Peritumoral Lymphocytes Research Articles

B7-H1 Expression Model for Immune Evasion in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma

Human papillomavirus (HPV) is associated with oropharyngeal squamous cell carcinomas. Persistent viral infection is postulated to lead to carcinogenesis, although infection of benign adjacent epithelium is not typically observed. It is known that immune evasive tumor cells can provide an ideal niche for a virus. The B7-H1/PD-1 cosignaling pathway plays an important role in viral immune evasion by rendering CD8+ cytotoxic T cells anergic. We hypothesized that HPV-related oropharyngeal squamous cell carcinomas express B7-H1 as a mechanism for immune evasion. A tissue microarray was utilized, for which HPV E6/E7 mRNA by in situ hybridization was previously performed. Immunohistochemistry was performed to detect B7-H1 and staining was characterized by pattern, distribution, and intensity. B7-H1 was expressed by 84 of the 181 (46.4%) cases. Both tumor cell membranous and cytoplasmic expression were present and cytoplasmic expression was identified in some peritumoral lymphocytes. Expression was analyzed in several different ways and then considered binarily as positive versus negative. Tumors expressing B7-H1 were more likely to be HPV positive (49.2 vs. 34.1 %, p = 0.08). B7-H1 expression showed no correlation with disease recurrence in the entire cohort (OR = 1.09, p = 0.66), HPV positive cohort (OR = 0.80, p = 0.69) or HPV negative cohort (OR = 2.02, p = 0.22). However, B7-H1 expression intensity did correlate with the development of distant metastasis (p = 0.03), and B7-H1 intensity of 3+ (versus all other staining) showed a strong trend towards distant metastasis in the HPV positive (OR = 6.67, p = 0.13) and HPV negative (OR = 9.0, p = 0.13) cohorts. There was no correlation between B7-H1 expression and patient survival for any of the different ways in which staining was characterized, whether binarily, by distribution, intensity, or combined scores. B7-H1 is expressed in the majority of oropharyngeal squamous cell carcinomas with transcriptionally-active HPV. This suggests that B7-H1 expression by tumor cells may play a role in harboring persistent HPV infection.

Diagnostic Biopsy Does Not Commonly Induce Intratumoral CD8 T Cell Infiltration in Merkel Cell Carcinoma

BackgroundMerkel cell carcinoma is a polyomavirus-associated cancer that is strongly linked with T lymphocyte immune suppression in epidemiologic studies. CD8+ T cell infiltration into MCC tumors (intratumoral) has recently been shown to be strongly predictive of improved survival. In contrast, the presence of CD8+ T cells at the border of the tumor (peritumoral) had no independent prognostic value. Spontaneous regression has been reported for MCC approximately one thousand times more often than would be expected given the frequency of this cancer. Many of these events began shortly after biopsy, and in some cases lymphocytic infiltration was described.Methodology/Principal FindingsTo determine whether CD8+ lymphocyte infiltration in MCC tumors is commonly altered by biopsy.33 MCC patients who had microscopic confirmation of MCC on both an initial biopsy and a re-excision specimen were included in this study. Intratumoral and peritumoral CD8 lymphocyte infiltration was quantitated using immunohistochemistry and compared using the paired t-test in biopsy versus re-excision samples. There was a trend toward increased CD8 infiltration after biopsy in a peritumoral (‘stalled’) pattern (p = 0.08), however, biopsy was not associated with a significant increase in CD8 T cells in the clinically more important intratumoral location (p = 0.58).Conclusions/SignificanceThe initial diagnostic biopsy for MCC does not commonly alter intratumoral CD8+ T cell infiltration, suggesting it does not directly induce immunologic recognition of this cancer. Because CD8 infiltration is typically stable after biopsy, this parameter may be useful to assess the efficacy of future immune therapies for this virus-associated, immunogenic, often-lethal cancer.

Abstract 701: TUMOR lymphocyte infiltration, expression of CD4, CD8, FOXP3, CD34 molecules and their relationship with tumor evolution after primary treatment in breast cancer patients

Abstract Considering that, approximately, only half of breast cancer patients respond to present therapies, a better knowledge of breast cancer biology, one of the most common neoplasms in women, will enable to design better therapeutic approaches. It has been proposed that different tumor characteristics like inflammatory infiltrate intensity, number of T regulatory (Tregs) cells and density of tumor vasculature could be useful to anticipate the response to therapy. Our aim was: a) to analyze the lymphocytic infiltrate and the expression of CD4, CD8, CD34 (endothelial marker) and Foxp3 (Treg marker) in primary tumors of breast cancer patients, and b) to relate them with clinical evolution (disease free: DF or relapsed: R) after 5 years from the primary treatment (surgery). There were analyzed archive samples of ductal mammary tumors (n=27), mostly in stages I and II. The expression of CD4 and CD8 in intra- and peri-tumoral lymphocytes was determined by immunohistochemistry (IHC) and confirmed by confocal microcopy; also the expression of Foxp3 in lymphocytes and tumor cells and CD34 in endothelial cells was evaluated by IHC. The lymphocytic infiltrate was assessed in histological sections stained with hematoxylin-eosin. The quantification was done in 20 high magnification fields and a score ranging from 0 (null) to 6 (high) was utilized. In DF patients (n=22) the intratumoral lymphocytic infiltrate (median [range]: 3 [0-6]) was more intense than that of R patients (n=5), (2 [0-2]), (P=0.05). For CD4, CD8, CD34 and Foxp3 molecules no differences between groups of patients were observed, being their expression highly variable: the score for CD34 varied from 1 to 6 and for the other three molecules from 0 to 6, in either group. In conclusion, the presence of an intense intratumoral lymphocytic infiltrate could be a prognostic marker of good response to treatment, at least in the first 5 years after surgery. These results warrant the study of higher number of tumor samples, since its confirmation could give support for its use in the clinical setting. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 701. doi:1538-7445.AM2012-701

Prognostic impact of peritumoral lymphocyte infiltration in soft tissue sarcomas

BackgroundThe purpose of this study was to clarify the prognostic significance of peritumoral lymphocyte infiltration in the capsule of soft tissue sarcomas (STS). Multiple observations in preclinical and clinical studies have shown that the immune system has a role in controlling tumor growth and progression. Prognostic markers in potentially curable STS should guide therapy after surgical resection. The immune status at the time of resection may be important, but the prognostic significance of peritumoral lymphocytes is unknown.MethodsTissue microarrays from 80 patients with STS were constructed from duplicate cores of tissue from the tumor and the peritumoral capsule. Immunohistochemistry was used to evaluate the CD3+, CD4+, CD8+ and CD20+ lymphocytes in the tumor and the peritumoral capsule.ResultsIn univariate analyses, increasing numbers of CD20+ (P = 0.032) peritumoral lymphocytes were associated with a reduced disease free survival (DSS). In multivariate analyses, a high number of CD20+ peritumoral lymphocytes (P = 0.030) in the capsule was an independent negative prognostic factor for DSS. There were no such associations of lymphocyte infiltration in the tumor.ConclusionsA high density of CD20+ peritumoral lymphocytes is an independent negative prognostic indicator for patients with STS. Further research is needed to determine whether CD20 cells in the peritumoral capsule of STS may promote tumor invasion in the surrounding tissue and increase the metastatic potential.

Ovarian Endometrioid Adenocarcinoma

A subset of women with uterine cancer exhibiting defective mismatch repair (MMR) proteins and microsatellite instability (MSI) may have Lynch syndrome, which also confers a risk for colorectal cancer and other cancers in the patient and in her family. Screening algorithms based on clinical and pathologic criteria are effective in determining which patients with uterine cancer are most likely to benefit from definitive genetic testing for Lynch syndrome. Ovarian cancer, particularly endometrioid adenocarcinoma, is also associated with Lynch syndrome, although the risk is much smaller than for uterine cancer. This study evaluated whether the morphologic criteria [tumor-infiltrating lymphocytes (TILs), peritumoral lymphocytes (PTLs), dedifferentiated morphology)] currently used to screen uterine cancer for further Lynch syndrome testing can be applied to ovarian cancer. Among 71 patients with pure ovarian endometrioid adenocarcinoma treated at a single institution, 13% had a tumor with TILs, 3% had PTLs, and none had dedifferentiated morphology. Overall, 10% of tumors had abnormal MMR protein status, defined as complete immunohistochemical loss of expression of MLH1, MSH2, MSH6, and/or PMS2. Each of these tumors with abnormal MMR status demonstrated MSI using a polymerase chain reaction-based assay evaluating 5 mononucleotide repeat markers. No relationship was found between patient age, TILs, PTLs, or a spectrum of other morphologic variables and MMR protein status/MSI. Only 1/7 tumors with abnormal MMR/MSI had TILs/PTLs. Among 14 patients who died, 12 (86%) had normal MMR status. Among 7 patients with tumors with abnormal MMR/MSI, 5 (71%) were alive without disease. Concurrent uterine tumor was present in 5/7 patients whose ovarian tumor had abnormal MMR/MSI. This study suggests that the morphologic criteria used to screen patients with uterine cancer for further Lynch syndrome testing are not applicable in patients with ovarian cancer. Although abnormal MMR/MSI did not carry prognostic value in this study, it did predict the involvement of the uterus by the tumor. Thus, in patients with ovarian endometrioid adenocarcinoma who undergo uterus-sparing surgery, abnormal MMR/MSI should prompt further diagnostic evaluation of the endometrium for tumor.

Lymphocyte-rich Renal Cell Carcinoma

Lynch syndrome (LS) is characterized by familial clustering of early cancer development in various organs. One of the histologic characteristics of carcinomas associated with LS is prominent intratumoral and peritumoral lymphocytes. The relationship between LS and the rare lymphocyte-rich clear cell renal cell carcinoma (CRCC) has been not been studied. We compared lymphocyte-rich CRCC (N=15) with CRCC with no or minimal lymphoid infiltration, occurring in young (<40 y of age) patients (N=15) and in a control group of older (>62 y of age) patients (N=5) with CRCC having conventional histologic features. All cases were analyzed histologically and immunohistochemically using antibodies against the mismatch repair (MMR) proteins MLH1, MSH2, MSH6, and PMS2. The mutational status of the Von Hippel-Lindau (VHL) gene was analyzed successfully in 25 cases. We found no case with complete absence of immunoreactivity for the MMR proteins/ enzymes studied in any of the groups. Hence, none of the RCCs with heavy lymphocytic infiltration displayed complete absence of protein expression of any of the MMR enzymes. We found mutation of the VHL gene in 2 of 8 tumors from group A, in 4 of 12 tumors from group B, and no mutation in the control group C. We conclude that this rare subset of renal neoplasms is not part of the spectrum of tumors seen in LS. The results of the VHL gene analysis are in concordance with published data on sporadic CRCCs.

FOXP3 Can Predict Disease Progression and Risk of Transformation in Uniformly Treated Patients with Mycosis Fungoides

Abstract 5182 Background:Mycosis fungoides (MF) is a heterogeneous lymphoid neoplasm with a variable clinical course. In early stages MF often runs an indolent course. A small but significant part of these patients develop an aggressive course frequently associated with inferior survival. No consistent biological markers are predictive of survival or risk of transformation (RT). Foxp3 belongs to a novel forkhead transcription factor essential for the development and regulation of regulatory T-cells (Treg). Recent studies have shown conflicting results when expression of Foxp3 was analyzed as a prognostic factor in MF. We hypothesized that Foxp3 could be an important marker in predicting for overall survival (OS), progression-free (PFS) survival and RT in MF patients managed by uniform treatment regimens. Methods:42 patients with newly diagnosed MF were retrieved form the record files. All patients were managed and treated at our institute. Complete follow-up and pathological material (paraffin blocks) was available for 35/42 patients. In all 35 cases the diagnostic biopsies were reviewed concurrently by an expert dermatopathologist and hematopathologist and diagnosis fully confirmed. The diagnostic biopsies were immunostained with CD3, CD4, CD7, CD8, CD30 and CD56 specific antibodies. Clonality for TCR gamma was performed for most of the cases in the study (85%). FOXP3 antibody (clone 221D/D3) that recognizes the Foxp3 in the nucleus (but does not cross react with other Foxp proteins) was utilized for studying the Foxp3 expression by the tumor cells and or peritumoral lymphocytes. 20 cases of reactive non-neoplastic dermal lesions including lichen planus, lupus and dermatitis were also immunostained for Foxp3 for comparison. Only high intensity nuclear staining was accepted as positive expression. The Foxp3 staining was further semi quantitatively estimated as no expression (0), 0–10% (1+), 10–50% (2+) and >50% (3+). Both the cell content and immuno-architectureal pattern were determined. Age, sex, clinical presentation, stage of disease was compared to Fox3 expression by chi-square and Fishers’s exact test. The Kaplan-Meyer method and log rank test were used to evaluate survival data. Results:34 of 35 (97%) patients were alive at 8 years. Tumor stage at the time of diagnosis as defined by ISCL-EORTC, 2008 was as follows: stage 1A (57%), 1B (25%), 2A (6%), 2B (6%), 3 (6%). 19/35 (54%) were female and 16/35 (46%) were male. The median age at diagnosis was 44.0 years (range 7–80 years). The median follow-up period was 37 months (range 12– 96 months). Foxp3 expression showed predominantly intraepidermal or basal localization of tumor cells. In most of the cases the epidermotropism and the nuclear atypia was helpful in easily discerning tumor cells from reactive non-neoplastic Tregs. Reactive dermal lesions served as an excellent control in that the distribution of Tregs in these lesions was predominantly dermal and rarely basal. Overall 28/35 (80%) and 7/35 (20%) cases were positive and negative for Foxp3 respectively. There was no significant correlation between disease pattern, clinical presentation, stage, age or sex and marker expression. In the Foxp3 positive patients 17/28(61%) showed disease progression whereas 11/28 (39%) were free of disease at last follow-up (FU period 12–96 months) (p=0.05, Fisher’s exact test). 13/28 (46%) Foxp3+ patients were found to have relapse of disease after initial response compared to only 2/7 (28.5%) patients, who relapsed but lacked Foxp3 expression (p=0.242, Fisher’s exact test). Comparing disease progression and aggressiveness as evidenced by lymph node metastasis and transformation to Sezary syndrome: only Foxp3 positive cases (4 versus 0) had evidence of disease progression (3 lymph node metastasis alone and one Sezary syndrome) thus indicating increased RT. One patient who died of widespread disease showed >30% Foxp3 expression in the neoplastic lymphoid cells. Conclusions:Specific biological markers for outcome and prognosis in MF remain elusive. A regulatory T-cell (Treg) phenotype defines a subset of MF patients who might carry a different prognosis and might require more aggressive and or targeted therapy. More data on Foxp3 expression in cutaneous T-cell lymphomas and its clinical significance is needed. Disclosures:No relevant conflicts of interest to declare.

Is diffuse and peritumoral lymphocyte infiltration in papillary thyroid cancer a marker of good prognosis?

Papillary thyroid carcinoma (PTC) is the most frequently diagnosed endocrine neoplasia, representing 70 to 80% of all diagnosed thyroid cancers. Furthermore, Hashimoto's thyroiditis is a frequent inflammatory thyroid disease and the main cause of hypothyroidism. The relationship between Hashimoto's thyroiditis and PTC remains controversial. Surgery for PTC was performed at our institution on 157 consecutive patients. They were classified by the degree of lymphocyte infiltration (LI). LI was classified as diffuse LI or peritumoral LI (only in or around the tumor), or absent. In addition, age, gender, tumor size, histopathological findings, lymph-node metastasis, extra- thyroidal extension, multifocal tumor, coexistence of LI and clinical outcomes were analyzed. Out of the 141 patients included in the study, 83 (59%) had diffuse LI and 22 (16%) had peritumoral LI. In 36 patients (25%) LI was absent. A comparison of patients in the 3 groups revealed no significant difference in their genders, ages, smoking status, thyroid function, or nodule size at the time of surgery. The characteristics of PTC showed no differences in lymph-node metastasis, tumor invasion into contiguous neck structures, angioinvasion, or PTC subtypes. Tumor-node-metastasis (TNM) classification and classes did not differ among the 3 groups. During the follow-up, 64 out of 141 patients with PTC (55%) had recurrences from 6 to 130 months after the initial treatment. After a mean follow-up period of 8 yr we observed a significantly (p=0.01) high recurrence (66.6%) in the LI absent group with 24 of 36 patients when compared to patients from the diffuse LI group (32 out of 83 patients; 38.5%) and peritumoral LI group (8 out of 22 patients; 25%). Although the role of the inflammatory-immune cells is complex and little understood, we found a more favorable course of PTC in the presence of LI (diffuse or peritumoral); this supports the hypothesis that LI represents a form of immune reaction to control tumor growth and proliferation.

Lynch syndrome-associated breast cancers: clinicopathologic characteristics of a case series from the colon cancer family registry.

The recognition of breast cancer as a spectrum tumor in Lynch syndrome remains controversial. The aim of this study was to explore features of breast cancers arising in Lynch syndrome families. This observational study involved 107 cases of breast cancer identified from the Colorectal Cancer Family Registry (Colon CFR) from 90 families in which (a) both breast and colon cancer co-occurred, (b) families met either modified Amsterdam criteria, or had at least one early-onset (<50 years) colorectal cancer, and (c) breast tissue was available within the biospecimen repository for mismatch repair (MMR) testing. Eligibility criteria for enrollment in the Colon CFR are available online. Breast cancers were reviewed by one pathologist. Tumor sections were stained for MLH1, PMS2, MSH2, and MSH6, and underwent microsatellite instability testing. Breast cancer arose in 35 mutation carriers, and of these, 18 (51%) showed immunohistochemical absence of MMR protein corresponding to the MMR gene mutation segregating the family. MMR-deficient breast cancers were more likely to be poorly differentiated (P = 0.005) with a high mitotic index (P = 0.002), steroid hormone receptor-negative (estrogen receptor, P = 0.031; progesterone receptor, P = 0.022), and to have peritumoral lymphocytes (P = 0.015), confluent necrosis (P = 0.002), and growth in solid sheets (P < 0.001) similar to their colorectal counterparts. No difference in age of onset was noted between the MMR-deficient and MMR-intact groups. MMR deficiency was identified in 51% of breast cancers arising in known mutation carriers. Breast cancer therefore may represent a valid tissue option for the detection of MMR deficiency in which spectrum tumors are lacking.

HLA‐DR expression is associated with better prognosis in sporadic Australian clinicopathological Stage C colorectal cancers

Predicting patient outcome for colorectal carcinoma (CRC) with lymph node but not distant metastases remains challenging. Various prognostic markers have been identified including microsatellite instability (MSI) and possibly expression of the MHC Class II protein, HLA-DR. About 15% of sporadic CRC exhibits MSI associated with methylation of the DNA mismatch repair gene hMLH1 promoter. In addition, a significant proportion of unselected CRC demonstrates expression of HLA-DR. We sought to examine the relationship between HLA-DR expression, MSI status and prognosis in sporadic Australian Clinicopathological (ACP) Stage C CRC. Two hundred seventy consecutive patients with sporadic ACP Stage C CRC were treated at Concord Repatriation General Hospital between 1986 and 1992. None of these patients received adjuvant chemotherapy and all were followed for a minimum of 5 years or until death. DNA was extracted from paraffin sections and MSI status determined by PCR. HLA-DR expression was determined immunohistochemically using an antibody against the HLA-DR alpha chain. MSI status could be assigned in 235 cases: 176 CRCs (74.9%) were microsatellite stable, whereas 23 (9.8%) had high levels of MSI (MSI-H) and 36 (15.3%) had low levels of MSI (MSI-L). HLA-DR expression by CRC cells was seen in 148 (60.1%) cases and correlated with the presence of tumor-infiltrating lymphocytes (p = 0.0005) and peritumoral lymphocytes (p = 0.003), but not other clinicopathological features or MSI status. HLA-DR-positive CRCs were strongly associated with better patient outcome (p < 0.0001).

The effects of systemic and intratumoral interleukin-12 treatment in C6 rat glioma model

Objective: Cytokine based immunotherapy has long been an exciting field for many investigators aiming to provide an effective alternative treatment modality for glioma management. Among these cytokines, interleukin-12 (IL-12) plays a crucial role in mediating inflammatory and antitumoral activity on the host defence. We have investigated the therapeutic role of systemic and local delivery of IL-12 in C6 rat glioma model and compared these two modalities.Methods: The donor C6 glioma cells were injected stereotactically to 32 Wistar rats and right frontal tumor formation was established in all subjects. The rats were evenly divided into four groups as intratumoral (i.t.) control group (Group IA), intraperitoneal (i.p.) control group (Group IB), i.t. treatment group (Group II) and i.p. treatment group (Group III). Magnetic resonance imaging were performed to 12 rats (three from each group) on the seventh post-inoculation day. Recombinant mouse IL-12 (rmIL-12) was administered via i.t. (0.1 μg 5 μl/day/rat) and i.p. (0.1 μg 20 μl/day/rat) routes to treatment groups between days 9 and 11 following tumor inoculation, for 3 consecutive days. The rats which were unresponsive to the external stimuli, unable to feed themselves or having severe neurological impairment were decapitated and the specimens were histopathologically examined.Results: The subjects of Group III (i.p.) showed a statistically significant prolongation in survival time (mean=39 days) when compared to the control group (mean=31.7 days) (p=0.035) and Group II (i.t.) (mean=24.5 days) (p=0.005). Histopathologic examination of Group III revealed markedly increased intratumoral and peritumoral lymphocyte infiltration compared with the other groups.Conclusion: This study demonstrated that systemic administration of IL-12 in C6 glioma model in rats prolongs the survival, probably by stimulating the cellular immunity leading to lymphocytic infiltration.

Routinely assessed morphological features correlate with microsatellite instability status in endometrial cancer

Microsatellite instability (MSI) has been shown to be important in the molecular pathogenesis of both sporadic and inherited endometrial carcinomas of endometrioid type. It is likely prognostically significant as well. The aim of this study was to determine whether MSI phenotype in endometrial carcinoma was associated with specific morphologic patterns and therefore predictable by tumor morphology. The study subjects consisted of 102 patients with nearly equal representation of MSI high (MSI-H; n = 52) and non-MSI-H (n = 50) endometrial tumors. Microsatellite instability was determined by the standard polymerase chain reaction method using the National Cancer Institute-recommended set of 5 markers. The MSI-H and non-MSI-H groups were matched for patient age, race, histologic type (all endometrioid), International Federation of Gynecology and Obstetrics grade, and disease stage. Assessed morphological features included host inflammatory response (tumor infiltrating lymphocytes [TILs], peritumoral lymphocytes, peritumoral lymphoid follicles, and neutrophilic infiltration), tumor characteristics (cytologic grade, growth pattern, tumor heterogeneity, invasion pattern, metaplastic changes, necrosis, and lymphovascular invasion), and background endometrium (hyperplasia, atrophy, and polyp). Of all the features examined, TIL counts and peritumoral lymphocytes correlated significantly with MSI-H status. Their statistical relationship was strengthened in the presence of a nonpapillary growth pattern and endometrial hyperplasia. On multivariate analysis, TIL counts and peritumoral lymphocytes remained independent predictors for MSI-H status. At a cutoff point of 40 TILs/10 high power fields, TIL counts had a sensitivity of 85% in predicting MSI status in endometrioid endometrial carcinoma, with a specificity of 46%. This specificity increased as higher cutoff points were selected, but sensitivity decreased. Given that analogous features have been encountered in MSI-H colorectal cancers, our findings suggest a similar relationship between tumor phenotype and DNA mismatch repair abnormalities in both endometrial and colorectal tumors. Therefore, morphological patterns encountered in endometrial carcinoma may prove useful in screening tumors under consideration for MSI testing and identifying appropriate patients for referral to a genetic counseling service.

A comparative analysis of angiogenesis between male and female breast cancers

21101 Background: Tumor angiogenesis and vascularization are essential for the growth and metastasis of tumors. VEGF-C expression and peritumoral lymphocyte density (PLD) are markers of angiogenesis. They have been correlated with poor prognosis in female breast cancer (FBC). The purpose of this study is to characterize VEGF-C expression and PLD in MBC and correlate with FBC specimens. Method: We reviewed records of patients diagnosed with MBC and FBC at the Cincinnati VAMC, from 1989 to 2006. Pathology slides were retrieved. We used VEGF-C (Host Rabbit, PAD: Z-CVC7) . Imunohistochemical stains of VEGF-C were given scores of 0 to 3+ based on nuclear stains. PLD was analyzed based on the number of lymphocyte cells surrounding the tumor; score of 0 to 3+. Slides were reviewed independently by two pathologists. Results: We found nine MBC cases and selected 9 FBC cases. Mean age was 72 in the male patients and 62 in the females. Stages of disease were distributed as follows in MBC versus FBC, 11% versus 22% stage 0, 23% versus 23% stage I, 44% versus 44% stage II, and 22% versus 11% stage IV. Ductal carcinoma was the predominant histology in 88% of FBC and 88% MBC. Other histological types included papillary (1 MBC) and lobular (1 FBC). Among the invasive MBC tumors , 75 % were ER+/PR +, 13% ER+/PR-, and 12% ER -/PR- , compared to 72 % ER+/PR+, 14% ER+/PR-, and 14% ER-/PR- in FBC. Eight out of the 9 MBC cases (89%) stained positive for VEGF-C expression, compared to one FBC case (11%). The 1 male breast intraductal carcinoma was positive for VEGF-C expression, compared to none of the two intraductal FBC. PLD was more intense in male than female tumors : score 0 or 1+: 44% in MBC versus 67% in FBC , score 2+: 22% in MBC Versus 22% in FBC, and score 3+: 22% in MBC versus 11% in FBC. VEGF-C expression did not seem to correlate with ER/PR status. The median survival for patients with MBC was 4.5 years and for patients with FBC 6.9 years. Conclusion: VEGF-C expression and PLD were more pronounced in MBC versus FBC. This finding may correlate with more aggressive behavior of breast tumor cells in male patients, more intense angiogenic reaction and lower median survival. Further studies are warranted to further elucidate the role of angiogenesis in male breast cancer and explore potential antiangiogenic therapeutic modalities. No significant financial relationships to disclose.

Role of APAF‐1, E‐cadherin and peritumoural lymphocytic infiltration in tumour budding in colorectal cancer

Tumour budding or dedifferentiation at the invasive margin of colorectal cancer (CRC) is an important prognostic marker and linked mechanistically to dysregulation of Wnt pathway signalling. Since budding is observed in only 40% of CRCs, we hypothesized that Wnt pathway dysregulation may be a necessary but insufficient explanation for budding and that buds may be destroyed selectively by tumour immune mechanisms. Twenty potential markers of tumour budding were evaluated in tissue microarrays (TMAs) obtained from the main tumour body of 1164 DNA mismatch repair-proficient CRCs and the findings were correlated with tumour budding, lymphocytic infiltration and survival. Loss of expression of E-cadherin and APAF-1 were independent predictors of budding (sensitivity 70.3% and specificity 48.2% when one or the other was lost). Peritumoral lymphocytes (PTLs) were observed more frequently in CRCs with loss of either E-cadherin or APAF-1 that were budding-negative. PTLs and tumour-infiltrating lymphocytes (TILs) were strongly correlated. The absence of TILs increased the adverse prognostic impact of E-cadherin and APAF-1 loss. Co-occurrence of E-cadherin loss, APAF-1 loss and low TIL counts in CRCs was an independent prognostic factor. The findings were verified in whole tissue sections from 88 CRCs with known KRAS mutation status (which was not associated with budding). Loss of E-cadherin and APAF-1 within the main body of CRCs are independent predictors of tumour budding. The prognostic benefit of lymphocytic infiltration may be explained by the immune destruction of budding cells.

Tumor Signaling to the Bone Marrow Changes the Phenotype of Monocytes and Pulmonary Macrophages during Urethane-Induced Primary Lung Tumorigenesis in A/J Mice

Little is known about how the composition of stromal cells within the lung cancer microenvironment varies during tumor progression. We examined by immunohistochemistry each of six different stromal cell populations during the development of chemically induced primary lung cancer in mice. Blood vessels were seen even in microscopic lesions, and their numbers increased with tumor size. Neutrophils infiltrated the alveoli of tumor-bearing lungs and within the periphery of macroscopic adenomas and adenocarcinomas. The numbers of peritumoral lymphocytes and macrophages increased during oncogeny, but quantitative changes in mast cells and fibroblasts were not evident. Because macrophage depletion reduces tumor growth and these cells are thus important to tumorigenesis, we also investigated their phenotype. Pulmonary macrophages expressed arginase I (subtype M2) but not inducible nitric-oxide synthase in lungs with premalignant lesions, whereas macrophages in carcinoma-bearing lungs expressed inducible nitric-oxide synthase (subtype M1) but not arginase I. Local pulmonary stimuli did not seem responsible for this shift in macrophage activation state because monocytes still residing within the bone marrow adopted these expression patterns before entering the circulation, presumably in response to tumor-derived signals. These biochemical markers of macrophage activation states would have diagnostic and/or therapeutic value if analogous systemic shifts occur in humans.

Low-dose Interleukin-2 Administered Pre-operatively to Patients with Gastric Cancer Activates Peripheral and Peritumoral Lymphocytes But Does Not Affect Prognosis

There is evidence that cancer is immunogenic under certain situations. IL-2 is described to stimulate an effective antitumor immune response in vitro and in vivo. The ability of cancer patients to undergo surgical resection is still the most important prognostic factor for many solid tumors, including gastric adenocarcinoma. The host immune system may be further compromised by surgical procedures leading to a generalized state of immunodepression in the post-operative period. The aim of this randomized case-control study is to evaluate the effects of pre-operative low-dose IL-2 treatment on patients with gastric adenocarcinoma who undergo surgery. Sixty-eight patients with gastric adenocarcinoma were enrolled in the study and randomized in two groups: 36 patients were pre-treated with IL-2 and 32 underwent surgery without any treatment. Total peripheral WBC, neutrophils, CD3(+) T, CD4(+) T, CD8(+) T and NK cells were obtained before and after surgery, at different times. Peritumoral infiltration was analyzed on all surgical specimens. Overall survival and relapse-free survival were studied with a median follow-up of 51 months. Low-dose IL-2 treatment resulted in an increase peritumoral lymphocytic and eosinophilic infiltrations and in a minor decrease in CD3(+) T and CD4(+) T cells after surgery (P < 0.05). A stepwise multivariate analysis revealed that overall survival and relapse-free survival were affected only by stage of tumor and age of patients. According to our data low-doses of IL-2 administered pre-operatively to patients with gastric cancer activate peripheral and peri-tumoral lymphocytes but did not affect prognosis.

Immunohistochemical Expression of MYH Protein Can Be Used to Identify Patients With MYH-Associated Polyposis

MYH-associated polyposis is a recently described, autosomal-recessive disease characterized by multiple colorectal adenomas and cancer. There are only few immunohistochemical studies of the MYH protein. We investigated the expression pattern of the MYH protein to evaluate whether a immunohistochemical approach could be used in clinical practice to screen patients for germline mutations in the MYH gene. The expression of MYH, MSH2, MLH1, and MSH6 proteins was studied by immunohistochemistry in 20 samples (colorectal adenomas or cancer) from 18 patients with biallelic MYH mutation, in 11 samples from patients with germline adenomatous polyposis coli (APC) mutations, in 20 samples from patients with sporadic colorectal cancers, and in 10 samples from patients with normal colonic mucosa without malignancies. In all cases the mismatch repair proteins were expressed normally. Nuclear and cytoplasmic immunoreactivity for the MYH protein were observed in normal colorectal mucosa, in sporadic colorectal carcinomas, and in adenomas and carcinomas from patients carrying APC germline mutations. Adenomas and carcinomas from patients with MYH biallelic mutation showed a different pattern of expression: a strong granular cytoplasmic staining was observed without any nuclear expression. The same immunophenotype was observed in the surrounding normal mucosa. Patients with biallelic MYH mutations showed disappearance of staining from the nucleus, and segregation of immunoreactivity in the cytoplasm, both in neoplastic and surrounding healthy mucosa. Because this pattern of expression seems to be specific for biallelic mutations, it follows that immunohistochemistry might be used in clinical practice to screen patients at risk for MYH-associated polyposis.

Influence of clinical and pathomorphological parameters on prognosis in colon carcinoma and rectal carcinoma

To investigate the effects of clinical and pathomorphological parameters on the prognosis of colon carcinoma and rectal carcinoma. Univariate and multivariate COX proportional hazard models were used to study the effects of the clinical and pathomorphological factors on the prognosis in 101 cases of colon carcinoma, 219 of rectal carcinoma and 137 of rectal carcinoma under curative resections. By using univariate analysis, we identified that lymph node metastasis and distant metastasis were the common prognostic factors for both colon carcinoma and rectal carcinoma. Smoking, deep infiltration, chemotherapy and serum albumin concentration were the uncertain prognostic factors for colon carcinoma. Signet-ring cell carcinoma, larger tumor size (>6 cm), deep infiltration, lack of radical surgery, and advanced TNM stage were the exclusive adverse prognostic factors for rectal carcinoma. Further studies showed that the adverse prognostic factors for the rectal carcinoma under curative resection included deep infiltration, lymph node metastasis, vessel invasion, less of peritumoral lymphocyte infiltration, lack of Crohn's like reactivity, high level of tumor budding, advanced TNM stage and positive urine glucose. By using multivariate analysis based on a COX proportional hazard model, it was identified that smoking, lymph node metastasis and serum albumin concentration were independent prognostic factors for colon carcinoma; advanced TNM stage, distant metastasis and palliative surgery for rectal carcinoma; and vessel invasion, lymph node metastasis and urine glucose for rectal carcinoma under curative resections. The various clinical and pathomorphological parameters show different prognostic value for colon carcinoma, rectal carcinoma and rectal carcinoma under curative resections.

The correlation of angiogenesis with metastasis in primary cutaneous melanoma: a comparative analysis of microvessel density, expression of vascular endothelial growth factor and basic fibroblastic growth factor

To establish whether there is a correlation between angiogenesis and metastasis in primary cutaneous melanoma (PCMM). We studied the microvessel density and the expression of vascular endothelial growth factor (VEGF) and basic fibroblastic growth factor (bFGF) in 22 cases of PCMM with metastasis at presentation (metastatic group) and 28 cases of PCMM without metastasis for 24 months or more (non-metastatic group). Microvessels were stained with CD31/PECAM-1 antibody and counted. We assessed the proportion of VEGF expression in tumour cells, lymphocytes infiltrating the tumour (TIL) and lymphocytes at the periphery of the tumour, as well as the proportion of bFGF expression in tumour cell cytoplasms, nuclei and intra- and peritumoral vessels. An increased microvessel density was detected in the metastatic group (15-33 [24.09 +/- 5.55] versus 2-24 [12.96 +/- 6.02]). Moreover, enhanced expression of VEGF in tumour cells and peritumoral lymphocytes (Chi-square p = 0.038 and p = 0.018) and bFGF in peritumoral vessels (chi(2) p = 0.013) correlated with the simultaneous presence of melanoma metastasis in PCMM. Furthermore, microvessel density was correlated with the expression of bFGF in peritumoral vessels (rs = 0.53, p = 0.049) and VEGF in tumour cells (rs = 0.37, p = 0.019). Microvessel density as well as the expression of both VEGF and bFGF might be informative concerning the progression of melanoma.

Germline polymorphisms of Bat26 and its significance in gastric cancer microsatellite instability

To detect the germline polymorphic variations of Bat26 in Chinese and its significance in microsatellite instability (MSI) study of gastric cancers. Bat26 was analyzed by PCR-based denatured polyacrymide gel electrophoresis-silver stain method in peripheral blood from 389 healthy people and 34 gastric cancers with matched normal mucosa. Eleven other microsatellite loci were also detected for gastric cancers. (1) No Bat26 variations were identified in 423 genomic DNA from peripheral blood or normal mucosa by polyacrymide gel electrophoresis. (2) Two MSI-H cancers, oth Bat26+, were detected in 34 cases of gastric cancer. The alterations of Bat26 and MSI-H status were identical (P<0.05). (3) Compared with those of RER-cancers, MSI-H (RER+)cancers showed more obvious infiltration of intraepithelial lymphocytes and peri-tumoral lymphocytes, and more pushing borders (P<0.05). (1) The germline polymorphisms of Bat26 in Chinese people are quasimonomorphic. Thus, no matched genomic DNA is needed while Bat26 was selected for tumor MSI analysis. (2) Bat26 is an independent indicator of MSI-H gastric cancers with distinct clinicopathological features.