Extensive necrosis of visceral melanoma metastases after immunotherapy

<p>Abstract</p> <p>Background</p> <p>The prognosis for metastatic melanoma remains poor even with traditional decarbazine or interferon therapy. 5-year survival is markedly higher amongst patients undergoing metastatectomy. Unfortunately not all are suitable for metastatectomy. Alternative agents for systemic therapy have, to date, offered no greater rates of survival beyond traditional therapy. A toll-like receptor 9 agonist, PF-3512676 (formerly known as CPG 7909) is currently being evaluated for its potential.</p> <p>Case presentation</p> <p>We present the case of a 54-year-old Caucasian male with completely resected metastatic cutaneous melanoma after immunotherapy. The patient initially progressed during adjuvant high-dose interferon, with metastases to the liver, spleen, and pelvic lymph nodes. During an 18-month treatment period with PF-3512676 (formerly known as CPG 7909), a synthetic cytosine-phosphorothioate-guanine rich oligodeoxynucleotide, slow radiologic disease progression was demonstrated at the original disease sites. Subsequent excision of splenic and pelvic nodal metastases was performed, followed by resection of the liver metastases. Histologic examination of both hepatic and splenic melanoma metastases showed extensive necrosis. Subsequent disease-free status was demonstrated by serial positron emission tomography (PET).</p> <p>Conclusion</p> <p>Existing evidence from phase I/II trials suggests systemic treatment with PF-3512676 is capable of provoking a strong tumor-specific immune response and may account for the prolonged tumor control in this instance.</p

Management of suspected herpes simplex virus encephalitis in adults in a UK teaching hospital

The outcome of herpes simplex virus (HSV) encephalitis is improved with prompt initiation of aciclovir treatment. Delays are common, but there is little understanding of why they occur. The case notes of 21 adults admitted with suspected HSV encephalitis over one year were reviewed. The median (range) duration of illness was 2.5 (1–99) days. Seventeen (81%) patients had a lumbar puncture (LP) performed, at a median (range) time of 24 (2–114) hours after encephalitis was suspected. Lumbar puncture was delayed for a computed tomography (CT) scan in 15 patients, but only one of these had contraindications to an immediate LP. The median (range) time from presentation to starting aciclovir was 48 (2–432) hours. HSV-PCR (polymerase chain reaction) was requested on cerebrospinal fluid from 12 patients, one of whom was positive. Five (24%) patients were given the wrong dose of aciclovir. Overall the management of suspected HSV encephalitis was often sub-optimal, with delays in LP occurring due to unnecessary CT scans, and the wrong aciclovir dose administered. Guidelines for the management of suspected encephalitis are needed

Extensive necrosis of visceral melanoma metastases after immunotherapy-1

Capsule. Cells adjacent to the capsule contain a brown pigment. B). The pigment disappears in melanin bleach preparation. C). Very few cells stained positive for S100. In this section, only 1 positive cell was observed, staining a homogeneous dark brown color compared with the dotted granular brown appearance of neighboring cells. D). The majority of the pericapsular cells containing melanin stained positive for CD68, indicating that they are macrophages.<p><b>Copyright information:</b></p><p>Taken from "Extensive necrosis of visceral melanoma metastases after immunotherapy"</p><p>http://www.wjso.com/content/6/1/30</p><p>World Journal of Surgical Oncology 2008;6():30-30.</p><p>Published online 4 Mar 2008</p><p>PMCID:PMC2292185.</p><p></p

Extensive necrosis of visceral melanoma metastases after immunotherapy-0

Capsule. Cells adjacent to the capsule contain a brown pigment. B). The pigment disappears in melanin bleach preparation. C). Very few cells stained positive for S100. In this section, only 1 positive cell was observed, staining a homogeneous dark brown color compared with the dotted granular brown appearance of neighboring cells. D). The majority of the pericapsular cells containing melanin stained positive for CD68, indicating that they are macrophages.<p><b>Copyright information:</b></p><p>Taken from "Extensive necrosis of visceral melanoma metastases after immunotherapy"</p><p>http://www.wjso.com/content/6/1/30</p><p>World Journal of Surgical Oncology 2008;6():30-30.</p><p>Published online 4 Mar 2008</p><p>PMCID:PMC2292185.</p><p></p