Follicular lesions include germinal center (GC) hyperplasia, regressive transformation of GCs, and follicle lysis. The present histologic, electron microscopic, and immunohistochemical study of six autopsy cases after organ transplantation accompanied by the administration of immunosuppressive drugs revealed a peculiar regression of lymph node GCs in two cases, which has not been noted previously. The histologic findings of the regressive GCs were classified into three patterns. In pattern A, the GCs had few or no lymphocytes and were surrounded by a poorly developed mantle zone-like structure. Apoptotic cell death of GC lymphocytes was found in a few GCs, but most GCs lacked tingible body macrophages. In pattern B, the GC lymphocytes and tingible body macrophages were absent, showing crowded follicular dendritic cells (FDCs) in a corpuscular shape. In pattern C, the lymphocytic mantle was absent. The GCs were smaller than those in the other patterns, and the shape was irregular because of disintegration of FDCs. The immunostaining for FDC markers revealed dispersed growth of FDCs. On electron microscopy, the lesions were composed of a dense mass of elliptical and oval cells without prominent cytoplasmic processes, a labyrinthlike structure, and emperipolesis of lymphocytes. The distinct desmosomelike adhesive junctions, specific electron microscopic features of FDCs, were evident. We propose to call these follicular lesions "FDC-only lymphoid follicles." It is speculated that this follicle may be evoked after preceding follicular hyperplasia with a complicated mechanism including increased apoptosis of GC lymphocytes and decreased lymphocyte migration to lymph node GCs caused by immunosuppressive drugs.

Purpose: The effects of oxygen supplementation status and other clinical risk factors on the development of severe retinopathy of prematurity (ROP) were evaluated. Methods: Clinical records of 143 newborn infants with a gestational age of 32 weeks or less were reviewed. Severe ROP was diagnosed when photocoagulation due to progression to stage 3 was identified or when ‘plus disease' developed. The factors were evaluated with univariate and multivariate logistic regression analyses between the groups with severe (n = 24) and non-severe (n = 119) ROP. Results: Gestational age, birth weight, duration of oxygen supplementation, duration of directional positive air pressure and maximum fraction of inspiratory oxygen (FiO₂) were significantly associated with severe ROP in the univariate analyses. In the multivariate analysis, a longer duration of oxygen supplementation and a higher maximum FiO₂ were revealed as significant risk factors associated with severe ROP. Conclusions: Duration of oxygen supplementation and maximum FiO₂ required were important factors associated with severe ROP.

Background: Recent immune therapy with checkpoint inhibitors (CPIs) has demonstrated remarkable antitumor effects on specific tumors, such as malignant lymphoma and non-small cell lung carcinoma. By contrast, CPIs cause an imbalance in the immune system, triggering a wide range of immunological side effects termed immune-related adverse effects (irAEs). Here, we report a rare case of optic neuritis and hypopituitarism during anti-programmed death-ligand 1 (PD-L1) antibody treatment. Case Presentation: A patient with non-small cell lung carcinoma received anti-PD-L1 antibody treatment every 3 weeks; however, the patient started experiencing headaches, general fatigue, anorexia, and diarrhea approximately 1 year after the initiation of the treatment. Moreover, sudden visual loss of the right eye occurred 1 week after the interruption of the anti-PD-L1 antibody treatment. MRI findings showed gadolinium enhancement in the left optic nerve, but no enlargement of the pituitary gland and stalk. Laboratory data showed decreased serum adrenocorticotropic hormone (ACTH), cortisol, and free T₄ levels, and a hormone tolerance test indicated hypopituitarism, hypothyroidism, and hypoadrenocorticism. The central scotoma caused by optic neuritis completely disappeared immediately after a course of steroid pulse therapy, and no recurrence occurred up to 2 years after initiation of the steroid pulse therapy while replacement therapy for hypothyroidism and hypoadrenocorticism was continued. Conclusions: The patient presented with optic neuritis and hypopituitarism, possibly due to irAEs of the anti-PD-L1 antibody treatment. Steroid pulse therapy was effective for optic neuritis, suggesting underlying immunological mechanisms. Neurological complications including optic neuritis should be considered when examining patients with cancer undergoing CPI treatment.

Purpose To investigate the outcomes of a suspension of anti-vascular endothelial growth factor (anti-VEGF) treatments in the eyes with neovascular age-related macular degeneration (nAMD). Methods This was a retrospective study that examined eyes having no exudation for 48 weeks while undergoing intravitreal anti-VEGF injections every 12 to 16 weeks. The rate and time of recurrences, best-corrected visual acuity (BCVA), central subfield thickness (CST), number of visits, and reactivity to anti-VEGF were determined after the suspension of the anti-VEGF treatments. Results In 34 eyes of 34 patients, 17 eyes (50.0%) had a recurrence during the 24-month follow-up period. The median time of a recurrence was 10 months. The BCVA was maintained for 24 months after the suspension regardless of the development of any recurrences. In 41.7% of the eyes that resumed treatment, the duration of exudation suppression by the anti-VEGF therapy was shorter than 12 weeks during the 12 months after restarting the anti-VEGF treatments. There was a significant increase in the number of visits during the first year after beginning the suspension versus during the 1 year before the suspension (non-recurrence group; P = 0.007, recurrence group; P = 0.001). Conclusion Although one-half of the eyes had a recurrence within 24 months after a suspension of anti-VEGF treatment, the BCVA was maintained after a resumption of the anti-VEGF treatments. However, the number of hospital visits increases regardless of the recurrences and the lesion stability is altered by the anti-VEGF suspension. Clinicians should explain both the advantages and disadvantages of anti-VEGF suspension to nAMD patients.

No abstract