Giant Cell Tumor of the Pelvis: a Systematic Review

This is a systematic review of articles concerning the morbidity, recurrence rate, treatment and treatment complications of pelvic giant cell tumors (GCTs). The key words “giant cell tumor, pelvis” were used to identify articles which included data on patients with pelvic GCTs in English and Chinese databases of published reports from 1949–2012. The articles were filtered by title, abstract and full text. Thirty‐eight articles and 165 patients were identified for this review. Data on all identified patients were studies; data in different articles on the same patients was not used repeatedly. The following patient data were collected where possible and subjected to systematic analysis; age, location of GCT, treatment, follow‐up, complications, recurrence and whether alive or dead. The mean age of onset was 33.2 years (range, 14–73 years), the peak ages of onset being between 21 and 40 years. A pronounced sex difference was identified, the male : female ratio being 1:1.7. The acetabulum was the commonest area for pelvic GCTs. Forty‐eight tumors were primarily located in the iliac, 60 in the acetabular and 31 in the ischiopubic area. Twenty‐seven patients experienced complications of treatment. Patients who had been treated by wide resection had the most complications; these included incisional infection and delayed healing of incisions. Local recurrence was common, having occurred in 39/158 patients (24.6%), comprising 24/72 (33.3%) who had undergone intralesional surgery only; 9/20 (45.0%) who had undergone radiotherapy only; 1/51 (2.0%) who had undergone wide resection; and 5/14 patients (35.7%) who had undergone radiation therapy or cryotherapy plus intralesional surgery. Mortality was low (3.2%, 5/158). Pelvic GCT is not common, the acetabular area appears to the most frequent site and the peak age is the third and fourth decades. Although the recurrence rate is high for all pelvic GCTs, the mortality is low. Treatment has a critical influence on recurrence. In spite of the associated complications, the lower local recurrence rate makes wide resection a reasonable option for patients with extensive and/or aggressive GCTs.     

Diagnosis and Treatment of Testicular Cancer: A Clinician’s Perspective

Testicular germ cell tumors (GCTs) include seminoma and nonseminoma. Chance of cure is excellent for clinical stage I disease regardless of whether adjuvant treatment or a surveillance strategy with treatment only for those who relapse is used. Risk of recurrence is greater in nonseminoma with evidence of lymphovascular invasion, but most can be salvaged with chemotherapy and survival rates remain high. This article outlines key pathologic and clinical considerations in clinical stage I seminoma, nonseminoma, advanced disease, and assessment of cancer of unknown primary as a potential GCT.     

Spontaneous regression of Merkel cell carcinoma: A case report and review of the literature

INTRODUCTIONMerkel cell carcinoma (MCC) is a rare and highly aggressive primary cutaneous neuroendocrine carcinoma, most often occurring in the elderly. Recurrence is frequent and in 40% of cases regional and distant metastases develop. Despite this, there have been reports of spontaneous regression. We report the first case of MCC with primary complete spontaneous regression of the nose in an 86-year-old woman following an incisional biopsy.PRESENTATION OF CASEAn 86-year-old woman presented with a violaceous lump on the left side of the nose measuring 25 × 25 mm. Incisional biopsy of the lesion showed MCC and immunohistochemistry confirmed diagnosis. Following an 8-week period the lesion completely disappeared and histology did not show any residual MCC but immunohistochemistry demonstrated a mixture of T and B cells.DISCUSSIONComplete spontaneous regression (CSR) is rare. The literature documents 22 similar cases of CSR of MCC. From this case report and previous literature the most likely reason for regression is a T-cell mediated immune response.CONCLUSIONTo the best of our knowledge, this is the first described case of MCC with primary CSR of the nose. Exact mechanism of regression remains unclear. Further research is needed in identifying pathway of immune response and possible immunotherapy as a cure.     

CD4 T Cells but Not Th17 Cells Are Required for Mouse Lung Transplant Obliterative Bronchiolitis

Lung transplant survival is limited by obliterative bronchiolitis (OB), but the mechanisms of OB development are unknown. Previous studies in a mouse model of orthotopic lung transplantation suggested a requirement for IL‐17. We have used this orthotopic mouse model to investigate the source of IL‐17A and the requirement for T cells producing IL‐17A. The major sources of IL‐17A were CD4⁺ T cells and γδ T cells. Depletion of CD4⁺ T cells led to a significantly decreased frequency and number of IL‐17A⁺ lymphocytes and was sufficient to prevent acute rejection and OB. However, mice with STAT3‐deficient T cells, which are unable to differentiate into Th17 cells, rejected lung allografts and developed OB similar to control mice. The frequency of IL‐17A⁺ cells was not decreased in mice with STAT3‐deficient T cells due mainly to the presence of IL‐17A⁺ γδ T cells. Deficiency of γδ T cells also did not affect the development of airway fibrosis. Our data suggest that CD4⁺ T cells are required for OB development and expansion of IL‐17A responses in the lung, while Th17 and γδ T cells are not absolutely required and may compensate for each other.     

Comparing Humoral and Cellular Immune Response Against HBV Vaccine in Kidney Transplant Patients

Host protection upon vaccination usually results from the complex interplay of humoral and cellular components of the immune system. Exploring hepatitis B surface antigen (HBsAg)‐specific T cell responses and their correlation with humoral responses under immunosuppression, we analyzed 51 renal transplant recipients, differing in HBV vaccine–specific antibody titers (non [NRs]‐, low [LRs]‐, and high responders [HRs]) and in 22 healthy controls (HCs) in a cross‐sectional study. HBsAg‐specific T cells were analyzed by flow cytometry according to expression of activation markers CD40L and/or CD69, and the cytokines IFNγ, IL‐2, TNFα, and IL‐17. No significant differences in responder rate and magnitude of HBsAg‐specific T cell responses were found between HCs and HRs. Interestingly, HBsAg‐specific Th‐cells were also observed in 50% of humoral NRs. Frequencies of HBsAg‐specific CD40L+ Th‐cells were significantly higher in HRs compared to LRs (p = 0.009) and in LRs in comparison to NRs (p = 0.043). All but NRs showed a predominance of multi‐potent HBsAg‐specific TNFα+IL‐2+ Th‐cells. As expected, HBsAg‐specific CD8⁺ T cells were rarely found. In conclusion, mounting of hepatitis B vaccine‐specific T cell responses is possible in kidney transplant recipients despite immunosuppression. Detection of HBV‐specific Th‐cells in a significant proportion of humoral NRs contributes to the current discussion on conferring immune protection by cellular memory in such patients.     

Immunophenotypic Profile and Increased Risk of Hospital Admission for Infection in Infants Born to Female Kidney Transplant Recipients

Children born to female kidney recipients are exposed to immunosuppressive drugs during gestation. Little is known about their immune system at birth or in the long term. Twenty‐eight children born to female kidney recipients and 40 full‐term children born to healthy mothers were evaluated. T, B, NK, NKT, γδT cells were assessed by flow cytometry and functional evaluation of T and dendritic cells after in vitro activation was performed at birth and at 8 months of age. At birth, infants born to female kidney recipients showed lower numbers of CD4+ T, NKT and intense reduction of B cells (median cells/mm³, transplant: 153.7 X control: 512.4; p < 0.001). There was also a reduced percentage of activated CD8+ T and of CD4+ regulatory T cells. Activated memory and exhausted memory B cells showed higher percentages among children exposed to immunosuppressors when compared to control group. At 8 months, most immune alterations were no longer observed, but four children still had low numbers of some lymphocyte subsets at this age. Children born to female kidney recipients had 4.351 (95% CI: 1.026–15.225; p = 0.046) higher risk of hospital admission in the first months of life—some, with severe clinical manifestations—than those born to healthy women.