帕博利珠单抗诱导的甲状腺炎在甲状腺组织中显示 PD-L1 表达的组织细胞和浸润的 T 细胞 - 病例报告。
Pembrolizumab-Induced Thyroiditis Shows PD-L1Expressing Histiocytes and Infiltrating T Cells in Thyroid Tissue - A Case Report.
机构信息
Department of Dermatology, Ordensklinikum Linz (Elisabethinen), Linz, Austria.
Institute of Pathology, Steyr Hospital, Steyr, Austria.
出版信息
Front Immunol. 2021 Jun 18;12:606056. doi: 10.3389/fimmu.2021.606056. eCollection 2021.
CONTEXT
Immune-related adverse events frequently take place after initiation of immune checkpoint inhibitors (ICI) therapy. The thyroid gland is the endocrine organ most commonly affected by ICI therapy, the pathological mechanism is still poorly understood.
CASE DESCRIPTION
A 60-year old Upper Austrian male melanoma patient under pembrolizumab therapy received thyroidectomy because of a suspicious FDG avid thyroid nodule. Histopathology showed a pattern comparable with thyroiditis de Quervain. The inflammatory process consisted predominantly of T lymphocytes with a dominance of CD4+ T helper cells. In addition CD68+ histiocytes co-expressing PD-L1 were observed.
CONCLUSION
Clusters of perifollicular histiocytes expressing PD-L1 were observed in this case of pembrolizumab induced thyroiditis - probably induced by the former ICI therapy. This finding might indicate the initial target for the breakdown of self tolerance. In context with other data the immunological process seems to be driven by CD3+ lymphocytes infiltrating the thyroid.
背景
免疫检查点抑制剂（ICI）治疗后常发生免疫相关不良反应。甲状腺是最常受 ICI 治疗影响的内分泌器官，但其病理机制仍知之甚少。
病例描述
一名 60 岁的上奥地利男性黑色素瘤患者在接受 pembrolizumab 治疗期间，因可疑 FDG 摄取性甲状腺结节而行甲状腺切除术。组织病理学显示类似于桥本甲状腺炎的表现。炎症过程主要由 T 淋巴细胞组成，其中 CD4+T 辅助细胞占优势。此外，还观察到共表达 PD-L1 的 CD68+组织细胞。
结论
在 pembrolizumab 诱导的甲状腺炎病例中观察到滤泡周围组织细胞簇表达 PD-L1，可能是由先前的 ICI 治疗引起的。这一发现可能表明自身耐受破坏的初始靶标。结合其他数据，免疫过程似乎是由浸润甲状腺的 CD3+淋巴细胞驱动的。
Zotero 插件