Relevance of mutation-derived neoantigens and non-classical antigens for anticancer therapies

Efficacy of cancer immunotherapies relies on correct recognition of tumor antigens by lymphocytes, eliciting thus functional responses capable of eliminating tumor cells. Therefore, important efforts have been carried out in antigen identification, with the aim of understanding mechanisms of response to immunotherapy and to design safer and more efficient strategies. In addition to classical tumor-associated antigens identified during the last decades, implementation of next-generation sequencing methodologies is enabling the identification of neoantigens (neoAgs) arising from mutations, leading to the development of new neoAg-directed therapies. Moreover, there are numerous non-classical tumor antigens originated from other sources and identified by new methodologies. Here, we review the relevance of neoAgs in different immunotherapies and the results obtained by applying neoAg-based strategies. In addition, the different types of non-classical tumor antigens and the best approaches for their identification are described. This will help to increase the spectrum of targetable molecules useful in cancer immunotherapies.

Identification of HLA class I-restricted immunogenic neoantigens in triple negative breast cancer

Immune checkpoint inhibitor (ICI)-based immunotherapy in triple negative breast cancer (TNBC) is achieving limited therapeutic results, requiring the development of more potent strategies. Combination of ICI with vaccination strategies would enhance antitumor immunity and response rates to ICI in patients having poorly infiltrated tumors. In heavily mutated tumors, neoantigens (neoAgs) resulting from tumor mutations have induced potent responses when used as vaccines. Thus, our aim was the identification of immunogenic neoAgs suitable as vaccines in TNBC patients. By using whole exome sequencing, RNAseq and HLA binding algorithms of tumor samples from a cohort of eight TNBC patients, we identified a median of 60 mutations/patient, which originated a putative median number of 98 HLA class I-restricted neoAgs. Considering a group of 27 predicted neoAgs presented by HLA-A*02:01 allele in two patients, peptide binding to HLA was experimentally confirmed in 63% of them, whereas 55% were immunogenic in vivo in HLA-A*02:01⁺ transgenic mice, inducing T-cells against the mutated but not the wild-type peptide sequence. Vaccination with peptide pools or DNA plasmids expressing these neoAgs induced polyepitopic T-cell responses, which recognized neoAg-expressing tumor cells. These results suggest that TNBC tumors harbor neoAgs potentially useful in therapeutic vaccines, opening the way for new combined immunotherapies.

A white raven detected by imaging

The purpose of this case report is to describe a rare case of a patient with a phaeochromocytoma with several cardiovascular complications, which can be attributed to the tumour. Detection of a phaeochromocytoma sometimes needs a ‘Sherlock Holmes spirit’ or simply time.

Primary large cell neuroendocrine carcinoma of the presacral region

A 7 cm diameter presacral tumour, not related to the intrapelvic organs, was found in a 51 year old woman. The needle biopsy showed a poorly differentiated large cell carcinoma. The patient died of urosepsis after chemotherapy. Postmortem examination revealed no other primary or metastatic tumour. Histological examination of the presacral tumour showed a large cell carcinoma with a trabecular pattern and strong immunoreactivity for neuroendocrine markers. The tumour was finally classified as a primary large cell neuroendocrine carcinoma of the presacral region.

Effects of discontinuation of growth hormone treatment on body composition and metabolism

This study was directed to the investigation of two different aspects of growth hormone: What are the metabolic consequences following the discontinuation of treatment and are these metabolic effects correlated with the growth-promoting effects seen in the first year of treatment? The study was performed on 12 growth hormone-deficient (GHD) patients who reached their final height. Each patient was matched with a non-GHD person of the same sex and about the same age. Immediately after the discontinuation of treatment, and 6 weeks and 6 months later, the following anthropometric variables were assessed: height, weight, skinfold thicknesses (biceps, triceps, subscapular and suprailiacal), body volume (underwater weighing) and total body water (deuterium dilution). To describe energy metabolism, basal metabolic rate assessed by ventilated hood, and sleep metabolic rate assessed by respiration chamber, were studied. Body composition was calculated from weight, volume and total body water. Clear metabolic effects were found after the discontinuation of treatment in GHD children: there was a decrease in fat free mass and sleep metabolic rate. Also, a strong correlation between the above-mentioned effects and the growth-promoting effects of human growth hormone at the beginning of the treatment was observed. The fact that this correlation exists poses the interesting question of whether the results from a test treatment lasting some weeks could be used to predict the long-term effects of hGH.

Giant fibrovascular polyp of the esophagus

We report on a patient who presented a fibrovascular polyp of the esophagus, which is an uncommon submucosal tumor that can attain giant proportions. It is covered with squamous epithelium and consists of a mixture of myxoid-collagenous fibrous elements, vascular structures and adipose cells. Diagnosis is made via upper endoscopy, echoendosonography and barium studies. CT and MR imaging can be helpful for full evaluation of this rare lesion.

Amiodarone induced pulmonary toxicity

We report on a case of complicated long-term amiodarone therapy. CT demonstrated high attenuation pleural-parenchymal lesions and increased liver and spleen density. This article stresses the important role of CT in the diagnosis of amiodarone related disease.

Partial trisomy 15q: report of a patient and literature review

We report a girl with severe developmental delay, scoliosis and mild dysmorphism. She was found to have a partial duplication of the long arm of chromosome 15. Precise cytogenetic diagnosis was possible after additional in situ hybridisation. A Karyotype of 46,XX,dup (15) (pter-->q26.3::q24-->qter) was concluded. We compare her data with the literature. No specific phenotype was found.

Pulmonary sarcoid-like granulomata in a patient treated for extrapulmonary Hodgkin's disease

We report a case of interstitial lung disease developing during treatment with chlorambucil, vinblastine, procarbazine and prednisone for extrapulmonary Hodgkin's disease. Transbronchial biopsies demonstrated noncaseating epithelioid cell granulomata, and bronchoalveolar lavage fluid showed an increased percentage of lymphocytes, with a raised T cell helper-suppressor ratio, suggesting a diagnosis of sarcoidosis. Treatment with corticosteroids brought about complete resolution of the radiographic lesions. A possible relationship between sarcoidosis and lymphoma is discussed, and a short review of the literature is given. This case report has some unique features that, to our knowledge, have not been published before.

Androgen receptor content in human endometrium

Human endometrium changes morphologically and biochemically during the various phases of the menstrual cycle, influenced by not only estrogens and progesterone, but probably also by androgens. The purpose of this study was to investigate the androgen receptor (AR) content in human endometrium and myometrium and its significance. AR immunocytochemistry was performed on 30 paraffin-embedded uterine sections of pre-menopausal women who were scheduled for hysterectomy because of benign gynaecologic abnormalities. AR receptor content was seen in all cell types of the human endometrium and myometrium and was cyclic dependent. AR immunostaining of stromal and smooth muscle cells was more profound than AR staining of glandular cells. There was more AR expression in the proliferative phases than in the secretory phases: in the late secretory phase there was no immunostaining in any of the cell types. AR expression is primarily under androgenic control. Inside the cell testosterone may be 5 alpha-reduced to dihydrotestosterone (DHT). Due to local competition between testosterone and the excess of progesterone in the secretory phase for the same iso-enzyme 5 alpha-reductase, the level of DHT will be diminished in the late secretory phase. If AR synthesis in endometrium would be DHT dependent, the virtual disappearance of DHT would explain the lack of AR expression in the late secretory phase. Whether the cyclic pattern of AR expression is merely an epiphenomenon to progesterone production, or whether androgens play a causal role in the cyclic modulation of endometrium is subject to further research.

Granulocytic sarcoma with expression of CD30

A case of a young man with a spinal epidural tumour, initially diagnosed as large cell anaplastic malignant lymphoma, is reported. The tumour consisted of poorly differentiated cells showing immunoreactivity with antibodies directed against CD30 and CD45. Ten months later the patient developed acute myeloid leukaemia. The histological slides of the epidural tumour were reviewed, including additional enzymochemical and immunochemical stains. As the tumour showed immunoreactivity for myeloperoxidase and chloroacetate esterase, it was reclassified as a granulocytic sarcoma.

Urethral metastasis from a rectal carcinoma

A 67-year-old man presented with a tumour of the penis. Endoscopy revealed a bleeding tumour. Histological examination showed an adenocarcinoma; urethral metastasis of rectal carcinoma. As far as we know only 6 previous cases have been described.

Secondary signet ring cell tumour of the prostate

We report a rare case of clinically significant secondary prostatic neoplasm. In a patient with outflow obstruction, a transurethral resection of the prostate revealed a metastasis of a signet ring cell carcinoma of the stomach in the resected prostatic tissue.

Meningeal melanoma associated with nevus of Ota: case report and review

A case report is presented of a 30-year old woman with a primary meningeal melanoma associated with an ipsilateral nevus of Ota (oculodermal melanosis). Nine similar cases described in the literature are reviewed including additional personal communications after follow-up of three of these patients. The mean age of the patients is 42 years. In half of these tumors a dural attachment has been documented, the present case included. All patients with a dural melanoma were alive at least 2 years and 4 months after the primary craniotomy with a maximal survival of 8 years.

[Pancreaticopleural fistula]

We describe the case of a patient with a subdiaphragmatic collection and massive pleural effusion due to a pancreatico-pleural fistula. The fistulous tract was secondary to the extension of an intraabdominal pseudocyst through the diaphragmatic hiatus into the mediastinum, where it perforated into the right pleural cavity. Spontaneous closure of the fistula occurred after a three-week treatment with somatostatin.

On the variable expression of the Brachmann-de Lange syndrome

A mother of normal intelligence and her moderately mentally retarded son, both with the typical facial features of the Brachmann-de Lange syndrome, are reported. We discuss the variable expression of the Brachmann-de Lange syndrome by comparing the autosomal dominant cases with the sporadic or presumed autosomal recessive cases. The autosomal dominant cases show milder symptoms in general. In our opinion, a de novo autosomal dominant mutation causes the severe form of the syndrome, recurrence within sibships being explained by germline mosaicism. In all convincingly autosomal dominant cases we found that the mother is the transmitting parent, suggesting genomic imprinting.

Procainamide therapy, physical performance and energy expenditure in the Schwartz-Jampel syndrome

The effects of procainamide administration were assessed in a 5-yr-old boy with Schwartz-Jampel syndrome (chondrodystrophic myotonia). Without procainamide the resting metabolic rate was found to be significantly higher than in an age-matched control group. With a serum level of 3.8 mg l-1 procainamide a reduction of the resting metabolic rate of 22% was observed, and times needed to climb stairs and to re-open eyes after forceful contraction (blepharospasm) were significantly reduced.

Schwartz-Jampel syndrome: I. Clinical, electromyographic, and histologic studies

In a new, typical case of Schwartz-Jampel syndrome (SJS) the origin of the disorder was found to be purely myogenic. Concentric needle EMG showed abundant and persistent spontaneous activity, maximal at insertion, and uninfluenced by local curarization. Single-fiber EMG showed rather stable, sometimes intermittent, discharge series with occasional amplitude and/or frequency fluctuations. It could be demonstrated that this activity did not consist of complex repetitive discharges, but of independent activity of individual muscle fibers. This contrasts with findings by other investigators that have been published in this journal. Light microscopic studies of quadriceps and intercostal muscles showed no abnormalities, whereas electron-microscopic findings were in accordance with earlier studies in SJS. Endplate analysis revealed no specific changes; the postsynaptic structures gave the impression of an accelerated-maturation.

Primary nonspecific ulcers of the small intestine: an unsolved diagnostic problem

Two patients with nonspecific small intestinal ulceration were observed. In the two cases, the ulceration was responsible for (sub)obstruction. The medical history, the gastrointestinal roentgenographic examination and the pathologic anatomy were remarkably similar. Some aspects of these quite rare lesions are discussed.