Malignant melanoma arising from a perianal fistula and harbouring a BRAF gene mutation: a case report

<p>Abstract</p> <p>Background</p> <p>Melanoma of the anal region is a very uncommon disease, accounting for only 0.2-0.3% of all melanoma cases. Mutations of the <it>BRAF </it>gene are usually absent in melanomas occurring in this region as well as in other sun-protected regions. The development of a tumour in a longstanding perianal fistula is also extremely rare. More frequent is the case of a tumour presenting as a fistula, that is, the fistula being a consequence of the cancerous process, although we have found only two cases of fistula-generating melanomas reported in the literature.</p> <p>Case Presentation</p> <p>Here we report the case of a 38-year-old male who presented with a perianal fistula of four years of evolution. Histopathological examination of the fistulous tract confirmed the presence of malignant melanoma. Due to the small size and the central location of the melanoma inside the fistulous tract, we believe the melanoma reported here developed in the epithelium of the fistula once the latter was already formed. Resected sentinel lymph nodes were negative and the patient, after going through a wide local excision, remains disease-free nine years after diagnosis. DNA obtained from melanoma tissue was analysed by automated direct sequencing and the <it>V600E </it>(<it>T1799A</it>) mutation was detected in exon 15 of the <it>BRAF </it>gene.</p> <p>Conclusion</p> <p>Since fistulae experience persistent inflammation, the fact that this melanoma harbours a <it>BRAF </it>mutation strengthens the view that oxidative stress caused by inflammatory processes plays an important role in the genesis of <it>BRAF </it>gene mutations.</p

Successful Second-Line Metronomic Temozolomide in Metastatic Paraganglioma: Case Reports and Review of the Literature

Metastatic pheochromocytoma and paraganglioma (mPHEO/PGL) are frequently associated with succinate dehydrogenase B ( SDHB ) mutations. Cyclophosphamide-dacarbazine-vincristine (CVD) regimen is recommended as standard chemotherapy for advanced mPHEO/PGL. There is limited evidence to support the role of metronomic schemes (MS) of chemotherapy in mPHEO/PGL treatment. We report 2 patients with SDHB -related mPGL who received a regimen consisting of MS temozolomide (TMZ) and high-dose lanreotide after progression on both CVD chemotherapy and high-dose lanreotide. Molecular profiling of the tumor tissue from both patients revealed hypermethylation of the O6-methylguanine-DNA-methyltransferase ( MGMT ) promoter. In one patient, progression-free survival was 13 months and the second patient remained under treatment after 27 months of stabilization of metabolic response of his disease. Treatment was well tolerated, and adverse effects were virtually absent. A modification in the scheme of TMZ from standard schemes to MS is safe and feasible and can be considered in patients with progressive mPHEO/PGL refractory to dacarbazine in standard doses

Successful induction therapy with sequential CVD followed by high-dose lanreotide in for metastatic SDHB paraganglioma: Case report

Objective: Pheochromocytomas (PHEOs) and paragangliomas (PGLs) arise from adrenal extra-adrenal paraganglia. They often secrete catecholamine and approximately 1/3 are hereditary. Almost 50% of metastatic PGLs are caused by mutations in the succinate dehydrogenase gene, particularly in subunits B and D (SDHB/D). These tumors remain a diagnostic and therapeutic challenge due to a limited number of effective treatment options. To our best knowledge, we present the first report that uses induction therapy to elicit a significant response in both primary and metastatic lesions, followed by complete surgical resection of a primary SDHB-related PGL. Case description: A 45-year-old female presented with an 8.5 cm unresectable primary SDHB-related PGL with multiple bone metastases. She had an initial blood pressure of 210/130 mmHg and a heart rate of 150 bpm. Initially, she was treated with cisplatin, vinblastine, and dacarbazine (CVD) chemotherapy and lanreotide (120 mg/sc/28d), which resulted in tumor shrinkage. The patient later progressed, and monotherapy with a shortened interval of lanreotide (120 mg/sc/14d) was initiated. Following 2.5 months at this interval, the patient nearly achieved complete control of her clinical symptoms, and experienced a 30% reduction in 18F-flurodeoxyglucose uptake in her primary and metastatic lesions. Following the surgical resection of her primary PGL, all prior antihypertensive medications were stopped. Conclusions: CVD, together with a 14-day regimen of high dose lanreotide, may be an effective treatment option for SDHB-related metastatic PGLs. Therefore, further evaluation of somatostatin analogues, preferably lanreotide, in the treatment of metastatic SDHB-related PGLs is warranted. We believe that ours is the first report detailing the successful use of lanreotide treatment prior to a surgical rescue after systemic treatment. Keywords: Paraganglioma, Lanreotide, SDHB, Metastati

Supplementary_data – Supplemental material for Successful Second-Line Metronomic Temozolomide in Metastatic Paraganglioma: Case Reports and Review of the Literature

<p>Supplemental material, Supplementary_data for Successful Second-Line Metronomic Temozolomide in Metastatic Paraganglioma: Case Reports and Review of the Literature by Isabel Tena, Garima Gupta, Marcos Tajahuerce, Marta Benavent, Manuel Cifrián, Alejandro Falcon, María Fonfria, Maribel del Olmo, Rosa Reboll, Antonio Conde, Francisca Moreno, Julia Balaguer, Adela Cañete, Rosana Palasí, Pilar Bello, Alfredo Marco, José Luis Ponce, Juan Francisco Merino, Antonio Llombart, Alfredo Sanchez and Karel Pacak in Clinical Medicine Insights: Oncology</p