Journal of Pathology and Translational Medicine

Original Article

The impairment of CD3⁺ T lymphocytes in sentinel lymph node of high-risk cutaneous melanoma patients in stage IIB and IIC: Emilija Filipović, Katarina Mirjačić Martinović, Ognjen Živković, Nataša Medić Milijić, Ana Lazarević, Zoran Bukumirić, Marko Jevrić, Milan Žegarac; J Pathol Transl Med. 2026;60(4):422-435. Published online July 15, 2026; DOI: https://doi.org/10.4132/jptm.2026.04.02

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Abstract PDF: Background
The sentinel lymph node (SLN) in melanoma is almost always the first site of metastasis and its histopathological assessment is essential for the determination of staging and clinical outcome. Furthermore, this procedure offers the investigation of the early immune response in SLN as melanoma-derived factors suppress the immunity in an early stage that may facilitate metastasis. A better understanding of the immunological changes in SLN may help in the therapeutic stimulation of melanoma immunity to prevent tumor metastasis. Methods: SLN tissues without malignant cells from 74 cutaneous melanoma patients (stage I and II) were analyzed. By flow cytometry, we measured the percentage of natural killer cells, CD3+ T lymphocytes, and their expression of interferon-γ (IFN-γ) and inhibitory immune checkpoint molecules (ICMs), and the percentage of CD4+Foxp3+ regulatory T cells (Tregs). Results: Melanoma patients with worse prognosis, in stage IIB–C, had decreased percentage of total CD3+ and CD3+CD8+ T lymphocytes, trend of IFN-γ decrease, increased inhibitory programmed cell death 1 and T cell immunoglobulin and mucin-domain containing 3 ICMs, and higher percentage of Tregs in their SLNs compared with stage I-IIA patients. Furthermore, patients with nodular melanoma had decreased CD3+CD8+ cells compared with patients with superficial spreading melanoma and together with patients with localization of primary tumor on extremities had an increase in the expression of analyzed ICMs. Conclusions: This study provides new results of the impairment of immune response in SLN of cutaneous melanoma patients with high risk for metastasis and could help in the introduction of new immunotherapies that could restore immunity and prevent metastasis in SLN.

Case Reports

Hyperinfection Syndrome with Strongyloides Stercoralis: Report of a case.: Soo Im Choi, Soon Won Hong, Kwang Gil Lee; Korean J Pathol. 1989;23(3):359-364.

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Abstract PDF: Strongyloides stercoralis is a nematodes and is prevalent in the tropical regions. In Korea, 6 cases have been reported in which the parasites were identified in feces. We report a case of hyperinfection syndrome with Strongyloides stercoralis confirmed in the tissue sections. A 52-year-old woman was admitted to the hospital because of generalized edema and weakness. She received steroid therapy for 30 years because of rheumatoid arthritis. One year ago, generalized edema and dyspnea were developed and she was diagnosed as minimal change nephrotic syndrome for which she received cyclosporin. On admission, she complained of generalized weakness and edema, multiple arthralgia and abdominal discomfort with nausea. The white-cell count was 14,600 without eosinophilia. A stool specimen was negative for occult blood, ova or parasites. Right lower quadrant abdominal pain and tenderness were developed, and the exploratory laparotomy was done under the impression of the acute appendicitis. An appendectomy with a biopsy of mesenteric lymph nodes was performed. From the 5th day after operation, the patient began to complain of the abdominal pain and constipation. Under the impression of adhesion bad formation, the laparotomy was done and disclosed that the proximal ileum was markedly dilated. On jejunotomy, a great amount of formed stool and barium was noticed in the proximal portion of small bowel. The jejunal tissue was biopsied. Grossly, the appendix was unremarkable. Microscopically, the inflammatory reaction was nearly absent, but in serosa, minute granulomas were found which contain a part of the parasite. Same feature was noted in the mesenteric lymph node. The biopsied jejunum contains numerous adult female, filariform and rhabdidiform larvae and eggs in the mucosa, submucosa and muscle wall. Their morphology was compatible with Strongyloides stercoralis. The patient died 5 days later in the state of multiple organ failure.

Fatal Strongyloidiasis with Residual Cutaneous Larvae: An Autopsy Case Report.: Na Rae Kim, Dae Su Kim, Joungho Han, Dong Cheol Choe; Korean J Pathol. 2002;36(4):266-270.

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Abstract PDF: Strongyloides stercoralis hyperinfection in immunocompromised patients is difficult to control due to delayed diagnosis, especially in nonendemic areas. A 70-year-old diabetic woman came in with an intermittent diarrhea. She received massive steroid therapy for a week under the impression of idiopathic gastrointestinal eosinophilic syndrome. Diagnosis of strongyloidiasis was made by demonstration of filariform larvae in two repeated sputum specimens two months later. Despite massive administration of albendazole, she died of diabetic ketoacidosis and septic shock. Autopsy revealed a diffusely thickened bowel wall, superimposed invasive pulmonary aspergillosis and the near total destruction of the lungs. Filariform larvae were detected only in the cutaneous lesions. It was presumed that Strongyloides stercoralis hyperinfection was caused by autoinfection in the patient's immunosuppressed status. The present case has two clinical importances; first, intensive treatment with albendazole could erradicate parasites except for the skin but sepsis presumably occurred due to a hypersensitivity reaction against liberated endotoxins during the death of the parasites by the drug. Second, cutaneous parasitic lesion resists the intensive antihelminthic treatment in an immunocompromised host.

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