Characterization of the Immune Microenvironment in Inflammatory Breast Cancer Using Multiplex Immunofluorescence

INTRODUCTION

Inflammatory breast cancer (IBC) is an aggressive form of breast cancer with a poorly characterized immune microenvironment.

METHODS

We used a five-colour multiplex immunofluorescence panel, including CD68, CD4, CD8, CD20, and FOXP3 for immune microenvironment profiling in 93 treatment-naïve IBC samples.

RESULTS

Lower grade tumours were characterized by decreased CD4+ cells but increased accumulation of FOXP3+ cells. Increased CD20+ cells correlated with better response to neoadjuvant chemotherapy and increased CD4+ cells infiltration correlated with better overall survival. Pairwise analysis revealed that both ER+ and triple-negative breast cancer were characterized by co-infiltration of CD20 + cells with CD68+ and CD4+ cells, whereas co-infiltration of CD8+ and CD68+ cells was only observed in HER2+ IBC. Co-infiltration of CD20+, CD8+, CD4+, and FOXP3+ cells, and co-existence of CD68+ with FOXP3+ cells correlated with better therapeutic responses, while resistant tumours were characterized by co-accumulation of CD4+, CD8+, FOXP3+, and CD68+ cells and co-expression of CD68+ and CD20+ cells. In a Cox regression model, response to therapy was the most significant factor associated with improved patient survival.

CONCLUSION

Those results reveal a complex unique pattern of distribution of immune cell subtypes in IBC and provide an important basis for detailed characterization of molecular pathways that govern the formation of IBC immune landscape and potential for immunotherapy.

Does JC virus have a role in the etiology and prognosis of Egyptian colorectal carcinoma?

John Cunningham virus (JCV) encodes an oncogenic T-antigen, which is capable of interacting with key growth regulatory pathways. JCV definite role as causal agent of human cancer, still awaits final confirmation. The present study was conducted to assess the possible role of JCV in Egyptian colorectal carcinoma (CRC) and correlate the expression with the clinicopathological features and survival. JCV in situ hybridization (ISH) signals and large T antigen immunoreactivity were examined in 87 colonic specimens. Positive glandular JCV ISH signals were detected in 20%, 25% and 40% of normal, adenoma and CRC cases respectively. Stromal JCV ISH signals were identified in 26% of CRC cases and 5% of adenoma however, normal mucosa did not show stromal positivity with significant difference (p = 0.03). Glandular JCV expression was significantly associated with high grade (p = 0.03), high mitotic index (p=0.02) and low apoptotic index (p = 0.00). Positive stromal signals were significantly associated with low apoptosis (p = 0.00). No positive nuclear immunostaining of JCV large T antigen was detected in all specimens. JCV stromal expression was the 2nd most powerful indicator of short survival and bad prognosis (p = 0.03) in CRC patients. JCV might play an etiological role in CRC tumorogenesis and short survival in Egyptian CRC patients.

Cyclooxygenase-2 expression in chronic gastritis and gastric carcinoma, correlation with prognostic parameters

BACKGROUND

Cyclooxygenase-2 (Cox-2) is the inducible form of cyclooxygenase enzyme. Cox-2 is induced in numerous processes such as cellular growth, differentiation, inflammation and tumorogenesis.

PURPOSE

Assessment of Cox-2 expression in chronic gastritis and gastric carcinoma.

MATERIAL AND METHODS

Sixteen chronic gastritis (CG) and 43 gastric carcinoma cases were subjected to an immunohistochemical approach using anti Cox-2 antibody.

RESULTS

All CG cases displayed positive epithelial Cox-2 expression with only 25% positivity for stromal expression. Eighty six percent of gastric carcinoma showed epithelial Cox-2 expression that was significantly correlated with lymph node involvement (p<0.01), advanced stage (p=0.01), high microvessel density (MVD) (p=0.0001), vascular invasion (p=0.002), perineural invasion (p=0.01) and low apoptotic count (p<0.0001). Stromal Cox-2 expression was seen in 79% of gastric carcinoma cases and was significantly associated with low apoptotic count (p=0.0007), vascular invasion (p=0.001) and high microvessel density (MVD) (p=0.0003). Only stromal Cox-2 expression was significantly higher in gastric carcinoma than chronic gastritis (p=0.0001).

CONCLUSIONS

Cox-2 appears to be involved in gastric carcinoma progression as it promotes angiogenesis, suppresses apoptosis and facilitates invasion and metastasis. Double expression of Cox-2 in gastric carcinoma epithelium and stroma and significant association between them demonstrate a paracrine cross effect between stromal and malignant epithelium.

Human telomerase reverse transcriptase (hTERT) gene expression in thyroid carcinoma: diagnostic and prognostic role

BACKGROUND

The catalytic component of telomerase, human telomerase reverse transcriptase (hTERT) has been found to be reactivated in immortalized cell lines and considered as a diagnostic marker for malignancy in different body tissues.

AIM OF WORK

Therefore we thought to determine whether hTERT gene detection could serve as an adjunct in the diagnosis of thyroid lesions together with evaluation of its prognostic value.

PATIENTS AND METHODS

The study included 50 cases of primary thyroid carcinoma including; 28 papillary carcinoma, 14 follicular carcinoma, 5 anaplastic carcinoma and 3 medullary carcinoma in addition to 5 cases of nodular hyperplasia and 5 cases of follicular adenoma. RNA was extracted from paraffin sections of those patients and hTERT gene expression was identified by Reverse Transcription-Polymerase Chain Reaction (RT-PCR).

RESULTS

RT-PCR of hTERT gene revealed expression in 43/50 (86%) malignant thyroid cases; including 25 papillary, 11 follicular, 4 anaplastic and 3 medullary carcinoma cases. On the other hand, hTERT gene expression could not be detected in either hyperplastic nodule or in follicular adenoma cases. The diagnostic validity of hTERT gene detection in benign and malignant thyroid lesions was in the form of 88.3% accuracy, 86% sensitivity, 100% specificity, 100% positive predictive value and 90% negative predictive value. No significant association has been found between hTERT gene expression and any clinicopathologic parameters concerned in this study. In thyroid carcinoma cases, hTERT gene detection was the most independent predictor of poor survival by multivariate survival analysis.

CONCLUSION

Detection of hTERT gene expression should be considered in confirmation of malignant thyroid lesions. Moreover it could be one of the helpful tools in addition to grade, tumor type, and age to stratify patients with thyroid carcinoma into different prognostic categories. Hence, inhibition of hTERT could be of use prospectively in the era of cancer therapy as an attractive weapon in thyroid carcinoma.

Predictive value of thymidine phosphorylase in gastric carcinoma

BACKGROUND AND PURPOSE

Thymidine Phosphorylase/ Platelet Derived-Endothelial Cell Growth Factor (TP/PD-ECGF) has an angiogenic and chemotherapeutic effects. The aim of this work was to evaluate TP/PD-ECGF expression in gastric adenocarcinoma and find its correlation with established clinicopathological parameters and patients' survival.

MATERIALS AND METHODS

Samples studied consisted of fifty-two gastric specimens (27 cases of chronic gastritis and 25 cases of malignant adenocarcinoma). Immunohistochemical staining for TP/PD-ECGF was done and the tumor was considered positive when more than 5% of cells showed positive staining.

RESULTS

TP/PD-ECGF expression was significantly higher in the malignant group when compared to the control group (p = 0.001). Tumor and stromal cell TP/PD-ECGF expression in the malignant group was significantly correlated with size of the tumor, mitotic count, stage grouping, depth of invasion, number of lymph nodes (LN) involved, perineural invasion, lymphoplasmacytic and tumor associated macrophages (TAMs) infiltration and vessel density (VD). Furthermore, stromal expression of TP/PD-ECGF was significantly correlated with postoperative chemotherapy and apoptotic count. Survival analysis revealed that proximal tumor, small size, early stage, negative LN metastasis, absence of perineural invasion, low VD and negative tumor and stromal TP/PD-ECGF expression correlated with better patients' survival.

CONCLUSIONS

TP/PD-ECGF might have an angiogenic function and role in tumor growth, invasion and metastasis. TP/PD-ECGF could enhance the effect of postoperative chemotherapy.