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Query: EC:2.7.10.1 (
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Inflammatory myofibroblastic tumor
(
IMT
) is a relatively rare soft tissue tumor. The reactive versus neoplastic pathogenesis of this tumor is unresolved. We found clonal chromosome aberrations involving 2p23 upon metaphase analysis of two IMTs. Fluorescence in situ hybridization with a probe flanking the
ALK
gene at 2p23 demonstrated rearrangement of the probe in both of these cases and in a third case, and immunohistochemistry revealed
ALK
expression in all three cases. 2p22-24 involvement has been reported previously in four additional cases of
IMT
. We suggest that chromosomal rearrangements involving 2p23 near or within
ALK
are recurrent alterations in
IMT
and that
ALK
may have a novel role outside its previously recognized realm of lymphoid neoplasms.
...
PMID:Recurrent involvement of 2p23 in inflammatory myofibroblastic tumors. 1038 29
Inflammatory myofibroblastic tumors (IMTs) are neoplastic mesenchymal proliferations featuring an inflammatory infiltrate composed primarily of lymphocytes and plasma cells. The myofibroblastic cells in some IMTs contain chromosomal rearrangements involving the
ALK
receptor tyrosine-kinase locus region (chromosome band 2p23).
ALK
-which is normally restricted in its expression to neural tissues-is expressed strikingly in the
IMT
cells with 2p23 rearrangements. We now report a recurrent oncogenic mechanism, in IMTs, in which tropomyosin (TPM) N-terminal coiled-coil domains are fused to the
ALK
C-terminal kinase domain. We have cloned two
ALK
fusion genes, TPM4-
ALK
and TPM3-
ALK
, which encode approximately 95-kd fusion oncoproteins characterized by constitutive kinase activity and tyrosylphosphorylation. Immunohistochemical and molecular correlations, in other IMTs, implicate non-TPM
ALK
oncoproteins that are predominantly cytoplasmic or pre- dominantly nuclear, presumably depending on the subcellular localization of the
ALK
fusion partner. Notably, a TPM3-
ALK
oncogene was reported recently in anaplastic lymphoma, and TPM3-
ALK
is thereby the first known fusion oncogene that transforms, in vivo, both mesenchymal and lymphoid human cell lineages.
...
PMID:TPM3-ALK and TPM4-ALK oncogenes in inflammatory myofibroblastic tumors. 1143 87
Inflammatory myofibroblastic tumor
(
IMT
) is a rare, but distinctive mesenchymal neoplasm composed of fascicles of bland myofibroblasts admixed with a prominent inflammatory component. Genetic studies of IMTs have demonstrated chromosomal abnormalities of 2p23 and rearrangement of the
anaplastic lymphoma kinase
(
ALK
) gene locus. In a subset of IMTs, the
ALK
C-terminal kinase domain is fused with a tropomyosin N-terminal coiled-coil domain. In the current study, fusion of
ALK
with the clathrin heavy chain (CTLC) gene localized to 17q23 was detected in two cases of
IMT
. One of these cases exhibited a 2;17 translocation in addition to other karyotypic anomalies [46,XX,t(2;17)(p23;q23),add(16)(q24)].
...
PMID:Fusion of the ALK gene to the clathrin heavy chain gene, CLTC, in inflammatory myofibroblastic tumor. 1148 98
Inflammatory myofibroblastic tumor
(
IMT
) is an uncommon mesenchymal neoplasm with a variable histologic appearance that may mimic other spindle cell processes, particularly nodular fasciitis, desmoid tumor, and in intra-abdominal locations, gastrointestinal stromal tumor. Recently, gene fusions involving
ALK
at chromosome 2p23 have been described in IMTs. The resultant
ALK
protein overexpression in the myofibroblastic component of these tumors is detectable by immunohistochemistry. We examined 73 IMTs, 20 cases of nodular fasciitis, 15 desmoid fibromatoses, and 15 gastrointestinal stromal tumors by immunohistochemistry using
ALK
-11, a rabbit polyclonal antibody that recognizes the C-terminus of the protein.
ALK
positivity was detected in 44 of 73 (60%) IMTs. All cases of nodular fasciitis, desmoid fibromatosis, and gastrointestinal stromal tumors were
ALK
negative (p < 0.001). These findings demonstrate that
ALK
positivity is common in IMTs, and immunohistochemistry using anti-
ALK
antibodies can be helpful in the differential diagnosis of these neoplasms. In addition, anti-
ALK
staining seems to correlate with those IMTs that have the typical tri-patterned histologic appearance and clinical presentation, providing additional support to the premise that
IMT
is a distinctive clinicopathologic entity within the broad category of inflammatory pseudotumors.
...
PMID:Anaplastic lymphoma kinase (ALK) expression in the inflammatory myofibroblastic tumor: a comparative immunohistochemical study. 1168 52
Inflammatory pseudotumors (IPTs) of the lymph node and spleen are an uncommon, benign cause of lymphadenopathy and/or splenomegaly that often bear striking clinicopathologic similarities to the inflammatory myofibroblastic tumors (IMTs) found in soft tissues. These tumors have classically been grouped together under the umbrella category of "inflammatory pseudotumor." Recent evidence shows that IMTs are in fact neoplastic processes that often harbor balanced chromosomal translocations involving the
ALK
kinase gene. These translocations result in expression of
ALK
kinase in IMTs as assessed by immunohistochemical studies. However, the relationship between IMT and
IPT
of the lymph node and spleen is uncertain. To determine if
ALK
tyrosine kinase expression is also present in
IPT
, 13 cases of
IPT
(9 involving lymph nodes, 4 splenic lesions) were examined for the presence of
ALK
tyrosine kinase by immunohistochemical staining on paraffin-embedded tissue. In addition, in situ hybridization studies for Epstein-Barr virus--encoded RNAs (EBER) and immunoperoxidase studies for human herpesvirus-8 (HHV8)--specific proteins were performed. All cases had clinical, morphologic, and immunophenotypic findings typical of
IPT
and had varying proportions of fibroblastic and inflammatory components. Age ranged from 11 to 75 (median, 40) years; 8 subjects were male, and 5 were female. None of the cases (0 of 13) had positive staining for
ALK
kinase or HHV8, and in 1 a lymph node (1 of 13) was focally positive for EBV (EBER) by in situ hybridization. The absence of
ALK
kinase as detected by immunohistochemical studies in
IPT
of the lymph node and spleen suggests that this entity is biologically distinct from the histologically similar IMT.
...
PMID:Inflammatory pseudotumor of lymph node and spleen: an entity biologically distinct from inflammatory myofibroblastic tumor. 1177 73
Inflammatory myofibroblastic tumor
(
IMT
) is a rare mesenchymal proliferation of transformed myofibroblasts, with a prominent inflammatory cell component, that can mimic other spindle cell processes such as nodular fasciitis, desmoid tumor, and gastrointestinal stromal tumor. Genetic analyses have recently demonstrated rearrangements of
anaplastic lymphoma kinase
(
ALK
), located at 2p23, in a subset of IMTs. Molecular characterizations have identified
ALK
fusions involving tropomyosin-3 and -4 (TPM-3 and -4), the clathrin heavy chain (CLTC), and the cysteinyl-tRNA synthetase (CARS) genes as fusion partners. Here we describe two IMTs with a novel
ALK
fusion that involves the Ran-binding protein 2 (RANBP2) gene at 2q13, which normally encodes a large (358-kDa) nucleopore protein localized at the cytoplasmic side of the nuclear pore complex. The N-terminal 867 residues of RANBP2 are fused to the cytoplasmic segment of
ALK
in the 1,430-amino acid RANBP2-
ALK
chimeric protein. Myofibroblasts that express RANBP2-
ALK
exhibit nuclear membrane-associated
ALK
staining that is unique compared to the subcellular localization observed with other
ALK
fusions in
IMT
, presumably attributable to heteroassociation of the fusion with normal RANBP2 at the nuclear pore. These findings expand the spectrum of
ALK
abnormalities observed in
IMT
and further confirm the clonal, neoplastic nature of these lesions.
...
PMID:Fusion of ALK to the Ran-binding protein 2 (RANBP2) gene in inflammatory myofibroblastic tumor. 1266 Oct 11
Inflammatory myofibroblastic tumor
is a rare entity composed of spindle cells admixed with variable amounts of extracellular collagen, lymphocytes, and plasma cells. In the genitourinary tract, inflammatory myofibroblastic tumor most commonly occurs in the bladder. Isolated case studies of inflammatory myofibroblastic tumor of the kidney, renal pelvis, and ureter have been previously reported. Our series includes 12 cases of inflammatory myofibroblastic tumor occurring in the renal pelvis (six cases), renal parenchyma (four cases), and immediate perirenal soft tissue (two cases). Clinical presentation included flank pain (two patients), painless gross hematuria (one patient), and ureteropelvic junction stenosis with hydronephrosis (one patient). The remaining eight patients were asymptomatic. All patients underwent nephrectomy. The tumors were characterized by firm white tissue or had a myxoid "gelatinous" appearance. Three histologic patterns were identified in the tumors, including a myxoid vascular pattern, a compact spindle cell pattern, and a hypocellular fibrous pattern. Immunohistochemical and electron microscopic studies supported a myofibroblastic proliferation. All cases were negative for
anaplastic lymphoma kinase
. Follow-up was available in eight cases and ranged from 1 to 17 years with no evidence of recurrence. Based on this series, renal inflammatory myofibroblastic tumor is a proliferative lesion of myofibroblasts of uncertain pathogenesis with no identified potential for recurrence or metastases.
...
PMID:Inflammatory myofibroblastic tumors of the kidney: a clinicopathologic and immunohistochemical study of 12 cases. 1271 50
Over the last two decades the large volume of research involving various brain tracers has shed invaluable light on the pathophysiology of cerebral neoplasms. Yet the question remains as to how best to incorporate this newly acquired insight into the clinical context. Thallium is the most studied radiotracer with the longest track record. Many, but not all studies, show a relationship between (201)Tl uptake and tumor grade. Due to the overlap between tumor uptake and histologic grades, (201)Tl cannot be used as the sole noninvasive diagnostic or prognostic tool in brain tumor patients. However, it may help differentiating a high-grade tumor recurrence from radiation necrosis. MIBI is theoretically a better imaging agent than (201)Tl but it has not convincingly been shown to differentiate tumors according to grade. MDR-1 gene expression as demonstrated by MIBI does not correlate with chemoresistance in high grade gliomas. Currently, MIBI's clinical role in brain tumor imaging has yet to be defined.
IMT
, a radio-labeled amino acid analog, may be useful for identifying postoperative tumor recurrence and, in this application, appears to be a cheaper, more widely available tool than positron emission tomography (PET). However, its ability to accurately identify tumor grade is limited. 18 F-2-Fluoro-2-deoxy-d-glucose (FDG) PET predicts tumor grade, and the metabolic activity of brain tumors has a prognostic significance. Whether FDG uptake has an independent prognostic value above that of histology remains debated. FDG-PET is effective in differentiating recurrent tumor from radiation necrosis for high-grade tumors, but has limited value in defining the extent of tumor involvement and recurrence of low-grade lesions. Amino-acid tracers, such as
MET
, perform better for this purpose and thus play a complementary role to FDG. Given the poor prognosis of patients with gliomas, particularly with high-grade lesions, the overall clinical utility of single photon emission computed tomography (SPECT) and PET in characterizing recurrent lesions remains dependent on the availability of effective treatments. These tools are thus mostly suited to the evaluation of treatment response in experimental protocols designed to improve the patients' outcome.
...
PMID:Imaging gliomas with positron emission tomography and single-photon emission computed tomography. 1275 47
Inflammatory myofibroblastic tumor
(
IMT
), synonymously referred to as inflammatory pseudotumor, is a distinctive mesenchymal lesion composed of spindle cells displaying morphological features of myofibroblasts admixed with considerable numbers of inflammatory cells. Recent genetic and molecular studies have shown that a subset of
IMT
is characterized by the expression of altered
anaplastic lymphoma kinase
(
ALK
) protein mostly resulting from rearrangements of the
ALK
gene such as TPM3-
ALK
, TPM4-
ALK
and CLTC-
ALK
fusion genes. We analyzed the
ALK
status in nine cases of
IMT
arising in various anatomical locations. Six cases showed immunohistochemical expression of the
ALK
protein, and two
ALK
-positive lesions examined by reverse transcription-polymerase chain reaction and a subsequent sequencing analysis harbored the TPM4-
ALK
fusion gene. Of note, the majority of
ALK
-positive tumor cells in four of the six lesions lacked the coexpression of myogenic markers including alpha-smooth muscle actin, a cytoskeletal protein indicating myofibroblastic differentiation, whereas a substantial number of tumor cells in the remaining two cases coexpressed
ALK
and alpha-smooth muscle actin and/or desmin. In an ultrastructural study of the lesion with predominant
ALK
-positive/actin-negative cells, spindle cells failed to demonstrate features of myofibroblasts such as intracytoplasmic bundles of thin filaments and dense bodies. The current findings suggest that
ALK
-positive cells in
IMT
are not always myofibroblastic but might be immature primitive mesenchymal cells.
...
PMID:Inflammatory myofibroblastic tumor with predominant anaplastic lymphoma kinase-positive cells lacking a myofibroblastic phenotype. 1278 12
Inflammatory myofibroblastic tumor
, also referred to as inflammatory fibrosarcoma, is a rare tumor composed of myofibroblastic spindle cells of uncertain etiology and disputed nosology. We report a case of inflammatory myofibroblastic tumor of the omentum with involvement of the bone marrow in an 18-year-old man. Histologic and immunohistochemical studies of the abdominal mass and bone marrow were consistent with inflammatory myofibroblastic tumor. Additionally, fluorescence in situ hybridization using a probe specific for the
ALK
gene showed disruption of the gene. The literature is reviewed with emphasis on the ability of inflammatory myofibroblastic tumor to recur, metastasize, and cause mortality.
...
PMID:Inflammatory myofibroblastic tumor with bone marrow involvement. A case report and review of the literature. 1282 44
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