ABSTRACT
The prognostic role of PDL1 expression, CD8+ and FoxP3+ lymphocytes in vulvar melanomas has not been studied. We correlated PDL1 expression and CD8+ and FoxP3+ immune infiltrates with clinicopathologic variables and patient outcomes in a series of 75 vulvar melanomas. Tumoral PDL1 expression (>5%) was seen in 23% of cases. By Fisher exact test, PDL1 expression and peritumoral FoxP3+ lymphocytes significantly correlated with less disease-specific death. By linear regression analysis, correlations between tumoral PDL1 expression with the density of tumoral CD8+ and peritumoral CD8+ lymphocytes, tumoral FoxP3+ with tumoral CD8+ lymphocytes, and peritumoral FoxP3+ with peritumoral CD8+ lymphocytes were observed. By univariate analyses, tumor thickness >4 mm predicted poorer progression-free survival, melanoma-specific survival, and overall survival. PDL1 expression >5% and peritumoral CD8+, peritumoral FoxP3+, and tumoral FoxP3+ lymphocytes correlated with better overall survival. By multivariate analyses, high peritumoral FoxP3+ lymphocytes independently predicted better melanoma-specific survival (P = .023), and tumor thickness independently predicted poorer progression-free survival (P = .05) and overall survival (P = .039). In conclusion, our study shows that, independent from tumor thickness, an increased density of peritumoral FoxP3+ lymphocytes may positively impact survival in a subset of vulvar melanomas. Tumoral PDL1 expression correlated with tumoral as well as peritumoral CD8+ and FoxP3+ lymphocytes, supportive of an adaptive immune response. Although the frequency of PDL1 expression is low in vulvar melanoma, its expression may identify a subset of vulvar melanoma that might respond to immunotherapy.
Subject(s)
B7-H1 Antigen/biosynthesis , Lymphocytes, Tumor-Infiltrating/immunology , Melanoma/immunology , T-Lymphocytes, Regulatory/immunology , Vulvar Neoplasms/immunology , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/analysis , Biomarkers, Tumor/immunology , CD8-Positive T-Lymphocytes/immunology , Female , Forkhead Transcription Factors/analysis , Forkhead Transcription Factors/biosynthesis , Humans , Kaplan-Meier Estimate , Melanoma/mortality , Melanoma/pathology , Middle Aged , Prognosis , Progression-Free Survival , Vulvar Neoplasms/mortality , Vulvar Neoplasms/pathology , Young AdultABSTRACT
This group of biologically diverse entities is united by topographic localization to the hands and feet. Categorizing tumors by body site narrows the differential into a short list of possibilities that can facilitate accurate and rapid diagnosis. The goal of this review is to provide a practical approach to soft tissue tumors of acral locations for clinicians, pathologists, and researchers alike. What ensues in the following text is that tight coupling of the clinical picture and histopathologic findings should produce the correct diagnosis, or at least an abbreviated differential. The salient clinicopathologic, immunohistochemical, and molecular features are presented alongside current treatment recommendations for each entity.
Subject(s)
Angiofibroma/pathology , Fibroma/pathology , Fingers , Giant Cell Tumor of Tendon Sheath/pathology , Glomus Tumor/pathology , Sarcoma/pathology , Skin Neoplasms/pathology , Soft Tissue Neoplasms/pathology , Toes , Fibroma/diagnosis , Humans , Skin Neoplasms/diagnosis , Soft Tissue Neoplasms/diagnosis , TendonsABSTRACT
Angiosarcoma arising in association with an arteriovenous graft (AVG) or fistula is a unique clinicopathologic scenario that appears to be gaining recognition in the literature. Among reported cases, none has described high-level MYC gene amplification, a genetic aberration that is increasingly unifying the various clinicopathologic subdivisions of angiosarcoma. We therefore report the MYC gene status in a case of angiosarcoma arising at an AVG site.
ABSTRACT
OBJECTIVE: This study evaluated the use of stromal biomarkers CD34 and α smooth muscle actin (α-SMA) to distinguish verrucous carcinoma (VC) from verrucous hyperplasia (VH). STUDY DESIGN: Thirteen VH, 15 VC, 20 squamous cell carcinoma (SCC), and 16 of uninvolved adjacent stroma specimens were analyzed for α-SMA and CD34 expression by immunohistochemistry. RESULTS: Stromal α-SMA positivity was observed in 100% (20 of 20) of the SCC and in 93% (14 of 15) of the VC, whereas none of the VH (0 of 13) or adjacent uninvolved stroma (0 of 16) demonstrated α-SMA reactivity. Stromal CD34 positivity was observed in 100% (13 of 13) of VH and adjacent stroma (16 of 16), while 20% (3 of 15) of VC and 11% (2 of 18) of SCC stroma expressed CD34. The SCC and VC groups differed significantly from the VH and uninvolved stroma groups for both α-SMA and CD34 expression (P < .0001). CONCLUSIONS: Stromal CD34 and α-SMA protein expression patterns may aid in distinguishing between VC and VH in challenging cases.
