Inflammatory cell infiltrate in a responding metastatic nodule after vaccine-based immunotherapy

A patient with von Hippel Lindau disease, bilateral symmetric renal cell ca rcinoma and pulmonary metastases treated with immunotherapy is the subject of this study. A left kidney and tumour mass were removed and the tumour ce lls used to make an autologous tumour/bacille Calmette-Guerin (BCG) vaccine as part of the treatment protocol. The patient's pulmonary nodules respond ed, but the remaining renal nodule subsequently grew. Samples of both tumou rs were obtained allowing for an internally controlled evaluation of the hi stological and immunohistologic differences between a responding and non-re sponding tumour nodule after therapy. The immunotherapy protocol is designe d to promote a T cell response to autologous tumour. Cellular infiltrates w ere demonstrated in both responding and non-responding nodules compared wit h the pretreatment tumour specimen, but the responding nodule contained pro portionately more T cells as well as markedly increased numbers of plasma c ells and granulocytes. This suggested that several arms of the immune syste m may have been operative in the responding nodule.