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Introduction Allograft rejection is unique among immune responses in that it enlists 1%-10% of the total T cell repertoire, a proportion that is 100- to 1000-fold greater than that observed [...], Activation of host T cells that mediate allograft rejection is a 2-step process. The first occurs in secondary lymphoid organs where T cells encounter alloantigens presented by host DCs and differentiate to effectors. Antigen presentation at these sites occurs principally via transfer of intact, donor MHC-peptide complexes from graft cells to host DCs (cross-dressing) or by uptake and processing of donor antigens into allopeptides bound to self-MHC molecules (indirect presentation). The second step takes place in the graft, where effector T cells reengage with host DCs before causing rejection. How host DCs present alloantigens to T cells in the graft is not known. Using mouse islet and kidney transplantation models, imaging cytometry, and 2-photon intravital microscopy, we demonstrate extensive cross-dressing of intragraft host DCs with donor MHC- peptide complexes that occurred early after transplantation, whereas host DCs presenting donor antigen via the indirect pathway were rare. Cross-dressed DCs stably engaged TCR-transgenic effector [CD8.sup.+] T cells that recognized donor antigen and were sufficient for sustaining acute rejection. In the chronic kidney rejection model, cross-dressing declined over time but was still conspicuous 8 weeks after transplantation. We conclude that cross-dressing of host DCs with donor MHC molecules is a major antigen presentation pathway driving effector T cell responses within allografts.

Objectives Our aim was to explore the performance of TRPS1 as an immunohistochemical diagnostic marker; find the optimal conditions for its use in breast carcinomas, especially triple-negative breast cancers (TNBCs); and compare its results in carcinomas of a select few organ sites, with an emphasis on gynecologic tumors. Methods Tissue microarrays from breast carcinomas (n = 197), endometrial adenocarcinomas (n = 69), ovarian tumors (n = 250), vulvar squamous cell carcinomas (n = 97), pancreatic ductal adenocarcinomas (n = 20), and gastric adenocarcinomas (n = 12) were stained with TRPS1 using 2 different conditions (protocol 1: high pH; protocol 2: low pH). Breast carcinomas consisted of hormone receptor (HR)–positive/ERBB2 (formerly HER2 or HER2/neu)–negative (n = 53) samples, HR-positive/ERBB2-positive (n = 6) samples, and TNBCs (n = 138). Results Comparing TRPS1 results in breast carcinomas vs tumors from other organ sites, the sensitivity of TRPS1 was 91% and 87%, respectively, while the specificity was 66% and 74% for protocol 1 and 2, respectively. For TNBCs vs gynecologic tumors, the sensitivity of TRPS1 was 89% and 85%, respectively, while the specificity was 65% and 73%, respectively. Conclusions TRPS1 stains approximately 90% of breast carcinomas but also up to 71% of endometrial carcinomas, albeit with a weaker median expression. Our data show that although TRPS1 is a highly sensitive marker for TNBCs, it is not as highly specific as previously reported. [ABSTRACT FROM AUTHOR]

Introduction Squamous cell carcinoma of the cervix (SCC) accounts for 85% of the cases of cervical cancer. The most common sites of recurrence postoperatively are in the pelvis and vagina. Metastases to the abdominal wall from cervical carcinoma are rare with reported incidence of 0.1 to 2 %, and a survival rate ranging from 1 week to 7 months. Case report A 43-year-old woman with stage IB2 SCC of the cervix underwent a radical hysterectomy, with bilateral salpingo-oophorectomy and pelvic lymph node dissection at a different institution. She did not receive any adjuvant treatment, although she is considered at intermediate risk by Sedlis criteria (size of 4 cm and deep stromal invasion). Fifteen months later, she presented to our institution with a painful suprapubic rapidly growing mass. MRI of pelvis showed a 13 x11x 9 cm mass adherent to the anterior abdominal wall, to the dome of the bladder and to the small bowel with enlarged right pelvic lymph nodes. There was no evidence of intra-abdominal or distant metastases. The mass was removed en bloc, with rectus abdominus muscles, 2 segments of small bowel and a portion of the bladder, along with right pelvic lymphadenectomy. The resultant infra-umbilical abdominal wall defect measured 20 x 15 cm. It was reconstructed with an island pedicle of right thigh anterolateral vastus and vastus lateralis muscle flap. Histology showed invasive non-keratinizing moderately differentiated SCC, consistent with uterine cervical primary, involving urinary bladder, bowel and soft tissue, with negative margins and one positive right pelvic lymph node. Adjuvant treatment was delayed for 3 months to allow for complete healing as the patient had to undergo de-epithelialization of a segment of the flap. She received 6 cycles of Carboplatin, Taxol and Avastin and was then lost to follow up for 4 months. CT scan confirmed the absence of recurrence and she is currently receiving the pre-planned radiation therapy. She remains free of recurrence after 12 months of the surgery. Discussion We describe the case of a 43-year-old woman with abdominal wall lesion that turned out to be metastatic from primary cervical carcinoma. Metastatic carcinoma to the abdominal wall is uncommon. Treatment involves chemotherapy and/or radiotherapy. Two cases in the literature are similar to our case, and treatment consisted of palliative resection of the abdominal wall lesion, followed by reconstruction with various muscular flaps. Recurrence is deemed to be the result of residual occult cancer after surgical resection. Other mechanisms of spread proposed are through implantation of cancer cells at the time of surgery or via retrograde spread through the lymphatics. Conclusion The present case is uncommon because abdominal wall metastasis from SCC of the cervix after radical surgery is rare. It was also challenging since the removal of the lesion has resulted in a large soft tissue defect. However, with advancement in reconstructive surgery, extensive resection with defect closure with rotational flaps may be the standard of care in the management of abdominal wall lesion after cervical cancer in order to improve the overall survival. [ABSTRACT FROM AUTHOR]

Context.—: Unlike parotid fine-needle aspiration biopsy, standardized reporting for core needle biopsy (CNB) and incisional biopsy (IB) is not established., Objective.—: To examine the value of risk stratification by a Milan System for Reporting Salivary Gland Cytopathology (MSRSGC)-like classifier for parotid CNB/IB., Design.—: Five hundred ninety-two parotid biopsy records (CNB = 356, IB = 236) were retrieved (1994-2022) along with clinicopathologic data. Diagnoses were transformed to an MSRSGC-like classifier and compared with end points including risk of malignancy., Results.—: Over time, CNB was progressively more used compared with IB. Overall malignancy call rate was 223 of 592 (37.7%). Common specific diagnoses included Warthin tumor, lymphoma subtypes, and metastatic squamous cell carcinoma for CNB and IB, in addition to pleomorphic adenoma for CNB. Descriptive diagnoses were still frequent. Nondiagnostic rates were higher in CNB (26 of 356; 7.30%) than IB (5 of 236; 2.12%; P <.001). Tissue volumes significantly influenced CNB adequacy, with minimum and optimal volumes of 4.76 mm³ (J index, receiver operating characteristic curve) and 12.92 mm³ (95th percentile of distribution), respectively. One hundred forty-four patients (112 CNBs) had follow-up resections; diagnoses were concordant for 66 of 73 adequate CNBs (90.41%). Our restructured risk grouping of MSRSGC categories performed robustly in terms of risk of malignancy (sensitivity = 85.5%, specificity = 100%, accuracy = 92.3%, area under the curve = 0.9677)., Conclusions.—: Although CNB and IB are amenable to a risk stratification system, there are some differences as compared with fine-needle aspiration biopsy, particularly given the high baseline prevalence of malignancy. Specific diagnoses are often feasible and concordant with resection. CNB tissue volume can inform optimal and minimal sampling recommendations for adequacy., (© 2024 College of American Pathologists.)