Defining Melanoma Immune Biomarkers-Desert, Excluded, and Inflamed Subtypes-Using a Gene Expression Classifier Reflecting Intratumoral Immune Response and Stromal Patterns.

The spatial distribution of tumor infiltrating lymphocytes (TILs) defines several histologically and clinically distinct immune subtypes-desert (no TILs), excluded (TILs in stroma), and inflamed (TILs in tumor parenchyma). To date, robust classification of immune subtypes still requires deeper experimental evidence across various cancer types. Here, we aimed to investigate, define, and validate the immune subtypes in melanoma by coupling transcriptional and histological assessments of the lymphocyte distribution in tumor parenchyma and stroma. We used the transcriptomic data from The Cancer Genome Atlas melanoma dataset to screen for the desert, excluded, and inflamed immune subtypes. We defined subtype-specific genes and used them to construct a subtype assignment algorithm. We validated the two-step algorithm in the qPCR data of real-world melanoma tumors with histologically defined immune subtypes. The accuracy of a classifier encompassing expression data of seven genes (immune response-related: CD2, CD53, IRF1, and CD8B; and stroma-related: COL5A2, TNFAIP6, and INHBA) in a validation cohort reached 79%. Our findings suggest that melanoma tumors can be classified into transcriptionally and histologically distinct desert, excluded, and inflamed subtypes. Gene expression-based algorithms can assist physicians and pathologists as biomarkers in the rapid assessment of a tumor immune microenvironment while serving as a tool for clinical decision making.

Hybrid intercalated duct lesion of the parotid: A case report.

BACKGROUND: Intercalated duct lesions (IDLs) are considered relatively benign and rare tumors of salivary glands, that were only described recently. Their histopathological appearance may range from ductal hyperplasia to encapsulated adenoma with hybrid patterns of both variants. It is thought that IDLs may be the precursor for malignant proliferations, therefore their correct diagnosis remains crucial for proper lesion management. It is the first reported IDL case arising from the accessory parotid gland (APG), which stands for less frequent but higher malignancy rate tumor developmental area. CASE SUMMARY: A 24-years-old male with no accompanying diseases was referred to the hospital with a painless nodule on the right cheek. On physical examination, the stiff, immobile, and painless mass was palpable in the anterior portion of the right parotideomasseteric region, just superior to the parotid duct. Ultrasound examination demonstrated 1.5 cm × 1.0 cm hypoechogenic mass on the anterior part of the right parotid gland. Ultrasound-guided fine needle aspiration cytology, followed by liquid-based fine needle aspiration biopsy were performed. However, the results were uninformative. A contrast-enhanced magnetic resonance imaging (MRI) of the parotid was obtained, demonstrating a 1.5 cm × 1.0 cm × 0.5 cm tumor with high intensity capsule together with low intensity core in the very anterior part of right superficial lobe, situated in the APG. An MRI features were uncharacteristic to common parotid tumors, therefore surgical resection followed up. After histopathological examination, the final diagnosis of hybrid IDL was confirmed. CONCLUSION: Fine needle aspiration biopsy might not always be diagnostic, and given the malignant potential, the surgical resection of such lesion remains the treatment of choice.

Surgical treatment of synkinesis between smiling and eyelid closure.

Synkinetic movements are common among patients with incomplete recovery from facial palsy, with reported rates ranging from 9.1% to almost 100%. The authors propose the separation of the neural stimulus of the orbicularis oculi from that of the zygomatic muscular complex to treat eyelid closure/smiling synkinesis. This technique, associated with an anastomosis between the masseteric nerve and a central branch of the facial nerve, as well as with the use of a cross-facial nerve graft, resolves most of the spasms of the midface musculature, leading to a more relaxed tone when the mimic muscle is at rest and enhancing muscle excursion during voluntary and spontaneous smiling. Between 2011 and 2016, 18 patients affected by segmental paresis of the middle of the face underwent surgical treatment at the Maxillofacial Surgery Department of the San Paolo Hospital (Milan, Italy). Of these patients, 72.22% of cases with hypertone obtained partial to complete relaxation. Synkinesis was completely resolved in 83.33% of cases, and a significant improvement in facial movement was achieved in all patients. Neurorrhaphy of the masseteric nerve and the central branch of the facial nerve appears to produce favorable results. These initial data should be confirmed by further studies.

Surgical treatment of painful inferior alveolar nerve injuries following endodontic treatment: a consecutive case series of seven patients.

PURPOSE: Injuries of the inferior alveolar nerve (IAN) related to endodontic treatment are being increasingly reported. However, consensus on the preferred intervention and the timing of and indications for surgical treatment is lacking. Here, we describe our experience with painful IAN injuries arising from endodontic treatment and requiring prompt microsurgical treatment. METHODS: Seven consecutive patients with painful IAN injuries were referred to the Maxillofacial Surgery Unit of San Paolo Hospital in Milan. All patients had undergone root canals endodontic treatment in the mandibular molar or premolar between 2007 and 2014. The time elapsed between injury and referral for surgical treatment ranged from 10 days to 20 months. Each patient was treated by one of several different microsurgical procedures, described herein. RESULTS: Overall, neurosensory status and IAN-related pain improved in all seven patients. The best results were obtained by IAN replacement with a sural nerve graft. However, complete sensory recovery was not achieved in any of the patients. CONCLUSIONS: Although our sample includes only seven patients, early surgical treatment with an interpositional sural nerve graft seems to allow neurosensory recovery. Less satisfactory results are achieved in patients with IAN injuries of > 12 months duration.