Using macrophage activation to augment immunotherapy of established tumours.

BACKGROUND: Successful immunotherapy will require alteration of the tumour microenvironment and/or decreased immune suppression. Tumour-associated macrophages (TAMs) are one major factor affecting tumour microenvironment. We hypothesised that altering TAM phenotype would augment the efficacy of immunotherapy. METHODS: We and others have reported that 5,6-Dimethylxanthenone-4-acetic-acid (DMXAA, Vadimezan) has the ability to change TAM phenotypes, inducing a tumour microenvironment conducive to antitumour immune responses. We therefore combined DMXAA with active immunotherapies, and evaluated anti-tumour efficacy, immune cell phenotypes (flow cytometry), and tumour microenvironment (RT-PCR). RESULTS: In several different murine models of immunotherapy for lung cancer, DMXAA-induced macrophage activation significantly augmented the therapeutic effects of immunotherapy. By increasing influx of neutrophils and anti-tumour (M1) macrophages to the tumour, DMXAA altered myeloid cell phenotypes, thus changing the intratumoural M2/non-M2 TAM immunoinhibitory ratio. It also altered the tumour microenvironment to be more pro-inflammatory. Modulating macrophages during immunotherapy resulted in increased numbers, activity, and antigen-specificity of intratumoural CD8(+) T cells. Macrophage depletion reduced the effect of combining immunotherapy with macrophage activation, supporting the importance of TAMs in the combined effect. CONCLUSION: Modulating intratumoural macrophages dramatically augmented the effect of immunotherapy. Our observations suggest that addition of agents that activate TAMs to immunotherapy should be considered in future trials.

Primary Non-Hodgkin Lymphoma of frontal sinus diagnosed by fine needle aspiration cytology.

UNLABELLED: We present a rare case of primary non-Hodgkins Lymphoma of the frontal sinus diagnosed by Fine needle aspiration cytology (FNAC). FNAC is a safe, simple, rapid and effective technique that could be used to diagnose lesions even in unusual sites like paranasal sinuses with effective radiological guidance. Neoplasms of the frontal sinus could be easily misdiagnosed as an inflammatory process clinically. FNAC is a simple test to rule out a neoplasm. A review of a single case including radiographic, clinical, and pathologic findings was done, followed by a discussion on the pathological differential diagnosis highlighting relevant literature. Timely diagnosis is critical in the management of these cases. KEYWORDS: Fine needle aspiration cytology, non-Hodgkin lymphoma, diffuse large B cell lymphoma, frontal sinus.

Soft-tissue recurrence of giant cell tumor of bone associated with pulmonary metastases.

A soft tissue recurrence associated with pulmonary metastases developed in a 46 year old lady one year after intra-lesional excision and autogenous bone graft of giant cell tumor of bone of the distal end of the right radius. The different imaging modalities and procedures used for staging as well as the management were discussed. Brief review of relevant literatures addressed different factors that influence addressed different factors that influence recurrence, treatment Options of primary and recurrent GCT of distal radius, and metaplastic recurrent GCT of distal radius, and metaplastic bone formation in such lesions.

Follicular variant of papillary thyroid carcinoma -- a cytological study.

The cytological diagnosis of classical papillary carcinoma is easily established based on the characteristic architectural and nuclear features. However, the follicular variant of papillary thyroid carcinoma(FVPTC) poses a diagnostic challenge. In this study we analysed the cytological features of 14 histopathologically proven cases of FVPTC. We inferred that a combination of architectural features such as follicles and syncytial clusters and nuclear features, viz grooves, pseudoinclusions and enlarged nuclei with fine chromatin, were helpful in establishing the diagnosis. It is hence suggested that based on the combination of the aforesaid features a diagnosis of FVPTC be offered whenever it is possible. This helps in patient management, obviating the need for a second surgical intervention.

Macrofollicular variant of papillary thyroid carcinoma diagnosed by fine needle aspiration biopsy: a case report.

BACKGROUND: Macrofollicular variant of papillary thyroid carcinoma (PTC) is an uncommon, recently described thyroid tumor. By frozen section it can be confused easily with goiter or macrofollicular adenoma. CASE: A 41-year-old female presented with a huge mass in the right thyroid lobe, cold on scintigraphy. By fine needle aspiration fluid was obtained. Smears of the sediment of the fluid showed epithelial cells with morphologic features diagnostic of PTC. Frozen section diagnosis was benign. CONCLUSION: This is the first reported case of macrofollicular variant of PTC diagnosed preoperatively by cytology. In our case the cytology was similar to that of cystic PTC.

Papillary carcinoma of the thyroid with numerous spindle-shaped tumor cells in fine needle aspiration smears. A case report.

A papillary carcinoma of the thyroid characterized by numerous spindle-shaped tumor cells in fine needle aspiration (FNA) smears is reported. The oval nuclei of the spindle cells, arranged in monolayered sheets, occasionally showed "rhythmic," palisaded patterns. Comparative study of cytology and histology of this tumor revealed that the spindle cells observed in FNA smears originated in the epithelium covering the edematous neoplastic papillae.