Intraneural synovial sarcoma of the median nerve

Synovial sarcomas are soft-tissue malignancies with a poor prognosis and propensity for distant metastases. Although originally believed to arise from the synovium, these tumors have been found to occur anywhere in the body. We report a rare case of synovial sarcoma arising from the median nerve. To our knowledge, this is the twelfth reported case of intraneural synovial sarcoma, and only the fourth arising from the median nerve. Because the diagnosis may not be apparent until after pathological examination of the surgical specimen, synovial sarcoma should be kept in mind when dealing with what may seem like a benign nerve tumor

Filarial Lymphedema Is Characterized by Antigen- Specific Th1 and Th17 Proinflammatory Responses and a Lack of Regulatory T Cells

Background: Lymphatic filariasis can be associated with development of serious pathology in the form of lymphedema, hydrocele, and elephantiasis in a subset of infected patients. Methods and Findings: To elucidate the role of CD4+ T cell subsets in the development of lymphatic pathology, we examined specific sets of cytokines in individuals with filarial lymphedema in response to parasite antigen (BmA) and compared them with responses from asymptomatic infected individuals. We also examined expression patterns of Toll-like receptors (TLR1–10) and Nod-like receptors (Nod1, Nod2, and NALP3) in response to BmA. BmA induced significantly higher production of Th1-type cytokines—IFN-c and TNF-a—in patients with lymphedema compared with asymptomatic individuals. Notably, expression of the Th17 family of cytokines—IL-17A, IL-17F, IL-21, and IL-23—was also significantly upregulated by BmA stimulation in lymphedema patients. In contrast, expression of Foxp3, GITR, TGFb, and CTLA-4, known to be expressed by regulatory T cells, was significantly impaired in patients with lymphedema. BmA also induced significantly higher expression of TLR2, 4, 7, and 9 as well Nod1 and 2 mRNA in patients with lymphedema compared with asymptomatic controls. Conclusion: Our findings implicate increased Th1/Th17 responses and decreased regulatory T cells as well as regulation of Toll- and Nod-like receptors in pathogenesis of filarial lymphedema

Filarial lymphedema is associated with lack of Foxp3, GITR, TGFβ, and CTLA-4 upregulation.

<p>(A, B) PBMCs from filarial lymphedema [CP] (n = 12) and asymptomatic infected [INF] (n = 10) patients were stimulated with (A) BmA (10 µg/ml) or (B) PPD (10 µg/ml) for 24 hours, and Foxp3, GITR, TGFβ, and CTLA-4 mRNA were measured by real-time RT-PCR. Results are shown as fold change over media control. P values were calculated using the Mann-Whitney test.</p

Filarial lymphedema is associated with increased expression of TLR2, 4, 7 and 9 mRNA.

<p>PBMCs from filarial lymphedema [CP] (n = 12) and asymptomatic infected [INF] (n = 10) patients were stimulated with BmA (10 µg/ml) for 24 hours, and TLR1-10 mRNA were measured by real-time RT-PCR. Results are shown as fold change over media control. P values were calculated using the Mann-Whitney test.</p

Characteristics of the study population.

*<p>The lower limit of the assay detection was 32 U/ml.</p

Filarial lymphedema is associated with enhanced expression of the IL-17 family of cytokines.

<p>PBMC expression of IL-17A, IL-17F, IL-21 and IL-22 mRNA as measured by real-time RT-PCR following 24-hour stimulation with (A) BmA or (C) PPD and PBMC secretion of IL-6 and IL-1β as measured by ELISA and IL-23 mRNA as measured by real-time RT-PCR following 24-hour stimulation with (B) BmA or (D) PPD in filarial lymphedema [CP] (n = 12) and asymptomatic infected [INF] (n = 10) patients. Results are depicted as net cytokine production or as fold change over media control. P values were calculated using the Mann-Whitney test.</p

Filarial lymphedema is not associated with elevated Th2 cytokine secretion.

<p>(A, B) PBMCs from filarial lymphedema [CP] (n = 12) and asymptomatic infected [INF] (n = 10) patients stimulated with (A) BmA (10 µg/ml) or (B) PPD (10 µg/ml) for 24 hours, and Th2 - IL-4 and IL-13, as well as IL-10, cytokine levels were measured by ELISA. Results are shown as net cytokine production over media control. P values were calculated using the Mann-Whitney test.</p

Filarial lymphedema is associated with elevated Th1 cytokine secretion.

<p>(A, B) PBMCs from filarial lymphedema [CP] (<i>n</i> = 12) and asymptomatic infected [INF] (n = 10) patients stimulated with (A) BmA (10 µg/ml) or (B) PPD (10 µg/ml) for 24 hours, and Th1 - IL-2, IFN-γ, and TNF-α cytokine levels were measured by ELISA. Results are shown as net cytokine production over media control. P values were calculated using the Mann-Whitney test.</p