Virtual Library
Start Your Search
Shunta Ishihara
Author of
-
+
P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
-
+
P1.14-11 - The Expression Pattern of Programmed Death-Ligand 1 According to the Pathological Type of Malignant Thymic Epithelial Tumors (ID 12665)
16:45 - 18:00 | Presenting Author(s): Shunta Ishihara
- Abstract
Background
Malignant thymic epithelial tumors (TETs) have pathological types ranging from low-grade to high-grade malignancy, while the pattern of PD-L1 expression remains unclear. We investigated PD-L1 expression in TETs and verified the pattern of expression associated with the pathological type.
a9ded1e5ce5d75814730bb4caaf49419 Method
We examined 66 malignant TETs. Immunohistochemical evaluation of PD-L1 expression was performed using anti-PD-L1 antibody (SP263). We calculated the tumor cell positive rate (Total Proportion Score: TPS) of PD-L1 expression. The discrimination of the tumor region was confirmed by immunostaining with anti-pan-cytokeratin antibody (AE1AE3). PD-L1 expression was examined for each type of histological classification of TETs. We classified a High TPS group (H group) and Low TPS group (L group) using a TPS cut-off value of 25% and examined the correlation with clinical background and prognosis. We classified Type B2, B3, and thymic carcinomas into a high-malignancy group. PD-L1 expression was also digitally analyzed based on Whole Slides Imagings (WSI) for objective analysis as Digital TPS.
4c3880bb027f159e801041b1021e88e8 Result
We identified WHO histological types (Type A/AB/B1/B2/B3/metaplastic tumor/thymic carcinomas = 8/19/5/15/6/2/11). In Type A, PD-L1 expression was low in most cases and the median of TPS was 22%. In Type AB, Type A and B regions showed low and high TPS, respectively, and the median was 23%. In Type B1, TPS was low in most cases and the median was 26%. In Type B2, TPS was higher than that in Type B1, and the median was 69%. In Type B3, TPS was high (>50%) in all cases and the median was 86%. The PD-L1 expression of thymic carcinomas ranged from low to high and the median was 28%. Metaplastic tumors showed scanty PD-L1 expression. The High PD-L1 group showed more advanced disease stages according to the Masaoka stage and TMN classification, and the TPS of Type B2 and B3 was significantly higher than that of Type A, AB and B1. The disease-free survival rate was significantly lower in the H group than that in the L group. When we examined the prognosis in high-malignancy group, there were no significant differences in the disease-freel and overall survival rates by TPS. Based on measurements using WSI, Digital TPS correlated with visual TPS (correlation coefficient=0.85,pvalue<0.001).
8eea62084ca7e541d918e823422bd82e Conclusion
TETs had the characteristic features of the PD-L1 expression according to histological types. Type B2 and B3 thymomas was higher PD-L1 expression than the other types of TETs.
6f8b794f3246b0c1e1780bb4d4d5dc53
-
+
P3.CR - Case Reports (Not CME Accredited Session) (ID 984)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
-
+
P3.CR-31 - A Case of Thymoma with Autoimmune Hepatitis Following Preoperative Chemotherapy (ID 13065)
12:00 - 13:30 | Author(s): Shunta Ishihara
- Abstract
Background
We encountered a case of thymoma with autoimmune hepatitis.
a9ded1e5ce5d75814730bb4caaf49419 Method
A 63-year-old woman was found to have an abnormal finding on chest radiography during a medical checkup, but did not seek further care. She was referred to our hospital one year later when a bilateral hilar abnormality was again found during a checkup. Chest computed tomography (CT) showed a 4.6 × 3.0 × 5.6 cm mass with calcifications in the anterior mediastinum. The tumor invaded the right lung and middle lobe, in association with a 2.0-cm daughter nodule in the head of the main tumor, with multiple pleural seeding lesions in the right thoracic cavity. Although she was asymptomatic, the anti-acetylcholine receptor antibody level was elevated to 33 nmol/L and the soluble IL-2 receptor antibody was elevated to 1,700 U/mL. The mass was diagnosed with CT-guided biopsy as a type-B2 thymic tumor (cT3N0M1a, c-Stage IV). She underwent induction chemotherapy (ADOC, 2 courses). After chemotherapy, abnormal liver enzyme levels (aspartate aminotransferase: 451 U/L, alanine aminotransferase: 529 U/L) were noted on preoperative examination. She was diagnosed with autoimmune hepatitis based on liver biopsy findings and treated with oral prednisolone 30 mg.
4c3880bb027f159e801041b1021e88e8 Result
Surgery was performed after prednisolone dose was gradually decreased to 20 mg. Extended thymectomy and pulmonary wedge resection using median sternotomy were performed. Pleural dissemination was resected using video-assisted thoracoscopic surgery. The pathological findings showed type-B3 thymic carcinoma (pT3N0M1a, p-Stage IV, Masaoka classification IVa). She was placed under observation without any additional treatment. Prednisolone dose has been gradually decreased to 15 mg without exacerbation of liver function. The anti-acetylcholine receptor antibody level decreased after surgery.
8eea62084ca7e541d918e823422bd82e Conclusion
Autoimmune diseases in association with thymoma are well known, but reports of autoimmune hepatitis are very rare. Autoimmune hepatitis must be considered when acute liver damage is observed.
6f8b794f3246b0c1e1780bb4d4d5dc53
