Controvers y continues to attend the routine histologi c examina tion ofto nsillec tomy speeimens. We perfonn ed a retrospective eva luation of400 tonsil specimens removed f rom 200 pati ents. Wefound that 68.3% of the specimens contained rea ctive lymphoid hyp erpl asia, J3.5% hadfo llicular hyperplas ia, 10.0% represented acute or chronic tons illitis, and 7.5% were normal. Only one case of malignan cy was detected: a non-Hodgk in 's lymphotna in one tonsil of a patient who was a cigare tte smoke r and who had asymmetric tOIlSi/S. The results of our study, taken in combination with data already published in the literature, indicate that routine histologic examination of tonsillectom y speci mens is unnecessary and resul ts only in added costs and a loss of man-hours. Ho wever, in patients who have certain pre op erative risk fa ctors, a hist opathologic evaluation of tonsillar spe cimens remahu mandatory.

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Background: Granular cell tumors (GCTs) are extremely rare lesions of the urinary bladder with only nine cases being reported in world literature of which one was malignant. Generally believed to be of neural origin based on histochemical, immunohistochemical, and ultrastructural studies; they mostly follow a clinically benign course but are commonly mistaken for malignant tumors since they are solid looking, ulcerated tumors with ill-defined margins.

Background: As a single agent, rituximab produces an overall response rate (ORR) of 20-50% in patients with relapsed/refractory (r/r) B-cell non-Hodgkin lymphomas (NHL). Acquired resistance occurs, however, partially due to defective host immune effector mechanisms. Efforts to augment immune function have included combining rituximab with immune modulators such as IL-2, IL-12, interferonand lenalidomide. These efforts have resulted in improved efficacy of rituximab. Ipilimumab is a human IgG1κ monoclonal antibody (mAb) specific for the cytotoxic T lymphocyte-associated antigen-4 (CTLA-4, CD152) expressed on activated T cells. CTLA-4 is a negative regulator of T-cell responses. Ipilimumab augments the immune response by disrupting the interaction of CTLA-4 with its ligands, B7-1 (CD80) and B7-2 (CD86). We therefore hypothesize that ipilimumab will augment the efficacy of rituximab. This phase I with an expansion cohort was designed to assess the safety of this combined therapy. Methods: Patients ≥ 18 years old with r/r CD20+ NHL, measurable disease, KPS ≥ 70%, neutrophils ≥ 1000, platelets ≥ 50,000 and adequate kidney and liver function were eligible. In this phase I with an expansion cohort, after establishing the recommended Phase II dose (RP2D), study patients would be randomized to differing treatment schedules of rituximab and ipilimumab. For induction in phase I, rituximab was given every week for four weeks and ipilimumab was administered every 3 weeks for 4 doses. Primary endpoints included toxicity and determination of the maximum tolerated dose (MTD)/RP2D during the first 7 weeks of induction of ipilimumab (2 doses) when given in combination with rituximab (4 doses, 375mg/m2 per dose). Secondary end points included immune response, ORR and progression free survival (PFS). In the phase I component, a standard 3+3 design was used to determine the MTD/RP2D. After the RP2D was established, 20 more patients would be randomized to one of two schedules: Arm A - ipilimumab on Day 1 together with the first dose of rituximab, or Arm B - ipilimumab on Day 15 together with the third rituximab dose. After induction in both the Phase I and the expansion cohorts, ipilimumab and rituximab were given every 12 weeks (+/- 1 week) on the same day for 1 year. Results: As of August 1 2015, 21 patients have been enrolled (1SLL, 9FL, 6DLCL, 1MCL, 4 indeterminate): 15 are evaluable for toxicity assessment at 7 weeks. The median age was 62 (32-71) and the median number of prior regimens was 2 (1-6). The RP2D of ipilimumab when given with rituximab (375 mg/m2) was 3 mg/kg, which was the highest dose tested. The most common grade 1-2 AEs (>20%) were:anemia (33%); diarrhea (20%); constipation (27%); nausea/vomiting (33%); fatigue (40%); anorexia (33%); low albumin (53%); hypocalcemia (33%); hyponatremia (27%). The most common grade 3-4 AEs (≥ 5%) were: anemia (20%); diarrhea (13%); leukopenia (13%); and hyponatremia (27%). There were no study related deaths. Twelve patients remain on treatment, 6 came off due to progression, 2 due to toxicity, and there was one death (unrelated). Conclusion: The RP2D of ipilimumab when given in combination with rituximab is 3 mg/kg. This dose is safe and moderately well tolerated. Enrollment continues in the expansion cohort to assess efficacy and the ability of ipilimumab to augment the rituximab-mediated immune response. Disclosures Off Label Use: Ipilimumab to augment rituxan in treating lymphoma. Chen:Merck: Consultancy, Research Funding; genentech: Consultancy, Speakers Bureau; Millennium: Consultancy, Research Funding, Speakers Bureau; Seattle Genetics: Consultancy, Research Funding, Speakers Bureau.