The clinical importance of PD‑L1 and PD‑1 expression in diffuse large B cell lymphoma

Introduction. The target pathway programmed cell death‑1 (PD‑1)/ programmed death‑ligand 1 (PD‑L1) shows clinical efficacy in solid tumors, but also in Hodgkin’s and non‑Hodgkin’s lymphoma. PD‑L1 expression most often correlates with a poor prognosis and a PD‑1 regulatory factor that mediates immunosuppression. The presence of an increased number of tumor‑infiltrating lymphocytes (TILs) PD‑1 + is a favorable prognostic factor in patients with diffuse large B cell lymphomas (DLBCLs) and follicular lymphomas, while the low number of TILs PD‑1 + is associated with an increased risk of histological transformation. In DLBCLs, TILs PD‑1 + may not reflect the depletion of T‑mediated tumor cells but may be an indicator of lymphoid cell origin. Objectives. The objective of this study was to describe the correlation between PD‑1 and PDL‑1 with survival in patients with the diagnosis of diffuse large B cell lymphoma. Material and methods. We have studied 80 patients and we have analyzed DLBCLs according to the Hans algorithm; in addition, we analyzed PD‑1 and PD‑L1 in tumor cells and in immune cells and we correlated this data with patient’s survival. Results. We found that there is a tendency of decreased survival and therapeutic response in DLBCL patients, with both an intense and weak PD‑L1 positivity in tumor cells. PD‑1 low positivity was associated in higher percentage with relapse and treatment unresponsiveness. Conclusions: Our data suggested that PD‑L1 expression correlates with a poor clinical response although it is not an independent prognostic marker and PD‑1 represents a favorable prediction factor for survival

Secretory Carcinoma of the Breast with Apocrine Differentiation—A Peculiar Entity

Background and Objectives: Secretory carcinoma of the breast is an uncommon histological subtype of breast cancer. There is little research on this entity and only a few larger studies, which lack consensus. We aim to report a particular apocrine differentiation in this subtype and ponder upon the clinical outcome of this case. Case presentation: We report the case of a 72-year-old female patient who presented to our hospital with a suspicious breast tumor. Core biopsy and mastectomy showed a low-grade breast carcinoma, a secretory subtype with apocrine differentiation. Immunohistochemistry confirmed both the secretory nature and the apocrine nature of the tumor cells. Surgical excision was considered curative and the patient is under long-term surveillance for any recurrences. Conclusions: There is very little research on the clinical behavior of secretory carcinomas with apocrine differentiation. The clinical outcome is unknown and, unfortunately, besides surgery, no other adjuvant treatments have shown efficacy. Further studies on long-term clinical progression are required for this rare entity

BETA-CATENIN – AN IMPORTANT IMMUNOHISTOCHEMICAL TOOL IN STRATIFYING ENDOMETRIAL CARCINOMAS?

Introduction. Recent research has demonstrated that the immunohistochemical nuclear -catenin expression is a valid surrogate for CTNNB1 exon 3 mutation in endometrial carcinomas (ECs). This mutation is an independent prognostic factor which identifies a subgroup of low-grade endometrial carcinomas that have a tendency for recurrence and worse prognosis. The objective of the study was to evaluate nuclear -catenin expression in different molecular subgroups of E Cs. Material and methods. We tested immunohistochemical nuclear -catenin expression in 50 cases of endometrial carcinomas diagnosed in two clinical institutions. Statistical analysis was performed between -catenin expression and various clinical, demographic, pathological and immunohistochemical parameters (age, myometrial invasion, FIGO grade, histopathological subtype, hormone receptors – ER, PR etc). Additionally, we analysed what molecular subgroup of ECs (MSS, MSI, p53wt, p53abn) revealed the most frequent cases with -catenin expression. Results. Our study indicated that ECs with nuclear -catenin positivity were observed in cases with higher FIGO grade (p=0.02), in endometrioid carcinomas (p=0.04) and in cases with lympho-vascular invasion (p=0.05). ER and PR were frequently expressed in the positive -catenin subgroup (p=0.03, p=0 .02). Our results show that ECs which express nuclear -catenin correlate with parameters that are already considered unfavourable. Conclusions. mmunohistochemical -catenin nuclear expression is an excellent replacement for the CTNNB1 exon 3 mutation in ECs and helps to stratify and predict prognosis in certain cases of ECs. We believe that future research will include this marker as part of the routine immunohistochemical panel for ECs

Endoscopic management of a rare case of obstructive giant duodenal Brunner’s gland hamartoma

Introduction. Brunner’s gland hamartomas are very uncommon. They are small, benign lesions, frequently located in the bulb of the duodenum. Usually found incidentally during routine esophago-gastro-duodenoscopies, these lesions are frequently asymptomatic, but some patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Surgical excision is required, especially if the lesion has large dimensions. The pathological examination is the most important in confirming the diagnosis.Case presentation. We report a case of a 64-year-old female patient, who presented to the emergency room for vomiting partially digested food, without blood. Upper digestive endoscopy revealed a polypoid mass, with a 1 cm stalk, located in the duodenal bulb. The polyp was successfully endoscopically resected and the pathological diagnosis was of Brunner’s gland hamartoma. Histologically, this polyp consisted of the components of Brunner’s gland cells, as well as glandular, adipose and muscle cells. Conclusions. Brunner’s gland hamartomas are rare duodenal tumors occurring in middle-aged patients that present either with gastrointestinal hemorrhage, obstructive symptoms or as an incidental finding. Surgical or endoscopic excision is uncomplicated, and the long-term outcome is favorable. The particularity of our case is given by the fact that this lesion was very large, it caused symptoms such as vomiting and was managed solely by endoscopic resection

Giant Gallbladder Tumor, Unusual Cancer—Case Report and Short Review of Literature

Background: Giant gallbladder is an uncommon condition that can result from a benign pathology and rarely presents with malignancy. Intracholecystic papillary–tubular neoplasm (ICPN) is a relatively new entity first described by V. Adsay in 2012 and included in the World Health Classification of Digestive System Tumours in 2019. Intracholecystic papillary-tubular neoplasm is a preinvasive lesion with an incidence of around 1% that may present as four histologic subtypes—biliary, gastric, intestinal, or oncocytic—of which the biliary subtype has the highest risk of associated invasive cancer. Although invasive carcinoma is present in about 50% of cases of ICPN, these patients have a significantly better prognosis than those with usual gallbladder cancer, suggesting that the entities may have distinct biological signatures. Case report: A 77-year-old female presented to the hospital with progressive swelling in the right hemiabdomen, a loss of appetite, and weight loss. MRI highlighted a giant abdominal tumor located in the right hypochondrium and right abdominal flank with liver invasion (segment V). Preoperatively, a gallbladder 25 × 17 cm in size was noted, and the patient underwent radical cholecystectomy. It was surprising to find such a giant malignant gallbladder tumor, diagnosed as invasive poorly cohesive carcinoma associated with ICPN. Discussion: A megacholecyst is a rare discovery. Although most often found in benign pathologies, giant gallbladder cancer can be considered. The neoplastic features and the loco-regional extension of the tumor must be evaluated by imaging scans. Few cases of giant benign gallbladder have been reported in the literature; however, this appeared to be the largest resectable gallbladder carcinoma reported to date according to the literature. Conclusion: The stage of gallbladder neoplasia is not correlated with the size of the gallbladder. Regardless of tumor size, the prognosis seems to be directly related to the stage, morphology, and resectability