Pembrolizumab-Induced Thyroiditis Shows PD-L1Expressing Histiocytes and Infiltrating T Cells in Thyroid Tissue - A Case Report

Front Immunol. 2021 Jun 18:12:606056. doi: 10.3389/fimmu.2021.606056. eCollection 2021.

Abstract

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.

Keywords: FDG; PET; melanoma; pembrolizumab; thyroiditis.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • B7-H1 Antigen / metabolism*
  • CD4-Positive T-Lymphocytes / immunology*
  • Cell Movement
  • Drug-Related Side Effects and Adverse Reactions / diagnosis*
  • Histiocytes / immunology*
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects*
  • Immune Checkpoint Inhibitors / therapeutic use
  • Immunotherapy / methods*
  • Male
  • Melanoma / complications
  • Melanoma / diagnosis
  • Melanoma / drug therapy*
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Skin Neoplasms / complications
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / drug therapy*
  • Thyroid Gland / immunology
  • Thyroid Gland / pathology*
  • Thyroidectomy
  • Thyroiditis / diagnosis*
  • Thyroiditis / etiology

Substances

  • Antibodies, Monoclonal, Humanized
  • B7-H1 Antigen
  • CD274 protein, human
  • Immune Checkpoint Inhibitors
  • pembrolizumab