David Nolte

Interests

Teaching

Gastrointestinal, liver, pancreas, head and neck, genitourinary, bone and soft tissue pathology

Research

Gastrointestinal, liver, pancreas, head and neck, genitourinary, bone and soft tissue pathology

Courses

Scholarly Contributions

Journals/Publications

• Sun, B., Elliott, A., Nolte, D. A., & Sun, X. (2024). Immune checkpoint inhibitor–related colitis in patients on immunotherapy for cancer. American Journal of Clinical Pathology. doi:10.1093/ajcp/aqae002
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  Abstract Objectives Immune checkpoint inhibitors, a revolutionary class of cancer immunotherapy drugs, have transformed cancer treatment by bolstering antitumor immunity for various advanced-stage solid cancers. The US Food and Drug Administration has approved 7 immune checkpoint inhibitors that target 3 major immune checkpoint proteins: cytotoxic T-lymphocyte–associated protein 4, programmed cell death 1 protein, and programmed cell death 1 ligand 1. In addition to their remarkable efficacy, however, these inhibitors have been observed causing immune-related adverse events, particularly immune checkpoint inhibitor–related colitis, which often results in severe or life-threatening clinical issues. Methods The diagnosis of immune checkpoint inhibitor–related colitis relies on incorporation of clinical evaluation as well as endoscopic and histopathologic examination, with exclusion of other potential etiologies. Results The common histopathologic manifestations of immune checkpoint inhibitor–related colitis are acute active colitis, chronic active colitis, microscopic colitis (collagenous or lymphocytic), and ischemic colitis, with patterns overlapping. Notably, enterocyte apoptosis is a unique feature of immune checkpoint inhibitor toxicity. The proposed mechanisms for the pathogenesis of immune checkpoint inhibitor–related colitis are primarily associated with autoimmune-type dysregulation and gut microbiome alteration. This review summarizes the clinical and pathologic characteristics of immune checkpoint inhibitor–related colitis and elucidates its underlying pathogenic mechanisms. Conclusions Future successful management of this form of colitis relies on our comprehension of the intricate interplay between tumoral and systemic immune responses to immune checkpoint inhibitors and innovative approaches to modify these responses, along with specific immune cell populations, to preclude immune-related adverse events while achieving antitumor therapeutic outcomes.
• Nolte, D. A., Tranesh, G., & Wanes, P. (2020). Hypopharyngeal Dedifferentiated Liposarcoma in the MDM2 Era: A Case Report and Short Review. Case reports in pathology, 2020, 1-4. doi:10.1155/2020/2968467
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  Pharyngeal liposarcomas are very rare; still more rare are dedifferentiated liposarcomas in the pharynx. An 82-year-old man presented with dysphagia, voice changes, weight loss, nasal regurgitation of liquids, and coughing spells. A 3.5 cm mass was identified in the hypopharynx. The mass was biopsied and diagnosed as a benign fibroepithelial polyp. Continued symptoms and airway obstruction prompted a pharyngectomy, and the mass was then diagnosed as dedifferentiated liposarcoma. Due to infrequency and subtle histological findings, liposarcomas of the head and neck can be misdiagnosed and recur.
• Nolte, D. A., Larsen, B. T., Sobonya, R. E., Al-Amoodi, M., & Khalpey, Z. (2019). Recurrent Intracardiac Juvenile Xanthogranuloma in an Adult. Annals of Thoracic Surgery. doi:10.1016/j.athoracsur.2018.09.069
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  A 50-year-old woman with fatigue and mitral regurgitation was admitted to the hospital for mitral valve surgery. Eighteen years previously, she had a 9-cm mass removed from inside her heart. More recently, intraoperative dissection revealed a firm inoperable mass encasing the right atrium (Fig 1A, arrow). After an iatrogenic preoperative superior vena cava tear, she passed away 2 weeks later from hypotensive multiorgan complications. At autopsy a 10.5-cm yellow-tan mass involved both atria and the left ventricle, with near obliteration of the right atrial chamber (Fig 1B, arrow; AV = aortic valve; LV = left ventricle; Pulm. = pulmonary; RV = right ventricle; SVC = superior vena cava). Microscopic sections of the mass showed dense sheets of foamy histiocytes (Fig 1C, arrowhead, original magnification ×200) and rare Touton-type giant cells (Fig 1C, arrow), identical to the mass previously removed. The histiocytes stained with factor XIIIa (Fig 1D, original magnification ×200), CD11c, and CD68; they did not stain with CD1a, S-100, or BRAF V600E. This scenario is consistent with recurrent juvenile xanthogranuloma, an indolent tumor of histiocytes that usually presents as a solitary skin lesion in children. Cardiac juvenile xanthogranuloma has rarely been reported in children, and to our knowledge only once in an adult [1Lehrke H.D. Johnson C.K. Zapolanski A. Kasatki A. Grau J.B. Maleszewski J.J. Intracardiac juvenile xanthogranuloma with presentation in adulthood.Cardiovasc Pathol. 2014; 23: 54-56Crossref PubMed Scopus (6) Google Scholar]. Older lesions can create extensively fibrotic masses and can cause significant complications, especially in visceral sites. Cutaneous lesions usually regress spontaneously and require no treatment. When involving visceral organs, or causing dysfunction due to mass effect, these lesions should be treated by surgery, radiation, and/or chemotherapy.
• Mushtaq, R., Nolte, D. A., Shareef, F., & Taljanovic, M. S. (2018). Diffuse periostitis as the primary presenting radiological finding in an AML patient with disease relapse. Radiology Case Reports. doi:10.1016/j.radcr.2018.07.012
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  Acute myelogenous leukemia is a hematologic malignancy defined by the presence of myeloid blasts causing bone marrow infiltration. Evaluation and workup of acute myelogenous leukemia is based on comprehensive medical history, physical examination, laboratory evaluation, and bone marrow sampling. Magnetic resonance (MR) imaging is the study of choice in the evaluation of this disease including the initial evaluation, treatment follow-up, and complications. Herein, we report a case of relapse of the acute myelogenic leukemia in an adult patient who presented with diffuse periostitis in his lower extremities diagnosed on MR imaging and confirmed on Technetium bone scan, which also showed periostitis along the bilateral humeri. To our knowledge, this was not previously reported in the English literature.

Poster Presentations

• Carlson, Q., McDougall, R., & Nolte, D. (2024, October). High Risk Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma with Discordant p16 Expression: Is p16 enough? . College of American Pathologists Annual Meeting. Las Vegas, Nevada: College of American Pathologists.
• Lybarger, L. P., Woolridge, D. P., Conn, A., Elliott, A., Nolte, D., & O'brien, H. (2024, March). Development of Foundational/Applied Integrative Learning Sessions for Histology and Pathology for Pre-Clerkship Medical Students.. American Association for Anatomy.