FISH analysis reveals CDKN2A and IFNA14 co-deletion is heterogeneous and is a prominent feature of glioblastoma.

Deletion of CDKN2A occurs in 50% of glioblastomas (GBM), and IFNA locus deletion in 25%. These genes reside closely on chromosome 9. We investigated whether CDKN2A and IFNA were co-deleted within the same heterogeneous tumour and their prognostic implications. We assessed CDKN2A and IFNA14 deletions in 45 glioma samples using an in-house three-colour FISH probe. We examined the correlation between p16INK4a protein expression (via IHC) and CDKN2A deletion along with the impact of these genomic events on patient survival. FISH analyses demonstrated that grades II and III had either wildtype (wt) or amplified CDKN2A/IFNA14, whilst 44% of GBMs harboured homozygous deletions of both genes. Cores with CDKN2A homozygous deletion (n = 11) were negative for p16INK4a. Twenty p16INK4a positive samples lacked CDKN2A deletion with some of cells showing negative p16INK4a. There was heterogeneity in IFNA14/CDKN2A ploidy within each GBM. Survival analyses of primary GBMs suggested a positive association between increased p16INK4a and longer survival; this persisted when considering CDKN2A/IFNA14 status. Furthermore, wt (intact) CDKN2A/IFNA14 were found to be associated with longer survival in recurrent GBMs. Our data suggest that co-deletion of CDKN2A/IFNA14 in GBM negatively correlates with survival and CDKN2A-wt status correlated with longer survival, and with second surgery, itself a marker for improved patient outcomes.

Impact of Anxiety and Depression on the Level of Asthma Control Among Jordanian Adults with Asthma.

Purpose: Recent studies imply that psychological factors may actively contribute to the development of asthma. It is generally known that people with asthma frequently suffer from psychological illnesses. This association can make it challenging to reach asthma control. This study aimed to assess the prevalence of depression and anxiety among Jordanian adults with asthma, in addition to the link between asthma control levels and these psychological disorders. Patients and Methods: This cross-sectional study included 175 adults with asthma who visited the tertiary asthma clinic in three Jordanian Governmental hospitals. Sociodemographic data was collected directly from the patients who were assessed for their level of depression and anxiety using a self-administered questionnaire, the Hospital Anxiety and Depression Scale (HADS). Also, asthma control was assessed using the Asthma Control Test (ACT). The relation between the different sociodemographic variables and clinical data, particularly depression and anxiety and asthma control level, was assessed. Results: Among 175 asthmatic patients, 60.57% had poor disease control, 8% had anxiety alone, 11.43% had depression alone, and 53.14% had anxiety plus depression. Poor asthma control was significantly associated with anxiety and depression (p= 0.044) and low levels of education (p=0.001). Further, a lower level of education was also related to higher levels of anxiety and depression. Conclusion: Most of the assessed Jordanian patients with asthma had their disease poorly controlled. Anxiety and depression are common among the studied sample of adults with asthma, and they appear to affect the level of disease control, suggesting the possibility that addressing these psychological conditions could enhance asthma control levels.

GRP78 is Overexpressed in Non-small Cell Lung Cancer Tissues and is Associated with High VEGF Expression in Squamous Cell Carcinoma: A Pilot Study.

BACKGROUND: Neovascularization is essential for the growth and progression of tumor tissues. GRP78 is frequently overexpressed in various cancers and has been suggested as a proangiogenic factor. PURPOSE: This study aimed to investigate the expression levels of GRP78 and to test for significant relationships with the angiogenic markers, VEGF, and CD31. METHODS: In this study, paraffin-embedded NSCLC tissue samples (71 adenocarcinomas and 23 squamous cell carcinoma) were retrospectively collected from 94 patients with NSCLC. The expressions of VEGF, CD31, and GRP78 were determined by immunohistochemistry. RESULTS: High expression levels of VEGF and GRP78 were observed in 65 and 74 cases, respectively. Thirty-six patients expressed high CD31 levels. Adenocarcinomas expressed higher levels of the three proteins than squamous cell carcinomas (p-value < 0.05). Moreover, a statistically significant association was found between the expression levels of VEGF and CD31 (p-value = 0.001) and VEGF and GRP78 (p-value=0.028). CONCLUSION: GRP78 overexpression was revealed in most of the investigated samples. The positive association between VEGF and GRP78 may indicate the proangiogenic role of GRP78 in lung cancer. Moreover, the positive association between VEGF and CD31 expression levels suggests that VEGF may cooperate with CD31 to promote angiogenesis in NSCLC.

Chromophobe renal cell carcinoma with sarcomatoid and heterologous osteosarcoma-like differentiation: a case report and literature review.

Chromophobe renal cell carcinoma (CRCC) is a subtype of renal cell carcinoma (RCC) with a favorable prognosis. Sarcomatoid differentiation in RCC is assumed to be the outcome of the parent tumor's dedifferentiation and associated with poorer prognosis. Sarcomatoid differentiation can be detected in CRCC as well as other subtypes, but the occurrence of divergent osteosarcoma-like components in sarcomatoid CRCC is extremely unusual. Only six cases have been previously reported in the literature, we reviewed them and presented the seventh case in a 71-year-old male who had a left kidney heterogeneous mass. The resected tumor showed a sarcoma-like spindle cell area with an adjacent osteosarcoma area producing lacy bone material and bony trabeculae in a hard area mixed with a typical CRCC. In conclusion, sarcomatoid CRCC with osteosarcomatous differentiation is a very rare tumor and should be kept in mind especially when dealing with small or frozen sections biopsies.

Cauda equina syndrome as the initial presentation of uveal melanoma metastasis.

PURPOSE: Uveal melanoma extension to the central nervous system (CNS) is exceedingly rare, and can occur through optic nerve invasion. We report a rare clinical case that presented with cauda equina syndrome as the initial manifestation of metastasis of choroidal melanoma, and showed neurotropic extension by histopathology. Our patient did not demonstrate any evidence of systemic metastasis otherwise. OBSERVATIONS: A 60-year-old male patient with treated choroidal melanoma in his right eye, with presumed clinical control, developed radiation-induced neovascular glaucoma refractory to medical therapy. The eye required enucleation for pain control. One month post-enucleation, he presented to the emergency department with severe abdominal pain, urine retention, constipation, and leg weakness. Magnetic resonance imaging (MRI) of the spine showed extensive leptomeningeal involvement along the entire spinal cord and the cauda equina. On further inquisition, the patient noted prior visual field defect in the contralateral eye. Brain MRI revealed intracranial metastasis with chiasmal involvement. The patient underwent radiotherapy for the brain and spine to improve his symptoms, and was ultimately transferred to palliative care. CONCLUSION AND IMPORTANCE: Optic nerve invasion in uveal melanoma may lead to neurotropic spread of melanoma cells with risk of intracranial and spinal cord metastasis. Neurological symptoms should raise the suspicion of clinicians regarding this complication, which is associated with increased melanoma-related mortality.

Pregnancy and Delivery After Ovarian Yolk Sac Tumor: A Case Report.

BACKGROUND A yolk sac tumor (YST) is a rare, malignant tumor of cells that line the yolk sac of the embryo. It most frequently occurs in the ovary (ovarian yolk sac tumor: OYST) in children and adolescents. Thus, fertility-preservation treatment is a concern. CASE REPORT A 24-year-old nulliparous woman visited us for infertility treatment and then right OYST was detected. A unilateral right salpingo-oophorectomy, infra-colic omentectomy, ipsilateral lymph node dissection, and peritoneal biopsies were performed. Histological examination confirmed the diagnosis of a stage IC OYST. Six cycles of bleomycin-etoposide-cisplatin chemotherapy were performed. She had no recurrence over the next 16 months. She conceived by in-vitro fertilization, and abdominally gave birth to a term infant. Both mother and baby had a smooth recovery. CONCLUSIONS This case adds further evidence to the 5-year survival and progression-free survival following surgery and chemotherapy in OYSTs, while preserving fertility.