Giant haemorrhagic hepatic cyst with flame-like morphology in a patient with polycystic kidney and liver disease.

INTRODUCTION: Intracystic haemorrhage is a rare complication of hepatic cysts, and is often mistaken for a malignant lesion. CASE REPORT: A 55-year-old female with a history of polycystic kidney and liver disease presented with a six-month history of abdominal distension, abdominal pain, early satiety, shortness of breath and 5 kg of weight loss. Imaging revealed a 20 cm mixed solid-cystic hepatic lesion containing peripheral avascular mobile echogenic material with a flame-like morphology. After experiencing symptomatic relief from ultrasound-guided aspiration, the patient underwent cyst fenestration for more definitive treatment. DISCUSSION: Haemorrhagic hepatic cysts are uncommon and may present on imaging as having lace-like retractile clot, internal layering or shading of separating blood products or avascular mobile flame-like excrescences. The presence of avascular mobile flame-like excrescences appears to be a unique feature of haemorrhagic hepatic cysts. CONCLUSION: While haemorrhagic hepatic cysts are rare and commonly mistaken for biliary cystadenomas or adenocarcinomas, the identification of particular features on high-resolution magnetic resonance imaging and contrast-enhanced ultrasound can lead to the correct diagnosis.

Dural venous sinus tumour thrombus from metastatic thymoma.

Thymomas are the most common primary tumours of the anterior mediastinum. While intrathoracic disease progression through local invasion is well described in the literature, extrathoracic extension of disease is uncommon and intracranial metastases have seldom been reported. We present a case of extensive dural venous sinus tumour thrombus in a patient with metastatic invasive thymoma.

Deep infiltrating endometriosis: Can magnetic resonance imaging anticipate the need for colorectal surgeon intervention?

OBJECTIVE: To identify magnetic resonance imaging (MRI) features associated with colorectal surgical bowel resection for treatment of deep infiltrating endometriosis (DIE). MATERIALS AND METHODS: 122 preoperative pelvic MRIs in women with laparoscopically-proven DIE and subsequent surgery (2006-2015) were identified, and retrospective cohort analysis performed. MRIs were reviewed independently by two radiologists blinded to surgical/histopathological outcomes. Associations between MRI characteristics of middle/posterior compartment endometriosis and surgical outcomes were investigated to identify MRI features associated with colorectal surgical bowel resection. RESULTS: MRI features associated with colorectal surgical intervention were: presence of an MRI bowel lesion (sensitivity 95.3%, specificity 63.3%, ROC-AUC 0.79); MRI bowel lesions ≥20 mm in length (sensitivity 91%, specificity 77%, ROC-AUC 0.84); MRI bowel lesions invading the muscularis or submucosa/mucosa layers (sensitivity 95.3%, specificity 63.3%, ROC-AUC 0.90). CONCLUSION: This study identifies MRI features that have potential diagnostic utility in identifying the need for colorectal surgical intervention in patients with DIE.

Autologous CLL cell vaccination early after transplant induces leukemia-specific T cells.

BACKGROUND: Patients with advanced hematologic malignancies remain at risk for relapse following reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (allo-HSCT). We conducted a prospective clinical trial to test whether vaccination with whole leukemia cells early after transplantation facilitates the expansion of leukemia-reactive T cells and thereby enhances antitumor immunity. METHODS: We enrolled 22 patients with advanced chronic lymphocytic leukemia (CLL), 18 of whom received up to 6 vaccines initiated between days 30 and 45 after transplantation. Each vaccine consisted of irradiated autologous tumor cells admixed with GM-CSF-secreting bystander cells. Serial patient PBMC samples following transplantation were collected, and the impact of vaccination on T cell activity was evaluated. RESULTS: At a median follow-up of 2.9 (range, 1-4) years, the estimated 2-year progression-free and overall survival rates of vaccinated subjects were 82% (95% CI, 54%-94%) and 88% (95% CI, 59%-97%), respectively. Although vaccination only had a modest impact on recovering T cell numbers, CD8+ T cells from vaccinated patients consistently reacted against autologous tumor, but not alloantigen-bearing recipient cells with increased secretion of the effector cytokine IFN-γ, unlike T cells from nonvaccinated CLL patients undergoing allo-HSCT. Further analysis confirmed that 17% (range, 13%-33%) of CD8+ T cell clones isolated from 4 vaccinated patients by limiting dilution of bulk tumor-reactive T cells solely reacted against CLL-associated antigens. CONCLUSION: Our studies suggest that autologous tumor cell vaccination is an effective strategy to advance long-term leukemia control following allo-HSCT. TRIAL REGISTRATION: Clinicaltrials.gov NCT00442130. FUNDING: NCI (5R21CA115043-2), NHLBI (5R01HL103532-03), and Leukemia and Lymphoma Society Translational Research Program.

Detecting T-cell reactivity to whole cell vaccines: Proof of concept analysis of T-cell response to K562 cell antigens in CML patients.

BCR-ABL(+) K562 cells hold clinical promise as a component of cancer vaccines, either as bystander cells genetically modified to express immunostimulatory molecules, or as a source of leukemia antigens. To develop a method for detecting T-cell reactivity against K562 cell-derived antigens in patients, we exploited the dendritic cell (DC)-mediated cross-presentation of proteins generated from apoptotic cells. We used UVB irradiation to consistently induce apoptosis of K562 cells, which were then fed to autologous DCs. These DCs were used to both stimulate and detect antigen-specific CD8(+) T-cell reactivity. As proof-of-concept, we used cross-presented apoptotic influenza matrix protein-expressing K562 cells to elicit reactivity from matrix protein-reactive T cells. Likewise, we used this assay to detect increased anti-CML antigen T-cell reactivity in CML patients that attained long-lasting clinical remissions following immunotherapy (donor lymphocyte infusion), as well as in 2 of 3 CML patients vaccinated with lethally irradiated K562 cells that were modified to secrete high levels of granulocyte macrophage colony-stimulating factor (GM-CSF). This methodology can be readily adapted to examine the effects of other whole tumor cell-based vaccines, a scenario in which the precise tumor antigens that stimulate immune responses are unknown.

Enhancing graft-versus-leukemia after transplant: the rise of anti-cancer vaccines.

Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only truly effective curative treatment for refractory hematological malignancies. Unfortunately, relapse and transplant rejection continue to be of major concern. In order to enhance the effectiveness of the HSCT, various strategies have been explored to amplify the graft versus leukemia (GvL) effect. Cancer vaccines have emerged in recent years as a promising strategy for the immunotherapeutic treatment of cancer. Evidence shows that they are most likely to have the greatest effect in the setting of minimal residual disease and as adjuvant agents. With this in mind, researchers have begun to explore the use of cancer vaccines in conjunction with HSCT, with exciting results. There has also been recent work examining the effect of novel adjuvants or blockers of negative immune regulation to augment the effect of cancer vaccines in both the transplant and non-transplant settings. The addition of these agents may prove.