Pathology & Oncology Research最新文献

Introduction: Hairy cell leukemia (HCL) is an indolent B-cell lymphoproliferative disease. Interferon-alpha (IFN-alpha) was the first successfully used drug in HCL; its favourable effect has been known since the early 1980s. However, currently the first-line treatment of the disease consists of purine nucleoside analogs.

Objectives: The aim of our study was to assess the efficacy of pegylated IFN-alpha in HCL patients treated with this drug at a single university center.

Methods: We report the treatment characteristics and outcome of seven classical HCL patients treated with pegylated IFN-alpha at the Department of Internal Medicine and Oncology, Semmelweis University.

Results: As a result of pegylated interferon-alpha treatment, 3 of 7 patients (3/7) achieved an unconfirmed complete remission, 3 of 7 patients (3/7) achieved partial remission. One patient had stable disease while receiving pegylated IFN-alpha. Only mild adverse effects and no infectious complications were observed during our treatment.

Conclusion: Our clinical data support that pegylated IFN-alpha in monotherapy is effective and safe even in elderly and frail HCL patients. It may also be a preferred therapeutic option in patients with profound immunosuppression and in patients with severe active infections.

The accurate distinction between primary and secondary mucinous ovarian cancers is a crucial tool for effective surgical and systematic treatment. Mucinous ovarian metastases of appendiceal origin are a special group of tumors because they appear even in half of female patients with primary appendiceal mucinous carcinomas and demonstrate pathological similarity to primary ovarian mucinous neoplasms. The current literature review focuses on the differences based on pre-operative symptoms, radiological findings, the spectrum of microscopic features, and the significance of the immunophenotype of each tumor. Treatment options, including surgical management and adjuvant chemotherapy protocols, are also briefly overviewed. In conclusion, the source of the ovarian tumor mass might be suggested by preoperative symptoms, values of antigens, and imaging findings. However, the confirmation of the tumor origin is only made after the postoperative pathological examination. Investigating the most accurate immunohistochemical markers and new molecular features may improve diagnostic efficiency in future research.

Background: MRI-based image-guided adaptive brachytherapy (IGABT) is a new approach for individual dose escalation and control of organ at risk (OAR) doses and toxicities in the treatment of locally advanced cervical cancer.

Methods: Various radiotherapy-related parameters and the feasibility of the treatment based on acute toxicity were analyzed in a total of 50 cases in two cohorts who received a brachytherapy (BT) boost after definitive chemoradiotherapy with either an MRI-based IGABT technique (24 patients) or CT-only image guidance (26 patients). For target volume, OAR delineation, and dose prescription, the EMBRACE II protocol was followed.

Results: The features of the target volumes and dose coverage did not differ between the two groups regarding teletherapy. At BT, however, while the High-Risk Clinical Target Volumes (CTVHR) did not differ the D90 dose coverage was significantly higher in the MRI-based IGABT group than in the non-MRI-based group (7.37 ± 0.55 Gy vs. 6.87 ± 0.84 Gy, p = 0.015). The CTVHR D98 doses showed a strong trend in favor of the MRI-based technique (6.16 ± 0.59 Gy, vs. 5.72 ± 0.95 Gy, p = 0.051). Cumulative doses to the CTVHR by means of both D90 and D98 were significantly higher in the MRI-based treatment group than the other group (86.64 ± 4.76 Gy vs. 81.56 ± 8.29 Gy, p = 0.011 and 77.23 ± 4.39 Gy vs. 73.40 ± 7.80 Gy, p = 0.037, respectively). Regarding OAR exposure, doses to the bladder, rectum, and sigmoid did not differ between the two cohorts.

Conclusion: Our first clinical results support the implementation of IGABT as a key component of image-guided adaptive radiotherapy (IGART) aiming at tumor dose-escalation and OAR protection.

Purpose: Positron emission tomography (PET) hybrid imaging targeting HER2 requires antibodies labelled with longer half-life isotopes. With a suitable radiation profile, ⁵²Mn coupled with DOTAGA as a bifunctional chelator is a potential candidate. In this study, we investigated the tumor HER2 specificity and the temporal biodistribution of the [⁵²Mn]Mn-DOTAGA(anhydride)-trastuzumab in preclinical models.

Methods: PET/MRI and PET/CT were performed on SCID mice bearing orthotopic and ectopic HER2-positive and ectopic HER2-negative tumors at 4, 24, 48, 72, and 120 h post-injection with [⁵²Mn]Mn-DOTAGA(anhydride)-trastuzumab. Melanoma xenografts were included for comparison of specificity.

Results: In vivo biodistribution demonstrated strong contrast in HER2-positive tumors, particularly in orthotopic tumors, where uptake was significantly higher than in the blood pool and other organs from 24 h onwards and consistently higher than in ectopic HER2-positive tumors at all time points. Significantly higher tumor-to-blood and tumor-to-muscle ratios were observed in HER2-positive ectopic tumors compared to HER2-negative tumors but only at 4 and 24 h; the differences were likely due to non-specific binding of the tracer. The ratios for orthotopic HER2-positive tumors were significantly higher than those for ectopic HER2-negative tumors and melanoma at all time points. However, the differences between HER2-positive and HER2-negative tumors decreased at later time points.

Conclusion: These results suggest that [⁵²Mn]Mn-DOTAGA(anhydride)-trastuzumab demonstrates efficient tumor-to-background contrast, emphasize the higher tumor uptake observed in orthotopic tumors, and highlight the influence of tumor environment characteristics on uptake.

Kaposi's sarcoma (KS) is a vascular intermediate malignant tumor classified into four clinical types: classic, AIDS-related, iatrogenic, and endemic. Kaposi's sarcoma-associated herpesvirus (KSHV) is the causative agent of KS. Six KSHV genotypes (A, B, C, D, E, and F) classified by K1 or two genotypes (P and M) by K15 have been reported. However, whether the KSHV genotype affects clinical presentation remains elusive. Herein, we investigated the association between viral genotypes and clinical presentations in patients with KS in Okinawa, an endemic area in Japan. Classic KS caused by KSHV genotype C was identified as the most common clinical type of KS in Okinawa. Conversely, 80% of the patients with AIDS-related KS were associated with genotype A. According to K15 genotyping, the population of genotype M was higher than that of genotype P. Although genotype M accounted for most cases of both classic and iatrogenic KS in Okinawa, genotype P constituted the majority of AIDS-related KS. Regarding the association between the K1 and K15 genotypes, single genotype A was associated with genotype P, whereas single genotype C was associated with genotype M. These K1 and K15 associations in Okinawa differed from those in Europe and Africa. In terms of the association between viral genotype and clinical types, A/P tended to be associated with AIDS-related KS and genotype C/M tended to be associated with classic KS. The findings of the current study suggest that the KSHV genotype in Okinawa differs from that in other countries, which is related to the KSHV geographic distribution and population migration. Our data also suggest that the viral genotype in Okinawa is associated with clinical presentations.

Introduction: Several novel morphological variants of inflammatory bowel disease (IBD)- associated dysplasias have been described in recent years. The objective of our study was to reevaluate some of our IBD-associated neoplasia cases and retrospectively identify the so-called non-conventional dysplasias (NCDs).

Methods: We established a database of IBD patients registered between 2011 and 2015 at the Department of Pathology, University of Szeged. Patients with neoplastic samples were extracted into a separate database. Clinical and pathological characteristics were documented for each case. Histological slides were retrospectively reviewed, and cases were reclassified.

Results: During the study period, 57 patients had neoplastic samples, and 47 patients were identified with conventional dysplasias (82.5%). A significant association was found between conventional dysplasias and dysplasia localization (P = 0.004), size (P = 0.012), endoscopic appearance (P = 0.006), grade (P = 0.011), macroscopic appearance of colorectal carcinoma (P = 0.009), and pT stage (P = 0.01). NCD was identified in 20 cases (35.1%). The most frequently observed subtype was serrated not otherwise specified (NOS) dysplasia (n = 6; 30%). Significant associations were detected between the development of NCD and several clinical-pathological features, including the occurrence (P < 0.001), localization (P = 0.001), size (P = 0.002), macroscopic appearance (P = 0.01), grade (P = 0.005), histological subtype (P = 0.003), pT (P = 0.003) and pM stage (P = 0.047) of colorectal carcinoma, as well as microsatellite status (P < 0.001).

Discussion: The identification of IBD-associated NCDs might play a crucial role in future clinical practice. Some authors suggest closer patient follow-up upon identification of these lesions and recommend random biopsy sampling in IBD patients to detect potentially occult lesions. Further studies involving larger national and international patient cohorts are warranted to gain a more comprehensive understanding of the clinical behavior of NCDs.

Background: Autosomal dominant genodermatoses with a predisposition for cancer make up a well-described disease group with unique cutaneous alterations in each. This should urge dermatologists to think of other consequences beyond the skin. Histological examination serves as the gold standard, and it is an effective tool for the first investigation, even nowadays in the "next-generation genetic" era. Multiple appearances of benign tumours histologically proved to be cutaneous leiomyomatosis suggest a rare disorder with germline heterozygous pathogen variant in the FH gene. The encoded fumarate hydratase is a Krebs cycle enzyme, and has a role in catalysing the transition from fumarate to malate.

Case presentation: Years before the easy accessibility of the complete genetic workup in Hungary, a yearly abdominal MRI check-up was suggested preventively for a middle-aged man with multiplex cutaneous leiomyomata. During the follow-up period papillary type 2 renal cell carcinoma was diagnosed in the left kidney at an early stage, and a successful operation saved his life without the need for aggressive chemotherapy or immunotherapy. Immunohistochemistry of tumour tissue proved FH-deficient renal cell cancer. We discuss in short the current knowledge of pathophysiology and accessible therapies regarding this aggressive malignant tumour type in the kidney, which is usually detected in the advanced stage with early metastasis. We also highlight an early sign, i.e., solitary cystic alteration in the kidney, which can be preliminarily observed before malignant transformation, which was also described in mouse models. Sanger sequencing and Multiplex-Ligation-Dependent Probe Amplification (MLPA) analysis of the FH gene was completed in the affected son of the original proband, and Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC) was confirmed by demonstrating a large germline deletion in this family after years of observation.

Conclusion: Regular observation of individuals with hereditary leiomyomatosis may prevent a serious sequelae of untreatable renal malignancy.

Photobleaching of immunofluorescence signal is a well-known phenomenon, however, its impact on derived parameters characterizing number and shape of different cell types in tissue sections is less understood. Our aim was to determine whether the duration of illumination and the type of fluorophore (Alexa Fluor 546 (A546), and Alexa Fluor 488 Plus (A488)) can influence the acquired morphometric parameters of cells in the nervous system. Immunofluorescent staining of microglia and neurons was performed on mouse spinal cord sections. Mean color intensity in a field of view, number of detectable neuronal cell profiles, partial coverage of microglial profiles, and fractal geometrical parameters were determined. All measurements were made using epifluorescence microscopy with identical acquisition parameters. Most of the measured parameters suffered significant alternation after 30-60 s of illumination. The data-altering effect of photobleaching was most prominent in the case of mean fluorescent intensity. Thus, while immunofluorescent staining is useful for co-localizing different groups of cells, cell-specific quantitative morphological measurements require photostable staining. Possibility of the combination of these methods on the same section in order to achieve multi-channel localization without photobleaching is exemplified.

Pazopanib is a tyrosine-kinase inhibitor also used for the treatment of advanced soft tissue sarcomas. Our retrospective study analyzed real-world data of stage 4 sarcoma patients treated with pazopanib in our department in the past 10 years. Data were collected from the Medworks medical system, which is used for daily work in our center. A total of 99 patients were included: 46 men and 53 women The median age at the diagnosis was 49.8 years. The most common histological subtypes were leiomyosarcoma and synovial sarcoma. All patients received 800 mg of pazopanib per day, which was reduced to 400 mg in the event of toxicity. Treatment was continued until disease progression or unmanageable toxicity. The primary endpoint of the study was progression-free survival and the secondary endpoints were overall survival, overall response rate and disease control rate. The results in relation to demographic data, previous treatments, localizations of primary tumors and metastasis and histological subtypes were analyzed. In our center pazopanib was most frequently used in the third line. In total, 61 patients received perioperative therapy; the most common regimen used in the metastatic setting was VIP. Median PFS and OS were 3 months and 7 months, respectively. ORR was 14% and DCR was 40.45%. Dose reductions were necessary during the treatment of 56 patients. Hematological toxicity was detected in 23% of cases, with the most frequent events being grade 1 thrombocytopenia and grade 2 leukocytopenia. Non-hematological adverse events were documented in half of the patients. Pazopanib was more effective in earlier lines of treatment. Compared to the PALETTE phase 3 trial more patients received perioperative therapy, median PFS and OS were shorter (3 months vs. 4.6 months and 7 months vs. 11.9 months) and ORR was higher (14% vs. 9%) in our patient population. Dose reductions were more frequent in our center. Pazopanib is a therapeutic option for the treatment of advanced soft tissue sarcoma, also according to real-world data. Further investigations are needed to select patients who can benefit the most from pazopanib and to determine the most appropriate sequence of therapy.