Case Report: Long-Term Survival of a Pediatric Patient With an Intra-Abdominal Undifferentiated Carcinoma of Unknown Primary.

An 8-year and 10-month-old boy presented following 2 weeks of abdominal pain, vomiting, constipation, and rectal pain. A diffuse lower-abdominal mass was felt upon palpation, with radiological findings confirming the presence of a large, multilobulated intraperitoneal mass with mesenteric lymphadenopathy and hepatic metastatic disease. A biopsy of the mass revealed anatomical pathological findings consistent with a diagnosis of intra-abdominal undifferentiated carcinoma of unknown primary (CUP). The patient was treated with six cycles of carboplatin and gemcitabine prior to surgery. Following incomplete resection of the tumor, four further cycles were administered resulting in resolution of the pelvic mass, but progression in the right and left lobes of the liver. Therapy was accordingly adjusted, with administration of six cycles of ifosfamide and doxorubicin followed by 1 year of metronomic vinorelbine and cyclophosphamide maintenance therapy. The patient remains in remission 7 years from completion of therapy. Whole exome sequencing revealed missense mutations in the DNA-repair and chromatin-remodeling genes FANCM and SMARCD2, and a tumor-derived cell line revealed a complex karyotype suggesting chromosomal instability. CUP is an extremely rare diagnosis in the pediatric population, previously reported during adolescence. This report provides detailed characterization of CUP in a young child and in the absence of defined therapeutic guidelines for pediatric CUP, the successful treatment strategy described should be considered for similar cases.

Chromosomal instability in first trimester miscarriage: a common cause of pregnancy loss?

BACKGROUND: First trimester miscarriage without underlying medical conditions is most commonly caused by chromosomal abnormalities reported to occur in 50% or more of cases. These chromosomal changes in early losses include both numerical abnormalities and structural alterations that result in gain and/or loss of genetic information. Structural alterations are much less common than numerical changes. Jumping translocations (JTs) are considered extremely rare with only four cases previously reported. METHODS: We report 12 examples of chromosome instability seen in the fetal material of spontaneous first trimester miscarriages in a single study population. RESULTS: In these examples, we observed different cell lines with related chromosomal alterations. Some may be considered to be JT, where a single donor site was observed with different recipients. Others involved more than one site on the "donor" chromosome. One reported miscarriage involved multiple aneuploidy. All alterations resulted in partial trisomies and monosomies which predisposed the pregnancy to chromosomal imbalance and subsequent demise. Patient demographic data did not indicate possible causes of the errors observed. CONCLUSIONS: This is the first report of such a large cohort and is believed to be the result of increased knowledge and depth of analysis in this area, rather than a representation of confounding factors in this population. It is therefore proposed that identifying these chromosomal changes must be incorporated into the system of testing within the clinical environment. We must also recognize that some routine laboratory techniques will fail to detect such genetic changes.

Temporal changes in chromosome abnormalities in human spontaneous abortions: Results of 40 years of analysis.

Studies during the past 50 years demonstrate the importance of chromosome abnormalities to the occurrence of early pregnancy loss in humans. Intriguingly, there appears to be considerable variation in the rates of chromosome abnormality, with more recent studies typically reporting higher levels than those reported in early studies of spontaneous abortions. We were interested in examining the basis for these differences and accordingly, we reviewed studies of spontaneous abortions conducted in our laboratories over a 40-year-time span. Our analyses confirm a higher rate of abnormality in more recent series of spontaneous abortions, but indicate that the effect is largely, if not entirely, attributable to changes over time in the maternal age structures of the study populations. © 2016 Wiley Periodicals, Inc.

1(st) trimester miscarriage: four decades of study.

Miscarriage is a very common occurrence in humans. This paper sets out to present published data on research that has provided increased understanding of pregnancy failure. Clarification of definitions, exploring the range of failures from preclinical to later pregnancy losses, and the scientific tools employed to find information on the losses have been documented. What is now understood, which tools work best, and the associated limitations are all discussed. Early studies used cytogenetic methods and tissue culture to obtain results. Improvements in laboratory tools such as better tissue culture incubators, inverted microscopes, laminar flow hoods, improvements in culture media, all contributed to obtaining more results for patients. These studies demonstrated the significant contribution of unbalanced chromosomal karyotypes to pregnancy failure. Maternal age as a contributing factor in trisomy was clearly demonstrated. First trimester miscarriage exhibits very high cytogenetic abnormality; in contrast to very low rates in later losses. Combining data across all time periods of pregnancy will affect the significance of chromosomal error in the early pregnancy failures. Cytogenetic methods investigate whole genomes, and are considered to represent the standard against which new methods must be validated. New molecular genetic methods provide the opportunity to examine samples without the necessity of tissue culture. Techniques may be site-specific or whole genome. Fluorescent in situ hybridisation (FISH), comparative genomic hybridisation (CGH), array-based CGH, single nucleotide polymorphism (SNP) detection, quantitative polymerase chain reaction (qPCR), and quantitative fluorescent PCR (QF-PCR), have all been utilised. In comparison studies with classical/conventional cytogenetics, each newer method offers advantages and limitations. At the present time, a combined approach using conventional and molecular methods will elucidate the cause of miscarriage for almost all samples. In a clinical setting this would be optimum.

Human liver progenitor cell lines are readily established from non-tumorous tissue adjacent to hepatocellular carcinoma.

Non-tumorous liver tissue removed during surgery to resect hepatocellular carcinoma (HCC) is potentially a useful source of material from which cells, particularly liver progenitor/stem cells (LPCs), can be isolated to establish cell lines. The purpose of this study was to evaluate the applicability of the "plate-and-wait" method to derive LPCs from resections to remove HCC. Three independent non-tumorous liver samples from HCC resection and 3 samples from liver donors were used for LPC isolation. Staining for LPC markers, OV6, CK19, and EpCAM, in the above liver samples demonstrated staining in only 2 of the non-tumorous samples. We isolated 2 human liver epithelial cell lines (HLECs) from these 2 samples. These HLECs were positive for general stem cell markers CD133, EpCAM, and Oct4. They expressed the liver progenitor cell markers OV6, CK14, and M2PK but not CK19. They also expressed the hepatocellular markers albumin, CK8, CK18, HNF4-alpha, and the drug-metabolizing gene CYP3A4. These cells accumulated glycogen, indocyanine green, and synthesized urea. They produced colonies in soft agar that showed anchorage-independent growth and their tumorigenic status was confirmed when they produced tumors following transfer to athymic nude mice. In contrast, the third non-tumorous tissue and 3 normal liver samples did not produce cell lines. This study establishes a correlation between the presence of LPCs in the source liver tissue and the ability to derive cell lines from these tissues. The phenotypic similarities between the LPCs and the HLECs suggest that a precursor-product relationship may exist between the 2 cell types.

Further insight into the heparin-releasable and glycosylphosphatidylinositol-lipid--anchored forms of tissue factor pathway inhibitor.

The release of tissue factor pathway inhibitor (TFPI) from human umbilical vein endothelial cells (HUVECs) was investigated using heparin and phospholipase C. The experiment included incubating HUVECs with 0, 1, or 10 U/mL heparin diluted in Dulbecco Modified Eagle's Medium plus 5% fetal calf serum for 1 or 24 hours. A statistically significant increase in TFPI activity levels was seen at 1 hour, but not at 24 hours. A 20-fold increase in the release of TFPI after phospholipase C treatment of HUVECs was demonstrated, confirming that it is glycosylphosphatidylinositol-lipid (GPI) anchored. Sequential treatment of HUVECs with phospholipase C and heparin was performed, and a trend was observed where GPI-anchored TFPI levels were increased after 1 hour of pretreatment with heparin but were decreased after 24 hours. Serum is a requirement for the heparin-dependent release of TFPI from HUVECs. Heparin pretreatment of HUVECs may affect levels of GPI anchored TFPI in a time and dose-dependent manner.