南口 早智子

OBJECTIVE: Central nervous system (CNS) solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms with a high propensity for local recurrence and extracranial metastasis. Although surgery and radiotherapy are the mainstays of treatment, systemic therapeutic options for recurrent disease remain limited. Pazopanib, a multitargeted tyrosine kinase inhibitor, has demonstrated clinical activity in extracranial SFTs; however, evidence in CNS SFTs is scarce. METHODS: We conducted a retrospective, single-institution study of patients with recurrent CNS SFTs treated with pazopanib. Clinical data, including prior treatments, imaging responses, treatment duration, and adverse events, were collected from medical records. Exploratory next-generation sequencing-based cancer panel testing was performed in two patients. RESULTS: Four patients with recurrent CNS SFTs were included. All had undergone prior surgical resection and radiotherapy. Pazopanib achieved partial response in one patient and stable disease in three patients, with treatment durations ranging from 7 months to over 2 years. One patient experienced disease progression after an initial period of response. Adverse events, including fatigue, gastrointestinal symptoms, and hypertension, were observed in all patients but were generally manageable with supportive care or dose adjustment. Exploratory molecular profiling identified various genomic alterations in two patients. CONCLUSIONS: In this single-institution retrospective series, pazopanib provided durable disease control with acceptable tolerability in selected patients with recurrent CNS SFTs. These findings support considering pazopanib as a systemic treatment option when further local therapies are not feasible, while highlighting the need for larger multicenter studies.

B cells play a critical role in tumor immunity, with their presence associated with improved prognosis in various cancers, including endometrial cancer (EC). However, the nature of the B-cell response within the tumor microenvironment (TME) remains incompletely understood. In this study, we conducted single-cell analyses of B cells and CD4+ T cells in the TME of EC. We found that the TME of EC harbored abundant plasmablasts and plasma cells (PCs), which were rare in normal endometria. PCs primarily expressed either IgG or IgA, and a high abundance of IgG in TME was associated with better overall survival. B-cell receptor (BCR) repertoire analysis revealed a clonal expansion of IgG+ B cells, coinciding with an increased presence of T follicular helper (Tfh) cells in the TME. Notably, Tfh cells shared T-cell receptor clones with cycling CD4+ T cells, indicating local proliferation. BCR repertoire analysis also suggested that IgG+ PCs differentiate from IFN-responding B cells and double-negative B cells in the TME. Additionally, recombinant oligoclonal IgG antibodies were found to recognize antigens expressed by tumor cells as well as normal endometrial cells. Collectively, our study shows that the clonal expansion of IgG+ B cells, along with the Tfh cell response, is associated with a better outcome in EC.

Herein, we present the first case of chronic Campylobacter fetus infection-related glomerulonephritis (IRGN) in a 69-year-old man with a permanent cardiac pacemaker. The patient had a prior episode of fever and glomerulonephritis of undetermined etiology, and at that time, low-dose steroid therapy resulted in improved urinary findings and kidney function. This time the patient again developed deterioration of kidney function with microhematuria, proteinuria, high serum C-reactive protein levels, and positive titers of anti-double-stranded DNA antibody and proteinase 3 anti-neutrophil cytoplasmic antibody (ANCA). A kidney biopsy revealed endocapillary and mesangial hypercellularity, interstitial infiltration of neutrophils, and positive staining for C3 and IgM in the mesangium and glomerular capillary walls. Notably, histological staining for nephritis-associated plasmin receptor (NAPlr)/plasmin activity was also positive. Similar laboratory and pathological findings in the first and second kidney biopsies and repeated detection of C. fetus in blood cultures led to the diagnosis of IRGN associated with persistent pacemaker-related infection. The nephritis improved following antibiotic therapy targeting C. fetus. C. fetus can cause sustained bacteremia and prolonged infection of indwelling devices, and can be a causative organism for recurrent IRGN. Clinicians must distinguish IRGN from autoimmune diseases such as lupus nephritis and ANCA-associated vasculitis.

ABSTRACT Background Subamniotic or subchorionic hematoma (SAH/SCH) is associated with diverse pregnancy outcomes. The clinical implications of accompanying oligohydramnios and hemorrhagic amniotic fluid on MRI remain unclear. Purpose To investigate the importance of oligohydramnios and hemorrhagic amniotic fluid on placental MRI for SAH/SCH in risk stratification. Study Type Retrospective. Population Seventy‐one singleton pregnancies with SAH/SCH identified on placental MRI performed during the second or third trimesters, from 2016 to 2023. Field Strength/Sequence 1.5 T, Fat‐saturated T1‐weighted gradient echo and half‐Fourier‐acquired single‐shot turbo spin echo sequences. Assessment Cases were classified into three groups: Groups A (oligohydramnios and hemorrhagic amniotic fluid), B (either oligohydramnios or hemorrhagic amniotic fluid), and C (SAH or SCH only). Groups B and C were subclassified as B‐1 (oligohydramnios), B‐2 (hemorrhagic amniotic fluid), C‐1 (detected hematoma on ultrasound before MRI), and C‐2 (incidentally detected hematoma on MRI). Unfavorable obstetric outcome (abortion or birth before 34 gestational weeks) and neonatal outcome (duration of neonatal intensive care unit [NICU] stay) were compared. Statistical Tests Fisher's exact test, Kruskal–Wallis test, Mann–Whitney U test, and Kaplan–Meier analysis with Log‐rank test. Significance was determined at p  < 0.05. Results Unfavorable obstetric outcomes were significantly higher in Group A (11/12, 91.7%) than groups B (6/17, 35.3%) and C (9/42, 21.4%). Significant differences were found among the five subclassified groups, most notably between B‐1 and B‐2. The median duration of NICU stay was 87, 30.5, 0, 25, and 8 days in Groups A ( n  = 12), B‐1 ( n  = 5), B‐2 ( n  = 12), C‐1 ( n  = 11), and C‐2 ( n  = 31), respectively. Group A showed the worst neonatal outcomes. Data Conclusion MRI findings of oligohydramnios and/or hemorrhagic amniotic fluid in pregnancies with SAH/SCH are associated with adverse obstetric and neonatal outcomes, supporting risk stratification. Evidence Level 4. Technical Efficacy Stage 5.