1.Pathological significance of plasma cell infiltration in diagnosing lymph node diseases.
Hao HU ; Ying Jie JIANG ; Lei XU ; Li Juan YIN ; Xue Fei LIU ; Shu Yi YIN ; Jing Jing XU ; Miao Xia HE
Chinese Journal of Pathology 2023;52(7):702-709
Objective: To investigate the value of plasma cells for diagnosing lymph node diseases. Methods: Common lymphadenopathy (except plasma cell neoplasms) diagnosed from September 2012 to August 2022 were selected from the pathological records of Changhai Hospital, Shanghai, China. Morphological and immunohistochemical features were analyzed to examine the infiltration pattern, clonality, and IgG and IgG4 expression of plasma cells in these lymphadenopathies, and to summarize the differential diagnoses of plasma cell infiltration in common lymphadenopathies. Results: A total of 236 cases of lymphadenopathies with various degrees of plasma cell infiltration were included in the study. There were 58 cases of Castleman's disease, 55 cases of IgG4-related lymphadenopathy, 14 cases of syphilitic lymphadenitis, 2 cases of rheumatoid lymphadenitis, 18 cases of Rosai-Dorfman disease, 23 cases of Kimura's disease, 13 cases of dermal lymphadenitis and 53 cases of angioimmunoblastic T-cell lymphoma (AITL). The main features of these lymphadenopathies were lymph node enlargement with various degrees of plasm cell infiltration. A panel of immunohistochemical antibodies were used to examine the distribution of plasma cells and the expression of IgG and IgG4. The presence of lymph node architecture could help determine benign and malignant lesions. The preliminary classification of these lymphadenopathies was based on the infiltration features of plasma cells. The evaluation of IgG and IgG4 as a routine means could exclude the lymph nodes involvement of IgG4-related dieases (IgG4-RD), and whether it was accompanied by autoimmune diseases or multiple-organ diseases, which were of critical evidence for the differential diagnosis. For common lesions of lymphadenopathies, such as Castleman's disease, Kimura's disease, Rosai-Dorfman's disease and dermal lymphadenitis, the expression ratio of IgG4/IgG (>40%) as detected using immunhistochemistry and serum IgG4 levels should be considered as a standard for the possibility of IgG4-RD. The differential diagnosis of multicentric Castleman's diseases and IgG4-RD should be also considered. Conclusions: Infiltration of plasma cells and IgG4-positive plasma cells may be detected in some types of lymphadenopathies and lymphomas in clinicopathological daily practice, but not all of them are related to IgG4-RD. It should be emphasized that the characteristics of plasma cell infiltration and the ratio of IgG4/IgG (>40%) should be considered for further differential diagnosis and avoiding misclassification of lymphadenopathies.
Humans
;
Castleman Disease/pathology*
;
Plasma Cells/pathology*
;
Immunoglobulin G4-Related Disease
;
China
;
Lymphadenopathy/pathology*
;
Inflammation/pathology*
;
Lymph Nodes/pathology*
;
Diagnosis, Differential
;
Lymphadenitis/pathology*
;
Immunoglobulin G/metabolism*
2.Comparison of programmed death-ligand 1 protein expression between primary tumors and lymph node metastatic lesions in oral squamous cell carcinoma.
Rong Hui XIA ; Yu Hua HU ; Chun Ye ZHANG ; Sheng Ming XU ; Jiang LI
Chinese Journal of Stomatology 2022;57(11):1113-1118
Objective: To investigate the difference of programmed death-ligand 1 (PD-L1) expression between primary lesions and lymph node metastatic lesions in oral squamous cell carcinoma. Methods: Eighty-two patients diagnosed with oral squamous cell carcinoma from December 2020 to July 2021 in Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University, were enrolled in this study. All the patients underwent neck dissection concurrently and had lymph node metastasis. Among them, there were 28 females and 54 males. The age range was 24-79 years old [(58.6±11.7) years old]. The expression of PD-L1 protein in primary tumors and lymph node metastatic lesions was detected by immunohistochemistry. Combined positive score (CPS) was used to evaluate the PD-L1 expression. And the difference of PD-L1 expression between primary tumors and metastatic lesions was analyzed. Results: Among 82 primary tumors, 9 cases (11%) had PD-L1 CPS<1, 31 cases (38%)≥ 1 and <20, and 42 cases (51%)≥20. Cases with perineural invasion had lower CPS (χ2=6.35, P=0.042). Among 82 matched lymph node metastatic lesions, 9 cases (11%) had CPS<1, 38 cases (46%)≥1 and<20, and 35 cases (43%)≥20. The CPS of 27 pairs (33%) of primary and metastatic lesions were discordant. The statistical results showed that the Kappa value of consistency evaluation was 0.446, indicating that the consistency of PD-L1 CPS in primary and metastatic lesions of OSCC was medium. Conclusions: There are differences in PD-L1 expression between the primary lesion of OSCC and cervical lymph node metastatic lesions, and the consistency is medium. In the routine practice, lymph node metastatic lesions should be carefully used to replace the primary lesion for PD-L1 CPS evaluating.
Adult
;
Aged
;
Female
;
Humans
;
Male
;
Middle Aged
;
Young Adult
;
B7-H1 Antigen/metabolism*
;
Biomarkers, Tumor
;
Carcinoma, Squamous Cell/pathology*
;
China
;
Head and Neck Neoplasms
;
Lymph Nodes/pathology*
;
Mouth Neoplasms/pathology*
;
Squamous Cell Carcinoma of Head and Neck
3.Tumor-induced osteomalacia with IgG4-related lymph node disease.
Ye ZHANG ; Chang XU ; Yan YANG
Chinese Medical Journal 2019;132(8):994-995
4.Expression of hypoxia-inducible factor 1α is associated with lymph node metastasis in oral squamous cell carcinoma.
Jian Nan LI ; Zhi En FENG ; Lin WANG ; Yi Xiang WANG ; Chuan Bin GUO
Journal of Peking University(Health Sciences) 2018;50(1):26-32
OBJECTIVE:
To explore the association between hypoxia-inducible factor 1α (HIF-1α) expression and lymph node metastasis in oral squamous cell carcinoma (OSCC).
METHODS:
Tumor specimens from 125 patients with histologically-proven, surgically-treated OSCC were examined by immunohistochemical staining for expression of HIF-1α. The patients were divided into two groups by the expression of HIF-1α, high expression of HIF -1α group (H-group) and low expression of HIF-1α group (L-group). The main assessment parameters were lymph node metastasis rate and disease-specific survival (DSS). The lymph node metastasis rate and clinicopathologic features were compared using Mann-Whitney test. The Kaplan-Meier curve was generated for each group and compared using the log-rank test. Cox proportional hazard models were utilized for multivariate analyses of HIF-1α expression and other baseline factors with DSS. All calculations and analyses were performed using the SPSS 17.0 software package.
RESULTS:
The protein expression levels of HIF-1α were up-regulated in OSCC and two patients were unable to evaluate. There were 48 patients in L-group and 75 patients in H-group. Lymph node metastasis rate was 37.5% (18/48) for L-group and 58.7% (44/75) for H-group (P=0.027). Expression of HIF-1α was significantly correlated with lymph node metastasis. The patients of L-group had a significantly better DSS than the patients of H-group (70.8% vs. 46.7%, P=0.005), while the patients of L-group had a significantly better disease-free survival (DFS) than the patients of H-group (60.4% vs. 36.0%, P=0.009) by Kaplan-Meier method. A multivariate survival analysis also showed that HIF-1α expression (HR=2.164, 95%CI: 1.150-4.074, P=0.017) and T-stage (HR=1.387, 95%CI: 1.066-1.804, P=0.015) both were the independent factors associated with prognosis.
CONCLUSION
HIF-1α expression is significantly correlated with lymph node metastasis in OSCC. HIF-1α expression is an independent predictive factor for prognosis of OSCC patients, and may serve as a potential biomarker for molecular diagnosis and targeted therapy in future.
Biomarkers/metabolism*
;
Carcinoma, Squamous Cell/pathology*
;
Humans
;
Hypoxia
;
Hypoxia-Inducible Factor 1, alpha Subunit/metabolism*
;
Immunohistochemistry
;
Lymph Nodes
;
Lymphatic Metastasis/genetics*
;
Mouth Neoplasms/pathology*
;
Prognosis
5.Radical retropubic prostatectomy for prostate cancer with pelvic lymph node metastasis.
Ding-Yi LIU ; Sang HU ; Yan-Feng ZHOU ; Hong-Chao HE ; Jia-Shun YU ; Jian WANG ; Wei-Mu XIA ; Qi TANG ; Ming-Wei WANG ; Wen-Long ZHOU
National Journal of Andrology 2017;23(11):982-986
Objective:
To investigate the safety and effectiveness of radical retropubic prostatectomy (RRP) with adjuvant androgen deprivation or external radiotherapy in the treatment of prostate cancer (PCa) with pelvic lymph node metastasis (PLNM).
METHODS:
Twenty PCa patients underwent bilateral pedal lymphangiography (PLG) preoperatively, and 11 of them received lymph node aspiration for examination of the mRNA expressions of prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) in the lymph fluid by real-time RT-PCR. All the patients were treated by RRP with extended dissection of pelvic lymph nodes, and 3 of them by external radiotherapy in addition after recovery from urinary incontinence because of positive surgical margins, followed by adjuvant androgen deprivation therapy.
RESULTS:
Real-time RT-PCR showed positive mRNA expressions of PSA and PSMA in the lymph fluid of the 11 patients, all pathologically confirmed with PLNM. The median intraoperative blood loss was 575 ml, with blood transfusion for 5 cases. Positive surgical margin was found in 3 cases, lymphorrhagia in 2 and urinary leakage in another 2 each. There were no such severe complications as vascular injury and rectum perforation. The patients were followed up for 6-48 (mean 42) months, during which, biochemical recurrence was observed in 12 cases at a median of 12 months postoperatively and 2 patients died at 12 and 48 months respectively.
CONCLUSIONS
Bilateral PLG and lymph node aspiration for examination of the mRNA expressions of PSA and PSMA in the lymph fluid help to confirm PLNM preoperatively. Radical retropubic prostatectomy with adjuvant androgen deprivation or external radiotherapy is safe and effective for the treatment of PCa with PLNM, but it should be chosen cautiously for those with Gleason 5+5.
Androgen Antagonists
;
therapeutic use
;
Antigens, Surface
;
metabolism
;
Chemotherapy, Adjuvant
;
Glutamate Carboxypeptidase II
;
metabolism
;
Humans
;
Lymph Node Excision
;
Lymph Nodes
;
pathology
;
Lymphatic Metastasis
;
Male
;
Pelvis
;
Postoperative Period
;
Prostate-Specific Antigen
;
metabolism
;
Prostatectomy
;
methods
;
Prostatic Neoplasms
;
drug therapy
;
metabolism
;
surgery
6.IFN-γ secretion in gut of Ob/Ob mice after vertical sleeve gastrectomy and its function in weight loss mechanism.
Jin-Peng DU ; Geng WANG ; Chao-Jie HU ; Qing-Bo WANG ; Hui-Qing LI ; Wen-Fang XIA ; Xiao-Ming SHUAI ; Kai-Xiong TAO ; Guo-Bin WANG ; Ze-Feng XIA
Journal of Huazhong University of Science and Technology (Medical Sciences) 2016;36(3):377-382
Vertical sleeve gastrectomy (VSG) is becoming more and more popular among the world. Despite its dramatic efficacy, however, the mechanism of VSG remains largely undetermined. This study aimed to test interferon (IFN)-γ secretion n of mesenteric lymph nodes in obese mice (ob/ob mice), a model of VSG, and its relationship with farnesoid X receptor (FXR) expression in the liver and small intestine, and to investigate the weight loss mechanism of VSG. The wild type (WT) mice and ob/ob mice were divided into four groups: A (WT+Sham), B (WT+VSG), C (ob/ob+Sham), and D (ob/ob+VSG). Body weight values were monitored. The IFN-γ expression in mesenteric lymph nodes of ob/ob mice pre- and post-operation was detected by flow cytometry (FCM). The FXR expression in the liver and small intestine was detected by Western blotting. The mouse AML-12 liver cells were stimulated with IFN-γ at different concentrations in vitro. The changes of FXR expression were also examined. The results showed that the body weight of ob/ob mice was significantly declined from (40.6±2.7) g to (27.5±3.8) g on the 30th day after VSG (P<0.05). At the same time, VSG induced a higher level secretion of IFN-γ in mesenteric lymph nodes of ob/ob mice than that pre-operation (P<0.05). The FXR expression levels in the liver and small intestine after VSG were respectively 0.97±0.07 and 0.84±0.07 fold of GAPDH, which were significantly higher than pre-operative levels of 0.50±0.06 and 0.48±0.06 respectively (P<0.05). After the stimulation of AML-12 liver cells in vitro by different concentrations of IFN-γ (0, 10, 25, 50, 100, and 200 ng/mL), the relative FXR expression levels were 0.22±0.04, 0.31±0.04, 0.39±0.05, 0.38±0.05, 0.56±0.06, and 0.35±0.05, respectively, suggesting IFN-γ could distinctly promote the FXR expression in a dose-dependent manner in comparison to those cells without IFN-γ stimulation (P<0.05). It was concluded that VSG induces a weight loss in ob/ob mice by increasing IFN-γ secretion of mesenteric lymph nodes, which then increases the FXR expression of the liver and small intestine.
Animals
;
Body Weight
;
Cell Line
;
Gastrectomy
;
methods
;
Gene Expression
;
Hepatocytes
;
cytology
;
drug effects
;
metabolism
;
Interferon-gamma
;
biosynthesis
;
pharmacology
;
secretion
;
Intestine, Small
;
drug effects
;
metabolism
;
Liver
;
drug effects
;
metabolism
;
Lymph Nodes
;
drug effects
;
metabolism
;
Mesentery
;
drug effects
;
metabolism
;
Mice
;
Mice, Obese
;
Obesity
;
metabolism
;
pathology
;
surgery
;
Receptors, Cytoplasmic and Nuclear
;
agonists
;
genetics
;
metabolism
;
Weight Loss
7.Influence of Yanyankang Powder on Th1/Th2 in rats with experimental autoimmune uveitis.
Qing-mei TIAN ; Hong-sheng BI ; Yan CUI ; Jian-feng WU ; Xiao-feng XIE ; Jun-guo GUO ; Da-dong GUO ; Ji-cun QIAN
Chinese journal of integrative medicine 2016;22(3):214-218
OBJECTIVETo study the influence of Yanyankang powder on Th1/Th2 in rats with experimental autoimmune uveitis (EAU).
METHODSThe EAU models were induced in Lewis rats by immunization with interphotoreceptor retinoid binding protein (IRBP) 1177-1191 in complete Freund's adjuvant. The rats were randomly divided into 3 groups: a model control group, a Yanyankang group, and a prednisone group, 9 rats in each group. The model control group was intervened with saline solution by gavage. The Yanyankang group was intervened with Yanyankang powder 4 g/(kg day) by gavage. The prednisone group were intervened with prednisone acetate tablets 5 mg/(kg d) by gavage. All groups were intervened after immunization once every 2 days for 18 days and monitored by slit-lamp biomicroscopy daily until day 18. The levels of gamma interferon (INF-γ) and interleukin-10 (IL-10) in the supernatants of T cells were determined by enzyme-linked immunosorbent assay. Polymerase chain reaction (PCR) technology was used for measuring Th1 and Th2 related cytokine mRNA expressions.
RESULTSSlighter intraocular inflammation was found in the Yanyankang group and the prednisone group than the control group. The levels of the IFN-γ and IL-10 in the supernatants of the spleen lymph node cells were 382.33±6.30, 155.87±4.46 μg/L in the Yanyankang group and 270.93±7.76, 265.32±11.88 μg/L in the prednisone group. Both had significant differences compared with the control group (941.53±8.59, 20.67±4.65 μg/L; =0.01). The PCR results showed the same tendency.
CONCLUSIONYanyankang powder showed favorable effects in the rats with EAU by influencing the function of Th1 and Th2 cells.
Animals ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Eye ; pathology ; Female ; Immunization ; Inflammation ; pathology ; Interferon-gamma ; genetics ; metabolism ; Interleukin-10 ; genetics ; metabolism ; Lymph Nodes ; drug effects ; metabolism ; Powders ; RNA, Messenger ; genetics ; metabolism ; Rats, Inbred Lew ; Spleen ; metabolism ; Th1 Cells ; drug effects ; immunology ; Th2 Cells ; drug effects ; immunology ; Uveitis ; drug therapy ; genetics ; immunology
8.Neuroendocrine differentiation and Wilms' tumor protein-1 expression in breast mucinous carcinoma and their significance.
Jiaochen WANG ; Shouxiang WENG ; Xiaofen JIN ; Wenjie YU ; Tao ZHOU ; Meifu GAN
Journal of Zhejiang University. Medical sciences 2016;45(1):45-50
OBJECTIVETo investigate neuroendocrine differentiation and Wilms' tumor protein-1 (WT-1) expression in breast mucinous carcinoma and their clinicopathological significance.
METHODSThe clinicopathological data of 65 patients with breast mucinous carcinoma, including 31 cases of mixed mucinous carcinoma, 23 cases of hypocellular pure mucinous carcinoma and 11 cases of hypercellular pure mucinous carcinoma, admitted in Taizhou Hospital from January 2010 to June 2015 were retrospectively reviewed. The expression of neuroendocrine markers and WT-1 was detected by immunohistochemistry staining in all cases.
RESULTSThe mixed mucinous carcinomas and hypercelluar pure mucinous carcinomas had higher incidence of axillary lymph node metastasis and human epidermal recepter 2 (HER-2) positive than hypocellular pure mucinous carcinoma (all (P<0.01). However, the difference was not significant between mixed mucinous carcinomas and hypercellular pure mucinous carcinomas (all P>0.05). The expression of neuroendocrine marker was stronger in hypercellular mucinous carcinoma than that in mixed mucinous carcinoma and hypocellular mucinous carcinoma (all (P<0.05), but the difference was not statistically significant between mixed mucinous carcinoma and hypocellular pure mucinous carcinoma (P>0.05). The expression of WT-1 was weaker in mixed mucinous carcinoma than that in hypercellular and hypocellular pure mucinous carcinoma(all (P<0.05), but the difference was not statistically significant between hypercellular and hypocellular pure mucinous carcinoma (P>0.05). The mucinous carcinomas with lymph node metastasis had lower expression of neuroendocrine markers than those without lymph node metastasis ((P<0.01). The expression of WT-1 in breast mucinous carcinoma with lymph node metastasis trended lower than that in those without lymph node metastasis, but the difference was not statistically significant (P>0.05).
CONCLUSIONHypercellular pure mucinous breast carcinoma has higher rates of lymph node metastasis and HER-2 amplification than hypocellular pure mucinous carcinoma, the sub-classification of breast pure mucinous carcinoma should be considered. Neuroendocrine differentiation and WT-1 expression may be helpful in distinguishing the subtypes of breast mucinous carcinoma. Breast mucinous carcinoma with neuroendocrine differentiation trends to have less lymph node metastasis.
Adenocarcinoma, Mucinous ; classification ; diagnosis ; pathology ; Axilla ; Breast Neoplasms ; classification ; diagnosis ; pathology ; Female ; Humans ; Immunohistochemistry ; Incidence ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Neuroendocrine Tumors ; diagnosis ; pathology ; Receptor, ErbB-2 ; metabolism ; Retrospective Studies ; WT1 Proteins ; metabolism
9.Analysis of Clinical Characteristics and Prognostic Factors of 223 Newly Diagnosed Hodgkin's Lymphoma Patients.
Su LIU ; Jing MA ; Yuan-Fang YUE ; Qian LI ; Hong-Liang YANG ; Yong YU ; Xiao-Fang WANG ; Zhi-Gang ZHAO ; Yi-Zhuo ZHANG ; Ya-Fei WANG
Journal of Experimental Hematology 2015;23(5):1296-1300
OBJECTIVETo analyze the clinical characteristics and prognostic factors of the newly diagnosed Hodgkin's lymphoma (HL) patients.
METHODThe clinical data of 223 patients with pathologically confirmed and newly diagnosed HL (since January 2001 to December 2012) were collected from Tianjin Medical University Cancer Hospital. The patients' route features, laboratory examination results, clinical manifestations and short-term efficacy were analyzed. Furthermore, the Log-rank test and Cox proportional hazard model were applied to analyze the prognosis. All data were analyzed with SPSS software version 1.0 and graphPad Prism 5.
RESULTSAmong the 223 newly diagnosed HL patients, the ratio of male to female was approximately 1.25:1 and the median age was 40 years old (range 3-84 years). The median survival period is 62 months (range 8-189 months). The 5-year overall survival (OS) rate was 92.8% for all 223 HL patients. Multivariate analysis showed that HL originated from mediastinal lymph node region, the extranodal sites were involved, lactate dehydrogenase (LDH) level increased and CR2 was unable to fulfil the CR/CRu which are independent prognostic factors of HL patients (P < 0.05). Therefore, according to the above-mentioned adverse prognostic factors, 223 cases of HL patients were regrouped as low, intermediate and high risk. The HL 5-year OS rate of three groups were 100%, 96.9% and 42.9%, OS in each group was significantly different (P < 0.05).
CONCLUSIONHL displays a high incidence in young male patients but the curative efficacy is optimal and the survival period is long. The HL originated at mediastinal lymph node region, involved extranodal sites, lactate dehydrogenase (LDH) level increased and CR2 is unable to fulfil the CR/CRu which are independent prognostic factors of HL patients. According to the above-mentioned factors for the initial treatment of patients with HL, risk discrimination can predict the prognosis of patients with HL to a certain extent.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Hodgkin Disease ; diagnosis ; pathology ; Humans ; Incidence ; L-Lactate Dehydrogenase ; metabolism ; Lymph Nodes ; pathology ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Survival Rate ; Young Adult
10.Eupatilin Ameliorates Collagen Induced Arthritis.
Juryun KIM ; Youngkyun KIM ; Hyoju YI ; Hyerin JUNG ; Yeri Alice RIM ; Narae PARK ; Seung Min JUNG ; Sung Hwan PARK ; Ji Hyeon JU
Journal of Korean Medical Science 2015;30(3):233-239
Eupatilin is the main active component of DA-9601, an extract from Artemisia. Recently, eupatilin was reported to have anti-inflammatory properties. We investigated the anti-arthritic effect of eupatilin in a murine arthritis model and human rheumatoid synoviocytes. DA-9601 was injected into collagen-induced arthritis (CIA) mice. Arthritis score was regularly evaluated. Mouse monocytes were differentiated into osteoclasts when eupatilin was added simultaneously. Osteoclasts were stained with tartrate-resistant acid phosphatase and then manually counted. Rheumatoid synoviocytes were stimulated with TNF-alpha and then treated with eupatilin, and the levels of IL-6 and IL-1beta mRNA expression in synoviocytes were measured by RT-PCR. Intraperitoneal injection of DA-9601 reduced arthritis scores in CIA mice. TNF-alpha treatment of synoviocytes increased the expression of IL-6 and IL-1beta mRNAs, which was inhibited by eupatilin. Eupatilin decreased the number of osteoclasts in a concentration dependent manner. These findings, showing that eupatilin and DA-9601 inhibited the expression of inflammatory cytokines and the differentiation of osteoclasts, suggest that eupatilin and DA-9601 is a candidate anti-inflammatory agent.
Animals
;
Anti-Inflammatory Agents/pharmacology/*therapeutic use
;
Arthritis, Experimental/chemically induced/*drug therapy
;
Arthritis, Rheumatoid/drug therapy/pathology
;
Cell Differentiation/*drug effects
;
Cells, Cultured
;
Collagen Type II
;
Cytokines/biosynthesis
;
Disease Models, Animal
;
Drugs, Chinese Herbal/therapeutic use
;
Female
;
Flavonoids/pharmacology/*therapeutic use
;
Humans
;
Inflammation/drug therapy/immunology
;
Interleukin-1beta/genetics/metabolism
;
Interleukin-6/genetics/metabolism
;
Lymph Nodes/cytology
;
Mice
;
Mice, Inbred DBA
;
Monocytes/cytology
;
Osteoclasts/*cytology
;
Plant Extracts/pharmacology
;
RNA, Messenger/biosynthesis
;
Synovial Membrane/cytology
;
T-Lymphocytes, Regulatory/cytology/immunology
;
Tumor Necrosis Factor-alpha/pharmacology

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