Background: Anaplastic thyroid carcinoma (ATC) is a highly aggressive, undifferentiated carcinoma that may arise on top of normal or abnormal thyroid. Making the diagnosis by fine needle aspiration (FNA) of the thyroid with a long-standing history of multinodular goiter (MNG) is not uncommon. We report a case discussing the cytopathologic findings and the relationship with long-standing goiter and thyroid exposure to radioactive iodine treatment. Case: A 90-year-old male patient presented with a > 45-year history of MNG that was associated with thyrotoxicosis and multiple courses of radioiodine (I-131) treatment. He developed recent symptoms of dyspnea, dysphagia, neck swelling and unintentional weight loss. Computed tomography of the neck was done revealing a large MNG with retrosternal extension and calcifications. FNA was performed revealing highly anaplastic cells with a colloid background and presence of neutrophils. The diagnosis of ATC was made. The patient refused any kind of management and was discharged upon his request. He died 2 days after the procedure, and no autopsy was performed. Conclusion: ATC is an aggressive, undifferentiated thyroid carcinoma that can be diagnosed by FNA and save the patient a surgical intervention. A background of MNG and history of radioactive iodine therapy is not uncommon.

The anaplastic lymphoma kinase (ALK) protein drives tumorigenesis in subsets of several tumors through chromosomal rearrangements that express and activate its C-terminal kinase domain. In addition, germline predisposition alleles and acquired mutations are found in the full-length protein in the pediatric tumor neuroblastoma. ALK-specific tyrosine kinase inhibitors (TKIs) have become important new drugs for ALK-driven lung cancer, but acquired resistance via multiple mechanisms including kinase-domain mutations eventually develops, limiting median progression-free survival to less than a year. Here we assess the impact of several kinase-domain mutations that arose during TKI resistance selections of ALK+ anaplastic large-cell lymphoma (ALCL) cell lines. These include novel variants with respect to ALK-fusion cancers, R1192P and T1151M, and with respect to ALCL, F1174L and I1171S. We assess the effects of these mutations on the activity of six clinical inhibitors in independent systems engineered to depend on either the ALCL fusion kinase NPM-ALK or the lung-cancer fusion kinase EML4-ALK. Our results inform treatment strategies with a likelihood of bypassing mutations when detected in resistant patient samples and highlight differences between the effects of particular mutations on the two ALK fusions.

Les neuroblastomes, même de haut risque répondent bien à la chimiothérapie initiale mais deviendront fréquemment résistants au traitement. Les inhibiteurs de topoisomérase I représentent un outil thérapeutique important dans la prise en charge des neuroblastomes réfractaires. Pour étudier la résistance aux inhibiteurs de topoisomérase I acquise dans un contexte thérapeutique, un modèle murin de neuroblastome résistant au CPT-11 a été développé. La chimiorésistance est connue comme un phénomène multifacoriel. Nous avons donc utilisé plusieurs approches pour mieux caractériser les mécanismes à l'origine de la résistance dans notre modèle. Une approche génomique a permis d'identifier la dérégulation de la voie de signalisation formée du récepteur ALK et de deux ligands PTN et MDK. Alors que ALK est décrit comme gène majeur de prédisposition au neuroblastome, principalement par le biais de mutations activatrices, nous avons démontré que l'activation du récepteur survenait par des mécanismes alternatifs aux mutations dans une large majorité de cas et participerait à l'initiation de la maladie. En revanche, nous n'avons pas pu prouver l'implication de ce récepteur dans la progression de la maladie ou dans sa réponse au traitement. Il semble que la régulation de ALK soit complexe et le rôle exact de ce récepteur dans la progression du neuroblastome reste à établir. En revanche, nous avons démontré l'importance du ligand MDK dans la régulation de l'expression et de l'activation de ALK ainsi que dans le contrôle de la survie des cellules neuroblastiques. Inhiber cette cytokine représente une stratégie thérapeutique intéressante, complémentaire des thérapies anti-ALK, actuellement en développement clinique dans le neuroblastome. D’autre part, la caractérisation phénotypique du modèle a permis de mettre en évidence une signalisation altérée des dommages à l'ADN associée à une instabilité génétique accrue dans les tumeurs résistantes. Celles-ci présentent également une modification de progression dans le cycle cellulaire et une proportion plus importante de cellules quiescentes. Au final, ce travail a permis d'identifier différents mécanismes de résistance qui représentent des marqueurs de réponse au traitement et des cibles thérapeutiques intéressantes dans le neuroblastome. / Neuroblastoma, including high-risk cases, show a good initial response to chemotherapy but will frequently become resistant to treatment. Topoisomerase I inhibitors represent an important therapeutic option for refractory neuroblastoma. To study the reisitance to topoisomerase I inhibitors acquired in a therapeutic setting, we developed in vivo a resistant model to irinotecan (CPT-11). Chemoresistance is known as a multifactorial phenomenon. We have therefore used several approaches to better characterize mechanisms leading to resistance in our model. A genomic approach enabled us to identify the deregulation of a signaling pathway, constituted with a receptor (ALK) and two lignads (PTN and MDK). While ALK is decsribed as a major neuroblastoma predisposition gene, mainly through activating mutations, we demonstrated that the activation of ALK occurs via mechanisms others than mutation in a large majority of cases. Moreover ALK activation is an important event in the initiation of the disease. However, we couldn’t prouve the implication of the receptor in the progression of the disease or in its response to treatment. It seems that the regulation of ALK is complex and its precise role in the progression of neuroblastoma remains to be precisely defined. Nevertheless, we have demonstrated the importance of MDK, one of ALK ligands in the regulation of the expression and activation of ALK as well as in the control of the neuroblastoma cells survival. The inhibition of the cytokine, MDK represents an interesting therapeutic strategy, complementary to anti-ALK therapies, currently in clinical development in neuroblastoma. On another hand, the phenotypic characterization of the model, showed an alteration of the signaling of DNA damage and an increased genomic instability in the resistant tumors. Those tumors also harbor a modification in the cell cycle progression, particularly an increased proportion of quiescent cells. Finally, this work enables us to identify several resistance mechanism that represent markers of response to chemotherapy and relevant therapeutic targets in neuroblastoma.

The first case of breast implant-associated anaplastic large cell lymphoma (breast implant ALCL) was described by John Keech and the late Brevator Creech in 1997. In the following 2 decades, much research has led to acceptance of breast implant ALCL as a specific clinicopathologic entity, a process that we bring up to life through the memories of 6 persons who were involved in this progress, although we acknowledge that many others also have contributed to the current state of the art of this disease. Dr. Keech recalls the events that led him and Creech to first report the disease. Ahmet Dogan and colleagues at the Mayo Clinic described a series of 4 patients with breast implant ALCL, and led to increased awareness of breast implant ALCL in the pathology community. Daphne de Jong and colleagues in the Netherlands were the first to provide epidemiologic evidence to support the association between breast implants and ALCL. Garry Brody was one of the first investigators to collect a large number of patients with the disease, present the spectrum of clinical findings, and alert the community of plastic surgeons. Roberto Miranda and L. Jeffrey Medeiros and colleagues studied the pathologic findings of a large number of cases of breast implant ALCL, and published the findings in 2 impactful studies in the medical oncology literature. The recognition and acceptance of this disease by surgeons, epidemiologists, and medical oncologists, working together, has led to subsequent studies on the pathogenesis and optimal therapy of this disease. / Revisión por pares

Though most primary brain gliomas present as a single mass lesion in the brain, this potential diagnosis must be considered in the differential diagnosis when faced with a case of multifocal brain mass lesions. Among the most common brain tumors in humans, glioblastomas can be classified into four classes, one of which consists of anaplastic astrocytomas (AA). Due to its significant malignant potential, a prompt stereotactic brain biopsy should be considered to allow for early diagnosis. Karyotypic analysis of the specimen may allow for the discovery of 1p12q and IDH132 gene mutations. This knowledge can be used to best determine prognosis and guide therapy.

No description available.

Anaplastic Lymphoma Kinase (ALK) is a Receptor Tyrosine Kinase (RTK) and an oncogene associated with several human diseases, but its normal function in humans and other vertebrates is unclear. Drosophila melanogaster has an ALK homolog, demonstrating that the RTK has been conserved throughout evolution. This makes Drosophila a suitable model organism for studying not only Drosophila ALK function, but also to study mammalian forms of ALK. In Drosophila the ligand Jeb activates ALK, initiating signaling crucial for visceral mesoderm development. The activating ligand for mammalian ALK is unclear, and for this reason Drosophila was employed in a cross-species approach to investigate whether Drosophila Jeb can activate mouse ALK. Jeb is unable to activate mouse ALK, and therefore mouse ALK is unable to substitute for and rescue the Drosophila ALK mutant phenotype. This suggests that there has been significant evolution in the ALK-ligand relationship between the mouse and Drosophila. In humans ALK has recently been shown to be involved in the development of neuroblastoma, a cancer tumor in children. I have developed a Drosophila model for examining human gain of function ALK mutants found in neuroblastoma patients. The various ALK variants have acquired point mutations in the kinase domain that have been predicted to activate the RTK in a constitutive and ligand independent manner. When expressed in the fly eye, active human ALK mutants result in a rough eye phenotype, while inactive wild type ALK does not, due to the lack of an activating ligand in the fly. In this way  several of the ALK mutations identified in neuroblastoma patients could be confirmed to be activated in a ligand independent manner. Moreover, a novel ALK mutant; ALKF1174S, was discovered in a neuroblastoma patient and was in the Drosophila model shown to be a gain of function mutation, and a previously predicted gain of function mutation; ALKI1250T, was shown to be a kinase dead mutation. This fly model can also be used for testing ALK selective inhibitors, for identifying activating ligands for human ALK and for identifying conserved components of the ALK signaling pathway. Gut musculature development in Drosophila is dependent on ALK signaling, while somatic muscle development is not. Proteins of the Wasp-Scar signaling network regulate Arp2/3-complex mediated actin polymerization, and I have investigated their function in visceral and somatic muscle fusion. I found that Verprolin and other members of this protein family are essential for somatic but not visceral muscle development. Despite fusion defects in both tissues in Verprolin and other examined mutants, gut development proceeds, suggesting that fusion is not crucial for visceral mesoderm development. Hence the actin polymerization machinery functions in both somatic and visceral muscle fusion, but this process only appears to be essential in somatic muscle development. / Exploiting Drosophila as a model system for studying Anaplastic Lymphoma Kinase in vivo

The rate of thyroid cancer diagnosis has risen, and researchers' findings point to improved diagnostic testing and overdiagnosis as well as increases in actual incidences as the reasons behind this rise. With improved treatments and testing methods, the number of thyroid cancer survivors has also increased. Thyroid cancer presents challenges to coping and can cause significant stress in an individual's life. More specifically, anaplastic thyroid cancer (ATC) creates complicated challenges for patients and survivors. The problem is patients need support during diagnosis and treatment when adjusting to their 'new normal' and may be reaching to Internet based social support groups to gain health information. Lazarus's transactional theory of stress and coping formed a framework for this generic qualitative exploration of the types of support and information ATC patients and survivors receive through participating in an online Facebook support group. Thematic content analysis was conducted on archival data collected from the group over 4 months, namely 2,384 posts created by 166 group members. From this analysis, a picture relevant to all group participants was developed to include themes found among the data. Themes of emotional, informational and spiritual support emerged as well as the significance of using emojis as symbolic expressions of support. Implications for social change include expanding the theoretical knowledge of the ATC patient and survivor experience and the types of support available in online environments. This knowledge can lead to positive social change in terms of improving support resources, which may help in recovery from ATC; lessening the burden on patients, families, providers, insurance, the healthcare system, and our society as a whole.

L'oncogène ALK (Anaplastic Lymphoma Kinase) est une tyrosine kinase constitutivement active, impliquée dans divers cancers, tels que les lymphomes anaplasiques à grandes cellules (LAGC), ou certains carcinomes bronchiques. Ces tumeurs sont traitées par chimiothérapie, ce qui n'est pas un traitement optimal (30% de rechutes, abaissement de la qualité de vie). Dans ce contexte, de nombreux inhibiteurs spécifiques de la tyrosine kinase ALK tels que le Crizotinib ont été développés et ont prouvé leur efficacité à la fois dans des modèles in vitro, in vivo ainsi que chez les patients. Néanmoins, le succès de cette thérapie ciblée est limité par l'apparition de résistances. Il est donc essentiel de mettre au jour de nouvelles stratégies thérapeutiques permettant de contrecarrer ces résistances. Récemment, l'autophagie, un processus catabolique intracellulaire de dégradation lysosomale, a été proposée comme nouvelle cible thérapeutique dans le traitement des cancers résistants aux inhibiteurs de tyrosine kinase. Le premier objectif de mon projet de thèse a été de caractériser ce processus autophagique dans les LAGC ALK+, en réponse à différents traitements. Nous avons montré que (1) l'autophagie était activée dans des lignées de LAGC en réponse à l'inhibition de ALK, (2) que cette autophagie jouait un rôle cytoprotecteur dans ce modèle et (3) que les traitements par chimiothérapies de ces cellules n'induisaient pas de réponse autophagique. Dans un deuxième temps, nous nous sommes intéressés à la régulation potentielle de l'autophagie par les microARNs. Nous avons montré que plusieurs microARNs, dont le miR-7, étaient sous-exprimés en réponse au traitement par le Crizotinib et que la réexpression ectopique de ce miR-7 permettait une potentialisation de l'effet du Crizotinib, par l'induction d'autophagie cytotoxique dans notre modèle. Nous avançons également l'hypothèse que le " switch " autophagique de la cytoprotection à la cytotoxicité, que nous observons pourrait s'expliquer par la régulation de l'expression de plusieurs protéines cibles de miR-7 telles que Bcl-2 ou c-Raf. Ainsi, l'ensemble de nos résultats nous permettent de mieux comprendre le rôle et la régulation de l'autophagie induite en réponse à l'inhibition de ALK dans les LAGC ALK+, et pourrait à terme contribuer à l'amélioration des thérapies actuelles de divers cancers dépendants de l'oncogène ALK. / The ALK oncogene (Anaplastic Lymphoma Kinase) is a constitutively activated tyrosine kinase implied in various cancers including Anaplastic Large Cell Lymphomas (ALCL), or some lung adenocarcinomas. The current operative treatment is standard chemotherapy, which is not optimal (30% of relapses, low quality of life). In this context, new specific ALK inhibitors such as Crizotinib have been developed, and have showed their efficiency in vitro, in vivo and in patients. However, the emergence of resistant mutations has been described. Thus, the identification of alternative therapies targeting new pathways appears as mandatory to counteract those resistances. In this context, autophagy, an intracellular catabolic lysosomal process, has been described as a new therapeutic target in the treatment of cancers resistant to tyrosine kinase inhibitors. The first aim of my project was to characterize the autophagic process in ALK+ ALCL, upon different treatments. We showed that (1) autophagy was activated in ALK+ ALCL cell lines in response to ALK inhibition (2) that this autophagy played a cytoprotective role in our model and (3) that treatment with chemotherapies did not trigger an autophagic response. In a second part of the project, we focused on the potential regulation of autophagy by microRNAs. We showed that several microRNAs including miR-7 were down-regulated upon Crizotinib treatment and that ectopic re-expression of this miR-7 potentiates the effects of Crizotinib by induction of cytotoxic autophagy in our model. We hypothesized that this switch in the role of autophagy from cytoprotection to cytotoxicity observed in our model, could be explained by the regulation of several protein targets of miR-7 such as Bcl-2 or c-Raf. Altogether, these results enable a better understanding of the role and regulation of autophagy induced upon ALK inhibition in ALCL, and could in the longer term, contribute to improvement of current therapies of cancers involving the ALK oncogene.

Arkadia participa do processo de amplificação da sinalização de TGF-b mediada por Smads, via degradação do I-Smad. O objetivo desse estudo foi caracterizar e investigar a influência de Arkadia em linhagens celulares de cânceres de tiróide. A expressão gênica de Arkadia em linhagens celulares de carcinomas papílifero (NPA), folicular (WRO) e anaplásico (ARO), foi avaliada por PCR quantitativo. Em ARO, que apresenta a maior expressão de Arkadia, foram identificados subclones (ARO_1 e ARO_2) com expressão diferencial de Arkadia, ARO_2>ARO_1. A expressão gênica de SMAD2, 3, 4, 7 e de genes do ciclo celular modulados por TGF-b, foi maior em ARO_2. Os subclones respondem ao tratamento com peptídeo de TGF-b1 e activina A. O crescimento in vivo (xenotransplante) mostra que ARO_2 desenvolve um tumor de menor volume. Recentemente a origem de ARO foi questionada e comprovamos sua origem por análises de expressão gênica e morfologias. Desta maneira, observamos que a expressão diferencial de Arkadia indica que ela está envolvida na modulação inibitória da via de TGF-b. / Arkadia is involved in the process of amplification of the TGF-b signaling mediated by Smads, by degradation of I-Smad. The aim of this study was to characterize and investigate the influence of Arkadia in thyroid cancers cell lines. Arkadia gene expression in the papillary (NPA), follicular (WRO) and anaplastic carcinoma cell lines (ARO) was evaluated by quantitative PCR. In ARO, which presents the highest Arkadia expression, we identified subclones (ARO_1 and ARO_2) with differential Arkadia expression ARO_2> ARO_1. The expression of SMAD2, 3, 4, 7 and the cell cycle genes modulated by TGF-b, was also higher in ARO_2. However both the subclones responded to treatment with peptide of TGF-b1 and activin A. The in vivo growth (evaluated by xenotransplant), showed that ARO_2 developed tumors of lower volume. Recently the ARO origin was questioned and we proved its origin by gene expression and morphological analysis. This way, the differential Arkadia expression indicates that it is involved in modulation of the inhibitory TGF-b pathway.