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Preoperative simulation using a three-dimensional printer is effective to perform safe surgery by knowing the range limit of drilling in the temporal bone. Moreover, simulations using models are thought to be useful for education of young surgeon.
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Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant salivary gland tumor, and its prognosis is determined by the histological progression beyond the adenoma capsule. However, a preoperative evaluation of the histological progression remains challenging, and there is no consensus regarding treatment strategies for CXPA. Herein, we aimed to predict the histological progression preoperatively and develop an appropriate treatment strategy for CXPA. We retrospectively reviewed 22 patients with parotid gland CXPA recorded at our hospital. The clinicopathological characteristics were assessed, and survival analysis was performed. T3≤ or N+ were common in widely invasive CXPA (WICXPA) (p < 0.05). A tumor diameter > 40 mm and the N+ status were associated with poor prognosis considering overall survival (OS) and locoregional recurrence rate (LRC) (p < 0.05). Patients with facial nerve paralysis exhibited better OS and LRC than those without facial nerve paralysis. More than 90% of patients with WICXPA experienced distant metastases. Meanwhile, there were no cases of recurrence or death due to intracapsular and minimally invasive CXPA. A preoperative advanced T stage or N+ status was suspected as WICXPA. Tumors > 40 mm in size and N+ status necessitate high-intensity local treatment. Facial nerve invasion can be controlled by nerve resection. Postoperative systemic therapy could control distant metastases.
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BACKGROUND: Several theories explaining the development of pneumatosis intestinalis (PI) have been reported, but a substantial portion of cases have been idiopathic. Additionally, predictors of bowel ischaemia in PI have not been fully investigated, while PI with bowel ischaemia has deteriorated overall outcomes of PI. METHODS: Sixty-four patients diagnosed with PI (2009-2019) were allocated to two groups: with (group 1; n = 15 (23%)) and without (group 2; n = 49 (77%)) bowel ischaemia. Fourteen patients underwent emergency surgery, and bowel ischaemia was identified in nine (64%). Six patients in group 1 were diagnosed with bowel ischaemia, and were treated palliatively. On medical charts, we determined underlying conditions of PI, compared the characteristics and outcomes between the groups, and identified the predictors of bowel ischaemia. RESULTS: Group 1 patients more commonly showed abdominal pain, lower base excess, higher C-reactive protein concentrations, higher white blood cell counts and higher neutrophil-to-lymphocyte ratios, and more frequent comorbid ascites, free air and hepatic portal vein gas. Of nine bowel ischaemia surgery patients, three (33%) died; all because of anastomotic leak. All except three patients in group 2, who presented with aspiration pneumonia, responded to treatment. Only one patient had an unknown cause (1/64, 1.6%), and various underlying conditions in secondary PI were confirmed. CONCLUSION: Idiopathic PI may be identified rarely using current imaging and knowledge, but outcomes in PI patients with bowel ischaemia remain unsatisfactory. Earlier identification of bowel ischaemia by various specialists in accordance with predictors of bowel ischaemia could improve overall outcomes in PI patients.
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Isquemia Mesentérica , Pneumatose Cistoide Intestinal , Dor Abdominal , Ascite , Humanos , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/cirurgia , Veia Porta/diagnóstico por imagemRESUMO
BACKGROUND: Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated. METHODS: Thirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n = 12 [40%]) and without (Group 2; n = 18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia. RESULTS: At admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment. CONCLUSIONS: Earlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.
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Embolia Aérea/diagnóstico , Intestinos/fisiopatologia , Isquemia Mesentérica , Veia Porta , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Fígado , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Pregnancy has been demonstrated as a significant risk factor of splenic artery aneurysm (SAA) formation and rupture. However, prompt diagnosis of SAA rupture in a pregnant patient showing acute abdomen has been practically challenging in light of its rarity and vague initial presentation. PRESENTATION OF CASE: A 40-year-old woman (gravida 1, para 0) at 35 weeks' gestation presented to the emergency department with upper abdominal pain and nausea. Because of fetal dysfunction, emergency caesarian section was performed by a Pfannenstiel incision. Following delivery, 400 g of hemorrhage was removed from the upper abdominal cavity. Computed tomography showed a 37-mm SAA associated with copious adjacent fluid. Although selective angiography did not demonstrate active extravasation, interventional isolation of the SAA was not performed because of multiple surrounding arteries. Relaparotomy with an upper midline incision was then performed. Sudden cardiac arrest occurred upon opening the lesser sac to irrigate clots, and cardiac massage and proximal and distal clamping of the SAA were required. Eventually, splenectomy with excision of the SAA and pancreatic tail was successfully performed, but gauze packing of the open surgical wound was required because of severe coagulopathy. Following removal of the packs and closure of the abdomen 2 days after splenectomy, the patient and infant satisfactorily recovered without sequelae. DISCUSSION: Given continual awareness of abdominal vascular collapse during pregnancy, undelayed diagnosis and safer intervention might be achieved. CONCLUSION: Awareness at initial presentation and multidisciplinary efforts might be essential to achieve maternal and fetal survival in SAA rupture during pregnancy.
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BACKGROUND: Due to the strong tumoricidal activities of activated natural killer T (NKT) cells, invariant NKT cell-based immunotherapy has shown promising clinical efficacy. However, suppressive factors, such as regulatory T cells (Tregs), may be obstacles in the use of NKT cell-based cancer immunotherapy for advanced cancer patients. Here, we investigated the suppressive effects of Tregs on NKT cells and the underlying mechanisms with the aim to improve the antitumor activities of NKT cells. METHODS: Peripheral blood samples were obtained from healthy donors, patients with benign tumors, and patients with head and neck squamous cell carcinoma (HNSCC). NKT cells, induced with α-galactosylceramide (α-GalCer), and monocyte-derived dendritic cells (DCs) were co-cultured with naïve CD4+ T cell-derived Tregs to investigate the mechanism of the Treg suppressive effect on NKT cell cytotoxic function. The functions and phenotypes of NKT cells were evaluated with flow cytometry and cytometric bead array. RESULTS: Treg suppression on NKT cell function required cell-to-cell contact and was mediated via impaired DC maturation. NKT cells cultured under Treg-enriched conditions showed a decrease in CD4- NKT cell frequency, which exert strong tumoricidal responsiveness upon α-GalCer stimulation. The same results were observed in HNSCC patients with significantly increased effector Tregs. CONCLUSION: Tregs exert suppressive effects on NKT cell tumoricidal function by inducing more CD4- NKT cell anergy and less CD4+ NKT cell anergy. Both Treg depletion and NKT cell recovery from the anergy state may be important for improving the clinical efficacy of NKT cell-based immunotherapy in patients with advanced cancers.
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Neoplasias de Cabeça e Pescoço/imunologia , Células T Matadoras Naturais/imunologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/imunologia , Linfócitos T Reguladores/imunologia , Idoso , Idoso de 80 Anos ou mais , Células Cultivadas , Anergia Clonal , Citotoxicidade Imunológica , Feminino , Humanos , Vigilância Imunológica , Terapia de Imunossupressão , Masculino , Pessoa de Meia-IdadeRESUMO
Patients with protein S deficiency are prone to developing thrombosis. During laparoscopic surgery in patients with protein S deficiency, there is a risk of deep venous thromboembolism. In the present case, the patient was a 66-year-old man. He was diagnosed with colon cancer, and surgery was planned. Because of the presence of protein S deficiency, he required careful perioperative management for laparoscopic surgery. Surgery was successfully performed. On postoperative assessment, no thrombi were observed. Our approach of perioperative management might help in the treatment of patients with protein S deficiency.
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Neoplasias do Colo/cirurgia , Laparoscopia , Assistência Perioperatória , Deficiência de Proteína S/complicações , Idoso , Neoplasias do Colo/complicações , Humanos , Masculino , Tromboembolia/etiologia , Tromboembolia/prevenção & controleRESUMO
Various methods to generate the lining for a full-thickness nasal reconstruction have been reported. We used bilateral septal mucoperichondrial flaps, the distal portion of an expanded median forehead flap, and a nonlaminated vascularized free temporal fascia flap as a lining during total nasal reconstruction of a total full-thickness nasal defect in a 45-year-old woman with a nasal squamous cell carcinoma. In the first step of the two-stage surgery, a tissue expander was inserted into the forehead simultaneously with tumor resection. In the second step, the expanded median forehead flap, cartilage graft, bilateral septal mucoperichondrial flaps, and short pedicle vascularized free temporal fascia transfer were performed. Total nasal reconstruction could be completed without any skin graft or skin paddle of the free flap. Epithelialization of the mucosa on the transferred vascularized free temporal fascia without contracture deformity of the nasal cavity was confirmed by endoscopic examination after 8 years of follow-up. In the surgical procedure described, the facial skin, including the lining of the nostril rim, and the mucous membrane of the nasal cavity were reconstructed using facial skin and mucous membrane without long-term contracture, respectively.
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An approach for total maxillectomy with endoscopic transection of the pterygoid process via the contralateral maxillary sinus is described. In total maxillectomy, the resection of the pterygoid process of the sphenoid is a key step for successful resection. However, a conventional craniofacial approach requires extensive incision in the face, elevation of the lateral cheek flap. Even after elevation of the lateral cheek flap, visualization of this region is not good. An endoscopic approach through the contralateral maxillary sinus improved visualization of the pterygoid process, and osteotomy using a diamond-drilling bar was successfully performed. This technique has the potential to widen the indication for total maxillectomy in malignant neoplasms of the maxillary sinus.
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Endoscopia/métodos , Maxila/cirurgia , Neoplasias Maxilares/cirurgia , Melanoma/cirurgia , Osteotomia/métodos , Osso Esfenoide/cirurgia , Humanos , Masculino , Seio Maxilar , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Although regulatory T cells (Tregs) are thought to play an important role in immune suppression, their clinical significance in head and neck squamous cell carcinoma (HNSCC) is unclear. A recent study reported Tregs could be divided into functional subsets based on the expression of CD45RA and Foxp3. METHOD: The frequency of circulating Treg subsets was analyzed in patients with HNSCC and compared with the frequency in patients with benign tumors. The association of Treg subsets with the frequency of lymphocyte subsets, status of progression, clinical course, and prognosis were also examined. RESULTS: The frequency of CD4+Foxp3+ Tregs was comparable between HNSCC patients and age-matched benign tumor patients; however, CD45RA-Foxp3high Tregs were significantly increased in HNSCC patients, in particular those with advanced stage tumors. The high frequency of CD45RA-Foxp3high Tregs correlated with a poor prognosis and the low frequency of CD45RA-Foxp3high Tregs before treatment showed a better clinical outcome, even in patients with advanced stage tumors. CD45RA-Foxp3high Treg numbers were decreased after intensive treatments; however, Treg numbers recovered in the early stages of recurrent cases, even before the clinical manifestation. CONCLUSION: CD45RA-Foxp3high Tregs are associated with the clinical course of HNSCC and might be a new target for treatment and an early marker of tumor recurrence in HNSCC patients.
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Carcinoma de Células Escamosas/genética , Fatores de Transcrição Forkhead/genética , Neoplasias de Cabeça e Pescoço/genética , Idoso , Idoso de 80 Anos ou mais , Proliferação de Células , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma de Células Escamosas de Cabeça e Pescoço , Linfócitos T Reguladores/imunologia , Resultado do TratamentoRESUMO
Adamantinoma-like Ewing family tumor (EFT) is a rare subset of EFTs showing mixed features of Ewing sarcoma and adamantinoma of the long bones. All currently reported cases of the adamantinoma-like type have been associated with bone. Recently, a unique type of EFT was reported showing complex epithelial differentiation associated with the vagus nerve. Here we describe another unique type of EFT arising in the soft tissue of the neck associated with the vagus nerve. An 11-year-old girl presented to our hospital with a neck tumor on her right side. Surgical resection was performed, and histopathologic examination demonstrated a high-grade malignant neoplasm. The tumor was composed of sheets of small round proliferating cells, basaloid tumor nests with marked squamous differentiation, biphasic growth pattern with epithelioid tumor nests, and spindle cell proliferation. Immunohistochemically, the tumor cells showed diffuse expression of CD99 and FLI-1. In addition, small round cells and basaloid/squamoid components were immunoreactive for AE1/AE3, CAM5.2, cytokeratin 5/6, high-molecular weight keratin, p63, and p40 (ΔNp63). Reverse transcription polymerase chain reaction and direct sequencing analysis revealed that the tumor harbored a t(11;22) translocation, involving EWSR1 and FLI-1, which are characteristic of EFTs. According to these findings, our case has characteristics of both a subset of adamantinoma-like EFT and EFT with complex epithelial differentiation. We suggest that EFT with complex epithelial differentiation is in a common spectrum with the adamantinoma-like type and that adamantinoma-like EFTs can arise in soft tissue, leading to difficulty in differential diagnosis with malignant epithelial tumors.
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Neoplasias Ósseas/patologia , Sarcoma de Ewing/patologia , Neoplasias de Tecidos Moles/patologia , Nervo Vago/patologia , Adamantinoma/patologia , Biomarcadores Tumorais/análise , Neoplasias Ósseas/genética , Neoplasias Ósseas/metabolismo , Criança , Feminino , Humanos , Imuno-Histoquímica , Proteínas de Fusão Oncogênica/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sarcoma de Ewing/genética , Sarcoma de Ewing/metabolismo , Neoplasias de Tecidos Moles/genética , Neoplasias de Tecidos Moles/metabolismoRESUMO
PURPOSE: The intravenous administration of α-Galactosylceramide (α-GalCer)-pulsed antigen presenting cells (APCs) is well tolerated and the increased IFN-γ producing cells in the peripheral blood after the treatment appeared to be associated with prolonged survival. An exploratory study protocol was designed with the preoperative administration of α-GalCer-pulsed APCs to clarify the mechanisms of these findings, while especially focusing on the precise tumor site. METHODS: Patients with operable advanced lung cancer received an intravenous injection of α-GalCer-pulsed APCs before surgery. The resected lung and tumor infiltrating lymphocytes (TILs) as well as peripheral blood mononuclear cells were collected and the invariant NKT (iNKT) cell-specific immune responses were analyzed. RESULTS: Four patients completed the study protocol. We observed a significant increase in iNKT cell numbers in the TILs and augmented IFN-γ production by the α-GalCer-stimulated TILs. CONCLUSION: The administration of α-GalCer-pulsed APCs successfully induced the dramatic infiltration and activation of iNKT cells in the tumor microenvironment.
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Células Apresentadoras de Antígenos/imunologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Galactosilceramidas , Imunoterapia , Neoplasias Pulmonares/terapia , Células T Matadoras Naturais/imunologia , Adenocarcinoma/imunologia , Adenocarcinoma/terapia , Idoso , Carcinoma Pulmonar de Células não Pequenas/imunologia , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/terapia , Humanos , Neoplasias Pulmonares/imunologia , Linfonodos/imunologia , Masculino , Receptores de Antígenos de Linfócitos T/genética , Receptores de Antígenos de Linfócitos T/imunologia , Microambiente Tumoral/imunologiaRESUMO
Human NKT cells are known to have strong antitumor activities and to be activated by specific ligand, α-galactosylceramide (αGelCer). We examined the migration pattern of αGalCer-pulsed DCs and the immune responses after administration by different routes. DCs injected into nasal submucosa quickly migrated to the lateral neck lymph rather than the lateral lymph nodes. The absolute number of NKT cells and the IFN-γ-producing cells increased in peripheral blood after injection of the DCs into nasal submucosa. We conducted a phase I study with αGalCer-pulsed DCs administered in nasal submucosa of patients with head and neck cancer, and evaluated safety and feasibility. The results showed that nasal submucosal administration of α-GalCer-pulsed DCs was safe and a smaller number of these DCs could exhibit significant immune responses and some positive clinical effects. In additional study, the use of the intra-arterial infusion of activated NKT cells and the submucosal injection of α-GalCer-pulsed DCs has been shown to induce significant antitumor immunity and had beneficial clinical effects in the management of advanced head and neck squamous cell carcinoma. The NKT cell-based cancer immunotherapy may be helpful in management of head and neck cancer and needs to be explored in further detail.
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Células Apresentadoras de Antígenos , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Imunidade nas Mucosas , Imunoterapia/métodos , Receptores de Antígenos de Linfócitos T/imunologia , Administração Intranasal , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/imunologia , Seguimentos , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/imunologia , Humanos , Estadiamento de Neoplasias , Pulsoterapia , Receptores de Antígenos de Linfócitos T/administração & dosagem , Carcinoma de Células Escamosas de Cabeça e Pescoço , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do TratamentoRESUMO
BACKGROUND: Antigen-presenting cells (APCs) play a crucial role in the induction of immune responses. However, the optimal administration route of tumor-specific APCs for inducing effective immunological responses via cancer immunotherapy remains to be elucidated. Human NKT cells are known to have strong anti-tumor activities and are activated by the specific ligand, namely, α-galactosylceramide (αGalCer). METHODS: Seventeen patients with head and neck squamous cell carcinoma (HNSCC) were enrolled in this study. Patients received an injection of αGalCer-pulsed APCs into the nasal, or the oral floor submucosa. Then total body image and single photon emission computed tomography (SPECT) images were examined. The immunological responses including the number of peripheral blood NKT cells, anti-tumor activities and the CD4(+) CD25(high) Foxp3(+) T cells (Tregs) induced following APCs were also compared. RESULTS: APCs injected into the nasal submucosa quickly migrated to the lateral lymph nodes and those injected into the oral floor submucosa dominantly migrated to the submandibular nodes rather than the lateral lymph nodes. An increase in the absolute number of NKT cells and the IFN-γ producing cells was observed in peripheral blood after injection of the APCs into the nasal submucosa, however, these anti-tumor activities were not detected and the increased frequency of Treg cells were observed after administration into oral floor. CONCLUSIONS: These results indicate that a different administration route of APCs has the potential to bring a different immunological reaction. The submucosal administration of αGalCer into the oral submucosa tends to induce immunological suppression.
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Células Apresentadoras de Antígenos/imunologia , Células Apresentadoras de Antígenos/transplante , Galactosilceramidas/imunologia , Neoplasias de Cabeça e Pescoço/terapia , Mucosa Bucal/imunologia , Mucosa Nasal/imunologia , Administração através da Mucosa , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD4/análise , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/terapia , Movimento Celular , Feminino , Neoplasias de Cabeça e Pescoço/imunologia , Humanos , Ligantes , Masculino , Pessoa de Meia-Idade , Coloração e Rotulagem , Resultado do TratamentoRESUMO
Vα24 natural killer T (NKT) cells have potent anti-tumor activity. We performed a phase II clinical study in patients with head and neck squamous cell carcinoma (HNSCC) using ex vivo expanded Vα24 NKT cells and α-galactosylceramide (αGalCer; KRN7000)-pulsed antigen-presenting cells (APCs) to investigate the efficacy and induction of NKT cell-specific immune responses. The subjects were 10 patients with locally recurrent and operable HNSCC. One course of nasal submucosal administration of αGalCer-pulsed APCs and intra-arterial infusion of activated NKT cells via tumor-feeding arteries was given before salvage surgery. Anti-tumor effects, NKT cell-specific immune responses in extirpated cancer tissue and peripheral blood, safety, and pathological effects were evaluated. Five cases achieved objective tumor regression. The number of NKT cells increased in cancer tissues in 7 cases and was associated with tumor regression. The combination therapy induced NKT cell-specific immune responses in cancer tissues that were associated with beneficial clinical effects.
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Neoplasias de Cabeça e Pescoço/imunologia , Neoplasias de Cabeça e Pescoço/terapia , Imunoterapia Adotiva , Células T Matadoras Naturais/imunologia , Neoplasias de Células Escamosas/imunologia , Neoplasias de Células Escamosas/terapia , Idoso , Células Apresentadoras de Antígenos/imunologia , Protocolos Antineoplásicos , Terapia Combinada , Feminino , Galactosilceramidas/imunologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias de Células Escamosas/cirurgia , Resultado do TratamentoRESUMO
Invariant natural killer T (iNKT) cells possess potent antitumor effects after activation with a specific glycolipid antigen, α-galactosylceramide (αGalCer). A phase I-II clinical study of αGalCer-pulsed dendritic cells (DC) to activate endogenous iNKT cells was previously performed in patients with non-small-cell lung cancer (NSCLC). In this clinical trial, the patients with increased interferon-γ (IFN-γ) production (>two-fold) in PBMC after the DC treatment (good responder group) experienced a prolonged overall survival time in comparison with the poor responder group. We extended the previous study and performed a microarray-based gene expression analysis using peripheral blood CD56(+) cells and CD56(-) CD3(+) T cells from patients enrolled in the above-mentioned clinical study. We sought to identify any biomarkers associated with the immune responses in this immunotherapy trial. Six patient samples corresponding to three subjects in the good responder group and three subjects in the poor responder group were included in the microarray analysis. Genes differentially expressed between pre-treatment and post-treatment samples were selected for analysis. Subsequently, genes that were only expressed in the good responder group or poor responder group were chosen. After these procedures, four selected genes were quantified by reverse transcriptase-polymerase chain reaction in another eight patient samples, and two genes, LTB4DH and DPYSL3, were confirmed to be candidate genes for the predictor of a good immune response. The expression profile of these two genes may be associated with the responsiveness of IFN-γ production after αGalCer-pulsed DC treatment.
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Oxirredutases do Álcool/genética , Perfilação da Expressão Gênica , Proteínas Musculares/genética , Linfócitos T/metabolismo , Adulto , Idoso , Complexo CD3/metabolismo , Antígeno CD56/metabolismo , Carcinoma Pulmonar de Células não Pequenas/imunologia , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Carcinoma Pulmonar de Células não Pequenas/terapia , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase II como Assunto , Análise por Conglomerados , Células Dendríticas/imunologia , Células Dendríticas/transplante , Feminino , Galactosilceramidas/imunologia , Predisposição Genética para Doença/genética , Humanos , Imunoterapia Adotiva , Interferon gama/metabolismo , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sobrevida , Linfócitos T/imunologiaRESUMO
To evaluate the safety, immune responses, and antitumor responses after the administration of alpha-galactosylceramide (alphaGalCer) KRN7000-pulsed PBMC cultured with IL-2 and GM-CSF (IL-2/GM-CSF-cultured PBMCs), a phase I-II study in patients with non-small cell lung cancer was conducted. Patients with advanced non-small cell lung cancer or recurrent lung cancer refractory to the standard therapy were eligible. alphaGalCer-pulsed IL-2/GM-CSF-cultured PBMCs (1 x 10(9)/m(2)) were i.v. administered four times. Immune responses were monitored weekly. Twenty-three patients were enrolled in this study and 17 cases (73.9%) completed. No severe adverse event related to the treatment was observed. After the injection of alphaGalCer-pulsed IL-2/GM-CSF-cultured PBMCs, an increased number of IFN-gamma-producing cells in the peripheral blood were detected in 10 patients (58.8%). Five cases remained as stable disease, and the remaining 12 cases were evaluated as progressive disease. The estimated median survival time (MST) of the 17 cases was 18.6 mo (range, 3.8 to 36.3 mo). Ten patients who displayed increased IFN-gamma-producing cells (> or =2-fold) showed prolonged MST (31.9 mo; range, 14.5 to 36.3 mo) as compared with poor-responder patients (n = 7) MST (9.7 mo; range, 3.8 to 25.0 mo) (log-rank test, p = 0.0015). The administration of alphaGalCer-pulsed IL-2/GM-CSF-cultured PBMCs was well tolerated and was accompanied by the successful induction of NKT cell-dependent immune responses. The increased IFN-gamma-producing cells that result from alphaGalCer stimulation in PBMCs were significantly associated with prolonged MST. These results are encouraging and warrant further evaluation for survival benefit of this immunotherapy.
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Galactosilceramidas/imunologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/imunologia , Imunoterapia Adotiva/métodos , Interleucina-2/imunologia , Leucócitos Mononucleares/transplante , Neoplasias Pulmonares/terapia , Adulto , Idoso , Vacinas Anticâncer/imunologia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/terapia , Células Cultivadas , Feminino , Citometria de Fluxo , Humanos , Imunoterapia Adotiva/efeitos adversos , Interferon gama/biossíntese , Interferon gama/imunologia , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Células T Matadoras Naturais/imunologia , Recidiva Local de Neoplasia/terapiaRESUMO
Mixed-type liposarcoma is a rare soft tissue tumor. This report describes a 50-year-old man with retroperitoneal mixed-type liposarcoma that consisted of four pathologically different components. Preoperative CT and MRI showed a giant retroperitoneal mass composed of several nodules with various attenuation and signal intensity. At laparotomy, the tumor appeared to be composed of four components. Pathologic examination revealed that each component was of a histologically different subtype. Mixed-type liposarcoma containing four different subtypes is extremely rare. Its clinical and pathologic features are briefly reviewed.
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Lipossarcoma/patologia , Neoplasias Retroperitoneais/patologia , Humanos , Lipossarcoma/diagnóstico , Lipossarcoma/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Isolated periportal tuberculous lymphadenopathy is a rare clinical entity. This report describes a 56-year-old woman with the disease, who showed characteristic findings on clinical imaging studies. Computed tomography showed a low-density mass with peripheral enhancement and calcification, adjacent to the pancreatic head and caudate lobe of the liver. 2-[Fluorine 18]fluoro-2-deoxy-D-glucose positron emission tomography imaging co-registered with computed tomography showed slightly increased uptake along the periphery of the lesion. The diagnosis was confirmed at laparotomy. The manifestation of the disease is nonspecific, and preoperative differential diagnosis from neoplastic disease is often difficult. Its clinical and radiological features are briefly reviewed.
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Tuberculose dos Linfonodos/diagnóstico , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Pressão na Veia Porta , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XRESUMO
Pseudomyxoma peritonei is a rare disease characterized by intraperitoneal accumulation of mucinous ascites produced by neoplastic cells, which mostly originate from an appendiceal adenoma. The clinical presentation of the disease varies, and preoperative diagnosis is often difficult. This report describes a 76-year-old female patient with pseudomyxoma peritonei who presented with lower abdominal pain and bilateral femoral masses. Computed tomography revealed bilateral femoral hernias and fluid collection in the peritoneal cavity. Laparotomy was performed, during which we found extensive diffuse gelatinous material mixed with purulent ascites, and the diagnosis of pseudomyxoma peritonei was confirmed. The disease is rarely associated with femoral hernias or peritonitis. Its clinical presentation, including the characteristic findings on computed tomography, and surgical management are briefly reviewed.