Histopathology of Synovial Cysts of the Spine

Abstract

Aims

Cystic lesions derived from the synovial and ligamentous structures of the spine have varied histologic appearances. Not uncommonly, there is discrepancy between the clinico-radiologic diagnosis and histology. Therefore, we sought to characterize the histologic features of tissue submitted as "synovial cysts" of the spine.

Methods

Resected specimens of the spine labeled "synovial cysts" and "lumbar cysts" were histologically evaluated and classified based on histopathologic features.

Results

75 histologic samples of spinal cysts were identified. 31 were classified as synovial cysts (definite synovial lining), 28 showed pseudocystic degeneration of the ligamentum flavum, 7 showed pseudocyst formation without evidence of synovial lining or degeneration of the ligamentum flavum, 8 showed cyst contents only or no histologic evidence of cyst wall for evaluation. Twenty-five cases (33%), especially those showing pseudocystic degeneration of the ligamentum flavum were associated with very characteristic tumor calcinosis-like calcium deposition with surrounding foreign-body giant cell reaction.

Conclusion

Histology of "synovial cysts" of the spine shows varied types of cysts; a large proportion are not synovial lined cysts but rather show pseudocystic degenerative changes of the ligamentum flavum often associated with very characteristic finely granular calcifications and foreign body giant cell reaction. This may have implications, not only in understanding the pathogenesis of these lesions, but also in their varied response to non-surgical interventions.

This article is protected by copyright. All rights reserved.

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Comparison of EBV-positive Mucocutaneous Ulcer (EBVMCU) Associated with Treated Lymphoma or Methotrexate in Japan

Abstract

Aims

The present study compared treated lymphoma-associated EBV-positive mucocutaneous ulcer (EBVMCU) and methotrexate (MTX)-associated EBVMCU.

Methods and results

Of a series of 15 Japanese patients (11 women, 4 men; median age 74 years, range 35–84 years). 7 received MTX for autoimmune disease and 8 developed EBVMCU after treatment of malignant lymphoma (diffuse large B-cell lymphoma [n=4] without EBV association, adult T-cell leukaemia/lymphoma [n=2], angioimmunoblastic T-cell lymphoma [n=1], and follicular lymphoma [n=1]). Ulcers were observed in the oral cavity (n=11), GI tract (n=2), and skin (n=2). All were histologically characterized by a mixture of EBV-positive large B-cell proliferation and Hodgkin-Reed Sternberg-like cells on a polymorphous background. A total of 46% (6/13) had monoclonal IgH gene rearrangement, but none had clonal T-cell receptor gene rearrangement. Spontaneous regression occurred in 13/15 cases (87%); the other 2 cases (13%) achieved complete remission after treatment. In two patients in the treated lymphoma-associated subgroup, one developed multiple new ulcerative lesions on previously unaffected skin and the other had a relapse of EBVMCU in the oral cavity. No significant clinicopathological differences were found between the subgroups. Notably, none of the patients died from EBVMCU. However, the treated lymphoma-associated subgroup had lower overall survival (P=0.004) and a shorter follow-up period (P=0.003) than the MTX-associated subgroup due to death by non-associated causes.

Conclusions

Treated lymphoma-associated EBVMCU, an indolent and self-limited condition, must be recognized to avoid misdiagnosing it as a relapse of malignant lymphoma during treatment.

This article is protected by copyright. All rights reserved.

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Blueprint for the House Dust Mite

Int Arch Allergy Immunol

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Performance of Harmonic devices in surgical oncology: an umbrella review of the evidence

Abstract

Background

We performed an umbrella review of systematic reviews summarizing the evidence on the Harmonic scalpel (HS) compared with conventional techniques in surgical oncology (including lymph node dissection).

Methods

We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from inception to end of March of 2017 for meta-analyses or systematic reviews of randomized trials comparing HS to conventional techniques in surgical oncology. We assessed the quality of included systematic reviews with AMSTAR (A MeaSurement Tool to Assess systematic Reviews) and assessed the certainty in evidence for each pooled outcome using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).

Results

We identified ten systematic reviews on breast cancer (n = 3), gastric cancers (n = 3), oral, head, and neck cancers (n = 1), and colon cancers (n = 3). Most reviews received a higher rating using AMSTAR. For operative time, systematic reviews reported a reduction of 25 to 29 min for HS compared with conventional methods across oncology types, with the exception of breast cancer where little differences were observed (very low to moderate quality of evidence (GRADE)). For blood loss and drainage volume, the majority of reviews reported statistically significant reductions with HS, and reductions ranged from 42 to 141 mL, and from 42 to 292 mL, respectively (very low to moderate quality of evidence). Hospitalization days were reported to decrease with use of HS by 0.2 to 3.2 days; however, reductions were only statistically significant for half of the included reviews (low to moderate quality of evidence). Regarding perioperative complications, two of six reviews reported a significantly reduced risk with HS use (breast cancer surgery) (moderate to high quality evidence)).

Conclusion

Across surgical oncology types, the majority of included systematic reviews showed a statistically significant or numerical improvement in surgical outcomes with use of the HS compared with conventional methods. Well-designed randomized studies with large sample sizes will help to provide more precise estimates and reduce the risk of heterogeneity.

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Cancer statistics, 2018

Abstract

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2014, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2015, were collected by the National Center for Health Statistics. In 2018, 1,735,350 new cancer cases and 609,640 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2005-2014) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2006-2015) declined by about 1.5% annually in both men and women. The combined cancer death rate dropped continuously from 1991 to 2015 by a total of 26%, translating to approximately 2,378,600 fewer cancer deaths than would have been expected if death rates had remained at their peak. Of the 10 leading causes of death, only cancer declined from 2014 to 2015. In 2015, the cancer death rate was 14% higher in non-Hispanic blacks (NHBs) than non-Hispanic whites (NHWs) overall (death rate ratio [DRR], 1.14; 95% confidence interval [95% CI], 1.13-1.15), but the racial disparity was much larger for individuals aged <65 years (DRR, 1.31; 95% CI, 1.29-1.32) compared with those aged ≥65 years (DRR, 1.07; 95% CI, 1.06-1.09) and varied substantially by state. For example, the cancer death rate was lower in NHBs than NHWs in Massachusetts for all ages and in New York for individuals aged ≥65 years, whereas for those aged <65 years, it was 3 times higher in NHBs in the District of Columbia (DRR, 2.89; 95% CI, 2.16-3.91) and about 50% higher in Wisconsin (DRR, 1.78; 95% CI, 1.56-2.02), Kansas (DRR, 1.51; 95% CI, 1.25-1.81), Louisiana (DRR, 1.49; 95% CI, 1.38-1.60), Illinois (DRR, 1.48; 95% CI, 1.39-1.57), and California (DRR, 1.45; 95% CI, 1.38-1.54). Larger racial inequalities in young and middle-aged adults probably partly reflect less access to high-quality health care. CA Cancer J Clin 2018. © 2018 American Cancer Society.

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Notch1 signaling in melanoma cells promoted tumor-induced immunosuppression via upregulation of TGF-β1

Abstract

Background

The receptors of Notch family play an important role in controlling the development, differentiation, and function of multiple cell types. The aim of this study is to investigate the role of Notch1 signaling upon immune suppression induced by melanoma cells.

Methods

Melanoma cell line B16 cells were transfected by lentivirus containing mouse Notch1 gene or Notch1 shRNA to generate B16 cell line that highly or lowly expressed Notch1. Notch1 in anti-tumor immune response was comprehensively appraised in murine B16 melanoma tumor model in immunocompetent and immunodeficient mice. The ratios of CD3⁺CD8⁺ cytotoxic T cells, CD49b⁺NK cells, CD4⁺CD25⁺FoxP3⁺ Tregs and Gr1⁺CD11b⁺ MDSCs in tumor-DLN or spleen were examined by flow cytometry. After the co-culture of B16 cells and CD8⁺ T cells, the effects of Notch1 on the proliferation and activation of T cells were assessed by CCK8 assay, CFSE dilution and Chromium-release test. The mRNA expression and supernatant secretion of immunosuppressive cytokines, TGF-β1, VEGF, IL-10 and IFN-γ were measured by RT-PCR and ELISA, respectively.

Results

Downregulation or overexpression of Notch1 in B16 melanoma cells inhibited or promoted tumor growth in immunocompetent mice, respectively. Notch1 expression in B16 melanoma cells inhibited the infiltration of CD8+ cytotoxic T lymphocytes and NK cells and reduced IFN-γ release in tumor tissue. It could also enhance B16 cell-mediated inhibition of T cell proliferation and activation, and upregulate PD-1 expression on CD4⁺ and CD8⁺ T cells. The percentage of CD4⁺CD25⁺FoxP3⁺ Tregs and Gr1⁺CD11b⁺MDSCs were significantly increased in tumor microenvironment, and all these were attributed to the upregulation of TGF-β1.

Conclusion

These findings suggested that Notch1 signaling in B16 melanoma cells might inhibit antitumor immunity by upregulation of TGF-β1.

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Ampicillin and Sulbactam for Injection USP 1.5 g/vial by Auromedics: Recall - Presence of Glass Particles in Vial

Audience: Pharmacy, Risk Manager [Posted 01/04/2018] ISSUE: AuroMedics Pharma is voluntarily recalling one lot of Ampicillin and Sulbactam for Injection USP, 1.5 g in a Single-Dose vial (equivalent to 1 g ampicillin as the sodium salt plus 0.5 g...

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