Hepatocellular carcinoma(HCC)is rarely associated with autoimmune paraneoplastic syndromes.We report a case of anti-transcriptional intermediary factor-1 gamma(TIF1-γ)-positive dermatomyositis(DM)as clinical presenta...Hepatocellular carcinoma(HCC)is rarely associated with autoimmune paraneoplastic syndromes.We report a case of anti-transcriptional intermediary factor-1 gamma(TIF1-γ)-positive dermatomyositis(DM)as clinical presentation of HCC recurrence in a 72-year-old male patient admitted to our hospital due to fatigue,myalgia,and typical skin rash.His medical history was notable for hepatitis C-related cirrhosis,successful treatment with direct-acting antiviral agents,and previously efficacious treatment of HCC.Laboratory testing showed significant rhabdomyolysis with antiTIF1-γantibodies at high titer,and DM was diagnosed.After a careful diagnostic workup,HCC recurrence was diagnosed.After first-line corticosteroid treatment,azathioprine and intravenous immunoglobulin treatments were administered;unfortunately,he mounted only partial response.Owing to the compromised performance status,no HCC treatment was feasible,and,according to international guidelines,he received only best supportive care.Here,we discuss the diagnostic,prognostic,and pathogenic roles of anti-TIF1-γantibodies associated with paraneoplastic DM and the scant literature data on its occurrence in HCC patients.Considering the TIF1 gene family’s established role in oncogenesis,we also review the role of TIF1-γas a tumor-related neoantigen,leading to the development of clinically overt antiTIF1-γantibodies-positive DM.展开更多
AIM:To determine the expression and clinical significance of transcriptional intermediary factor 1 gamma (TIF1γ),Smad4 and transforming growth factor-beta (TGFβR) across a spectrum representing colorectal cancer (CR...AIM:To determine the expression and clinical significance of transcriptional intermediary factor 1 gamma (TIF1γ),Smad4 and transforming growth factor-beta (TGFβR) across a spectrum representing colorectal cancer (CRC) development.METHODS:Tissue microarrays were prepared from archival paraffin embedded tissue,including 51 colorectal carcinomas,25 tubular adenomas (TA) and 26 HPs,each with matched normal colonic epithelium.Immunohistochemistry was performed using antibodies against TIF1γ,Smad4 and TGFβ RⅡ.The levels of expression were scored semi-quantitatively (score 0-3 or loss and retention for Smad4).RESULTS:Overexpression of TIF1γ was detected in 5/26 (19%) HP;however,it was seen in a significantly higher proportion of neoplasms,15/25 (60%) TAs and 24/51 (47%) CRCs (P<0.05).Normal colonic mucosa,HP,and TAs showed strong Smad4 expression,while its expression was absent in 22/51 (43%) CRCs.Over-expression of TGFβ RⅡ was more commonly seen in neoplasms,13/25 (52%) TAs and 29/51 (57%) CRCs compared to 9/26 (35%) HP (P<0.05).Furthermore,there was a correlation between TIF1γ overexpression and Smad4 loss in CRC (Kendall tau rank correlation value=0.35,P<0.05).The levels of TIF1γ overexpression were significantly higher in stage Ⅲ than in stage Ⅰ and Ⅱ CRC (P<0.05).CONCLUSION:The findings suggest that over-expression of TIF1γ occurs in early stages of colorectal carcinogenesis,is inversely related with Smad4 loss,and may be a prognostic indicator for poor outcome.展开更多
文摘Hepatocellular carcinoma(HCC)is rarely associated with autoimmune paraneoplastic syndromes.We report a case of anti-transcriptional intermediary factor-1 gamma(TIF1-γ)-positive dermatomyositis(DM)as clinical presentation of HCC recurrence in a 72-year-old male patient admitted to our hospital due to fatigue,myalgia,and typical skin rash.His medical history was notable for hepatitis C-related cirrhosis,successful treatment with direct-acting antiviral agents,and previously efficacious treatment of HCC.Laboratory testing showed significant rhabdomyolysis with antiTIF1-γantibodies at high titer,and DM was diagnosed.After a careful diagnostic workup,HCC recurrence was diagnosed.After first-line corticosteroid treatment,azathioprine and intravenous immunoglobulin treatments were administered;unfortunately,he mounted only partial response.Owing to the compromised performance status,no HCC treatment was feasible,and,according to international guidelines,he received only best supportive care.Here,we discuss the diagnostic,prognostic,and pathogenic roles of anti-TIF1-γantibodies associated with paraneoplastic DM and the scant literature data on its occurrence in HCC patients.Considering the TIF1 gene family’s established role in oncogenesis,we also review the role of TIF1-γas a tumor-related neoantigen,leading to the development of clinically overt antiTIF1-γantibodies-positive DM.
基金Supported by Department of Pathology Research Fund,NYU School of Medicine,New York,NY 10016,United States
文摘AIM:To determine the expression and clinical significance of transcriptional intermediary factor 1 gamma (TIF1γ),Smad4 and transforming growth factor-beta (TGFβR) across a spectrum representing colorectal cancer (CRC) development.METHODS:Tissue microarrays were prepared from archival paraffin embedded tissue,including 51 colorectal carcinomas,25 tubular adenomas (TA) and 26 HPs,each with matched normal colonic epithelium.Immunohistochemistry was performed using antibodies against TIF1γ,Smad4 and TGFβ RⅡ.The levels of expression were scored semi-quantitatively (score 0-3 or loss and retention for Smad4).RESULTS:Overexpression of TIF1γ was detected in 5/26 (19%) HP;however,it was seen in a significantly higher proportion of neoplasms,15/25 (60%) TAs and 24/51 (47%) CRCs (P<0.05).Normal colonic mucosa,HP,and TAs showed strong Smad4 expression,while its expression was absent in 22/51 (43%) CRCs.Over-expression of TGFβ RⅡ was more commonly seen in neoplasms,13/25 (52%) TAs and 29/51 (57%) CRCs compared to 9/26 (35%) HP (P<0.05).Furthermore,there was a correlation between TIF1γ overexpression and Smad4 loss in CRC (Kendall tau rank correlation value=0.35,P<0.05).The levels of TIF1γ overexpression were significantly higher in stage Ⅲ than in stage Ⅰ and Ⅱ CRC (P<0.05).CONCLUSION:The findings suggest that over-expression of TIF1γ occurs in early stages of colorectal carcinogenesis,is inversely related with Smad4 loss,and may be a prognostic indicator for poor outcome.
