Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways

BACKGROUND

The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL.

OBJECTIVES

To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL.

METHODS

We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined.

RESULTS

NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages.

CONCLUSIONS

Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.

Improved efficiency in Monte Carlo simulation for passive-scattering proton therapy

The aim of this work was to improve the computational efficiency of Monte Carlo simulations when tracking protons through a proton therapy treatment head. Two proton therapy facilities were considered, the Francis H Burr Proton Therapy Center (FHBPTC) at the Massachusetts General Hospital and the Crocker Lab eye treatment facility used by University of California at San Francisco (UCSFETF). The computational efficiency was evaluated for phase space files scored at the exit of the treatment head to determine optimal parameters to improve efficiency while maintaining accuracy in the dose calculation. For FHBPTC, particles were split by a factor of 8 upstream of the second scatterer and upstream of the aperture. The radius of the region for Russian roulette was set to 2.5 or 1.5 times the radius of the aperture and a secondary particle production cut (PC) of 50 mm was applied. For UCSFETF, particles were split a factor of 16 upstream of a water absorber column and upstream of the aperture. Here, the radius of the region for Russian roulette was set to 4 times the radius of the aperture and a PC of 0.05 mm was applied. In both setups, the cylindrical symmetry of the proton beam was exploited to position the split particles randomly spaced around the beam axis. When simulating a phase space for subsequent water phantom simulations, efficiency gains between a factor of 19.9  ±  0.1 and 52.21  ±  0.04 for the FHTPC setups and 57.3  ±  0.5 for the UCSFETF setups were obtained. For a phase space used as input for simulations in a patient geometry, the gain was a factor of 78.6  ±  7.5. Lateral-dose curves in water were within the accepted clinical tolerance of 2%, with statistical uncertainties of 0.5% for the two facilities. For the patient geometry and by considering the 2% and 2mm criteria, 98.4% of the voxels showed a gamma index lower than unity. An analysis of the dose distribution resulted in systematic deviations below of 0.88% for 20% of the voxels with dose of 20% of the maximum or more.

[Helicobacter pylori infection in children without dyspepsia in Curundu and Parque Lefevre]

A study of seroprevalence of Helicobacter pylori determined by ELISA IgG, was conducted in 83 consecutive healthy children. The majority of the children (55%) had the bacterium. Seropositivity was demonstrated in 55% of the age group 0-5 years old, in 47% of 6-10, and in 67%, of the group 11 to 15. Of the children without sanitary inside their homes 86% were seropositive, versus 47% of the children with sanitary in their homes.

[Clinico-epidemiologic study of microtia]

Microtia is a congenital malformation characterized by total or partial absence of the whole auricle or any of its components, varying from a small auricle to the total absence (anotia). There may be associated atresia of the external auditory meatus. The frequency varies in different parts of the world between 0.4 and 5.5/10,000 newborns. In this paper we report the clinical and epidemiological characterization of this congenital malformation in a sample of 97.759 neonates born at the Ruíz y Páez Hospital in Ciudad Bolivar, Venezuela, between April 1978 and December 1994. A total of 38 patients with microtia were identified. The global frequency was 3.8 per 10,000/newborns. In 47.4% of the patients microtia was an isolated malformation and in 52.6% was associated to other malformations. Sixty three percent of the affected were males. The unilateral form was present in 81.5% of the cases, more frequently on the right side. The annual frequency of the defect was stable over the studied years. The clinical classification of the cases with associated malformations allowed us to establish that 18.4% of the cases correspond to developmental fields defects, associated to preauricular dimples and/or tags, 7.8% were cases of the facio-auriculo-vertebral spectrum and in 15.7% the microtia was part of a monogenic or chromosomal syndrome. In 10.5% it was not possible to define any etiological or pathogenic mechanism. The frequency obtained in this study for microtia shows intermediate values when compared with others reports from Latin America.

[Severe dysplasia in Barrett's esophagus]

Two patients with Barret's esophagus developed severe dysplasia diagnosed during endoscopic surveillance. Both patients underwent esophagectomy. The surgical specimen revealed adenocarcinoma in situ in the first patient and invasive adenocarcinoma to the submucosa in the second one. The life expectancy in these patients is at least 75% at 5 years, much better than the 5% five year survival of the patients diagnosed when they present with dysphagia. The natural history, pathogenesis, diagnosis, treatment and prevention are discussed.

[The diagnostic and therapeutic unity of endoscopic retrograde cholangiopancreatography in patients with a diagnosis of choledocholithiasis and its complications]

Reviewing the records of 60 patients admitted with clinical diagnosis of common duct stone, we demonstrated that the symptoms and the biochemical liver tests were predictive of choledocholithiasis only 50% of the time. The sensitivity for the ultrasound was 42%. The ERCP diagnosed pancreatic or biliary pathology in over 90% of the patients. Through endoscopic sphincterotomy, the ERCP prevented the surgical exploration of the common bile duct in 93% of the patients, and did not aggravate the clinical picture in the group with acute pancreatitis. The sequence of ERCP--laparoscopic cholecystectomy decreased the hospital days and has emerged as the treatment of choice for the patients with cholelithiasis and suspected common duct stone.

[Combined endoscopic percutaneous drainage and endoscopic biliary lithotripsy in the management of acute cholangitis. First experience in Panama]

Two unusual cases of acute cholangitis are presented. One patient had a 3 cm. common duct stone successfully fragmented with an endoscopic mechanical lithotriptor. The other patient had a hemigastrectomy with a Billroth II anastomosis. A combined percutaneous--endoscopic approach was required to perform the sphincterotomy and remove the duct stones. The different treatment alternatives and the literature are discussed.

[Helicobacter pylori and gastroduodenal pathology in the Republic of Panama]

129 patients, Panamanians and North Americans, with chronic dyspepsia, were prospectively studied regarding infection by H. pylori and the type of gastroduodenal pathology diagnosed by endoscopy and histology. The rapid urea split test was compared with the culture. The percentage of patients infected by H. pylori increased with age. Patients under 30, 37%; 31 to 40, 61%; 41 to 76, 75%. H. pylori was found in 70% of the Panamanians and 54% of the americans. H. pylori infected 81%, 75%, 54% and 29% of the patients with duodenal ulcer, chronic gastritis, duodenitis, and patients with normal endoscopy and histology, respectively. The rapid urea split test had a positive predictive value of 98%. The results were discussed and the literature reviewed.