Molecular diagnosis and immunotherapy.

Purpose of review: To describe recent insights into how molecular diagnosis can improve indication and selection of suitable allergens for specific immunotherapy and increase the safety of this therapy.

Recent findings: As specific allergen immunotherapy targets specific allergens, identification of the disease-eliciting allergen is a prerequisite for accurate prescription of treatment. In areas of complex sensitization to aeroallergens or in cases of hymenoptera venom allergy, the use of molecular diagnosis has demonstrated that it may lead to a change in indication and selection of allergens for immunotherapy in a large proportion of patients when compared with diagnosis based on skin prick testing and/or specific IgE determination with commercial extracts. These changes in immunotherapy prescription aided by molecular diagnosis have been demonstrated to be cost-effective in some scenarios. Certain patterns of sensitization to grass or olive pollen and bee allergens may identify patients with higher risk of adverse reaction during immunotherapy.

Summary: Molecular diagnosis, when used with other tools and patients’ clinical records, can help clinicians better to select the most appropriate patients and allergens for specific immunotherapy and, in some cases, predict the risk of adverse reactions. The pattern of sensitization to allergens could potentially predict the efficacy of allergen immunotherapy provided that these immunotherapy products contain a sufficient amount of these allergens. Nevertheless, multiplex assay remains a third-level approach, not to be used as screening method in current practice.

Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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A prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2, based on simple clinical parameters

This study aims to develop a prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2 (CIN 2) lesions based on simple clinical and pathological parameters. The study was conducted at Maastricht University Medical Center, the Netherlands. The prediction model was developed in a retrospective cohort of 129 women with a histological diagnosis of CIN 2 who were managed by watchful waiting for 6–24months. Five potential predictors for spontaneous regression were selected based on the literature and expert opinion and were analyzed in a multivariable logistic regression model, followed by backward stepwise deletion based on the Wald test.

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Metachronous anaplastic sarcoma of the kidney and thyroid follicular carcinoma as manifestations of DICER1 abnormalities

Anaplastic sarcoma of the kidney (ASK) is a tumor found in the pediatric age group and shows many histopathological similarities to pleuropulmonary blastoma (PPB). We present a 12-year-old girl diagnosed with ASK and, three years later, with thyroid follicular carcinoma (TFC) with DICER1 abnormalities. Germline insertion/deletion (p.G1809_S1814delinsA) and independent somatic mutations (p.E1705K in ASK, p.E1813D in TFC) were identified. All of these abnormalities are in the catalytic domain of RNase IIIb.

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Increased Plasmacytic Differentiation in Gastric Mucosa-associated lymphoid tissue Lymphomas: H. pylori Eradication Response and IgG4+ Plasma Cell Association

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is a rare extranodal marginal zone B-cell lymphoma that is often associated with plasmacytic differentiation. However, the clinicopathologic characteristics of gastric MALT lymphoma with increased plasmacytic differentiation have not yet been studied. To assess the clinicopathologic implications of gastric MALT lymphoma with increased plasmacytic differentiation, thirty-six cases with increased plasmacytic differentiation and a control group of 16 cases with minimal plasmacytic differentiation were retrospectively collected from 65 primary gastric MALT lymphomas (2010~2012).

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Use of suborbicularis oculi fat flap to cover peri-orbital bone exposure

Wide resection of recurrent basal cell carcinoma (BCC) in the peri-orbital–infraorbital–nasal area may include periosteum resection with maxillary or nasal bone exposure. The absence of vascularized periosteum makes the defect ungraftable and local flaps are often required. As an alternative to a large single flap or a combination of flaps, it is possible to turn the ungraftable portion of the defect into a graftable one. The suborbicularis oculi fat (SOOF) flap is an advancement flap that is used in aesthetic surgery for midface rejuvenation.

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