A review of the epidemiology and treatment of Merkel cell carcinoma

Merkel cell carcinoma is a very rare and aggressive neoplasm. Due to its rarity, therapeutic guidelines are not well established, especially for regionally advanced disease. Articles in English, French, Italian, Portuguese, and Spanish from the last 20 years were identified in MEDLINE and reviewed. The key word “Merkel” was used for the search, relevant articles were selected, and their references were examined. The most important articles related to epidemiology, genesis and treatment were reviewed. The incidence of Merkel cell carcinoma is increasing due to the advancing age of the population, higher rates of sun exposure and an increasing number of immunocompromised individuals. With regard to etiology, the recently described Merkel Cell polyomavirus is thought to play a role. Either local or regional surgical intervention remains the standard of care, but adjuvant radiotherapy or radiotherapy as a primary treatment have been discussed as reasonable therapeutic options. An update on this rare neoplasia is essential because of its increasing incidence and changing treatment options

Rejeição e efeitos da ciclosporina nos transplantes cutâneos alógenos microcirúrgicos em ratos

Os efeitos da rejeição e da imunossupressão com ciclosporina A em retalhos epigástricos utilizados como transplantes cutâneos alógenos microcirúrgicos, foram estudados em 58 ratos, distribuídos em três grupos: Wistar-Furth isogênicos doadores e receptores; e Brown-Norway doadores e Wistar-Furth receptores, imunossuprimidos com cicloporina A(10mg/kg/dia). Biópsias dos retalhos e da pele normal contralateral utilizadas como contrôle foram colhidas no terceiro, sétimo, 15º e 30º dias pós transplante. As biópsias foram preparadas em historesina, e coradas em azul de toluidina, para avaliação do infiltrado inflamatório local, permitindo estudo quantitativo dos linfócitos infiltrantes nos retalhos. O modelo revelou-se eficiente, obtendo-se sobrevivência dos transplantes por 30 dias, de 83,3% entre animais isogênicos, e de 60% nos alogênicos sob ação da ciclosporina A. Em ratos alogênicos não imunossuprimidos houve 100% de rejeição dos retalhos, até o nono dia pós-operatório. Nos transplantes desses animais, verificou-se aumento significativo do número de linfócitos infiltrantes no terceiro dia, quando comparados aos ratos isogênicos. A linfocitose observada antecedeu os achados macroscópicos da rejeição, verificados apenas no quinto ou sexto dias.The rejection of allotransplantation of epigastric microsurgical flaps and the effect of immunosuppression have been studied in 58 rats. Three sets of experiments were planned: (1) Wistar Furth isogenic donors and receptors (control set); (2) Brown Norway donors and Wistar Furth receptors (rejection set); and (3) Brown Norway donors and Wistar Furth immunosuppressed receptors (cyclosporin A set). Cyclosporin A (10 mg/kg/d) treated rats had a transplantation survival rate of up to 30 days: 83.3% among isogenic animals and 60% among allogeneic. There was 100% rejection by the 9th day after the transplantation in allogeneic non-immunosuppressed rats. Biopsies embedded with historesin were taken from the flap and normal contralateral skin (used as control) on the 3rd, 7th, 15th, and 30th days after the surgery. A quantitative study of infiltrating lymphocytes in the flaps, with and without cyclosporin A, was done by evaluating the local inflammatory infiltrate. A significant increase in the number of lymphocytes among the rejection and immunosuppressed groups was seen, as compared to the isogenic set. Local lymphocytosis in allogeneic non-immunosuppressed transplantations reached its highest level on the 3rd day after surgery, before gross findings of rejection, which could only be seen by naked eye on the 5th or 6th day. Therefore, we conclude that cyclosporin A is effective in preserving allogenic transplantation in rats. Biopsies of transplanted areas may contribute to earlier diagnosis of the need for immunosuppressive therapy

Eyelid trichoadenoma: surgical treatment associated with aesthetic lepharoplasty

Trichoadenoma is a benign cutaneous tumor that is asymptomatic, rare, and slow growing. There are few cases reported in the literature, and we could only identify one description of trichoadenoma occurring in the eyelid area. We describe the case of a patient with trichoadenoma in the outer corner of the lower eyelid that we treated with surgical excision associated with blepharoplasty.O tricoadenoma é um tumor cutâneo benigno, assintomático, raro e de crescimento lento. Existem poucos casos relatados na literatura e identificamos apenas um descrito na região palpebral. Apresentamos o caso de uma paciente portadora de tricoadenoma no canto externo da pálpebra inferior direita, tratada com excisão cirúrgica associada a blefaroplastia.Universidade de São Paulo Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP)Universidade de UberabaUNIFESPSciEL

Atypical mole syndrome and dysplastic nevi: identification of populations at risk for developing melanoma - review article

Atypical Mole Syndrome is the most important phenotypic risk factor for developing cutaneous melanoma, a malignancy that accounts for about 80% of deaths from skin cancer. Because the diagnosis of melanoma at an early stage is of great prognostic relevance, the identification of Atypical Mole Syndrome carriers is essential, as well as the creation of recommended preventative measures that must be taken by these patients

UTILIDADE DA GRISEOFULVINA NO TRATAMENTO DO GRANULOMA ACTÍNICO DE O’BRIEN

Actinic granuloma of O’Brien, also called annular elastolytic giant cell granuloma is a rare condition. It shows clinically as papules lesions that converge in annular plaques lesions with an atrophic center. Histologically, it evidences elastophagocytosis and elastolysis. The case below describes a female patient, 53 years old, that had classical clinical and histopathological lesions of actinic granuloma that showed a significant improvement upon the introduction of adjunctive griseofulvin therapy.O granuloma actiníco de O’Brien, ou também chamado de granuloma anular elastolítico de células gigantes é uma afecção rara. Apresenta-se clinicamente como pápulas que se confluem formando lesões anulares com centro atrófico. Histologicamente, evidencia-se elastofagocitose e elastólise. O seguinte caso relata uma paciente com 53 anos, que apresentava lesões clínicas e histopatológicas clássicas de granuloma actínico que evoluiu com melhora importante no tratamento adjuvante com griseofulvina

Diagnostic line ratios in the IC 1805 optical gas complex

Large HII regions, with angular dimensions exceeding 10 pc, usually enclose numerous massive O-stars. Stellar winds from such stars are expected to play a sizeable role in the dynamical, morphological and chemical evolution of the targeted nebula. Kinematically, stellar winds remain hardly observable i.e., the typical expansion velocities of wind-blown bubbles being often confused with other dynamical processes also regularly found HII regions. However, supersonic shock waves, developed by stellar winds, should favor shock excitation and leave a well-defined spectral signature in the ionized nebular content. In this work, the presence of stellar winds, observed through shock excitation, is investigated in the brightest portions of the Galactic IC 1805 nebula, a giant HII region encompassing at least 10 O-stars from main-sequence O9 to giant and supergiant O4. The use of the imaging Fourier transform spectrometer SpIOMM enabled the simultaneous acquisition of the spectral information associated to the Halpha6563A, [NII]6548, 6584A, and [SII]6716, 6731A ionic lines. Diagnostic diagrams, first introduced by Sabbadin and collaborators, were used to circumscribe portions of the nebula likely subject to shock excitation from other areas dominated by photoionization. The gas compression, expected from supersonic shocks, is investigated by comparing the pre- and post-shocked material's densities computed from the [SII]/[SII] line ratio. The typical [NII]/[NII] line ratio slightly exceeds the theoretical value of 3 expected in low-density regimes. To explain such behavior, a scenario based on collisional de-excitations affecting the [NII]6548A line is proposed.Comment: 22 pages, 19 figures, 1 table, Accepted for publication by MNRAS on November 11th 201

Fractal dimension of chromatin is an independent prognostic factor for survival in melanoma

<p>Abstract</p> <p>Background</p> <p>Prognostic factors in malignant melanoma are currently based on clinical data and morphologic examination. Other prognostic features, however, which are not yet used in daily practice, might add important information and thus improve prognosis, treatment, and survival. Therefore a search for new markers is desirable. Previous studies have demonstrated that fractal characteristics of nuclear chromatin are of prognostic importance in neoplasias. We have therefore investigated whether the fractal dimension of nuclear chromatin measured in routine histological preparations of malignant melanomas could be a prognostic factor for survival.</p> <p>Methods</p> <p>We examined 71 primary superficial spreading cutaneous melanoma specimens (thickness ≥ 1 mm) from patients with a minimum follow up of 5 years. Nuclear area, form factor and fractal dimension of chromatin texture were obtained from digitalized images of hematoxylin-eosin stained tissue micro array sections. Clark's level, tumor thickness and mitotic rate were also determined.</p> <p>Results</p> <p>The median follow-up was 104 months. Tumor thickness, Clark's level, mitotic rate, nuclear area and fractal dimension were significant risk factors in univariate Cox regressions. In the multivariate Cox regression, stratified for the presence or absence of metastases at diagnosis, only the Clark level and fractal dimension of the nuclear chromatin were included as independent prognostic factors in the final regression model.</p> <p>Conclusion</p> <p>In general, a more aggressive behaviour is usually found in genetically unstable neoplasias with a higher number of genetic or epigenetic changes, which on the other hand, provoke a more complex chromatin rearrangement. The increased nuclear fractal dimension found in the more aggressive melanomas is the mathematical equivalent of a higher complexity of the chromatin architecture. So, there is strong evidence that the fractal dimension of the nuclear chromatin texture is a new and promising variable in prognostic models of malignant melanomas.</p

The EHA Research Roadmap : Malignant Lymphoid Diseases

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