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Berger O, Lerner I, Ohana G, Sinelnikov I, Talisman R. Desmoplastic Neurotropic Melanoma Presenting as Pilonidal Sinus: A Rare Clinical Association. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932922. [PMID: 34429392 PMCID: PMC8404162 DOI: 10.12659/ajcr.932922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient: Male, 31-year-old
Final Diagnosis: Melanoma
Symptoms: Coccycodynia
Medication:—
Clinical Procedure: —
Specialty: Pathology • Plastic Surgery • Surgery
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Affiliation(s)
- Ori Berger
- Plastic Surgery Unit, Barzilai University Hospital Medical Center, Ashkelon, Israel
| | - Igor Lerner
- Department of General Surgery, Barzilai University Hospital Medical Center, Ashkelon, Israel
| | - Gilbert Ohana
- Department of General Surgery, Barzilai University Hospital Medical Center, Ashkelon, Israel
| | - Igor Sinelnikov
- Department of Pathology, Barzilai University Hospital Medical Center, Ashkelon, Israel
| | - Ran Talisman
- Plastic Surgery Unit, Barzilai University Hospital Medical Center, Ashkelon, Israel
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2
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Murthy NK, Amrami KK, Spinner RJ. Perineural spread to the brachial plexus: a focused review of proposed mechanisms and described pathologies. Acta Neurochir (Wien) 2020; 162:3179-3187. [PMID: 32632655 DOI: 10.1007/s00701-020-04466-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Perineural spread (PNS) is an emerging mechanism for progressive, non-traumatic brachial plexopathy. We aim to summarize the pathologies (tumor and infection) shown to have spread along or to the brachial plexus, and identify the proposed mechanisms of perineural spread. METHODS A focused review of the literature was performed pertaining to pathologies with identified perineural spread to the brachial plexus. RESULTS We summarized pathologies currently reported to have PNS in the brachial plexus and offer a structure for understanding and describing these pathologies with respect to their interaction with the peripheral nervous system. CONCLUSIONS Perineural spread is an underrepresented entity in the literature, especially regarding the brachial plexus. It can occur via a primary or secondary mechanism based on the anatomy, and understanding this mechanism helps to support biopsies of sacrificial nerve contributions, leading to more effective and timely treatment plans for patients.
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Kalfas F, Scudieri C. Intramedullary Metastasis to the Cervical Spinal Cord from Malignant Pleural Mesothelioma: Review of the Literature and Case Reports. Asian J Neurosurg 2020; 15:70-75. [PMID: 32181176 PMCID: PMC7057903 DOI: 10.4103/ajns.ajns_234_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 08/20/2019] [Indexed: 11/04/2022] Open
Abstract
Context: Malignant mesothelioma is an aggressive tumor; median survival of patients following diagnosis is 12 months. Aims: Pleural malignant mesothelioma tends to spread along preexisting tissue planes and has the rare ability to spread along the nerve root into the spinal cord. In our case, there is an evidence of exceptional direct hematogenous spread to the spinal cord by the spinal branch of the intercostal arteries or the veins of Batson's plexus. Settings and Design: The authors report a case of intramedullary hematogenous metastasis to the cervical spinal cord from malignant mesothelioma, with a review of the literature. Materials and Methods: A 68-year-old male was admitted to our department because of a slowly progressive mild weakness of both low extremities, more pronounced on the left side. The patient has been treated for a malignant mesothelioma with left thoracotomy and subsequently underwent radiotherapy. Magnetic resonance imaging of the cervical-thoracic spine revealed a contrast-enhancing intramedullary expansive lesion of the left half of the spinal cord at the C6–C7 level. Results: The patient underwent surgical treatment through a C6–C7 laminectomy. Through a median posterior spinal cord incision, an intramedullary grayish lesion was completely removed. The paraparesis progressively improved and 20 days after surgery, the patient had regained normal lower extremity function. Conclusions: Malignant mesothelioma can spread to the spinal canal by the direct extension through the intervertebral foramina, by hematogenous spread to the spinal meninges, and by perineural growth along a single nerve root. The cleavage plane of the tissue may determine whether a successful gross total resection can be achieved with a good outcome for the patient.
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Affiliation(s)
- Fotios Kalfas
- Department of Neurological Surgery, Galliera Hospitals, Genova, Italy
| | - Claudia Scudieri
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Zhu S, Mendenhall WM. Radiotherapy for Melanoma with Perineural Invasion: University of Florida Experience. Cancer Invest 2018; 36:389-394. [PMID: 30188744 DOI: 10.1080/07357907.2018.1504055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Outcomes after adjuvant radiotherapy for cutaneous melanoma with perineural invasion (PNI). METHODS Seven patients (5 cutaneous, 2 recurrent nerve lesions) received radiotherapy. RESULTS At a median 4.5 years: Two patients did not recur; no local failures occurred. Three patients who omitted nodal irradiation developed regional failures (2 out-of-field, 1 in-field). Three patients developed distant metastases. Four died with disease (median, 3.6 years); 1 died from intercurrent disease (13.0 years). Two are alive without disease (6.8 and 11.6 years). No patient experienced grade ≥3 toxicity. CONCLUSIONS Postoperative radiotherapy can reduce local recurrences; primary radiotherapy for unresectable disease is recommended.
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Affiliation(s)
- Simeng Zhu
- a Department of Radiation Oncology , University of Florida College of Medicine , Gainesville , FL , USA
| | - William M Mendenhall
- a Department of Radiation Oncology , University of Florida College of Medicine , Gainesville , FL , USA
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5
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Chua SJ, Sun MT, James C, Huilgol SC, Selva D. Perineural Invasion of the Orbit by Neurotropic Nondesmoplastic Melanoma. Ophthalmic Plast Reconstr Surg 2017; 33:S131-S133. [PMID: 26784552 DOI: 10.1097/iop.0000000000000630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors report a case of neurotropic nondesmoplastic melanoma involving the ophthalmic division of the trigeminal nerve and the cavernous sinus in a patient with recurrent scalp melanoma. This case highlights the importance of earlier diagnosis of local recurrence of melanoma and the rare association of neurotropic melanoma and orbital metastasis.
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Affiliation(s)
- Su Jen Chua
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, Australia
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6
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Bourque PR, Bourque G, Miller W, Woulfe J, Warman Chardon J. Combined isolated trigeminal and facial neuropathies from perineural invasion by squamous cell carcinoma: A case series and review of the literature. J Clin Neurosci 2017; 35:5-12. [DOI: 10.1016/j.jocn.2016.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/26/2016] [Indexed: 02/01/2023]
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Erkan S, Acharya AN, Savundra J, Lewis SB, Rajan GP. En Bloc Resection of Desmoplastic Neurotropic Melanoma with Perineural Invasion of the Intracranial Trigeminal and Intraparotid Facial Nerve: Case Report and Review of the Literature. J Neurol Surg Rep 2016; 77:e008-12. [PMID: 26929895 PMCID: PMC4726377 DOI: 10.1055/s-0035-1566254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/14/2015] [Indexed: 12/31/2022] Open
Abstract
Background Desmoplastic neurotropic melanoma (DNM) is a rare, highly malignant, and locally invasive form of cutaneous melanoma with a tendency for perineural invasion (PNI). Methods We report a case of a 61-year-old man presenting with right-sided trigeminal neuralgia and progressive facial paresis due to the PNI of the intracranial trigeminal nerve and the intraparotid facial nerve from DNM. We also present a review of the literature with six cases of DNM with PNI of the intracranial trigeminal nerve identified. Results The combined transtemporal-infratemporal fossa approach was performed to achieve total en bloc resection of the tumor mass followed by postoperative radiotherapy (PORT). After 24 months of follow-up, the patient remains disease free with no signs of recurrence on magnetic resonance imaging. Conclusion We recommend the en bloc resection of the tumor mass followed by PORT for the management of DNM with PNI. A high index of suspicion for PNI as a cause of cranial neuropathies is essential for the early detection and treatment of patients with known melanoma.
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Affiliation(s)
- Serkan Erkan
- Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Aanand N Acharya
- Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Savundra
- Department of Plastics Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Stephen B Lewis
- Perth Neurosurgery, Hollywood Medical Centre, Nedlands, Western Australia, Australia
| | - Gunesh P Rajan
- Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Skull Base Division, Otolaryngology, Head and Neck Surgery, University of Western Australia, Murdoch, Western Australia, Australia
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8
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Restrepo CE, Spinner RJ, Howe BM, Jentoft ME, Markovic SN, Lachance DH. Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report. J Neurosurg 2015; 122:784-90. [DOI: 10.3171/2014.12.jns14852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perineural spread is a well-known mechanism of dissemination of head and neck malignancies. There are few reports of melanoma involving the brachial plexus in the literature. To their knowledge, the authors report the first known case of perineural spread of malignant melanoma to the brachial plexus. Clinicoradiological and anatomopathological correlation is presented, highlighting the importance of peripheral nerve communications in perineural spread.
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Gorayski P, Burmeister B, Foote M. Radiotherapy for cutaneous melanoma: current and future applications. Future Oncol 2015; 11:525-34. [PMID: 25675130 DOI: 10.2217/fon.14.300] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cutaneous malignant melanoma remains a significant health burden worldwide despite advances in the management of locoregionally advanced and metastatic disease. Historically, the efficacy of radiation therapy (RT) has been questioned due to the perceived radioresistance of melanoma cancer cells in vitro. Nowadays, RT has limited indications for primary disease, but is used for high-risk nodal disease and in the palliative setting. This review article outlines the current role of RT for melanoma and its expanding role in oligometastatic disease scenarios as an alternative approach to surgery and highlights potential future applications to harness RT interaction with immunomodulatory targeted therapies.
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Affiliation(s)
- Peter Gorayski
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Chen L, Xiong Y, Wang H, Liang L, Shang H, Yan X. Malignant melanoma of the vagina: A case report and review of the literature. Oncol Lett 2014; 8:1585-1588. [PMID: 25202372 PMCID: PMC4156219 DOI: 10.3892/ol.2014.2357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 07/01/2014] [Indexed: 12/22/2022] Open
Abstract
Primary malignant melanoma of the vagina is an extremely rare variant of melanoma that accounts for <3% of all vaginal malignancies. Primary malignant melanoma of the vagina has a worse prognosis as compared with non-genital melanomas or other vaginal malignant neoplasms. A-35-year-old female had a diagnosis of primary malignant melanoma of the vagina. A local excision of the tumor was first performed, followed by a radical excision as a further therapeutic measure. The patient returned after three weeks, presenting with a vesico-vaginal fistula. A conservative operation was subsequently performed in order to improve the quality of life of the patient. Pelvic metastases were identified 6 months after the completion of the last surgical therapy and subsequent follow-up examinations were performed in another hospital. The present case study describes the clinical features and surgical procedures of this patient with primary malignant melanoma of the vagina. In conclusion, melanoma of the vagina is an extremely aggressive cancer and the overall prognosis is poor despite the various treatment options.
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Affiliation(s)
- Lifeng Chen
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Yin Xiong
- Department of Gynecology, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Huan Wang
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Lizhi Liang
- Department of Gynecology, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Huiling Shang
- Department of Gynecology, The First People's Hospital of Foshan, Guangzhou, Guangdong 528000, P.R. China
| | - Xiaojian Yan
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Yamamoto J, Ueta K, Takenaka M, Takahashi M, Nishizawa S. Sarcomatoid malignant mesothelioma presenting with intramedullary spinal cord metastasis: a case report and literature review. Global Spine J 2014; 4:115-20. [PMID: 25054098 PMCID: PMC4078123 DOI: 10.1055/s-0033-1361589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/24/2013] [Indexed: 10/27/2022] Open
Abstract
Study Design Case report. Objective Malignant mesothelioma (MM) is an uncommon tumor of the pleural epithelium with a predilection for local spread into adjacent tissues. The sarcomatoid type accounts for ∼10% of MM cases and is associated with poorer survival than the epithelioid, desmoplastic, and biphasic types. MM commonly presents with involvement of the vertebral body or epidural space. However, intradural spinal extension of MM is extremely rare. Only eight cases of intradural spinal extension have been reported. We report this rare case and discuss the clinical manifestations of intradural spinal extension of MM with literature review. Methods This report describes the case of a 62-year-old man with Brown-Séquard syndrome and radiculopathy of the left C5 nerve root detected during treatment for pleural sarcomatoid MM. Magnetic resonance imaging (MRI) showed an intramedullary lesion at the C3 level and a small nodule at the left C5 nerve root with cervical canal stenosis. Results The patient underwent surgery, and intramedullary metastasis of sarcomatoid MM was diagnosed. Subsequently, radiotherapy was administered, resulting in temporary improvement of the patient's condition. Thereafter, his condition gradually deteriorated, and follow-up MRI showed a more extensive residual C3 intramedullary lesion. Thus, a second surgery was performed after chemotherapy, but the patient died 5 months after the initial diagnosis. Conclusion We present this rare case, and emphasize intramedullary spinal cord metastasis of MM as differential diagnosis in primary cord lesion.
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Affiliation(s)
- Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan,Address for correspondence Junkoh Yamamoto, MD, PhD Department of Neurosurgery, University of Occupational and Environmental Health1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555Japan
| | - Kunihiro Ueta
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Takenaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mayu Takahashi
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shigeru Nishizawa
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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Scanlon P, Tian J, Zhong J, Silva I, Shapiro R, Pavlick A, Berman R, Osman I, Darvishian F. Enhanced immunohistochemical detection of neural infiltration in primary melanoma: is there a clinical value? Hum Pathol 2014; 45:1656-63. [PMID: 24890944 DOI: 10.1016/j.humpath.2014.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/27/2014] [Accepted: 04/02/2014] [Indexed: 11/17/2022]
Abstract
Neural infiltration in primary melanoma is a histopathologic feature that has been associated with desmoplastic histopathologic subtype and local recurrence in the literature. We tested the hypothesis that improved detection and characterization of neural infiltration into peritumoral or intratumoral location and perineural or intraneural involvement could have a prognostic relevance. We studied 128 primary melanoma cases prospectively accrued and followed at New York University using immunohistochemical detection with antihuman neurofilament protein and routine histology with hematoxylin and eosin. Neural infiltration, defined as the presence of tumor cells involving or immediately surrounding nerve foci, was identified and characterized using both detection methods. Neural infiltration rate of detection was enhanced by immunohistochemistry for neurofilament in matched-pair design (47% by immunohistochemistry versus 25% by routine histology). Immunohistochemical detection of neural infiltration was significantly associated with ulceration (P = .021), desmoplastic and acral lentiginous histologic subtype (P = .008), and head/neck/hands/feet tumor location (P = .037). Routinely detected neural infiltration was significantly associated with local recurrence (P = .010). Immunohistochemistry detected more intratumoral neural infiltration cases compared with routine histology (30% versus 3%, respectively). Peritumoral and intratumoral nerve location had no impact on clinical outcomes. Using a multivariate model controlling for stage, neither routinely detected neural infiltration nor enhanced immunohistochemical characterization of neural infiltration was significantly associated with disease-free or overall survival. Our data demonstrate that routinely detected neural infiltration is associated with local recurrence in all histologic subtypes but that improved detection and characterization of neural infiltration with immunohistochemistry in primary melanoma does not add to prognostic relevance.
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Affiliation(s)
- Patrick Scanlon
- Department of Dermatology, New York University School of Medicine, 10016, New York, NY; The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Jaiying Tian
- Department of Dermatology, New York University School of Medicine, 10016, New York, NY; The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Judy Zhong
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Ines Silva
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Richard Shapiro
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY; Department of Surgery, New York University School of Medicine, 10016, New York, NY
| | - Anna Pavlick
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Russell Berman
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY; Department of Surgery, New York University School of Medicine, 10016, New York, NY
| | - Iman Osman
- Department of Dermatology, New York University School of Medicine, 10016, New York, NY; The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY
| | - Farbod Darvishian
- The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY; Department of Pathology, New York University School of Medicine, 10016, New York, NY.
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Su A, Dry SM, Binder SW, Said J, Shintaku P, Sarantopoulos GP. Malignant melanoma with neural differentiation: an exceptional case report and brief review of the pertinent literature. Am J Dermatopathol 2014; 36:e5-9. [PMID: 23782676 PMCID: PMC4079032 DOI: 10.1097/dad.0b013e31828cf90a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
: The term neurotropic melanoma has been used to refer to malignant melanoma with associated infiltration of nerve or "neural differentiation"--that is, melanoma cells exhibiting cytological characteristics of nerve cells. Historically, neurotropic melanoma has generally been discussed within the context of desmoplastic melanoma. We report an exceptional case of melanoma notable for a very well-differentiated neural component that was contiguous with obvious overlying melanoma. After careful consideration of all pertinent histological features, the overall diagnostic impression was that of melanoma with associated "malignant neurotization." We have not encountered a previously reported case with such a well-differentiated neural component. The following article details our exceptional case of melanoma with "malignant neurotization" and presents a discussion of the differential diagnosis and brief review of the pertinent literature.
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Affiliation(s)
- Albert Su
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Chen LL, Jaimes N, Barker CA, Busam KJ, Marghoob AA. Desmoplastic melanoma: a review. J Am Acad Dermatol 2013; 68:825-33. [PMID: 23267722 PMCID: PMC4703041 DOI: 10.1016/j.jaad.2012.10.041] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 09/30/2012] [Accepted: 10/25/2012] [Indexed: 11/17/2022]
Abstract
Desmoplastic melanoma (DM) is a variant of spindle cell melanoma typically found on chronically sun-damaged skin of older individuals. Early diagnosis can be challenging because it is often amelanotic and has a predominantly dermal component. DM can be difficult to diagnose not only clinically but also histologically, and can be mistaken for a variety of benign and malignant nonmelanocytic spindle cell tumors when viewed on prepared histopathology slides. Pathologists have observed that DMs can manifest significant variation with respect to the extent of intratumoral cellularity, fibrosis, and/or perineural invasion. Furthermore, some tumors present with a pure desmoplastic invasive component (>90%) while other tumors display mixed features of DM and nondesmoplastic melanoma. This has led to the separation of DM into 2 histologic subtypes, pure and mixed. With a focus on the distinction between pure and mixed DM, this review will detail what is currently known about the diagnostic features of DM, discuss risk and prognostic factors, and examine the current literature on disease progression and management.
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Affiliation(s)
- Lucy L. Chen
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Natalia Jaimes
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Christopher A. Barker
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ashfaq A. Marghoob
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY
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Chen W, Zhang H, Wang J, Cao G, Dong Z, Su H, Zhou X, Zhang S. Lentiviral-mediated gene silencing of Notch-4 inhibits in vitro proliferation and perineural invasion of ACC-M cells. Oncol Rep 2013; 29:1797-804. [PMID: 23450325 DOI: 10.3892/or.2013.2317] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/08/2013] [Indexed: 11/06/2022] Open
Abstract
Salivary adenoid cystic carcinoma (SACC) is a common type of salivary gland cancer. The poor long-term prognosis for patients with SACC is mainly due to local recurrence, perineural invasion (PNI) and distant metastasis. Notch signaling plays a critical role in determining cell fate such as proliferation, differentiation and apoptosis. Accumulating evidence indicates that aberrant Notch-4 expression has a tumor-promoting function in SACC. In the present study, we used lentiviral-mediated RNA interference (RNAi) targeted against Notch-4 to determine the effects of decreased levels of this protein in the human highly metastatic adenoid cystic carcinoma cell line ACC-M. Furthermore, the proliferative capability as well as the PNI potential of the treated cells were observed in vitro. Our studies demonstrated that RNAi directed against Notch-4 markedly decreased Notch-4 gene expression, resulting in the inhibition of cell proliferation, and G0/G1 to S phase arrest in ACC-M cells. Knockdown of Notch-4 also resulted in a decrease in the in vitro PNI activity in ACC-M cells. To conclude, RNAi targeting against Notch-4 induces the suppression of cell growth and inhibition of PNI in vitro in ACC-M cells. Notch-4 may play an important role in regulating proliferation and PNI activity of SACC.
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Affiliation(s)
- Wei Chen
- Department of Stomatology, Nanjing Jinling Hospital, Nanjing University, School of Medicine, Nanjing, Jiangsu, PR China
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Abstract
UNLABELLED Basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and primary cutaneous melanoma (PCM) are the major forms of skin cancer. Surgical excision is one of the most frequently utilized treatment modalities for these tumors. METHODS literature review. RESULTS recommendations for lateral surgical excision margin (LEM) for BCCs is 4 mm for low-risk BCCs and Mohs surgery or resection with complete circumferential peripheral and deep margin assessment for high risk. Recommended LEM is 4-6 mm for low-risk SCCs and Mohs surgery or resection with complete circumferential peripheral and deep margin assessment for high risk BCCs. If SCC or BCC is >20 mm in area L with no other high-risk factors and can be repaired primarily, 10-mm clinical margins may be used. Recommended LEM is 5 mm for melanoma-in-situ; 1 cm for PCM <1 mm (Breslow); 1-2 cm for PCM 1.01-2 mm (Breslow); and, 2-3 cm for high-risk PCM >2.01 mm (Breslow). Tumor subtype-specific recommendations for histologic margins are offered which provide the greatest degree of certainty regarding the completeness of excision. CONCLUSION Recommendations can be made regarding appropriate surgical excision margins by classifying skin cancers as low-risk or high-risk based on histopathological and clinical factors. Ascertaining that histopathologic margins are free of tumor is not a perfect science and requires thoughtful sampling, grossing, and staining procedures.
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Neurotropic melanoma: the management of localised disease. J Skin Cancer 2012; 2012:706452. [PMID: 23133758 PMCID: PMC3486009 DOI: 10.1155/2012/706452] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/23/2012] [Indexed: 11/26/2022] Open
Abstract
Neurotropic melanoma is a rare subtype of cutaneous malignant melanoma. Compared with conventional melanoma, it is more locally aggressive with an increased tendency for local recurrence but less likely for nodal or distant metastases. These tumours can be a diagnostic dilemma with a variety of morphological, histopathological, and immunophenotypical expressions. The often amelanotic, benign appearance may lead to treatment issues such as late presentation, diagnostic delay, misdiagnosis, insufficient surgical margins, and recurrence with resulting poor outcome. The neurotropic nature of the disease and prevalence in the head and neck region can result in perineural and neural invasion along named large nerves into the brain with resulting neuropathies. Wide local excision with adjuvant radiotherapy where indicated remains the current practice for treatment with chemotherapy predominately being reserved as a salvage treatment for patients with disseminated disease.
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Factores pronósticos en el melanoma cutáneo primario no incluidos en la clasificación de la American Joint Committee on Cancer (AJCC). ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:255-63. [DOI: 10.1016/j.ad.2011.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 01/20/2011] [Accepted: 01/27/2011] [Indexed: 11/17/2022] Open
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Abstract
OBJECTIVE To describe the clinical and pathologic features of vaginal melanoma and to determine predictors of outcome in patients with this disease. METHODS Thirty-seven women with clinical and radiographic stage I vaginal melanoma treated at one institution between 1980 and 2009 were included in this retrospective study. Treatment modalities were assigned to one of three categories: pelvic exenteration, wide excision, and nonsurgical (primary radiation therapy, chemotherapy, or both). Overall survival and progression-free survival were calculated from the date of the surgical diagnosis. RESULTS The median age was 60.6 years. Eighty-four percent of patients were white. Vaginal bleeding was the most common presenting symptom. Lesions were located in the distal third of the vagina in the majority (65%) of patients. Initial management included a wide local or radical excision (76% of patients); pelvic exenteration (14%); and radiotherapy, chemotherapy, or radiotherapy and chemotherapy (10%). At a median follow-up of 17.4 months, 33 women experienced disease recurrence. Recurrence was local only in seven patients (22%), distant only in 20 (63%), and both in five (15%). The most common sites of distant recurrence were lungs and liver. Median progression-free survival was 11.4 months, and median overall survival was 19 months. The 5-year progression-free and overall survival rates were 9.5% and 20.0%, respectively. Patients treated surgically had significantly longer survival than those treated nonsurgically (P=.01). Radiotherapy after wide excision reduced local recurrence risk and increased survival from 16.1 months to 29.4 months, although the increase was not significant (P=.46). CONCLUSION Malignant vaginal melanoma, even when localized at presentation, has a very poor prognosis. Patients treated surgically have longer survival than those treated nonsurgically. Radiotherapy after wide excision reduces local but not distant recurrences.
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Primary Cutaneous Melanoma: Prognostic Factors Not Included in the Classification of the American Joint Committee on Cancer. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/s1578-2190(11)70800-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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21
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Dunn M, Morgan MB. Perineural invasion progressing to leptomeningeal carcinomatosis: Is the absence of peripheral nerves an important sign? J Am Acad Dermatol 2010; 62:270-6. [DOI: 10.1016/j.jaad.2009.06.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 06/04/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
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22
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Dunn M, Morgan MB, Beer TW, Chen KTK, Acker SM. Histologic mimics of perineural invasion. J Cutan Pathol 2009; 36:937-42. [DOI: 10.1111/j.1600-0560.2008.01197.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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23
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Payette MJ, Katz M, Grant-Kels JM. Melanoma prognostic factors found in the dermatopathology report. Clin Dermatol 2009; 27:53-74. [PMID: 19095154 DOI: 10.1016/j.clindermatol.2008.09.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Significant prognostic information is available in a routine melanoma dermatopathology report. Features that are enumerated in the pathology report and that portend a potentially poorer prognosis are older age, site (acral, head, neck), male sex, increasing Breslow tumor thickness, increasing Clark's level, ulceration, increasing number of mitoses, vertical growth phase, regression, absence of a host inflammatory response, increased tumor vascularity, angiotropism, vascular invasion, neurotropism, marked atypia, and satellite metastasis.
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Affiliation(s)
- Michael J Payette
- Department of Dermatology, MC-6230, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
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Luna M. Uses, Abuses and Pitfalls of Frozen-Section Diagnoses of Diseases of the Head and Neck. SURGICAL PATHOLOGY OF THE HEAD AND NECK, THIRD EDITION 2008:95-108. [DOI: 10.3109/9781420020373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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25
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Chen W, Zhang HL, Jiang YG, Li JH, Liu BL, Sun MY. Inhibition of CD146 gene expression via RNA interference reduces in vitro perineural invasion on ACC-M cell. J Oral Pathol Med 2008; 38:198-205. [DOI: 10.1111/j.1600-0714.2008.00706.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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LEACH BRIANC, KULBERSH JONATHANS, DAY TERRYA, COOK JOEL. Cranial Neuropathy as a Presenting Sign of Recurrent Aggressive Skin Cancer. Dermatol Surg 2008; 34:483-97. [DOI: 10.1111/j.1524-4725.2007.34094.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Cranial Neuropathy as a Presenting Sign of Recurrent Aggressive Skin Cancer. Dermatol Surg 2008. [DOI: 10.1097/00042728-200804000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen W, Zhang HL, Shao XJ, Jiang YG, Zhao XG, Gao X, Li JH, Yang J, Zhang YF, Liu BL, Sun MY. Gene Expression Profile of Salivary Adenoid Cystic Carcinoma Associated with Perineural Invasion. TOHOKU J EXP MED 2007; 212:319-34. [PMID: 17592219 DOI: 10.1620/tjem.212.319] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Adenoid cystic carcinoma (ACC) is a common salivary gland malignancy characterized by slow but progressive clinical course, proclivity for hematogenous spread and perineural invasion (PNI) that exhibits inherent resistance to complete surgical resection, systemic chemotherapy and conventional radiotherapy. The molecular alterations that underlie its PNI are poorly characterized. We report the combined use of laser capture microdissection (LCM) and high-throughput cDNA microarray to monitor in vivo gene expression profile of salivary ACC and to correlate the profile with PNI. Consecutive section staining with hematoxylin & eosin was applied to 15 cancerous tissues, among which 6 were judged as PNI. Pure cancer cells adjacent to the nerve tracts from 6 cancerous tissues judged as PNI were laser captured, and pure cancer cells from the same 6 tumors distant from the nerve tracts were also procured. Total RNA was extracted, amplified and subjected to cDNA microarray-based expression analysis. The patterns of gene expression were verified by quantitative real-time PCR and immunohistochemistry. As to the result of 6 arrays, a total of 53 genes were identified as being 2-fold or more differentially expressed in PNI cancer cell group as compared to non-PNI cancer cell control. Out of the 53 genes found consistently differentially expressed, 38 were up-regulated and 15 down-regulated. The combined use of LCM and cDNA microarray analysis provides a powerful new approach to monitor the in vivo molecular events of PNI in salivary ACC. These identified novel genes deserve further investigations to elucidate their clinicopathological significance.
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Affiliation(s)
- Wei Chen
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Shaanxi, P.R. China
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Hillard VH, Liu JK, Kwok A, Schmidt MH. Perineural Spread of Malignant Mesothelioma Resulting in an Intradural Spinal Cord Mass: Case Report. J Neurooncol 2006; 81:185-9. [PMID: 16850102 DOI: 10.1007/s11060-006-9215-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 06/13/2006] [Indexed: 10/24/2022]
Abstract
Spinal cord involvement by perineural spread of malignant mesothelioma is rare. We report a case of malignant mesothelioma that spread locally to invade the bony spine with both extradural and intradural perineural spread into the spinal canal that resulted in spinal cord compression. A 61-year-old man with a history of malignant mesothelioma presented with progressive leg weakness and right-sided arm weakness. Magnetic resonance imaging showed an enhancing lesion in the apex of the right lung with extension through the C7-T1 foramina with right hemicord enhancement. The patient underwent a C7-T1 laminectomy and right-sided C7-T1 and T1-T2 foraminotomies for neural decompression and biopsy of the lesion. Intraoperatively, tumor extended epidurally, and intradural perineural tumor spread along the C8 and T1 nerve roots into the spinal cord. Because it adhered to the spinal cord, no dissectible plane could be identified that would allow for safe total removal of the tumor. The epidural portion of the tumor, the adjacent involved bone, and the T1 nerve root were resected. Pathologic examination revealed malignant mesothelioma with bony invasion and perineural spread along the T1 nerve root. After decompression of the spinal cord, the patient had moderate improvement of his hand and leg function. Perineural spread of malignant mesothelioma resulting in spinal cord compression is an unusual clinical presentation. Intimate involvement of the spinal cord may prohibit aggressive tumor resection.
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Affiliation(s)
- Virany Huynh Hillard
- Department of Neurosurgery, University of Utah School of Medicine, 30 North 1900 East, Suite 3B409, Salt Lake City, UT 84132, USA
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Warner GC, Gandhi M, Panizza B. Slowly progressive cranial nerve palsies. Med J Aust 2006; 184:641-3. [PMID: 16803446 DOI: 10.5694/j.1326-5377.2006.tb00423.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 04/20/2006] [Indexed: 11/17/2022]
Affiliation(s)
- Giles C Warner
- Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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