85 research outputs found
Current concepts of ectopic nodal inclusions with special emphasis on nodal nevi
Nodal inclusions of ectopic tissue within lymph nodes are seen comparatively often in
dermatopathology and general pathology. Glandular and nonglandular epithelium,
as well as melanocytic nevi can be observed within lymph nodes and represent mostly incidental findings without any relevance. The main challenge in reporting these
morphologic features is to differentiate such benign inclusions from metastatic settlements of distinct organ tumors. As sentinel node biopsy and lymph node dissection
have become standard procedure in clinical oncology and have an immense clinical
impact, the correct evaluation of these nodal inclusions is indispensable to avoid undertreatment or overtreatment of patients. In addition, the genesis of these inclusions
has not yet been satisfactorily clarified. Two concepts have been laid out: the theory
of benign metastases and the migration arrest theory. However, neither theory has so
far been able to answer the following questions: Why do we find more nodal nevi in
patients with melanoma who had a sentinel node biopsy than in patients without melanoma, and why do we not find nodal nevi in deep visceral lymph nodes? We present
a comprehensive review of the current knowledge on nodal inclusions, proposing a
concept for the pathogenesis of nodal nevi, to answer these questions
Klinische und diagnostische Befunde bei beruflicher Exposition gegenĂŒber Nanopartikeln und neuen Materialien
Die Nanotechnologie gilt als SchlĂŒsseltechnologie des 21. Jahrhunderts. Mit Nanomaterialien wurden jedoch nicht nur technologisch hoch interessante, vielfĂ€ltig einsetzbare nanoskalige Produkte geschaffen, sondern auch eine neue Kategorie von potentiell toxischen Substanzen fĂŒr BeschĂ€ftigte, Endverbraucher und Umwelt. Vor dem Hintergrund individueller Faktoren, potentieller Wirkprinzipien und adverser Gesundheitseffekte durch Nanomaterialien erfolgte die Konzeption eines vielschichtigen Diagnostik-Programms, welches einer Gruppe von BeschĂ€ftigten in der Nanotechnologie angeboten wurde
Etanercept leads to a rapid recovery of a Dabrafenibâ/Trametinibâassociated toxic epidermal necrolysisâlike severe skin reaction
Targeted therapy with BRAFâ and MEKâInhibitors (BRAFi, MEKi) provides
an excellent therapeutic option for patients with malignant melanomas with
a BRAFâMutation. Mild cutaneous adverse events have been common
under the BRAFâ and MEKâInhibitor therapy, on the contrary, severe cutaneous adverse reactions to drugs (SCARs) are rarely reported. We present
the case of a 59â yearâold female patient who after the resection of cutaneous inâtransit metastases of a malignant melanoma received one adjuvant cycle of Nivolumab followed by a switch of the therapy to an oral
BRAFi/MEKi therapy. 3â4 Weeks after the therapy switch she developed
high fever, chills, progredient general weakness, headaches, abdominal
complaints, generalised rash as well as thrombocytopaenia, eosinophilia,
elevated liver enzymes, declining kidney, and pulmonary function as well as
a maculopapular exanthema. She was diagnosed with drug reaction with
eosinophilia and systemic symptoms (DRESS) and quickly started recovery
after initiation of a high steroid substitution. Under steroid dose reduction,
the exanthema worsened and toxic epidermal necrolysis (TEN) was histologically diagnosed. After a series of unsuccessful therapeutic approaches
(high dose steroid, human immunoglobulins and ciclosporin) the patient
received a single dose of the TNFâalpha inhibitor etanercept, which led to a
quick recovery. This case demonstrates that DRESS and TEN can present
a spectrum of possibly transitioning SCARs providing a diagnostic and
therapeutic challenge. Nevertheless, in a such complicated therapeutic
setting, etanercept may be lifesaving even after multiple previous unsuccessful therapies. This effective approach provides evidence SCARs due to
BRAF/MEK targeted therapy may be driven by TNFâalpha
Low Vitamin D Status Predicts Poor Clinical Outcome in Advanced Melanoma Treated With Immune Checkpoint or BRAF/MEK Inhibitors: A Prospective Non-Interventional Side-by-Side Analysis
In melanoma and other malignancies, low vitamin D status is associated with increased risk and poor prognosis. However, there are limited data of the impact of 25(OH)D serum concentration (s.c.) on clinical outcome in advanced melanoma. We tested the hypothesis that vitamin D status is predictive of efficacy and safety in patients treated for metastasized melanoma with B-rapidly accelerated fibrosarcoma (BRAF), mitogen-activated protein kinase kinase (MEK), cytotoxic T lymphocyte-associated protein-4 (CTLA-4), and/or programmed cell death protein-1 (PD-1) inhibitors. Severe vitamin D deficiency [defined as 25(OH)D s.c. <10 ng/ml] was associated with markedly reduced overall (OS) and progress-free (PFS) survival, with increased tumor load [TL; measured as s.c. of S100 protein or lactate dehydrogenase (LDH)], and with a trend for higher frequency of adverse events (AEs). An increase in average 25(OH)D s.c. of 1 ng/ml was associated with a 3.9% reduced risk for progressive disease [hazard ratio (HR) = 0.961, p = 0.044], with a reduction of LDH s.c. of 3.86 U/l (p = 0.034, indicating a reduction of TL), and with a trend for reduced frequency of AEs (AE ratio -0.005; p = 0.295). Patients with average 25(OH)D s.c. â„10 ng/ml and BRAF-mutant melanoma showed a trend for a higher frequency of AEs as compared to individuals with BRAF wild-type melanomas. Our data indicate that vitamin D deficiency is associated with poor clinical outcome in patients treated for metastasized melanoma with BRAF/MEK inhibitors or immunotherapy. Although it needs to be proven in future interventional trials whether optimizing serum 25(OH)D improves clinical outcome in these patients, we recommend that 25(OH)D s.c. should be analyzed and vitamin D deficiency treated in all patients with advanced melanoma
Implementation of anaphylaxis management guidelines
Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted
Analysis of clinical and diagnostic findings during exposures in chemical nanotechnology
The rapid development of nanotechnology - the key technology of the 21th century - demands a consideration of risks and assessment of health effects during exposures to nanomaterials. Due to their high surface to volume ratio, nanoscaled materials exhibit exceptional physical and chemical properties when compared to larger particles of the same composition. Therefore toxicological informations of the bulk material should be carefully applied to nano particles. One of the most relevant uptake pathways is the inhalation of nanoscaled particles. Effects on the respiratory tract like inflammation, oxidative stress and pulmonary fibrosis, adverse effects on the cardiovascular and central nervous system are considered. In addition, nanotubes with their structure similar to asbestos-fibres may have a carcinogenic potential. Taking into consideration the various possible working mechanism of nanomaterials, an extensive diagnostic program was designed and offered to a collective of employees in chemical nanotechnology
Expression of SEC62 Oncogene in Benign, Malignant and Borderline Melanocytic TumorsâUnmasking the Wolf in Sheepâs Clothing?
SEC62 oncogene located at chromosomal region 3q26 encodes for a transmembrane protein
of the endoplasmic reticulum (ER) and is expressed at high levels in numerous human malignancies. SEC62 overexpression has been associated with worse prognosis and high risk for lymphatic
and distant metastases in head and neck cancer, cervical cancer, hepatocellular cancer, and lung
cancer. However, its role in the development and tumor biology of melanocytic lesions has not
been investigated so far. An immunohistochemical study including 209 patients with melanocytic
lesions (malignant melanoma (MM), n = 93; melanoma metastases (MET), n = 28; Spitz nevi (SN),
n = 29; blue nevi (BN), n = 21; congenital nevi (CN), n = 38) was conducted and SEC62 expression
was correlated with clinical data including patient survival and histopathological characteristics.
SN showed the highest SEC62 expression levels followed by MET, MM, CN, and BN. High SEC62
expression correlated with a shorter overall and progression-free survival in MM patients. Additionally, high Sec62 levels correlated significantly with higher tumor size (T stage), the presence of
tumor ulceration, and the presence of lymph node as well as distant metastases. Strikingly, SEC62
expression showed a strong correlation with Clark level. Taken together, these data demonstrate that
SEC62 is a promising prognostic marker in MM and has the potential to predict biological behavior
and clinical aggressiveness of melanocytic lesions
Analysis of clinical and diagnostic findings during exposures in chemical nanotechnology
The rapid development of nanotechnology - the key technology of the 21th century - demands a consideration of risks and assessment of health effects during exposures to nanomaterials. Due to their high surface to volume ratio, nanoscaled materials exhibit exceptional physical and chemical properties when compared to larger particles of the same composition. Therefore toxicological informations of the bulk material should be carefully applied to nano particles. One of the most relevant uptake pathways is the inhalation of nanoscaled particles. Effects on the respiratory tract like inflammation, oxidative stress and pulmonary fibrosis, adverse effects on the cardiovascular and central nervous system are considered. In addition, nanotubes with their structure similar to asbestos-fibres may have a carcinogenic potential. Taking into consideration the various possible working mechanism of nanomaterials, an extensive diagnostic program was designed and offered to a collective of employees in chemical nanotechnology
Reinduction of Hedgehog Inhibitors after Checkpoint Inhibition in Advanced Basal Cell Carcinoma : A Series of 12 Patients
For patients with advanced basal cell carcinoma (aBCC) first-line treatment with hedgehog
inhibitors (HHIs) and second-line treatment with PD1 inhibitors (PD1i) is available, offering combination and sequencing options. Here, we focus on the efficacy and safety of HHI reinduction after PD1i
failure. Retrospective data analysis was performed with 12 patients with aBCC (locally advanced
(n = 8)/metastatic (n = 4)). These patients (male:female 6:6, median age 68 years) initially received
HHIs, leading to complete/partial response (66%) or stable disease (33%). Median treatment duration
was 20.8 (2â64.5) months until discontinuation due to progression (n = 8), adverse events (n = 3), or
patient request (n = 1). Subsequent PD1 inhibition (pembrolizumab 42%, cemiplimab 58%) yielded a
partial response (8%), stable disease (33%), or progression (59%). Median treatment duration was 4.1
(0.8â16.3) months until discontinuation due to progression (n = 9), adverse events (n = 1), patient
request (n = 1), or missing drug approval (n = 1). HHI reinduction resulted in complete/partial
response (33%), stable disease (50%), or progression (17%). Median treatment duration was 3.6 (1â29)
months. Response duration in the four responding patients was 2â29+ months. Thus, a subgroup
of patients with aBCC responded to reinduction of HHI following PD1i failure. Therefore, this
sequential treatment represents a feasible treatment option
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