FUS-CREM-rearranged malignant epithelioid neoplasm mimicking neuroendocrine neoplasm of unknown primary

A 76-year-old women presented with abdominal pain. Diagnostic investigations suggested peritoneal carcinomatosis. Histological examination of laparoscopic biopsies showed large epithelioid cells forming sheets intermingled with some lymphocytes. There was no clearly distinguishable stroma. Immunohistochemistry showed diffuse and strong expression of cytokeratin AE1/AE3, synaptophysin and chromogranin-A.

Primary antibiotic resistance of Helicobacter pylori isolates is twofold more frequent in HIV-positive than HIV-negative individuals: A descriptive observational study

The antimicrobial susceptibility of Helicobacter pylori strains isolated from HIV-positive individuals is not well characterized. This study aimed to measure the prevalence and long-term trends associated with primary H. pylori antibiotic resistance, evaluate correlations with antibiotic consumption, and compare predictors for H. pylori antibiotic resistance between HIV-positive and HIV-negative individuals. In this longitudinal registry study, we evaluated consecutive adults with and without HIV infection, naïve to H. pylori treatment, who underwent upper gastrointestinal endoscopy and had a positive H. pylori culture, with susceptibility testing available, between 2004 and 2015. Outpatient antibiotic consumption data were based on nationwide aggregated numbers. H. pylori was isolated from gastric biopsies of 3008/8321 patients, 181/477 (37.9%) were HIV-positive and 2827/7844 (36.0%) HIV-negative. Overall cohort mean prevalence of H. pylori primary antibiotic resistance was 11.1% for clarithromycin, 17.8% levofloxacin, and 39.4% metronidazole. The prevalence of H. pylori primary resistance was significantly higher for these three drugs in HIV-positive individuals across the study period. Linear regression showed that the prevalence of clarithromycin and levofloxacin resistance correlated with the country aggregate daily dose consumption of macrolides and quinolones, respectively. Multivariable regression analysis showed that HIV infection is a strong independent risk factor for multiple H. pylori antibiotic resistance. In summary, HIV infection is a risk factor for carrying multi-resistant H. pylori strains and this is correlated with antibiotic consumption. Empirical therapies should be avoided in HIV-positive individuals. These data highlight the need to implement ongoing monitoring of H. pylori antimicrobial susceptibility among HIV-positive individuals. The study is registered at ISRCTN registry, number 13466428: https://www.isrctn.com/ISRCTN13466428.

Pneumocystis Infection in Two Patients Treated with Both Immune Checkpoint Inhibitor and Corticoids

The introduction of immune checkpoint inhibitor (ICI) targeting cytotoxic T-lymphocyte-associated antigen-4 and programmed cell death receptor 1 has dramatically improved clinical outcome for cancer patients. Nevertheless, this treatment can be associated with immune-related adverse events (irAEs) which sometimes need management with prolonged immune suppression. In order to analyze the risk of Pneumocystis jiroveci pneumonia (PJP) in this population, all PJP cases at our oncological hospital between 2004 and 2019 were searched. Only two cases were found in patients treated with ICI (480 patients received ICI during that period). The first was treated with both ipilimumab and nivolumab for metastatic melanoma and required long-term corticosteroids plus infliximab for immune-related colitis. The second received both pembrolizumab and brentuximab for Hodgkin's lymphoma and received corticosteroids for macrophage-activating syndrome. These two cases illustrate that PJP is rare but might be severe in the ICI population and should be differentiated from tumor progression or irAE.

Inflammatory hepatocellular adenoma, focal nodular hyperplasia and hepatic granulomas in one single patient : possible physiopathologic explanations

We report the case of a hepatocellular adenoma associated with focal nodular hyperplasia and hepatic granulomas in a 30-yearsold woman. This association has rarely been described before but might be explained by underlying common pathophysiologic mechanisms. In this manuscript possible links between the three entities are discussed.

Tumor Banks: A Quality Control Scheme Proposal

Introduction: Tumor banks make a considerable contribution to translational research. Using emerging molecular tests on frozen material facilitates the development of new diagnostic and therapeutic strategies, especially in rare cases. However, standard quality control schemes are lacking in the current literature.

Methods: In 2017, we have conducted a robust quality control test on 100 of 15,000 fresh frozen samples collected between 2000 and 2013 at the Jules Bordet Tumor Bank (Brussels). RNA and DNA extraction was done. The quality of RNA, DNA and proteins were evaluated, respectively by measuring RNA Integrity Number (RIN), by checking Electrophoretic Integrity (EI) and by performing Immunohistochemistry staining (IHC). A score, ranging from poor (1) to excellent (4), was attributed based on technical analysis.

Results: RNA purity was scored 4 in 97% of the cases, 3 in 2%, and 2 in 1%. RIN scores were similarly 4 in 89%, 3 in 10%, and 2 in 1% of the cases. DNA purity was scored 4 in 94% and 3 in 6%, EI was scored 4 in 100% of the cases. Despite morphology loss after freezing, HER2, ER, and Ki67 IHC stainings yielded a score of 4 in the majority of samples. Furthermore, participating in the ISBER Proficiency Testing helped us validate our techniques and the technician's work. Seven processing schemes were carried out, the scores obtained were very satisfactory (20/27) or satisfactory (7/27).

Conclusion: Tumor Banks can be precious for translational research. Nevertheless, firm quality controls should be applied to ensure high quality material delivery. Only then can biobanks contribute to diagnostics, biomarkers discovery and reliable molecular test development.

A rare case of hematemesis following gastro-duodenal strongyloides infection

We report the case of a 30-year old Black African man with a two-year history of nausea, abdominal discomfort and pruritus due to infection with Strongyloides stercoralis, which was successfully treated, but then complicated by the development of a bleeding pseudo-tumor in the duodenum. A review of the literature was performed.

Comparison of demographic characteristics and upper gastrointestinal endoscopy findings in HIV-positive, antiretroviral-treated patients with and without Helicobacter pylori coinfection

OBJECTIVES

We evaluated demographic characteristics in HIV-positive patients receiving highly active antiretroviral therapy (HAART) who had upper gastrointestinal (UGI) symptoms requiring UGI endoscopy and compared the findings in patients with and without H. Pylori coinfection.

METHODS

We prospectively observed all HIV-infected patients treated with antiretroviral therapy who underwent UGI endoscopy for the first time and were tested for H. pylori from January 2004 to December 2008. Data collected included the following: demographics (age, gender, ethnicity, body mass index [BMI], tobacco use, alcohol intake, and HIV risk behavior); comorbidity (viral hepatitis B or C, any organ dysfunction, or opportunistic disease); medication, including antibiotics, H2 blockers, proton pump inhibitors, and NSAIDs; CD4 cell counts, viral load; symptoms; and endoscopic and histologic diagnoses (H. pylori determined by Giemsa staining). Patients were compared according to H. pylori status (presence vs absence).

RESULTS

One hundred and forty-five patients were evaluated. Compared to patients without H. pylori infection (n = 97), those with H. pylori infection (n = 48) had a significantly higher CD4 cell count (p = .008), were more likely to be heterosexual (p = .047), had a higher BMI (p = .027), had a greater incidence of duodenal ulcers (p = .005), had lower viral loads (p < .01), were less likely to have received macrolide antibiotics in the last 3 months (p = .00), and had less comorbidity (p = .03). They were also more frequently of Black African than Caucasians. In multivariate analysis, being heterosexual and having a low viral load were independently associated with an increased risk of having H. Pylori coinfection.

CONCLUSION

In the antiretroviral therapy era, HIV-H. pylori coinfection is associated with a greater incidence of duodenal ulcers and higher CD4 counts, higher BMI, less comorbidity, and less frequent use of macrolides.

Polysomy 17 in HER-2/neu Status Elaboration in Breast Cancer: Effect on Daily Practice

PURPOSE

To assess the effect of chromosome 17 copy number on HER-2/neu status determination in breast cancers.

EXPERIMENTAL DESIGN

HER-2/neu gene copy and chromosome 17 centromere numbers were evaluated on 893 breast carcinomas using double color fluorescence in situ hybridization (FISH). The net and chromosome 17 corrected (ratio) HER-2/neu copy numbers were compared and related to immunohistochemistry done according to the Food and Drug Administration (FDA)-approved scoring system (0, 1+, 2+, and 3+) as a first screening step in 584 cases.

RESULTS

When a ratio > or = 2 was considered as criterion for FISH positivity, 49.3% (440 of 893) of cases showed amplification versus 56.2% (502 of 893) by using a net HER-2/neu gene copy number >4 as a alternative criterion; 14.8% (67 of 453) of cases having a ratio <2 had a net HER-2/neu gene copy number >4 and 1.1% (5 of 440) with a ratio > or = 2 had a net HER-2/neu gene copy number <4. Among discordant cases, 88.8% (64 of 72) were polysomic (>2.25 chromosomes 17/cell) and among polysomic cases, 12.8% (40 of 312) of the low polysomic (2.26-3.75 chromosomes 17/cell) and 36.9% (24 of 65) of the highly polysomic (>3.75 chromosomes 17/cell) cases showed discordance. In cases with a ratio <2, polysomy 17 incidences were 85.7% (6 of 7) in IHC 3+, 42.4% (79 of 186) in IHC 2+, 33.3% (15 of 45) in IHC 1+, and 29.1% (16 of 55) in IHC 0.

CONCLUSION

A net increase in HER-2/neu gene copy number consecutive to polysomy 17 in the absence of specific gene amplification might lead to a strong protein overexpression in a small subset of breast carcinomas. HER-2/neu status determination by FISH is dependent on the criterion considered for positivity in clinical practice.