PD-L1 protein expression assessed by immunohistochemistry is neither prognostic nor predictive of benefit from adjuvant chemotherapy in resected non-small cell lung cancer.

Background: The expression of programmed death (PD) ligand 1 (PD-L1) protein expression assessed by immunohistochemistry (IHC) has been correlated with response and survival benefit from anti-PD-1/PD-L1 immune checkpoint inhibitor therapies in advanced non-small cell lung carcinoma (NSCLC). The efficacy of several agents appears correlated with PD-L1 expression. It remains controversial whether PD-L1 is prognostic in NSCLC. We assessed the prognostic value of PD-L1 IHC and its predictive role for adjuvant chemotherapy in early stage NSCLC. Patients and methods: Tumor sections from three pivotal adjuvant chemotherapy trials (IALT, JBR.10, CALGB 9633) using the E1L3N antibody were studied in this pooled analysis. PD-L1 staining intensity and percentage in both tumor cells (TCs) and immune cells (ICs) were scored by two pathologists. The average or consensus PD-L1 expression levels across intensities and/or percent cells stained were correlated with clinicopathological and molecular features, patient survivals and potential benefit of adjuvant chemotherapy. Results: Results from 982 patients were available for analysis. Considering staining at any intensities for overall PD-L1 expression, 314 (32.0%), 204 (20.8%) and 141 (14.3%) tumor samples were positive for PD-L1 staining on TCs using cut-offs at ≥1%, ≥10% and ≥25%, respectively. For PD-L1 expressing ICs, 380 (38.7%), 308 (31.4%) and 148 (15.1%) were positive at ≥ 1%, ≥10% and 25% cut-offs, respectively. Positive PD-L1 was correlated with squamous histology, intense lymphocytic infiltrate, and KRAS but not with TP53 mutation. EGFR mutated tumors showed statistically non-significant lower PD-L1 expression. PD-L1 expression was neither prognostic with these cut-offs nor other exploratory cut-offs, nor were predictive for survival benefit from adjuvant chemotherapy. Conclusions: PD-L1 IHC is not a prognostic factor in early stage NSCLC patients. It is also not predictive for adjuvant chemotherapy benefit in these patients.

[Guillain-Barré syndrome heralding acute query fever]. / Syndrome de Guillain-Barré révélant une fièvre Q aiguë.

INTRODUCTION: Q fever is a polymorphic disease, which can induce neurological disturbances. The central nervous system is mainly involved while peripheral neuropathies are rare with less than 15 cases reported in the literature. CASE-REPORT: We report here a case of acute polyradiculoneuritis associated with acute Q fever, with favorable outcome after antibiotic and intravenous immunoglobulin therapies. CONCLUSION: Serologic tests for Coxiella burnetii should be performed in case of unusual polyradiculoneuritis with fever, headache and neuro-ophthalmologic disorders, even when environmental exposure is lacking, because Q fever requires specific antibiotic treatment and serological follow-up.

Histopathology of a granulomatous lobular panniculitis in acute Q fever: a case report.

Q fever is a zoonotic infection caused by Coxiella burnetii. Two forms of the disease have been described: an acute form with pneumonia, hepatitis or a flu-like syndrome; and a chronic form in which endocarditis is the most frequent clinical expression. We report a 77 year old male with fever and an erythematous nodule on the right leg. Biopsy revealed a granulomatous lobular panniculitis with some granulomas rimmed by an eosinophilic material, giving a "doughnut" or "fibrin-ring" appearance. Q fever serological studies were positive. Cutaneous signs, among them panniculitis, are probably underestimated during the acute phase of the disease, and recognizing different granulomatous patterns may contribute to the diagnosis.

[First documented cases of rheumatoid arthritis in Niger]. / Premiers cas documentés de polyarthrite rhumatoïde au Niger.

The authors report the first eight documented cases of rheumatoid arthritis in Niger, all diagnosed during one year at the National Lamordé Hospital of Niamey. Systemic manifestations were rare.

[Oedematous polyarthritis and myopericarditis as presenting features of periarteritis nodosa]. / Polyarthrite oedémateuse et myopéricardite révélatrices d'une périartérite noueuse.

Remitting symmetrical seronegative synovitis with pitting edema (RS3PE) syndrome is a rare type of seronegative polyarthritis occurring in the elderly. It can be associated to various diseases. We report a case of RS3PE syndrome associated with myopericarditis, leading to the diagnosis of polyarteritis nodosa in a 71-year-old patient admitted to the hospital for a febrile acute polyarthritis with pitting edema of the hands associated with a marked inflammatory syndrome. On second day of hospitalization, a sustained chest pain led to the diagnosis of myopericarditis. Muscular biopsy showed necrotizing vasculitis, characteristic of polyarteritis nodosa. The coexistence of RS3PE and myopericarditis has never been described in the literature. Its association with polyarteritis nodosa is also very rare and only one case has been previously reported.

[Lepromatous leprosy revealed by a swollen hands syndrome]. / Syndrome des mains boudinées révélant une lèpre lépromateuse.

Osteoarticular pathology in leprosy is common and described at all stages, but rarely as the most evident clinical manifestation. We report a case of borderline lepromatous leprosy with initial and disabling hands edema. The swollen hands syndrome is probably due to chronic Mycobacterium leprae tenosynovitis.

[Non-diseases: another field for the specialist of internal medicine]. / Les non-maladies: un autre domaine de linterniste.

PURPOSE: Non-diseases are a heterogeneous group of symptoms, preoccupations or phenomenon that are felt or interpreted as pathological and so justifiable of medical intervention. Most doctors easily recognize illnesses that require no medical act. However, as a result of a medical misinterpretation or wrong reasoning, physicians may diagnose a non-disease and prescribe a non adapted treatment. KEY POINTS: This non exhaustive literature review, gives examples of anatomical, clinical, investigational, iatrogenic, psychiatric and collective non-diseases. Health education of the population, initial and continuing education of general and specialist practitioners and continuous assessment of advertising by the pharmaceutical industry are probably useful to limit the provision of medical care of non-pathological problems, which excessively request the physicians. CONCLUSION: The specialist of internal medicine, because of a wide knowledge of the medical specialities, has to recognize and learn the frequent traps of non-diseases.

[Recurrence of thromboembolic disease after splenectomy for hereditary xerocytosis]. / Maladie thromboembolique récidivante après splénectomie pour stomatocytose héréditaire.

CASE REPORT: The diagnosis of hereditary xerocytosis is made in a 57 year old woman splenectomized 30 years ago for a chronic hemolytic anemia. In following, she developed many thrombophlebitis of lower limbs and portal vein. DISCUSSION: The methods of diagnosis of this rare hereditary stomatocytosis are recalled, and the mechanisms of thrombotic tendency after splenectomy are discussed. This case underlines the fact that splenectomy is banned in the treatment of hereditary stomatocytosis, and that the serious consequences of iron overload, which is very frequent in this disease, must be prevented.

[Diabetes insipidus revealing chronic myelomonocytic leukemia]. / Diabète insipide central inaugural d'une leucémie myélomonocytaire chronique.

INTRODUCTION: Central diabetes insipidus is most frequently reported to occur after a trauma from surgery or accident. However, between 30 and 50% of cases are considered idiopathic. It's a rare complication of myelodysplastic syndrome. CASE REPORT: A 61-year-old patient presented central diabetes insipidus revealing, 17 months before, chronic myelomonocytic leukemia. Cytogenetics studies revealed monosomy 7. Acute myeloid leukemia appears 3 months after training rapid patient's death. DISCUSSION: Blood examination is necessary before to conclude idiopathic central diabetes insipidus. The discovery of chronic myelomonocytic leukemia implicates a rapid managing before its possible acute myeloid leukemia transformation. Indeed, prognosis of central diabetes insipidus and acute myeloid leukemia associated, in presence of monosomy 7, is very poor.

[Acute abdominal pain in a 8-year-old girl with Epstein-Barr infection]. / Douleur abdominale aiguë au cours d'une primo-infection par le virus d'Epstein-Barr.

Abdominal pain is uncommon in patient with Epstein-Barr infection and is usually attributed to an enlargement of the liver or spleen. We report on an 8-year-old girl with a pseudoperitonitis due to a mesenteric lymphadenitis associated with Epstein-Barr infection. Outcome was favourable without surgery. We review the different causes of abdominal pain occurring during Epstein-Barr infection.

[Left atrial thrombus in multiple myeloma treated with thalidomide]. / Thrombus de l'oreillette gauche au cours d'un myélome multiple traité par thalidomide.

The occurrence of a left atrial thrombus without a haemodynamic predisposing factor (arrhythmia, mitral valvulopathy, severe left ventricular dysfunction) is a rare event. We report a case during the progression of refractory myeloma, four months after stopping treatment with thalidomide. The promoting haemodynamic factors for left atrial thrombosis in sinus rhythm, described in the literature, had been excluded. In our case the potential role of thalidomide is debatable, in the light of recent publications about venous and arterial thromboses observed with this treatment.