ABSTRACT
Se presenta un caso de una paciente de 80 años con una tumoración abdominal orientada erróneamente como neoplasia de ovario. La paciente acudió a nuestro servicio médico por presentar dolor en la fosa ilíaca derecha y pérdida de 5 kg de peso en 1 mes. En las exploraciones efectuadas se detectó una tumoración de 17 x 10 cm de diámetro y una pequeña cantidad de ascitis. Se intentó realizar una paracentesis sin obtener resultados positivos. Analíticamente, destacamos Ca125: 484 U/ml. Se decide realizar un intervención quirúrgica, tras la cual se detectó un fibroma de ovario torsionado, sin criterios de malignidad e implantes de fibrina en Douglas
We present the case of an 80-year-old patient with a large abdominal tumor erroneously interpreted as ovarian cancer. The patient presented with pain in the right iliac fossa and weight loss of 5 kg in the previous month. Investigations revealed a 17 x 10 cm tumor and a small quantity of ascites. An attempt at paracentesis was unsuccessful. A notable laboratory finding was Ca125: 484 U/ml. Surgical intervention was performed, revealing a twisted ovarian fibroma, without criteria for malignancy, and fibrin implants in Douglas's pouch
Subject(s)
Female , Aged , Humans , Fibroma/diagnosis , Ovarian Neoplasms/diagnosis , Meigs Syndrome/diagnosis , Torsion Abnormality/physiopathologyABSTRACT
The present study aimed to describe the general tissular composition of the immune infiltrate observed in Hodgkin's lymphoma (HL) and its possible relationship with clinical and survival prognostic factors. In this retrospective study of 267 HL patients, the relative proportions of infiltrating T lymphocytes (CD4+, CD8+), natural killer cells (CD 56+, CD 57+), cytotoxic cells (Granzyme B+, TIA-1+) and dendritic cells (CD 21+, S-100+) were quantified immunohistochemically with tissue microarray technology. Our results confirm the predominance of CD4 + T lymphocytes in the background of tumoral cells, in addition to a high number of cytotoxic lymphocytes (CD8, CD 57 and TIA-1). Patients with low numbers of infiltrating CD8, CD 56, CD 57+cells and high numbers of Granzyme B and TIA-1+cells presented a significantly unfavourable clinical course (presence of leukocytosis, B symptoms, advanced clinical stage (III/IV), non-responding patients). A reduced infiltration of CD4+T lymphocytes was related with the presence of Epstein - Barr virus. Significantly longer survival times were observed in patients with a high level of infiltrating CD 57, as well as a low level of Granzyme B and TIA-1+cells (log-rank test). When evaluated in a multivariate model, high levels of infiltrating TIA-1 and Granzyme B+cells were shown to be independent prognostic factors that negatively influenced overall survival. The presence of TIA-1+cells was found to be the only unfavorable prognostic factor of event-free survival and disease-free survival. The overall detection of tumor-infiltrating cells in HL confirms the importance of cytotoxic T lymphocyte infiltration (Granzyme B and TIA-1+cells) in these patients. Independently of the classical clinical and pathological features, these cells appear to be an unfavourable prognostic factor in HL and, more particularly, the presence of cytotoxic TIA-1+cells.
Subject(s)
Hodgkin Disease/pathology , Neoplasm Invasiveness/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Cell Count , Child , Dendritic Cells/pathology , Female , Granzymes , Hodgkin Disease/mortality , Humans , Immunohistochemistry , Killer Cells, Natural/pathology , Male , Middle Aged , Poly(A)-Binding Proteins , Prognosis , RNA-Binding Proteins/analysis , Retrospective Studies , Serine Endopeptidases/analysis , Survival Analysis , T-Cell Intracellular Antigen-1 , T-Lymphocytes/pathology , T-Lymphocytes, Cytotoxic/pathology , Tissue Array AnalysisABSTRACT
This study aimed to assess the differences in the cellular composition of the inflammatory reactive background around tumoral cells of classical Hodgkin's lymphomas (cHL) inside and outside the HIV settings. This retrospective study evaluates the infiltrating T lymphocytes (CD4 and CD8), natural killer cells (CD57+ cells), and more especially cytotoxic cells [granzyme B (GrB) and TIA-1+ cells] in the background of 99 EBV+ cHL. Sections from paraffin-embedded tumor samples from nine HIV-infected cHL patients were immunostained, using standard immunohistochemical protocols and were compared to a control group of 90 HIV-noninfected cHL patients. Our clinical and histological data indicate that HIV-infected cHL patients present a higher frequency of mixed cellularity (MC) histological subtypes, more advanced disease stages, a poor response to treatment, and a poor overall survival compared to control patients. In controls, CD4/CD8 and GrB/TIA-1 ratios were determined as 2:1 and 1:2, respectively. The inflammatory infiltrate of HIV-infected patients had a significant reduction of CD4+ T lymphocytes (CD4/CD8 ratio 1:23), a decrease in infiltrating GrB+ cells (activated cytotoxic cells) and an increase in infiltrating TIA+ T cells (mainly nonactivated cytotoxic cells) in these patients (GrB/TIA-1 ratio 1:12). In conclusion, this study highlights an important intratumoral loss of CD4+ T cells (striking inversion in the CD4/CD8 ratio) and a decrease in intratumoral activated cytotoxic T lymphocytes in HIV-associated cHL patients. Further studies are required to confirm these results and to determine the role of these findings on the antitumoral immune response observed in HIV-associated cHL.
