Nuclear protein in testis (NUT) carcinoma is a rare, aggressive carcinoma that is a diagnostic challenge for pathologists. Here, we report a case of NUT carcinoma in a 63-year-old woman with uncommon immunohistochemical results. The initial bronchoscopic biopsy revealed a poorly differentiated carcinoma with p63 immunohistochemical stain positivity. However, the cytomorphological features of the pleural fluid were unusual. Immunohistochemical staining of the pleural fluid revealed diffuse positivity for vimentin and focal positivity for cytokeratin and neuroendocrine markers. Because of chemoresistance, other malignancies, including sarcomatoid carcinoma, combined small cell carcinoma, and an unusual form of NUT carcinoma, were considered as differential diagnoses. The diagnosis of NUT carcinoma was confirmed using NUT-specific antibodies and fluorescence in situ hybridization. The current case was a diagnostic challenge because of the poorly differentiated cytomorphology and uncommon immunohistochemical results. Pathologists and clinicians should consider NUT carcinoma in the differential diagnosis, as this malignancy has a dismal prognosis and needs to be diagnosed accurately for the most effective treatment. Key points:• Metastatic NUT carcinoma can show diffuse vimentin positivity and focal neuroendocrine marker positivity. NUT carcinoma can be misdiagnosed as basaloid squamous cell carcinoma in routine diagnosis, especially in older-aged patients. • This study was a diagnostic challenge because of the poorly differentiated cytomorphology and uncommon immunohistochemical results for NUT carcinoma. Pathologists should differentially diagnose NUT carcinoma when rare cytohistological features are observed at any age.
Highly active and durable systemic therapies such as targeted therapy and immunotherapy can convert widespread metastatic disease into oligometastatic status, for which metastasis-directed local intervention can control and potentially prolong survival. Radiation therapy is an effective therapeutic option for oligometastatic and oligoprogressive disease. Here, we present a case of induced oligometastasis and repeated oligoprogressive lung cancer in which more than 6 years of survival was achieved with a combination of immunotherapy and radiotherapy.
B7‐H1 encompasses a recently discovered cell surface glycoprotein within the B7 family of T‐cell co‐regulatory molecules. Some human tumors acquire the ability to aberrantly express B7‐H1. Tumor‐associated B7‐H1, as well as B7‐H1 on activated lymphocytes, has been shown to impair antigen‐specific T‐cell function and survival in vitro. In contrast, the monoclonal antibody‐mediated stimulation of B7‐H1(reverse signaling) on cancer cells expressing B7‐H1 molecule itself has not been studied. Our group has recently reported that B7‐H1 is induced on EBV‐transformed B cells via immunohistochemical staining and flow cytometric analysis. In addition, We observed that B7‐H1 ligation with anti‐B7‐H1 mAb enhanced the apoptosis of EBV‐transformed B cells. And B7‐H1 ligation induced the expression of both FasL and Fas in theses cells. Furthermore, anti‐Fas blocking antibody, ZB4, blocked B7‐H1‐mediated apoptosis effectively and caspase inhibitors also effectively blocked B7‐H1‐induced cell death. Western blot analysis showed down‐regulated expression of procaspase‐8, 3 and PARP. The release of cytochrome c and translocation to nucleus of endoG and AIF were showed by confocal micoscopy. The findings suggested that Fas/FasL pathway was activated by B7‐H1 ligation on EBV‐transformed B cells.
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