Publications by authors named "Brooke Howitt"

Single-cell genomics technologies have accelerated our understanding of cell-state heterogeneity in diverse contexts. Although single-cell RNA sequencing identifies rare populations that express specific marker transcript combinations, traditional flow sorting requires cell surface markers with high-fidelity antibodies, limiting our ability to interrogate these populations. In addition, many single-cell studies require the isolation of nuclei from tissue, eliminating the ability to enrich learned rare cell states based on extranuclear protein markers.

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The advent of spatial transcriptomics and spatial proteomics have enabled profound insights into tissue organization to provide systems-level understanding of diseases. Both technologies currently remain largely independent, and emerging same slide spatial multi-omics approaches are generally limited in plex, spatial resolution, and analytical approaches. We introduce IN-situ DEtailed Phenotyping To High-resolution transcriptomics (IN-DEPTH), a streamlined and resource-effective approach compatible with various spatial platforms.

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Uterine carcinosarcomas (UCS) are high-grade biphasic neoplasms with generally poor outcomes. Based on The Cancer Genome Atlas molecular classification of endometrial carcinomas, the majority of UCS are classified as copy-number high/serous-like (p53-abnormal); however, a small subset represent other molecular subtypes, including those that harbor POLE mutations. We identified 11 POLE-mutated (POLEmut) UCS across 3 institutions and assessed the clinical, histopathologic, immunohistochemical, and molecular features of these tumors.

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Extrachromosomal DNA (ecDNA) is a major contributor to treatment resistance and poor outcome for patients with cancer. Here we examine the diversity of ecDNA elements across cancer, revealing the associated tissue, genetic and mutational contexts. By analysing data from 14,778 patients with 39 tumour types from the 100,000 Genomes Project, we demonstrate that 17.

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Article Synopsis
  • - KAT6B/A::KANSL1 gene fusion tumours display similarities with endometrial stromal and smooth muscle tumours, causing debate over their classification as a unique tumour type or variants of existing ones.
  • - Analysis of DNA methylation and genetic variations revealed a distinct subgroup of these tumours that presented with less aggressive histological features, while others exhibited high-grade characteristics linked to poorer clinical outcomes.
  • - The study indicates that KAT6B/A::KANSL1 uterine sarcomas are distinct molecular entities, with significant differences in prognosis, suggesting they should be classified separately from other uterine tumours.
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Objective: Identifying clinical features that are associated with recurrence of endometrioid endometrial carcinoma (EEC) in patients with diabetes mellitus (DM).

Methods: A single-center retrospective cohort study was performed on patients with a diagnosis of both DM and Stage I EEC. Clinical and pathologic features were analyzed in relation to 5-year progression free survival (PFS).

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  • SOX17 has potential as a biomarker for non-mucinous Müllerian carcinomas, but its expression in mesonephric-like adenocarcinoma (MLA) has not been previously studied.
  • Recent research revealed that 68% of MLAs showed low or negative SOX17 expression, contrasting with higher levels in most Müllerian carcinomas, although a small subset exhibited high expression.
  • The findings suggest that negative SOX17 staining can help differentiate MLA from other non-mucinous Müllerian carcinomas, and it may also assist in distinguishing mesonephric remnants from related malignancies.
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  • The GCIG Endometrial Cancer Consensus Conference was held in Incheon, South Korea, aimed at creating consensus statements to improve future clinical trials in endometrial cancer.
  • Representatives from 33 member groups developed 18 statements across four key topics, focusing on treatment strategies and trial methodologies, including consideration for low-resource settings.
  • For the first time, the conference included patient advocates and early-career investigators, resulting in a high consensus rate on the statements, reinforcing progress in global clinical research for endometrial cancer.
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Aims: The 2023 FIGO staging criteria for endometrial cancer (EC) introduced marked changes from the 2009 version. The full implication of these changes for patient diagnosis and treatment is unknown. We evaluate the differences in staging and prognostication between the two systems, with and without inclusion of molecular classification.

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The drivers of immune evasion are not entirely clear, limiting the success of cancer immunotherapies. Here we applied single-cell spatial and perturbational transcriptomics to delineate immune evasion in high-grade serous tubo-ovarian cancer. To this end, we first mapped the spatial organization of high-grade serous tubo-ovarian cancer by profiling more than 2.

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  • - STK11 adnexal tumours are rare malignant neoplasms associated with Peutz-Jeghers syndrome, primarily arising from para-adnexal soft tissues and potentially affecting the fallopian tube and ovary; diagnosis currently involves identifying STK11 mutations.
  • - Researchers conducted immunohistochemistry (IHC) on 122 tumours, including 17 STK11 adnexal tumours and 105 lookalikes; results showed that STK11 adnexal tumours had complete loss of STK11 protein expression, while other tumour types generally retained it.
  • - The study concludes that STK11 serves as a sensitive and specific marker for distinguishing STK11 adnexal tumours
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  • Low-grade serous ovarian carcinoma (LGSC) is a rare and dangerous type of ovarian cancer that is different from the more common high-grade version.
  • Researchers studied tissue samples from LGSC, high-grade serous ovarian carcinoma (HGSC), and serous borderline tumors (SBTs) to understand how they differ.
  • They found that the environment around the tumors was different in LGSC, including specific proteins and immune cells, which suggests that changing this environment could help develop new treatments.
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In pathology, the deployment of artificial intelligence (AI) in clinical settings is constrained by limitations in data collection and in model transparency and interpretability. Here we describe a digital pathology framework, nuclei.io, that incorporates active learning and human-in-the-loop real-time feedback for the rapid creation of diverse datasets and models.

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  • Decreased oestrogen receptor (ER) expression in endometrial carcinomas (EC) is linked to poorer prognosis, but the exact cut-off for distinguishing high-risk from low-risk cases is still unclear.
  • In a study of 120 biopsy specimens, the Allred scores indicated that the majority (over 80%) of non-specific molecular profile ECs had high ER expression (scores ≥ 7), while most non-endometrioid types had lower scores (≤ 6).
  • Results from analyzing matched biopsies and hysterectomies showed consistent ER staining, with only minor discrepancies, indicating reliable assessment methods for determining ER expression.
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Aims: Molecular classification according to The Cancer Genome Atlas (TCGA) improves endometrial endometrioid carcinoma (EEC) prognostication and has specific treatment implications; however, original data were skewed towards low-grade and low-stage tumours. Herein, we molecularly classify EECs metastatic at the time of diagnosis or with subsequently documented recurrent/metastatic disease to examine correlation with clinical outcomes.

Methods: TCGA categories include POLE-mutated, microsatellite instability (MSI), p53 abnormal (p53 abnl) and no specific molecular profile (NSMP).

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Since the establishment of 4 molecular subgroups of endometrial carcinoma (EC), there has been significant interest in understanding molecular classification in the context of histologic features and diagnoses. ECs with undifferentiated, spindle, and/or sarcomatous components represent a diagnostically challenging subset of tumors with overlapping clinical and histologic features. We examined the clinicopathologic, morphologic, immunohistochemical, and molecular features of these tumors identified in our institutions' pathology databases using immunohistochemistry and targeted sequencing.

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  • High-grade endometrial stromal sarcoma is a rare, aggressive tumor that typically affects older women and has a poor survival rate of 30-40%.
  • A 16-year-old patient with this condition, who had metastases in her lymph nodes and lungs, achieved long-term survival following complete tumor removal, chemotherapy, and radiation.
  • The case also revealed a new type of genetic translocation, suggesting that aggressive treatment and fertility preservation are vital for young patients diagnosed with this cancer.
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Purpose: Risk prediction with genomic and transcriptomic data has the potential to improve patient outcomes by enabling clinicians to identify patients requiring adjuvant treatment approaches, while sparing low-risk patients from unnecessary interventions. Endometrioid endometrial carcinoma (EEC) is the most common cancer in women in developed countries, and rates of endometrial cancer are increasing.

Experimental Design: We collected a 105-patient case-control cohort of stage I EEC comprising 45 patients who experienced recurrence less than 6 years after excision, and 60 Fédération Internationale de Gynécologie et d'Obstétrique grade-matched controls without recurrence.

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Demand for anal cancer screening is expected to rise following the recent publication of the Anal Cancer-HSIL Outcomes Research trial, which showed that treatment of high-grade squamous intraepithelial lesions significantly reduces the rate of progression to anal cancer. While screening for human papillomavirus-associated squamous lesions in the cervix is well established and effective, this is less true for other sites in the lower anogenital tract. Current anal cancer screening and prevention rely on high-resolution anoscopy with biopsies.

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Mesonephric adenocarcinomas (MAs) and mesonephric-like adenocarcinomas (MLAs) are rare, aggressive neoplasms that arise in the gynecologic tract and show overlapping morphologic, immunohistochemical, and molecular features. While MAs occur in the cervix and are thought to arise from mesonephric remnants, MLAs occur in the endometrium and ovary and are believed to originate from transdifferentiation of Müllerian lesions. Both MAs and MLAs show a variety of architectural patterns, exhibit frequent expression of GATA3 by immunohistochemistry, and harbor KRAS mutations.

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Steroid cell tumors (SCTs) of the ovary are rare and understudied, and as such, uncertainties remain about their malignant potential, as well as clinicopathologic predictors of patient outcome. Based on a multi-institutional cohort of cases, we present findings from the largest study of SCT reported to date. Clinicopathologic data were documented on 115 cases of SCT that were assembled from 17 institutions.

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  • Vulvar cancer is diagnosed in about 6,470 individuals each year, primarily as squamous cell carcinomas, constituting 5% to 8% of gynecologic cancers.
  • Key risk factors include older age, HPV infection, smoking, inflammatory vulvar conditions, and weakened immune systems.
  • The text reviews NCCN Clinical Practice Guidelines for treatments, surveillance, systemic therapies, and survivorship for those affected by vulvar cancer.
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Neuroendocrine carcinomas, such as neuroendocrine prostate cancer and small-cell lung cancer, commonly have a poor prognosis and limited therapeutic options. We report that ubiquitin carboxy-terminal hydrolase L1 (UCHL1), a deubiquitinating enzyme, is elevated in tissues and plasma from patients with neuroendocrine carcinomas. Loss of UCHL1 decreases tumor growth and inhibits metastasis of these malignancies.

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The NCCN Guidelines for Cervical Cancer provide recommendations for all aspects of management for cervical cancer, including the diagnostic workup, staging, pathology, and treatment. The guidelines also include details on histopathologic classification of cervical cancer regarding diagnostic features, molecular profiles, and clinical outcomes. The treatment landscape of advanced cervical cancer is evolving constantly.

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Identification of ultramutated/ POLE -mutated endometrial carcinomas ( POLEM ECs) has important implications given its association with better prognosis. However, POLE mutation testing is not widely available. Our objective was to evaluate POLEM ECs versus POLE wild-type ( POLEWT ) ECs, within a cohort of consultation cases with features suggestive of an ultramutated phenotype.

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