Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Pancreatic Neoplasms: HELP
Articles by John Hart
Based on 6 articles published since 2010
(Why 6 articles?)
||||

Between 2010 and 2020, John Hart wrote the following 6 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Article Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles. 2016

Kwak, Heewon A / Liu, Xiuli / Allende, Daniela S / Pai, Rish K / Hart, John / Xiao, Shu-Yuan. ·Department of Pathology, University of Chicago, Chicago, IL, USA. · Department of Pathology, University of Florida, Gainesville, FL, USA. · Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA. · Department of Pathology, Mayo Clinic, Scottsdale, AZ, USA. ·Mod Pathol · Pubmed #27198568.

ABSTRACT: Intraductal papillary mucinous neoplasm is considered a precursor lesion to pancreatic adenocarcinoma. These are further classified into four histologic subtypes: gastric, intestinal, pancreatobiliary, and oncocytic. The first aim of this study was to assess the interobserver variability among five gastrointestinal pathologists in diagnosing intraductal papillary mucinous neoplasm subtypes by morphology alone. The second aim of the study was to compare intraductal papillary mucinous neoplasm subtypes, which received consensus diagnoses (≥80% agreement) with their respective mucin immunoprofiles (MUC1, MUC2, MUC5AC, MUC6, and CDX2). A consensus histologic subtype was reached in 58% of cases (29/50) among the five gastrointestinal pathologists. Overall there was moderate agreement (κ=0.41, P<0.01) in subtyping intraductal papillary mucinous neoplasms without the use of immunohistochemistry. The histologic subtype with the best interobserver agreement was intestinal type (κ=0.56, P<0.01) followed by pancreatobiliary, gastric, mixed, and oncocytic types (κ=0.43, P<0.01; κ=0.38, P<0.01; κ=0.17, P<0.01; κ=0.08, P<0.04, respectively). Both kappa values for mixed and oncocytic subtypes were likely artificially low due to the underrepresentation of these subtypes in this study and not a true indication of poor interobserver agreement. Following an intradepartmental consensus meeting between two gastrointestinal pathologists, 68% of cases (34/50) received a consensus intraductal papillary mucinous neoplasm subtype. Sixty-nine percent of cases (11/16) that did not receive a consensus intraductal papillary mucinous neoplasm subtype could be classified based on their respective immunoprofiles. Standardizing the use of immunohistochemistry with a mucin immunopanel (MUC1, MUC2, MUC5AC, and MUC6) may improve the agreement of diagnosing intraductal papillary mucinous neoplasm histologic subtypes.

2 Article The expression of FOXL2 in pancreatic, hepatobiliary, and renal tumors with ovarian-type stroma. 2014

Westerhoff, Maria / Tretiakova, Maria / Hart, John / Gwin, Katja / Liu, Xiuli / Zhou, Ming / Yeh, Matthew M / Antic, Tatjana. ·University of Washington Medical Center, Seattle, WA 98195. Electronic address: mwest2@uw.edu. · University of Washington Medical Center, Seattle, WA 98195. · University of Chicago Medical Center, Chicago, IL 60637. · Cleveland Clinic, Cleveland, OH 809835. · New York University, New York, NY 10012. ·Hum Pathol · Pubmed #24746205.

ABSTRACT: FOXL2, a gene encoding a member of the fork-head-winged-helix family of transcription factors, is one of the earliest expressed genes during female gonadal development. It is expressed in normal ovarian stroma and ovarian neoplasms with granulosa cell lineage. Nonovarian tumors such as pancreatic mucinous cystic neoplasms (PMCs), hepatobiliary cystadenomas (HBCs), and mixed epithelial and stromal tumor of the kidney (MEST) have ovarian-type stroma. Immunohistochemical staining with FOXL2, estrogen receptor, and progesterone receptor was performed on 21 PMCs, 13 HBCs, and 10 MESTs and assessed for nuclear immunohistochemical positivity in the tumor stroma. All cases of PMC and HBC demonstrated nuclear reactivity for FOXL2 in the subepithelial stromal cells. Ninety percent of MEST demonstrated nuclear FOXL2 positivity. Estrogen receptor nuclear positivity was demonstrated in 57% of PMC, 77% of HBC, and 80% of MEST. Progesterone receptor nuclear positivity was present in 67% of PMC, 100% of HBC, and 90% of MEST. Clinical information was available for 37 patients. Seventy-eight percent of the patients had a history of obesity, heavy alcohol use, or hormone-related therapy. The 2 male patients had histories significant for morbid obesity and chronic alcoholism. FOXL2 is expressed from the early stages of ovarian development and has been shown to be mandatory for normal ovarian function. We have shown that it is also expressed in the aberrant ovarian-type stroma characteristic of PMC, HBC, and MEST. Most of such patients, including the rare male patients, have risk factors for hormonal abnormalities such as obesity and hormonal replacement therapy.

3 Article Pancreatic ductal adenocarcinoma with autoimmune pancreatitis-like histologic and immunohistochemical features. 2014

Zhang, Xuefeng / Liu, Xiuli / Joseph, Loren / Zhao, Lei / Hart, John / Xiao, Shu-Yuan. ·Department of Pathology, University of Chicago Medical Center, 5841S Maryland Ave, Chicago, IL 60605, USA. · Department of Pathology, Cleveland Clinics, Cleveland, OH 55195, USA. · Department of Pathology, University of Chicago Medical Center, 5841S Maryland Ave, Chicago, IL 60605, USA. Electronic address: sxiao@bsd.uchicago.edu. ·Hum Pathol · Pubmed #24457081.

ABSTRACT: Autoimmune pancreatitis (AIP) often manifests as a mass lesion causing obstructive jaundice, clinically mimicking pancreatic carcinoma. A diagnosis of AIP may obviate the need for surgical resection, as most patients respond to steroid treatment. However, it is not clear whether these 2 conditions can coexist. In this study, 105 specimens resected for pancreatic ductal adenocarcinoma (PDAC) that also have changes of chronic pancreatitis were examined for features considered to be characteristic of AIP. Of 105 cases of PDAC with changes of chronic pancreatitis, 10 (9.5%) exhibited histologic features of AIP, including exuberant fibrosis, lymphoplasmacytic infiltration, obliterative phlebitis, or granulocytic epithelial lesions. Of these 10 cases, 7 had more than 20 immunoglobulin G4+ plasma cells per high-power field. Of these 7 cases, 5 were analyzed for Kirsten rat sarcoma viral oncogene mutation and SMAD4 expression. Three cases showed K-ras mutation and/or loss of SMAD4 expression in benign AIP-like areas. These findings suggest 2 possibilities: first, AIP-like lesions may occur in a small but significant portion of PDAC cases; second, some PDACs may arise in a background of AIP. Therefore, caution is necessary when making a diagnosis of AIP by needle biopsy of a mass lesion, and patients with a tentative AIP diagnosis should be closely followed up clinically.

4 Article A pilot study of in vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy under endosonographic guidance. 2013

Konda, Vani J A / Meining, Alexander / Jamil, Laith H / Giovannini, Marc / Hwang, Joo Ha / Wallace, Michael B / Chang, Kenneth J / Siddiqui, Uzma D / Hart, John / Lo, Simon K / Saunders, Michael D / Aslanian, Harry R / Wroblewski, Kirsten / Waxman, Irving. ·Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, University of Chicago Medicine, Chicago, Illinois, USA. ·Endoscopy · Pubmed #24163192.

ABSTRACT: BACKGROUND AND STUDY AIMS: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) of pancreatic cystic lesions (PCL) is flawed by inadequate diagnostic yield. Needle-based confocal laser endomicroscopy (nCLE) utilizes a sub-millimeter probe that is compatible with an EUS needle and enables real-time imaging with microscopic detail of PCL. The aims of the In vivo nCLE Study in the Pancreas with Endosonography of Cystic Tumors (INSPECT) pilot study were to assess both the diagnostic potential of nCLE in differentiating cyst types and the safety of the technique. PATIENTS AND METHODS: Eight referral centers performed nCLE in patients with PCL. Stage 1 defined descriptive terms for structures visualized by an off-line, unblinded consensus review. Cases were reviewed with a gastrointestinal pathologist to identify correlations between histology and nCLE. Stage 2 assessed whether the specific criteria defined in Stage 1 could identify pancreatic cystic neoplasms (PCN) including intraductal papillary mucinous neoplasms, mucinous cystic adenoma, or adenocarcinoma in an off-line blinded consensus review. RESULTS: A total of 66 patients underwent nCLE imaging and images were available for 65, 8 of which were subsequently excluded due to insufficient information for consensus reference diagnosis. The presence of epithelial villous structures based on nCLE was associated with PCN (P=0.004) and provided a sensitivity of 59%, specificity of 100%, positive predictive value of 100 %, and negative predictive value of 50%. The overall complication rate was 9% and included pancreatitis (1 mild case, 1 moderate case), transient abdominal pain (n=1), and intracystic bleeding not requiring any further measures (n=3). CONCLUSIONS: These preliminary data suggested that nCLE has a high specificity in the detection of PCN, but may be limited by a low sensitivity. The safety of nCLE requires further evaluation.

5 Article First assessment of needle-based confocal laser endomicroscopy during EUS-FNA procedures of the pancreas (with videos). 2011

Konda, Vani J A / Aslanian, Harry R / Wallace, Michael B / Siddiqui, Uzma D / Hart, John / Waxman, Irving. ·Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois 60637, USA. ·Gastrointest Endosc · Pubmed #21924718.

ABSTRACT: BACKGROUND: Challenges in EUS-guided FNA (EUS-FNA) include sampling error, nondiagnostic cytology, and limited on-site cytological evaluation. A prototype needle-based confocal laser endomicroscopy (nCLE) probe is a submillimeter probe that provides real-time imaging at the microscopic level through the FNA needle. OBJECTIVE: To evaluate the feasibility of nCLE during EUS-FNA of pancreatic lesions. DESIGN: Feasibility study. SETTING: Multicenter, tertiary care. PATIENTS: Eighteen patients presenting for EUS-FNA. INTERVENTIONS: Patients were injected with 2.5 mL of 10% fluorescein. The lesion was interrogated with the nCLE probe positioned at the tip of a 19-gauge FNA needle. MAIN OUTCOME MEASUREMENTS: Device integrity, technical ease, safety, and image acquisition. RESULTS: Cases included 16 cysts and 2 masses. There were no device malfunctions. Technical challenges were encountered in 6 of 18 attempts to image and reflected challenges with a postloading technique, the longer ferule tip, and a transduodenal approach. Technical feasibility to perform imaging with nCLE during a pancreatic EUS-FNA procedure was achieved in 17 of 18 cases. Ten cases had good to very good image quality. Two serious adverse events occurred; both were pancreatitis requiring hospitalization. LIMITATIONS: Limited sample size, small number of patients with confirmed pathological diagnosis, lack of coregistered pathology and images. CONCLUSIONS: nCLE in the pancreas is technically feasible via a 19-gauge needle under endosonographic guidance. Future studies will address identification of structures, diagnostic accuracy, and complication profiles. The rate of pancreatitis needs to be further clarified and mitigated.

6 Minor Cytological features of pancreatic intraductal tubulopapillary neoplasm and an unexpected immunohistochemical profile. 2014

Zhao, Lei / Hart, John / Xiao, Shu-Yuan / Antic, Tatjana. ·Department of Pathology, The University of Chicago, Chicago, IL, USA. ·Pathology · Pubmed #25393265.

ABSTRACT: -- No abstract --