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BackgroundSpecific immune response is a hallmark of cancer immunotherapy and shared tumor-associated antigens (TAAs) are important targets. Recent advances using combined cellular therapy against multiple TAAs renewed the interest in this class of antigens. Our study aims to determine the role of TAAs in esophago-gastric adenocarcinoma (EGA).MethodsRNA expression was assessed by NanoString in tumor samples of 41 treatment-naïve EGA patients. Endogenous T cell and antibody responses against the 10 most relevant TAAs were determined by FluoroSpot and protein-bound bead assays. Digital image analysis was used to evaluate the correlation of TAAs and T-cell abundance. T-cell receptor sequencing, in vitro expansion with autologous CD40-activated B cells (CD40Bs) and in vitro cytotoxicity assays were applied to determine specific expansion, clonality and cytotoxic activity of expanded T cells.Results68.3% of patients expressed ≥5 TAAs simultaneously with coregulated clusters, which were similar to data from The Cancer Genome Atlas (n=505). Endogenous cellular or humoral responses against ≥1 TAA were detectable in 75.0% and 53.7% of patients, respectively. We found a correlation of T-cell abundance and the expression of TAAs and genes related to antigen presentation. TAA-specific T-cell responses were polyclonal, could be induced or enhanced using autologous CD40Bs and were cytotoxic in vitro. Despite the frequent expression of TAAs co-occurrence with immune responses was rare.ConclusionsWe identified the most relevant TAAs in EGA for monitoring of clinical trials and as therapeutic targets. Antigen-escape rather than missing immune response should be considered as mechanism underlying immunotherapy resistance of EGA.

A 50-year-old man presented at the emergency unit with abdominal pain in the right lower quadrant and dysuria. He described an increase in pain during micturition.After multiple examinations (CT-scan, MR-scan, ileocolonoscopy) were performed to no avail, a toothpick was detected in the terminal ileum during an ultrasound scan of the small intestine. Prompted elevation of intra-abdominal pressure led to migration of the radiolucent sharp foreign body into the wall of the urinary bladder, inducing pain.Median laparotomy revealed a two-sided perforation of the terminal ileum with ileosigmoidal fistula, which was induced by an ingested toothpick. The patient underwent en-bloc resection of the infectious tumor by segmental ileal resection and sigma resection. Anastomoses were performed as hand-sewn end-to-end ileoileostomy and end-to-end stapled colorectal anastomosis, respectively.Ingested foreign bodies and perforation of the gastrointestinal tract by foreign bodies are rare events but may cause serious gut injuries. The ingestion of foreign bodies should be kept in mind as an important differential diagnosis in patients with acute abdomen or chronic abdominal pain of unknown origin, especially in children. Abdominal ultrasound can be a useful diagnostic tool in identifying ingested foreign bodies.Ein 50-jähriger Patient stellt sich mit rechtsseitigen Unterbauchschmerzen in der Notaufnahme vor. Er gibt an, dass jene Beschwerden seit ca. 5 Monaten bestünden und bei der Miktion an Intensität zunähmen.Nach einer Vielzahl frustraner diagnostischer Maßnahmen (CT Abdomen, MR-Sellink, Ileokoloskopie) gelingt es letztlich mittels Darmsonografie, einen ingestierten Zahnstocher im terminalen Ileum als Ursache für die Beschwerden zu identifizieren. Jener perforiert die Darmwand lokal und affektiert die angrenzende Blasenwand bei jeder Erhöhung des intraabdominellen Druckes schmerzhaft.Explorative Laparotomie mit Nachweis eines entzündlichen Konglomerattumors mit ileosigmoidaler Fistel im rechten Unterbauch. Die Entzündungsreaktion wird durch einen das terminale Ileum zweifach perforierenden Zahnstocher verursacht. Die operative Versorgung erfolgt mittels Ileumsegmentresektion und Sigmaresektion mit End-zu-End-Anastomosierung. Im postoperativen Verlauf kommt es zu einer subkutanen Wundheilungsstörung, die mittels VAC-Therapie versorgt wird. Am 16. postoperativen Tag kann der Patient in einem guten Allgemeinzustand nach Hause entlassen werden.Eine Fremdkörperingestion stellt eine seltene, aber relevante Differenzialdiagnose unklarer abdomineller Schmerzen, insbesondere im Kindesalter, dar. Neben einer ausführlichen Anamnese sollte als primäre apparative Maßnahme stets zunächst eine qualifizierte und sorgfältig durchgeführte Abdomensonografie erfolgen, mithilfe derer auch strahlentransparente ingestierte Fremdkörper detektiert werden können.