Expression of PD-L1 in mononuclear cells, multinucleated cells, and foam cells in tenosynovial giant cell tumors.

Tenosynovial giant cell tumor (TGCT) is a rare, proliferative and inflammatory disease with activation of colony stimulating factor 1 (CSF1) expression, and exhibits abnormal proliferation of mononuclear cells, multinucleated cells and foam cells. PD-L1 inhibitors represent a promising strategy in a variety of tumors. However, PD-L1 expression has never been studied in CSF1 activated TGCT. In this study, we determined the expression of programmed cell death ligand 1 (PD-L1) in 40 TGCT cases by immunohistochemistry and evaluated its clinical significance. We found that PD-L1 was positively expressed in 52.5% of all patients, and among them, the mononuclear cells, multinucleated cells, and foam cells with positive PD-L1 expression were observed in 21 (52.5%), 10 (25.0%), and 7 (17.5%) patients, respectively. The mononuclear cells and foam cells exhibited PD-L1 expression on the membrane or in the cytoplasm, and the multinucleated cells showed membranous PD-L1 expression. In addition, the PD-L1-positive mononuclear cells, multinucleated cells, and foam cells co-expressed CD68. Moreover, the patients with positive PD-L1 expression had a larger tumor size than those with negative PD-L1 expression. We further found that the foam cells of human coronary atherosclerosis also exhibited the expression of PD-L1 in two of three patients. These findings provide valuable evidence that PD-L1 is highly positive in CSF1-activated TGCT, and treatment with anti-PD-L1 agents may be a valuable therapeutic option for those diseases with PD-L1 expression on mononuclear cells, multinucleated cells, or foam cells.