Assessing the Magnitude of Immunogenic Cell Death Following Chemotherapy and Irradiation Reveals a New Strategy to Treat Pancreatic Cancer.

Pancreatic ductal adenocarcinoma (PDAC) continues to have a dismal prognosis, in part, due to ineffective treatment strategies. The efficacy of some chemotherapies and especially radiotherapy is mediated partially by the immune system. Therefore, we hypothesized that profiling the immune response following chemotherapy and/or irradiation can be used as a readout for treatment efficacy but also to help identify optimal therapeutic schedules for PDAC. Using murine models of PDAC, we demonstrated that concurrent administration of stereotactic body radiotherapy (SBRT) and a modified dose of FOLFIRINOX (mFX) resulted in superior tumor control when compared with single or sequential treatment groups. Importantly, this combined treatment schedule enhanced the magnitude of immunogenic cell death, which in turn amplified tumor antigen presentation by dendritic cells and intratumoral CD8+ T-cell infiltration. Concurrent therapy also resulted in systemic immunity contributing to the control of established metastases. These findings provide a rationale for pursuing concurrent treatment schedules of SBRT with mFX in PDAC.

Infiltrative squamous cell carcinoma in hidradenitis suppurativa: A case report for early surgical intervention.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin that has potential for malignant transformation into squamous cell carcinoma (SCC). The pathogenesis of HS is poorly understood but thought to be from follicular keratinization, occlusion, and rupture of the pilosebaceous unit, followed by an infiltration of inflammatory cells into the dermis. Treatment is challenging due to a lack of effective medical therapies. PRESENTATION OF CASE: In this case report, we describe a patient with chronic HS that developed into SCC who underwent late surgical intervention after failing medical management. At the time malignant transformation was discovered, the SCC was beyond resectability and ultimately fatal. DISCUSSION: Based on the morbidity and mortality of chronic HS illustrated in our case and presented in the literature, we advocate for early surgical intervention. CONCLUSION: Wide surgical excision offers a near definitive intervention and should at least be considered for all chronic HS patients due to high morbidity and malignant transformation risk.

High-grade angiosarcoma presenting with cytology-negative hemorrhagic ascites.

Angiosarcomas are a rare subtype of soft-tissue sarcomas originating from the vascular endothelium. Both retroperitoneal and omental angiosarcomas tend to be aggressive and rapidly fatal if not amenable to early intervention. In this report, we describe an unusual case of high-grade angiosarcoma with cytology-negative hemorrhagic ascites and diffuse omental invasion. Multiple investigations into the origin of the hemorrhagic ascites, including cytological analysis, tumor marker measurements, serum-ascites albumin gradient calculation and frozen section pathological examination, failed to reveal a diagnosis. We conclude that malignancy should be considered in the differential diagnosis in the presence of suspicious cytology-negative hemorrhagic ascites and concomitant retroperitoneal and abdominal findings.

Children with partial IgA deficiency: clinical characteristics observed in the pediatric rheumatology clinic.

Literature is lacking on partial IgA deficiency. In this study, the authors propose to describe the clinical manifestations of patients with partial IgA deficiency. Methods. The authors conducted a retrospective chart review of 13 patients with partial IgA deficiency followed at the pediatric rheumatology clinic at Robert Wood Johnson Medical School. They looked for the presence of rashes, joint pain, joint swelling, and morning stiffness. The authors also examined charts for a history of frequent infections, allergies, and the presence of elevated antinuclear antibody. Results. Eleven out of the 13 patients complained of joint pain, joint swelling, or morning stiffness. Six patients carried a diagnosis of a definitive rheumatic disease. Four patients suffered from frequent infections and 2 patients reported allergies. Conclusion. Partial IgA deficiency appears to be associated with rheumatic diseases and complaints of joint pain, joint swelling, and morning stiffness. A larger study is needed to confirm these results.