Induction of lytic Epstein-Barr virus (EBV) infection by synergistic action of rituximab and dexamethasone renders EBV-positive lymphoma cells more susceptible to ganciclovir cytotoxicity in vitro and in vivo

The purposeful induction of the lytic form of Epstein-Barr virus (EBV) infection combined with ganciclovir (GCV) treatment has been advocated as a novel strategy for EBV-positive B-cell lymphoma. We demonstrated that rituximab had a synergistic effect with dexamethasone on induction of the lytic EBV infection in CD20-positive lymphoma cells. Addition of GCV to the dexamethasone/rituximab-treated cells was more effective than dexamethasone/rituximab alone in killing EBV-positive lymphoma cells in vitro and in lymphoma-bearing nude mice but not in EBV-negative cells. These data suggest that induction of the lytic EBV infection with dexamethasone/rituximab in combination with GCV could be a potential virally targeted therapy for EBV-associated B-cell lymphoma.

Miliary tuberculosis not affecting the lungs but complicated by acute respiratory distress syndrome

A 61-year-old woman was admitted with fever and headache of 10-day duration. She was found to have anemia, jaundice, and signs of meningitis. The erythrocyte sedimentation rate was increased and the tuberculin skin test was positive. A provisional diagnosis of miliary tuberculosis was made and antituberculous therapy was started, although no miliary lesions were seen on chest radiography. However, her condition rapidly deteriorated with diffuse opacification of both lungs and she died on the 7th hospital day. Postmortem examination revealed miliary tuberculosis in several organs but not in the lungs with acute respiratory distress syndrome accounting for the lung pathology. It should be noted that on rare occasions the lungs may not be involved by miliary tuberculosis.

Midline Carcinoma of Children and Young Adults With NUT Rearrangement

Purpose

A balanced chromosomal translocation, t(15;19), resulting in the BRD4-NUT oncogene, has been identified in a lethal carcinoma of young people, a disease described primarily in case reports. We sought to amass a more definitive series of tumors with NUT and/or BRD4 gene rearrangements and to determine distinct clinicopathologic features.

Patients and Methods

Carcinomas (N = 98) in young individuals (median age, 32.5 years) were screened for NUT and BRD4 rearrangements using dual-color fluorescence in situ hybridization. Four published carcinomas with BRD4 and NUT rearrangements were also evaluated. Immunophenotypic analyses were performed.

Results

Eleven tumors had NUT gene rearrangements, including eight with BRD4-NUT fusions and three with novel rearrangements, which were designated as NUT variant. All NUT-rearranged carcinomas (NRCs) arose from midline epithelial structures, including the first example arising below the diaphragm. Patients were young (median age, 17.6 years). Squamous differentiation (seen in 82% of NRCs) was particularly striking in NUT-variant cases. In this first description of NUT-variant carcinomas, the average survival (96 weeks, n = 3) was longer than for BRD4-NUT carcinomas (28 weeks, n = 8). Strong CD34 expression was found in six of 11 NRCs but in zero of 45 NUT wild-type carcinomas.

Conclusion

NRCs arise from midline structures in young people, and NRCs with BRD4-NUT are highly lethal, despite intensive therapies. NUT-variant carcinomas might have a less fulminant clinical course than those with BRD4-NUT fusions. CD34 expression is characteristic in NRCs and, therefore, holds promise as a diagnostic test for this distinctive clinicopathologic entity.

[Three-dimensional dynamic MR imaging with a volumetric interpolated breath-hold examination for solitary pulmonary lesions: correlation of contrast enhancement pattern with pathological features]

PURPOSE

To evaluate the clinical feasibility of dynamic MR imaging of solitary pulmonary lesions (SPLs) using a fat-suppressed three-dimensional gradient-echo technique with a volumetric interpolated breath-hold examination (VIBE). Correlation between the enhancement pattern and the histological characteristics of the nodules was also assessed.

MATERIALS AND METHODS

Dynamic 3D-VIBE was performed in 16 patients with pathologically proven SPLs. Each lesion was analyzed for its internal enhancement pattern, dynamic enhancement pattern, and peripheral enhancement (PE).

RESULTS

A heterogeneous pattern of internal enhancement was well correlated with histological observation of necrosis, cystic changes, and variously sized air spaces. The washout pattern was seen in the medullary parts of the nodules with little fibrous stroma. The progressive pattern was seen at foci of collapse in the alveolar structure, central scars, and prominent fibrosis. PE was also seen in 6 malignant lesions (43%), and was well correlated with the medullary growth of adenocarcinoma and marginal fibrosis with lymphocytic infiltration of squamous cell carcinoma. The presence of PE was statistically significantly related with tumor size (p < 0.05).

CONCLUSION

Dynamic 3D-VIBE allows assessment of the histological characteristics of SPLs. It is also thought that this technique may be a promising method for differentiation between benign and malignant lesions.