Purpose:The negative regulatory programmed death-1/programmed death-1ligand (PD-1/PD-L) pathway inT-cell activation has been suggested to play an important role in tumor evasion from host immunity. In this study, we investigated the expression of PD-L1 and PD-L2 in human esophageal cancer to define their clinical significance in patients'prognosis after surgery. Experimental Design: PD-L1 and PD-L2 gene expression was evaluated in 41esophagectomy patients by real-time quantitative PCR. The protein expression was also evaluated with newly generated monoclonal antibodies that recognize human PD-L1 (MIH1) and PD-L2 (MIH18). Results: The protein and the mRNA levels of determination by immunohistochemistry and realtime quantitative PCR were closely correlated. PD-L^positive patients had a significantly poorer prognosis than the negative patients. This was more pronounced in the advanced stage of tumor than in the early stage. Furthermore, multivariate analysis indicated that PD-L status was an independent prognostic factor. Although there was no significant correlation between PD-L1 expression and tumor-infiltrating T lymphocytes, PD-L2 expression was inversely correlated with tumor-infiltrating CD8 + Tcells. Conclusions:Thesedatasuggest thatPD-L1andPD-L2statusmaybeanewpredictorofprognosis for patients with esophageal cancer and provide the rationale for developing novel immunotherapy of targeting PD-1/PD-L pathway.

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An 87-year woman with pain in left coxa and left leg had a medical examination to another hospital. She was diagnosed by abdominal CT scan as the left obturator hernia, and presented to our hospital. The abdominal CT scan suggested the left obturator hernia, but the small bowel obstruction was not presented. We diagnosed her illness as the left obturator hernia with the Howship-Romberg sign, and without the small bowel obstruction. So, we performed an elective laparoscopic surgery on the patient. It was possible to observe the intraperitoneal space, and repaired the hernia orifice with the mesh sheet in a good view. The post operative course was uneventful. The obturator hernia without the small bowel obstruction is very rare. I give a presentation such a case be a standard treatment procedure for operating of the laparoscopic surgery.

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