11 research outputs found
Metasztatikus progresszió kezelése primer cutan és ocularis melanoma szinkrón előfordulását követően = Treatment of metastatic progression following the synchronous occurrence of cutaneous and ocular primary melanomas
Absztrakt:
A melanoma előfordulási gyakorisága az életkorral nő, legnagyobb arányban a nem
hispániai fehérekben fordul elő. Bár az ocularis melanoma gyakorisága a töredéke
a cutan melanomáénak – az összes melanomás eset mintegy 4%-a, éves incidenciája
0,6 : 100 000 –, a szemtumorok között a leggyakrabban előforduló malignitás. Az
ocularis Ă©s a cutan melanoma egyĂĽttes elĹ‘fordulása irodalmi ritkaságnak számĂt.
Közleményünkben egy 80 éves férfi esetét prezentáljuk, akinél 2008-ban cutan
nodularis melanomát excindáltak. Szemészeten 2013-ban fokozódó visuscsökkenés
miatt uvealis melanomát diagnosztizáltak, amelyet brachytherapiával kezeltek.
Képalkotó vizsgálatokkal és biopsziával 2015-ben melanoma hepaticus propagatiója
igazolĂłdott. A primer cutan laesio mutáciĂłanalĂzise BRAF V600 K tĂpusĂş
funkciĂłnyerĹ‘ mutáciĂłt igazolt, mĂg az áttĂ©tben a vad tĂpusĂş gĂ©n jelenlĂ©tĂ©t
mutattuk ki. Onkoteam javaslata alapján 2015 augusztusában intraarterialis
májkemoterápia kezdődött, melyből 11 ciklust kapott meg, 21 napos
időintervallumokkal. A beteg a kezelést jól tolerálta, mellékhatás nem
jelentkezett. A 2016. februári CT a májban lévő laesio parciális regresszióját
igazolta; a tizenegyedik ciklus intraarterialis májkemoterápiáját követően a
beteg komplett remisszióba került, amely több mint egy évig tartott. Az ocularis
és a cutan melanoma szinkrón előfordulása igen ritka, metasztatikus progresszió
esetĂ©n ugyanakkor az optimális onkoterápia kiválasztása komoly kihĂvást jelent.
A kĂ©t melanomatĂpus molekuláris patolĂłgiai háttere eltĂ©rĹ‘, amely segĂtheti a
metasztatikus laesiĂłk eredetĂ©nek azonosĂtását Ă©s az optimális, szemĂ©lyre szabott
kezelés megválasztását. Orv Hetil. 2018; 159(16): 642–647.
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Abstract:
The incidence rates of cutaneous melanoma in non-Hispanic whites show an
increasing tendency with age. While uveal melanoma in general is a rare disease,
representing only 4% of all melanomas with an incidence rate of 0.6 per 100 000,
it is still the most frequent malignancy of the eye. Synchronous occurrence of
ocular and cutaneous melanoma is an exceptional rarity, due to the distinct
genetic background of the diseases. We report the case of a 80-year-old man who
underwent total excision of a cutaneous melanoma in 2008. In 2013, he was
diagnosed with uveal melanoma as part of a routine work-up for reduced vision.
The uveal melanoma was treated by brachytherapy. In 2015, liver metastases were
suspected by routine ultrasonography. Core biopsy was carried out, and the
histology confirmed melanoma metastases. The molecular analysis of the cutaneous
lesion showed gain of function mutation of the BRAF V600 K gene, while we found
a wild-type BRAF gene in the metastatic lesion. Based on the recommendation of
the oncoteam, hepatic intra-arterial Epirubicin-Platidiam therapy was
introduced. He received 11 doses of intra-arterial chemotherapy (IAC), in 21
cycles. IAC was well tolerated without any catheter-related complications or
toxicities. Partial regression of the hepatic metastases were documented in
February 2016. After completing the eleventh cycle of intrahepatic chemotherapy,
the disease remained in complete remission for over a year. The parallel
occurrence of cutaneous and ocular melanoma is rare, however, the metastatic
progression in such cases make the selection of optimal medical therapy
challenging. The distinct genetic background of two melanoma types may help the
identification of the source of the metastatic lesions, in order to guide the
treatment decisions. Orv Hetil. 2018; 159(16): 642–647
Urogenitalis lokalizációjú mucosamelanoma primer és áttétes esetei klinikánkon = Mucosal melanoma primary and metastatic cases with urogenital localization in our department
Absztrakt:
Bevezetés: Az urogenitalis lokalizációban előforduló
mucosamelanomáknak mind a primer, mind az áttétes esetei ritka daganatok. A
primer melanomás esetek mindössze 4–5%-a extracutan eredetű, melyek általában
későn kerülnek felismerésre, ezért prognózisuk rossz. Betegek és
módszer: Intézetünkben az elmúlt években húgy-ivar szervi melanomát
7 esetben Ă©szleltĂĽnk. Egy amelanoticus hĂşgycsĹ‘, egy hĂşgyhĂłlyag, kĂ©t hĂmvesszĹ‘
melanomás esetet és három metasztatikus daganatot. A megjelenésről, a kezelésről
Ă©s a klinikai kimenetelrĹ‘l rendelkezĂ©sre állĂł adatokat retrospektĂv mĂłdon
értékeltük. Eredmények: Három inoperábilis áttétes esetben
palliatĂv, urolĂłgiai-sebĂ©szeti beavatkozás Ă©s szisztĂ©más daganatellenes terápia
történt. Négy primer urogenitalis tumorból kettő lokalizálódott a péniszre. Az
egyik esetben helyi recidĂva alakult ki műtĂ©ti ellátás után, azonban radikális,
ismételt műtéttel a beteg másfél éve tünetmentes. A másik, igen elhanyagolt
hĂmvesszĹ‘-melanoma radikális műtĂ©t Ă©s inguinalis blokkdissectio után kĂ©t Ă©vvel
disszeminálódott. A nőbeteg primer húgycsőmelanomájánál az első szövettani
vizsgálat primer mesenchymalis tumort Ărt le, a másfĂ©l Ă©vvel kĂ©sĹ‘bb kialakult
recidĂv tumorbĂłl igazolĂłdott a melanoma diagnĂłzisa. A hĂşgycsĹ‘Ă©rintettsĂ©g miatt
elvégzett radikális műtét 5 év tünetmentességet eredményezett, ezt követően
alakult ki helyi recidĂva Ă©s távoli áttĂ©t. A negyedik, elĹ‘ször primer hĂşgyhĂłlyag
eredetű melanomának tartott esetben a rapid progressziót mutató kórlefolyás és a
tumor BRAF-pozitivitása alapján felmerült, hogy nem az elsőként húgyhólyagban
diagnosztizált melanoma volt a primer tumor. Következtetés: A
húgy-ivar szervi melanoma előfordulása igen ritka. Felfedezése sokszor már
disszeminált állapotban történik, ezért az esetek várható prognózisa is rossz. A
terápiás hatékonyságot növelő legfontosabb tényezők a korai diagnózis és a
radikális műtéti beavatkozás. A cutan melanomához képest prognózisuk rosszabb,
aminek hátterében a klinikai és patológiai diagnosztikus nehézség állhat. A
legújabb célzott és immunterápiás szerek az áttétes betegek túlélését lényegesen
javĂthatják. Orv Hetil. 2019; 160(10): 378–385.
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Abstract:
Introduction: Both primary and metastatic cases of mucosal
melanoma in urogenital localization are rare tumors. Only 4–5% of all primary
melanomas do not arise from the skin. Extracutaneous melanomas have a complex
clinical presentation, but these aggressive tumors have a poor prognosis.
Materials and method: In our department, we found 7
patients with malignant melanoma of the genitourinary tract in the past few
years. The 7 cases were: primary amelanotic melanoma of the female urethra, a
primary melanoma of the bladder, two primary melanomas of the penis, a
metastatic melanoma of the urethra and another to the testis and a metastatic
melanoma of the bladder with melanuria. We retrospectively analyzed the
available data to describe the presentation, management, and clinical outcome of
the patients. Results: In the three inoperative cases,
palliative, urologic surgical procedures and systemic antitumor therapy were
performed. Two of the four primary urogenital tumors were localized to the
penis. In one case, local recurrence developed after surgical treatment, but
with a radical, repeated surgery, the patient has been asymptomatic for a year
and a half. In the other, neglected case, the penis melanoma spread through the
urethra and the inguinal lymph nodes two years after radical surgery and
inguinal block dissection. In the female primary urethral melanoma case, the
first histological study reported a primary mesenchymal tumor, and the recurrent
tumor that occurred one and a half years later showed melanoma diagnosis.
Radical surgery performed because of urethral involvement resulted in a 5-year
asymptomatic state, followed by local recurrence and distant metastasis. In the
fourth case of a primary bladder melanoma, the rapid progression of the disease
and the BRAF positivity of the tumor suggested that not the firstly diagnosed
bladder melanoma was the primary tumor. Conclusion: The
occurrence of urinary tract melanoma is very rare and its discovery happens
often in a disseminated state, so the expected prognosis of the cases is also
poor. The most important factors for increasing therapeutic efficacy are early
diagnosis and radical surgical intervention. Tumors appearing in different
localizations require different urological surgical approaches. The literature
recommendations for treatment are not uniform. Their prognosis is worse compared
to the cutaneous melanoma, which may be due to clinical and pathological
diagnostic difficulties. The latest targeted and immunotherapeutic agents can
significantly improve the survival of metastatic patients. Orv Hetil. 2019;
160(10): 378–385
Az aspirációs citológia jelentősége a recidiváló és metasztatizáló melanoma diagnosztikájában = The Importance of Fine Needle Aspiration Cytology in the Management of Recurrent and Metastatic Melanoma
A vĂ©konytű-aspiráciĂłs citolĂłgia világszerte elfogadott, megbĂzhatĂł diagnosztikus mĂłdszer, amely segĂti a korai diagnĂłzist. CĂ©lkitűzĂ©s: Melanoma malignum miatt kezelĂ©s alatt állĂł betegek aspiráciĂłs citolĂłgiai vizsgálatainak minĹ‘sĂ©gbiztosĂtási szempontĂş elemzĂ©se. MĂłdszer: 142 beteg 194 aspiráciĂłs citolĂłgiai vizsgálati eredmĂ©nyĂ©t retrospektĂv vizsgálattal dolgozták fel. EredmĂ©nyek: 138 (71,13%) kután, szubkután elváltozást, illetve 56 (28,87%) megnagyobbodott nyirokcsomĂłt vizsgáltak. A 194 vizsgált mintábĂłl 87 (44,85%) valĂłdi pozitĂv, 92 (47,42%) valĂłdi negatĂv, három (1,55%) álpozitĂv Ă©s 12 (6,19%) álnegatĂv eredmĂ©nyt kaptak. A mĂłdszer szenzitivitása 87,89%-nak, specificitása 96,84%-nak, diagnosztikus biztonsága 93,72%-nak bizonyult. KövetkeztetĂ©sek: A szerzĹ‘k megállapĂtják, hogy tanulmányukban a recidiválĂł Ă©s metasztatikus melanomák vĂ©konytű-aspiráciĂłs citolĂłgiai vizsgálatainak minĹ‘sĂ©gbiztosĂtása megfelel a nemzetközi elvárásoknak.
Fine needle aspiration cytology is a widely accepted, reliable diagnostic modality for the early detection of metastases. Objective: Quality assurance analysis of fine needle aspiration cytology in melanoma patients. Method: A total of 194 biopsies performed in 142 melanoma patients were analyzed retrospectively. Results: 138 (71.13%) cutaneous or subcutaneous nodules and 56 (28.87%) palpable lymph nodes were studied. 87 (44.85%) true positive, 92 (47.42%) true negative, 3 (1.55%) false positive and 12 (6.19%) false negative cytology results were found. High sensitivity (87.89%), specificity (96.84%) and diagnostic accuracy (93.72%) were confirmed. Discussion: The quality assurance of fine needle aspiration biopsy in these patients with recurrent and metastatic melanoma meets the international requirements
Social support decreases depressogenic effect of low-dose interferon alpha treatment in melanoma patients
Depressogenic effects of low-dose interferon alpha treatment in melanoma patients are significantly alleviated by social support: potential biological explanations
Metasztatikus progresszió kezelése primer cutan és ocularis melanoma szinkrón előfordulását követően
Biomarkers Associated with Clinical Outcome of Advanced Melanoma Patients Treated with Ipilimumab
Ipilimumab was the first immunotherapy approved for metastatic melanoma in decades and is currently registered as a second-line treatment. However, new immunotherapies, in combination with ipilimumab, offer even better clinical outcomes for patients compared with single-agent treatments, at the expense of improved toxicity. The aim of this study was to evaluate the feasibility of ipilimumab outside the clinical trials and to identify survival predictors for treatment benefit. Data were collected on 47 advanced melanoma patients treated with ipilimumab between 2010 and 2015 at a single center. Association of clinical characteristics (including primary tumor characteristics), serum lactate dehydrogenase (LDH), erythrocyte sedimentation rate, absolute eosinophil, lymphocyte, and neutrophil count, neutrophil/lymphocyte and eosinophil/lymphocyte ratio with toxicity and clinical outcome were assessed using univariate and multivariate analysis. Median progression-free survival at a median follow-up of 10 months was 2.7 months and median overall survival was 9.8 months. Objective response was observed in 17% of patients and the disease control rate at week 24 was 40%. The 1- and 2-year survival rates documented were 40 and 28%, respectively. Significant association between high LDH level (>1.5x upper limit of normal) and decreased overall survival was demonstrated in uni- and multivariate analysis (hazard ratio [HR]: 3.554, 95% CI: 1.225-10.306, p = 0.019). Neither biomarkers nor clinical outcome were associated with toxicity. Using baseline serum LDH to identify patients most likely to benefit from ipilimumab therapy could serve as a simple and inexpensive biomarker of clinical outcome
Epileptic Seizure Provoked by Bone Metastasis of Chronic Lymphoid Leukemia and Merkel Cell Carcinoma
Background. Merkel cell carcinoma (MCC) is a rare primary neuroendocrine cutaneous tumor, rarely metastasizing to the brain. Chronic lymphoid leukemia (CLL) is a disease predisposing to MCC. According to previous reports, headache and focal neurological deficits suggest disease progression to the brain. We present a patient with MCC whose seizure was not elicited by a cerebral metastasis, but by bone metastases compressing the brain. Case Presentation. A 62-year-old female patient had a history of CLL. A lesion with the appearance of an atheroma was removed from the right upper arm. Histology confirmed the diagnosis of MCC. She was admitted to the neurology department with her first GM seizure. The cranial MRI/MRA showed bone metastases in the right parietal and both frontal areas, compressing the brain. Flow cytometry of CSF did not reveal metastasis of MCC. Conclusions. The case history of the patient was unique even among the rare cases of MCC with neurological involvement. The seizure was not elicited by a cerebral metastasis, but by bone metastases compressing the brain. In addition to patient history, clinical presentation and radiological findings enabled a suspected diagnosis of skull metastasis of MCC compressing the brain, causing symptomatic epileptic seizures
Psychological Changes in Melanoma Patients During Ipilimumab Treatment Compared to Low-Dose Interferon Alpha Therapy-A Follow-Up Study of First Experiences.
Immuntherapies are frequently accompanied by psychological side effects. Our goals were to detect the changes of psychological factors (depression, anxiety) among melanoma patients during ipilimumab treatment. Ten ipilimumab treated melanoma patients (Group 1.) and 18 low-dose interferon-alpha treated patients (Group 2.) were compared. In our longitudinal study we measured depression (Zung Self-Rating Depression Scale) and anxiety (State-Trait Anxiety Inventory, STAI). Psychological status was tested four times: in every 3 week during ipilimumab treatment according to the relevant treatment protocol and at baseline, 1st, 3rd and 6th month of interferon therapy. No significant differences were detected at different timepoints in the level of depression or in the anxiety scale in Group 1. However significant increase of depression was found in Group 2 during the 6 months of the study. Increased levels of anxiety were found in the second timepoint in both treatment groups. This increase was only temporary and the level of anxiety returned to the baseline. In our sample no measurable psychological differences were detectable during the 12 weeks treatment period of ipilimumab. Ipilimumab seems to have fewer psychological side-effects compared to other immune therapies