In dedifferentiated CS, tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs) exhibit divergent prognostic associations: higher CD3+ and CD8+ T cell densities correlate with improved overall survival, whereas a higher CD68+ macrophage to CD8+ T cell ratio and elevated macrophage-attracting chemokines indicate poorer prognosis. Here, CD8A is linked to Cowden syndrome 1.