Value of GCET1, HGAL (GCET2), and LMO2 in the Determination of Germinal Center Phenotype in Diffuse Large B-cell Lymphoma

Objective

Diffuse large B-cell lymphoma (DLBCL) is a biologically heterogeneous disease that is classified into germinal center B-cell (GCB) and non-GCB subtypes, which are prognostically different. The Hans algorithm is the most widely used tool based on CD10, BCL6, and MUM1 expression, but some cases with the non-GCB phenotype are still known to be misclassified. In this study, we investigate the extent to which GCET1, HGAL, and LMO2 protein expressions reflect GCB phenotype together with their roles in determining the GCB phenotype of DLBCL and their contributions to the performance of the Hans algorithm.

Materials and Methods

Sixty-five cases of DLBCL-not otherwise specified, 40 cases of follicular lymphoma (FL), and 19 non-GC-derived lymphoma cases were included in this study. The DLBCL cases were grouped as CD10+ (Group A) or only MUM1+ (Group B), and the remaining cases constituted the intermediate group (Group C). GCET1, HGAL, and LMO2 expressions were evaluated.

Results

In the FL group, GCET1, HGAL, and LMO2 were positive in 85%, 77.5%, and 100% of the cases, respectively. Among the non-GC-derived lymphoma cases, all three markers were negative in cases of small lymphocytic lymphoma, plasmablastic lymphoma, peripheral T-cell lymphoma, and anaplastic large cell lymphoma. GCET1 and HGAL were negative in cases of marginal zone lymphoma (MZL) and mantle cell lymphoma (MCL). Two of the 3 MZL and 2 of the 4 MCL cases were positive for LMO2. In the DLBCL group, the number of cases with GCET1, HGAL, and LMO2 positivity was 18 (90%), 17 (85%), and 20 (100%), respectively, in Group A and 0 (0%), 2 (13.3%), and 2 (13.3%), respectively, in Group B. Considering these rates, when the cases in the intermediate group were evaluated, it was concluded that 13 cases typed as non-GCB according to the Hans algorithm may have the GCB phenotype.

Conclusion

GCET1, HGAL, and LMO2 are highly sensitive markers for determining the germinal center cell phenotype and can increase the accuracy of the subclassification of DLBCL cases, especially for cases that are negative for CD10.

Biosimilar Rituximab (Redditux) Added to CHOP Chemotherapy for De-novo Diffuse Large B-cell Lymphoma Patients: Real-life Single Center Experience

Objective

Redditux®(RED), the biosimilar rituximab, was approved in Turkey for all indications of the original Mabthera®(MAB) in March 2018. The aim of our study was to evaluate the efficacy and safety of RED in de-novo DLBCL.

Materials and Methods

Fifty-one patients received RED combined with CHOP regimen. The median follow-up was 31 months. The historical control group included 219 patients treated with MAB-CHOP regimen and the median follow-up time was 38 months. We compared the response rates and survival outcomes of the RED- and MAB-CHOP treated cohorts.

Results

In the RED cohort, the overall response rate (ORR) at the end of the treatment protocol was 86%, with 37 CR (72.5%) and 7 PR (13.5%). In the historical MAB cohort, the overall response rate was 84%, with a CR and PR rate of 82% and 2%, respectively. The 24-month PFS rates were 73.76% (95%CI 0.59-0.84) and 85.2 (95%CI:0.79-0.90) for RED and MAB cohorts, respectively (p=0.0106). The 24-month OS rates were 78.4% (95%CI:0.64-0.87) and 81.4% (95%CI:0.75-0.86) for RED and MAB cohorts, respectively (p=0.7461). For pts with high R-IPI score; the 24-month PFS was 45.5% (95%CI:0.17-0.71) and 63% (95%CI:0.37-0.80) for RED and MAB cohorts, respectively (p=0.0711). In the RED cohort, CNS relapse was significantly increased compared to MAB cohort (10% vs 1.83%, p=0.004). Among our RED cohort, bone involvement at the time of diagnosis was a risk factor for CNS relapse (p=0.028). Thirteen pts died in the follow-up. There was not any serious adverse event causing the cessation of the drug.

Conclusion

RED has similar ORR to MAB. However, PFS rates were worse in the RED cohort. Additionally, CNS relapse ratio was a major concern for our RED cohort. Large prospective controlled studies and real-life data with longer follow-up are needed to document the non-inferiority of RED compared to MAB.

Diffuse Large B-Cell Non-Hodgkin Lymphoma Involving Multiple Different Organs in a Young Adult with 18F-FDG PET/CT

Extranodal-multiorgan involvement is rarely presented in diffuse large B-cell non-Hodgkin lymphoma. ¹⁸Fluorine-fluorodeoxyglucose positron emission tomography/computed tomography findings of a 22-year-old female patient with supra/infra-diaphragmatic nodal and skeletal involvements and thyroid, pancreas, right breast, bilateral renal, and ovarian involvements were presented.

A rare presentation of adrenal adenoma in infancy: isolated Cushing`s syndrome

Adrenocortical tumors are rare in children. Most of these tumors present with endocrinological manifestations, majority of which with virilizing features alone or in combination with over production of other adrenal hormones. However, it is uncommon of an adrenocortical tumor to present solely with Cushing`s syndrome. In this paper we discuss the clinical presentation and management of a 5-month-old infant who had presented with Cushing`s syndrome due to a functioning adrenocortical adenoma without androgen and mineralocorticoid excess, and made a brief review on the clinical and histopathological characteristics of adrenocortical tumors.

The Impact of Primary Tumor and Locoregional Metastatic Lymph Node SUVmax on Predicting Survival in Patients with Rectal Cancer

Objectives:

The aim of this study was to evaluate the impact of maximum standard uptake value (SUV_max) of the primary tumor and locoregional metastatic lymph node in predicting survival in patients with the preoperative rectal adenocarcinoma.

Methods:

One hundred and fifteen patients [mean age ± standard deviation (SD): 58.7±11.4 years] with biopsy-proven rectal adenocarcinoma underwent ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging for the staging were included in this study. All patients were followed-up for a minimum of 12 months (mean ± SD: 29.7±13.5 months). Tumor-node-metastasis 2017 clinical staging, SUV_max of the primary rectal tumor and locoregional lymph nodes on the PET/CT studies were evaluated.

Results:

All patients had increased FDG activity of the primary tumor. The mean ± SD SUV_max of the primary tumor and locoregional metastatic lymph node were 21.0±9.1 and 4.6±2.8, respectively. Primary tumor SUV_max did not have an effect on predicting survival (p=0.525) however locoregional metastatic lymph node SUV_max had an effect (p<0.05) on predicting survival. Clinical stage of the disease was a factor predicting survival (p<0.001).

Conclusion:

¹⁸F-FDG PET/CT is an effective imaging modality for detecting primary tumors and metastases in rectal adenocarcinoma and clinical stage assessment with PET/CT had an effect on predicting survival. Furthermore, in our study locoregional lymph node SUV_maks was defined as a factor in predicting survival.

Does the number of mucosal immune cells differ in irritable bowel syndrome and its subtypes?

BACKGROUND/AIMS

Recently, mucosal inflammation has been proposed to be one of the mechanisms underlying the pathophysiology of irritable bowel syndrome (IBS); however, there are controversial results regarding this hypotheses. Our aim was to evaluate immune cell infiltration in rectal and ileal biopsy specimens of patients with IBS and to compare it with those of healthy controls.

MATERIALS AND METHODS

In total, 36 patients with IBS (15 with diarrhea and 21 with constipation) and 16 healthy volunteers were enrolled. Ileocolonoscopy and ileal/rectal biopsies were performed. Rectal and terminal ileal biopsy specimens were evaluated for mucosal immune cell infiltration using immunohistochemical analysis. Serotonin positivity as well as counts of intraepithelial lymphocytes (IEL) and CD4+, CD8+, CD20+, and CD3+ cells were determined by a single pathologist who is an expert in the gastrointestinal system.

RESULTS

CD3+ and CD4+ cell counts in rectal and terminal ileal biopsy specimens were lower in the IBS group than in the controls. Conversely, there was no statistically significant difference between the IBS and control groups in terms of serotonin positivity as well as counts of IEL and CD20+ and CD8+ cells. Comparison between the IBS subgroups revealed a higher number of IEL in rectal biopsy specimens of the diarrhea dominant group. In the IBS subgroups, immune cell counts in terminal ileal and rectal biopsy specimens showed a positive correlation.

CONCLUSION

IBS and its subgroups showed lower immune cell counts than the controls in our study. These results indicate that there is no significant mucosal inflammation in homogeneous groups of patients with IBS. Rectal biopsies may be sufficient for the evaluation of inflammation in IBS.

Clinicopathological Characteristics of Papillary Thyroid Cancer in Children with Emphasis on Pubertal Status and Association with BRAFV600E Mutation

OBJECTIVE

Papillary thyroid cancer (PTC) may behave differently in prepubertal children as compared to pubertal children and adults. BRAF gene activating mutations may associate with PTC by creating aberrant activation. We aimed to evaluate the clinicopathological characteristics of PTC patients with emphasis on the pubertal status and also to investigate the association of BRAF^V600E mutation with disease characteristics.

METHODS

The medical records of 75 patients with PTC were reviewed retrospectively. BRAF^V600E mutation status was available only in the medical records of 56 patients.

RESULTS

Mean age at diagnosis was 12.4±3.8 years. There was no difference in sex, initial signs, tumor histopathology, and pathological evidence of tumor aggressiveness between prepubertal and pubertal children. Although not statistically significant, lateral neck nodal metastasis and lung metastasis at diagnosis were more prevalent in prepubertal children. After excluding patients with microcarcinoma, prepubertal children were found to require lateral neck dissection and further doses of radioactive iodine more frequently than pubertal patients. Recurrence was also more frequent in prepubertal children (p=0.016). Frequency of BRAF^V600E mutation was similar in prepubertal and pubertal patients. BRAF^V600E mutation was found in 14/56 (25%) patients and was high in the classic variant PTC (p=0.004). Multicentricity was high in BRAF^V600E mutation (p=0.01). There was no relation between BRAF^V600E mutation and lymph node and pulmonary metastasis at diagnosis, or between BRAF^V600E mutation and pathological evidence of tumor aggressiveness.

CONCLUSION

PTC is more disseminated in prepubertal children. BRAF^V600E mutation does not correlate with a more extensive or aggressive disease. BRAF^V600E mutation is not the cause of the differences in the biological behavior of PTC in prepubertal and pubertal children.

Primary intestinal lymphangiomatosis of the ileum in an adult-the role of surgical approach

Lymphangioma is a rare benign tumor that occurs due to abnormalities occurring during lymphatic development. It is usually seen in children and young adults. The incidence of lymphangiomas in the gastrointestinal tract is very low. Here we describe the case of 43-year-old woman with lymphangioma of the ileum with infiltrative polyposis-like appearing lesions diagnosed by capsule endoscopy and treated with segmental resection of affected intestinal part with laparotomy. Lesions involving mesentery and ileum were confirmed by pathology. After surgery, the patient's symptoms improved. No further therapy was needed because of the benign manner of the lesions. Patient had no symptoms in 10 months follow-up after surgery.

Treatment of atypically-localized cavernous hemangioma in abdomen with atypical pain

INTRODUCTION

Hemangiomas are the most common benign lesions of the liver. They usually remain asymptomatic and it is sufficient to follow up with intermittent imaging methods. The case presented herein featured with localization and atypical symptoms.

PRESENTATION OF CASE

A man aged 59 years was admitted with a three-month history of continuous and recently increased abdominal pain, and also early satiety. Computed Tomography (CT) showed a 9×6-cm mass that compressed the spleen on the left sub-diaphragmatic area, attached to the inferior part of the diaphragm. The mass was removed laparoscopically and pathology was cavernous hemangioma.

DISCUSSION

Although surgical treatment of cavernous hemangioma of the liver (CHL) remains in the background, for symptomatic patients who have no clear diagnosis, when complications emerge, surgery can be preferable. Here in minimally invasive surgery was performed in this case suffering from atypical abdominal pain.

CONCLUSION

Cavernous hemangiomas of the liver rarely require treatment. Surgery is one of the options in selected cases and abdominal pain is one of the indications. In patients complaining from persistent abdominal pain, if intraabdominal atypical-localized mass was seen in examinations, hemangioma should be remembered in differential diagnosis.

Metastatic gastric signet-ring cell carcinoma: A rare cause of acute appendicitis

We report a 32-year-old patient who underwent laparoscopy with classical symptoms and signs of acute appendicitis. An inflamed, edematous and non-perforated appendix, also a large amount gelatinous ascites, omental and peritoneal implants were seen. Appendectomy was performed and multiple biopsies were taken from omentum and peritoneum for definitive diagnosis. Histopathologic diagnosis was a metastatic gastric signet-ring cell carcinoma (GSRCC) involving appendix and other specimens. A flat lesion involving corpus to antrum was diagnosed by gastroscopy and GSRCC was verified histopathologically in a tertiary centre and the case evaluated as stage IV gastric carcinoma. This case with no sign of gastric cancer was presented as an acute appendicitis. Metastatic carcinoma to the appendix, causing acute appendicitis is extremely rare in clinical practice and usually associated with high morbidity and mortality.