Expression patterns and clinical implications of PDL1 and DLL3 biomarkers in small cell lung cancer retrospectively studied: Insights for therapeutic strategies and survival prediction.

Lung cancer is a leading cause of cancer-related deaths globally, includes small cell lung cancer (SCLC), characterized by its aggressive nature and advanced disease at diagnosis. However, the identification of reliable biomarkers for SCLC has proven challenging, as no consistent predictive biomarker has been established. Nonetheless, certain tumor-associated antigens, including programmed death-ligand 1 (PDL1) and Delta-Like Ligand 3 (DLL3), show promise for targeted antibody-based immunotherapy. To ensure optimal patient selection, it remains crucial to comprehend the relationship between PDL1 and DLL3 expression and clinicopathological characteristics in SCLC. In this study, we investigated the expression patterns of PDL1 and DLL3 biomarkers in endobronchial samples from 44 SCLC patients, examining their association with clinical characteristics and survival. High PDL1 expression (>1%) was observed in 14% of patients, while the majority the SCLC patients (73%) exhibited high DLL3 expression (>75%). Notably, we found a positive correlation between high PDL1 expression (>1%) and overall survival. However, we did not observe any significant differences in the biomarkers expression concerning age, sex, disease status, smoking status, or distant metastases. Further subgroup analysis revealed that a high co-expression of both PDL1 (>1%) and DLL3 (100%) antigens was associated with improved overall survival. This suggests that SCLC expressing PDL1 and DLL3 antigens may exhibit increased sensitivity to therapy, indicating their potential as therapeutic targets. Thus, our findings provide novel insights into the simultaneous evaluation of PDL1 and DLL3 biomarkers in SCLC patients. These insights have significant clinical implications for therapeutic strategies, survival prediction, and development of combination immunotherapies.

Lung cancer as a predominant feature in a patient with Peutz-Jeghers syndrome: Case report.

Peutz-Jeghers syndrome (PJS) is characterized by mucocutaneous pigmentation and gastrointestinal hamartomatous polyposis, which can lead to intussusception. PJS patients face high lifetime risks for various cancer types, with the majority of patients being diagnosed with tumors along the gastrointestinal tract. Herein, we present the case of a 34-year-old man who carried a germline STK11 pathogenic variant, while lacking the cardinal features of PJS syndrome. Interestingly, he was diagnosed with lung adenocarcinoma despite being a never-smoker. Tumor testing revealed clinically relevant molecular alterations, including the known germline pathogenic variant STK11, a KRAS somatic pathogenic variant, and FGFR3 gene amplification. Treatment with standard chemotherapy and immunotherapy did not have a clinical benefit. Due to clinical deterioration, the patient deceased 18 months after his initial diagnosis prior to having the chance for targeted therapy. Identification of rare hereditary cancer syndromes and the respective presence of tumor biomarkers can provide important alternatives to targeted treatments, including immunotherapy in patients with tumors unresponsive to conventional treatment protocols. This case highlights that although only a small proportion of lung cancer diagnoses will be due to hereditary predisposition, STK11 germline carriers should be under close surveillance for early detection of lung cancer.

Extramedullary relapse and discordant CD19 expression between bone marrow and extramedullary sites in relapsed acute lymphoblastic leukemia after blinatumomab treatment.

Blinatumomab, a bispecific T-cell engager antibody construct targeting CD19, has been shown to improve the outcome in patients with relapsed and/or refractory B-cell acute lymphoblastic leukemia. Treatment with blinatumomab demonstrated significant survival benefit over chemotherapy, supporting its use as a bridge therapy to allogeneic hematopoietic stem cell transplantation. Unfortunately, following initial response, approximately 50% of responding patients eventually relapse. At the time of failure, the majority of patients have CD19-positive blasts, yet a concerning number of CD19-negative relapses has been reported. In the data reported herein, we present an interesting case of a 42-year-old patient with primary refractory B-cell acute lymphoblastic leukemia who achieved complete morphologic remission after one cycle of blinatumomab as a single agent. Notably, and in the absence of extramedullary disease history, the response in marrow coincided with the emergence of CD19-positive extramedullary relapse including sites of previous punctures for blood and bone marrow samples, as confirmed by biopsy, as well as parenchymal organs (eg breast and lung). During the second cycle of blinatumomab, a CD19-negative morphological relapse emerged. The loss of CD19 was a transient event, as leukemic cells partially regained it after chemotherapy. This study illustrates a challenging situation of relapsed and refractory acute lymphoblastic leukemia complicated with extramedullary disease after exposure to a bispecific T-cell engager antibody, such as blinatumomab. Physicians should maintain a high level of suspicion for the evolution of extramedullary leukemia. This pattern of resistance and/or relapse to blinatumomab resembles the graft-versus-leukemia effect after allogeneic transplantation (stronger in blood and marrow than in other tissues). Mechanisms of resistance to blinatumomab are not yet clear. Combination treatments for refractory patients and those at high risk for exramedullary disease may warrant future assessment.

Lipoma of Parotid Gland: Report of Two Cases.

INTRODUCTION: Lipoma is a benign mesenchymal tumor originating from adipose tissue cells. In the head and neck, this tumor is not common. The occurrence of lipomas in the parotid gland is extremely rare, ranging between 0.6 and 4%. CASE REPORTS: In this article, we present two clinical cases of lipomas of the superficial lobe of the parotid gland. DISCUSSION: Clinical diagnosis of parotid gland lipomas is difficult, while usually, they are asymptomatic and presented as a painless swelling of the parotid gland. Tomographic imaging modalities are very accurate in preoperative diagnosis in contrast to FNA or FNAB which is not helpful in the case of lipoma. This pathological entity should be considered in the differential diagnosis of parotid gland's mass lesions. The usual indication for surgical intervention is cosmetic appearance. Meticulous surgical excision should be performed to avoid disturbing adverse events.

Α 78-year-old female who presents with a non-resolving pneumonia: what is your diagnosis?

Non-resolving pneumonia with a mass-like radiological appearance raises clinical suspicion of many causes, with malignancy the most prominent. Infectious causes should be investigated thoroughly as they carry a better prognosis. http://ow.ly/QEPL30mLIk4.