Selective internal radiotherapy (SIRT) is a safe and efficacious, minimally invasive procedure to treat primary and secondary unresectable liver tumors. For hepatocellular carcinoma (HCC), SIRT has proven to be a well-tolerated therapy option even in advanced stages of disease. In cases of portal vein thrombosis SIRT is the alternative to transarterial chemoembolization (TACE). The role of SIRT regarding downstaging and bridging to transplantation is promising and SIRT has also been shown to be highly effective and well-tolerated in metastastic liver disease. The results of prospective randomized trials are awaited to prove the efficiency and safety of SIRT described in numerous retrospective and prospective non-randomized studies. The indications are established within the framework of a tumor board.

While there is agreement that quality of life (QoL) is a central aim of medical treatment, the methods of its evaluation as well as its role in the patient’s overall treatment experience are under continuous scrutiny. Different perspectives on patients’ QoL have emerged; from the treating physician, from the psychologist, and naturally from the patient him/herself. This article provides insights into each of these views within the context of thyroid cancer where, as a consequence of increasing incidence and decreasing mortality rates, QoL aspects deserve close attention. Physicians often find themselves in situations where they perform a balancing act between what they know is best from a somatic point of view and learning about what is best for the individual patient. For psychologists in the field of oncology, a main area of interest is the incorporation of the patient’s perspective into research by using patient-reported outcomes (PROs) which include QoL assessment. PROs can also be used in clinical practice as a way to start a conversation about symptoms and QoL aspects that perhaps patients might not volunteer, and this allows physicians to address QoL issues more directly. Patients usually appreciate being asked about all aspects of QoL, and need sound information about how their QoL might be affected by the disease and its treatment. By examining and understanding the different perspectives on QoL, and how QoL differs in patients with thyroid cancer compared with other cancers, it is hoped that the QoL can be enhanced in this particular patient group.

Die SIRT ist ein sicheres und effizientes, minimal-invasives nuklearmedizinisch-radiologisches Verfahren zur Therapie von primären und sekundären nicht resezierbaren Lebertumoren. Beim hepatozellulärem Karzinom (HCC) stellt die SIRT eine gut verträgliche Therapieoption auch in fortgeschrittenem Stadium dar.

Background Rheumatoid arthritis (RA) has a defi nite autoimmune pathogenesis.Rising evidence suggests that deregulated and/or defi cient clearance of apoptotic materials may lead to the release of potential autoantigens provoking a break in the self-tolerance mechanism.Major autoantigens in RA include immunoglobulin G, the target of rheumatoid factor (RF), citrullinated proteins and the heterogeneous nuclear ribonucleoprotein (hnRNP) A2.To gain more insight into the role of apoptotic processes in lymphoid tissues in the generation of arthritogenic autoantigens, we studied the autoimmune responses in the pristane-induced arthritis (PIA) model which shows some striking similarities with human RA, including symmetrical polyarthritis, massive bone erosion and the presence of RF and autoantibodies to hnRNP-A2.Methods Pristane (2,6,10,14-tetramethylpentadecane) was injected intradermally at the base of the tail into DA.1Frats.Lymph nodes were analysed by immunohistochemistry and immunoblotting at various time points after pristane application.The fate of potential neoantigens, particularly hnRNP-A2, during apoptosis of lymphoid cells was studied in cultured cells by inducing apoptosis with agents such as etoposide or anti-Fas antibody, or by cultivating cells in the presence of pristane/cyclodextrine complexes.To investigate apoptotic cleavage of hnRNP-A2 in vitro, caspase digestion assays were performed.Results Three days after pristane application the amount of apoptotic cells was strongly increased in draining inguinal lymph nodes of DA.1F rats compared with naïve animals.Immunoblotting analysis of inguinal lymph nodes revealed cleavage of hnRNP-A2.Furthermore, a cleaved product of hnRNP-A2 was also detected in cellular apoptosis assays performed with human peripheral blood cells and rat splenocytes.Cleavage was most pronounced after apoptosis induction via the Fas receptor.Interestingly, the cleaved product was preferentially detected in cell supernatants compared with cell lysates, whereas the intact protein was found in similar amounts in lysates and supernatants.Furthermore, both caspase 3 and caspase 6 were able to effi ciently cleave recombinant hnRNP-A2 in vitro.The in vivo relevance of these fi ndings was further strengthened by results obtained with pristane-cyclodextrine complexes which were able to induce apoptosis in both human and rat cells.Conclusion Pristane induces apoptosis in draining lymph nodes leading to cleavage of hnRNP-A2 by proteolytic enzymes such as caspase 3 or caspase 6.This suggests a mechanism for the generation of neoepitopes which are subsequently targeted by arthritogenic T cells.These data further strengthen the view of hnRNP-A2 as a key player in the pathogenesis of PIA and possibly also human RA.

BackgroundMonitoring and repeated staging is of substantial importance in many patients with primary cutaneous T-cell lymphomas (CTCL). For primary cutaneous B-cell lymphomas (CBCL), extensive initial staging is the mainstay for correct diagnosis.AimTo evaluate the value of somatostatin receptor scintigraphy using the radiolabeled somatostatin analog 111In-pentetreotide in comparison to conventional imaging methods for the staging of patients with primary CTCL and primary CBCL.MethodsTwenty-two patients (15 patients with histologically verified CTCL and 7 patients with histologically verified CBCL) were included. Stage of disease was established by physical examination, laboratory screening, skin inspection, palpation of superficial lymph nodes, sonography and computed tomography (CT) in patients with advanced clinical stage. Focally elevated tracer uptake of 111In-pentetreotide was compared to common imaging modalities, physical aspect and digital photographs of the respective skin lesions.ResultsOf the 15 patients with CTCL, only 4 (27%) showed positive scintigraphic results, but not in all sites of lymphomatous involvement. None of the five patients with mycosis fungoides in stage I, nor any of the four patients with Sezary syndrome, had a positive 111In- pentetreotide scan. Of the seven patients with CBCL three positive scintigraphic results (43%) could be obtained: in two patients with a follicular center lymphoma and one patient with a diffuse large B-cell lymphoma - leg type, but again not in all apparent sites of lymphoma.ConclusionsBased on our results, we do not recommend the use of somatostatin receptor scintigraphy for routine staging of patients with CTCL and CBCL. As our series includes only 22 patients, and the number of patients with rarer variants of CTCL was rather small, it might be too premature to abandon SST-R in the staging of patients with cutaneous lymphomas.

Toll-like receptor (TLR)-mediated autoimmunity to nucleic acid-protein complexes has been implicated in the pathogenesis of systemic lupus erythematosus, whereas information regarding the influence of nucleic acid sensing TLRs on the development of rheumatoid arthritis (RA) is scarce. The authors have recently shown that the nucleic acid-binding autoantigen heterogeneous nuclear ribonucleoprotein (hnRNP)-A2 is not …

BACKGROUND Autoimmune diseases have been implicated in the genesis of MALT lymphoma of various localizations. The development of thyroidal MALT lymphoma has been described as an adverse event in patients suffering from long-standing chronic autoimmune thyroiditis (CAT, Hashimoto's thyroiditis). The percentage and possible association between CAT and extrathyroidal MALT lymphoma, however, have not been assessed so far. PATIENTS AND METHODS A retrospective analysis of 80 patients with MALT lymphoma diagnosed and treated at our institution identified a total of 13 patients (16%) with MALT lymphoma suffering from an underlying CAT. Patient characteristics including site of disease, stage, genetic changes and clinical course were assessed and evaluated. RESULTS In total, 10 patients were female and 3 male, with the median age being 57 years (range: 31-80). Four patients suffered from thyroidal lymphoma and nine patients had extrathyroidal lymphoma (four gastric, two orbital, one small intestinal and two salivary gland lymphomas). Three patients had a long-standing history of CAT at diagnosis of MALT lymphoma, while CAT was discovered during staging and clinical work-up of MALT lymphoma in the remaining 10 patients. All 13 patients had localized disease, i.e. stage I or II. Only one of the four patients with gastric MALT lymphoma responded to antibiotic treatment against Helicobacter pylori infection. Genetic aberrations were detected in four patients, two of whom had a t(11;18)(q21;q21) translocation, one patient had trisomies 3 and 18 and one had trisomy 18. CONCLUSION Our findings suggest that CAT is found in patients with not only thyroidal but also nonthyroidal MALT lymphoma. While the nature of our data does not allow for delineation of a direct association between CAT and development of extrathyroidal MALT lymphoma, further prospective studies on this issue are warranted.