Characterising the immune microenvironment in liposarcoma, its impact on prognosis and the impact of radiotherapy.

BACKGROUND AND OBJECTIVES: Limited literature exists examining the immune microenvironment in liposarcoma, particularly with regard to the impact of radiotherapy. A major problem is the lack of scoring system for the tumour-infiltrating lymphocytes (TILs) in sarcoma. This study aims to describe the immune environment pre- and postradiotherapy and identify the optimal immune infiltrate scoring system for sarcoma. METHODS: Thirty-nine paired tissue samples (pre- and postradiotherapy) from patients with liposarcoma were scored by two pathologists for TILs using pre-existing systems (for breast cancer and melanoma) and compared for interobserver reliability. Immunohistochemical staining was performed for various immune markers. RESULTS: The TIL scoring system for breast cancer yielded perfect agreement (κ = 1.000). 21% of patients had increased TILs after radiotherapy, 87.5% of whom had dedifferentiated liposarcoma. Immune suppressor expression was increased frequently after radiotherapy (CD68 increased in 59.4%, PD-L1 increased in 25%). Immune effector expression (CD8) was unchanged in 84.4%. CONCLUSIONS: Breast cancer TIL scoring is reproducible in liposarcoma and has high interobserver reliability. Radiotherapy was observed to have a limited impact on immune effectors but seemed to have more impact in upregulating immune suppressors, suggesting radiotherapy may contribute to disease control through immunomodulatory effects. Dedifferentiated liposarcoma represents a uniquely responsive subtype.

Cervical Nodal Metastatic Pituitary Carcinoma: A Case Report.

Pituitary carcinomas are rare tumors with only 170 cases reported in the literature.1 They form a very small proportion of pituitary tumors, which are commonly benign adenomas. Metastatic disease diagnosed by fine needle aspiration cytology is extremely rare and has only been reported in 6 patients,2-5 3 of whom had cervical nodal metastases, with other sites of metastases being the liver and cervical vertebra. We report a case of cervical metastatic pituitary carcinoma diagnosed by core needle biopsy.

Isolated prostate cancer soft tissue recurrence 10 years after radical prostatectomy.

In advanced disease, prostate cancer is well known to invade locally as well as metastasise to distant locations. Metastases occur commonly in lymph nodes and bone but have also been known to involve certain visceral organs, particularly the lungs. Involvement of soft tissue by metastases is far less common, particularly in the context of cancer recurrence. We present the case of a male aged 68 years who presented with a rising prostate-specific antigen (PSA) 10 years after radical prostatectomy (RP). The PSA increased despite salvage radiotherapy and was ultimately found to be caused by a PSA secreting prostate cancer soft tissue mass in the suprapubic region. Surgical resection of the mass caused a sharp decline in the PSA to negligible levels. This case highlights the need for ongoing surveillance post-RP and the potential for prostate cancer recurrence in the soft tissue that is refractory to routine salvage radiotherapy.

Observations on the application of the Papanicolaou Society of Cytopathology standardised terminology and nomenclature for pancreaticobiliary cytology.

In 2014 the Papanicolaou Society of Cytopathology (PSC) published a system of standardised terminology and nomenclature for pancreaticobiliary cytology (STNPC). In the present study, 232 previously reported pancreaticobiliary cytology specimens were categorised according to this set of guidelines in order to identify potential challenges to implementation of the PSC system into routine practice. Overall, 207 (89%) of the cases were found to comply with the PSC scheme in their original form. Twenty-five cases (11%) demonstrated that the application of the PSC system would result in a change of category. In the majority of these cases, the change was related to the method of categorising low grade and premalignant neoplasms, using the categories of 'Neoplastic: other' (a new category unique to STNPC classification scheme) and 'Atypical', for specimens deemed to be diagnostic of or suspicious for these lesions, respectively. The study also highlighted the emphasis on the inclusion of imaging context and cyst fluid analysis in the interpretation of endoscopic ultrasound guided fine needle aspiration specimens in the guidelines. The STNPC offers an approach to pancreaticobiliary cytology that reflects the considerable variation in the nature and treatment of the entities that may be encountered in these specimens. Challenges in utilisation of the scheme include awareness of the unique approach to the categorisation of premalignant and low grade neoplasms, and the amount and quality of available clinical and imaging information.