Lymphocytic ganglionitis leading to megacolon in lymphocyte-rich glioblastoma
Lymphocytic ganglionitis leading to megacolon in lymphocyte-rich glioblastoma
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DOI：
10.1016/j.jneuroim.2019.577075
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发表时间：
2019-12-15
影响因子：
3.3
通讯作者：
Anderson, Matthew P.
中科院分区：
文献类型：
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作者：
Ahrendsen, Jared T.;Anderson, Kevin R.;Anderson, Matthew P.
t细胞对癌细胞的免疫攻击是免疫检查点抑制剂在许多癌症亚型中有效性的基础，但尚未在原发性脑癌胶质母细胞瘤中得到很好的证实。免疫检查点抑制剂治疗解除对免疫系统的抑制，增强对癌症的免疫清除，在极少数情况下导致t细胞攻击外周神经节，引起淋巴细胞神经节炎。在胶质母细胞瘤中，淋巴细胞神经节炎尚未报道，检查点抑制剂也未常规使用。在这里，我们报告了一例未使用检查点抑制剂治疗的胶质母细胞瘤，其中原发肿瘤和乳糜泻和交感神经链的外周神经节以及肌肠丛被CD8（+）细胞毒性t细胞浸润。除了明显的淋巴细胞浸润外，该病例在诊断为胶质母细胞瘤后也有异常长的生存期（8年），但最终因肠梗阻而死亡。研究结果表明，t细胞免疫攻击胶质母细胞瘤可能延长生存期，但也表明，t细胞自身免疫性疾病，如淋巴细胞神经节炎，可能成为未来使用免疫靶向治疗胶质母细胞瘤的风险。
T-cell immune attack of cancer cells underlies the efficacy of immune checkpoint inhibitors in many cancer subtypes, but is not yet well established in the primary brain cancer glioblastoma. Immune checkpoint inhibitor treatments that disinhibit the immune system to enhance immune clearance of cancer have in rare cases resulted in T-cell attack of peripheral ganglia causing lymphocytic ganglionitis. In glioblastoma, lymphocytic ganglionitis has not been reported and checkpoint inhibitors are not routinely used. Here we report a case of glioblastoma not treated with checkpoint inhibitors in which the primary tumor and peripheral ganglia of the celiac and sympathetic chains, as well as myenteric plexus, are infiltrated by CD8(+) cytotoxic T-cells. In addition to the marked lymphocytic infiltrates, this case is also notable for an unusually long survival (8 years) after diagnosis with glioblastoma, but an ultimately fatal outcome due to ileus. The findings suggest T-cell immune attack of glioblastoma may prolong survival, but also suggest T-cell autoimmune diseases such as lymphocytic ganglionitis could become a risk with the future use of immune-targeted therapies for glioblastoma.