Clinicopathological features of splenic tumours of lymphoid tissue.

BACKGROUND: To study the effects of splenectomy on treatment and diagnosis of tumours of lymphoid tissue of the spleen. METHODS: Fifty-three cases were reviewed from Peking University People's Hospital from 2002 to 2017. According to WHO classification of tumours of haematopoietic and lymphoid tissues (2008) and classification updated (2016), the cases were studied by microscopy, immunohistochemistry and in situ hybridization, combined with the bone marrow biopsy and clinical examination. RESULTS: In 53 cases, the male to female ratio was 3.4:1, the mean age was 55.4 years old, the median survival time was 17.0 months, and all patients present with variable degree of splenomegaly. The elevated percentage of lymphocyte in peripheral blood can be seen in 22 cases, and elevated LDH level in 24 cases. Abnormal blood counts can be seen in 26 cases before operation, and 22 cases remission to normal level partly or completely after operation. The clinical symptoms included abdominal pain or distension, fatigue, fever, and weight loss, etc. Seventeen cases present with lymphoadenopathy of abdomen or other sites. Fourteen cases were stage I or II, whereas 6 were stage III, 28 were stage IV. Forty-three cases were splenic B-cell marginal zone lymphoma (SMZL)(48.8%,21/43), DLBCL(23.3%,10/43), splenic diffuse red pulp small B-cell lymphoma (SDRPSBL)(11.6%,5/43), mantle cell lymphoma (MCL)(9.3%,4/43), follicular lymphoma (FL)(4.7%,2/43), composite lymphoma (CL, DLBCL and classical Hodgkin lymphoma)(2.3%,1/43) in turn, and the remaining 10 cases were chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) (n = 4), hairy cell leukaemia (HCL) (n = 1), hepatosplenic T-cell lymphoma (HSTL) (n = 5). The survival period of SMZL and DLBCL was 25.7, 18.6 months, respectively. Thirteen cases were dead (27.1%, 13/48). The chemotherapy protocol included Hyper-CVAD A/B with/without R (Rituximab), COP, CHOP with/without R etc. The prognosis of those with elevated LDH level, high clinical staging, B symptom, and older than 60 year old was obviously worse, and the prognosis of DLBCL was worse than that of SMZL. CONCLUSIONS: Most splenic lymphoid tumors present with splenomegaly and abnormal blood counts, and complete or part remission of blood counts can be seen after splenectomy, and splenectomy is also helpful for pathological diagnosis. The most common pathological types are SMZL and DLBCL. The definite diagnosis can be made by combining with clinical features, histopathology, immunophenotype, genetics, bone marrow biopsy and laboratory examination.

Primary invasive extramammary Paget disease on penoscrotum: a clinicopathological analysis of 41 cases.

To investigate the clinicopathological and immunohistochemical features and prognostic factors for invasive extramammary Paget disease (EMPD) on penoscrotum, we described the clinical presentations, histopathology, and follow-up courses of 41 cases. The age of the patients ranged from 42 to 84 years. All the patients were treated with wide surgical excision, and 14 were confirmed to have lymph node metastasis. During follow-up, 18 patients (43.9%) developed local or distant recurrence, and 13 patients (31.7%) died of the disease. Histologically, glandular formation with true lumina within the epidermis was found in 29 cases, and signet ring cells were seen in 11 cases. In invasive components, nodular/micronodular growth pattern, glandular formation, and strands/solid sheets existed in 95.1% (39/41), 43.9% (18/41), and 24.4% (10/41) of the cases, respectively. More than half of the cases had at least 2 different types of invasive growth pattern. CK7 was diffusely positive in all cases, whereas CK20 was focally positive in 8 cases. GCDFP-15 was expressed to a variable degree in 24 cases. Presence of strands/solid sheets, lymphovascular invasion, and perineural invasion in invasive EMPD were found to be correlated with higher lymph node metastatic rate. Univariate analysis revealed that patients with one of the following prognostic factors: delay in diagnosis more than 7.5 years, depth of invasion more than 1 mm, invasive pattern of strands/solid sheets, marked inflammation, lymphovascular invasion, and lymph node metastasis at diagnosis, had significantly shorter cancer-specific survival. We concluded that invasive EMPD is a rare malignant skin neoplasm with morphological diversity. Invasive pattern of strands/solid sheets is significantly associated with both lymph node metastasis and worse prognosis. Delay in diagnosis, depth of invasion, marked inflammation, lymphovascular invasion, and regional lymph node status are important prognostic factors.

[Expression of CD4(+) and IL-17, Foxp3 in non-small cell lung cancer and their correlation with microvessel density].

OBJECTIVE: To explore the expression of CD4(+), IL-17 and Foxp3 in non-small cell lung cancer (NSCLC) and their relationship with microvessel density (MVD). METHODS: The expressions of CD4(+), IL-17, Foxp3, CD31 and CD34 in the cancer tissues of 102 NSCLC cases were detected by immunohistochemisty. The relationship among the expressions of CD4(+), IL-17, Foxp3 and MVD was analyzed. The count data were analyzed using χ(2) test. The measurement data were analyzed using single-factor analysis of variance, and significance level α = 0.05. RESULTS: Among the factors affecting CD31 expression, there was a statistically significant difference between the strong positive Foxp3 expression (++) and negative (-) and positive expressions (+) in the NSCLC cancer tissues (P < 0.05), and between the expressions in stage I and III cancer tissues (P < 0.05). Among the factors affecting CD34 expression, there was a significant difference between positive IL-7 expression (+) and strong positive IL-7 expression (++) (P < 0.05), between negative Foxp3 expression (-) and strong positive Foxp3 expression (++) (P < 0.05), and between the CD34 expressions in stage I and III and between those in stage II and III NSCLC cancer tissues (P < 0.05). CONCLUSIONS: CD4, IL-17and Foxp3 may be involved in the tumor suppression caused by host immune response, and are related with the NSCLC invasion and metastasis.

CD4+, IL17 and Foxp3 expression in different pTNM stages of operable non-small cell lung cancer and effects on disease prognosis.

OBJECTIVE: To investigate the effects of CD4+ , IL17 and Foxp3 expression on prognosis of operable non-small cell lung cancer (NSCLC) with different pTNM stages. METHODS: Expression of CD4+ , IL17 and Foxp3 in 102 cases of NSCLC tissues and adjacent cancer tissues was detected by immunohistochemistry and associations with prognosis with different pTNM stages were analyzed. The Chi-square test was used to compare count data. Survival differences were evaluated by Kaplan-Meier single factor analysis and the COX regression model was used to analyze the relationship between influential factors and the disease prognosis. The significance level was α= 0.05. RESULTS: Expression of CD4, IL-17 and Foxp3 significantly varied in different pTNM stages of NSCLC tissues (P < 0.05). The same was true for CD4 expression (P < 0.05). The median survival time (MST) in the positive CD4 expression group was evidently higher than that in the negative group (25.8/23.9 months). Compared with stage III, the MST difference of stages I and II in the positive CD4 expression group were statistically significant (P < 0.05). The MST in positive IL-17 and Foxp3 expression groups was obviously lower than that in the corresponding negative group (P < 0.05) (25.6/35.1 months and 24/35.3 months, respectively). There was a significant difference of MST between any two of three stages of positive IL-17 expression group (P < 0.05), and it was the same with positive Foxp3 expression group. TNM stage, negative CD4 expression, and positive IL-17 and Foxp3 expression were the main risk factors for the prognosis of NSCLC. CONCLUSIONS: Surgical prognosis of NSCLC can be better assessed by the combination of clinical staging and expression of IL17 and Foxp3.

[Clinicopathological and immunohistochemical features of pulmonary blastoma: analysis of 4 cases and review of the literature].

OBJECTIVE: To analyze the clinicopathological and immunohistochemical features of pulmonary blastoma (PB). METHODS: Four patients with PB, 1 male and 3 females, with the onset age of 2 months approximately 80 years, underwent resection of the tumor and were followed up for 32 months at most. The clinical data were analyzed retrospectively. RESULTS: Pathology showed that the 4 cases all suffered from epithelial type PB. Under microscope, epithelial cells were atypical, mostly in mitogenic phase, and were lined up as many dense tubes. All of the patients underwent surgical resection and 3 - 5 cycles of chemotherapy and one had radiotherapy following surgery. The survival time was 5 - 32 months. One of the four patients died during follow-up due to metastasis 5 months after operation. The other patients still survived. Immunohistochemistry showed that cytokeratin and thyroid transcription factor-1 were positive, and vimentin, epithelial membrane antigen, and S-100 protein were negative in the tumor tissues; and a part of tumor cell presented positive Cg-A. CONCLUSION: PB is rare and presents different clinical features. It is difficult to determine the diagnosis before operation. The modular structures and expression of neuroendocrine markers are helpful in differentiating epithelial type PB from usual adenocarcinoma in immunohistochemical staining.