Demaretta S Rush

Interests

Research

I am most interested in clinically applicable projects and collaborations with clinical colleagues. My recently concluded and ongoing projects include investigation of PAX8 staining patterns in cholangiocarcinoma, investigation of FOX03 expression in human ovarian tissue (in collaboration with reproductive endocrinology/gynecology and cell biology at the University of Florida), investigation of vigilin expression in breast cancer, investigation of the utility of fallopian tube cytology in gynecologic cancers, and molecular changes in flutamide treated patients (all in collaboration with gynecologic oncology at the University of Arizona), and correlation of radiographic and histopathologic findings in carotid artery plaques (in collaboration with radiology and vascular surgery at the University of Arizona.

Teaching

My expertise is in gynecologic pathology, but I am comfortable teaching any area of pathology.

Courses

Scholarly Contributions

Chapters

• Rush, D. S., & Wilkinson, E. J. (2019). Benign Disease of The Vulva. In Blaustein's Pathology of the Female Genital Tract, 7th ed.. Springer.
• Rush, D. S., & Wilkinson, E. J. (2019). Premalignant and Malignant Tumors of the Vulva. In Blaustein's Pathology of the Female Genital Tract, 7th ed.. Springer.
• Rush, D. S., & Wilkinson, E. J. (2018). Benign Diseases of the Vulva. In Blaustein's Pathology of The Female Genital Tract, 7th Ed.. doi:10.1007/978-1-4614-3165-7_1-2
• Wilkinson, E. J., & Rush, D. S. (2018). Premalignant and Malignant Tumors of the Vulva. In Blaustein's Pathology of the Female Genital Tract, 7th Ed.. doi:10.1007/978-1-4614-3165-7_2-2
• Rush, D. S., & Wilkinson, E. J. (2016). Vulvar Intraepithelial Neoplasia. In Precancerous Lesions of the Gynecologic Tract: Diagnostic and Molecular Genetic Pathology. doi:10.1007/978-3-319-22509-8_9
• Rush, D. S., & Wilkinson, E. J. (2015). Squamous Intraepithelial Lesions of the Vulva. In Diagnostic problems in Vulvar Pathology. doi:10.1007/978-1-4939-1807-2_9

Journals/Publications

• Bryant, B. H., Anderson, S. R., Brissette, M., Childs, J. M., Gratzinger, D., Johnson, K., Powell, D. E., Zein-Eldin Powell, S., Timmons, C. F., Chute, D., Cummings, T. J., Furlong, M. A., Hébert, T. M., Reeves, H. M., Rush, D., Vitkovski, T., & McCloskey, C. B. (2024). National pilot of entrustable professional activities in pathology residency training. Academic pathology, 11(2), 100110.
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  Entrustable professional activities (EPAs) are observable clinical skills and/or procedures that have been introduced into medical education at the student and resident levels in most specialties to determine readiness to advance into residency or independent practice, respectively. This publication describes the process and outcomes of a pilot study looking at the feasibility of using two anatomic pathology and two clinical pathology EPAs in pathology residency in 6 pathology residency programs that volunteered for the study. Faculty development on EPAs and their assessment was provided to pilot program faculty, and EPA assessment tools were developed and used by the pilot programs. Pre- and post-study surveys were given to participating residents, faculty, and program directors to gauge baseline practices and to gather feedback on the EPA implementation experience. Results demonstrated overall good feasibility in implementing EPAs. Faculty acceptance of EPAs varied and was less than that of program directors. Residents reported a significant increase in the frequency with which faculty provided formative assessments that included specific examples of performance and specific ways to improve, as well as increased frequency with which faculty provided summative assessments that included specific ways to improve. EPAs offered the most benefit in setting clear expectations for performance of each task, for providing more specific feedback to residents, and in increasing Program director's understanding of resident strengths abilities and weaknesses.
• Lolli, N., McWhirter, A., Lesser, K., Rush, D., Aboul-Nasr, A., & Coppola, L. (2024). Zebras in a snowstorm: ultrasound guidance for differentiating placental mesenchymal dysplasia from hydatidiform mole. American Journal of Obstetrics and Gynecology. doi:10.1016/j.ajog.2024.07.025
• Wang, X., Woo, H., Wei, M., Gibson, S., Miranda, M., Rush, D., Cragun, J., Zheng, W., Yao, G., & Chambers, S. (2024). miR-449, identified through antiandrogen exposure, mitigates functional biomarkers associated with ovarian cancer risk. Scientific Reports, 14(1). doi:10.1038/s41598-024-80173-z
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  The involvement of the androgen receptor (AR) pathway in developing epithelial ovarian cancer is increasingly acknowledged. However, the specific mechanisms by which anti-androgen agents, such as flutamide, may prevent ovarian cancer and their efficacy remain unknown. This study was initiated by investigating the impact of flutamide on miRNA expression in women at high risk (HR) for ovarian cancer. Ovarian and tubal tissues, free from ovarian, tubal, peritoneal cancers, and serous tubal intraepithelial carcinoma (STIC), were collected from untreated and flutamide-treated HR women as well as low-risk (LR) women controls. We performed miRNA sequencing on these 3 sample cohorts and observed that flutamide normalized miRNA levels in HR tissues, notably upregulating the miR-449 family to levels seen in LR tissues. In subsequent tests in primary ovarian epithelial cells and ovarian cancer cell lines (SKOV3 and Hey), flutamide also increased miR-449a and miR-449b-5p levels. Introducing mimics of these miRNAs reduced the mRNA and protein levels of AR and colony-stimulating factor 1 receptor (CSF1R, also known as c-fms), both of which are known contributors to ovarian cancer progression, with emerging evidence also supporting their roles in ovarian cancer initiation. Ovarian cancer cell migration was inhibited upon introducing miR-449a and miR-449b-5p mimics. Together, our study suggests a novel dual-inhibitory mechanism of flutamide on the AR pathway (AR expression suppression in addition to direct androgen antagonism) and supports its chemopreventive potential in ovarian cancer, especially for HR patients with low miR-449 expression.
• Rush, D. S., Kinson, M. S., Santamaria Flores, E., Cardenas-Goicoechea, S. J., & Moawad, N. S. (2022). Occult Synchronous Bilateral Fallopian Tube Cancers: Hysterectomy and Bilateral Salpingectomy for a Benign Indication. Journal of Gynecologic Surgery, 38(2), 170-172. doi:10.1089/gyn.2021.0135
• Mogor, O., Hargrave, E., Rush, D., & Hatch, K. (2019). Mucinous adenocarcinoma of the endometrium with metastasis to the clitoral glans after pelvic exenteration for radiation resistant vaginal cuff recurrence. Gynecologic oncology reports, 27, 46-49.
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  Mucinous adenocarcinoma of the endometrium (MACE) is a rare subtype of endometrial adenocarcinoma that often presents a significant diagnostic challenge due to its variation from the conventional morphologic appearance of endometrioid epithelium. This case report is of a woman who has survived 4 years after pelvic exenteration and subsequent vulvectomy for recurrent MACE.
• Woo, H. H., Lee, S. C., Stoffer, J. B., Rush, D., & Chambers, S. K. (2019). Phenotype of vigilin expressing breast cancer cells binding to the 69 nt 3'UTR element in CSF-1R mRNA. Translational oncology, 12(1), 106-115.
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  Vigilin, a nucleocytoplasmic shuttling protein, post-transcriptionally suppresses proto-oncogene c-fms expression (encoding CSF-1R) in breast cancer by binding to a 69 nt cis-acting 3-UTR element in CSF-1R mRNA. CSF-1R is an important mediator of breast cancer development, metastasis, and survival. We confirm that vigilin decreases in vitro reporter luciferase activity as well as the translation rate of target mRNAs. We further explore the mechanism of suppression of CSF-1R. We show that the 69 nt binding element has profound effects on translation efficiency of CSF-1R mRNA, not seen in the presence of mutation of the element. Also, mutation of the 69 nt element in the CSF-1R mRNA 3'UTR both interferes with direct vigilin binding and obviates effect of vigilin overexpression on translational repression of CSF-1R. We show that stable vigilin binding requires the full length 69 nt CSF-1R element, including the 26 nt pyrimidine-rich core. Furthermore, titration of endogenous vigilin and other proteins which bind the 69 nt element, by exogenously introduced CSF-1R mRNA 3'UTR containing the pyrimidine-rich sequence, increases the adhesion, motility, and invasion of breast cancer cells. This phenotypic effect is not seen when the 69 nt element is deleted. Lastly, we are the first to show that human breast tissues exhibit strong vigilin expression in normal breast epithelium. Our pilot data suggest decreased vigilin protein expression, along with shift from the nucleus to the cytoplasmic location, in the transition to ductal carcinoma in situ.
• Amensag, S., Goldberg, L., O'Malley, K. A., Rush, D. S., Berceli, S. A., & McFetridge, P. S. (2017). Pilot assessment of a human extracellular matrix-based vascular graft in a rabbit model. Journal of vascular surgery, 65(3), 839-847.e1.
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  Herein we describe a small-diameter vascular graft constructed from rolled human amniotic membrane (hAM), with in vitro evaluation and subsequent in vivo assessment of its mechanical and initial biologic viability in the early postimplantation period. This approach for graft construction allows customization of graft dimensions, with wide-ranging potential clinical applicability as a nonautologous, allogeneic, cell-free graft material.
• Carpenter, A. M., Rush, D. S., & Moawad, N. S. (2017). The Curious Case of the Uterine Cyst. Journal of minimally invasive gynecology, 24(6), 884-885.
• Carpenter, A., Rush, D. S., & Moawad, N. S. (2017). 30: The curious case of the uterine cyst. Journal of Minimally Invasive Gynecology. doi:10.1016/j.ajog.2016.12.077
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  To present a case in which a serous cystadenoma originated from the serosal surface of the uterus, to describe the surgical procedure, and to discuss the pathology of cystic structures arising from the uterus. A 40-year-old woman presented with pelvic pain, heavy menstrual bleeding, and radiculopathy affecting the right lower extremity. Ultrasound revealed a normal-sized uterus with a large, simple-appearing adnexal cyst, presumably originating from the right ovary, along with small fibroids. Endometrial biopsy was benign. A preoperative MRI visualized a non-enhancing, fluid-filled structure. No septations, debris, or nodular enhancement was identified, and the cyst was once again presumed to be of ovarian origin. The patient underwent laparoscopic removal of the mass. Surprisingly, the 8 cm cyst was found to arise from the serosal surface of the posterior uterine wall rather than the right ovary. The pedunculated, cystic mass was excised without rupture and retrieved in a specimen containment bag. Subsequent pathological evaluation revealed a thin-walled uterine serous cystadenoma without papillary excrescences. Bilateral salpingectomy revealed normal fallopian tubes with small paratubal cysts. Both ovaries were visualized and did not appear to have any associated abnormalities. Interestingly, the patient’s back pain and radiculopathy resolved after removal of the uterine cystadenoma. The case described herein is an unusual occurrence of a uterine serous cystadenoma. Cystic tumors of the uterus previously described in the literature have been largely of the intramyometrial type, including degenerated submucosal leiomyomata, unicornuate uteri with obstructed rudimentary horns, and cystic variants of adenomyosis. Cystic structures arising from the serosal surfaces of the uterus are even less common, such that only a few case reports are available in the literature to date. The authors believe this case to be the first serous cystadenoma arising from the uterus that is described in the literature to date. Laparoscopic images in this case portray a rare finding of a uterine serous cystadenoma, a pathology that has never before been described in the literature. Uterine sources of pelvic cystic structures should be considered when evaluating a patient with an adnexal mass.
• Patel, V., Wilkinson, E. J., Chamala, S., Lu, X., Castagno, J., & Rush, D. (2017). Endometrial Thickness as Measured by Transvaginal Ultrasound and the Corresponding Histopathologic Diagnosis in Women With Postmenopausal Bleeding. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists, 36(4), 348-355.
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  Endometrial thickness as measured by transvaginal ultrasound (TVUS) is being increasingly used as a first-line method to evaluate patients with vaginal bleeding. Our study aims to examine correlation between the histopathologic diagnosis and the results of TVUS and find a threshold that could reliably exclude carcinoma. We included women, age 55 years and above, who presented with postmenopausal bleeding and had a TVUS within 30 days of their endometrial biopsy. Total of 304 patients met our criteria and were divided into 4 groups. Patients in group A (n=198) had benign/atrophic endometrium, group B (n=44) had polyps, group C (n=30) had hyperplasia, and group D (n=32) had carcinoma. The endometrial thickness obtained by TVUS was compared with the histopathologic finding of the endometrial biopsy. The mean endometrial thickness was 7.5, 12.1, 14.8, and 16.9 mm for groups A to D, respectively. Statistical analysis showed that very low endometrial thickness (3 to 4 mm) would be ideal to use as a threshold to maximize sensitivity. Three of 32 patients in group D had an endometrial thickness ≤4 mm. At a threshold of 4 mm, the sensitivity is 90.6% and increases to 96.9% when decreasing the threshold to 3 mm. However, other parameters such as test accuracy, specificity, and positive predictive values are very low at these thresholds. Sensitivity can be maximized to 96.9% using a threshold of 3 mm. However, this would call into question the cost-effectiveness of this method. Postmenopausal bleeding remains the most reliable indicator of endometrial pathology.
• Solano, F. J., Rush, D. S., & Wilkinson, E. J. (2015). p16INK4a Immunohistochemical and Histopathologic Study of Pap Test Cases Interpreted as HSIL Without CIN2-3 Identification in Subsequent Cervical Specimens. International Journal of Gynecologic Pathology. doi:10.1097/pgp.0000000000000159
• Solano, F., Rush, D., & Wilkinson, E. (2015). P16INK4a immunohistochemical and histopathologic study of pap test cases interpreted as HSIL without CIN2-3 identification in subsequent cervical specimens. International Journal of Gynecologic Pathology, 34(3). doi:10.1097/PGP.0000000000000159
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  Tissue biopsy following a pap test diagnosis of high grade squamous intraepithelial lesion (HSIL) sometimes fails to confirm the presence of a corresponding high grade cervical intraepithelial lesion (CIN 2-3), leading to confusion as to how best to manage the patient. It has been shown that these patients are still at higher risk for future detection of CIN 2-3 even if the initial biopsy fails to detect it. It has also been shown that immunohistochemical staining for p16INK4a can be reliably used as a surrogate marker for infection with high risk human papillomavirus in cervical samples, and that it can be used to enhance detection of CIN2-3 in cases where suspicion is high. To evaluate the use of p16INK4a staining in cases of HSIL which were not confirmed on initial biopsy, two pathologists rereviewed Pap and hematoxylin and eosin preparations from all such cases seen within the preceding 3 years. Immunohistochemical study for p16INK4a was performed and graded on representative sections. The results were tabulated and analyzed. Of the identified 596 HSIL Pap cases, 82% had HSIL on initial cervical specimens. Table 1 shows the 56 cases included in the study with graded and stratified p16INK4a results. On review of the p16INK4a slides, only 2 cases could be upgraded to HSIL/CIN2-3 from the original diagnosis. p16INK4a 2-3+ was expressed more frequently in cases initially interpreted on Pap as low-grade cervical lesion as compared with benign (24 of 35 cases). In the younger than 24-yr-old group p16 2-3+ reactivity was more frequent in benign and low-grade cervical lesion/CIN1 groups (benign: 3 of 5 cases, and CIN1: 6 of 8), and p16 negative reactivity was not seen. p16INK4a was graded 0-1+ more frequently in specimens interpreted as benign in the older than 25 yr olds (10 of 16 cases). The study suggests some diagnostic benefit from the use of p16INK4a immunohistochemical study on cervical specimens from women with a HSIL Pap test without HSIL/CIN2-3 on original hematoxylin and eosin review.
• Simmons, M., Duckworth, L., Scherer, K., Drew, P., & Rush, D. (2013). Mullerian cysts of the posterior mediastinum: Report of two cases and review of the literature. Journal of Thoracic Disease, 5(1). doi:10.3978/j.issn.2072-1439.2012.07.10
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  Cystic lesions can be occasionally be found in the mediastinum, and typically include bronchogenic cysts, esophageal duplication cysts, and neuroenteric cysts. In 2005, Hattori described the first mediastinal cyst with Mullerian differentiation. Since that time, three other authors have described similar cysts occurring in the posterior mediastinum. Here we present two cases of patients with ciliated cysts with Mullerian differentiation with expression of estrogen receptor, progesterone receptor, PAX8 and Wilm's tumor 1, occurring in the posterior mediastinum and review the related literature. © Pioneer Bioscience Publishing Company.
• Bovio, I. M., Allan, R. W., Oliai, B. R., Hampton, T., & Rush, D. S. (2011). XpII.2 Translocation Renal Carcinoma With Placental Metastasis: A Case Report. International Journal of Surgical Pathology. doi:10.1177/1066896908331231
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  Renal cell carcinomas with sporadic Xp11.2 translocations are uncommon malignancies in children and young adults associated with several different reciprocal translocations involving the TFE3 gene located on chromosome Xp11.2. Placental metastases are extremely rare, with only a handful of cases reported. This study reports the case of a 20-year-old woman with an Xp11.2 translocation renal carcinoma that metastasized to the placenta. This is the first reported case of a renal cell carcinoma metastatic to the placenta and highlights the aggressive behavior of Xp11 translocation renal cell carcinomas.
• Rush, D. S., Hyjek, E., Baergen, R. N., Ellenson, L. H., & Pirog, E. C. (2005). Detection of Microinvasion in Vulvar and Cervical Intraepithelial Neoplasia Using Double Immunostaining for Cytokeratin and Basement Membrane Components. Archives of Pathology and Laboratory Medicine. doi:10.5858/2005-129-747-domiva
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  Abstract Context.—Identification of early invasion in vulvar intraepithelial neoplasia 3 (VIN 3) and cervical intraepithelial neoplasia 3 (CIN 3) may be difficult with the use of routine hematoxylin-eosin staining. Presence of obscuring inflammation and tangential tissue sectioning are the most common diagnostic pitfalls. Objective.—To examine the utility of double immunostaining for cytokeratin–collagen IV or cytokeratin-laminin in the detection of early invasion in VIN 3 and CIN 3. Design.—The study group consisted of 10 cases of “VIN 3, suspicious for invasion” and 10 cases of “CIN 3, suspicious for invasion.” The negative control group consisted of VIN 3 (n = 15) and CIN 3 (n = 10). The positive control group consisted of cases of invasive vulvar carcinoma (n = 11) and invasive cervical carcinoma (n = 25). All cases were double immunostained for cytokeratin and collagen IV and, in a separate reaction, for cytokeratin and laminin. The continuity of the basement membrane and the presence of stromal invasion were assessed in the stained sections. Results.—The staining for collagen IV and laminin yielded identical results. A well-defined, continuous basement membrane was visualized in all cases of VIN 3 and CIN 3. A discontinuous or absent basement membrane was observed around the malignant cells on the invasive tumor front in all cases of vulvar and cervical carcinoma. In 2 of 10 cases of VIN 3, suspicious for invasion and in 4 of 10 cases of CIN 3, suspicious for invasion definitive foci of microinvasion were identified with the use of double immunostaining. A well-defined, continuous basement membrane was present in the remaining cases “suspicious for invasion.” Conclusion.—Double immunostaining for cytokeratin– collagen IV or cytokeratin-laminin is useful for evaluation of early invasion in equivocal cases of VIN 3 and CIN 3.
• Heller, D., Rush, D., & Baergen, R. (2003). Subchorionic hematoma associated with thrombophilia: Report of three cases. Pediatric and Developmental Pathology, 6(3).
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  Subchorionic hematomas (SCHs) are associated with poor reproductive outcome including spontaneous abortions and stillbirth. Although many associations with maternal and prenatal factors have been reported, an underlying etiology has not been elucidated. We report three cases of SCHs associated with thrombophilias in the mother. One patient suffered a fetal demise at 30 wk gestational age, and two patients had second trimester losses. The mother of the 30-wk fetus was homozygous for mutations on the methylene-tetrahydrofolate reductase gene C677T. The other two patients had Protein S deficiency. SCHs may be associated with abnormal coagulative states suggesting that the underlying etiology of SCH may be related to hypercoagulability in the maternal circulation. The presence of a SCH may be the first indicator of an underlying thrombophilia and, thus, it is suggested that women who have placentas showing SCH should undergo a thrombophilia workup.
• Yilmaz, A., Rush, D., & Soslow, R. (2002). Endometrial stromal sarcomas with unusual histologic features: A report of 24 primary and metastatic tumors emphasizing fibroblastic and smooth muscle differentiation. American Journal of Surgical Pathology, 26(9). doi:10.1097/00000478-200209000-00004
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  We report the clinicopathologic features of 24 uterine primary and metastatic endometrial stromal sarcomas with fibromyxoid features (ESS-F) and smooth muscle differentiation (ESS-SM) (endometrial stromal sarcoma variants). Two groups of tumors were retrieved from the surgical pathology files at Memorial Sloan-Kettering Cancer Center: 1) gynecologic mesenchymal neoplasms with striking smooth muscle or fibroblastic differentiation that did not meet the clinical or histologic criteria for leiomyosarcoma or other established neoplasms containing smooth muscle; and 2) metastatic lesions showing ovoid and spindle cell morphology, involving lung, originally diagnosed as low-grade leiomyosarcoma, low-grade smooth muscle neoplasm, intravenous leiomyomatosis, fibrous hamartoma, and benign metastasizing leiomyoma. We identified 12 patients with 30 tumors; 24 were available for review. The mean age was 51 years (range 21-74 years). Follow-up >1 year was available for eight patients, with a mean time of 8.5 years. Each patient had a uterine primary and 10 experienced metastases. Mean time to recurrence was 6.8 years. Sites of metastasis included lung, retroperitoneum, right atrium/inferior vena cava, colon, and ovaries. No patient died of disease, but in many cases the follow-up period ended with the discovery of a metastasis. Four patients were originally diagnosed with endometrial stromal sarcoma, but other presenting diagnoses included benign metastasizing leiomyoma, fibroleiomyomatous tumor of lung, smooth muscle tumor of uncertain or low malignant potential, and intravascular leiomyomatosis. On review each patient had at least one tumor (primary and/or metastasis) that was determined to be an endometrial stromal sarcoma variant. Review diagnoses were as follows: endometrial stromal sarcoma (nonvariant), ESS-F, and ESS-SM. Eight of 10 primary tumors with available slides were endometrial stomal sarcoma variants (six ESS-F and two ESS-SM). When these variant features were present, they comprised between 50% and 100% of the neoplasm. The variant histology tumors exhibited prominent spiral arterioles, perivascular edema, and stromal cell condensation around blood vessels. All metastases but one were variant tumors; eight were ESS-F and five were ESS-SM. Four metastases did not resemble the uterine primary. Desmin marked smooth muscle mostly but not specifically. h-Caldesmon marked smooth muscle exclusively. Endometrial stromal cells as well as some fibroblasts and smooth muscle cells expressed CD10. We conclude that the presence of even focal endometrial stromal differentiation in an invasive uterine mesenchymal lesion with a predominant low-grade smooth muscle, fibroblastic, and/or myxoid phenotype should permit classification as low-grade sarcoma-they should be considered endometrial stromal sarcomas.
• Rush, D. S., Tan, J., Baergen, R. N., & Soslow, R. A. (2001). h-Caldesmon, a Novel Smooth Muscle-Specific Antibody, Distinguishes Between Cellular Leiomyoma and Endometrial Stromal Sarcoma. American Journal of Surgical Pathology. doi:10.1097/00000478-200102000-00014
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  The difficulty in distinguishing between smooth muscle and endometrial stromal-derived neoplasms of the uterine corpus is a notorious and clinically relevant problem in pathology of the female genital tract. Immunohistochemistry offers some aid in resolving this difficulty, because the expression of smooth muscle markers is reputed to indicate smooth muscle derivation. This expression, however, is not entirely specific, and difficult cases may still present in which immunohistochemistry is of little help. To explore this problem, the authors evaluated the expression of traditional muscle markers and high-molecular-weight caldesmon (h-cal), an actin and tropomyosin binding protein that has recently been described as a useful muscle marker, in uterine leiomyosarcoma (LMS), cellular leiomyomata (CL), and endometrial stromal sarcoma (ESS). Formalin-fixed and paraffin-embedded tissue sections from nine LMSs, 11 CLs, and 12 ESSs were evaluated with commercially available monoclonal antibodies against smooth muscle actin (SMA), desmin, and h-cal. Established morphologic criteria were used to classify the neoplasms. We found that there was, as expected, a significant difference in the expression of traditional smooth muscle markers (SMA and desmin) between tumors derived from smooth muscle and those derived from endometrial stroma (p = 0.005 for LMS and 0.013 for CL). We further found that h-cal was most useful in distinguishing between CL and ESS (p = 0.01). A significant difference between h-cal expression in LMS versus ESS was not found. Of note, one ESS expressed both SMA and desmin but lacked h-cal expression. Our findings confirm the most useful immunohistochemical data to date; smooth muscle neoplasms are generally distinguishable from endometrial stromal tumors by the expression of conventional muscle markers. We also report here that h-cal is useful more specifically in the differentiation of CL from ESS.
• Soslow, R., Dannenberg, A., Rush, D., Woerner, B., Nasir Khan, K., Masferrer, J., & Koki, A. (2000). COX-2 is expressed in human pulmonary, colonic, and mammary tumors. Cancer, 89(12). doi:10.1002/1097-0142(20001215)89:12<2637::AID-CNCR17>3.0.CO;2-B
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  BACKGROUND. The cyclooxygenase (COX) enzyme catalyzes the formation of prostaglandins, which can affect cell proliferation and alter the response of the immune system to malignant cells. The inducible form of COX, COX-2, has been shown to be important in carcinogenesis. METHODS. The authors studied COX-1 and -2 expression in 20 tumors of the lung, colon, and breast (60 total) by using commercially available monoclonal and polyclonal antibodies on formalin fixed, paraffin embedded tissue. Our evaluation also included seven carcinoma-associated colonic adenomas and 10 mammary ductal carcinomas in situ (DCIS). Quantitation of immunoreactivity was accomplished using an immunohistochemical scoring system that approximates the use of image analysis-based systems. RESULTS. Ninety percent of lung tumors (squamous cell carcinomas and adenocarcinomas), 71% of colon adenocarcinomas and 56% of breast tumors (DCIS and infiltrating ductal and lobular carcinomas) expressed COX-2 at a moderate to strong level, which was significantly different from the negligible expression in distant nonneoplastic epithelium (controls; P < 0.0001). Poorly differentiated histologic features were correlated with low COX-2 expression overall, especially in colon carcinomas. Among breast carcinomas, DCIS was more likely to express COX-2 than invasive carcinomas. Adenomatous colonic epithelium showed moderate COX-2 expression, as did adjacent nonneoplastic epithelium. COX-1 immunoreactivity was essentially weak to moderate in all tissues evaluated. CONCLUSIONS. COX-2 expression is upregulated in well and moderately differentiated carcinomas of the lung, colon, and breast whereas COX-1 appears to be constitutively expressed at low levels. A possible COX-2 paracrine effect is suggested by moderate immunoreactivity in adjacent nonneoplastic epithelium. © 2000 American Cancer Society.

Poster Presentations

• Rush, D., Cheong, S., Rodden, D., Melson, J., & Witten, B. (2024, October). When Nivolumab turns nasty: a rare case of hemorrhagic gastritis. American College of Gastroenterology Annual Meeting. Philadelphia, PA: American College of Gastroenterology.
• Rush, D., Morgan, L., & Bracamonte, E. R. (2022, October). A rare Case of Urorectal Septum Malformation Sequence. Society for Pediatric Pathology Annual Meeting. Rochester NY: SPP.
• Rush, D., & Meiklejohn, K. (2020, October). An Unusual Case of Placental Coccidiodomycosis. CAP Annual Meeting. Virtual: College of American Pathologists.
• Rush, D. S., Collinsworth, A., & Isom, J. A. (2018, March). PAX8 expression in cholangiocarcinoma. United States and Canadian Academy of Pathology Annual Meeting. Vancouver, BC, Canada: United States and Canadian Academy of Pathology.
• Rush, D., & Gupta, D. (2017, April). Unusual presentation of multifocal cardiac rhabdomyoma requiring orthotopic heart transplantation. International Society for Heart and Lung Transplantation annual meeting. San Diego: International Society for Heart and Lung Transplantation.
• Rush, D., Swenson, H. L., Nick, H., & Rhoton-Vlasak, A. (2017, March). FOX03A expression in human ovarian tissue samples. Society for Reproductive Investigation Annual Meeting. Orlando, FL: Society for Reproductive Investigation.
• Rush, D., Vertes, E., & Robert, A. A. (2017, February). Synchronous Endometrial Adenocarcinoma and Marginal Zone Lymphoma. Florida Society of Pathology Winter Meeting. Orlando, FL: Florida Society of Pathology.
• Rush, D. S., Kinson, M. S., Cardenas-Goicoechea, S. J., & Moawad, N. S. (2016, August/September). Bilateral primary fallopian tube carcinoma; a case report and review of the literature. Society of Laparoscopic Surgeons Annual Meeting. Boston: Society of Laparoscopic Surgeons.