RezumatÎn echilibrul perfect dintre invazia tumorală şi sistemele noastre de apărare, rolul jucat de răspunsul imun adaptiv la nivel tumoral este critic. Dincolo de faptul că toate elementele sistemului imun ce intervin în răspunsul imun înnăscut şi cel adaptativ pot fi observate la diferite grade în micromediul tumoral, se pare că există o densitate crescută de limfocite cu memorie T citotoxice, în contextul unei orientări imune Th1 la nivel intratumoral şi al frontului de invazie tumorală, ce oferă un marker de prognostic de importanţă majoră în cancerul colorectal şi în tumorile solide în general. Înţelegerea rolului pe care imunitatea îl are în cancer, în urma unui secol de intensă cercetare, a condus la o schimbare completă a paradigmei. Pentru a arăta impactul major al acestui concept revoluţionar, vom evidenţia aici prin exemplul cancerului colorectal, cum un test imun eficient şi anume "Immunoscore" a fost dezvoltat. De asemenea, oferim date actualizate care demonstrează capacitatea Immunoscorului de a prezice cu o acurateţe superioară stadializării TNM evoluţia clinică a pacienţilor şi ghidarea strategiilor terapeutice. AbstractIn the fine balance between tumor invasion and our defensive systems, the role played by the adaptive immune response at the tumor site is critical. Beyond the fact that all the immune components of the innate and adaptive response can be observed to varying degrees in the tumor microenvironment, it appears that a high density of T cytotoxic and memory lymphocytes, in a context of Th1 immune orientation in the tumor and its invasion front, provides a prognostic marker of paramount importance for colorectal cancer and more generally all solid tumors. The understanding of the role of immunity in cancer, tailored during one century of intensive research, has led to a complete paradigm shift. In order to show the major impact of this conceptual revolution, we herein retrace through the example of colorectal cancer, how an effective immune test, namely the "Immunoscore", has been developed. We also provide up to date data demonstrating the capacity of the Immunoscore to prognosticate with a better accuracy than the TME classification clinical outcomes and to guide therapeutic strategies.

Porocarcinoma is a rare tumor of the eccrine sweat glands that usually disseminates to the regional lymph nodes, but it can also develop distant metastasis. Case presentation: We report the case of a 67 year-old female patient who underwent wide surgical resection of a left cervical cutaneous tumor in a primary care center, for which the histology exam of the specimen was mixed basal cell and squamous cell carcinoma. She was referred to our hospital's oncology clinic and histologic re-evaluation changed the diagnosis to eccrine porocarcinoma (EPC). Computer-tomography (CT) revealed cervical lymphadenopathies for which the patient underwent 4 cycles of chemotherapy, without regression. She subsequently underwent a left upper anterior jugular lymphadenectomy (group IIa) with all nodes being negative and, three months later, she developed a unique adenopathy under the parotid gland that was excised and confirmed to be metastatic. Postoperative external radiotherapy was administered with a good outcome on CT scan. Nine months after her last surgery, the patient did not show any sign of recurrence or distant metastasis. Conclusion: EPC is a challenge, both diagnostically and therapeutically. In the absence of consensus regarding the indications and extent of lymphadenectomy and adjuvant therapy, patients with EPC should be referred to an experienced multidisciplinary team in a tertiary center.

Castleman's disease (CD) is a rare disorder that involves the lymphoid system and can be unior multicentric. While it can arise in any organ that contains lymphoid tissue, most commonly is observed in the mediastinum. Abdominal localizations come second, more often in the retroperitoneum. We report the case of a 49-year-old woman presenting with biliary type dyspepsia and early post-prandial satiety whose imaging evaluations revealed uncomplicated cholelithiasis and a 3.5 cm nodule situated at the root of the mesentery. The patient was treated with surgerycholecystectomy and en bloc resection of the mesenteric root mass. Histology exam of the surgical specimen concluded for a hyaline-vascular type CD, also confirming the negative resection margins of the tumor. Postoperatively, the patient's evolution was favorable, with discharge at the 5 th postoperative day. No adjuvant treatment was necessary. The hematology evaluation excluded any underlying lymphoproliferative disorder or chronic viral infection. One year after surgery, the patient has no recurrence.