Medical image of the week: lepidic growth

Lepidic growth is most often seen in adenocarcinoma in situ (Figure A, 40x magnification). Adenocarcinoma in situ is formerly known as bronchoalveolar cell carcinoma (BAC). A similar growth pattern in a morphologically very different tumor (mucinous adenocarcinoma) is shown for comparison (Figure B, 400x). Mucinous adenocarcinoma growing on alveolar septae nearly always is invasive, so the entity of mucinous adencioarcinoma in situ practically doesn't exist, further differentiating this entity from BAC

Dysregulation of IL-2 and IL-8 production in circulating T lymphocytes from young cystic fibrosis patients

It is well documented that patients with cystic fibrosis (CF) are unable to clear persistent airway infections in spite of strong local inflammation, suggesting a dysregulation of immunity in CF. We and others have reported previously that T lymphocytes may play a prominent role in this immune imbalance. In the present work, we compared the reactivity of CD3(+) T cells obtained from young CF patients in stable clinical conditions (n = 10, aged 9–16·5 years) to age-matched healthy subjects (n = 6, aged 9–13·5 years). Intracellular levels of interferon (IFN)-γ, interleukin (IL)-2, IL-8 and IL-10 were determined by flow cytometry after whole blood culture. The data identified T lymphocyte subsets producing either low levels (M1) or high levels (M2) of cytokine under steady-state conditions. We found that the production of IFN-γ and IL-10 by T lymphocytes was similar between young CF patients and healthy subjects. In contrast, after 4 h of activation with PMA and ionomycin, the percentage of T cells producing high levels of IL-2 (M2) was greater in CF patients (P = 0·02). Moreover, T cells from CF patients produced lower levels of IL-8, before and after activation (P = 0·007). We conclude that a systemic immune imbalance is present in young CF patients, even when clinically stable. This disorder is characterized by the capability of circulating T lymphocytes to produce low levels of IL-8 and by the emergence of more numerous T cells producing high levels of IL-2. This imbalance may contribute to immune dysregulation in CF