DOCSLIB.ORG

A Case of Pulmonary MALT Lymphoma Arising From

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Case of Pulmonary MALT Lymphoma Arising From http://dx.doi.org/10.4046/trd.2012.73.2.115 Case Report ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2012;73:115-121 CopyrightⒸ2012. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved. A Case of Pulmonary MALT Lymphoma Arising from Lymphocytic Interstitial Pneumonitis Ki Hoon Park, M.D.1, Soon Seog Kwon, M.D., Ph.D.1, Myung Hee Chung, M.D., Ph.D.2, Jeana Kim, M.D., Ph.D.3, Hee Jung Lee, M.D., Ph.D.3, Ji-Won Min, M.D.4, Yong Hyun Kim, M.D.1 Departments of 1Internal Medicine, 2Radiology, and 3Pathology, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Bucheon, 4Department of Internal Medicine, Catholic Medical Center, The Catholic University of Korea School of Medicine, Seoul, Korea Pulmonary mucosa-associated lymphoid tissue-derived (MALT) lymphoma is a rare disease. This disorder is considered to be a model of antigen-driven lymphoma, which is driven either by autoantigens or by chronic inflammatory conditions. Low-grade B-cell MALT lymphoma may develop from a nonneoplastic pulmonary lymphoproliferative disorder, such as lymphocytic interstitial pneumonitis (LIP). A recent estimate predicts that less than 5% of LIP patients acquire malignant, low-grade, B-cell lymphoma. In Korea, there has been no previous report of malignant low-grade, B-cell lymphoma, acquired from LIP. Here, we present the case of a patient with LIP that developed into pulmonary MALT lymphoma, six years after diagnosis. Key Words: Lymphoma; Lymphoproliferative Disorders; Lung Diseases, Interstitial; Lymphoid Tissue Introduction orders, or autoimmune diseases is thought to be the ini- tial event leading to the development of MALT lympho- There are various lymphoproliferative disorders which ma5,6. In rare cases, a nonneoplastic pulmonary lym- affect the lung parenchyme. Among these, primary pul- phoproliferative disorder (p-LPD), such as lymphocytic monary lymphomas (PPLs) represent only 3∼4% of ex- interstitial pneumonitis (LIP) can develop into malig- tranodal non-Hodgkin's lymphoma (NHL). Pathologically, nant, low-grade, B-cell lymphoma. A recent and real- Low grade B-cell NHL accounts for 58∼72% of cases istic estimate is closer to 5% of patients with LIP acquire of PPL1. Mucosa-associated lymphoid tissue-derived malignant, low-grade, B-cell lymphoma7,8. In Korea, (MALT) lymphoma is a low grade B-cell extranodal lym- there has been no previous report of pulmonary MALT phoma characterized by a proliferation of clonal margin- lymphoma acquired from LIP. We describe here, a rare al zone lymphocytes2,3 that arise from bronchial-associated case of pulmonary MALT lymphoma that arose from a lymphoid tissue4. Stimulation of bronchus-associated LIP. lymphoid tissue by antigens, smoking, inflammatory dis- Case Report Address for correspondence: Yong Hyun Kim, M.D. Division of Allergy and Pulmonology, Department of A 60-year-old woman was admitted to our hospital Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, 327, with cough and dyspnea. At the time of admission, her Sosa-ro 327beon-gil, Wonmi-gu, Bucheon 414-717, Korea medical history included medically controlled essential Phone: 82-32-340-7039, Fax: 82-32-340-2669 E-mail: [email protected] hypertension, diabetes mellitus and old cerebral infarction. Received: Apr. 9, 2012 She was a smoker of 10 pack-years. Physical examina- Revised: Apr. 13, 2012 Accepted: Apr. 26, 2012 tion revealed that she had no skin lesions or neuro- CC It is identical to the Creative Commons Attribution Non-Commercial logical abnormalities. There was no lymphadenopathy License (http://creativecommons.org/licenses/by-nc/3.0/). in the cervical, axillary, or inguinal regions. On auscul- 115 KH Park et al: A case of pulmonary MALT lymphoma arising from LIP Figure 1. Initial radiographic findings. (A) Chest posterior- anterior shows multifocal peribronchial consolidations, involving both lungs. (B, C) There are diffuse bilateral ground-glass opacity with intralobular septal thicken- ings and condolidative le- sion on a chest computed tomography scan. (D) A chest X-ray after 8 months steroid treatment. tation of the chest, a coarse breathing sound with crack- thoracoscopic lung biopsy specimens from the left up- les in both lower lung fields was heard. Chest radio- per lobe revealed diffuse severe lymphoid cell infiltra- graphs and computed tomography (CT) scans showed tion with some plasma cells in the interstitium and al- diffuse bilateral ground-glass opacity with intralobular veolar walls (Figure 2A). Immunohistochemical exami- septal thickenings and consolidative lesions (Figure 1A nation revealed lymphoid cells evenly admixed with B ∼C). Laboratory investigations revealed a total leuko- lymphocytes and T lymphocytes, which were immunor- cyte count of 7,200 cells/mm3, comprising 40.8% of eactive for CD79a (Figure 2B) and CD3 (Figure 2C), neutrophils, 49.7% lymphocytes, 7.2% monocytes, 1% respectively. These findings were consistent with the di- basophils, and 1.3% eosinophils. The level of C-reactive agnosis of LIP with follicular bronchiolitis components. protein was slightly elevated to 2.39 mg/dL. The serum Our patient was treated with prednisone 1 mg/kg per lactate dehydrogenase level had increased to 543 U/L day with gradual tapering for 8 months. She showed (normal, 110∼230 U/L). Arterial blood gas analysis in progressive clinical and radiographic improvement room air showed a PaO2 of 56.5 mm Hg, PaCO2 39.3 (Figure 1D). mm Hg, SaO2 90.5% and pH 7.41. Autoantibody tests Five years later, at the age of 65 years, our patient were negative. Cellular analysis of the bronchoalveolar started re-experiencing dyspnea and cough symptoms. lavage fluid (BALF) revealed a composition of 25% lym- A chest CT scan revealed diffuse bilateral ground-glass phocytes, 3% eosinophils, 0% neutrophil, and 72% opacity with fine reticulation, traction bronchiectasis macrophages. Histological examination of video-associated and consolidative lesions (Figure 3A, B). Pulmonary 116 Tuberculosis and Respiratory Diseases Vol. 73. No. 2, Aug. 2012 Figure 2. Initial histopathological findings. (A) Video-asso- ciated thoracoscopic lung biopsy specimens from the left upper lobe revealed diffuse severe lymphoid cell infiltration with some plasma cells in the interstitium and alveolar walls (H&E stain, ×40). (B) Immunohistochemical exami- nation revealed that the lymphoid cells were evenly ad- mixed with B lymphocytes and T lymphocytes, which were immunoreactive for CD79a and (C) CD3 (B, ×400; C, ×400). function tests revealed a reduced vital capacity (VC) of phoid cells (Figure 5A). Immunohistochemical examina- 73% predicted value, a reduced total lung capacity tion revealed that the lymphoid cells were diffusely pos- (TLC) of 69% predicted value and a reduced diffusion itive for CD79a and B-cell markers (Figure 5B), but neg- lung capacity for carbon monoxide of 49% predicted ative for Bcl6 (Figure 5C), CD10 and MUM-1 (Figure value. Cellular analysis of the BALF revealed a composi- 5D). These findings were consistent with the diagnosis tion of 80% lymphocytes, 2% eosinophils, 5% neu- of pulmonary MALT lymphoma. Our patient was treated trophil, 13% macrophages and a CD4/CD8 ratio of with 3 cycles of cyclophosphamide, hydroxydaunor- 0.959. Our patient was again treated with 60 mg of pre- ubicin (doxorubicin), Oncovin (vincristine), and predni- dnisone per day, which was gradually tapered for 6 sone. Her chest radiographs (Figure 4C, D) and symp- months. This led to improvement of VC (92% of pre- toms showed improvement. Chemotherapy was continued. dicted value), TLC (100% of predicted) and radiographic findings (Figure 3C, D). Discussion Eighteen months later, our patient suffered a relapse of dyspnea. A chest CT scan revealed diffuse peribron- Major nonneoplastic p-LPD, which includes lesions of chial thickening, extensive consolidative lesions and the intrapulmonary lymph nodes, consists of follicular nodular lesions in both lung fields (Figure 4A, B). bronchitis/bronchiolitis, lymphocytic interstitial pneu- Histological examination of percutaneous lung needle monia, and nodular lymphoid hyperplasia. Such disease biopsy specimens revealed marked infiltration of lym- entities are inflammatory and reactive lesions that are 117 KH Park et al: A case of pulmonary MALT lymphoma arising from LIP Figure 3. Radiographic find- ings of second episode. (A, B) Initial chest computed tomography (CT) scan re- vealed diffuse bilateral gro- und-glass opacity with fine reticulation, traction bronchi- ectasis and consolidative le- sion. (C, D) A chest CT scan after 6 months of ste- roid treatment. often difficult to diagnose, since it is difficult to differ- infiltrates that diffusely expand alveolar septa. The in- entiate them from each other and from other neoplastic filtrate is composed of lymphocytes admixed with varia- entities. Therefore, these disorders should be dis- ble numbers of histiocytes and plasma cells. Reactive tinguished by clinical, radiographic, and histologic lymphoid follicles are more prominent and consistent in features. Radiologic findings of nodular lymphoid hy- nodular lymphoid hyperplasia. In follicular bronchioli- perplasia consist of well-demarcated nodules or masses. tis, numerous lymphoid follicles with associated reactive On the other hand, the CT features of LIP consist of germinal centers are present around the bronchi and a bilateral area of poorly defined centrilobular nodules, bronchioles10. Interstitial lymphocytes
Load more

Recommended publications
  • Ocular HIV/AIDS Related Diseases (Initial and Follow-Up Evaluation)
    Ocular HIV/AIDS Related Diseases (Initial and Follow-up Evaluation) (Ratings: A: Most important, B: Moderately important, C: Relevant but not critical Strength of Evidence: I: Strong, II: Substantial but lacks some of I, III: consensus of expert opinion in absence of evidence for I & II) General - Initial Exam History Age (B:III) Ocular symptoms including laterality (A:III) Systemic symptoms (A:III) Complete review of systems (A:III) Prior ocular history (A:III) Prior medical history (A:III) Prior surgical history (B:III) History of other sexually transmitted diseases (A:III) History of AIDS-defining illnesses or complications (A:III) Method of HIV acquisition (B:III) Duration of HIV infection (A:III) Past and current risk factors – sexual behavior, intravenous drug abuse, transfusion history (A:III) Current anti-HIV regimen – duration and compliance (A:III) Current medications (A:II) Current CD4 count (A:II) Current viral load (A:II) Medication allergies (B:III) General - Initial Physical Exam General appearance (A:III) External examination – face, ocular adnexa (A:III) Lymphatics – preauricular and submandibular nodes (A:III) Visual acuity (A:III) Extraocular motility (A:III) Confrontation visual fields (A:III) Eyelids – lid closure, interpalpebral fissure height (B:III) Lacrimal gland (B:III) Evaluation of tear film – Schirmer, rose bengal and fluorescein staining (A:III) Nasolacrimal function (B:III) Slit-lamp examination o Eyelid margins (A:III) o Conjunctiva (A:III) o Sclera (A:III) o Cornea (A:III) o
    [Show full text]
  • Immunoglobulin and T Cell Receptor Genes: IMGT(®) and the Birth and Rise of Immunoinformatics Marie-Paule Lefranc
    Immunoglobulin and T Cell Receptor Genes: IMGT(®) and the Birth and Rise of Immunoinformatics Marie-Paule Lefranc To cite this version: Marie-Paule Lefranc. Immunoglobulin and T Cell Receptor Genes: IMGT(®) and the Birth and Rise of Immunoinformatics. Frontiers in Immunology, Frontiers, 2014, 5, pp.22. 10.3389/fimmu.2014.00022. hal-00957520 HAL Id: hal-00957520 https://hal.archives-ouvertes.fr/hal-00957520 Submitted on 28 May 2021 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Distributed under a Creative Commons Attribution| 4.0 International License CLASSIFICATION ARTICLE published: 05 February 2014 doi: 10.3389/fimmu.2014.00022 Immunoglobulin and T cell receptor genes: IMGT® and the birth and rise of immunoinformatics Marie-Paule Lefranc* The International ImMunoGenetics Information System® (IMGT®), Laboratoire d’ImmunoGénétique Moléculaire (LIGM), Institut de Génétique Humaine, UPR CNRS, Université Montpellier 2, Montpellier, France Edited by: IMGT®, the international ImMunoGeneTics information system®1, (CNRS and Université Kendall A. Smith, Weill Cornell Montpellier 2) is the global reference in immunogenetics and immunoinformatics. By its Medical College of Cornell University, ® USA creation in 1989, IMGT marked the advent of immunoinformatics, which emerged at ® Reviewed by: the interface between immunogenetics and bioinformatics.
    [Show full text]
  • Immunoglobulin and T Cell Receptor Genes: IMGT and the Birth and Rise
    CLASSIFICATION ARTICLE published: 05 February 2014 doi: 10.3389/fimmu.2014.00022 Immunoglobulin and T cell receptor genes: IMGT® and the birth and rise of immunoinformatics Marie-Paule Lefranc* The International ImMunoGenetics Information System® (IMGT®), Laboratoire d’ImmunoGénétique Moléculaire (LIGM), Institut de Génétique Humaine, UPR CNRS, Université Montpellier 2, Montpellier, France Edited by: IMGT®, the international ImMunoGeneTics information system®1, (CNRS and Université Kendall A. Smith, Weill Cornell Montpellier 2) is the global reference in immunogenetics and immunoinformatics. By its Medical College of Cornell University, ® USA creation in 1989, IMGT marked the advent of immunoinformatics, which emerged at ® Reviewed by: the interface between immunogenetics and bioinformatics. IMGT is specialized in the Edward J. Collins, University of North immunoglobulins (IG) or antibodies, T cell receptors (TR), major histocompatibility (MH), Carolina at Chapel Hill, USA and proteins of the IgSF and MhSF superfamilies. IMGT® has been built on the IMGT- David K. Cole, Cardiff University, UK ONTOLOGY axioms and concepts, which bridged the gap between genes, sequences, and *Correspondence: three-dimensional (3D) structures.The concepts include the IMGT® standardized keywords Marie-Paule Lefranc, The International ® ® ImMunoGenetics Information (concepts of identification), IMGT standardized labels (concepts of description), IMGT System® (IMGT®), Laboratoire standardized nomenclature (concepts of classification), IMGT unique numbering, and
    [Show full text]
  • Genomic Analysis Offers Insights Into the Evolution of the Bovine TRA/TRD Locus', BMC Genomics, Vol
    Edinburgh Research Explorer Genomic analysis offers insights into the evolution of the bovine TRA/TRD locus Citation for published version: Connelley, TK, Degnan, K, Longhi, CW & Morrison, WI 2014, 'Genomic analysis offers insights into the evolution of the bovine TRA/TRD locus', BMC Genomics, vol. 15, no. 1, 994. https://doi.org/10.1186/1471- 2164-15-994 Digital Object Identifier (DOI): 10.1186/1471-2164-15-994 Link: Link to publication record in Edinburgh Research Explorer Document Version: Publisher's PDF, also known as Version of record Published In: BMC Genomics Publisher Rights Statement: © 2014 Connelley et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. General rights Copyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s) and / or other copyright owners and it is a condition of accessing these publications that users recognise and abide by the legal requirements associated with these rights. Take down policy The University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorer content complies with UK legislation. If you believe that the public display of this file breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim.
    [Show full text]
  • Next Generation Sequencing Reveals Changes of the Γδ T Cell Receptor
    www.nature.com/scientificreports Correction: Author Correction OPEN Next generation sequencing reveals changes of the γδ T cell receptor repertoires in patients Received: 24 November 2017 Accepted: 14 February 2018 with pulmonary tuberculosis Published online: 02 March 2018 Chaofei Cheng1, Bei Wang1,2, Lei Gao1, Jianmin Liu4, Xinchun Chen5, He Huang1,2 & Zhendong Zhao1,2,3 Tuberculosis (TB) is a severe global threat to human health. The immune protection initiated by γδ T cells play an important role in mycobacterial infection. Vaccines for Mycobacterium tuberculosis (Mtb) based on γδ T cells provide a novel approach for TB control. In our previous studies, we found a preponderant complementarity-determining region 3 (CDR3) sequence of the γδ T cell receptor (TCR) in TB patients, and successfully identifed a tuberculosis antigen that can efectively activate γδ T cells with a reverse genetic strategy. However, due to the throughput limitation of the method we used, the information we obtained about the γδ TCR repertoire and preponderant CDR3 sequences was limited. In this study, we introduced next generation sequencing (NGS) to study the γδ TCR CDR3 repertoires in TB patients. We found that the CDR3δ tended to be more polyclonal and CDR3γ tended to be longer in TB patients; the γδ T cells expressing CDR3 sequences using a Vγ9-JγP rearrangement expanded signifcantly during Mtb infection. We also identifed new preponderant CDR3 sequences during Mtb infection. This study comprehensively characterized the γδ T cell receptor repertoire changes, and provides useful information for the development of new vaccines and adjuvants against TB. Tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb), the top infectious disease killer worldwide, remains a severe global threat to human health.
    [Show full text]
  • Download Slides
    PEARLS OF LABORATORY MEDICINE Pearl Title: Immunoglobulin and T Cell Receptor Genetics Name of Presenter: Bing Melody Zhang Affiliation: Stanford University School of Medicine DOI: 10.15428/CCTC.2020.318055 © Clinical Chemistry Outline • Structure of Immunoglobulin (Ig) and TCR (T cell receptor) • TCR/Ig genetics • T/B cell development and TCR/Ig gene rearrangement • Molecular testing of TCR/Ig rearrangement • Clinical utility of molecular TCR/Ig rearrangement analysis in lymphoid malignancies 2 Immunoglobulin (Ig) and T Cell Receptor (TCR) 3 TCR/Ig Genetics • Each receptor chain is encoded in the germline genome as different gene segments (V, D, J). • During T/B lymphocyte development, the gene segments undergo random somatic DNA recombination (VDJ or VJ) to form a complete variable region sequence, known as gene rearrangement. • Non-templated insertion and deletion of random nucleotides at the junctional regions. • Somatic hypermutation: high rate of point mutations in V region of Ig genes (mature B cells). 4 IGH Gene Rearrangement V genes D genes J genes Constant region Germline V-N-D-N-J 5 B cell development and BCR/Ig gene rearrangement Large pre- Small pre- Immature B Mature B Stem cells Early pro-B Late pro-B cell cell B cell B cell cell cell IgH: germline D-J joining V-DJ joining VDJ rearranged VDJ rearranged VDJ rearranged VDJ rearranged IgK/L: germline germline germline germline V-J joining VJ rearranged VJ rearranged Order of gene rearrangements: IGH → IGK If IGK rearrangement fails → IGL gene rearrangement The Immune System,
    [Show full text]
  • Cracking the Carbohydrate Code for Selectin Recognition
    CAROLYN R BERTOZZI CROSSTALK Cracking the carbohydrate code for selectin recognition Selectins are central in the inflammatory response; the discovery that they bind to carbohydrate ligands has galvanized carbohydrate chemists to search for inhibitors of the process. Recent progress in identifying and analyzing physiological selectin counter-receptors suggests new approaches to the design of ligands that bind to specific selectins. Chemistry & Biology November 1995, 2:703-708 White blood cells (leukocytes) circulate throughout the by designing specific antagonists, which may also serve as blood vasculature, patrolling the body for sites of tissue leads for therapeutics. damage or microbial infection. When such a site is encountered, the leukocytes must exit the blood stream Carbohydrate specificity of the selectins and migrate into the surrounding tissue to perform their The selectin family of adhesion molecules has three protective f&ctions. The sequence of events leading to members, E-, l’- and L-selectin (for a recent review see leukocyte recruitment, referred to as the inflammatory [a]). These share a common domain structure, which cascade, begins with the interaction of circulating leuko- includes an amino-terminal calcium-dependent (C-type) cytcs with endothelial cells lining the blood vessel (Fig. lectin domain, the sequence of which is highly conserved 1) [II. First, the leukocytes tether to and roll along the between family members, an epidermal growth factor endothelial layer, propelled by the force of the blood (EGF)-like domain, and a series of short consensus repeat flow.The leukocytes then firmly adhere to the endothe- sequences that are homologous to complement regulatory lial layer, and migrate between endothelial cells to com- proteins.
    [Show full text]
  • Committed to Innovation and Growth
    Committed to innovation and growth Alan Hippe, CFO Roche Group New York , February 2013 Roche strategy: Focused on medically differentiated therapies Regulators: Pharma Dia Optimised benefit / risk ratio Payors: Focus Optimised benefit / cost ratio MedTech Premium for innovation OTC Generics Differentiation 2 Roche: Operating profit and margin continuously increased Group core operating profit and margin 37.7% 34.9% 35.6% % of sales 33.0% 33.2% +11%1 17.16 16.27 16.59 15.07 15.15 CHF bn 2008 2009 2010 2011 2012 3 1 At CER=Constant Exchange Rates Roche: Cash flow and margin continuously increased Group operating free cash flow and margin % of sales 33.8% 32.1% 32.3% 29.8% 27.1% +10%1 15.7 15.4 14.1 13.7 12.4 CHF bn 2008 2009 2010 2011 2012 4 1 At CER=Constant Exchange Rates R&D productivity differs substantially among players Average annual 1 NME peak sales (2001-10) $ 710 m Peak Sales 4 x US$ bn (per $1 bn R&D) Roche $ 165 m Peak Sales (per $1 bn R&D) Average annual R&D investment (1997-2006)1 US$ bn 1 Peak sales and R&D calculated pro forma to account for major M&A 5 Source: EvaluatePharma; BCG analysis; Roche analysis Roche: R&D well balanced from a risk & disease point of view 2012 Roche budget Oncology Metabolism Inflammation CNS Virology 0% 5% 10% 15% 20% 25% 30% Industry average probability of success – Phase 0 to Registration 6 Source: Bernstein Equity Research, Tufts University and Roche analysis Changing the standard of care in HER2 Securing future growth by improving the standard of care Biosimilars launch (EU) 2nd line Xeloda
    [Show full text]
  • Role of the Actin Cytoskeleton in Acinar Cell Protein Secretion
    Role of the Actin Aytoskeleton in Acinar Cell Protein Secretion Robert C. De Lisle Anatomy and Cell Biology, University of Kansas School of Medicine, Kansas City, KS 66160 USA e-mail: [email protected] Version 2.0, November 9th, 2020 [DOI: 10.3998/panc.2020.07] Abstract different functions, as mutations in the two genes have very different effects (2). In the mouse acinar All eukaryotic cells, including the pancreatic acinar cell, Actb mRNA is expressed more than 2-fold cell, tightly control organization of their cytoplasm greater than Actg1 (Table 1); presumably their which in large part relies on the cytoskeleton. The protein levels match this expression although this cytoskeleton is comprised of three filament types: has not been measured in the pancreas. In gastric microtubules (tubulin), intermediate filaments parietal cells, β-actin is more localized to the apical (keratins), and microfilaments (actin). In addition to cortical cytoskeleton whereas γ-actin is more characteristics common to all cells, the pancreatic localized along the basolateral plasma membrane acinar cell is a polarized epithelial cell with a (BLPM) (47). If the same is true in the acinar cell, vectorial arrangement of the secretory machinery then β-actin is more likely to be important in protein and apically-directed protein secretion, with secretion which is also localized to the apical important roles of the cytoskeleton in this polarity. surface of the cell. In the acinar cell, γ-actin may be The most investigated of the cytoskeleton involved in the BLPM blebs that form under elements in the acinar cell are actin-based supraphysiologic stimulation.
    [Show full text]
  • SUPPLEMENTAL FIGURE LEGEND Supplemental Figure 1. Representative HGA Histology of (A) Greater Than Median, and (B) Less Than
    SUPPLEMENTAL FIGURE LEGEND Supplemental figure 1. Representative HGA histology of (A) greater than median, and (B) less than median tumor infiltration of helper T-cells (CD4; brown), (C) greater than median, and (D) less than median tumor infiltration of cytotoxic T-cells (CD8; red), (E) greater than 75th percentile, and (F) less than 75% percentile tumor infiltration of microglia/macrophages (AIF1; brown). Immunohistochemistry was performed using FFPE tumor sections and with hematoxylin counterstaining (400x magnification). Supplemental table IA. High grade astrocytoma long-term survivor patient details. Sample Survival Dead Age Karnofsky/ Dx detail location of Extent of Therapy received Used in ID (yrs) at Lansky tumor surgery microarray Dx performance study (yrs) score HGA1 17.0 N 34 100 AA pons biopsy radiation and BCNU HGA2 16.5 N 8 80 AA cerebrum GTR carboplatin, etoposide, CCNU, vincristine and radiation HGA3 16.0 N 47 90 GBM 1o cerebrum STR radiation and temozolmide HGA4 11.0 N 45 60 GBM, giant cell cerebrum GTR none HGA5 10.5 N 27 100 GBM 1o, cerebrum GTR radiation, CCNU, irinotecan, and temozolmide epithelioid HGA6 8.5 Y 21 100 RIG cerebellum STR radiation and temozolmide HGA7 8.5 N 2 80 GBM 1o thalamus/ STR cisplatin, vincristine, cytoxan, etoposide, carboplatin, cerebrum thiotepa HGA8 8.5 N 42 100 GBM 2o cerebrum GTR radiation, CCNU, irinotecan and temozolmide HGA9 8.5 N 46 80 GBM 1o cerebrum GTR radiation, CCNU, erlotinib and temozolmide yes HGA10 7.0 N 10 80 GBM 1o thalamus biopsy radiation and temozolmide HGA11 7.0 Y 24
    [Show full text]
  • Final Rule Is at 410–786–4142 Or Mitali Dayal Via Effective on January 1, 2020
    61142 Federal Register / Vol. 84, No. 218 / Tuesday, November 12, 2019 / Rules and Regulations DEPARTMENT OF HEALTH AND DATES: via email [email protected] or HUMAN SERVICES Effective date: This final rule is at 410–786–4142 or Mitali Dayal via effective on January 1, 2020. email [email protected] or at Centers for Medicare & Medicaid Comment period: To be assured 410–786–4329. Services consideration, comments on the Ambulatory Surgical Center Quality payment classifications assigned to the Reporting (ASCQR) Program 42 CFR Parts 405, 410, 412, 414, 416, interim APC assignments and/or status Administration, Validation, and 419, and 486 indicators of new or replacement Level Reconsideration Issues, contact Anita II HCPCS codes in this final rule with [CMS–1717–FC] Bhatia via email Anita.Bhatia@ comment period must be received at one cms.hhs.gov or at 410–786–7236. RIN 0938–AT74 of the addresses provided in the Ambulatory Surgical Center Quality ADDRESSES section no later than 5 p.m. Reporting (ASCQR) Program Measures, Medicare Program: Changes to EST on December 2, 2019. contact Nicole Hewitt via email Hospital Outpatient Prospective ADDRESSES: In commenting, please refer [email protected] or at 410– Payment and Ambulatory Surgical to file code CMS–1717–FC when 786–7778. Center Payment Systems and Quality commenting on the issues in this final Blood and Blood Products, contact Reporting Programs; Revisions of rule with comment period. Because of Josh McFeeters via email Organ Procurement Organizations staff and resource limitations, we cannot [email protected] or at Conditions of Coverage; Prior accept comments by facsimile (FAX) 410–786–9732.
    [Show full text]
  • Genomic and Expression Analyses of Tursiops Truncatus T Cell Receptor
    Linguiti et al. BMC Genomics (2016) 17:634 DOI 10.1186/s12864-016-2841-9 RESEARCH ARTICLE Open Access Genomic and expression analyses of Tursiops truncatus T cell receptor gamma (TRG) and alpha/delta (TRA/TRD) loci reveal a similar basic public γδ repertoire in dolphin and human Giovanna Linguiti1†, Rachele Antonacci1†, Gianluca Tasco2, Francesco Grande3, Rita Casadio2, Serafina Massari4, Vito Castelli1, Arianna Consiglio5, Marie-Paule Lefranc6 and Salvatrice Ciccarese1* Abstract Background: The bottlenose dolphin (Tursiops truncatus) is a mammal that belongs to the Cetartiodactyla and have lived in marine ecosystems for nearly 60 millions years. Despite its popularity, our knowledge about its adaptive immunity and evolution is very limited. Furthermore, nothing is known about the genomics and evolution of dolphin antigen receptor immunity. Results: Here we report a evolutionary and expression study of Tursiops truncatus T cell receptor gamma (TRG) and alpha/delta (TRA/TRD) genes. We have identified in silico the TRG and TRA/TRD genes and analyzed the relevant mature transcripts in blood and in skin from four subjects. The dolphin TRG locus is the smallest and simplest of all mammalian loci as yet studied. It shows a genomic organization comprising two variable (V1 and V2), three joining (J1, J2 and J3) and a single constant (C), genes. Despite the fragmented nature of the genome assemblies, we deduced the TRA/TRD locus organization, with the recent TRDV1 subgroup genes duplications, as it is expected in artiodactyls. Expression analysis from blood of a subject allowed us to assign unambiguously eight TRAV genes to those annotated in the genomic sequence and to twelve new genes, belonging to five different subgroups.
    [Show full text]