Acetone compression improves lymph node yield and metastasis detection in colorectal cancer.

Lymph node status is one of the most important prognostic factors in colorectal cancer, and accurate pathological nodal staging and detection of lymph node metastases is crucial for determination of post-operative management. Current guidelines, including the TNM staging system and European Society for Medical Oncology (ESMO) guidelines, recommend examination of at least 12 lymph nodes. However, identification of an adequate number of lymph nodes can be challenging, especially in the setting of neoadjuvant treatment, which may reduce nodal size. In this study, we investigated 384 colorectal cancer resections that were processed at our department of pathology between January 2012 and December 2022, in which the number of detected lymph nodes was less than 12 subsequent to conventional preparation of mesocolic fat tissue. By means of acetone compression, lymph node harvest increased significantly (p < 0.0001), and the intended number of ≥ 12 lymph nodes was achieved in 98% of resection specimens. The number of nodal positive cases increased significantly from n = 95 (24.7%) before versus n = 131 (34.1%) after acetone compression due to additionally identified lymph node metastases (p < 0.001). In 36 patients (9.4%) initially considered as nodal negative, acetone compression led to a staging adjustment to a nodal positive category and thereby drove a recommendation to offer post-operative therapy. In conclusion, acetone compression is a reliable and useful method implementable in routine surgical pathology for the retrieval of lymph nodes in colorectal cancer specimen, allowing for an adequate lymph node sampling and an increase in nodal staging reliability.

Toxicity associated with PD-1 blockade after allogeneic haematopoietic cell transplantation.

Cancer immunotherapy with immune checkpoint inhibitors (ICIs) such as programmed death ligand-1 (PD-L1) blockers offers pronounced clinical benefit with durable responses and a manageable safety profile. Patients with a high risk of immune-related adverse events are generally excluded from clinical trials testing ICI therapy. Thus, only a little information on the safety and clinical outcome of patients treated with an ICI after allogeneic haematopoietic cell transplantation (HCT) is currently available. Here, we report the characteristics and outcomes of six patients with, respectively, clear cell renal carcinoma, diffuse large cell B-cell lymphoma, Hodgkin lymphoma, a microsatellite instable colorectal cancer and melanoma who were treated with PD-1 blocking antibodies. All patients had previously undergone allogeneic HCT. Severe grade 3–5 immune-related adverse events were observed in three of five patients who received full-dose ICI therapy. One patient received a lower dose of PD-1 blocking antibody. Only one patient had an objective response, whereas all the other patients had progressive disease. The high toxicity of a full- dose anti-PD-1 treatment regimen suggests that other treatment approaches for patients after allogeneic HCT are needed outside of the context of relapsed Hodgkin disease. In cases where ICI therapy is the only treatment option, reduced dosing should be explored.

Treatment of mycophenolate-resistant immune-related organizing pneumonia with infliximab.

BACKGROUND: The development of pulmonary immune-related adverse events (irAEs) in patients undergoing PD-(L)1 targeted checkpoint inhibitors are rare, but may be life-threatening. While many published articles and guidelines are focusing on the presentation and upfront treatment of pulmonary irAEs, the strategy in patients with late-onset pneumonia that are resistant to commonly used immunosuppressive drugs remains unclear. CASE PRESENTATION: Here, we report the successful treatment of a mycophenolate-resistant organizing pneumonia (OP) with infliximab in a patient with metastatic melanoma after PD-1 blockade. The patient received two years of PD-1 targeted immunotherapy when he developed multiple nodular lung lesions mimicking a metastatic progression. However, wedge resection of these lesions showed defined areas of OP, which responded well to corticosteroids. Upon tapering, new foci of OP developed which were resistant to high-dose steroids and mycophenolate treatment. The TNFα antagonist infliximab led to a rapid and durable regression of the inflammatory lesions. CONCLUSION: This case describes a not well-studied situation, in which a mycophenolate-resistant PD-1 blocker-associated pneumonitis was successfully treated with a TNFα neutralizing antibody. The outcome of this case suggests that infliximab might be the preferable option compared to classical immunosuppressants in the case of steroid-resistant/-dependent late onset pulmonary irAEs.

¿Existen diferencias clínicas y metabólicas entre diabéticos inmigrantes y autóctonos? / Are there any clinical and metabolic differences between immigrant and Spanish-born diabetic patients?

Objetivo: Conocer las características clínicas y metabólicas de los pacientes diabéticos inmigrantes en 2 centros de salud de La Rioja. Diseño: Estudio descriptivo. Emplazamiento: Dos centros de salud urbanos que atienden a una población de 11.700 y 23.000 personas en Logroño. Participantes: Setenta personas diabéticas inmigrantes de entre 18 y 70 años, registradas hasta diciembre de 2009 y 70 diabéticos autóctonos seleccionados por muestreo consecutivo. Mediciones principales: Variables sociodemográficas (edad, sexo, país de origen, edad en el momento del diagnóstico de diabetes), clínicas (presión arterial, perímetro abdominal, talla y peso) y analíticas (glucemia basal, HbA1c y perfil lipídico). Se estudió la inmunología de la diabetes y el péptido C en los menores de 40 años. Resultados: Muestra final 140 pacientes. La edad media de los diabéticos inmigrantes fue de 45,7 vs. 55,5 años en los autóctonos (p = 0,002). La edad media en el momento del diagnóstico en los inmigrantes fue de 38,4 vs. 48,1 años en los autóctonos (p = 0,004). El perímetro abdominal en los inmigrantes fue de 104,1 vs. 105,3cm en los autóctonos (p = 0,56). El índice de masa corporal (IMC) en inmigrantes fue de 29 vs. 32,1 en los autóctonos (p = 0,06). La HbA1c media en los inmigrantes fue de 8,4 vs. 7,5% en los autóctonos (p = 0,002). Los valores de presión arterial y control lipídico resultaron inferiores en pacientes indostánicos y norteafricanos en comparación con la población autóctona y los otros grupos de inmigrantes. Conclusiones: Los diabéticos inmigrantes son más jóvenes en el momento del diagnóstico, tienen valores de HbA1c superiores, mayor perímetro abdominal con IMC más bajos que los diabéticos autóctonos. La secreción de péptido C está conservada en la mayoría de los diabéticos menores de 40 años(AU)

Aim: To determine the clinical features and the metabolic control in immigrant diabetic patients in two Primary Care centres in La Rioja, Spain. Design: Descriptive study. Setting: Two urban Primary Care centres which cover a population of 11,700 and 23,000 patients in Logroño. Primary outcomes: Socio-demographic variables (age, sex, origin country of origin, age at onset of diabetes), clinical variables (blood pressure, waist circumference (WC), high, weight, BMI) and analytical variables (fasting blood glucose, HbA1c, lipid profile). The immunology of DM and baseline C-peptide were studied in patients younger than 40 years old. Participants: A total of 70 diabetic immigrants, aged between 18 and 70 years old and registered until December 31st 2009, and 70 Spanish-born diabetic patients were selected by consecutive sampling. Results: The final sample consisted of 140 patients (70 immigrants, 70 Spanish). Mean age of Spanish-born diabetics, 55.5 years, of immigrants 45.7 years (P=.002).Age at diagnosis 38.4 years in immigrants and 48.1 years in autochthonous (P=.004).WC in immigrants 104.1cm, in Spanish-born, 105.3cm (P=.56).BMI in immigrants 29, in Spanish-born 32.1 (P=.06).Mean glycated haemoglobin (HbA1c) in immigrants 8.4%, in Spanish-born 7.5% (P=.002). Blood pressure and lipid values were lower in Hindustani and North African patients than in Spanish-born and other immigrant groups. Conclusions: Immigrant diabetic patients are younger at diagnosis, have an unchanged baseline C-peptide secretion, higher HbA1c levels, higher WC with lower BMI compared to Spanish-born patients(AU)

[Are there any clinical and metabolic differences between immigrant and Spanish-born diabetic patients?]. / ¿Existen diferencias clínicas y metabólicas entre diabéticos inmigrantes y autóctonos?

AIM: To determine the clinical features and the metabolic control in immigrant diabetic patients in two Primary Care centres in La Rioja, Spain. DESIGN: Descriptive study. SETTING: Two urban Primary Care centres which cover a population of 11,700 and 23,000 patients in Logroño. PRIMARY OUTCOMES: Socio-demographic variables (age, sex, origin country of origin, age at onset of diabetes), clinical variables (blood pressure, waist circumference (WC), high, weight, BMI) and analytical variables (fasting blood glucose, HbA1c, lipid profile). The immunology of DM and baseline C-peptide were studied in patients younger than 40 years old. PARTICIPANTS: A total of 70 diabetic immigrants, aged between 18 and 70 years old and registered until December 31(st) 2009, and 70 Spanish-born diabetic patients were selected by consecutive sampling. RESULTS: The final sample consisted of 140 patients (70 immigrants, 70 Spanish). Mean age of Spanish-born diabetics, 55.5 years, of immigrants 45.7 years (P=.002).Age at diagnosis 38.4 years in immigrants and 48.1 years in autochthonous (P=.004).WC in immigrants 104.1cm, in Spanish-born, 105.3 cm (P=.56).BMI in immigrants 29, in Spanish-born 32.1 (P=.06).Mean glycated haemoglobin (HbA1c) in immigrants 8.4%, in Spanish-born 7.5% (P=.002). Blood pressure and lipid values were lower in Hindustani and North African patients than in Spanish-born and other immigrant groups. CONCLUSIONS: Immigrant diabetic patients are younger at diagnosis, have an unchanged baseline C-peptide secretion, higher HbA1c levels, higher WC with lower BMI compared to Spanish-born patients.

¿Antiagregamos a todos los pacientes diabéticos? / No disponible

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