Hepatocellular carcinoma (HCC) represents a major health problem and ranked as the sixth most common cancer worldwide and the third most common cause of cancerrelated mortality. The prognosis of HCC is usually poor due to post surgery recurrence and metastasis. Both Cells mediated and humoral immunity is considered as key players in the immunopathology of HCC. Recently, there is a special subset of B cells defined as regulatory B cells (Bregs) found to be abundant in the tumor microenvironment and was a leading cause of progression of various cancers, including HCC.Bregs arise from a common progenitor named transitional 2 marginal zone precursor (T2-MZP) B cells as they have most of the indicated markers for Bregs. Human Bregs or also known as human IL-10 producing B cells (B10) is a subset of B cells is enriched in the CD19 + CD24 high CD27 − CD38 high CD1d high CD5 + transitional B cell subset. Tumor-Evoked Regulatory B Cells (tBreg) exert antitumor activity by promoting conversion of the resting CD4 + T cell into FoxP3 + Treg by secretion of TGF-β then the Treg inhibit T cell proliferation and promote tumor metastasis by suppression of the anti-tumor effects of CD8 + T cells and NK cells.Bregs may suppress the antitumor immunity and promote HCC progression via several mechanisms including the CD40/CD40L signaling-mediated cytokine production of IL10, TGF-β which down regulate TNF-α, PD-1 hi B-cell, Granzyme B secreting B cells (GrB+ B cells), Treg upregulation, TH17 downregulation and IL35 which triggers the genesis of Tregs from naive T cells with subsequent suppression of the anticancer immune response. The hallmark of Breg function is IL-10, which inhibits proinflammatory cytokines and supports Treg differentiation. In this review, we highlight the role and mechanisms by which Breg cells are involved in HCC. Understanding these mechanisms may direct us to a novel therapeutic approach targeting Breg for treatment of HCC.
Intracapsular Total thyroid enucleation technique is safe with the least serious complications, especially RLN injury and hypoparathyroidism, with no recurrence, but this technique still not radical so couldn't be used in suspicious cases for malignancy.
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