Clinicopathologic implications of CD8+/Foxp3+ ratio and miR-574-3p/PD-L1 axis in spinal chordoma patients

Currently, little is known about the interactions between microRNAs (miRNAs) and the PD-1/PD-L1 signaling pathway in chordoma, and data discussing the role of the immune milieu in chordoma prognosis are limited. We aimed to analyze the relationship between PD-L1, miR-574-3p, microenvironmental tumor-infiltrating lymphocytes (TILs) and clinicopathological features of spinal chordoma patients. PD-L1 expression and TILs (including Foxp3+, CD8+, PD-1+ and PD-L1+) were assessed by immunohistochemistry in tumor specimens of 54 spinal chordoma patients. MiRNAs microarray and bioinformatical analysis were used to identify miRNAs potentially regulating PD-L1 expression, which were further validated by quantitative RT-PCR. miR-574-3p was identified to potentially regulate PD-L1 expression in chordoma, which inversely correlated with PD-L1. Positive PD-L1 expression on tumor cells was associated with advanced stages (P = 0.041) and TILs infiltration (P = 0.005), whereas decreased miR-574-3p level correlated with higher muscle invasion (P = 0.012), more severe tumor necrosis (P = 0.022) and poor patient survival. Importantly, a patient subgroup with PD-L1+/miR-574-3plow chordoma phenotype was significantly associated with worse local recurrence-free survival (LRFS) (P = 0.026). PD-1+ TILs density was associated with surrounding muscle invasion (P = 0.014), and independently portended poor LRFS (P = 0.040), while PD-L1+ TILs showed tendencies of less aggressive clinical outcomes. Multivariate analysis of OS only found CD8+/Foxp3+ ratio to be independent prognostic factor (P = 0.022). These findings may be useful to stratify patients into prognostic groups and provide a rationale for the use of checkpoint blockade therapy, possibly by administering miR-574-3p mimics, in spinal chordoma.

[A clinicopathological and immunohistochemical study of 34 cases of chordoma]

In order to investigate the clinicopathological and immunohistochemical features of chordomas, 34 chordomas, with 5 chondrosarcomas for comparison, were studied by clinicopathological and immunohistochemical methods.

RESULTS

Based on the presence or absence of cartilaginous areas, chordomas are classified into two subtypes: chondroid chordoma (14 cases) and classic chordoma (20 cases). Chondroid chordoma occurred in a younger age group (mean age 40.9 years) than classic chordoma (mean age 51.1 years). 7/14 (50%) of chondroid chordomas occurred in the sacrococcygeal region, 4/ 14 (28.6%) occurred in the spheno-occipital region. Immunohistochemical staining showed that all chordomas were positive for cytokeratin, and 16 (47.1%) chordomas were also positive for EMA. In contrast, 5 chondrosarcomas were immunonegative for both cytokeratin and EMA. Vimentin and S-100 protein were positive in the majority of chordomas (29 & 24 respectively) and in the 5 chondrosarcomas. The present study confirms the dual features of chordoma-epithelial and mesenchymal, and also the utility of immunohistochemical staining in the differential diagnosis of chordoma and chondrosarcoma. The pathologic diagnosis of chondroid chordoma and other issues were also discussed in the study.

Solitary plasmacytoma of the spine: relationship of IGM to tumour progression and recurrence

The authors report a retrospective study of 15 patients with solitary vertebral plasmacytoma. 15 patients were considered in this study on the basis of the following characteristics: 1) histologically confirmed plasmacytoma following surgical removal; 2) existence of a single vertebral lesion, documented by skeletal and MRI scan; 3) no signs, at diagnosis of disseminated disease by blood laboratory test, urine analysis, sternal puncture, iliac bone marrow biopsy, a total-body CT scan. The clinical course of the patients has been analysed on the basis of the following factors: age, sex, length of clinical history before diagnosis, site, presence/absence of the M component. The M component is an electrophoretically homogeneous immunoglobin. The most significant factors for predicting development of multiple myeloma proved to be the presence /absence of the M component at diagnosis and, to a lesser degree, the age of the patient. In the light of other reports too, it would seem that the presence of the M component at diagnosis is a reflection of aggressive biological and clinical tumour behaviour.

Unilateral hyperhidrosis associated with intrathoracic IgD lambda myelomatous tumour

Localized sympathetic over-activity is a rare manifestation of intrathoracic malignancy. We report the case of a 62-year-old woman who presented with a right-sided hyperhidrosis limited to the face, trunk and upper extremities; this revealed a left paraspinal intrathoracic IgD lambda myelomatous tumour. The episodes of sweating were abolished by local radiotherapy, concomitant with the disappearance of the tumour.

[Adult T-cell leukemia with cervical bone tumor showing immunophenotypic change]

A 60-year-old man born in Miyazaki prefecture was admitted to our hospital complaining of skin rash in December 1989. On hematological examinations, leukocyte count was 14,200/microliters with 49% of abnormal lymphocytes showing lobulated nuclei. The surface marker study revealed their phenotype as CD4+8-. Anti human T cell leukemia virus type I (HTLV-I) antibody and monoclonal integration of proviral DNA were positive. From the above results, he was diagnosed as adult T-cell leukemia (ATL). Abnormal lymphocytes gradually decreased without treatment after the first admission. In January, 1990, he began to complain of neck pain. Two months later he was readmitted because of paresis of extremities and disturbance of urination. Vertebral bone mass and a compressed spinal cord in the 4th cervic level were confirmed by MR imaging. He received a resection of tumor and an anterior fusion of vertebrae. The bone tumor was histologically diagnosed as malignant lymphoma, diffuse medium-size cell type and the infiltrating cells had their phenotype as CD4+8+. He was postoperatively treated with combination chemotherapies, but neurological abnormalities did not improve. He died of pneumonia on 35 days after the operation. A postmortem examination revealed extradural tumor formation with ATL cells. This case is considered to be rare in respect of both the disappearance of most peripheral abnormal lymphocytes without any treatments and the cervical bone tumor showing immunophenotypic change.

Mycoplasma pneumoniae as the causative agent for pneumonia in the immunocompromised host

A young man undergoing chemotherapy for Ewing's sarcoma presented with fever, neutropenia, anemia, thrombocytopenia, and a new infiltrate on the chest roentgenogram. Routine cultures and cytopathologic examination of bronchoalveolar lavage fluid provided no evidence for an etiology; however, special cultures of the BAL fluid demonstrated heavy growth of Mycoplasma pneumoniae. We recommend that evaluation of pneumonia in the immuno-compromised host include appropriate cultures of BAL fluid for M pneumoniae, particularly when the patient is 5 to 25 years old, the age of high incidence of mycoplasmal pneumonia.

[A four-year follow-up study of hepatocellular carcinoma with bone metastasis]

A 68-year-old male was admitted to hospital for treatment of a hepatocellular carcinoma with a bone metastasis. By TAE and the administration of PSK, the tumor was necrotized and the AFP level returned to normal range. We presume that this combination therapy of TAE and PSK was able to maintain normal cellular immunity and bring about this good result.

Extranodal non-T-cell lymphoblastic lymphoma in adults. A report of two cases

Typical adult cases of malignant lymphoma, diffuse, lymphoblastic type (MLLB), are of the T-cell immunophenotype and occur as mediastinal masses. The authors report two unusual adult cases with initial extranodal sites of involvement and non-T-cell immunophenotype that were originally misclassified. One patient presented with a right submaxillary salivary gland mass and the other presented with a T7-8 spinal cord compression resulting from a vertebral body tumor. A lymphoblastic leukemic phase developed in both patients after 15 months and 5 months, respectively. The bone marrow blasts of both patients had positive results for cluster designation (CD) 10, CD19, HLA-DR, and terminal deoxynucleotidyl transferase. Because both extranodal sites of presentation and non-T-cell immunophenotype are unusual in adult MLLB, these features may have contributed to the original misclassification of these lesions.

Epithelioid haemangioendothelioma of the bone tissue

An epithelioid haemangioendothelioma arising in a 43-year-old Japanese woman is presented. The patient first complained of severe back pain and neurogenic disturbances due to compression fracture of the spinal bone. Radiographically the tumour masses showed osteolytic lesions without reactive new bone formation. Similar lesions were noted in other bones. Biopsy and surgical specimens showed the features of epithelioid haemangioendothelioma. A lymphocyte associated antigen, HLA-DR which has been regarded as a B lymphocyte marker was detected in the tumour cells. The importance of this finding was emphasized with respect to the identification or classification of vascular tumours.

[IgD-paraproteinemia in lymphoplasmacytoid immunocytoma]

Laminectomy was performed in a 54-year-old patient who had a hemicauda syndrome. An epidural tumour, extending into the spongiosa of the third lumbar vertebra was found. Histologically it was a lymphoplasmacytoid lymphoma. Subsequent haematological investigation revealed a multilocular involvement (stage IV) and paraproteinaemia of the IgD-kappa-type. There was no Bence-Jones protein in the urine. After irradiation of the affected lumbar vertebra the patient was treated with a combination of chlorambucil and prednisone, later on with COP and VMCP regimens. A rapid downhill course set in 16 months after diagnosis and the patient died from intracerebral expansion of the immunocytoma. The clinical diagnosis was confirmed at autopsy. The generalized lymphoplasmacytoid immunocytoma contained evidence of terminal transformation into the polymorph subtype.

Peripheral neuropathy and solitary myeloma: analysis of serum and CSF IgG in two cases

Clinical and laboratory findings of two patients affected by solitary myeloma, IgG3 lambda type, with peripheral neuropathy are reported. In both cases the same IgG isoelectrofocusing pattern was found in cerebrospinal fluid and serum samples. Data are consistent with damage of the blood-brain barrier.

Polyneuropathy, skin hyperpigmentation, edema, and hypertrichosis in localized osteosclerotic myeloma

1 61-year-old man had osteosclerotic myeloma that was localized in the eleventh thoracic vertebral body and associated with sensorimotor polyneuropathy, skin hyperipigmentation, edema, hypertrichosis, gynecomastia, and white nails. Cases of osteosclerotic myeloma with and without polyneuropathy in the literature were reviewed with special reference to accompanying dermatologic and endocrinologic signs and synmptoms. We assume that the polyneuropathy, cutaneous hyperpigmentation, edema, hypertrichosis, gynecomastia, and white nails are causally related to each other and are a remote effect of osteosclerotic myeloma. Quantitative histologic analysis of two sural nerves biopsied within 2 years of each other during the course of the disease indicated that both large and small myelinated fibers degenerated progressively, with relative preservation of unmyelinated fibers.