Background: The presence of tumor-infiltrating lymphocytes (TILs) in many studies is associated with a better prognosis in melanoma patients. Programmed death-ligand 1 (PD-L1) expression has a significant value in predicting several cancers, but its role in melanoma remains ambiguous. The study aims to report a comprehensive analysis of TILs characteristics and their impact on survival in primary acral melanoma (AM). Methods: Clinical and pathological features and survival outcomes were investigated in 70 patients with AM. Immunohistochemical quantitative analysis of TILs, including expression of CD4, CD8, FOXP3, PD-1, and PD-L1, on melanoma cells was performed. Results: Kaplan-Meier analysis showed significant differences in overall survival (OS) for CD4+ (p = 0.021), CD8+ (p = 0.037), FOXP3+ (p = 0.007), and TILs density (p = 0.043). In univariate analysis of immunohistochemical features, FOXP3, CD4, CD8, PD-1, and Melanoma Institute of Australia (MIA) grading TILs (grade, density, and distribution) were correlated with survival. The higher density of FOXP3-positive cells was an independent factor associated with better survival. Conclusions: High TILs content (classed as brisk Clark scale and marked/diffuse TILs MIA grade) regardless of its immunophenotype was associated with better survival outcomes in AM. PD-L1 expression on tumor cells did not influence OS and was independent of clinical and pathological characteristics. We demonstrated that TILs are significant biomarkers in sentinel lymph node status prediction.
Acquired von Willebrand syndrome (AVWS) is a rare bleeding disorder that is associated with a variety of underlying diseases. We report a case of AVWS associated with plasma cell myeloma. The patient was a 57-year-old male with recurrent bleeding symptoms for a few months. Physical examination was normal. Laboratory studies revealed isolated prolongation of the activated partial thromboplastin time. His factor VIII activity, von Willebrand factor (VWF) Ag, and VWF activity were low. Bone marrow aspirate showed diffuse infiltration of atypical plasma cells and erythroid line hyperplasia.
We present the case of a 43-year old patient with inguinal lymphadenopathy 22 years after distal femoral resection for osteosarcoma with cemented distal femoral replacement reconstruction. Seven years after initial distal femoral resection patient underwent metal on metal hip resurfacing arthroplasty on the affected side. Twenty years after distal femoral replacement and 13 years after metal on metal hip resurfacing procedure, the patient underwent left inguinal lymphadenectomy for an enlarged mass of inguinal lymph nodes on suspicion for a sarcoma recurrence. On microscopic examination, excised lymph nodes were massively infiltrated with macrophages and multinucleated giant cells with focal asteroid bodies. An examination in polarized light revealed numerous metal particles; immunohistochemical stainings confirmed reactive character of changes, and florid metal-related sinus histiocytosis was finally diagnosed. Microscopic assessment of lymph nodes in the course of malignancy is a standard procedure; we present a rare case of non-neoplastic lymph node enlargement due to the late onset of metallosis, which might be a diagnostic challenge.
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