The complexity of cancer immunotherapy illustrated through skin tumors.

Skin tumours are among the cancer types most sensitive to immunotherapy, due to their unique immunogenic features including skin-associated lymphoid tissue, high mutational load, overexpression of tumour antigens, and high frequency of viral antigens. Despite this high immunotherapy response rate, however, ultimately most skin tumours develop similar treatment resistance to most other malignant tumours, which highlights the need for in-depth study of mechanisms of response and resistance to immunotherapy. A bibliographic review of the most recent publications regarding currently in use and emerging biomarkers on skin tumors has been done. Predictive biomarkers of treatment response, biomarkers that warn of possible resistance, and emerging markers, the majority of a systemic nature, are described. Including factors affecting not only genomics, but also the immune system, nervous system, microbiota, tumour microenvironment, metabolism and stress. For accurate diagnosis of tumour type, knowledge of its functional mechanisms and selection of a comprehensive therapeutic protocol, this inclusive view of biology, health and disease is fundamental. This field of study could also become a valuable source of practical information applicable to other areas of oncology and immunotherapy.

CD20-negative DLBCL transformation after rituximab treatment in follicular lymphoma: a new case report and review of the literature.

Rituximab is a monoclonal antibody against the CD20 molecule which is used to treat B-cell lymphomas. In 60% of low-grade B lymphomas in which rituximab was effective at first, there was no clinical response in a second treatment and a few cases of follicular lymphomas (FL) with transformation to diffuse large B-cell lymphoma (DLBCL) have been reported. We describe a new case and hypothesize about the mechanisms of transformation: a 52-year-old man, in follow-up during 8 years for FL, who after rituximab treatment and complete remission of FL showed progressive disease involving the liver and duodenal mucosa. Immunohistochemical and molecular studies were performed on paraffin-embedded tissue samples of lymph nodes, the small intestine, and liver tumors. After rituximab treatment, biopsies of a liver lesion and the small bowel both showed CD20-negative large B-cell lymphoma. Molecular study of the initial and relapse specimens shows a CDR2 IgH rearrangement with the same height and t14;18 (MBR). The rapid relapse with the same rearrangement of IgH seems to support the interpretation that the change of grade of lymphoma and loss of CD20 expression occurred before rituximab treatment. The existence of a varying proportion of a CD20-negative cell population in every B-cell lymphoma which does not respond to rituximab should therefore be considered. The reduction of CD20 expression could be a resistance mechanism to rituximab retreatment in DLBCL as a consequence of the progression of low-grade B-cell non-Hodgkin's lymphoma (B-NHL). It is necessary to perform new biopsies to evaluate CD20 expression in relapse or the progression of B-cell lymphoma after rituximab treatment.

Linfoma cardiaco primario. Presentación de dos casos en pacientes inmunocompetentes / Primary cardiac lymphoma: presentation of two cases in immunocompetent patients

Fundamento: El linfoma cardiaco primario (LCP) es muy infrecuente en pacientes sin alteraciones inmunitarias habiéndose descrito unos 50 casos en el mundo hasta 1996. Su patogenia no se conoce y algunos estudios que han investigado la presencia del virus de Epstein Barr en el tumor en general no lo han demostrado. Casos: Se describen los casos de dos pacientes con LCP. En ambos casos el diagnóstico fue realizado post mortem. Ambos pacientes presentaban un linfoma B de células grandes difuso. En los dos casos se ha identificado la presencia de focos inflamatorios a cierta distancia del tumor. No se ha podido demostrar la presencia de VEB en el tumor. Conclusiones: Los LCPs son tumores de rápido crecimiento con un pronóstico muy desfavorable. El virus de Epstein-Barr no parece desempeñar un papel en la etiopatogenia de estos tumores (AU)

Background: Primary cardiac lymphomas (PCL) are extremely rare in immunocompetent patients. Their pathogenesis seems obscure and a few studies which have sought Epstein Barr virus (EBV) agree that this is generally not demonstrable. Cases: Two cases of cardiac lymphoma have been described. In both cases, as usually occurs, the histological diagnosis was performed after post-mortem examination. Histological examinations revealed a B large cell lymphoma in both patients. Autopsy material from both cases showed an imflamatory focus distant from the tumoral mass. EBERs and LMP for EBV were negative. Conclusions: PCLs are often fast-growing tumours with a highly unfavorable prognosis. Epstein-Barr virus appears to play no role in the development of this malignant condition (AU)

[Primary cardiac lymphoma: presentation of two cases in immunocompetent patients]. / Linfoma cardiaco primario. Presentación de dos casos en pacientes inmunocompetentes.

BACKGROUND: Primary cardiac lymphomas (PCL) are extremely rare in immunocompetent patients. Their pathogenesis seems obscure and a few studies which have sought Epstein Barr virus (EBV) agree that this is generally not demonstrable. CASES: Two cases of cardiac lymphoma have been described. In both cases, as usually occurs, the histological diagnosis was performed after post-mortem examination. Histological examinations revealed a B large cell lymphoma in both patients. Autopsy material from both cases showed an inflammatory focus distant from the tumoral mass. EBERs and LMP for EBV were negative. CONCLUSIONS: PCLs are often fast-growing tumours with a highly unfavorable prognosis. Epstein-Barr virus appears to play no role in the development of this malignant condition.

Técnicas de desenmascaramiento antigénico e inmunohistoquímica. Estudio dirigido a anticuerpos con especiales dificultades de inmunodetección / Antigenic unmasking techniques in immunohistochemistry

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Sistemas de información en anatomía patológica: análisis de las soluciones existentes / Information System in anatomical pathology: Analysis of the existing solutions

Antecedentes: En los últimos dos años se está procediendo a la renovación de los sistemas informáticos en anatomía patológica de numerosos hospitales. Por ello consideramos interesante revisar los sistemas informáticos más habituales y conocer los principales aspectos que debemos exigir en estos programas. Material y métodos: Cuatro sistemas informáticos (Master-Pat NovoPath, PatWin e InfoPAT) han sido evaluados por los usuarios de siete hospitales distribuyendo entre los usuarios y los fabricantes una encuesta con 105 variables. Resultados: Los sistemas más modernos ofrecen un número muy alto de funcionalidades, destacando los más modernos por su integración en el resto del sistema de información hospitalario, si bien los sistemas de ayuda, la codificación y la gestión de imágenes son algunos aspectos que la mayoría de programas necesitan mejorar. Conclusión: Los nuevos programas informáticos son de gran calidad y las prestaciones muy parecidas, por lo que es aconsejable evaluar las necesidades de cada servicio para poder escogerla solución óptima (AU)

Fine needle aspiration and touch imprint cytology of a malignant fibrous histiocytoma of the spermatic cord. Case report.

BACKGROUND: No cytologic reports on spermatic cord sarcomas have been published. CASE: A 64-year-old man presented with a slowly growing, painless, left spermatic cord enlargement. Fine needle aspiration (FNA) obtained < 1 mL of bloody fluid consisting of solitary, mark-edly anaplastic and pleomorphic tumor giant cells occasionally arranged in small fragments. Rare atypical spindle cells could be observed. Some reactive lymphocytes were observed intermingled with tumor cells. Immunohistochemistry displayed vimentin reactivity and negativity for keratins and leukocytic common antigen. The specimen removed showed a well-circumscribed, 30-mm, yellowish solid tumor. Touch imprints displayed pleomorphic tumor cells showing intense anisonucleosis; a moderate amount of clear, sometimes microvacuolated cytoplasm; and tissue fragments with a storiform pattern. Histologic examination revealed microscopic and immunohistochemical features of malignant fibrous histiocytoma (MFH) arising in soft tissues of the spermatic cord. CONCLUSION: FNA of a spermatic cord lesion may reveal a pleomorphic sarcoma. A pleomorphic appearance together with some spindle elements and compatible immunocytochemistry could help diagnose spermatic cord MFH. This is one of the few reports dealing with FNA cytology of paratesticular tumors and the first report, to the best of our knowledge, showing the cytologic characteristics of a case of spermatic cord MFH.

[Hodgkin's disease. Etiopathogenic role of Epstein-Barr virus in Tarragona]. / Enfermedad de Hodgkin. Papel etiopatogénico del virus de Epstein-Barr en las comarcas de Tarragona.

BACKGROUND: The aim of this study is to assess the proportion of Hodgkin disease (HD) expressing Epstein-Barr virus (EBV) in our area (Tarragona-Spain). PATIENTS AND METHODS: A retrospective study was performed on paraffin embedded HD tissues from 49 patients to examine the presence of latent membrane protein (LMP-1) by immunohistochemistry and for EBER-1 in situ hybridization. RESULTS: Overall, EBV (EBER-1 and/or LMP positive) was expressed in 20 cases (40.8%). This percentage was higher, but not significant, in mixed cellularity, and significant higher in patients over 55 years old. No differences between sexes were observed. CONCLUSIONS: EBV is associated with 40.8% of HD in area of Tarragona.

Fine needle aspiration cytology of a cervical lymph node lymphangioma in an adult. A case report.

BACKGROUND: Although the cytologic features of cervical cystic lesions are well established, no cytology reports on lymphangioma in adults have been published. CASE: A 60-year-old male presented with a slowly growing, upper laterocervical, painless enlargement. Fine needle aspiration (FNA) obtained 15 mL of yellowish fluid, consisting predominantly of a uniform population of small and round lymphocytes without mitosis or atypia and with some histiocytes intermingled with them. Some centrocytes and occasionally centroblasts and plasma cells could also be observed. Immunohistochemistry performed on cell block sections displayed polyclonal B lymphocytes mixed with T cells. The specimen showed a clearly circumscribed, 50-mm, cystic lesion with a multilocular appearance and abundant, yellowish liquid. Microscopic examination demonstrated cystic lymphangioma arising from the medullary portion of a lymph node. CONCLUSION: FNA cytology permits a suggested diagnosis of lymphangioma. This is one of the few reports of FNA cytology of lymphangioma and, to the best of our knowledge, this entity has not previously been found as a neck mass in an adult.

[Wilms' tumor (nephroblastoma) of the adult]. / Tumor de Wilms (nefroblastoma) del adulto.

Presentation of one case of Wilms' tumour (nephroblastoma) in a 40-year old woman with clinical and investigational findings common to renal cells carcinoma. Wilms' tumour of the adult is susceptible to the same therapeutic approaches and surgical procedures as applied to childhood's tumours. The most useful prognostic factor is tumoral stage. The presence of anaplasia outside the kidney or a predominant blastemous component qualify the tumour as of "unfavourable histology" rendering it sensitive to the same treatment and prognosis than renal sarcoma. The remaining tumours, gathered under the global heading of "favourable histology", receive a much less aggressive therapy, and the predominant histological component (epithelial, muscular, etc.) does not modify the therapeutic approach.

[Histopathologic factors with prognostic significance in mesangial proliferative glomerulonephritis]. / Factores histopatológicos de valor pronóstico en glomerulonefritis proliferativa mesangial.

To investigate the histopathological findings with prognostic significance in mesangial proliferative glomerulonephritis (MPGN), 52 patients with this disease were evaluated with sufficient clinical follow-up. A moderate but highly significant correlation was found between the final creatinine levels and the percentage of sclerosed glomeruli and number of atrophic tubuli per 10 high power fields (r = 0.530, p less than 0.001). When the patients with idiopathic MPGN and those with MPGN secondary to systemic or streptococcal disease were separately considered, there was a remarkable increase in the correlation index for the primary cases (r = 0.912, p less than 0.001). It was concluded that the finding with the highest predictive value in idiopathic forms is tubular atrophy. Three levels of disease were proposed, respectively defining patients with preserved renal function, established chronic renal failure and unpredictable outcome of renal function after a follow-up of five years.

[Pure testicular choriocarcinoma]. / Coriocarcinoma testicular puro.

We present a case of pure testicle choriocarcinoma in a 13-year-old male. Its first clinical manifestation consisted in a pattern of acute dyspnea caused by multiple pulmonary metastases. Alphafetoprotein investigation in serum and tissue proved negative. We carry out an immunohistochemical study of the case and discuss its histogenesis current classification and prognostic significance.