Clinical implication of HLA class I expression in breast cancer

<p>Abstract</p> <p>Background</p> <p>Human leukocyte antigen (HLA)-class I molecules on tumor cells have been regarded as crucial sites where cytotoxic T lymphocytes (CTL) can recognize tumor-specific antigens and are strongly associated with anti-tumor activity. However, the clinical impact of HLA class I expression in breast cancer has not been clarified.</p> <p>Methods</p> <p>A total of 212 breast cancer patients who received curative surgery from 1993 to 2003 were enrolled in the current study. HLA class I expression was examined immunohistochemically using an anti-HLA class I monoclonal antibody. The correlation between HLA class I positivity and clinical factors was analyzed.</p> <p>Results</p> <p>The downregulation of HLA class I expression in breast cancer was observed in 69 patients (32.5%). HLA class I downregulation was significantly associated with nodal involvement (p < 0.05), TNM stage (p < 0.05), lymphatic invasion (p < 0.01), and venous invasion (p < 0.05). Patients with preserved HLA class I had significantly better disease-free interval (DFI) than those with loss of HLA class I (p < 0.05). However, in multivariable analysis, HLA class I was not selected as one of the independent prognostic factors of disease-free interval.</p> <p>Conclusion</p> <p>The examination of HLA class I expression is useful for the prediction of tumor progression and recurrent risk of breast cancer via the antitumor immune system.</p

Assessment of Percutaneous Laparoscopic Ultrasonography-Guided Core Needle Biopsy for the Advanced Diagnosis of Unresectable Pancreatic Cancer

Context Before the initiation of cytotoxic therapy for locally unresectable pancreatic cancer, staging laparoscopy is an important diagnostic method for both the detection of occult small lesions and the extraction of a tumor sample for advanced pathological examination using core needle biopsy (CNB) under laparoscopic ultrasonography (LUS) guidance. Objective This study aimed to evaluate the safety and usefulness of LUS-guided CNB in pancreatic cancer. Methods Consecutive patients with locally unresectable pancreatic cancer who underwent staging laparoscopy were retrospectively analyzed. LUS-guided CNB was performed percutaneously under a laparoscopic view. The clinical results of the LUS-guided CNB group and the non-LUS-guided CNB group were compared. Results Forty-eight patients who underwent staging laparoscopy by LUS-guided CNB or endoscopic ultrasound-guided fine needle aspiration were identified. LUS-guided CNB was performed in 25 patients. The mean tumor size in the LUS-guided CNB group was significantly larger than that in the non-LUS-guided CNB group. No significant difference was observed between the two groups in operating time or bleeding volume. The rates of malignancy diagnosis and histological classification subtyping were significantly higher in the LUS-guided CNB group. Histologically differentiated adenocarcinoma was identified in 15 patients using samples acquired by LUS-guided CNB. There was no uncontrollable bleeding or other complications, and a significant difference in the occurrence of peritoneal dissemination after laparoscopic examination was observed between the two groups. Conclusion LUS-guided CNB enables the safe acquisition of sufficient tissue volumes for certain pathological analyses required to determine treatment strategies for locally unresectable advanced pancreatic cancer

Management of horizontal duodenal perforation: a report of three cases and review of literature

Abstract Background Perforation of the horizontal duodenum is very rare due to the presence in retroperitoneal space. It depicts an unusual clinical picture and is difficult to diagnose, leading to increased morbidity and mortality. The treatment strategies are usually varied and based on small series of cases, literature reviews, and expert opinions. Case presentation Here, we presented three cases of horizontal duodenal perforation in three different clinical processes. The first case, a 30-year-old male patient, presented with abdominal pain and hematemesis after experiencing a physical assault on the previous day. Computed tomography (CT) scan showed rupture of the horizontal duodenum. It was repaired by side-to-side duodenojejunostomy. Postoperatively, he had anastomotic leakage, disseminated intravascular coagulation, and pulmonary failure and recovered after a long hospital stay. The second case, an 81-year-old female, had duodenal perforation with endoscopic coagulation of the bleeding diverticulum. Segmental resection of the duodenum and side-to-side duodenojejunostomy were performed. Postoperatively, there was slight anastomotic leakage, but surgical intervention was not needed. The third case, an 89-year-old female, was a patient with obstructive jaundice due to pancreas head carcinoma, who developed perforation of the horizontal duodenum during endoscopic retrograde cholangiopancreatography (ERCP). After unsuccessful conservative management, duodenojejunostomy at the perforated site and gastric bypass were performed. The postoperative course was uneventful. Conclusion Early suspicion and investigation is necessary for cases of abdominal injuries. CT scan is the investigation of choice. The management options should be based on the clinical condition of the patient, comorbidities, surgical expertise, existing guidelines, and available resources