Primary esophageal small cell carcinoma (PESCC) is a weakly prevalent but lethal malignancy with early metastasis and a poor prognosis. Currently, neither effective prognostic indicators nor curative therapies are available for PESCC. Immunotherapy has now evolved into one of the most promising therapies for cancer patients. Tumor-infiltrating immune cells which are integral to the tumor immune microenvironment (TIME) are recognized as highly important for prognosis prediction, while the responsiveness to immune checkpoint blockade may be subject to the features of TIME. In this study, we aim to identify the TIME and provide indication for the applicability of immune checkpoint therapy in PESCC. We found that PD-L1 expression was detected in 33.33% (27/81) of all the patients, mostly exhibiting a stroma-only pattern and that it was positively associated with tumor-infiltrating immune cells (CD4+, CD8+, and CD163+). In 74.07% of PD-L1-positive specimens, PD-L1+CD163+ cells were colocalized more with CD4+ than CD8+ T cells. 83.95% (68/81) of all the specimens were infiltrated with more CD4+ than CD8+ T cells. Further analysis showed FoxP3+ Tregs constituted 13-27% of the total CD4+ T cell population. The Kaplan-–Meier analysis indicated several factors that contribute to poor survival, including negative PD-L1 expression, rich CD4 expression, rich FoxP3 expression, a low CD8/CD4 ratio, and a high FoxP3/CD8 ratio. A nomogram model was constructed and showed good performance for survival prediction. These results highlight that a suppressive TIME contributes to poor survival of patients with PESCC. TIME analyses might be a promising approach to evaluate the possibility and effect of immune checkpoint-based immunotherapeutics in PESCC patients.

Objective:To explore the effects of cytotoxin-associated gene A (CagA) positive Helicobacter pylori (H. pylori or HP) infection on circulating B cells producing specific platelet glycoprotein antibodies and the association between therapeutic outcomes in primary idiopathic thrombocytopenic purpura (ITP) patients.Methods:A total of 76 newly diagnosed primary ITP patients were included in the study which was conducted at the first affiliated hospital of Shantou University Medical college, in Shantou city China, between January 2013 and January 2014. These patients were tested for H. pylori infection by 13C urea breath test and for anti-CagA antibody in H. pylori positive cases by enzyme-linked immunosorbent assay (ELISA) method. Anti-GPIb and anti-GPIIb/IIIa antibody-producing B cells were measured using an enzyme-linked immunospot (ELISPOT) assay in all ITP patients and 30 controls. Anti-nuclear antibody (ANA) was also detected in ITP patients.Results:The numbers of anti-GPIIb/IIIa antibody-producing B cells in HP+CagA+ patients were higher than in HP+CagA- or HP- patients. However, anti-GPIb antibody-producing B cells were found higher in HP- patients. Analysis of treatment outcomes showed that a therapeutic response was more likely in patients presenting anti-GPIIb/IIIa B cells, but the poor response was found to be associated with anti-GPIb B cells and ANA presences.Conclusion:CagA antigen of H. pylori may induce anti-GPIIb/IIIa antibodies production by a molecular mimicry mechanism. Anti-GPIIb/IIIa and anti-GPIb antibody producing B Cells detection is useful for predicting treatment effects of primary ITP.

Objective:To examine the expressions of MDM2, P53 and P27 proteins in chronic esophagitis, para-cancer mucosa and esophageal carcinoma. Methods: Immunohistochemistry was used to detect the expressions of MDM2, P53 and P27 proteins in forty-seven patients suffering from chronic esophagitis and eighty-five cases of esophageal carcinoma and corresponding para-cancer mucosa. Flow cytometry((FCM) was applied to detect the quantities of these proteins expressed in fresh tissues of 48 cases of esophageal cancer and their para-cancer tissues and 24 cases of relative normal mucosa at the surface of cutting edge. Results: Immunohistochemistry results showed that the expressions of the three studied proteins were very similar in the epithelia of chronic esophagitis and para-cancer mucosa (Ｐ>0.05). Both the qualitative and quantitative studies displayed that the P53 protein had no expression and its accumulations would appear only in the early stages of esophagus canceration while the MDM2 and P27 proteins had different degrees of expressions in cases of normal esophageal mucosa. MDM2 protein markedly increased in the advanced stages of esophageal canceration. A quantitative study showed that the expression of P27 protein had a linearity of decreasing tendency (F=9.132，P=0.002) in the course of esophageal canceration. Conclusion: Chronic esophagitis may be a precancerous lesion. Owing to the changes of the P53 and P27 proteins, we can also conclude that these occur in the early stages of esophagus oncogenesis, however the changes of MDM2 expression may occur in the advanced stage of esophageal canceration.

Esophageal carcinoma is one of the most common malignant tumors in China, and Shantou is the high-incidence area. Histological types of the esophageal tumor are primary for squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. Myogenic, neurogenic and angiogenic tumors of the esophagus are relatively frequent, while primary malignant fibrous histiocytoma (MFH) are extremely rare, and only a few cases were reported until now. In this report, three cases polypoid tumor of the esophagus consisting of spindle and pleomorphic sarcomatous tumors cell were confirmed to be MFH of the esophagus by histological, immunohistochemical and electron microscopic methods. Case 1A 52-year-old man with difficulty in swallowing was admitted to the Department of Surgery, Cancer Affiliated Hospital, Shantou University Medical College. The patient had a long history of laryngeal pain. At a 25 cm distance from the dentition, endoscopy revealed a polyplike neoplasm 5 cm long and 3 cm in diameter on a crus originating from the esophageal wall. Subtotal esophagectomy, cervical esophago-gastrostomy and lymph node dissection were performed. Macroscopically, the tumor was 5 × 3.5 × 3 cm in size and thrombus-like. Case 2A 70-year-old man presented with a one-month history of difficulty in swallowing. Esophagogram and upper gastrointestinal endoscopy revealed a polypoid mass in the midesophagus. Endoscopic biopsies demonstrated the malignant lesion of tumor. Subtotal esophagectomy, cervical esophagogastrostomy and lymph node dissection were performed. The resected polypoid mass was elliptical and measured 7.3 × 2.8 × 2.5 cm. The tumor surface was eroded with hemorrhage ( Fig. 1), its cut surface being murking gray. Case 3A 51-year-old man was admitted to the hospital because of dysphagia. An X-ray examination with contrast media revealed a polypoid lesion in the middle part of the esophagus. The endoscopic examination detected a mobile polypoid mass in the esophageal cavity. The preoperative pathological diagnosis confirms it is a squamous cell carcinoma. Subtotal esophagectomy, cervical esophagogastrostomy and lymph node dissection were performed. The resected polypoid mass was elliptical and measured 8 × 5 × 4 cm. The tumor surface was necrosis with hemorrhage, its cut surface being gray. MethodologySamples from the surgical operation were routinely fixed, embedded and stained with hematoxylin and eoAbstract We reported three cases of polypoid tumor of the esophagus, among them one case of sarcomatous tumor partly covered with superficial squamous cell carcinoma. The sarcoma was consisted of anaplastic spindle and pleomorphic tumor cells, which was similar to malignant fibrous histiocytoma (MFH) of the soft tissue. Diagnosis of the surgery resected specimen was confirmed by histological, immunohistochemical and electron microscopic methods. Both diagnostic and differential diagnostic problems of primary MFH of the esophagus and world medical literatures were discussed.