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Foo, Wen Chi

Positions:

Assistant Professor of Pathology

Pathology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2008

M.D. — Duke University School of Medicine

Anatomic And Clinical Pathology, Pathology

Duke University School of Medicine

Cytopathology Fellowship, Pathology

Harvard Medical School

Publications:

Image-guided fine-needle aspiration of secondary pancreatic neoplasms: A case series and review of the literature

© 2015 Wolters Kluwer Health, Inc. All rights reserved.Background Endoscopic ultrasound-guided fine-needle aspiration (FNA) has become a well-established diagnostic method for evaluation of focal lesions in the pancreas. While the majority of malignant lesions evaluated are primary pancreatic adenocarcinomas, rarely, metastatic lesions to the pancreas are discovered, altering treatment and prognosis for patients. In this retrospective case series study, we describe the 22-year experience with cytologic diagnosis of secondary pancreatic neoplasms in a tertiary medical center. Methods A search of the electronic pathology database at Duke University Medical Center was performed to identify all patients who had image-guided FNA biopsy of the pancreas diagnosed with secondary neoplasms from 1990 to 2012. Clinical information including sex, age, prior history of malignancy, imaging features of pancreatic mass(es), cytology diagnosis, treatment, and survival was collected. Descriptive statistics were performed. Results Fifty-three patients had a secondary malignancy of the pancreas from 11 primary sites diagnosed on FNA. The most common primary site was hematopoietic (36%), followed by renal (19%), melanocytic (11%), pulmonary (11%), ovarian (6%), breast (4%), esophageal (4%), and soft tissue (4%). Colorectal (2%), prostatic (2%), and nasopharyngeal (2%) metastases were also identified. No specific imaging features reliably differentiated secondary lesions from primary lesions. The majority of patients (75%) had a prior history of malignancy. Of those without a prior history of malignancy, greater than 90% had a secondary malignancy of hematopoietic origin. Conclusions Cytologic diagnosis of secondary pancreatic neoplasms is rare. The most common secondary neoplasm of the pancreas was of hematopoietic origin. Imaging characteristics of secondary neoplasms are variable and nonspecific.

Authors
Foo, WC; Youens, KE; Jowell, PS; Bean, SM
MLA Citation
Foo, WC, Youens, KE, Jowell, PS, and Bean, SM. "Image-guided fine-needle aspiration of secondary pancreatic neoplasms: A case series and review of the literature." Pathology Case Reviews 20.4 (January 1, 2015): 175-181. (Review)
Source
scopus
Published In
Pathology Case Reviews
Volume
20
Issue
4
Publish Date
2015
Start Page
175
End Page
181
DOI
10.1097/PCR.0000000000000096

Diagnosis of metastatic renal cell carcinoma on fine-needle aspiration cytology.

Fine-needle aspiration has assumed an increasingly important role in the diagnosis and management of patients with advanced stage cancer. Given its predilection for metastases to distant sites and organs at the time of presentation, metastatic renal cell carcinoma (RCC) is not infrequently encountered in the setting of fine-needle aspiration for initial diagnosis. In some instances, fine-needle aspiration may be the only opportunity to obtain diagnostic tissue to diagnose and subclassify RCC. Therefore, cytopathologists and cytotechnologists should be familiar with and recognize the cytomorphology of RCC and the ancillary studies that can be used to confirm and subclassify RCC. Herein, we describe a case of metastatic RCC initially diagnosed on fine-needle aspiration, discuss the cytomorphologic features of RCC subtypes, and review pertinent ancillary immunohistochemical and cytogenetic adjuncts.

Authors
Lew, M; Foo, W-C; Roh, MH
MLA Citation
Lew, M, Foo, W-C, and Roh, MH. "Diagnosis of metastatic renal cell carcinoma on fine-needle aspiration cytology." Archives of pathology & laboratory medicine 138.10 (October 2014): 1278-1285. (Review)
PMID
25268189
Source
epmc
Published In
Archives of Pathology and Laboratory Medicine
Volume
138
Issue
10
Publish Date
2014
Start Page
1278
End Page
1285
DOI
10.5858/arpa.2014-0283-cc

Radiologic-Pathologic Correlation of Uncommon Mesenchymal Liver Tumors

Mesenchymal liver tumors are rarely encountered in clinical practice. We review the spectrum of mesenchymal liver tumors with radiologic-pathologic correlation. There is an overlap of cross-sectional imaging findings of mesenchymal liver tumors with that of the more common malignant epithelial tumors. Familiarity with the radiologic findings and its pathologic basis would help radiologists to include these uncommon liver tumors in their differential diagnosis. © 2013.

Authors
Bhargava, P; Iyer, RS; Moshiri, M; Yeh, MM; Upton, MP; Foo, W-C; Mannelli, L; Gupta, RT
MLA Citation
Bhargava, P, Iyer, RS, Moshiri, M, Yeh, MM, Upton, MP, Foo, W-C, Mannelli, L, and Gupta, RT. "Radiologic-Pathologic Correlation of Uncommon Mesenchymal Liver Tumors." Current Problems in Diagnostic Radiology 42.5 (2013): 183-190.
PMID
24070712
Source
scival
Published In
Current Problems in Diagnostic Radiology
Volume
42
Issue
5
Publish Date
2013
Start Page
183
End Page
190
DOI
10.1067/j.cpradiol.2013.05.002

Biospecimens and biorepositories for the community pathologist.

Pathologists have long served as custodians of human biospecimens collected for diagnostic purposes. Rapid advancements in diagnostic technologies require that pathologists change their practices to optimize patient care. The proper handling of biospecimens creates opportunities for pathologists to improve their diagnoses while assessing prognosis and treatment. In addition, the growing need for high-quality biorepositories represents an opportunity for community pathologists to strengthen their role within the health care team, ensuring that clinical care is not compromised while facilitating research. This article provides a resource to community pathologists learning how to create high-quality biorepositories and participating in emerging opportunities in the biorepository field. While a variety of topics are covered to provide breadth of information, the intent is to facilitate a level of understanding that permits community pathologists to make more informed choices in identifying how best their skills and practice may be augmented to address developments in this field.

Authors
Dash, RC; Robb, JA; Booker, DL; Foo, W-C; Witte, DL; Bry, L
MLA Citation
Dash, RC, Robb, JA, Booker, DL, Foo, W-C, Witte, DL, and Bry, L. "Biospecimens and biorepositories for the community pathologist." Arch Pathol Lab Med 136.6 (June 2012): 668-678.
PMID
22646276
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
136
Issue
6
Publish Date
2012
Start Page
668
End Page
678
DOI
10.5858/arpa.2011-0274-SO

Acoustic radiation force impulse imaging of human prostates: initial in vivo demonstration.

Reliably detecting prostate cancer (PCa) has been a challenge for current imaging modalities. Acoustic radiation force impulse (ARFI) imaging is an elasticity imaging method that uses remotely generated, focused acoustic beams to probe tissue stiffness. A previous study on excised human prostates demonstrated ARFI images portray various prostatic structures and has the potential to guide prostate needle biopsy with improved sampling accuracy. The goal of this study is to demonstrate the feasibility of ARFI imaging to portray internal structures and PCa in the human prostate in vivo. Custom ARFI imaging sequences were designed and implemented using a modified Siemens Antares™ scanner with a three-dimensional (3-D) wobbler, end-firing, trans-cavity transducer, EV9F4. Nineteen patients were consented and imaged immediately preceding surgical prostatectomy. Pathologies and anatomic structures were identified in histologic slides by a pathologist blinded to ARFI data and were then registered with structures found in ARFI images. The results demonstrated that when PCa is visible, it generally appears as bilaterally asymmetric stiff structures; benign prostatic hyperplasia (BPH) appears heterogeneous with a nodular texture; the verumontanum and ejaculatory ducts appears softer compared with surrounding tissue, which form a unique 'V' shape; and the boundary of the transitional zone (TZ) forms a stiff rim separating the TZ from the peripheral zone (PZ). These characteristic appearances of prostatic structures are consistent with those found in our previous study of prostate ARFI imaging on excised human prostates. Compared with the matched B-mode images, ARFI images, in general, portray prostate structures with higher contrast. With the end-firing transducer used for this study, ARFI depth penetration was limited to 22 mm. Image contrast and resolution were decreased as compared with the previous ex vivo study due to the small transducer aperture. Even with these limitations, this study suggests ARFI imaging holds promise for guidance of targeted prostate needle biopsy and focal therapy, as well as aiding assessment of changes during watchful waiting/active surveillance.

Authors
Zhai, L; Polascik, TJ; Foo, W-C; Rosenzweig, S; Palmeri, ML; Madden, J; Nightingale, KR
MLA Citation
Zhai, L, Polascik, TJ, Foo, W-C, Rosenzweig, S, Palmeri, ML, Madden, J, and Nightingale, KR. "Acoustic radiation force impulse imaging of human prostates: initial in vivo demonstration." Ultrasound Med Biol 38.1 (January 2012): 50-61.
PMID
22104533
Source
pubmed
Published In
Ultrasound in Medicine and Biology
Volume
38
Issue
1
Publish Date
2012
Start Page
50
End Page
61
DOI
10.1016/j.ultrasmedbio.2011.10.002

Vulvar manifestations of Crohn's disease.

Crohn's disease is an inflammatory bowel disorder with several well-known extraintestinal manifestations, such as erythema nodosum, uveitis, and arthritis. Less commonly observed are vulvar manifestations, which have primarily been discussed in case reports or small case series. These cases generally highlight patients with histopathology limited to noncaseating granulomas. As these histological findings are identified in bowel biopsies from only approximately 50% of patients with gastrointestinal Crohn's disease, there is likely an under-recognition and underdiagnosis of vulvar lesions as Crohn's disease manifestations. We describe the largest case series to date involving patients with vulvar Crohn's disease, discuss the varied clinical presentations, and describe the histopathological findings, which include noncaseating granulomas, ulcerations, lymphatic lesions, and even dysplasia and carcinoma. Our findings underscore the importance of keeping vulvar Crohn's disease on the differential diagnosis when faced with a range of vulvar symptoms and suggest that regular gynecological surveillance in patients with Crohn's disease may be of benefit.

Authors
Foo, W-C; Papalas, JA; Robboy, SJ; Selim, MA
MLA Citation
Foo, W-C, Papalas, JA, Robboy, SJ, and Selim, MA. "Vulvar manifestations of Crohn's disease." Am J Dermatopathol 33.6 (August 2011): 588-593.
PMID
21697699
Source
pubmed
Published In
American Journal of Dermatopathology
Volume
33
Issue
6
Publish Date
2011
Start Page
588
End Page
593
DOI
10.1097/DAD.0b013e31820a2635

Primary intracerebral Hodgkin lymphoma with recurrence.

OBJECTIVE: To report a case of primary intracerebral Hodgkin lymphoma with disease recurrence. METHODS: Case report and review of the literature. RESULTS: A 58-year-old immunocompetent male presented with aphasia. Neuroimaging revealed a left temporal lobe lesion. A craniotomy and resection were performed, and the diagnosis of classical Hodgkin lymphoma was made. Systemic work-up for lymphoma was negative. Postoperatively, the patient was treated with whole brain irradiation. 14 months later, the patient developed an enhancing lesion in his pons and received combination chemotherapy and radiation therapy. Repeat imaging demonstrated leptomeningeal enhancement and multiple lesions throughout the cerebral hemispheres, cerebellum and brainstem. COMMENT: We report what appears to be the first case of a patient with aggressive primary intracerebral Hodgkin lymphoma with disease recurrence.

Authors
Foo, W-C; Desjardins, A; Cummings, TJ
MLA Citation
Foo, W-C, Desjardins, A, and Cummings, TJ. "Primary intracerebral Hodgkin lymphoma with recurrence." Clin Neuropathol 30.2 (March 2011): 75-79.
PMID
21329616
Source
pubmed
Published In
Clinical neuropathology
Volume
30
Issue
2
Publish Date
2011
Start Page
75
End Page
79

Concurrent classical Hodgkin lymphoma and plasmablastic lymphoma in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma treated with fludarabine: a dimorphic presentation of iatrogenic immunodeficiency-associated lymphoproliferative disorder with evidence suggestive of multiclonal transformability of B cells by Epstein-Barr virus.

A small fraction of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma develop Epstein-Barr virus-positive B-cell lymphoproliferative disorders. These Epstein-Barr virus-B-cell lymphoproliferative disorders are thought to be related to immune suppression induced by fludarabine/other chemotherapeutic regimens. As in other immunodeficiency-associated lymphoproliferative disorders, these disorders demonstrate a heterogeneous histological spectrum that ranges from polymorphic to monomorphic to classical Hodgkin lymphoma-like lesions. We report a case of concurrent classical Hodgkin lymphoma and plasmablastic lymphoma in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma treated with fludarabine. Both classical Hodgkin lymphoma and plasmablastic lymphoma were positive for Epstein-Barr virus-encoded RNA, whereas classical Hodgkin lymphoma was also positive for Epstein-Barr virus- latent membrane protein 1, suggesting a different viral latency. Immunoglobulin gene rearrangement studies demonstrated distinct clones in the plasmablastic lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma. These findings suggest biclonal secondary lymphomas associated with iatrogenic immunodeficiency. Epstein-Barr virus-B-cell lymphoproliferative disorders in the setting of chronic lymphocytic leukemia/small lymphocytic lymphoma, in particular those arising after chemotherapy, should be separated from true Richter's transformation, and be categorized as (iatrogenic) immunodeficiency-associated lymphoproliferative disorder.

Authors
Foo, W-C; Huang, Q; Sebastian, S; Hutchinson, CB; Burchette, J; Wang, E
MLA Citation
Foo, W-C, Huang, Q, Sebastian, S, Hutchinson, CB, Burchette, J, and Wang, E. "Concurrent classical Hodgkin lymphoma and plasmablastic lymphoma in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma treated with fludarabine: a dimorphic presentation of iatrogenic immunodeficiency-associated lymphoproliferative disorder with evidence suggestive of multiclonal transformability of B cells by Epstein-Barr virus." Hum Pathol 41.12 (December 2010): 1802-1808.
PMID
20869749
Source
pubmed
Published In
Human Pathology
Volume
41
Issue
12
Publish Date
2010
Start Page
1802
End Page
1808
DOI
10.1016/j.humpath.2010.04.019

Characterizing stiffness of human prostates using acoustic radiation force.

Acoustic Radiation Force Impulse (ARFI) imaging has been previously reported to portray normal anatomic structures and pathologies in ex vivo human prostates with good contrast and resolution. These findings were based on comparison with histological slides and McNeal's zonal anatomy. In ARFI images, the central zone (CZ) appears darker (smaller displacement) than other anatomic zones and prostate cancer (PCa) is darker than normal tissue in the peripheral zone (PZ). Since displacement amplitudes in ARFI images are determined by both the underlying tissue stiffness and the amplitude of acoustic radiation force that varies with acoustic attenuation, one question that arises is how the relative displacements in prostate ARFI images are related to the underlying prostatic tissue stiffness. In linear, isotropic elastic materials and in tissues that are relatively uniform in acoustic attenuation (e.g., liver), relative displacement in ARFI images has been shown to be correlated with underlying tissue stiffness. However, the prostate is known to be heterogeneous. Variations in acoustic attenuation of prostatic structures could confound the interpretation of ARFI images due to the associated variations in the applied acoustic radiation force. Therefore, in this study, co-registered three-dimensional (3D) ARFI datasets and quantitative shear wave elasticity imaging (SWEI) datasets were acquired in freshly-excised human prostates to investigate the relationship between displacement amplitudes in ARFI prostate images and the matched reconstructed shear moduli. The lateral time-to-peak (LTTP) algorithm was applied to the SWEI data to compute the shear-wave speed and reconstruct the shear moduli. Five types of prostatic tissue (PZ, CZ, transition zone (TZ) and benign prostatic hyperplasia (BPH), PCa and atrophy) were identified, whose shear moduli were quantified to be 4.1 +/- 0.8 kPa, 9.9 +/- 0.9 kPa, 4.8 +/- 0.6 kPa, 10.0 +/- 1.0 kPa and 8.0 kPa, respectively. Linear regression was performed to compare ARFI displacement amplitudes and the inverse of the corresponding reconstructed shear moduli at multiple depths. The results indicate an inverse relation between ARFI displacement amplitude and reconstructed shear modulus at all depths. These findings support the conclusion that ARFI prostate images portray underlying tissue stiffness variations.

Authors
Zhai, L; Madden, J; Foo, W-C; Mouraviev, V; Polascik, TJ; Palmeri, ML; Nightingale, KR
MLA Citation
Zhai, L, Madden, J, Foo, W-C, Mouraviev, V, Polascik, TJ, Palmeri, ML, and Nightingale, KR. "Characterizing stiffness of human prostates using acoustic radiation force." Ultrason Imaging 32.4 (October 2010): 201-213.
PMID
21213566
Source
pubmed
Published In
Ultrasonic Imaging
Volume
32
Issue
4
Publish Date
2010
Start Page
201
End Page
213
DOI
10.1177/016173461003200401

Acquired vulvar lymphangioma circumscriptum: a comparison of 12 cases with Crohn's associated lesions or radiation therapy induced tumors.

BACKGROUND: Lymphangioma circumscriptum (LC) is a benign lesion of lymphatic origin. Vulvar involvement occurs in various clinical settings. METHODS: We present 12 cases, and compare lesions in patients with Crohn's disease and those associated with pelvic radiation. RESULTS: The average age at presentation was 49 years. Thirty-three percent of the patients had Crohn's disease, 58% had radiation therapy and 9% had no significant medical history. Sixty-seven percent of the patients had multifocal lesions in anatomically distinct regions. Patients presented on average 16 years after onset of predisposing factors. Presenting complaints were pruritus, wetness and vulvar edema. Lesions were clinically heterogeneous, often found on the labia majora. Lesions consisted of dilated lymphatic channels at the junction of the reticular and papillary dermis. The cells lining these spaces lacked cytologic atypicality or mitotic activity. All lesions so examined were immunoreactive for D240. Patients were most often treated with surgical excision followed by laser ablation. Four of twelve patients, all with radiation-associated lesions, experienced disease progression necessitating additional surgery. CONCLUSIONS: Patients with LC secondary to radiation, when compared to those with Crohn's disease, were 10 years younger, more likely to have associated co-morbidities, and frequently experienced disease progression needing additional surgeries. Acquired vulvar LC has multiple causes with differing prognosis.

Authors
Papalas, JA; Robboy, SJ; Burchette, JL; Foo, W-C; Selim, MA
MLA Citation
Papalas, JA, Robboy, SJ, Burchette, JL, Foo, W-C, and Selim, MA. "Acquired vulvar lymphangioma circumscriptum: a comparison of 12 cases with Crohn's associated lesions or radiation therapy induced tumors." J Cutan Pathol 37.9 (September 2010): 958-965.
PMID
20653826
Source
pubmed
Published In
Journal of Cutaneous Pathology
Volume
37
Issue
9
Publish Date
2010
Start Page
958
End Page
965
DOI
10.1111/j.1600-0560.2010.01569.x

A sinusoidal large cell lymphoma with expression of CD30, CD15, and multiple B-cell antigens: a classical Hodgkin lymphoma with sinusoidal infiltrating pattern or a sinusoidal CD30 positive large B-cell lymphoma with CD15?

Authors
Wang, E; Foo, W-C; Huang, Q
MLA Citation
Wang, E, Foo, W-C, and Huang, Q. "A sinusoidal large cell lymphoma with expression of CD30, CD15, and multiple B-cell antigens: a classical Hodgkin lymphoma with sinusoidal infiltrating pattern or a sinusoidal CD30 positive large B-cell lymphoma with CD15?." Leuk Lymphoma 51.6 (June 2010): 1148-1151. (Letter)
PMID
20443679
Source
pubmed
Published In
Leukemia & Lymphoma (Informa)
Volume
51
Issue
6
Publish Date
2010
Start Page
1148
End Page
1151
DOI
10.3109/10428194.2010.480820

Acoustic radiation force impulse imaging of human prostates ex vivo.

It has been challenging for clinicians using current imaging modalities to visualize internal structures and detect lesions inside human prostates. Lack of contrast among prostatic tissues and high false positive or negative detection rates of prostate lesions have limited the use of current imaging modalities in the diagnosis of prostate cancer. In this study, acoustic radiation force impulse (ARFI) imaging is introduced to visualize the anatomical and abnormal structures in freshly excised human prostates. A modified Siemens Antares ultrasound scanner (Siemens Medical Solutions USA Inc., Malvern, PA) and a Siemens VF10-5 linear array were used to acquire ARFI images. The transducer was attached to a three-dimensional (3-D) translation stage, which was programmed to automate volumetric data acquisition. A depth dependent gain (DDG) method was developed and applied to 3-D ARFI datasets to compensate for the displacement gradients associated with spatially varying radiation force magnitudes as a function of depth. Nine human prostate specimens were collected and imaged immediately after surgical excision. Prostate anatomical structures such as seminal vesicles, ejaculatory ducts, peripheral zone, central zone, transition zone and verumontanum were visualized with high spatial resolution and in good agreement with McNeal's zonal anatomy. The characteristic appearance of prostate pathologies, such as prostate cancerous lesions, benign prostatic hyperplasia, calcified tissues and atrophy were identified in ARFI images based upon correlation with the corresponding histologic slides. This study demonstrates that ARFI imaging can be used to visualize internal structures and detecting suspicious lesions in the prostate and appears promising for image guidance of prostate biopsy.

Authors
Zhai, L; Madden, J; Foo, W-C; Palmeri, ML; Mouraviev, V; Polascik, TJ; Nightingale, KR
MLA Citation
Zhai, L, Madden, J, Foo, W-C, Palmeri, ML, Mouraviev, V, Polascik, TJ, and Nightingale, KR. "Acoustic radiation force impulse imaging of human prostates ex vivo." Ultrasound Med Biol 36.4 (April 2010): 576-588.
PMID
20350685
Source
pubmed
Published In
Ultrasound in Medicine and Biology
Volume
36
Issue
4
Publish Date
2010
Start Page
576
End Page
588
DOI
10.1016/j.ultrasmedbio.2009.12.006

Brain cancer stem cells display preferential sensitivity to Akt inhibition.

Malignant brain tumors are among the most lethal cancers, and conventional therapies are largely limited to palliation. Novel therapies targeted against specific molecular pathways may offer superior efficacy and less toxicity than conventional therapies, but initial clinical trials of molecular targeted agents in brain cancer therapy have been frequently disappointing. In brain tumors and other cancers, subpopulations of tumor cells have recently been characterized by their ability to self-renew and initiate tumors. Although these cancer stem cells, or tumor initiating cells, are often only present in small numbers in human tumors, mounting evidence suggests that cancer stem cells contribute to tumor maintenance and therapeutic resistance. Thus, the development of therapies that target cancer stem cell signal transduction and biology may improve brain tumor patient survival. We now demonstrate that populations enriched for cancer stem cells are preferentially sensitive to an inhibitor of Akt, a prominent cell survival and invasion signaling node. Treatment with an Akt inhibitor more potently reduced the numbers of viable brain cancer stem cells relative to matched nonstem cancer cells associated with a preferential induction of apoptosis and a suppression of neurosphere formation. Akt inhibition also reduced the motility and invasiveness of all tumor cells but had a greater impact on cancer stem cell behaviors. Furthermore, inhibition of Akt activity in cancer stem cells increased the survival of immunocompromised mice bearing human glioma xenografts in vivo. Together, these results suggest that Akt inhibitors may function as effective anticancer stem cell therapies.

Authors
Eyler, CE; Foo, W-C; LaFiura, KM; McLendon, RE; Hjelmeland, AB; Rich, JN
MLA Citation
Eyler, CE, Foo, W-C, LaFiura, KM, McLendon, RE, Hjelmeland, AB, and Rich, JN. "Brain cancer stem cells display preferential sensitivity to Akt inhibition." Stem Cells 26.12 (December 2008): 3027-3036.
PMID
18802038
Source
pubmed
Published In
Stem Cells
Volume
26
Issue
12
Publish Date
2008
Start Page
3027
End Page
3036
DOI
10.1634/stemcells.2007-1073
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