces the number of epicardial cells in adult mice, which was related to changes in the activation, proliferation, and apoptosis of epicardial cells. Epicardial SMARCA4 deletion reduced collagen deposition and angiogenesis in the infarcted area, exacerbated cardiac injury in MI. The exacerbation of cardiac injury was related to the inhibition of generation and differentiation of EPDCs. The alterations in EPDCs were associated with inhibited transition between E-CAD and N-CAD during the epicardial EMT, coupled with the down-regulation of WT1, SNAIL1, and PDGF signaling. In conclusion, this study suggests that Epicardial SMARCA4 plays a critical role in cardiac injury caused by MI, and its regulatory mechanism is related to epicardial EMT. Epicardial SMARCA4 holds potential as a novel molecular target for treating MI.


Subject(s)
DNA Helicases , Epithelial-Mesenchymal Transition , Gene Deletion , Myocardial Infarction , Pericardium , Transcription Factors , Animals , Myocardial Infarction/genetics , Myocardial Infarction/metabolism , Myocardial Infarction/pathology , Epithelial-Mesenchymal Transition/genetics , Pericardium/pathology , Pericardium/metabolism , Transcription Factors/metabolism , Transcription Factors/genetics , DNA Helicases/genetics , DNA Helicases/metabolism , Mice , Cell Differentiation , Apoptosis/genetics , Nuclear Proteins/genetics , Nuclear Proteins/metabolism , Nuclear Proteins/deficiency , Cell Proliferation , Disease Models, Animal
7.
Lung Cancer ; 192: 107818, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38763102

ABSTRACT

INTRODUCTIONS: The 2021 WHO Classification of Thoracic Tumors recognized SMARCA4-deficient undifferentiated thoracic tumors (SMARCA4-dUT) as a distinct entity that shows a striking overlap in demographic and molecular profiles with SMARCA4-deficient non-small lung cancer (SMARCA4-dNSCLC). The implications of SMARCA4 deficiency based on immunohistochemistry remain unclear. We aimed to investigate molecular characteristics of SMARCA4-deficient thoracic tumors (SDTT) and explore optimal therapeutics. METHODS: From June.15, 2018, to Nov.15, 2023, a large cohort including patients diagnosed with SMARCA4-deficient (N = 196) and SMARCA4-intact (N = 438) thoracic tumors confirmed by immunohistochemistry at SYSUCC were screened. Clinicopathologic and molecular characteristics were identified and compared. External SRRSH cohort (N = 34) was combined into a pooled cohort to compare clinical outcome of first-line therapy efficacy. RESULTS: SDTT is male predominance with smoking history, high tumor burden, and adrenal metastases. The relationship between SMARCA4 mutation and protein expression is not completely parallel. The majority of SMARCA4-deficient patients harbor truncating (Class-I) SMARCA4 mutations, whereas class-II alterations and wild-type also exist. Compared with SMARCA4-intact thoracic tumors, patients with SDTT displayed a higher tumor mutation burden (TMB) and associated with a shorter median OS (16.8 months vs. Not reached; P < 0.001). Notably, SMARCA4 protein deficiency, rather than genetic mutations, played a decisive role in these differences. SDTT is generally resistant to chemotherapy, while sensitive to chemoimmunotherapy (median PFS: 7.5 vs. 3.5 months, P < 0.001). In particular, patients with SMARCA4 deficient thoracic tumors treated with paclitaxel-based chemoimmunotherapy achieved a longer median PFS than those with pemetrexed-based chemoimmunotherapy (10.0 vs. 7.3 months, P = 0.028). CONCLUSIONS: SMARCA4 protein deficiency, rather than genetic mutations, played a decisive role in its characteristics of higher TMB and poor prognosis. Chemoimmunotherapy serves as the optimal option in the current treatment regimen. Paclitaxel-based chemoimmunotherapy performed better than those with pemetrexed-based chemoimmunotherapy.


Subject(s)
DNA Helicases , Lung Neoplasms , Nuclear Proteins , Thoracic Neoplasms , Transcription Factors , Humans , DNA Helicases/genetics , DNA Helicases/deficiency , Transcription Factors/genetics , Male , Female , Thoracic Neoplasms/genetics , Thoracic Neoplasms/pathology , Thoracic Neoplasms/drug therapy , Thoracic Neoplasms/therapy , Middle Aged , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Lung Neoplasms/drug therapy , Lung Neoplasms/mortality , Aged , Mutation , Prognosis , Adult , Biomarkers, Tumor/genetics
8.
Adv Biol (Weinh) ; 8(7): e2400210, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38712476

ABSTRACT

Aging-related bone loss is driven by various biological factors, such as imbalanced bone metabolism from decreased osteoblast and increased osteoclast activities. Various transcriptional and post-transcriptional factors increase osteoclast activity with aging; however, studies regarding the post-translational regulators of osteoclast activity are still limited. The ubiquitin E3 ligase Pellino-1 is a well-known post-translational regulator of inflammation. However, how Pellino-1 expression regulation affects osteoclast differentiation remains unclear. This study determined that Pellino-1 levels are reduced in bone marrow monocytes (BMMs) from 40-week-old mice compared to 4-week-old mice. Interestingly, conditional Knockout (cKO) of Pellino-1 in 6-week-old mice resulted in decreased bone mass, reduced body size, and lower weight than in Pellino-1 floxed mice; however, these differences are not observed in 20-week-old mice. The increased number of tartrate-resistant acid phosphatase (TRAP)-positive cells and serum levels of C-terminal telopeptides of type I collagen, a marker of bone resorption, in 6-week-old Pellino-1 cKO mice implied a connection between Pellino-1 and the osteoclast population. Enhanced TRAP activity and upregulation of osteoclast genes in BMMs from the cKO mice indicate that Pellino-1 deletion affects osteoclast differentiation, leading to decreased bone mass and heightened osteoclast activity. Thus, targeting Pellino-1 could be a potential gene therapy for managing and preventing osteoporosis.


Subject(s)
Bone Resorption , Mice, Knockout , Osteoclasts , Ubiquitin-Protein Ligases , Animals , Osteoclasts/metabolism , Mice , Bone Resorption/metabolism , Bone Resorption/genetics , Bone Resorption/pathology , Ubiquitin-Protein Ligases/genetics , Ubiquitin-Protein Ligases/metabolism , Aging/metabolism , Aging/genetics , Cell Differentiation , Osteoporosis/genetics , Osteoporosis/metabolism , Osteoporosis/pathology , Male , Mice, Inbred C57BL , Nuclear Proteins/genetics , Nuclear Proteins/metabolism , Nuclear Proteins/deficiency
9.
J Neuropathol Exp Neurol ; 83(8): 638-654, 2024 Aug 01.
Article in English | MEDLINE | ID: mdl-38687619

ABSTRACT

SMARCA4 alterations can be encountered in a variety of human neoplasms, and metastases to the central nervous system (CNS) are rare, offering a challenge to neuropathologists despite not representing a distinct diagnostic entity. To better understand the clinical and histologic presentation of such neoplasms, we report an observational case series and systematic review of 178 unique articles that yielded 15 published cases and 7 cases from institutional files. In the systematic review, the median age was 58 years, the male-to-female ratio was 2:1, and the most common diagnosis was lung adenocarcinoma; all CNS metastases were discovered within 1 year of presentation. In the case series, the median age was 58 years, the male-to-female ratio was 6:1, and all known metastases originated from the lung. Most patients had a smoking history and died of disease. GATA-3 positivity was seen in most case series examples. Concurrent TP53 mutations (83.3%) and a high tumor mutation rate (60%) were common. To our knowledge, this is the only case series and systematic review in the English literature aimed at assessing SMARCA4-altered metastases in the CNS and vertebral column. We highlight the challenges of neuropathologic evaluation of such tumors and provide observational evidence of early metastases, histologic appearances, and immunohistochemical findings, including previously unreported GATA-3 positivity.


Subject(s)
Central Nervous System Neoplasms , DNA Helicases , Nuclear Proteins , Transcription Factors , Humans , Transcription Factors/genetics , Transcription Factors/deficiency , Middle Aged , Female , Male , Aged , DNA Helicases/deficiency , DNA Helicases/genetics , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Central Nervous System Neoplasms/secondary , Central Nervous System Neoplasms/pathology , Central Nervous System Neoplasms/genetics , Lung Neoplasms/pathology , Lung Neoplasms/genetics , Lung Neoplasms/secondary , Adult
10.
Clin Nucl Med ; 49(8): 787-789, 2024 Aug 01.
Article in English | MEDLINE | ID: mdl-38537213

ABSTRACT

ABSTRACT: SMARCA4-deficient undifferentiated tumors (SMARCA4-dUT) are rare and aggressive neoplasms commonly found in male smokers and portend a poor prognosis. In this case, we reported 18 F-FDG and 68 Ga-FAPI-46 PET/CT findings in an occult SMARCA4-dUT located in the left pulmonary hilum along with mediastinal lymph node metastases. 68 Ga-FAPI-46 PET/CT showed superiority over 18 F-FDG for detecting SMARCA4-dUT lesions. This case highlighted that 68 Ga-FAPI-46 PET/CT may be a promising imaging modality in the evaluation of SMARCA4-dUT, particularly for detecting the occult SMARCA4-dUT arising in uncommon sites.


Subject(s)
Nuclear Proteins , Positron Emission Tomography Computed Tomography , Transcription Factors , Humans , Male , Transcription Factors/genetics , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , DNA Helicases/genetics , Carcinoma/diagnostic imaging , Gallium Radioisotopes , Middle Aged , Gallium Isotopes
11.
Cancer Res Treat ; 56(3): 967-971, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38351682

ABSTRACT

SMARCB1 or SMARCA4-deficient sinonasal carcinoma or thoracic undifferentiated tumor has aggressive nature with a poor prognosis. Patients with this disease were diagnosed by immunohistochemistry or next-generation sequencing. Those who were able to receive a surgery tended to be cured, while the others treated with chemotherapy, radiation therapy, or immune checkpoint inhibitor were often insensitive to these therapies. However, one having CD274 (PD-L1) amplification showed the response to immune checkpoint inhibitor and a good prognosis. We believed that this report could provide promising information for determining the optimal treatment option.


Subject(s)
DNA Helicases , SMARCB1 Protein , Transcription Factors , Adult , Aged , Female , Humans , Male , Middle Aged , Biomarkers, Tumor/genetics , DNA Helicases/genetics , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Prognosis , Retrospective Studies , SMARCB1 Protein/genetics , SMARCB1 Protein/deficiency , Thoracic Neoplasms/genetics , Thoracic Neoplasms/therapy , Thoracic Neoplasms/pathology , Transcription Factors/genetics
12.
Pathology ; 56(4): 504-515, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38413251

ABSTRACT

SMARCA4 mutation has emerged as a marker of poor prognosis in lung cancer and has potential predictive value in cancer treatment, but recommendations for which patients require its investigation are lacking. We comprehensively studied SMARCA4 alterations and the clinicopathological significance in a large cohort of immunohistochemically-subtyped non-small cell lung cancer (NSCLC). A total of 1416 patients was studied for the presence of SMARCA4 deficiency by immunohistochemistry (IHC). Thereafter, comprehensive sequencing of tumours was performed for 397 of these patients to study the mutational spectrum of SWI/SNF and SMARCA4 aberrations. IHC evidence of SMARCA4 deficiency was found in 2.9% of NSCLC. Of the sequenced tumours, 38.3% showed aberration in SWI/SNF complex, and 9.3% had SMARCA4 mutations. Strikingly, SMARCA4 aberrations were much more prevalent in large cell carcinoma (LCC) than other histological tumour subtypes. SMARCA4-deficient and SMARCA4-mutated tumours accounted for 40.5% and 51.4% of all LCC, respectively. Multivariable analyses confirmed SMARCA4 mutation was an independent prognostic factor in lung cancer. The immunophenotype of a subset of these tumours frequently showed TTF1 negativity and HepPAR1 positivity. SMARCA4 mutation or its deficiency was associated with positive smoking history and poor prognosis. It also demonstrated mutual exclusion with EGFR mutation. Taken together, the high incidence of SMARCA4 aberrations in LCC may indicate its diagnostic and prognostic value. Our study established the necessity of SMARCA4 IHC in the identification of SMARCA4-aberrant tumours, and this may be of particular importance in LCC and tumours without known driver events.


Subject(s)
Carcinoma, Large Cell , Carcinoma, Non-Small-Cell Lung , DNA Helicases , Nuclear Proteins , Transcription Factors , Female , Humans , Male , Biomarkers, Tumor/genetics , Carcinoma, Large Cell/genetics , Carcinoma, Large Cell/pathology , Carcinoma, Non-Small-Cell Lung/genetics , Carcinoma, Non-Small-Cell Lung/pathology , DNA Helicases/genetics , DNA Helicases/deficiency , Immunohistochemistry , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Mutation , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Prognosis , Transcription Factors/genetics , Transcription Factors/deficiency
13.
Clin Cancer Res ; 30(9): 1708-1711, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38416596

ABSTRACT

Small-cell lung carcinoma (SCLC) cell lines have been widely utilized as a preclinical model of this highly aggressive disease. However, since their creation decades ago, novel tumor entities have been defined that might clinicopathologically mimic SCLC, which notably includes thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT). Multiomic reassessment of the presumed SCLC cell lines with high YAP1 expression reveals that nearly all of these tumors represent unsuspected SMARCA4-UT. See related article by Ng et al., p. 1846.


Subject(s)
DNA Helicases , Lung Neoplasms , Nuclear Proteins , Small Cell Lung Carcinoma , Transcription Factors , Humans , DNA Helicases/genetics , DNA Helicases/deficiency , Small Cell Lung Carcinoma/diagnosis , Small Cell Lung Carcinoma/genetics , Small Cell Lung Carcinoma/pathology , Transcription Factors/genetics , Transcription Factors/deficiency , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Lung Neoplasms/diagnosis , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Diagnosis, Differential , Thoracic Neoplasms/diagnosis , Thoracic Neoplasms/genetics , Thoracic Neoplasms/pathology , Cell Line, Tumor
14.
Turk Patoloji Derg ; 40(2): 128-133, 2024.
Article in English | MEDLINE | ID: mdl-38265099

ABSTRACT

OBJECTIVE: SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a highly malignant neoplasm with an undifferentiated or rhabdoid phenotype, posing a diagnostic challenge. This case report aims to create awareness about this rare neoplasm while dealing with cases presenting with undifferentiated morphology. CASE REPORT: A 55-year-old gentleman with constitutional symptoms and lymphadenopathy. Imaging revealed a mass lesion in the right upper lobe of the lung. A biopsy of the cervical lymph node showed diffusely effaced architecture replaced by sheets of undifferentiated pleomorphic cells with vesicular nuclei, prominent nucleoli, eosinophilic cytoplasm, and multiple necrotic foci. An extensive immunohistochemistry (IHC) panel was applied, which showed positivity for synaptophysin, vimentin, and focal CD34 and EMA expression. Other markers like pan-cytokeratin, p40, TTF1, CD56, INSM1, calretinin, CD45, SOX10, S100, CD30, CD117, SMA, and Desmin were negative, with INI1 retained. The IHC panel excluded the morphological differentials of carcinoma, lymphoma, rhabdomyosarcoma, melanoma, and germ cell tumor. Further literature review led to the possibility of the SMARCA4-UT entity, which had a morphology and IHC profile similar to the present case. Testing for SMARCA4 (BRG-1) by IHC showed a complete loss in the tumor cells, favoring the diagnosis of Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT). CONCLUSION: SMARCA4-UTs are rare, highly aggressive, and poorly differentiated thoracic tumors. Recognizing them is vital as there is potential for therapeutic interventions such as immunotherapy and SMARCA4-targeted therapies, offering promising prospects for the future.


Subject(s)
Biomarkers, Tumor , DNA Helicases , Nuclear Proteins , Transcription Factors , Humans , Male , Transcription Factors/genetics , Transcription Factors/deficiency , Middle Aged , DNA Helicases/deficiency , DNA Helicases/genetics , Nuclear Proteins/deficiency , Nuclear Proteins/genetics , Biomarkers, Tumor/analysis , Biomarkers, Tumor/genetics , Lung Neoplasms/pathology , Lung Neoplasms/genetics , Immunohistochemistry , Thoracic Neoplasms/pathology , Thoracic Neoplasms/genetics , Thoracic Neoplasms/chemistry
15.
Int J Gynecol Pathol ; 43(4): 354-361, 2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38113031

ABSTRACT

SMARCA4 gene encodes BRG1 , a member of the SWItch/sucrose non-fermentable protein family involved in epigenetic transcriptional regulation of important cellular processes. In the uterine corpus, SMARCA4 / BRG1 deficiency is associated with a novel class of undifferentiated uterine sarcomas, characterized by younger age onset, rhabdoid histology, focal phyllodiform architecture, high-risk pathologic findings, and dismal prognosis. Herein, we report a case of a 34-year-old Asian woman with a SMARCA4 / BRG1 -deficient uterine tumor fulfilling the clinicopathologic features of an undifferentiated uterine sarcoma. However, the tumor exhibited several unique features that have not been previously emphasized, including (1) conspicuous phyllodiform architecture recapitulating conventional adenosarcoma, (2) rhabdoid tumor cells forming cords and keratin-positive cohesive epithelial islands, and (3) cooccurrence with a spatially distinct and discrete endometrial complex atypical hyperplasia from the rest of the proliferation. By immunohistochemistry, the tumor cells were diffusely positive for synaptophysin, whereas BRG1 was lost. Pertinent molecular findings included frameshift mutations in the SMARCA4 gene, mutations in histone modification and chromatin remodeling genes, including KMT2C , ARID1B , KAT6A , and NCOR1 , and mutations in Wnt signaling involving APC and CTNNB1 . Copy number gain in MDM2 and CDK4 were also identified. The tumor mutation burden was intermediate (6.8/MB) and it was microsatellite stable. On balance, our case exhibited morphologic and molecular features that overlap with (1) an undifferentiated uterine sarcoma, (2) an adenosarcoma with sarcomatous overgrowth, and (3) a mixed adenosarcoma and undifferentiated endometrial carcinoma. These hybrid features further expand the molecular-morphologic spectrum of SMARCA4 / BRG1 -deficient uterine neoplasms.


Subject(s)
Adenosarcoma , DNA Helicases , Nuclear Proteins , Transcription Factors , Uterine Neoplasms , Humans , Female , DNA Helicases/genetics , DNA Helicases/deficiency , Transcription Factors/genetics , Transcription Factors/deficiency , Nuclear Proteins/genetics , Nuclear Proteins/deficiency , Adult , Adenosarcoma/pathology , Adenosarcoma/genetics , Uterine Neoplasms/pathology , Uterine Neoplasms/genetics , Immunohistochemistry , Carcinoma/pathology , Carcinoma/genetics
16.
Nat Immunol ; 23(8): 1256-1272, 2022 08.
Article in English | MEDLINE | ID: mdl-35902638

ABSTRACT

The recombination-activating genes (RAG) 1 and 2 are indispensable for diversifying the primary B cell receptor repertoire and pruning self-reactive clones via receptor editing in the bone marrow; however, the impact of RAG1/RAG2 on peripheral tolerance is unknown. Partial RAG deficiency (pRD) manifesting with late-onset immune dysregulation represents an 'experiment of nature' to explore this conundrum. By studying B cell development and subset-specific repertoires in pRD, we demonstrate that reduced RAG activity impinges on peripheral tolerance through the generation of a restricted primary B cell repertoire, persistent antigenic stimulation and an inflammatory milieu with elevated B cell-activating factor. This unique environment gradually provokes profound B cell dysregulation with widespread activation, remarkable extrafollicular maturation and persistence, expansion and somatic diversification of self-reactive clones. Through the model of pRD, we reveal a RAG-dependent 'domino effect' that impacts stringency of tolerance and B cell fate in the periphery.


Subject(s)
B-Lymphocytes , DNA-Binding Proteins , Homeodomain Proteins , Nuclear Proteins , Cell Differentiation , DNA-Binding Proteins/deficiency , DNA-Binding Proteins/genetics , Homeodomain Proteins/genetics , Humans , Immune Tolerance , Lymphocyte Count , Nuclear Proteins/deficiency
17.
Oncologist ; 27(6): 501-511, 2022 06 08.
Article in English | MEDLINE | ID: mdl-35278076

ABSTRACT

BACKGROUND: Thoracic SMARCA4-deficient undifferentiated tumors (SMARCA4-UT) are aggressive neoplasms. Data linking BAF alterations with tumor microenvironment (TME) and efficacy of immune checkpoint inhibitors (ICI) are contradictory. The TME of SMARCA4-UT and their response to ICI are unknown. MATERIALS AND METHODS: Patients diagnosed with SMARCA4-UT in our institution were included. Immunostainings for tertiary lymphoid structures (TLS), immune cell markers, and checkpoints were assessed. Validation was performed using an independent transcriptome dataset including SMARCA4-UT, non-small cell lung cancers (NSCLC) with/without SMARCA4 mutations, and unclassified thoracic sarcomas (UTS). CXCL9 and PD-L1 expressions were assessed in NSCLC and thoracic fibroblast cell lines, with/without SMARCA4 knockdown, treated with/without interferon gamma. RESULTS: Nine patients were identified. All samples but one showed no TLS, consistent with an immune desert TME phenotype. Four patients received ICI as part of their treatment, but the only one who responded, had a tumor with a TLS and immune-rich TME. Unsupervised clustering of the validation cohort using immune cell scores identified 2 clusters associated with cell ontogeny and immunity (cluster 1 enriched for NSCLC independently of SMARCA4 status (n = 9/10; P = .001); cluster 2 enriched for SMARCA4-UT (n = 11/12; P = .005) and UTS (n = 5/5; P = .0005). SMARCA4 loss-of-function experiments revealed interferon-induced upregulation of CXCL9 and PD-L1 expression in the NSCLC cell line with no effect on the thoracic fibroblast cell line. CONCLUSION: SMARCA4-UT mainly have an immune desert TME with limited efficacy to ICI. TME of SMARCA4-driven tumors varies according to the cell of origin questioning the interplay between BAF alterations, cell ontogeny and immunity.


Subject(s)
Carcinoma, Non-Small-Cell Lung , DNA Helicases , Immune Checkpoint Inhibitors , Lung Neoplasms , Nuclear Proteins , Sarcoma , Soft Tissue Neoplasms , Thoracic Neoplasms , B7-H1 Antigen/antagonists & inhibitors , B7-H1 Antigen/immunology , Biomarkers, Tumor/immunology , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/immunology , Carcinoma, Non-Small-Cell Lung/pathology , DNA Helicases/deficiency , DNA Helicases/immunology , Humans , Immune Checkpoint Inhibitors/pharmacology , Lung Neoplasms/drug therapy , Lung Neoplasms/immunology , Lung Neoplasms/pathology , Nuclear Proteins/deficiency , Nuclear Proteins/immunology , Sarcoma/drug therapy , Sarcoma/immunology , Sarcoma/pathology , Soft Tissue Neoplasms/drug therapy , Soft Tissue Neoplasms/immunology , Soft Tissue Neoplasms/pathology , Thoracic Neoplasms/drug therapy , Thoracic Neoplasms/immunology , Thoracic Neoplasms/pathology , Transcription Factors/immunology , Tumor Microenvironment/immunology
18.
Life Sci Alliance ; 5(3)2022 03.
Article in English | MEDLINE | ID: mdl-34893559

ABSTRACT

Changes in histone post-translational modifications are associated with aging through poorly defined mechanisms. Histone 3 lysine 4 (H3K4) methylation at promoters is deposited by SET1 family methyltransferases acting within conserved multiprotein complexes known as COMPASS. Previous work yielded conflicting results about the requirement for H3K4 methylation during aging. Here, we reassessed the role of SET1/COMPASS-dependent H3K4 methylation in Caenorhabditis elegans lifespan and fertility by generating set-2(syb2085) mutant animals that express a catalytically inactive form of SET-2, the C. elegans SET1 homolog. We show that set-2(syb2085) animals retain the ability to form COMPASS, but have a marked global loss of H3K4 di- and trimethylation (H3K4me2/3). Reduced H3K4 methylation was accompanied by loss of fertility, as expected; however, in contrast to earlier studies, set-2(syb2085) mutants displayed a significantly shortened, not extended, lifespan and had normal intestinal fat stores. Other commonly used set-2 mutants were also short-lived, as was a cfp-1 mutant that lacks the SET1/COMPASS chromatin-targeting component. These results challenge previously held views and establish that WT H3K4me2/3 levels are essential for normal lifespan in C. elegans.


Subject(s)
Caenorhabditis elegans/genetics , Caenorhabditis elegans/metabolism , Fertility/genetics , Histone-Lysine N-Methyltransferase/deficiency , Longevity/genetics , Nuclear Proteins/deficiency , Animals , Caenorhabditis elegans Proteins/genetics , Caenorhabditis elegans Proteins/metabolism , Catalysis , Enzyme Activation , Histones/metabolism , Methylation , Nuclear Proteins/genetics , Nuclear Proteins/metabolism
19.
Pathol Oncol Res ; 27: 1610003, 2021.
Article in English | MEDLINE | ID: mdl-34970085

ABSTRACT

Small cell carcinoma of hypercalcemic type (SCCOHT) is a rare gynaecological neoplasm, originating mostly in the ovaries. Cervical origin of this very aggressive malignancy with unknown histogenesis is an extremely rare condition, without published management recommendations. Alterations in SMARCA4 gene are supposed to play the major role in SCCOHT oncogenesis and their identification is crucial for the diagnosis. Adequate genetic counselling of the patients and their families seems to be of great importance. Optimal management and treatment approaches are not known yet but may extremely influence the prognosis of young female patients that suffer from this very resistant disease. Nowadays, a translational research seems to be the key for the further diagnostic and treatment strategies of SCCOHT. The purpose of the case report is to provide practical information and useful recommendations on the diagnosis, management, and treatment of SMARCA4-deficient carcinoma of the uterine cervix resembling SCCOHT.


Subject(s)
Carcinoma, Small Cell/metabolism , DNA Helicases/deficiency , Hypercalcemia/metabolism , Nuclear Proteins/deficiency , Transcription Factors/deficiency , Uterine Cervical Neoplasms/metabolism , Adolescent , Biomarkers, Tumor/deficiency , Biomarkers, Tumor/genetics , Carcinoma, Small Cell/diagnosis , Carcinoma, Small Cell/genetics , Carcinoma, Small Cell/therapy , DNA Helicases/genetics , Fatal Outcome , Female , Humans , Hypercalcemia/diagnosis , Hypercalcemia/genetics , Hypercalcemia/therapy , Mutation , Nuclear Proteins/genetics , Transcription Factors/genetics , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/genetics , Uterine Cervical Neoplasms/therapy
20.
PLoS One ; 16(12): e0247261, 2021.
Article in English | MEDLINE | ID: mdl-34928942

ABSTRACT

POLDIP2 is a multifunctional protein whose roles are only partially understood. Our laboratory previously reported physiological studies performed using a mouse gene trap model, which suffered from three limitations: perinatal lethality in homozygotes, constitutive Poldip2 inactivation and inadvertent downregulation of the adjacent Tmem199 gene. To overcome these limitations, we developed a new conditional floxed Poldip2 model. The first part of the present study shows that our initial floxed mice were affected by an unexpected mutation, which was not readily detected by Southern blotting and traditional PCR. It consisted of a 305 kb duplication around Poldip2 with retention of the wild type allele and could be traced back to the original targeted ES cell clone. We offer simple suggestions to rapidly detect similar accidents, which may affect genome editing using both traditional and CRISPR-based methods. In the second part of the present study, correctly targeted floxed Poldip2 mice were generated and used to produce a new constitutive knockout line by crossing with a Cre deleter. In contrast to the gene trap model, many homozygous knockout mice were viable, in spite of having no POLDIP2 expression. To further characterize the effects of Poldip2 ablation in the vasculature, RNA-seq and RT-qPCR experiments were performed in constitutive knockout arteries. Results show that POLDIP2 inactivation affects multiple cellular processes and provide new opportunities for future in-depth study of its functions.


Subject(s)
CRISPR-Cas Systems , Gene Targeting , Membrane Proteins/genetics , Mitochondrial Proteins/deficiency , Mouse Embryonic Stem Cells/metabolism , Nuclear Proteins/deficiency , RNA-Seq , Animals , Membrane Proteins/metabolism , Mice , Mice, Knockout , Mitochondrial Proteins/metabolism , Nuclear Proteins/metabolism
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